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1839 Hwy 601Si "- �Y f $ / !—T_�`ti •.r .. / � / .._T lieJb � •Y c`44Rc1' Tedi M'a^ ;s if'.� --'•°.-�. ..... . ' e:...- w�s«xria. y ,. .. __ -. _ x� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND ;CERTIFICATE._OF COMPLETION `. OTE: Issued in Compliance With Article 11 of G.S. Chapter 130a r Sanitary Sewage Sysms �?�i55, Permit Number Name LAS l`.1 di(.�'lcT 'Date N2 7740 Subdivision Name Lot No. Sec. or Block No. Lot Size _,,KL� House Mobile Home, _!f Business __ Industry !` t , No. Bedrooms No. Baths _ % �� No. in Family __` Public Assembly `Other Garbage, Disposal YES ❑ NO Specifications/for System: Auto Dish Washer YES NO ❑ DDD Gu Auto Wash Ma^hine YES NO ❑ .. Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or thg i4+ed use change. : r r- r Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completi . T lephone Number: 704-634-5985. Final Installation Diagram: System Installed by _ 1� -4 a F, r' Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DATE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME sE� Cie DATE EVALUATED ADDRESS PROPERTY SIZE /�Iksp PROPOSED FACIILTY LOCATION OF SITE Water Supply: On -Site Well �/ _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position ,L 1Z -- Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC, Consistence l Structure l< Mineralogy A* HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , , SITE CLASSIFICATION: C EVALUATED BY: Aa�!/ LONG-TERM ACCEPTANCE RATE: , `7 OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty +:lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR-Very friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm Wet NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic Structure SC -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water' or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS (provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 ■■■■■■■■■.■■■.■■■■■■■■■■■■■■■.■■■■■...■.■■■■■■..■■.■■■■.■■ ■■■■v■■ ...■.■.........■........... ...................................... 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NE ME.■■MEM■ MENMME. ■E■■■■.E.EE■EEE..E/EM..E.CME■■.E.■■■.EE■EEEE.■■EEE.E.■EEENE.M.EE■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e.■..■■.■■■■.M.E■.C........... ................................ ■■EEEEEEE■■.■■EEE■■EMM■■MM■■MMM. ■■■■■■■MM■M■■E■MMM■MEMM■MM■M■MM■ ■■■■MMM■■M■■■■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■■■■■M■■■■■■■M■■■■■MM■M■ ■E■E.■■■..E■EMMMMEMMMMMMMM.■MMM.■■■■MMMMMM..■EM■.SEN■EE■EEEEE.e■■ ■■.■=E■■.EEM■■MMMMM■■■■M.■MMM.■■■■■.MM■■.E.MM.EE.■■E.E■E.■■■.■EE■■ CCCCCCCCCCCCCCCCCCCCCC'MCCCCCCCCC.■CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By / n d a r —�{ r- Mailing Address �f/ 3 Jul) �8T Home Phone 7d �l r4 a (� %'0 U�-C / /% C • Business Phone 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ House ❑ General Evaluation ❑ Business ❑ Industry Ja'6eptic Tank Installation Permit "obile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision 11 c Section Lot # No. of People _ No. of Bedrooms 2- 3 No. of Bathrooms ( i Dwelling Dimensions 1Z 4/ ✓` s 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 7. Type of water supply: ❑ Public Z Private ❑ Community 8. Property Dimensions�3 LjC reS Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: This is to certify that the information provided is correct to the best of incurred from this application. �- �3- 9� DATE r knowledge, and I understand I am responsible for all charges RUN SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: Er 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. �,- 1-3 - DATE SIGNATURE DCHD (1193) Davie County, NC (389) cP LO 7821 X14 N 393 I 7601 M vlg. 398 ------ 5 PH2_H�ei I I Parcel Number: K515OA0014 NCPIN Number: 5746193660 Account Number: 8305056 Listed Owner 1: TUTTEROW JAMES THOMAS Mailing Address 1: 1839 US HWY 601 S City: MOCKSVILLE State: NC Zip Code: 27028 Legal Description: LOT 48 + P/O 49 ANDERSON Assessed Acreage: 12.09 Deed Date: 4/2004 Deed Book/Page: 2004ED418 Plat Book: 0001 Plat Page: 097 Building Value: 63610.00 Outbuilding & Extra 9640.00 Freatures Value: Land Value: 78320.00 Total Market Value: 151570.00 Total Assessed Value: 151570.00 Tax Parcel Report Thursday, July 14, 201 E WARNING: THIS IS NOT A SURVEY Parcel Information Township: Municipality: Census Tract: Voting Precinct: Planning Jurisdiction: Zoning Class: Zoning Overlay: Voluntary Ag. District: Fire Response District: Elementary School Zone: Middle School Zone: Soil Types: Flood Zone: Watershed Overlay: Jerusalem 37059-807 JERUSALEM Davie County DAVIE COUNTY R-A,H-B,R-20 No JERUSALEM COOLEEMEE SOUTH DAVIE GnB2,GnC2,GaD x yr All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the Davie County, NC implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold � >L i harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or OU14 I causes of action due to or arising out of the use or inability to use the GIS data provided by this website. 1 Parcel #: K515OA0014 iPage 1 of 1 Davie County, NC - Basic Estate Search i Basic Search Real Estate Search Tax Bill Search 4�m"„r� Davie County Web Site Sales Search View Property Record fort Is Parcel View Mao for this Parcel View Tax Bill Information 63 61 Parcel #: K5150A0014 Account #:8305056 4 Owner Information 78 32 Tax Codes 151,57( rUTTEROW JAMES THOMAS 151,57( ADVLTAX - COUNTY T 1839 US HWY 601 S FIREADVLTAX - FIRE TAX MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 12.090 AC JERUSALEM ddress: 1839 S US HWY 601 Deed Information Local tonin Pate: 05/2015 Book: 00990 Page: 0369 Plat Book: 0001 Page: 097 Legal Description PIN OT 48 + P/0 49 ANDERSON 5746193660 Property Values Building: 63 61 BXF: 9,64( Land: 78 32 Market: 151,57( ssessed: 151,57( Deferred: Sales Information 14o. Book Page Month Year Instrument Quai/UnQual Improved Price 1987E 0172 10 1987 EF Unqualified Vacant 0 ! 2004E 0418 04 2004 DC Unqualified Vacant 0 i 00990 0369 05 2015 WD Qualified Improved 135,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search All information on this site Is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the Information set forth on this site whether express or Implied, In fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnetfView.aspx?prid=1452955 7/14/2016