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1887 Hwy 601SI - -a.rary-._. -maw• '-\a'-. ..T ,r_.. -. v.H r+' '.—. _.'-''n'y-. - f.- .S - L n . DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number k� '6 Name'� �T� ;� ,;,;, /iT'"� Dater' :' Locati Subdivision Name Lot No. _ Sec. or Block No. Lot Size ani House Mobile Home _� Business Speculation No. Bedrooms No. Baths —No. in Family _ Garbage Disposal YES ❑ NO E] - Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Machine YES j NO ❑ ,, „r Type Water Supply *This permit Void if se viage system described bi r is from date of issue. / �_�exlc K IIA Improvements permit by 27 *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. `r Final Installation Diagram: System Installed by sok �^y Certificat7te f�Con *The signing of this certificate shall indicate that systi the standards set forth in the above regulation, buall in satisfactorily for any given period of time. described above has been installed in compliance with ) way be taken as a guarantee that the system will function APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS, BEEN ISSUED. 1. Permit Requested 2. Address ,dam. d. 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption Home Phone 1--9`2'9% -r—P06 usiness P c) Sub -Division Sec. Lot No.- I? 5. System used to serve what type facility: House Mobile Home1Cbusiness IndustryOther b) Number of people ��� 6. a) If douse or mobile home, state size of home and number of rooms. House Dimensionsas�r- IAI - '? 0 % Bed Rooms— Bath Rooms.— Den w/Closet ,b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: 8. 9. commodes ig= urinals garbage disposal. lavatory v91 showers j washing machine dishwasher I sinks / a) Type water supply: Public � Private Community b) Has the water supply system been approved? Yesk�'_ No a) Property Dimensions 1 0 1 b) Land area designated to buil c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intenvded to serve? What type? This is to certify that the information is correct to the best f my knowledge. Date Owner ignature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: � © (� 'S " h 4o (,LV C-I,ass- DCHD (6-82) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: yJ�7` 6 DATE RECEIVED ,4 p �jc� (office use only) yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from iDa,wb mow, 7\ -LL W owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE NANURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: DATE DCHD (11 /84) — Owner only Owners designated representative -i.t-<nyone requesting results — Only those listed below SIGNATURE 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name �Date��� Address Lot Size✓ FAr..TnRc AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/ Landscape Position S S S S em PS PS ll U U ?) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) S PS PS U U U 1) Soil Structure (12-36 in.) S S Clayey Soils PS PS PS U U i) Soil Depth (inches) S S P PS PS U U U U ) Soil Drainage: Internal S S S 6) P PS PS U U U External S S S P PS PS U U i) Restrictive Horizons Available Space S S PS PS U U U 1) Other (Specify) S S S PS S PS PS U U U Classification !• 1) Site �Ji U—UNSUITABLE _S—/S,UITABLE PS—Provisionally Suitable Recommendations/Comments: --r1 �. '�/+� p/ec eJ�e/✓ 1pre--7, Described by,?� f f Title 4S7 Date r-zw 21 SITE DIAGRAM fob DCHD (6-82) 0a ` Davie County Ault Ten arfrn" acrd .fome Xealbcy 21 O HOSPITAL STREET/P.O. Box 668. MOCKSVILLE, N.C. 27028 PHONE:(704)6348885 May 23, 1988 No. Barbara Loflin P. O. Box 1103,; Mocksville, NC 27028 Res 2 Site Evaluations 601 South Lots 19 & 82 Dear Ms. Loflin: This office has evaluated two 100' x 200' lots on 601 south of Mocksville near Holy Cross Lutheran Church for the installation .of septic tank systems. Both lots are classified provisionally suitable for the installation of septic tank systems. Sincerely, ` Robert B. Hall, Jr., R.S. Environmental Health RH/wd - Enclosure cc: Jesse Boyce +� Zoning Officer County Office Building Mocksville, NC 27028 r Parcel #: L502OA0001 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View- Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: L5020A0001 Account #:46002000 Owner Information Building: Tax Codes BXF: OFLIN BARBARA Land: ADVLTAX - COUNTY T Market: O BOX 1103 ssessed: JFIREADVLTAX - FIRE TAX [Deferred: MOCKSVILLE NC 27028 PropertV Information Township Land (Units/Type): 1.850 AC JERUSALEM ddress: 1887 S US HWY 601 Deed Information Local Zoning Date: 08/2014 Book: 00965 Page: 0237 Plat Book: 0002 Page: 086 Le al Description PIN 1.85 AC HWY 601 5746181813 Property Values Building: 71,65CI BXF: 9 99 Land: 22 94 Market: 104 58 ssessed: 104 58 [Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00874 0624 11 2011 WD Unqualified Improved 0 2 00965 0237.08 2014 WD Unqualified Improved 0 3 00135 0040 12 1986 WD Qualified Improved 40,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 qP.r� 000r,14-14-1 Davie County Web Site 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=764799 8/2/2016