1887 Hwy 601S (2)DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION.
S fes.
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A1934-.1968) Permit Number
-917
1 r
Name v �' f��,�, .��•,;% �1%'. A�l f/T ? Date ,3
R Locati
Subdivision Name Lot No. Sec. or Block No.
Lo't~Size%) OLS House Mobile Home . Business Speculation
No. Bedrooms - No. Baths No. in Family _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO ❑ �,,,� `, _ ` -
Auto Wash Machine YES NO -❑
Type Water Supply _—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
J D� - �
,
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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by N (S �
*The signing of this certificate shall indic
the standards set forth in the above regul
satisfactorily for any given period of time.
rtificate of Completion C
that the system described a
�Q, but shall in NO way be taJ (
Date
ve has been installed in compliance with
as a guarantee that the system will function
4
rtificate of Completion C
that the system described a
�Q, but shall in NO way be taJ (
Date
ve has been installed in compliance with
as a guarantee that the system will function
A. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT UX�
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
1. Permit F
2. Address
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
3. Property
Address
er if Different than Above
4. Permit To: a) Install k Alter Repair
b) Privy Conventional Other Type
Home Phone /— 0119- 9/ , f"ff-0b
Riicinacc Phnno
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Homes
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 2 R- x 7a
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:
commodes f � urinals
lavatory �;. showers
dishwasher 1 sinks I
8. a) Type water supply: Public t --f Private Community
b) Has the water supply system been approved? Yes �-No
9. a) Property Dimensions / 6 0 x
b) Land area designated to building site G ,RL
c) Sewage Disposal Contractor Cuero 6 ,.T� j� -'N�v
10. Do you anticipate any additions or expansions of the faci
What type?
garbage disposal
washing machine
this sewage system is intended to serve?
This is to certify that the information is correct to the best of my knowledge.
Date Owner gignature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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: &L0 T DATE RECEIVED
(office use only)
ye 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 , 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 SI ATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
— Owners designated representative
.1CAnyone requesting results
— Only those listed below
DATE SIGNATIJE
DCHD (11 /84)
.• v
01
+' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
/,�
Name ���t Date
Address Lot Size
E
FAr:Tf1RC AREA 1 AREA 9 ARFA 3 AREA A
1) Topography/ Landscape Position
SS
S
S
S
PS
PS
PS
U
U
U
?) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
(FSS)
PS
PS
PS
��
U
U
U
3) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
PS
PS
PS
U
U
U
1) Soil Depth (inches)
S
S
S
PS
PS
PS
U
U
U
�) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
U
U
U
External
S
S
S
PS
PS
PS
U
U
U
1) Restrictive Horizons
.�
Available Space
S
S
S
S
PS
PS
PS
U
U
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Site Classification
U—UNSUITABLE S—SUITABLE Zi --Provisionally Suitable
Recommendations/Comments:
Described by `'���.b� `/ Title A/ Date
SITE DIAGRAM
UCHO (6-82)
IDS
Of
Sincerely,
i
Robert B. Hall, Jr., R.S.
Environmental Health
RH/wd
Enclosure
cc: Jesse Boyce
Zoning Officer
County Office Building
Mocksville, NC 27028
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
Tax Codes
ADVLTAX - COUNTYTBOX
FIREADVLTAX - FIRE TAXNC
FUN BARBARA
1103
10000CKSVILLE,27028
BXF:
9,20(
Property Information
Township
nd (Units/Type): 1.850 AC
ddress: 1887 S US HWY 601
JERUSALEM
Assessed:
90,44(
Deferred:
Deed Information
Local tonin
Date: 08/2014 Book: 00965 Page: 0237
plat Book: 0002 Page: 086
Improved 40,000
Le al Description
PIN
1.85 AC HWY 601
5746181813
Property Values
Building:
58,30CI
BXF:
9,20(
Land:
22,94(
Market:
90,44C
Assessed:
90,44(
Deferred:
3
Sales Information
No.
Book Page Month Year Instrument
Qual/UnQual
Improved Price
L
00874 0624 11 2011 WD
Unqualified
Improved 0
Z
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
oA�V„r�
I Cb
t -
°v �'�
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
h4://maps.daviecountync.gov/itsnet/View.aspx?prid=1468381 8/3/2016