2430 Hwy 601S.. ' • 3 .. "`'....-a W''i',"-a.,, i 'r ". Y a, ;..:.i'"'t' 4'1:=._.....'a "5., � . ,'�-.: ., . _ - _ - r _ <,:-ti . , .....
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DAVIE COUNTY HEALTH DEPARTMENT
el
Q' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems A"OF/ /o- /w, Permit Number
Name 0?,,/�_ Date /�`/� — N2 7642
Locate�/ -- /� !�f'' ��� �i ✓ //�/ /(� _
Subdivision Name l v Lot No. Sec. or Block No.
Lot Size House Mobile Home —�-�� Business -- Industry
No. Bedrooms !.No. Baths .2— No. in Family — Public Assembly Other
Garbage Disposal YES p NO E '" Specifications for System: �a
Auto Dish Washer YES NO
Auto Wash Ma^hine YES [� NO p (/
Type Water Supply --- �K,��/1 �•� ,�
'Thispermit 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 the intended use change.
r'.
Improvements permit by _ Ala
*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 completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
C
System Installed by
CertificateofCompletion _ Date
The signing of this certificate shail indicate that the system described above has been installed in compliance with
trj'andards set
'forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
k.`satistWorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER l
Davie County Health Department If'Ti727
jED
Environmental Health Section
P. O. Box 665 Opg�
Mocksville, NC 27028
1. Application/Permit Requested By K
Mailing Address 6 a'�° / g� Home Phone
/j'l ClcS �j� CG rYj'- 9-7 0 VLF Business Phone
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve: ❑ House
❑ Business ❑ Industry
5. If house mobile home Subdivision
No. of People 3
No. of Bedrooms
No. of Bathrooms
General Evaluation
*Septic Tank Installation Permit
X Mobile Home ❑ Place of Public Assembly
❑ Other ❑ Unknown
Dwelling Dimensions Ilf X 7 0
6. If business, industry, place of public assembly, other: Specify type _
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures _
7. Type of water supply: 9 --Public ❑ Private
8. Property Dimensions �z Sewage Disposal Contractor
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
R Washing Machine
❑ Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes R'No
If yes, what type?
❑ Community
'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:
/ Som � /�S'P�n 3 AL _, �!? l a
o
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: j� 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MU T be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davi County ealth Department to enter upon above described
property located in Davie County and owned by �o IY,- Cr
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (1183)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY "C
DATE EVALUATED L -
PROPERTY SIZE���
LOCATION OF SITE 4 O I S
. Water Supply: On -Site Well Community Public
Evaluation ByQ 1Q_. Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
-
.-s
_S
Slope %
HORIZON I DEPTH
10
Texture group
Consistence1-
Structure
-
Mineralogy
'777 —1
1;
HORIZON II DEPTH
Texture groupC-
Consistence
F
Structure
S3 N::�_
41c
Qk-
$
Mineralogy
`.
'
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
5
-S-S
-s-S
RESTRICTIVE HORIZON
—
---
�--
-"
SAPROLITE -
--
—
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
(4
SITE CLASSIFICATION: �i
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
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
Texture
S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt
SICL-Silty clay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR-Vc.-y 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
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Dame County Department
and Horne AaI Aeney
210 HOSPITAL STREET / P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 834.59$5
May 31 1994
Don Nichols
Rt. 4, Box,196
Mocksville, NC 27028
Re: Site Evaluation
Highway 601 South-1/2 Acre Tract
Dear Mr. Nichols:
As requested, a representative from.this office visited the aforementioned
site on May 2, 1994. Based upon the information provided on the
application for a site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable for the installation of an on—site
sewage disposal system.
If you have any questions, please feel free to contact this office.
Sincerely,
Charles E. Little, R.S.
Environmental Health Section
CL/wd
Enclosure
Parcel #: L515OA0002
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 #: L51SOA0002
Account #:53940000
Owner Information
Tax Codes
ADVLTAX - COUNTY T
READVLTAX - FIRE TAX
ICHOLS DONALD D& NICHOLS PRISCILLA B
430 US HIGHWAY 601 SOUTH
MOCKSVILLE NC 27028
BXF:
Property Information
Township
d (Units/Type): 0.460 AC JERUSALEM
Vddress:2430 S US HWY 601
Deed Information
Local tonin
Date: 07/1956 Book: 00058 Page: 0347
Plat Book: Page:
78,02(
Deferred*
Legal Description
PIN
1 LOT HWY 601
5746327660
Property Values
Building:
62,13C
BXF:
5,81C
Land:
10,08C
Market:
78,02(
ssessed:
78,02(
Deferred*
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00058 0347 07 1956 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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/itsnet/View.aspx?prid=1476712 . 8/9/2016