2625 Hwy 601SIf l
DAVIE COUNTY HEALTH DEPARTMENT '" t) b , o o 1-3 8 1
IMPROVEMENTS PERMIT AND, CERTIFICATE OF COMPLETION/ �I
*NOTE: I in - A
ssued Compliance With Article I I of G.S. Chapter 130a D
Sanitary Sewage Systems Permit Number
Name \ Cl) C. Date
. M n\ N- 6447-
Location �A til oy. rA `� \ �, o ,. S v �� e 1�, (� its
C> --C,
Subdivision Name Lot No. Sec. or. Block No.
Lot Size W'� k �� 'House Mobile Home — � Business Speculation
r
No. Bedrooms No. Baths No. in Family -�
Garbage Disposal YES p NO ET/ S ecifications for System:
Auto Dish Washer., YES ❑ NO p-'
Auto Wash Ma shine YES p' 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 the intended use chan e.
Out
improvem nts permit by
-2 �-� --- —
j
*Contact a representative. of the Davie Countk Health DepartmenWor final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of copletion. Te l?phone umber 704-634-5985.
�,.
Final Installation Diagram: System Installed by �-G - A \`�\
o �
I
S
r\. 1tl
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.
. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P
Davie County Health Department
Environmental Health Section
✓ P. 0. Box 665
Mocksville, NC 27028
1. Application/Permit ^Requested By -w
Mailing Address :AV zo -1
T
JUN 19 1991
6. If house, mobile home: Subdivision Sec. Lot#
09
No. of People Dwelling Dimensions i , .2 �f, 0
No. of Bedrooms Basement/Plumbing
No of Bathrooms Basement/No Plumbing
ashing Machine J Dishwasher 0 Garbage Disposai.
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
B. Type of water supply: /public
.04
9. Property Dimensions
10. Sewage Disposal Cont
No. of Sinks
No. of Urinals
No. of Water Coolers
0 Private
0 Community
11. Do you anticipate additions/exptnsions of the facility this system is
intended to serve? 0 Yes br"'-
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.
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 apple tion.
�I
Date Signature
Directions to Property:
DCHD (10-89)
c
Phone,
Home Phone
,!(v
_Business
2.
Name on Permit if
Different than
Above
3.
Property Owner if
Different than
Above
4.
Application/Permit
For: 0 GeneralEv luation
/S/TankInstallation5.
System to Serve:
[) House
Mobile Home
0 Business
a Industry
u Other
0 Unknown
6. If house, mobile home: Subdivision Sec. Lot#
09
No. of People Dwelling Dimensions i , .2 �f, 0
No. of Bedrooms Basement/Plumbing
No of Bathrooms Basement/No Plumbing
ashing Machine J Dishwasher 0 Garbage Disposai.
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
B. Type of water supply: /public
.04
9. Property Dimensions
10. Sewage Disposal Cont
No. of Sinks
No. of Urinals
No. of Water Coolers
0 Private
0 Community
11. Do you anticipate additions/exptnsions of the facility this system is
intended to serve? 0 Yes br"'-
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.
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 apple tion.
�I
Date Signature
Directions to Property:
DCHD (10-89)
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
es
yes
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
D(office use only)
no 1. 1 am the owner of the above described property.
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 / SIGNATURE
4. I hereby authorize the Davie County Health Department to release site
evaluation res s from the above described property to the following:
Owner only
— Owners designated representative
Anyone requesting results
— Only those listed below
DATE SIGNATURE
DCHD (11 /84)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME _�TO _P_ D t 1 R DATE EVALUATED 1, Q O - �r
.ADDRESS S p1 M I PROPERTY SIZE /00' k a 0c)'
PROPOSED FACIILTY _Q W' M 00 CM LOCATION OF SITE
Water Supply: On -Site Well' Community
Public I --
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
Sloe %
b -90
G - 100
0-90
O -8
HORIZON I DEPTH
Texture group
L,
,SCI-
S L -
Consistence
iz e-
F
Structure
C R
l;
G
Mineralogy
tl
I'll1�
HORIZON II DEPTH
0'
U o
4 7'40
Texture group
Q 1,
C L.
1—
�-
Consistence
ri;
_K
1=i;
F
Structure
G
G R
0, lz
C R
Mineralogy
1: t
1 5
1:1
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
-
—
—
-�
SAPROLITE
CLASSIFICATION
V
s
LONG-TERM ACCEPTANCE RATE
,y
,4
SITE CLASSIFICATION: S EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: ,4 OTHER(S) PRESENT:
REMARKS: 5 cno �6'C - 0 -b� _R_�,9- - �a�_ 6u
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-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
■
■
■
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■■�■■■■tltliiii!■■t!t!�
Parcel #: M503OA0021
Davie County, NC - Basic Estate Search
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i
Parcel #: M5030A0021
Account #: 82514642
owner Information
BXF:
Tax Codes
Land:
ILLARD JAMES DANIEL& DILLARD BEBEE J
Market:
ADVLTAX - COUNTY TA
ssessed:
625 US HIGHWAY 601 SOUTH
Deferred:
READVLTAX - FIRE TAX
MOCKSVILLE NC 27028
Property Information
Township
Land (Units/Type): 1.440 AC
Lan;
JERUSALEM
2625 S US HWY 601
Deed Information
Local Zonin
Date: 01/2001 Book:,00001 Page: 0001
Plat Book: Pa e:
Le al Description
PIN
1.460 AC HWY 601
5746506971
Property Values
Buildin :
106 59 0011
BXF:
2,24
Land:
2256
Market:
131 39
ssessed:
131 39
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
L 00001 0001 01 1901 WD Unqualified Improved 0
t 00330 0118 03 2000 QD Unqualified Improved 0
3 00159 0158 05 1991 WD Qualified Improved 50,000
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=1473532 7/19/2016