2918 Hwy 601S0
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
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IMPROVEMENT PERMIT
**MOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewate
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME "►� PROPERTY ADDRESS 60 LS Z Z a Z Q' DATE
LOCATION a I rj sr.� �ari•�9 3v s A,�►�
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE ,Sh -b Q 11 BEDROOMS 3 ,N BATHS a 1 OCCUPANTS GARBAGE DISPOSAL: Yes/No
4
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/Na-;Fr
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LOT SIZE 00os rso TVPE`'WATER SUPPLY � r *DESIGN WASTEWATER FLOW (GPD) (a� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZEL-011 GAL. 1'W TANK GAL. TRENCH WIDTH 3 ROCK DEPTH Ll u 'LINEAR FT.
OTHER rF
REQUIRED SITE MODIFICATIONS/CONDITI(NS:
***THIS PERMIT IS SUBJECT TO'REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE, YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE -SYSTEM.
SOI `(, t N Q
�. IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF 1k DAVIE COUNTY HEALTH DEPARTMENT FOR FINALaINSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1;30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT li�X_SYSTEM INSTALLED BY
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36
AUTHORIZATION N0. OPERATION PERMIT BY �� DATE 2'
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1908"SEWAR TREATMENT:AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
0
r , -. .a• } . "YDAVIE COUNTY HEALTH DEPARTMENT
=' IMPROVEMENT PERMIT and_ OPERATION PERMIT
IMPROVEMENT PERMIT
*ATE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
x > system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation,of a system or the issuance of a building permit.
�`. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1980 Sewage Treatment and Disposal Systems)
cw s• \ 1 PROPERTY ADDRESS Il w%l W I` 2 7 a Z DATE �o
LOCATION
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE oscr 4 # BEDROOMS ? # BATHS # OCCUPANTS J� GARBAGE DISPOSAL: Yes/No
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COMMERCIALSPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE / 00 TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) J '� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE1000 GAL. PUMP TANK GAL. TRENCH WIDTH .3 ROCK DEPTH a J� 'LINEAR FT. 00
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT -'IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHAFE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
_.. J �.
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IMPVYEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FIM INSPECTION OF THIS SYSTEM BETWEEN
8:38-9:38 A.M. OR 1:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT�i� Vo<�.SYSTEM INSTALLED B �.►�
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36 + rM1 r
AUTHORIZATION NO. Q OPERATION PERMIT BY TE
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**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE'SYSTEM DESCRIBED ABOVE HAS BEEN '-INSTALLED IN COMPLIANCE WITH,
ARTICLE 11 OF G.S. CHAPTER 138A, SECTION .1980 SEWAGE TREATMENT AND DISPOSAL SYSTEMS -BUT SHALL IN NO WAX BE TAKEN AS A, A-
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOPILY FOR ANY GIVEN PERIOD OF TIME.
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DCHD 10/95 t
xn Davie. County Health Department
ENVIRONMENTAL HEALTH SECTION
e P.O. Box 665
Mocksville, N.C. 27028 3:
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION.
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
issuance of any Building Permits. This Form/Authorization Number should be 'presented to the Davie County Building Inspections
Office when applying for Building Permits.***
AUTHORIZATION R
NAME P �. Aid P. \ `\ s NUY.9E
DATE i 1 - 9 ° 0 4 3 3
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
*mNOTICE**# THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVEi5)YEARS.
.,ENVIRONMENTAL HEALTH SPECIALIST DATE
DCHD 10/95
DAVIE COUNTY HEALTH DEPARTMENT
-- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems ` S / Permit Number
Name_i•� �� ;:��� l l' '>-, ;...fir -Date
I' f� _ �� N2 8042
Location r >> ..w; (," v�� ate` °� �'_ )t� �•
Subdivision ame Lot No. Sec. or Block No.
Lot. Size ° House — Mobile Home _ ,Business -- Industry
No. Bedrooms --� —.No. Baths —*-- No. in Family �� _ Public Assembly Other
Garbage Disposal YES p NO p"' Specifications for System:
Auto Dish Washer YES Co' NO p
Auto Wash Ma^hine YES Q" NO oiUO
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 change
ATTENTION:
YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
Improvements permit —7 —
*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: System Installed by
Co
s
1 +I
Certificate of Completion —_1 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.
\ ,v pJfj APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER 14
10
Davie County Health Department
�i Environmental Health Section
P. O. Box 665 ENVIRONMENTAL HWH
v Mocksville, NC 27028 DAVIECOUIM
1. Application/Permit Requested By - LX1 V4
Mailing Address co.? q/1Ff-1 f Home Phone 7a4l Fef " —23—?Sf�vl oCLGS ✓' /y 'R70AV Business Phone
2. Name on Permit if Different than Above /. S a ja: e 1 U,f I"I s
(" /0N
3. Application for: d General Evaluation 31-eptic Tank Installation Permit
4. System to Serve: ❑ House p' obile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
No. of People
No. of Bedrooms
3
No. of Bathrooms ?-
Dwelling Dimensions 30 X So A
6. If business, industry, place of public assembly, other: Specify type
No. of People Served -
No. of Commodes
❑ Basement/Plumbing
❑ Basement/No Plumbing
R4 -Washing Machine.
CB -Dishwasher
❑ Garbage Disposal
No. of Sinks
No. of Urinals
No. of Lavatories No. of Water Coolers.
No. of Showers Water Usage Figures.
7. Type of water supply: ❑ Public ? ❑ Private
8. Property Dimensions /Dd �7%�� Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If ves. what tvne?
❑ Yes P -W-0
❑ 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: IVoi 1141 Sa cc o %(l Ili l',�C f to
kJI 1 Y 70 i / Ovt 7Y -e t-jf L1`- a?� 7* PW,174 O 7°
JS ee f- Pr -ea c4-1 F&,6
Iq r air tet^ dv�r
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.
V / 9 6et
ATE ,AIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: SOWN 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 representativeSf ttLe Davie County H Ith epartme it to ent por}� bove described
property located in Davie County and owned by ca l
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorptions age treatment
and disposal syste .
DA
DCHD (1193)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME R 7S
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED a - J�
PROPERTY SIZE 1-06 i-
LOCATION OF SITE
Water Supply: On -Site Well _ Community Public
Evaluation Byl�.i�.L Auger Boring V Pit Cut
FACTORS
1
2
3
4
Landscape 2osition
Sloe R
-:
izo
8-
HORIZON I DEPTH
fall
`'
4
Texture group
L
(..
Consistence
Structure
G R
R
C R
C
Mineralogy
HORIZON II DEPTH
qA r
Texture group
C
Consistence
—
.t
Structure
Mineralogy
'.
I ', t
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
V-5
SS
SS
RESTRICTIVE HORIZON
'--
--
SAPROLITE
--
—
—^
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
�LN&,y
SITE CLASSIFICATION: \ .S ' 1
LONG-TERM ACCEPTANCE RATE: A2 ~
REMARKS: '�r �)_ 19 .� • i
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
`Affil t� e
Landscave Position v
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 :lay loam• SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V+ ---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
3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineralog
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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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
• APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME Atz�oAR IN PHONE NUMBER "x.333
ADDRESS of • 5 `-1w ti L� SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE � O 15 Q3 s'� C05� 31� lb sir.
DATE SYSTEM INSTALLED -%D -� NAME SYSTEM INSTALLED UNDER
TYPE FACILITY Xv Q NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED ��-
TYPE WATER SUPPLY L SPECIFY PROBLEM OCCURRING .
DATE REQUESTED 1 - I 1 SIL INFORMATION TAKEN BY \
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT.
Rev. 1193
Parcel #: M500000052
Davie County, NC - Basic Estate Search
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Parcel#: M500000052 Account #: 50144000
Owner Information
u[Id[n
Tax Codes
BXF•
MELOY BARBARA JEAN
Land:
ADVLTAX - COUNTY TA
Market:
918 US HIGHWAY 601 SOUTH
5sessed:
FIREADVLTAX - FIRE TAX
Deferred:
MOCKSVILLE NC 27028
Improved 0
2
Property Information
0123
Township
[Land (Units/Type): 97.240 AC
Qualified
JERUSALEM
[Address: 2918 S US HWY 601
00148
0663
Deed Information
1989 WD
Local tonin
Pate: 02/1996 Book: 00185 Page: 0448
Plat Book: Page:
Legal Description
PIN
8.70 AC HWY 601
5745861294
Property Values
u[Id[n
376,91
BXF•
43,39
Land:
519,00
Market:
939 30
5sessed:
479,19(
Deferred:
460,11(
Sales Information
No.
Book
Page
Month
Year Instrument
Qua[/UnQual
Improved Price
1
00185
0448
02
1996 WD
Unqualified
Improved 0
2
00125
0123
12
1984 WD
Qualified
Vacant 163,500
3
00148
0663
05
1989 WD
Qualified
Improved 470,000
View Prooertv Record for this Parcel View Man 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=1478169 1 8/3/2016