3164 Hwy 601S (2) 1UNTYAUTHOWI ATiON NO: & DAVIE HEALTH DEPARTMENT
!Environmental Health Section'. PROPERTY INFORMATION:
Permiitee's . `` • P.O.Box 848 ?,
Name: /';,`( _( %l0 Mocksville,NC 27028 Subdivision Name:
751-8760
`t� / ,r Phone# 336
Directions to property: i `� c'7t � Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office P N:# - -
Road N me: zi d
r:
*NOTE**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, '
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS. _
ENVIRONMENTAL HEALTHSPEC DATE ISSUED `:
ya'+PC x,Ft�yc C 'h`y., `"� r.f �'C. y� .vg...'v".My; ,,+..,�,.r k{y�4.y, :�7ri'a � Tr!'.;t io=y.,'} '-Li m^a i t •r. '"s. w: y¢-dti;, 4 i- -'"! ":i• 1 .T/'4.
Y x
.' DAVIE OUNTY HEALTH DEPARTMENT
' IMPROyEMENT AND OPERATION PERMITS PROPERTY INFORMATION
<Nariie Subdivision Name:
Dtrections to property:.:, _S' i, l j '� Section. Lot:
IMPROVEMENT
►,rr ;` .',, . {moi .,r, 'r't PERMIT i, s Tax Offi`e IN:# - -
Road Name: W Zip:
**NOTE**,This Improvement Permit DOES NOT authorize the construction"or installation of aseptic tank system or any wastewater 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)
,f t, _ ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
.,.` ' " PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS _#OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) Gl/NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE,/ GAL. PUMP TANK GAL.' TRENCH WIDTH ROCK DEPTH�r LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
- j
t r
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 r 9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
_ 1 i
t
r,
.41
AUTHORIZATION NO._A OPERATION PERMIT BY: DATE:
*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
F-777"
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE 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 05/96(Revised),
� �ie'''.sPll 7a �i�{ + —•"• A �'�"(,� � N +! t `< wK '�;5'�i'N 'yF`R kHY ".'i :�b>dYe�i�` if°;_ ..i L , k ...0 . � t `-,z v .. .®! � , ..
, . ` DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
- �..
Peftitte " • /
' •Name N / /�. �L5� Subdivision Name: ,
Directions to property:" s Section: Lot:
�- IMPROVEMENT
y , , ,r' ,; PERMIT A Tax Office PIN:# - -
14
Roa(Name• O Zip;
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALI T DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS —%F--# BATHS —.2—# OCCUPANTS,? GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: 'FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY �— DESIGN WASTEWATER FLOW (GPD) G NEW SITE REPAIR STfE
SYSTEM SPECIFICATIONS: TANK SIZE/_GAL. PUMP TANK GAL. TRENCH WIDTH —� ROCK DEPTH LINEAR FI.
i
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: —IJ
Y
AUTHORIZATION NO. � OPERATION PERMIT BY: DATE: "t
"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 .1900 "SEWAGE 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 05/96 (Revised)
i
r
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
ORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME f l/�' �2S PHONE NUMBER
ADDRESS -31 I & 6 IS - SUBDIVISION
DIRECTIONS TO SITE
NAME
SUBDIVISION LOT #
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING✓
DATE REQUESTED Gl" M INFORMATION TAKEN BY
F
Parcel #: M60000001701
Davie County, NC - Basic Estate Search
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Parcel#: M60000001701 Account #:82524253
Owner Information
uildin :
Tax Codes
BXF•
FALLER DIXIE MAE TRUSTEE
Land:
ADVLTAX - COUNTY T
Market:
IXIE MAE FALLER REV TRUST
essed:
FIREADVLTAX - FIRE TAX
Deferred
MOCKSVILLE NC 27028
Unqualified
Improved
Property Information
2
Township
Land (Units/Type): 1.220 AC
07
JERUSALEM
ddress: 3164 S US HWY 601
Improved
0
Deed Information
00925
Local tonin
�D,ate: Book: 00925 Page: 0308
2013 CA
Unqualified
a e:
0
4
Le al Description
0431
PIN
1.20 AC HWY 601
Qualified
5755051368
Property Values
uildin :
66,31
BXF•
4,12
Land:
19,05
Market:
89 48
essed:
89,48
Deferred
1989 WD
Sales Information
No.
Book
Page
Month
Year Instrument
Qual/UnQual
Improved
Price
1
00148
0079
04
1989 WD
Unqualified
Improved
0
2
00800
0005
07
2009 WD
Unqualified
Improved
0
3
00925
0308
05
2013 CA
Unqualified
Improved
0
4
00824
0431
04
2010 WD
Qualified
Improved
120,000
5
00924
0473
05
2013 WD
Qualified
Improved
114,000
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IZV �
ot-orni-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/itsnet/View.aspx?prid=1461941 7/29/2016