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6096 Hwy 601S4 �,y �' a• 4•, t,• v.... ra .Sj JT. ,i_. ,.,., 'a i e .. a s '! / DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a S�a.�nittsry Sewage Systems Permit Number Name—,=�,nI�'',%/'�'1it.�f Date N2 - ,� r+ �? Location �ar�f/ " ,�,�, r1�' ��,> �.; �aT,,. �� r> 1- % �' � ;,>r,r , (Pd�� A16'AVY V/S Subdivision Name Lot No. Sec. or Block No. Lot Size IAP' House #f'' Mobile Home _ Business Speculation No. Bedrooms Z_.No. Baths No. in Family ,Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES ❑ . NO Auto Wash Ma .hine YESQ-''NO ❑ !/ �� ` �r7 J Type Water Supply /,1 __=�!f�."?X/r *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. . P Improvements ermi b _J/' P *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 by9`r 'The signing of this certificate shall inc the standards set forth in the above reg satisfactorily for any given period of tiro ate F— - &? 9, led in compliance with the system will function APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By �Ohk�) C CECr=1z Mailing Address -1 X41 S �dCKSvs�CF Home Phone q °t 0l Ck @-� - S Z>I! Z Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: 4. System to Serve: ❑ Business BlAouse ❑ Industry 5. If house, mobile home: Subdivision No. of People 3 No. of Bedrooms ,- No. of Bathrooms ❑ General Evaluation ❑ Mobile Home ❑ Other [?Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing (lashing Machine ❑ Dishwasher Dwelling Dimensions S %4 4 5 ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: No. of People Served No. of Commodes No. of Lavatories Specify type W/ A' No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures _ 7. Type of water supply: SKPublic ❑ Private 8. Property Dimensions m (0 2, P, -( Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes P -WO 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: g u-) 3 ✓D Q, s_v-1-�`C" ti ZO o Yds , 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 applicatio . o DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 13'1. I OWN 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 representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. AT /` DCHD (12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME GSL, Ito"r ADDRESS PROPOSED FACIILTY ,Ly�yfY DATE EVALUATED 161A�A& PROPERTY SIZE 0- LOCATION OF SITE __ 001aoh /1r/� Water Supply: On -Site Well Community Public <� Evaluation By: Auger Boring Pit Cut L L Sloe % — FACTORS 1 2 3 4 Landscape position t: 4 L L Sloe % — -9- z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH" �• �/¢ T �- Texture group Consistence Structure Mineralogy/• HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: _ LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: - %� 4Z 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-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 watef 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 NONE ■O■■ ■■N■ ■OE■ ■ON■ ■O■■ ■OE■ ■■■■ ■ ■ ■ Parcel #: L600000024 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Q V ew Property Record for this Parcel View Mau for this Parcel View Tax Bill Information Parcel #: L600000024 Account #:56069500 Owner Information Building: Tax Codes BXF• EELER JOHN THOMAS [PV Land: ADVLTAX - COUNTY T Market: 096 NC HIGHWAY 801 SOUTH assessed: FIREADVLTAX - FIRE TAX eferred• OCKSVILLE NC 27028 1921 WD Information Vacant Township ��Property (UnitsTType): 90.500 AC 00117 JERUSALEM96 S NC HWY 801 1982 WD Deed Information Vacant Local Zonin ate: 01/1997 Book: 00192 Page: 0208 00151 0345 lat Book: Page: 1989 WD Legal Description Vacant PIN 0.495AC HWY 801 00192 5756654402 Property Values Building: 196 45 BXF• 12Q Land: 437,28( Market: 644,16( assessed: 274,81( eferred• 369,35( Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price L 00023 0370 04 1921 WD Unqualified Vacant 0 t 00117 0243 08 1982 WD Unqualified Vacant 0 3 00151 0345 10 1989 WD Unqualified Vacant 0 3 00192 0208 01 1997 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP-tF 6 A. R� 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=1478791 8/31/2016