2420 Hwy 64E . ;� : ..�. ..�.. . .. ._. . . . , .. . . ,� . . ... . , __
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�f�;-" �,•'; 1�� • DAVIE COUNTY HEALTH DEPARTMENT
�"`":.��,'";--�" IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
� Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) P@PI171t NU111b@f
t Name ���-,,�'_/a�,..f' ,,r�..:�rr.�,�i i� Date �.�"�` i'--��'� �.�,? �,���
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Location lr�'%�,�� /�,- ,- .��' �,�-��J.._ , �'='.�"P- -- ,_� ,,��- �� �j' ,.�.>;.�� r
�� � l��-'/��,�� .�J! � �^'���.� ✓ S�_ V�.I�W�� -✓�!-�Q/�.�?.' �/� VV�`� ���� . .
Subdivision Name Lot No. Sec. or Block No. ��Da'�
Lot Size '�r �-'' ��� House � Mobile Home _ Business Speculation
1
No. Bedrooms ? No. Baths —^� No. in Family_..'�_
Garbage Disposal YES ❑ NO p�r Specifications for System:
Auto Dish Washer YES NO p ✓' � �� y ;�,�--� f
Auto Wash Machine YES � NO �p� ��1�(�_,� f � � ,
,�i' �r , ,,
/ � `�'C}��',+.�,�./.��
Type Water Supply � T%- �''r __— '"�
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"'This permit Void if sewage syst m es ribed below is not installed within 36 months from date of issue.
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Improvements permit by —�r��"'✓"'�'��
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*Contact a representative of the Davie County Health Dapa�finent for final ins�ection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completio . elepho er: 704-634-5985.
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Di ram: stem Installed b ���?��'ra' y'�.���' �,��
Final Installation ag Y Y-�-�-�
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Certificate of Completion ���=�-�p'� - 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.
. �'�G�'0�'��3 �Lr;�� �
,� - = L APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT � � '��'�a `
Davie County Health Department
Environmental Health Section
P. O. Box 665
� ' Mocksville, N.C. 27028
, CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
, Home Phone � 998-J����
1. Permit Requested By�f��1V)� L ,_ /�a�l�l� � Business Phone ���'�4//
2. Address ��` � B�X ��`� �Dcl!t�tj//P �C
3. Property Owner if Different than Above �
Address
4. Permit To: a) Instail�Alter Repair
b) Privy Conventional�L Other Type
Ground Absorption
c) Sub-Division Se Lot Na
5. System used to serve what type facility: House�Mobile Home Business
Industry Other
� b) Number of people "�
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions �0� X 7S �
Bed Rooms�_Bath Rooms � Den w/Closet
b) If Business, Industry or Other, State: Number of persons served —
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures
commodes a urinals � garbage disposal O
lavatory � showers � washing machine�
dishwasher � sinks a ,
8. a) Type water supply: Public��Private Community ,
b) Has the water supply system been approved? Yes No�
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? "'�10
What type?
This is to certify that the information is correct to the best of my knowledge.
_� -�/- S � ,9,,�.�„n.,� �/6-c��
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: �����f tow��ds Lexi n�s ��iv, P,�ss /�%e�o� y ���� �� L�ff
�-�rk� ��rs� �i�, oN r,�,�,��'�Ja C:e ,�J .� �now L��vc � ���y ha�.sc� � �v �P�y/.�
yau � w,�N�-� P,�,,����� �
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, .;. ' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION ���? / �
N;3me Dennis C. Howell �� '
Date
Address Lot Size �`U`t�
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S
� PS PS PS
U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) PS �� PS PS
� U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils pi� . PS PS PS
�`[j �t�' U U
4) Soil Depth (inches) S S S
� S PS PS
� � U U
5) Soil Drainage: Internal ,E� S S
• • � PS PS
U U U
External � S S
pC� �,/�'' PS PS
� � U U U
6) Restrictive Horizons
c�..�-�--
7) Available Space S S
PS PS PS PS
� � U U U
8) Other (Specify) S S S S
pg PS PS PS
U U � . �
9) Site Classification , �
U—UNSUITABLE S—SUITABLE PS—Provisional{y Suitable
Recommendations/Comments:
Oescribed by Title —�!Lx,� Date �
SITE DIAGRAM
r
ocHo�s-sz�
Parcel#:J60000006501 Page 1 of 1
���f�
Davie County, NC - Basic Estate Search � � a
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View Pro�ertv Record for this Parcel View Mao for this Parcel View Tax B(II Information
Parcel#:160000006501 Account#:37802400
Owner Information Tax Codes
HOWELL DENNIS C ADVLTAX-COUNTY T
420 US HIGHWAY 64 EAST FIREADVLTAX-FIRE TAX
OCKSVILLE NC 27028
Pro e Information Townshi
nd(Units/Type): 18.550 AC FULTON
ddress: 2420 E US HWY 64
Deed Information Local Zonin
ate: 09/1996 Book: 00189 Page: 0893
lat Book: Pa e:
Le al Descri tion PIN
18.630 AC]OE RD 5767280786
Pro e Values
uildin : 159 81
BXF: 5 73
nd: 151 55
Market: 317 09
ssessed• 190 87
Deferred• 126 22
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00131 0105 04 1986 WD Unqualified Vacant 0
00189 0893 09 1996 WD Un ualified Im roved 0
View Prooertv Record for this Parcel View Ma�for this Parcel View Tax Bill Information
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Alt 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
impiled, in fact or in law, fncluding without limitation the implied warranties of inerchantability 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.da.viecountyna�ov/itsnet/View.aspx?prid=1479345 6/29/2016