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3248 Hwy 64EN OPERATION PERMIT edge Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: William C. Buchanan III 'Buck" Address: L3248-US:Hwy-64=East = City: Advance State/Zip: NC 27006 Phone #: (336) 998-1144 Address/Road #: Subdivision: 3248 US Hwy 64 East Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 5 # of People: 3 *Water Supply: PUBLIC *IP Issued by: *CA issued by: Design Flow: 6 0 0 Soil Application Rate: 0 3 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: /'Property Owner: William C. Buchanan III 'Buck" Address: 3248 US Hwy 64 East City: Advance State/Zip: NC 27006 one #: (336) 998-1144 Phase: Lot: Directions Hwy 64 East on right past Cedar Grove ch Rd. *System Classification/Description: TYPE III A. CONV SYSTEM > 480 GPD (EXCLUDING SFD) Saprolite System? O Yes 9 No *Distribution Type: GRAVITY - PARALLEL (eq. d -box) Pump Re red? Q Yes 20 No *Pre -Treatment: Sq. ft. a00ft. 9 0Inches O.C. ®Feet 0. C. 3 Inches Feet inches Minimum Trench Depth: 3 6 ,Inches Minimum Soil Cover: a 4 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches Page 1 of 4 *System Type: INFILTRATOR QUICK 4 STANDARD Installer: -Transou Septic Certification #: *EHS: 2140 - Nations, Robert Date: 0 5/ 0 6/ a 0 1 4 CDP File Number 120950 - 1 Manufacturer: Shoaf STB: 760 Gallons: 1000 Date: 0 3/ 3 0/ a 0 1 4 *Filter Brand: POLYLOK Dual PL -122 With Pipe Adapter ST Marker: ❑ Yes ❑ No nforced Tank: ❑ Yes ❑ NO 1 Piece Tank: ❑ Yes ❑ No ❑ Yes ❑ No Countv ID Number: 37-000-00-105 Lat. Long: Installer: Transou Certification #: *EHS: 2140 - Nations, Robert Date: 0 5/ 0 7/ a 0 1 4 / Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ No Approved fittings ❑ Yes ❑ No pply Line Installer: Certification #: *EHS: Date: / / Pump Type: Installer: Dosing Volume: - Gal Certification #: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ No PVC Unions El ElYes El No Ei Vent Hole El El No Anti -siphon Hole ❑ Yes ❑ No Page 2 of 4 CDP File Number 120950 - 1 County ID Number: 37-000-00-105 Electric Eauioment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date. Ap ivova! Status `£g Alarm Audible ❑ Yes ❑ No ❑ �4ppra, ❑ blsapprwed Alarm Visible ❑ Yes ❑ NO " 2140 - Nations, Robert *Operation Permit completed by: Authorized State Agent: A� Date of Issue: 0 6/ 0 6/ 2 0 1 4 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A.1 900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE lil A. sewage septic system. Rule .1961 requires that a Type TYPE iii A. septic system meet the following criteria: Minimum System Review By The Local Health Department: N/A Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator: N/A Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 3 of 4 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 `j -a i A6 c �') 11� --- Drawing Type: Operation Permit X. AWFISM Page 4 of 4 4 CDP File Number: 120950 - 1 County File Number: 37-000-00-105 Date: / / O Inch Scale: O Block O N/A Of IMSie UMME "G P1 P2 P3 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: County File Number: 37-000-00-105 Date:. —/ / . . / Click below to import an image from an external location: Drawing Type: Operation Permit Page 4 of 4 Pi P2 P3 CONSTRUCTION For Office Use Only AUTHORIZATION 'CDP File Number 120950 -1 Davie County Health Department County ID Number: 37-000-00-105 r¢ 210 Hospital Street Evaluated For: EXPANSION P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 1/ 0 1 0 0 0 6 Applicant: William C. Buchanan 111 "Buck" Address: 3248 US Hwy 64 East City: Advance State2ip: NC 27006 Phone #: (336) 998-1144 Address/Road #: Subdivision: 3248 US Hwy 64 East Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: .5 # of People: 3 'Water Supply: PUBLIC ,"Site Classification: PS Seprolite System? QYes (j)No Design Flow: 6 0 0 Property Owner: William C. Buchanan III "Buck". Address: 3248 US Hwy 64 East CRY: ,Advance - State2ip: NC 27006 Phone #: (336) 998-1144 Phase: Lot: Directions Hwy 64 East on right past Cedar Grove ch Rd. Minimum Trench Depth: .1 4 Inches Minimum Soil Cover. Inches Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: Inches 'System Classification/Description: 'Distribution Type: GRAVITY - PARALLEL (eq. d -box) TYPE II B. COW. SYSTEM WITH 750 LINEAR FEET OF Septic Tank: NITRIFICATION LINE OR LESS Gallons 'Proposed System: 25% REDUCTION 1 -Piece: QYes QNo Pump Required: QYes QNo OMay Be Required Nitrification Field Sq. ft. Pump Tank: Gallons No. Drain Lines 1 -Piece: QYes ONo Total Trench Length: a 0 0 ft. GPM—vs— ft. TDH Trench Spacing: _ 9 Olnches O.C. Feet O.C. Dosing Volume: _ Gallons Trench Width: 3 6 81nches Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 OII 0111 OIV Pagel of 3 CDP File Number 120950-1 N 'Site Classification: PS County ID Number: 37-000.00-105 System Kequlrea:V Tt:5 VIYo WIVo, oUL Ild5 mydlldul: J Design Flow: 6 0 0 Soil Application Rate: 0 3 'System Classification/Description: TYPE 11 B. CONY. SYSTEM WITH 750 LINEAR FEET OF NITRIFICATION LINE OR LESS 'Proposed System: 25% REDUCTION Nitrification Field Sq. ft. No. Drain Lines Total Trench Length: 5 0 0 ft ❑ Open Pump System Sheet Trench Spacing: _ Q Inches 0. 9 * Feet O.C. Trench Width: 3 6 � Inches C) Feet Aggregate Depth: • inches Minimum Trench Depth: 1 4 Inches Minimum Soil Cover. Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: Inches 'Distribution Type: GRAVITY - SERIAL Pump Required: OYes 4DNo OMay Be Required Pre -Treatment: ONSF OTS -1 OTS -11 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 'Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Penn it, not to exceed five year:, and maybe issued at the same time the Improvement Permit issued (NCGS 130A -336(b)), If the Installation has not been completed during the period of validity of the Construction Permit the Information submitted In the application for a permit or Construction Authorization is found to have been Incorrect, falsified or changed. or the site Is atteM, the pemilt or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rides, and permit conditions regarding system location, Installation, operation, maintenance; monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature Date. _ 'Issued By: 2244 - Daywalt. Authorized State Agent: Date of Issue: 0 4/ l a/ a 0 1 3 Malfunction Log Oyes QHandWrawing OlmportDrawing Total Time:(HH:MIA) **Site Plan/Drawing attached.** 0 1 Page 2 of 3 Hours _ Lt mutes S4 - CIA ISSUED - EXPANSION .CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Dra`ving Drawing Type: Construction Authorization CDP File Number: 120950 -1 County File Number: 37-000-00.105 Date: 04 / 1 2/ 2 0 1 3 Q Inch Scale: , QBlock QN/A Pane 3 of 3 MA, .� Ij s. ,k!Q it1 C; I C 10. �i irl�C' _...I A m. l , f I it f j , Pane 3 of 3 MA, IMPROVEMENT PERMIT :. Davie County Health Department k 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID UNTIL' 4/12/2018 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: William C. Buchanan 111 "Buck" Address: 3248 US Hwy 64 East City: Advance State2ip: NC 27006 Phone #: (336) 998-1144 ddress/Road #: Subdivision: 3248 US Hwy 64 East Advance NC 27006 Structure:. SINGLE FAMILY # of Bedrooms: 5 # of People: 3 *Water Supply: PUBLIC Ion: Saprolite System? . OYes (QNo Design Flow: 6 0 0 Soil Application Rate: 0 3 'System Classification/Description: TYPE 11 B. CONY. SYSTEM WITH 750 LINEAR FEET OF NITRIFICATION LINE OR LESS *Proposed System: 25% REDUCTION Property Owner: William C. Buchanan 111 "Buck" Address: 3248 US Hwy 64 East CtY: Advance State2ip: NC 27006 Phone #: (336) 998-1144 atio Phase: Lot: Directions Hwy 64 East on right past Cedar Grove ch Rd. Minimum Trench Depth: 2 4 Inches Maximum Trench Depth: 3 6 Inches Septic Tank: Gallons 1 -Piece: OYes ONo Pump Required: OYes QNo OMay Be Required Pump Tank: Gallons 1 -Piece: OYes ONo Repair System Required: 0 Yes ONo ONo, but has Available Space Reaair System .Site Classification: PS Soil Application Rate: 0 3 *System Classification/Description: TYPE 11 B. CONV. SYSTEM WITH 750 LINEAR FEET OF NITRIFICATION LINE OR LESS *Proposed System: 25% REDUCTION Minimum Trench Depth: a 4 Inches Maximum Trench Depth: 3 6 Inches Pump Required: OYes (E)No O MaybeRequired Pagel of 3 CDP File Number 120050 - 1 County ID Number. 37-000-00-105 *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shag be wild for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to O sate that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the site forthe proposed Wastewater system, and the location of water supplies and surface waters). Plat The Improvement Permit shag be wild without expiration with plat (means a property surveyed prepared by a registered land surveyor, drawn to a sale of one Inch equals no more than 60 feet, that Includes. the specific location of the proposed facility O and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy of the recorded subdivisions plat that Is accompanied by a site plan that Is drawn to scale). The Deportment and Local Health Deparlm ant may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions, the rules, or this article, This permit Is subject to revocation n the site plan, plat, or Intended use changes (NC135130A335(Q). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting, and repair (A938(b)j. Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature: Date: *Issued By: 2244 - Daywalt. Andrew Date of Issue: 0 4 / 1 a / 2 0 1 3 Authorized State Agent: , ,,� , ,� _ OValid without Expiration? 0Create CA. OHand DraIg OlmportDrawing **Site Plan/Drawing attached.** Total Time:(H H:M M) 1 Hours . 0 6I Inutes Page 2 of 3 Activitv Code: S•5 • IPS issued: expansion of existing system IMPROVEMENT PERMIT ._ Davie County Health Department CDP File Number: 120950 -1 210 Hospital Street37-000.00-105 P.O. sox 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawii1112 Drawing Type: Improvement Permit Scale:. . . QBlock QN/A Page 3 013 ice4 s {! ss IJ 3} I d; � ►�� i � d f :.__—_ --LJ- . JPj—W- — —_— I{{ _ r I 1 i ! i�, { i, �► II _ a i - -__-' 04 I _U4- ....... Page 3 013 ice4 m KI APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health Q P P.O. Boz 848/210 Hospital Street A �R Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 �*DNewSyste:m� r� Applicati,Wlldii� r:mprovement Permit ❑ Authorization To Construct (ATC) ❑ Both Type of ❑Repair to Existing System BExpansion/Modification of Existing System or Facility ***IMPORTANT'`** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name W1111i Address _ City/State/Z1P Email --12 uL Name on Perm Address ATC if Different than Above I W P V;I:4we1011 Lei NaI:r1Lei Contact Person S Am 1E zUL Home Phone 3 3 s; • 7.2-5 I Business Phone -3.3 4 - 4 % 8' ! 14 .Email: SAM e— Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan (Permit is valid fr 60 months with site Ian, no expiration with complete plat.) Owner's Name v a. Phor Owner's Address 3,2 1 aSh, City/State/Zip Property Address S AMS_ ICity Lot Size & 14L Tax PIN# Subdivision Name(if applicable) Sectiotn/�Lot# Directions To Site: E}jei 2DN1 M0 VI C ON /Y U,44— If Jy ❑Plat(to scale) If the answer to any of the following questions is "Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? Yes -ITo Does the site contain jurisdictional wetlands? . N"o Are there any easements or right-of-ways on the site? _Yes No— Is the site subject to approval by another public agency? _Yes _Yes Will wastewater other than domestic sewage be generated? Yes —N6 IF RESIDENCE FILL OUT THE BOX BELOW CJ1 AN i N 4o S C o m l i'N # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes Ds Basement: ❑Yes PNo Basement Plumbing: ❑Yes IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other _ Water Supply Type: R"County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of theacili this system is intended to serve? Wyes 11 No If yes, what type? Ca�t111'�tT LsXIs /VC M "ZPN" /ST F�Nrt �'� TC1L w., This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pennit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating and flagging ors��lcing t,�h� ouse/facility loc�tion�e� l location and the location of any other amenities. Property owner's or owner'slegal representative signature Site Revisit Charge 3 IV / �3 Client Date(s): Client Notification Date: ` Date EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # Appraisal Card View All Cards Next Card Page 1 of 1 UCHANAN WILLIAM C III BUCHANAN CYNTHIA S Retum/Appeal Notes: L J7 -000 -00 -SOS —_y 248 E US HWY 64 UNIQ ID 19671 11335870 D360 -P10 ID NO: 5777273089 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 2 eval Year: 2013 Tax Year: 2013 13.64 AC HWY 64 13.460 AC SRC= Inspection ,ppraised by 07 on 08/0112007 04002 CEDAR GROVE CHURCH TW -04 C- EX- AT- LAST ACTION 20110725 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 Standard 0.3900 ntinuous Footing 5.00 Eff. BASE ub Floor System - 4 USE MO Area QUA RATE RCN EYB AVBCREDENCE TO MARKET llywood 8-0001 01 13,8171 91 63.70 4764 197 191 % GOOD 1 61.0 DEPRL BUILDING VALUE - CARD 151,06 x[erior Walls - 10EPR. TYPE: Single Family Residential Single Family Residential OB/XF VALUE - CARD 33,93 %Iuminum/Vin I Siding 29.GC ARKET LAND VALUE -CARD 121,57 oo0ng Structure - 04 STORIES: 3 - 2.0 Stories TOTAL MARKET VALUE - CARD 306,56 ilp 10.0 Doling Cover- 03 ksphalt or Composition Shingle 3.0 TOTAL APPRAISED VALUE - CARD 306,5 nterior Wall Construction - 2 TOTAL APPRAISED VALUE - PARCEL 346,29 all Board or Wood Wall 14.0 nterior Wall Construction - 5 )rywall/Sheetrock 0.0c TOTAL PRESENT USE VALUE - PARCEL nterlor Floor Cover - 08 OTAL VALUE DEFERRED - PARCEL heet Vinyl/Laminate 8.0 OTAL TAXABLE VALUE - PARCEL 346,29 nterior Floor Cover - 09 + - - - - - - 3 9 - - - - - - + 1 F U S 1 PRIOR Ine or Soft Woods 0.0 I I eating Fuel - 02 I I UILDING VALUE BXF VALUE - 215,34 45,36 II Wood or Coal 0.0 3 3 2 2 - AND VALUE 114,52 eating Type - 04 1 I RESENT USE VALUE orced Air - Ducted 4.0 I I DEFERRED VALUE it Conditioning Type - 03 1 1 ',TOTAL VALUE 37S,22( entral 4.0 +-----.39------+ drooms/Bathrooms/Half-Bathrooms 2/1 15.000 rooms IWDDB+ +7-+ S-OFUS -4 LL -0 I 1 1 1 1 PERMIT throoms 2 1 1 1 I CODE DATE NOTE NUMBER AMOUNT AS -IFUS -ILL-O 3 0 0 2 1 alf-Bathrooms I + +-14-+ 9 AS - I FUS - 0 LL- 0 1 7 I OUT: WTRSHD: (floe +4+ ++ SALES DATA +----29----+ 1 1 FF. INDICATE OTAL POINT VALUE I BAS 100.00 I 4 ECORD ATE DEED SALES BUILDING ADJUSTMENTS I +8-+-12-+ OOK PAGE M R TYPE / / PRICE uali 3 AVG 1.000 2 1 1 0168 247 4 199 WD I 16500 6 I 1 ha a Desi 4 FACTOR 4 1.050 1 1 6 ize 3 Size 0.870 1 8 I OTAL ADJUSTMENT FACTOR 0.91 +----29----+ I +-12-+ OTAL QUALITY INDEX 91 + +1010- 13-+ 1 HEATED AREA 3,665 8 8FOP8FOP +-14-+30-+--21---+ 0 NOTES -IBARN ADDED AFTER SALE SUBAREA UNIT ORI G % ANN DEP % OB/XF DEPR TYPE GSA % RPL CS ODE ESCRIPTIO IT H NIT PRICE COND LOG N B AYB EYS - RATE OV GOND VALUE AS 2,417 10 153962 2 RAGE 2 3 72 20.0 10 _ L 197 198 5 1 -230 9 ABLE 11 111 3 3,54 20.0 10 L 199 199 S 4 2832 OP 58 03 1299 24 HED 1 118 5.1 _ L 0 S 5 331 US 124 09 7153 OTAL OB/XF VALUE 33 93 DD 3 02 465 5 - Two or IREPLACE 4,50 more UBARE 4,61 47,64 OTALSA BUILDING DIMENSIONS BAS-W4N19W7WDD-N4W26S23E4N17ESSIOE14N12$S12W14NIOW8S10S7W4S3W29S26E29S3S8E14FOP-E I0FOP-E21N10E12N16W12W8S18 W13S8 NBWIOSB N8E23N32 PTR-N30FUS=N32W39S32E39 S30$. ND INFORMATION IGHEST THER ADJUSTMENTS LAND TOTAL ND BEST USE LOCAL FRO N DEPTH / LND GOND ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TACE EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES RURAL AC 0120 527 0 1.0730 4 11.22001+02 +20 +00 +00 +00 PW 6,900.00 13.46 AC 1.30 9,032.11 12157 OTAL MARKET LAND DATA - 1,4 4601 1 121,57 ITOTAL PRESENT USE DATA S11we he, bol�^ 9 d A http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=J700000105 3/26/2013 �' ''"r°'1` ^'�X9YF �f a w-'u4'�,r•„r't4.'>%.�'Yryl�r.r,t ,,'�,. &i tfy .r Y ..: t. -a�. .n , -.: ',. ___ _:,.. ,. � .jiut s 3+' f ! °�i kl t""�� :'S.J�Q7.3`'yy,d^�'�,a i-;.`5a.,•fs x> }y r.s . ..r .; '.� '.t,s{jr..., ;fid { w '� 14 v1 j1 `l ♦ Y i -t'i'n o kM' A i, s .'•Y t.��t '' i -"A • _ .�-'' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Via• o� --*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a /G' a u (Ranitary Sew a Systems Permit Number Name �.��-�C. QC- Date 3 y 9 NO 7451 Location C 2 2 a A 1J �- �� N °L A-100% { �2 ICSH Subdivision Name 6-g6t No. Sec. or Block No. Lot Size - '"$ House.. Mobile Home Bbs0ess Industry t„i No. Bedrooms �No. Baths; No. in Family �_ Public Assembly Other Garbage Disposal YES C]Nb'V ' , Specifications for System: fl Auto Dish Washer YFS,ef NO ` ❑.; , ., y. Auto Wash Ma^hine YES 10"'N6`0 Type Water Supply *This permit Void if sewLge.zyste�m desc+ri �IQ�w is not installed within 5 years from date of issue This permit is subject t if site /p a or -t a intended use chfnge. o Improvements. permit by — *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 Di?gram: \ System Installed by is 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. � �,��f rte_ • - f.... ,:^ *-',"%� �," DAVIE COUNTY HEALTH DEPARTMENT IIAPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION. -`'' NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a ✓� '� _ anitary Sew a Syst ms Permit Number �-lame --- 19 U� N ,0 Date - - f `� 4 51 I , r� r1 Location C � - _o , 2- c� U P t� c N e .2 c., o b Subdivision Name 2� S p �/ ti l2� Cot No. Sec, or Block No. Lot Size 2f� House Mobile Home Business -- Industry No. Bedroo?ns ,No. Baths. No. in Family— Public Assembly Other Garbage Disposal YES p NO (d ' Specifications for System:' fl - Auto Dish Washer YES [Ef NO ❑, ' Auto Wash Ma^hine YES iy( NO p Type Water Supply — _-- *This permit Void if sew ge system c� describ�below is not installed within 5 years from date of issue. This permit is subject t is if site4) ans or the intended use chenge. r �KW r �\ !'•,..Ya•{. .f lA.,�' ) rL�t � r J— r; o 5ti \ 11 V ' r . Improvements permit by *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. b Installed System Final Installation Di gra � � Q,.,� �a�� Y d � o j Certificate of Completion Date - t 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 givenperiod of time: OKA= A) 4 ` DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION /p ,l ,Q APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAMEPHONE NUMBER BDIVISION NAME LOT # DIRECTIONS TO SITE .r !I ((S� - D x _S1 - DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY M111AIA UMBER BEDROOMS .5 NUMBER PEOPLE SERVED TYPE WATER SUPPLY CUu-I /-J SPECIFY PROBLEM OCCURRING DATE REQUESTED �'�T 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 / LA -5—r Davie County, NC - GoMaps Advanced J _16240 r #204,,r �r X18 136 J 217 iE i; X157 49 127 .234 A:: .-.,227 -,,l A, 249 rr � 243 i lain-, 39; i 100 m L 251 http://maps2.roktech.net/davie_gomaps/index.html L v3 32 3282 3294-,:-:.- - - 3313 4247 \ ` X4263' r� r4. r 3300 �'` 4290 f- 3341 3365, 4308 4294 6� Latitude 350 52' 42,12" Longitude -800 26' 48.35" Page 1 of 1 4/12/2013