3494 Hwy 64E (2) �.. ..._ . . .. . ...:,�..�..._- ,..r. ..:. . ... . � ..� _..... .�..'�.n ".��. .rr ' ' �v.—{::.x..� � i . .i � .. r . _ __. .
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'�� 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@I'1111t N1i111b@t' .
� Name f�/: J��// r'r_� l�-�{;�U.`r ��"` Date =-'���`�'��-s� -''%' F;+;, ''� '� �'r'�
Location � - ��`� �, � � �_
r ,+!�i.�=' [�.�.� -r`I�% � �-�%'�! �'�:�'/�'y'-r, �;_.!'�, /.7` .i, :f
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y
Subdivision Name Lot No. Sec. or Block Na
Lot Size %�, !� House Mobile Home ���� Business Speculation
No. Bedrooms _�� No. Baths � No. in Family � _,
� Garbage Disposal YES � NO p- Specifications for System:
�' Auto Dish Washer YES NO p � , ,,.E',,,.,
�-
/G'L � �- i
Auto Wash Machine YES � NO �� � �, �� _� �,�. , .,,, ��
Type Water Supply •�-�r f,� _ �::.���G iJ Syi��„i+�
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
� ___.._._.__..__.__.__..___.__.____..�__
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Improvements permit by � j-r`=Fr-�'`"
*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.
�- � i
Final Installation Diagram: System Instalied by ��� /' �'�%%���''--�
-�.�_____----,..__;_��
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Certificate of Completion � -r��''�"C'`� 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. .
. .;�
.
� � DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028 �
� SOIL/SITE EVALUATION
.�� vJ-� -�
Name Date ��/���
Address Lot Size���'
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position � � S S
PS S PS PS
U U
2) Soii Texture (12-36 in.) Sandy, � S S S
Loamy, Clayey, (note 2:1 Clay) � PS PS
U U U
3) Soil Structure (12-36 in.) S S
Ciayey Soils p , � PS PS
� U U U
4) Soil Depth (inches) � S S
pg � PS PS
� `� U U
5) Soil Drainage: Internal S S
� (� ' PS PS
U U U U
• External S S
. P PS PS PS
C� U U
6) Restrictive Horizons ` L_ —
7) Available Space S S
� PS PS PS
� � U U U
S) Other (Specify) S S S S
PS PS PS PS
� U U U
9) Site Classification , � ��-
U—UNSUITABLE S—SUITABLE �PS—Provisionally Suitable
Recommendations/Comments:
Described by ir��� Title Date �`
SITE DIAGRAM
: � � �
DCHD(6-82) -
, �z J q ,�,�
' �� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
• 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 �I�- 2� �7
� �3- �9��s �
1. Permit Requested By s. � Business Phone '�
2. Address t -� �� v
3. Property Owner if Different than Above
Address
4. Permit To: a) Install �Alter Repair
b) Privy Conventional ✓Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what rype facility: House Mobile Home�B�s
Industry Other
b) Number of people �
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions •
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 urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public `� Private Community
b) Has the water supply system been a�proved? Yes '� No
9. a) Property Dimensions �0 2_ ��c�o�
b) Land area designated to building site '"l� Q�r� -
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? .
What type?
This is to certify that the information is correct to the best of my knowledge
.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: -7-�
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. ��
DCHD(6-82)
1
Pazcel#: K800000004 Page 1 of 1
v��r�
Davie County, NC - Basic Estate Search � ' t,:
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xgw�"�aertv Record for this Parcel View Mao for this Parcel Vlew Tax Bill Information
Parcel#:K800000004 Account#:66210000
Owner Information Tax Codes
IDDEN BOBBY G&SIDDEN]UDITH E ADVLTAX-COUNTY T
494 US HIGHWAY 64 EAST FIREADVLTAX-FIRE TAX
DVANCE NC 27006
Pro e Information Townshi
nd(Units/Type): 6.310 AC FULTON
ddress: 3494 E US HWY 64
Deed Information Local Zonin
ate: Ol/1979 Book: 00106 Page: 0855
Plat Book: Pa e:
Le al Descri tion PIN -�
.48 AC HWY 64 5777551290
Pro e Vatues
uiidin : 9170
BXF� 9 72
nd: 64 13
Market: 165 55
ssessed: 165 55
eferred•
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00106 0855 01_ __ 1974.WD___ Un ualifled_ Im roved 0
View Pro�ertv Record for this Parcel View Ma�for this Parcel View Tax Bill Information
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All information on this site is prepared for the inventory of real properly found within Davie County. All data ts compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notifled that the aforementioned public information sources should be
consulted for verification of the Information. All information contafned 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 IimitaUon 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://ma�s.daviecountync.gov/itsnet/View.aspx?prid=1466992 6/21/2016