2966 Hwy 64W Permittee's /� DAVIE COUNTY HEALTH DEPARTMENT 6L sv Dv0�
Name. � �t'ti `"��` Environmental Health Section PROPERTY INFORMATION
t� e r�! 4- P.O. Box 848
Directions to property: L Mocksville;NC 27028 Subdivision Name:
Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: A Road Name: ` LVA -zip: . 704-0
**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 complia ce ith Article I 1 ofG. er 130A,Wastewater Systems,Section.]900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�• ______1�, q IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIR N'v11 NTL EACTH PE ALIT DA ISS ED '
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS L4 #BATHS #OCCUPANTS_(�GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLA Ot{, DESIGN WASTEWATER FLOW(GPD) 'l NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -ROCK DEPTH 12 LINEAR FT.
OTHER �ST 1~t 6tl`C i W &X14 J
2 °
REQUIRED SITE MODIFICATIONS/CONDITIONS: �'�`''�'U-' CA-_' 70i t:=� I" l"��'' t":)
IMPROVEMENT PERMIT LAYOUT
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1117 ATCA
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**CONTACT A REP ESENTATIVE OF THE DAVIE COUNTY HEALTH DEPA f�9R FINA INSPECTION OF THIS SYSTEM
BETWEE 8:30-9:30 .M.OR I:00-1:30 P.M.ON THE DAY OF INST LAT ONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: �I�V 2K
I�V--142-0 1,141E
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AUTHORIZATION N0. `��' ` OPERATION PERMIT B DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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 02/02(Revised)
.1,f ✓� r3
i Davie County Health Department
Y
ENVIRONMENTAL HEALTH SECTION f �,
- P.D. Box 665
Mocksville,' N.C. 27028 ,
AUTHORIZATION`FOR WASTEWATER SYSTEM CONSTRUCTION ; }
(Issued incompliance with Article 11 of
S. Chapter 13OA, Wastewater Systems)
i
***ThisAuthorization 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 I spections
Office when applying for Building Permits.***
DATE � i!G%6 AUT}DR ZATION NMRNAME ��%l'I �I Prrn � �� �`��
NAME ON IMPROVEMENT FRMS (If different than above)
SITE LOCATION S�r�
CGRWS/CONDITIONS ON AUTHORIZATION TD CONSTRUCT WA5TENATER SYSTEM
f*TICEm* THIS AUTHORIZATION F WAS WATEA SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIDKNTAL HEALTH IALIST DATE
I)CHD 10j95 .
t ,
. DAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIIATION 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)
NAME PROPERTY ADDRESS r / a DATES/dames
LOCATION
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE' # BEDROOMS _ # BATHSy# OCCUPANTS —7 GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY _ DESIGN WASTEWATER FLOW (GPD) -00 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE e�/,LI GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH , LINEAR FT. S�dll
OTHER gZl�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PIANS OR THE INTENDED USEYOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. CIV.
• /`'may✓l!
(
l
IMPROVEMENT,PERMIT,BY
**CONTACT A REPRESENTATIVE'OF`THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL;INSPECTIONJOF 1THIS-SYSTEM BETWEEN
.,,8:30-9:30 A.M. ORA-.W1:30 P.M. ON THE DAY OF INSTALLATION. tTELEPHO #` IS (704) 634 76:
OPERATION PERMIT Vl� SYSTEM INSTALLED BY � 1
�� • - _._;. � �.+ ''w 1, -_ '
Illlll "
N C;; i.,1,•l is �.�� �� 7 `-�
AUTHORIZATION N0. OPERATION PERMIT BY DATE Q�+
**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 IMj NO WAYIBE TAKEN`AS R
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD
DCHD 10/95
r� !t—w► �`+►• DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
'IMIPROVEMENT^-PERMIT
**NOTE** This improvement•permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
r` construction/installation of a system or the issuance.of a building permit.
r;
. (In compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems, Section .1980 Sewage Treatment and Disposal Systems)
NAMEi rt t ./;1�7'f�,�r G'� PROPERTY ADDRESS 7 w /!�p� DATE
LOCATION .<ij/�
SUBDIVISION WE ¢ LOT t ER SEC./BLOCK NUMBER`
RESIDENTAL.SPECIFICATION: BUILDING TYPE t%/ ' -_#..BEDROOMS # # THS � # OCCUPANTS � GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE PEOPLE/SHIFT # SEATS INDUSTRIAL WASTEf Yes/No
LOT SIZE TYPE NATER SUPPLY a DrEdIBN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
1 ,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. .PUMP TAN( GAL. TRENCH WIDTH " ROCK DEPTH ;-LINEAR FT.
OTHER
REOUIRED'SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT.TO REVOCATION IF SITE PLANS OR THE INTENDED USEYOUR WASTERWATER.ZYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE,,INSTALLING THE SYSTEM. � _. .� .:
.00110,
r� t
IMPROVEMENT PERMIT.BY l,5/
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL•INSPE�TION,0FJ�IS SYSTEM BETWEEN
8:38-9:38 A.M. OR 1:88-1:30 P.M. ON THE DAY OF INSTALLATION. 1ELEPHINE # I5 {700}634=8768.'
OPERATION PERMIT SYSTEM INSTALLED BY /_/J.��i1 ,
w NJ
IN
1
1. _- ff s,�Ji. �' �'� �•f elf '� /'
AUTHORIZATION NO. OPERATION PERMIT BY /N DATE
**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 MA, SECTION .1908 "SEWAGE TREATMENT AND D15MX SYSTEMS',)BUT.SHALL I9 NO WAY--BETAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD,IF TIME:"
DCHD 10/95 -,-
_ i�
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
t�
NAME <�i-�h. /`�_IS'o� PHONE NUMBER
ADDRESS �� SUBDIVISION NAME
d�i�l1l� i, C LOT#
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �1�r NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLYL SPECIFY PROBLEM OCCURRING
DATE REQUESTED �' 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.1/93
_ 3�0
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
AP LICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME ' ` PHONE NUMBER
ADDRESS �-�LeLo 4"�k? Uq t-2) SUBDIVISION NAME
LOT#
DIRECTIONS TO SITE
i
DATE SYSTEM INSTALLED 9lIe NAME SYSTEM INSTALLED UNDER �- S
TYPE FACILITY SIC NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING_ U)
DATE REQUESTED 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
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-X�1968) Permit Number
Name ,.J�'s' .�i1.n����s� Date k'C��� N2 5426
Location '/rr,
Subdivision Name Lot No. Sec. or Block No.
Lot Size -51919('2 House i-� Mobile Home _ Business Speculation
No. Bedrooms No. Baths - No. in Family %
Garbage Disposal YES ❑ NO p-- Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
1/31`a'��i
./
Certificate of Completions 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.
:... . y sti::a:irs- v'4 - r"F i.:=vv. , ,...i, -...._,..r.. -:_. .:-�_ -,. .r,• i5.:4 11.a 4 • -_ .,a u.-.,e,_..a. a +'.T i..r _ -. _ n_ _.-
DAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENTS PERMIT AND CERTIFICATE''OF COMPLETION
r ` ."NOTE:,Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968), Permit _Number,
Name �� ���%�.�r`�-' . Date.. >��. `�' ,,; NO
Location •`�-'
Subdivision Name Lot No. Sec. or Block No.
Lot Size _"/r%i 11 House 1/� Mobile Home _ --.,Business Speculation
No. Bedrooms _ No. Baths .4) No. in Family _
Garbage Disposal YES Q NO 0— Specifications for System:
Auto Dish Washer YES ❑ NO-,D—
Auto Wash Machine YES E] ANO!"0
� .
Type Water Supply
*This permit Void if sewag%system described below is not installed within 36 months from date of issue.
y.
t % y
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. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by L �-
�P
Certificate of Completion Date ;
'The signing of this certificate shall indicate that the system described above has been installed in compliance wit
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. 01.
Parcel#: H2O0000014 Page 1 of 1
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Parcel#: H2O0000014 Account#:82527519
Owner Information Tax Codes
NDERSON JAMES N&BARNETTE ALICE A ADVLTAX-COUNTY T
966 US HIGHWAY 64 WEST READVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Property Information Township
nd(Units/Type): 40.020 AC CALAHALN
[Address: 2966 W US HWY 64
Deed Information Local zoning
ate: 09/2006 Book: 2006E Page: 0273
Plat Book: Page:
Lecial Description PIN
9.74 AC HWY 64 5709843615
Property Values
Buildin 28913
BXF• 8,24
nd: 209,93
arket: 507,30
essed• 353,75
Deferred: 153,55
Sales Information
No. Book Page Month Year Instrument Qual/UnQuai Improved Price
2003E 0280 10 2003 WL Unqualified Improved 0
2006E 0273 09 2006 WL Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=755559 6/30/2016