3482 Hwy 64W_ �-�)0O
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*NOTE: Issued in Compliance with G.S. of North Carolina. Chapter 130 Article 13c
SeAiaoe Treatment and Disposal Rules (10 NOAO 10A .1834`1968) `' PermA&Lr
Name Date ' w ` 2 ~ ~ " ~^
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Subdivision Name --j -sk Lot No. Sec. or Block No.
Lot Size House 8oacu|obon Mobile Home Business ' __-=_--__ ___---- -' ----_-_-_
No. Bedrooms No. Baths / No. in Family
Garbage Disposa� YES NOff '
Auto O|oh Washer yBG NO
Auto Wash Machine YES E�
Tvoa Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue. �.
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Improvements permit bv
�,*Contact a representative of the Davie County Heath Department final inspection of this oyo1mm between 8:3O-
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Final Installation Diagram: System Installed oy
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Certificate ofCompletion Oot»
*The signing of this certificate shall indicate thatthe system described above has been installed in compliance with
the standards set forth in the above vogu|abon, but oho|| in NOway betaken oaaguarantee that the system will function
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department �CE�VE� MAY
Environmental Health Section R
R 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Re9.u?stesi By deL&oW
2. Address -JAL!
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
Home Phone S/92':S�-`d 7
Business Phone
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. ar If house or mobile home, state size of home and number of rooms.
House Dimensions '14 A S1 K 3 $
Bed Rooms — Bath Rooms 2 Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, eta
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes �-' urinals garbage disposal
lavatory Z showers Z- washing machine i
dishwasher sinks �-
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes 0 No
9. a) Property Dimensions x��� rG 77 k- 90,,.?7 4 ,2-7 �'. SSG A /ZSI. �rS X ,34 2 33
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?
What type?
This i$ 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:
DCHD (6-62)
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. 0. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
(office use only)
Ca (4�G.rl. /owns
no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that
have consent from , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a. ground absorption sewage treatment and
disposal system.
,es no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
�y 9
DATE SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
Owners designated representative
Anyone requesting results
Only those listed below
DATE
DCHD (11 /84)
14� /
SI NATURE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name
A N 'tJ Date
Address R M P Lot Size y c• Q
FArMIRR AR A l AREA 2 1 AR& 3 ARFA�
K
a
It,
1) Topography/ Landscape Position
PS
S
tsj
U
�) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
PS
U
SSS
96
U
PS
1) Soil Structure (12-36 in.)
Clayey Soils
PS
PS
PS
Sr
U
I) Soil Depth (inches)
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U
U
U
U
�) Soil Drainage: Internal
PS
PS
PS
tu
External
PS
PS
Ud
U
U
1) Restrictive Horizons
Available Space
is)
U
U
U
1) Other (Specify)
S
PS
U
S
PS
U
S
PS
S
PS
U
1) Site Classification
U—UNSUITABLE
Recommendations/Comments: �a
�-
Described by
SITE DIAGRAM
DCMD (6.82)
S—SUi1ABLE PS—Provisionally Suitable
14 C)1 0 (D'... - '3 o"�
Title
Date v -,
Parcel #: I10000002601
Davie County, NC - Basic Estate Search
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for -this Parcel View Map for this
Parcel View Tax Bill Information
arket:
Parcel #:I10000002601
Account #:62320000
Owner Information
BXF:
Tax Codes
nd:
OGERS BEVERLY STARR DUNN
arket:
ADVLTAX - COUNTY TA
ssessed:
98 ROCK SPRINGS RD
Deferred:
FIREADVLTAX - FIRE TAX
HARMONY NC 28634
Property Information
Township
Land (Units/Type): 0.830 AC
CALAHALN
Address: 3482 W US HWY 64
Deed Information
Local Zoning
ate: 01/1984 Book: 00121 Page: 0593
Plat Book: Page:
Le al Description
i-- PIN
1.93 AC HWY64
5709203319
Pro a Values
Buildin
118 37
BXF:
52CI
nd:
17,35
arket:
136,24
ssessed:
136,24
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00121 0593 01 1984 WD Un ualifled Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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.daviecountvnc.gov/itsnet[View.aspx?prid=1466459 7/12/2016