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3780 Hwy 64W ' •_-' . DAVIE COUNTY HEALTH DEPARTMENT • L;. IMPROVEMENTS PERMITAND CERTIFICATE OF COMPLETION 3 *NOTE:- Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAAC 10A .1934-.1968) Permit Number _ Name �`r�2 `�.\ �1�Er�� W �� Date i' - �U , N2 S h.1 Location Subdivision Name Lot No. Sec. or Block No. t Lot Size House Mobile Home _ Business Speculation No. Bedrooms _ -No. Baths No. in Family Garbage Disposal YES O NO [Z t Specifications for System: +. Auto Dish Washer YES ❑ NO -i+� h Auto Wash Machine YES ❑ NO / Oc>c� � ~ Type Water Supply *This permit Void if sewage system described below is not instilleil within 36 months from date of issue. ,l A. �- .4. Improvements permit bye *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 S S � ow � Certificate of Completion � Date l ', t `h 1 *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. 4,4 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT �c*� ` Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 BEEN ISSUED. CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BE =� Home Phone 4a a 6 1. Permit Requested By Business Phone -Q2Q'C?6F 2. Address �- - O u Al S • 220 3. Property Owner if Different than Above Address // 4. Permit To: a) Install V/ Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people_C) DO 1c//1J 6. ay If house or mobile home, state size of home and number of rooms. House Dimensions 2 Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served r, What type business, etc. ! ��¢lj%til Estimate amount of waste daily (24 hours) ? 7. Number and type of w, t using fixtures: commodes urinals garbage disposal r-- lavatory showers `—�' washing machine dishwasher sinks 8. a) Type water supply: Public Private be 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? What type? This is to certify that the information is correct to the best/off my knowledge. A?4,4r Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6-82) t 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 �N�gr �L,'oN (office use only) W4 b �- yes no 1. I 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 I 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. yes 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. 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 «- 9 �e DATE SIGNATURE DCHD(11/84) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION c Name °�� 1 W `z\ ��'� Date J.. Address Lot Size 2- FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position �� pS PS U U U U 2) Soil Texture (12-36 in.) Sandy, � S S Loamy, Clayey, (note 2:1 Clay) PS PS U U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils PS PS U U U 4) Soil Depth (inches) S S S Z PS PS PS U U U U 5) Soil Drainage: Internal S� S S PS PS U U U External S S S PS PS U U U U 6) Restrictive Horizons 7) Available Space S S PS PS U U 8) Other (Specify) S S S S PS PS PS PS U U 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/C,gmein_nts:� l `A Described by Title Date SITE DIAGRAM fl Qa rfl DCHD(6.82) - y Parcel#:I100000021 Page 1 of 1 Davie County, NC - Basic Estate Search oul; Davie County Web Site .Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:I100000021 Account#:6964000 Owner Information Tax Codes LACKWELDER ROBERT ALLAN ADVLTAX-COUNTY T 124 NC HIGHWAY 901 FIREADVLTAX-FIRE TAX HARMONY NC 28634 Property Information Township nd(Units/Type): 1.340 AC CALAHALN ddress: 3780 W US HWY 64 9 Deed Information Local Zoning ate: 07/2009 Book: 00799 Page: 1006 Plat Book: Page: Le al Description PIN 12.280 AC HWY 64&901 4798971920 Property Values uildin 18,51 BXF• 1,20 Land: 64,21 Market: 83 92 ssessed• 83 92 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00160 0291 08 1991 WD Unqualified Vacant 30,000 00535 0903 02 2004 WD Unqualified Improved 0 00799 1006 07 2009 WD Qualified Improved 84,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search r' 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/itsneWiew.aspx?prid=1474211 6/30/2016