4440 Hwy 64WAO
,�:•--" "� DAVIE COUNTY HEALTH DEPARTMENT
"IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE.Issued in Compliance With Article 11 of G.S. Chapter 130a
--Sanitary Sewage Systems Permit Number
Name No 8021
Location -� !:t b..,� �;� ._s
—��.� t tib. � �.. •. __.�"� .. � '_. -,_l � V
Subdivision Name Lot No. Seca or Block No.
Lot Size _ House — Mobile Home _`'�-- Business -- Industry
_ r r,,
No. Bedrooms --.No. Baths — — No. in Family Public Assembly Other
Garbage Disposal YES ❑ NO (Qf
Specifications for System:
Auto Dish Washer YES [ NO ❑
Auto Wash Ma hine YES NO ❑ -�� , �,
Type Water Supply
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
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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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion / y `�' r_ Date S 2``,� S _
'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.
1
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ' , `V4 19 9J
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By
Mailing Address ���5� f`d `7 CQ Home Phone (-17D �57g� - V,
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve
❑ Business
❑ General Evaluation
❑ House
❑ Industry
5. If house, mobile home: Subdivision
No. of People0
No. of Bedrooms � ?
Business Phone
Aseptic Tank Installation Permit
Mobile Home ❑ Place of Public Assembly
❑ Other ❑ Unknown
No. of Bathrooms c Z)
Dwelling Dimensions J �_gy
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes
No. of Lavatories
No. of Showers
7. Type of water supply: Public
8. Property Dimensions
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Private
Sewage Disposal Contractor
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
j Washing Machine
�( Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
�it veati what tvna?
❑ Community
*NOTE: Improvements Permits shall'be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
y voQ
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Axt<5v,�
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application. .
cS A5 ,9r'
DATE SI URE
r
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. A 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
1 hereby give consent to the authorized representative of the Davie County Health Departmeennt to enter upon above described
property located in Davie County and owned by OVZf�F1Q�c� til
to conduct all testing procedures as necessary to determine ddid site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (1/93)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation a
DATE EVALUATED o'
PROPERTY SIZE ate'
LOCATION OF SITE
NAME
ADDRESS �MA�
PROPOSED FACIILTY
Water Supply: On -Site Well Community Public
Evaluation BA'- ;� Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
:5;
S
Slope %
15c,
7-ISOS
HORIZON I DEPTH
7'
1 "
Texture group
CL
V L
C` -
Consistence
Structure
Mineralogy
HORIZON II DEPTH
IA2'
7S 47
Texture group
Consistence
Structure
li3"F-
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON---
M.%
-�
SAPROLITE
CLASSIFICATION
LONG -TERM ACCEPTANCE
RATE -A
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE: �
REMARKS: _N\1 o .� _ V1
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
LEGEND
b 0'p,
Landscape Position
R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope
CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope
Texture
S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt
SICL-Silty clay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR-Very friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm
Wet
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic
Structure
SC -Single grain M -Massive CR -Crumb GR -Granular. ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineraloey
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water' or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
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Parcel #: J10000001502
Davie County, NC - Basic Estate Search
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Parcel #:]10000001502 Account #:82530906
Owner Information
uildin
I Tax Codes
BXF•
PERROW JOSEPH A
nd•
ADVLTAX - COUNTY T
Market:
427 HIGHWAY 64 WEST
ssessed:
FIREADVLTAX - FIRE TAX
eferred•
OCKSVILLE NC 27028
Property Information
Township
nd (Units/Type): 2.730 AC
CALAHALN
ddress: 4427 W US HWY 64
Deed Information
Local Zoning
Date: 06/2009 Book: 00797 Page: 0366
Plat Book: Page:
Le al Description
PIN
82 AC HWY 64
4797598812
PopeValues
uildin
BXF•
4 58
nd•
31,45
Market:
3603
ssessed:
36,03
eferred•
Sales Information
No. Book Page Month Year Instrument Quai/Ungual Improved Price
1 00125 0095 01 1900 WD Unqualified Vacant 0
2 00797 0366 06 2009 WD Unqualified 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.daviecountync.gov/itsnet/View.asvx?prid=1479069 7/12/2016