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1919 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION I j `NOTE: Issued in Compliance With Article II of G.S. Chapter 130a 4 Sanitary Sewage Systems Permit Number Name iii �.1x i/' %�^ `/ , !'t; Date '� = i; _�.., N2 8 14 Location ell Subdivision Name Lot No. Sec. or Block No. Lot Size-{_— House - Mobile Home Business Business -- Industry No. Bedrooms 2-�' _.No. Baths --Z-- No. in Family — Public Assembly Other Garbage Disposal YES NO ❑ Specifications: for System: Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES NO L Type Water Supply ----- --- ..�:� `l ii, rJ//% t 'This permit Void if sewage system described below is not installed within y ar from date of issue. . This permit is subject to revocation if site plans or the intended use chai�g t )) ((( ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SYSTEM. IRE INSTALLING THIS 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., 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 v Certificate of Completion 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 MAY -400 1. Application/Permit Requested By (afi.u?� 14i— 1 unvn:cyUM Mailing Address l f � k / 6 V go Home Phone 9gp- SS -1-6 4 of J/AA16 a Business Phone 2. Name on Permit if Different than Above 3. Application for: D General Evaluation 4. System to Serve: ❑ House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms 2 No. of Bathrooms �— Dwelling Dimensions Septic Tank Installation Permit Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories _ No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: A Public ❑ Private 8. Property Dimensions Z,4-. a & Sewage Disposal Contractor Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing Washing Machine $j Dishwasher 1 Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes Z No If yes, what type? ❑ 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: Us E-0 I - ��j'ir ice- lZc�� „�,c--�— ems- R,/ 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. Q �/ e, ATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE:1. I OWN the property. ❑ 2. I 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: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation L �/ V �Z -s-_ _ Iv ~ NAME DATE EVALUATED ADDRESS �yJ PROPERTY SIZE��j+�G PROPOSED FACIILTY /e/� ��1i1 �' LOCATION OF SITE Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % �— — HORIZON I DEPTH '` `' 777 Texture group Consistence Structure Mineralogy HORIZON II DEPTH ��/` Texture groupC G Consistence r Structure r�o• .� Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 257 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 2C /� /fry_ EVALUATED BY: LONG-TERM ACCEPTANCE RATE: -J OTHER(S) PRESENT: REMARKS: LEGEND Landscave 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 ;lay loam• SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V+--. -y 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 3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralogy 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 DCHD(01-901 ■.■■..■■■■■■■■.■■■■■..■■■■■.■■■■■■■■■■■...■ /...MEMO ■.■....■..■■■ ■■■...■.■■.■■■■■■■■■■.■.■■■ ■■■■.■■■..■.■...... 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Parcel #: C600000002 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search QI View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: C600000002 Account #:8305194 Owner Information Tax Codes OWELL CHARLIE HOLT & HOWELL PAULINE MILLER ADVLTAX - COUNTY T 1919 NC HWY 801 N �READVLTAX - FIRE TAX OCKSVILLE NC 27028 Property Information Township nd (Units/Type): 1.070 AC ddress: 1919 N NC HWY 801 FARMINGTON 1,52 nd: 22,94 Deed Information Local Zonin ate: 06/2015 Book: 00993 Page: 0479 Iat Book: 11 Page: 53 87 31 eferred• 0 00049 Legal Description PIN 1.746 AC HWY 801 1.670 AC LIFE ESTATE 5852271855 Property Values Page uildin : 62,85 00001111 BXF: 1,52 nd: 22,94 Market: 87 31 eased: 87 31 eferred• 0 Sales Information No. Book Page Month, Year Instrument Qual/UnQual Improved Price 00031 0416 12 - 1928 WD Unqualified Vacant 0 00049 0377 09 1949 WD Unqualified Vacant 0 00114 0690 09 1981 WD Unqualified Vacant 0 00115 0082 10 1981 WD Unqualified Vacant 0 00339 0428 07 2000 WD Unqualified Improved 0 00339 0433 07 2000 WD Unqualified Improved 0 00993 0479 06 2015 WD Unqualified Improved 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information < Return to Basic Search Page 1 of 1 o0VI urjo ��• 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.aspx?prid=1454479 9/22/2016