2862 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT
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' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0
*NOTE: Issued' ih Compliance with G.S. of'North Carolina Chapter 130 Article 13c rn
. Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name - �, r,.� � � (., ..:., : \ � \ � �, Date -
Location.
-
Subdivision Name Lot No. \ Sec. or Block No.
Lot Size House l Mobile Home _ Business Speculation
r
No. Bedrooms r' — No. Baths --' No. in Family f —
Garbage Disposal YES p/ NO ❑ Specifications for System:
Auto Dish Washer YES [DI NO p
Auto Wash Machine YES p' NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Qa
Improvements permit by
*Contact a representative of -the Davie County Health Departmentfor 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 — wy 5 a
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10
*The signing of this certificate shall i dice
the standards set forth in the apove re ,ulc
satisfactorily for any given period of time..
? �
rtificate of Completion ��'� Date
that the system described above has been installed in compliance with
:)n, but shall in NO way be taken as a guarantee that the system will function
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-.1968) Permit Number
Name _ — Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size —---- House — ' Mobile Home ---- Business — Speculation
No. Bedrooms — No. Baths -- — No. in Family —
Garbage Disposal YES ❑, NO ❑ 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.
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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 —` a,v y
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—Certificate of Completion � _ ���°-" Date
*The signing of this certificatd�"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,
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT 0�
Davie County Health Department o
Environmental Health Section , Et8
P. O. Box 665 R�r�jIG
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Ri
2. Address
/.'/70 17 7 i Ii
3. Property Owner if Different than Above, ,1/72t-5 oo tier W- 41TA)l ®v,111110" gl-
Address "N501ne--
4. Permit To: a) Install '�_ Alter Repair
b) Privy Conventional 'Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House--z'—Mobile Home Business
Industry Other
b) Number oT people %
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions _
Bed Rooms Bath Rooms—L— Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes urinals
lavatory j showers
dishwasher % sinks 3
garbage disposal r
washing machine
8. a) Type water supply: Public Private v 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 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:
l e"� nrae� A'ell .. 1�� .
DCHD (6-82)
" DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name a-N-�- `�=� Date
Address -0 V CD e G�cU���Q Lot Size D
FACTORS AREA AREA 2) AREA0 AP;:A )
1) Topography/ Landscape Position
S(!t) 0>
( _
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U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay) 1�0 \
S
_PS
S
S
PS
S
77!�DS
3) Soil Structure (12-36 in.)
Clayey Soils
S
S
U
U
U
U
1) Soil Depth (inches)
S
S
&
S�
P<T95
U
U
i) Soil Drainage: Internal
S
SP
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t5
U
U
U
External
S
PS
S
6
4
U
U
i) Restrictive Horizons
Available Space
S
PS
S
-A
U
U
I) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
i) Site Classification
S
.(:"I—)NSUITABLE
dations/Comments: 69-•
3qO��
Described by
SITE DIAGRAM
DCHD (6-82)
S—SUITABLE
L•1
Title
PS -Provisionally
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Date 0
Parcel #: C50000002104
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Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: C50000002104 Account #:50970000
Owner Information
Building:
Tax Codes
BXF•
ILLER LONNIE G JR
Land:
ADVLTAX - COUNTY T
Market:
270 NC HIGHWAY 801 NORTH
Messed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Information
Township
EressProperty
(Units/Type): 2.510 AC
FARMINGTON
:2862 N NC HWY 801
Deed InformationLocal
Zoning
Date: 11/2001 Book: 00393 Page: 0787
Plat Book: Page:
Legal Description
El
i— PIN
2.519 AC N OF 801
1 5832985886
Property Values
Building:
70,9101
BXF•
Land:
23,47
Market:
94 38
Messed:
94,38
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
L 00354 0613 12 2000 WD Unqualified Vacant 0
t 00393 0787 11 2001 WD Unqualified Vacant 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,
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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=1468300 9/22/2016