3484 Hwy 801N• rt d, '�; ;; is r i ,. n �... . •. • . ,.. . t.- .>•.l.
5~,DAVIE COUNTY HEALTH DEPARTMENT
t IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
SeVva a Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name, f� 'lr .sz�!!r, `r`/�%°r, , f `' Date _✓ ��' A N2 iJ.'�i
U
Subdivision Name Lot No. Sec. or Block No.
Lot Size •( House Mobile Home _�''� Business Speculation
No. Bedrooms c No. Baths No. in Family r /
Garbage Disposal YES ;❑ NO p�
Specifications for, System
Auto Dish Washer YES NO J—"/eo e �% -
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.
�
\'AQ
Improve"ts permit by ^ ��
*Contact a representative of the Davie County Health Department for final inspectionof,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,/
h
Final Installation Diagram: System Installed by
r
k
i
Certificate of Completion `' Date 26 —7fY
*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.
Apt
1. Permit F
2. Address
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS. PERMIT0911
Davie County Health Department v f 0
Environmental Health Section 'R
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone '�aa -:5-605—
Business Phone -749-45s'
3. Property Owner if Different than Above
Address .. 4 x.41 2&4
4. Permit To: a) Install-e!!fAlter 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 3
6. a} If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms Z- Bath Rooms / �2 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 d garbage disposal O
lavatory 3 showers washing machine Z
dishwasher sinks
8. a) Type water supply: Public Private Community—
b)
ommunity b) Has the water supply system been approved? Yes NoT &v �rC(.•`� ���
9. a) Property Dimensions c
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 Signatur
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions two property: fj
rn ai-�d o U-�ot,
bi e.�'/O v "'^ 31 �j M -c.. i1/0 �S es'/ 7
� Y
f
744 4 !/0
DCHD (6-82)
i
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
ak h? fVe, l4- C."k, X4" 0^ f v gr A Ak4 44-<-� (office use only)
yest�o 1. 1 am the owner of the above described property.
es no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from Lk� G-ek 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.
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.
DCHD (11 /84)
DATE SIGNATUR
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
ATyDne requesting results
my those listed below
c
DATE SIGNATURE-/
Lk
15
eHURCiv
e
.t ll
,�� 4PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM10%
( Davie County Health Department PP
Environmental Health Section
P. O. Box 665ela
Mocksville, N.C. 27028 �
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
52 Home Phone
1. Permit Requested By SG Business Phone
2. Address o
3. Prope� Owner if Different than Above i
Addre4e
4. Permit To: a) Install–/—/Alter— Repair C�GGv�Ci
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
Industry Other
b) Number of people 7'X
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions ---
Bed Rooms Bath Rooms 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 v " 3 urinals garbage disposal
lavatory. / ' �% showers I -Z washing machine
dishwasher sinks L"," -� y
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions ,ae, 4Z4f 'C"
b) Land area designated to building site // J
c) Sewage Disposal Contractor 1412 21
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 co (;tt.to the bis f my knowledq�
Date Owner ignature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: ,
�n f
C
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. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATIO OF PROPER: DATE RECEIVED
(office use only)
yes no 1. 1 am the owner of the above described property.
Oyes no 2: lam not the owner of the above describe propert however, I certify that I'
have consent from wrier 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:
�&P
DATE
DCHD (11 /84)
— Owner only
—Owners designated represent
nyone requesting results
Only those listed below 17
645
a~4 10
r
t f xJ
v
U
132
8.
24 Act
R3.05AC)
. •s � lk
R
R . �_% r✓f�- 1 ' S # 1
rk ♦ O/ P/0 1 z/
3: int i ♦ P✓ "r< AC ! ° !q t
LE
/` CH4p ,
f •��.� '� ki i }K47�`�Cjrtr �;/)p� .i ;�rh4 �k '� �S_"/ �,I ; I � } " )''F
,c',`S'jj
4M• r C o +eta ♦ /• S `1�+� i7<<i. M,ro;.
Ic
�.,3i�e x d- tom..;
a. �. [' +a ss x x -
' d v
p�1 v� " aye r f c
owe
d l fl
r.e'rf �yy4it'+_ „S.�f' %• • L�
JN GQQ�'/a/�� °'f eh�s.. �t ' 7,. '{f �,1�y r dh
rY'T.
gY d
y�} ( s d{ n a31 a. 51
4 J
M� sK
rICO
*Ir
vp
lie
40 "{:• ~.�•�-'�` 1Y. �� fir. +, ... .,: " ��. ,•,d`f R�'":�
flu r � Y •.µ . ^, '` • S� f ^r f d ��•j"'Pr!
� a
1.
P < yr
t K a i :
Kr
is9
Y. •� �.af'�ta� S • h�, - ,.µii a � �' I � Z. _.
ISO
Co
r` -A f
4 Acy�
�= DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA d
1) Topography/ Landscape Position
d)
5)
6)
7)
8)
9)
S�
(moi'
S
c 7
�l:Y
PS
S
Z!)
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
S
PS4� r-iz'-)
S
P
S
PS
!) Soil Structure (12-36 in.)
Clayey Soils
S
��
S
(�j
S
PS
S
PS
Date
SITE DIAGRAM
�} /
Soil Depth (inches)
S
C
SS
(t
S
�
S
8
Soil Drainage: Internal
S
6UP,-
S
�
S
S
PS
External
S
S
PS
'SS
jS
Restrictive Horizons`
/
/
fPS
Available Space
C�
qS
0
PS
PS
U
U
U
U
Other (Specify)
1
$
V
PS
S
PS
S
PS
U
U
U
U
Site Classification
DCHD (6-82)
U—UNSUITABLE
S—SUITA LE
PS—Provisionally Su' I _
Recommendations/Comments:
Described by���
Title , ���'�`�
Date
SITE DIAGRAM
�} /
o� 71.19
if
DCHD (6-82)
�tti�ie (1�nixntg �ett1#� �e�rttz#mEn#
P. O. BOX 665
larkoville, �qurth Carolina 27028
OFFICE OF THE DIRECTOR
May 5, 1987
Ricky Bailey
Lifestyle Realty
8485 S. Main St.
Mocksville, NC 27028
Mr. Bailey:
This letter is in regard to two 5 acre tracts on land located
off 801 and Pino Road in Davie County.
The tract located next to the Wesley Chapel Church is classified
unsuitable; however, the other tract is classified provisionally suit-
able for an modified, oversized system.
When the house is located please contact this office so the
system can be designed.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health
Enclosure
RH/wd
cc: Crowder Realty (12-13-88)
TELEPHONE
17041 634-5985
Parcel #: C400000011
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search
VieW Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: C400000011
Account #:25566250
Owner Information Tax Codes
LEMING PHILLIP A & FLEMING SUSAN P ADVLTAX - COUNTY TAX
484 NC HIGHWAY 801 NORTH READVLTAX - FIRE TAX
OCKSVILLE NC 27028
Property Information
Townshi
9,97
Land (Units/Type): 7.310
FARMIN50N
nd•
[Address: 3484 N NC HWY 801
Market:
Deed Information
Local Zoning
102,7001
ate: 02/1989 Book: 00147 Page: 0377
0
Plat Book: Page:
Le ai Description
PIN
HWY 801
5833206392
Property Values
uiidin :
9,97
BXF•
8,260
nd•
84,470
Market:
102 70
ssessed:
102,7001
eferred•
0
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
00147 0377 02 1989 WD Qualified Vacant 35 000
View Property Record for this Parcel View Map for this Parcel View Tax Bili Information
« Return to Basic Search
0
Page 1 of 1
qP�t�
0 wri-
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/itsneWiew.aspx?prid=1460047 9/21/2016