4473 Hwy 801NL Y .y i Y Si Y X O
DAVIE COUNTY HEALTH DEPARTMENT
?IMPROVEMENTS'PERMIT AND .CERTIFICATE OF COMPLETION
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.<.: NOTE ass�ue'cJ'in CDmpliance Witte rticle I I of G.S. Chapter 130a
w " SanitaSewage System Permit Number
v
Name: lT L&re SSC i�, 4i Date
*� NO 7656
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Location aq 9JAI,-A-71
A70ag -
Subdivision �ame Lot No. Sec. or Block No.
Lot Size 111 House Mobile Home Business -- Industry
No. Bedrooms No. Baths'—i52 No. in Family_ Public Assembly Other
Garbage Disposal YES ❑ NO ,Q'
Specifications for System: '
``Auto Dish Washer YES NO ❑ � �! 6h
Auto Wash Ma^hine YES NO ❑ ,/�,, ,
Type Water Supply — �® ---- "?1 W'1 �/t 0
*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.
/
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Improvements permit by —
/–Z6ZZ-
*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.
A �
Final Installation Diagram:
System Installed by
Certificate of CompletionDate
*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.
h
_ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department IRi E1 � �'!
Environmental Health Section
P. O. Box 665 J U L 12 1994
Mocksville, NC 27028
1. Application/Permit Requested By (o�i.J�, !
Mailing Address 4-d-,4 4-:W & ",i _ Home Phone
2. Name on Permit if Different than Above
3. Application for: ❑ General Evaluation
4. System to Serve: mouse
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People _
No. of Bedrooms
Business Phone
❑ Septic Tank Installation Permit
C] Mobile Home ❑ Place of Public Assembly
❑ Other ❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
ZWNatfiing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers _ Water Usage Figures.
7. Type of water supply:Public ❑ Private
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8. Property Dimensions aCAQ1— Sewage Disposal Contractoi
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Yes ❑ No
❑ 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: / C
This is to certify that the information provided is correct to the best of my knowledg and I understand I am responsible for all charges
incurred from this application.
DAT SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 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 f the Davie C u alt Deaartment to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to etermine said si e's suits ' for a ground absorption sewage treatment
and disposal systerp._ „ , 11 n ,
DATE v — - SIGNATURE
WHO (1193)
•. DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY
Water Supply: On -Site Well
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Community
Public
Evaluation By: Auger Boring `/ Pit Cut
FACTORS 1
2 3 4
Landscape position 4-
t L G
Sloe %
^-
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
.4h
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
.37
LONG-TERM ACCEPTANCE RATE
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SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE: -
REMARKS:
DCHD(01-901
EVALUATED BY:
OTHER(S) PRESENT:
LEGEND
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
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
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Parcel #: B30000004105A
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search Q
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: B30000004105A Account #:68428000
Owner Information
ulldin
Tax Codes
BXF:
ITH WENDELL& SMITH GOLDIE M
[473
nd•
ADVLTAX - COUNTY T
Market:
NC HIGHWAY 801 NORTH
ssessed:
FIREADVLTAX - FIRE TAXCKSVILLE
efenred•
NC 27028
Property Information
Township
nd (Units/Type): 6.500 AC
CLARKSVILLE
ddress: 4473 N NC HWY 801
Deed Information
Local Zoning
ate: 07/2007 Book: 00723 Page: 0692
lat Book: age:
Legal Description
PIN
62 AC HWY 801
5823331297
Pro a Values
ulldin
57 97
BXF:
8,52
nd•
60,82
Market:
127 31
ssessed:
127,31(
efenred•
Sales Information
No. Book Pape Month Year Instrument Qual/UnQual Improved Price
1 00723 0692 07 2007 WD Unqualified Improved 0
2 00176 0382 09 1994 WD Qualified Vacant 20,500
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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0014
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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.aspx?prid=743998 9/22/2016
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�`AL¢Tifi7¥LATION NO..'�; '�/ DAVIE COUNTY HEALTH DEPARTMENT� �IO
_ Environmental Health Section PROPE Y INFORMATN
� � A
Peru - • r P.O. BOX 848
Mocksville, NC 27028 Subdivision Name
Phone # 33677M-8760
hl.11 ions to property! - Section: Lot:
' AUTHORIZATION FOR
2 l �%'
Tax s r.
SYSTEM CONSTRUCTION ; INAn� - -
ax Office
P�
..,; - • , /L (/ 4!O(!d` Road Name: 1 ip:2.7a 2
**NOTE** 'This Authorization for Wastewater System Construction MUST.BE ISSUED by the Davie County Environmental Health Sectton,prior
to'issuance of any Building -Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections ,
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD:OF, FIVE YEARS:
ENVIRONMENTALIHEALtIT SPECIALIST; DATE ISSUED