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1078 Hwy 801S_ _ .,. ', -._. .., ... .. ..., r ....� -w .y. i .. J� .. tw 3.wr U. 'v-:. �-r:_t Jc�'i:E r'""4r..�3 i•a'-e5'ii u' �.un S.� .. r. 31n 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 �i�/lf F.. Date : Location � _._ ,�� �r'rr f �%� ✓� ,- - , %. ., �i,�% ;,;'iri Hwy Zoe 6: a 7004 Subdivision Name Lot No. _ Sec. or Block No. Lot Size House Mobile Home %/ Business Speculation _ No. Bedrooms V' No. Baths _� No. in Family Garbage Disposal YES ❑ NO D' 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. Improvements permit by *Contact a representative of the Davie County 1jealth epart ent for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of comp{{ tion. elepho a Number: 7041-634-5985. L�— Final Installation Diagram: Installed by rAS Certificate of Completion 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. ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name ��% Date !o/yy'40-K Address Lot Size low FACTORS ARFA 1 ARFA 2 AREA 3 ARFA d 1) Topography/ Landscape Position S S S S PS PS PS U U U �) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 1) Soil Structure (12-36 in.) S S S Clayey Soils PS PS PS U U U U i) Soil Depth (inches) S S S PS PS PS PS U U U �) Soil Drainage: Internal SS S S PS PS PS U U U U External S S S PS PS PS U U U i) Restrictive Horizons Available Space SS S S S PS PS PS U U U U i) Other (Specify) S S S S PS PS PS PS U U U U i) Site Classification U—UNSUITABLE Recommendations/Comments: Described by _ SITE DIAGRAM DCHD (5.82) S—SUITABLE l PS—Provisionally Suitable Title Date APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT © Davie County Health Department %6 Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Request d I 2. Address 3. Property OwnerA Address . 4. Permit To: a) Install b) Privy - Home Phone Business Phone -N0 Different than Above I R0X �� Alter Repair Conventional-4ZOtherType 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 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions—1 -�f X 20 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 urinals lavatory showers dishwasher sinks 8. a) Type water supply: Public Private Community b),Has the water supply system been approved? YesizNo 9. a) Property Dimensions I G ` frizrJ 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? !� *C) /() yk5 U0kkc,C .) LrA9':�o✓-1 ""'AV\ garbage disposal washing machine 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: DCHD (8-82) b (As Vcvti-i cep ✓�� 0-" `m VVO0e& d; -2 e -?,y ICO -4-y J DCHD (8-82) b (As Parcel #: E815OA000101 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #:E8150A000101 Account #:51055500 Owner Information Tax Codes Building: ILLER RODNEY DWAYNE& MILLER NANCY PRATER ADVLTAX - COUNTY TA 01 1078 NC HIGHWAY 801 SOUTH READVLTAX - FIRE TAX Market: DVANCE NC 27006 essed• Property Information Deferred: Township nd (Units/Type): 1.100 AC Vddress: SHADY GROVE 1078 S NC HWY 801 Deed Information Local tonin Pate: 07/1997 Book: 00196 Page: 0202 Pat Book: Page: Legal Description PIN 1.070 AC W OFF HWY 801 5871717653 Property Values Building: 133,9401 BXF• 01 Land: 16,7201 Market: 150,6601 essed• 150,6601 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00196 0202 07 1997 WD Unqualified Improved 75 000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 o�-t� ®rnt-1-1- 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.claviecountync.gov/itsnet/View.aspx?prid=1472555 8/30/2016