5793 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
w 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 - - i ` :� 62
_
+ Location
_5'�3 PIc F1w� �o �;s. AA16Jie ll
Subdivision Name Lot N Sec. or Block No.
Lot Size �
House ��/ Mobile Home
_ Business _— Speculation
No. Bedrooms ' -
No.
Baths. �> - No. in Family
Garbage Disposal
YES
F] NO [
Specifications for System:
Auto Dish Washer
YES
p/ NO
Auto Wash Machine
YES
p' NO ,0
tji
r
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 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 �,& 4147L
r
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.
�W
t
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1, Permit Requ
2. Address —
By
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
Home Phone 7? 8- Z%-7 3
Business Phone
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 3 G ,X
Bed Rooms— Bath Rooms -2. Den w/Closet
b) If Business, Industry or Other,(�tate: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures
commodes 3
lavatory
urinals
showers
dishwasher I sinks
8. a) Type water supply: Public �rivate Community
b) Has the water supply system been ved? Yes Ln�No
9. a) Property Dimensions aC .
b) Land area designated to building site
garbage disposal
washing machine
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type? /Vo
This is to certify that the information is correct tothe 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:
.30 �1 O'er tf 30
-3-,'-)- a
C�A D
!o �a 1 �vcK �ccefs 3 ^- IcJQt� w 4c I ii$T )C,��C
�GCe�S E v enc kAYcT
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
r — I't
Name e '�� \ V s Date
s Address Lot Size T - , CJS
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/ Landscape Position
S
PS
U
P
U
S
PS
U
S
PS
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
S
PS
U
S
PS
U
3) Soil Structure (12-36 in.)
Clayey Soils
PS
PS
S
PS
S
PS
U
U
1) Soil Depth (inches)
PS
-
PS
S
PS
U
S
PS
U
i) Soil Drainage: Internal
PS
P
S
PS
U
S
PS
U
External
PS
S
PS
S
PS
U
U
U
i) Restrictive Horizons
Available SpaceS
S
U
S
U
S
PS
U
S
PS
U
I) Other (Specify)
S
PS
S
PS
U
S
PS
U
S
PS
U
q Site Classification
Cal
U—UNSUITABLE S—SUITABLEP Provisionally Suitable
Recommendations/Comments: "U. r� r ��
Described by Titley Date
SITE DIAGRAM
UCHD (6-82)
o-0 � -
_ 1
Parcel #: L600000049
Davie County, NC - Basic Estate Search
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Parcel #:L600000049 Account #: 19118500
Owner Information Tax Codes
ROTTS BENJAMIN F& CROTTS BONNIE C ADVLTAX - COUNTY TA
S.NC HIGHWAY 801 SOUTH FIREADVLTAX - FIRE TAX
OCKSVILLE NC 27028
Building:
247,59
BXF•
6,03
PropertV Information
Township
Market:
Land (Units/Type): 32.360 AC
Lan;
5793 S NC HWY 801
JERUSALEM
278,47
Deferred:
222 01
Deed Information
Local Zoning
ate: 12/1984 Book: 00125 Page: 0070
lat Book: age:
Le al Description
PIN
4.31 AC HWY 801
5766043848
Property Values
Building:
247,59
BXF•
6,03
Land:
246,86
Market:
500 48
ssessed:
278,47
Deferred:
222 01
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
. 00044 0439 04 1945 WD Unqualified Vacant 0
00125 0070 " 12 1984 WD Unqualified Improved 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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=1457260 8/25/2016