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UT DAVIE COUNTY HEALTH DEPARTMENT
`t'
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NATE: ssued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems /�3'Q�dr. Gam' % A-
-Name --Z
Location
Date
Permit Number
N2 7:R ;in
Subdivision Name Lot No. Sec. or Block No.
Lot. Size— House Mobile Home —l!� Business -- Industry
i
No. Bedrooms .No. Baths t '`� No. in Family — Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES 4 NO ❑ A ,r / -:k -/ :JZ�Uj%
Auto Wash Ma^hine YES.[+j NO ❑ L�
Type Water Supply
*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. t
Q
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
T—
Certificate of Completion Date`” 91
'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 betaken as a guarantee that the system will function
satisfactorily for any given period of time.
Lf- s/
I'" APPLICATION FOR SITE EVALUATION/IMPROVEMENTS �I V U
Davie County Health Department
Environmental Health Section
0 P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN U P OVEMENTS PERMIT HAS BEEN ISSUED. 1�►
Home Phone
1. Permit Requested By rk a.4w - Business Phone
2. Address -9 toy toa Trine, Al. 173-70 nn 9 �
-3. Property Owner if Different than Above CO owno� F1� 14ar , �LLJ - C�G.J LL2nh�✓ 1,,1
Address g4e, �6[t�
4. Permit To: a) Install Alter Repair
b) Privy Conventional f Other Type
Ground Absorption
c) Sub -Division Sec/. Lot,No.
5. System used to serve what type facility: HouseMobile Home Business
Industry Other
b) Number of people S
6. a) If house or mobile home, state size of home and number of rooms.
Z
House Dimensions
Bed Rooms + Bath Rooms °v 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 3 urinals garbage disposal
lavatory 3 showers Z washing machine
dishwasher sinks
8. a) Type water supply: Public Pie Private' '� Community
b) Has the water supply system been approved? YesT No
9. a) Property Dimensions ZS t6r6
b) Land area designated to building site 300 X -goo
c) Sewage Disposal Contractor J
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? /70
What type?
This is to certify that the information is correct to the best of myknowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
�Ma 1`l ,�.�+ t`c a•. Z -�a,te
�e4+ 4e4-" z s r/o�y w.(, ¢. Nsc C A� t%,L,,;
*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.
DCHD (6-82)
i.
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
LOCATION OF PROPERTY: DATE RECEIVED
AIA"I 801 - Milz irk aL "177 (p�.0 (office use only)
Go'
oy�s no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from oy ,. ��✓ �'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.
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.
to -7,0 2164 nc5L 81—A,
DATE SIGNATURE
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
✓ Anyone requesting results
Only those listed below
DATE SIGNATURE
DCHD (11 /84)
Name_
Address
FAr:Tr1RS
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
ARFA 1 ARFA
Date
Lot Size�li
AREA 3 AREA d
5
6)
1) Topography/ Landscape Position d
PS PS PS PS
U U U U
?) Soil Texture (12-36 in.) Sandy, � S S S
Loamy, Clayey,.(note 2:1 Clay) /P;✓
3) Soil Structure (12-36 in.) �S
Clayey Soils P _lam'
U U
d) Soil Depth (inches) S
( LUU '
) Soil Drainage: Internal �
P
U U U
External CS
U U
Restrictive Horizons
7)
-i,
8)
Available Space S ` S
PS S PS S
U U U U
Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification 'es' - S_
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS— Provisionally Suitable
Described by `� Title Date
SITE DIAGRAM
�l X
DCHD (6-82)
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS— Provisionally Suitable
Described by `� Title Date
SITE DIAGRAM
�l X
DCHD (6-82)
Dade County Nealel f 7y.enartm,
and .dome Nealilicy
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
October 26, 1989
Mark Denton
Rt. 2, Box 643
Trinity, NC 27370
Re: Site Evaluation
Off Highway 801N.
Dear Mr. Denton:
On October 25, 1989, as you requested a representative from this office
visited the above mentioned site. The soil was found provisionally suitable ,
for the installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Z61'01/11 17 2
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure
Parcel #: L514OA0014
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #:L5140A0014
Account #:21019130
Owner Information
Building:
Tax Codes
BXF:
ENTON MARK S & DENTON JANET 5
Land:
ADVLTAX - COUNTY T
Market:
056 HWY 801 S
assessed:
FIREADVLTAX - FIRE TAX
Deferred:
OCKSVILLE NC 27028
Property Information
Township
JERUSALEM
nd (Units/Type): 25.940 AC
ddress: 7046 S NC HWY 801
Deed Information
Local toning
Date: 05/2000 Book: 00334 Page: 0700
Plat Book: Page:
Legal Description
PIN
5.938 AC HWY 801
5746528960
Property Values
Building:
BXF:
3,83
Land:
174,00
Market:
177 83
assessed:
14,16CI
Deferred:
163,67
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00158 0234 03 1991 WD Unqualified Vacant 0
2 00334 0700 05 2000 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,
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
8/25/2016
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