249 Persimmon Grove Ln �
�ID, %"'.�•'��A,F� ��n/ DAVIE COUNTY HEALTH DEPARTMENT ��
- IMPROVEMENTS' PERMIT ANU CERTIFICATE OF COMPLETION �
����'NOTE: Issuetl in Compliance wilfi�GS. of North 6arolina Chapler 130 Anicle 13c
� Sewag/e�Trealment antl Disposal Rules (10 NCAC t0A .7934-.7968) Permit Number `
Name, � I/��/ f�� � �.n i, .,v�> D�a/te� !/iv�,P�� 1f� a26 �
Locati �=��i) /�%Jl�_ / ;�i/. �Y�,. � i�/i:/-.: — �—�/�
� --�.�`L�rs i�_m o�GrOve� Lc+,u e
� Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home � Business Speculation � /
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No. Bedrooms.� � No. Baths ^� No. in Family .
Garbage Disposal YES ❑ NO �� �
Specilica�ions for ��System; ,l ��
Auto Dish Washer YES � NO ❑ � r i�
Auto Wash Machine YES � NO ❑ / (�/�/J l �,) �
Type Waler Supply �" ���jv /
'This permit Voitl if sewage system tlescribetl below is not ins�a�within 36.monihs from da�e of issue.
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Improvemeri�s permit.by ���
'Contact a repPesemative of ihe Davie Coumy Health� Department,fo�final Inspection ol this syslem between 830-
9:30 A.M. or 7:00-1:30 P:M. on tlay �of completion. Telephone�Number"704-634-5985.
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Final Installation Diagram: f" Sy�rh Insla d by �rz»•p����=f��`��'�-�r
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Certificate of Completion ��� _ Date /3/�/
'The signing o6ihis certificate shalh indicate that the system described.above has been installeil in compliance with- '
ihe��stantlartls set fortB in the above regulation, but shall in NO way be taken asa�guarantee Ihat the system willlunction
satislaciorily for any given period,o� �ime. �
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` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER���`�� "'�� �"�«:t„� � �� ,e�
Davie County Health Department , ,,,,��
Environmental Health Section , \I �
P. O. Box 665 �
' Mocksville, N.C. 27028 �a � iy��
. CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
� Home Phone���� ` ���/ 1'
` 1. Permit Re uested By � V Business Phone
2. Address -� ` `'
3. Property Owner if Different than Above `''
Address "-
4. Permit To: a) InstaIl�LAlter Repair
b) Privy Conventional `� Other Type
Ground Absorption
c) Sub-Division Sec. Lot No,s�
5. System used to serve what type facility: House Mobile Home ��� Business L� j,,•�a 6 r �`�„ � ,,,.�,.Q�
Industry Other
bj Number of people �a � rec��
6. a) If house or mobite 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 serveci
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions -� r�-z2d
b) Land area designated to building site � �►.�t�-
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? n�
What type?
This is to certify that the information is corr t to the best of m knowledge.
�i -l� �t�6
a
Date Owne ign ture
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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G`� a�c.l GC ��� K�e � b e
���v�-�, � � e� � Oh.et � ��
DCHD(6-82)
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' DAVIE COUNTY HEALTH DEPARTMENT
; � Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name \ � ��� Date ���
Address Lot Size ����
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
�P5 S ' PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, � S S
Loamy, Clayey, (note 2:1 Clay) � P PS PS
U U
3) Soil Structure (12-36 in.) � S S
Clayey Soils PS � PS PS
U U U
4) Soil Depth (inches) S S
p C� PS PS
� U U U
5) Soil Drainage: Internal S S S S
� --'`� PS PS
U U
External � —, S S
�Q' PS PS PS PS
U U
6) Restrictive Horizons
7) Available Space � � S S
pg PS PS PS
U � U U U
8) Other (Specify) S S S S
PS PS PS PS
� U U U
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionaliy Suitable
Recommendations/Comments:
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Described by � Title ���� Date -
SITE DIAGRAM
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DCHD(6-82) . �
Pazcel#: J300000023 Page 1 of 1
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Davie County, NC - Basic Estate Search � ` t�.
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Pa�cel#:J300000023 Account#:41944000
Owner Information Tax Codes
OYNER JEFFREY DEAN ADVLTAX-COUNTY TA
171 LAKEY DRIVE FIREADVLTAX-FIRE TAX
MOCKSVILLE NC 27028
Pro e Information Townshi
Land (Units/Type): 23.680 AC MOCKSVILLE
ddress: 249 PERSIMMON GROVE LN
Deed Information Local 2onin
Date: 11/2013 Book: 00943 Page: 0159
Plat Book: 10 Pa e: 350
Le al Descri tion PIN
3.68 AC GREENHILL RD � 5727597580
Pro e Values
Buildin : 9193
BXF: 26 74
Land: 158 54
Market: 277 21
ssessed: 277 21
Deferced•
5ales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00078 0333 11 1967 WD Unqualifled Improved 0
00599 0501 03 2005 WD Unqualified Improved 257,000
00943 0159 11 2013 WD Un ualified Im roved 257 000
View Prooertv Record for this Parcel View Mao for thfs Parcel View Tax Bill Information
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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(nformation. All information contained herein was created for the Davie County's internal use. Davle 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, inciuding without limitation the implied warranties of inerchantability 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.�ov/itsneWiew.aspx?prid=969004 7/12/2016