965 Salisbury Rd —..,.. r a..- .:,.-,.:�,, .. o..,�-,..d_.: . . ..i .. , . , _ .
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_ �+-�-.- -� DAVIE COUNTY HEALTH DEPARTMENT S a. ��- 50 .�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Ia�
• *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c '
Sewage Treatment and Disposal Rules (10 NCAC 1OA .1934-.�sss) Permit Number
Name ���� � Q� �> e.`�� -e. Date � � �� " ��1 N� €"
5��a
Location � Q..1,���5.� ���-�:�., � �C. " �aC`�1 ���f, ��� ��,c>>K�� ��� �
� o C�� ,.� O� R.. � Q..�.n � �'���:. �� -�`�J ����.�- � �,`�,
. �U Q.�.a. c-�, �.��.x-Rc �Q� � ' ` v � . ..
Subdivision Name Lot Na Sec. or Block No.
Lot Size �b�� �. `�-n� � House • Mobile Home _ Business � Speculation
No. Bedrooms No. Baths—�_ No. in-Famil� �� '
Garbage Disposal YES p NO [� Specifications for System:
Auto Dish Wash'er � YES ❑ NO {{g� � O p � �'r� -�"� - `� �� �`,"���
Auto Wash Machine YES ❑ NO {� ", ~ , � , l
1� '���1. ' � Ou )( :� k � ^•
Type Water Suppl ��J . t;\� -- _
w�Q�
`This permit Void if se system described below is not installed within 3 m nths from�date of issue. '
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� Improvements permit by \- �- h-��^t� � ���9._
*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� �� � -
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' te of Com letion � � Date /b `� � o
Certifica p �
"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.
. �� � � � , �
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�� . A � ' �� APPUCATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT '
. � �o�
Davie County Health Department � —
Environmental Health Section AU6 2 3
P o. eoX sss RE����D
Mocksville, N.C. 27028 �
/
� ONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
. R Home Phone �9Z -�-��75
1. Permit Requested By ��k� � r� �UQY G Business Phone � ' �
2. Address Sn�' � �� 2 " � ���4 V'►`
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ✓Alter Repair
b) Privy Conventional_�Other Type �
Ground Absorption
' c) Sub-Division Sec. Lot No.
5. System used to serve what type faciliry: House Mobile Home Business��
Industry Other
b) Number of people Lo
6. aJ If house or mobile 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 served _ �.� .� �u� on �he roaol c�U�:�9 K�C�
Whattype business, eta �ea�.��a Qnal ,4i.� �ndr�ion���o "�°y
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 ���o � X ��� �
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the faciliry this sewage system is intended to serve? ���
What type?
This is to certity that the information is correct to the best of my knowledge.
R•,�3-g� y�/ e�5 /� '
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
(�6 / �o u�� � ��� �-� ��:.G�en, ��=�t �-GGb-�-
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DCH�(8-82) ' � •\
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'� � DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section. �
P. O. Box 665.
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
'Name ����� � A �'� � \ \� Date � ! �� - ��
Address s A�� Lot Size �b� X `�„U�
FACTORS AREA t AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position ��
'd" U- ^US `�
2) Soil Texture (12-36 in.) Sandy, S �
Loamy, Clayey, (note 2:1 Clay) PS PS PS PS
� U
3) Soil Structure (12-36 in.) ` `
Clayey Soils P , <�P P P
U U
4) Soil Depth (inches) S ��--. ��
�p PS � PS\
. �--{�' U �f� U
5) Soil Drainage: Internal . _ S S
pg � -IJ--� � PS
U
External — S S
�� PS �P�15� P
UJ U
6) Restrictive Horizons
�_ �.�
7) Available Space \
PS , PS PS �
�� U
8) Other (Specify) S S S S
pg PS PS PS
�� �
9) Site Classification �
U—UNSUITABLE S—S ABLE PS—Provisionaliy Suitable
Recommendations/Comments: ���- � � � °\ e�- �� ^ a`�� e�����`'
��1� � ��
-�_
Described by �' Title �S�-'�-��-�-�`+'�-� Date �� S
SITE DIAGRAM .
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UCHO Ih-82) �
Parcel#: J5160A0009 Page 1 of 1
o�'�j�
Davie County, NC - Basic Estate Search �ov���.
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Vfew Prooertv Record for this Parcel View Mao for this Parcei View Tax Bill Information
Parcel#:J5160A0009 Account#:4420000
Owner Information Tax Codes
ARNETTE MICKEL H&BARNEiTE ALICE A ADVLTAX-COUNTY T
966 US HIGHWAY 64 WEST FIREADVLTAX-FIRE TAX
OCKSVILLE NC 27028
Pro e Information Townshi
nd(Units/Type): 0.910 MOCKSVILLE
ddress: 965 SALISBURY RD
Oeed Information Local Zonin
ate: 10/1989 Book: 00150 Page: 0854
Plat Book: Pa e:
Le ai Descri tion PIN
.91 AC HWY 601 5737872991
Pro e Values
Buildin : 62 81
BXF:
nd• 100 19
arket: 163 00
ssessed• 163 00
eferred•
Sates Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00150 0854 10 1989 WD uaUfled Im roved 50 000
View Pro[�riv Record for this Parcei View Ma�for this Parcei yiew Tax Bill Information
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All informat(on 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 aforement(oned 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 warrant(es 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.gov/itsnet/View.aspx?prid=1424505 7/14/2016