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187 Woodburn Place Lot 22Dav [61 WARNING: THIS IS NOT A SURVEY All data is provided as Iswithout wammy or guarantee of any Idnd either expressed or Implied Including but not limited to Ne Impiledmi at esofinerchantablitty orfhnessfora pardcularuae All users ofOahe Courdps GIS website shall hold harmless the County ofDavie. North Carolina, its agent, cansuMatds, contractors;oremployees fromany and all claim or causes of action due to orarlslmJ out uftheuse orinabllMyto usethe GIS datapmWded byf lswebsite. . Parcel Information Parcel Number: C715OA0005 Township: Farmington NCPIN Number: 5862766298 Municipality: Account Number. 42654000 Census Tract: 37059-802 Listed Owner 1: KERR KEVIN S Voting Precinct: SMITH GROVE Mailing Address 1: 187 WOODBURN PLACE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: LOT 22 CREEKWOOD ESTATES Fire Response District: SMITH GROVE Assessed Acreage: 0.45 Elementary School Zone: PINEBROOK Deed Date: 811993 Middle School Zone: NORTH DAVIE Deed Book / Page: 001690893 Soil Types: GnB2,GnC2 Plat Book: 0004, Flood Zone: Plat Page: 171. Watershed Overlay: DAVIE COUNTY Obuildin& Extra Building Value: Freatures Va ue: Land Value: Total Market Value: Total Assessed Value: [61 Davie County, j� NC All data is provided as Iswithout wammy or guarantee of any Idnd either expressed or Implied Including but not limited to Ne Impiledmi at esofinerchantablitty orfhnessfora pardcularuae All users ofOahe Courdps GIS website shall hold harmless the County ofDavie. North Carolina, its agent, cansuMatds, contractors;oremployees fromany and all claim or causes of action due to orarlslmJ out uftheuse orinabllMyto usethe GIS datapmWded byf lswebsite. . DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME /\ C�V / All 7«A_ -K PHONE NUMBER �r ADDRESS-7`�c Z5OLthyu 0-41 PL- SUBDIVISION NAME `f4ff4Ce// 000c(VaLd van' //��Ci LOT# DIRECTIONS TO SITE DATE SYSTEM INSTALLED ± Z$ __7� NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY - SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY, This is to certify that the Information provided is Domed to the beet of my knowledge, and that I understand I am responelble for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT, Rev. 1193 IS VALID FOR APERIOD OFFIVE ' 'r EN�IR6NMENTAL HEALTH SPE ALIST DAMSSUED DCHD 05196 (Revised) DAVIE COUNTY HEALTH DEPARQNT `rd is IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pej�ittec' S Name. I -Subdivision Name: Directions to property: Section: dl Lot: IMPROVEMENT PERMIT Tax Office PIN:#L_ - Road Name: Zip: **NOTE** This Improvement Permi iDOES NOT authorize the constructionI . 1 1 or instal" of a - septic tank system or any wastewater system. An AUTHORIZATION FOkIWASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the 1: k construction/instaRation of a system or the issuance of a building permit (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. -.RESIDENTIAL SPECIFICATION: BUILDING TYPE — # BEDROOMS # BATHS ZI # OCCUPANTS --;y— GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITYTYPE#PEOPLE — #PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)"— NEW SITE_ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK _GAL. TRENCH WIDTH -'terf ROCK DEPTH -r?L!. LINEAR Fr -i OTHER REQUIRED SITE MODIFICATTONS/CONDMONS: 11 IMPROVEMENT PERMIT LAYOUT 01PPROVED EFFI-LffNT FILTER* *RlEjE(SY IF 6"' BELOW FINISHED UNRI)h* **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTWRFAqSA&ySTFM, BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # le��%%116 9760 OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION No. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION. 1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) 4.0 4 4z **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTWRFAqSA&ySTFM, BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # le��%%116 9760 OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION No. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION. 1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) 4.0 4 H. **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTWRFAqSA&ySTFM, BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # le��%%116 9760 OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION No. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION. 1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) 4.0 4 p� d DAVIE _COUNTY HEALTH DEPARTMENT .w ' (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR ';);IDATE 1-i 7- 7 � PERMITLOCATION ?, > 1 n , n :. u'v lr S.R. NO. _ SUBDIVISION NAME r- rr c Y J f r.4 of c s LOT NO. 71L SECTION OR BLOCK NO. NO. BEDROOMS '.� NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ®- NO ❑ AUTO. DISHWASHER YES .®- NO ❑ AUTO..WASH. MACHINE YES &3' NO ❑ SITE SUITABLE $v YES'.Crp E3NO i SIZE OF TANK 1!elbti#a gal. - c- - NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: ci rt�foc.t C1vti �r WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY Cosi_ �1f1 A 871 House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY CERTIFICATE OF COMPLETION By Date Z/- ar -7e. (8/16/73) *Construction must cooly with all other applicable State and local regulations LOT AREA CT I r 1.1 C 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 ii �r,��ii7,'*/ri:�J'.rso��ii abate /—//%—Q� i�2 J�O7 .- -..,- Location Subdivision Name Lot No. Sec. or Block No. �— Lot Size House,��Mobile Home Business Speculation No. Bedrooms 1 No. Baths � No. in, Family_ Garbage Disposal YES ❑ NO [— Specifications for System: Auto Dish Washer YES p NO ❑ Auto Wash Machine YES [ NO -❑ �Od X �X� J )0 Type Water Supply a *This permit Void if sewage system described below is not installed within 36 months from date of issue. r�P, D9 oo Improvements permit by ///a ZZ *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 3' lUJ 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.