204 Bean RdDavie County, NC _ ' Tax Parcel Report Wednesdav, October 12. 2016
WAlZN1NG: 1H1S 1S NUT A SUIZV�:Y
Parcel Information
Parcel Number: N600000094 Township:
NCPIN Number: 5745928793 Municipality:
Jerusalem
Account Number: 1050900 Census Tract: 37059-807
Listed Owner 1: ALLEN PHILLIP DUDLEY Voting Precinct: JERUSALEM
Mailing Address 1: 204 BEAN ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE
State:
Zoning Class: DAVIE COUNTY R-20
NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028-6603 Voluntary Ag. District:
Legal Description: LOT 8 BOXWOOD ACRES Fire Response District:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
9" �'�' Davie County,
°��N�� NC
5.23 Elementary School Zone:
5/1994 Middie School Zone:
001740460 Soil Types:
0005 Flood Zone:
137 Watershed Overlay:
208820.00 Outbuilding � Extra
Freatures Value:
48060.00 Total Market Value:
278360.00
JERUSALEM
COOLEEMEE
SOUTH DAVIE
PaD,PcB2,PcC2
DAVIE COUNN
21480.00
278360.00
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,, • DRVIE CDUNTY HERLTH DEPARTMENT
.. ` ' IM�ROVEM�IT PEAMIT and OPERATION PERMIT
II�AOVEMENT PERMIT
*+�NOTE�+� This i�prove�ent per�it DOE5 NDT autharize the constru�tion or installation of a septic tank systei or any NasteNater
syste�. RN RUTH�RIZATION FDR NflSTEWflTER 5Y5TEM CDNSTRUCTI�1 wst be obtained fro� this Depart�ent prior to the
construction/installation of a syste� or the issuance of a building per�it.
(In co�pliance with Article 11 of 6.5. Chapter 1�A, Wastenater Syste�s, Section .19@0 Sewage Treat�ent and Disposal 5yste�s)
NAl� Q , �• ��\� � PR�ERTY ADDRESS
LOCATIDN �oU � � � ��Cec�• � S2 E>'N �
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DATE #� .I�i -� 1,-,
5UHDIVISIDN NflME LDT M.R4BER SEC. /BL�1{ Nlll1BER
RESIDENTAL SPECIFICpTION: BUILDING TYPE oU� � AEDR�MS � # BATHS� t OCCURANTS � 6ARBf�E DISPOSAL: Ye�,�
. at
CDMMERCIAl. SPECIFICATI�V: F�ILITY TYPE . � PEDPLE �i PEDPLE/51iIFT � SEAi5 INDUSTRIRL NASTE: Yes/No
P
r.� H �
LOT SIZE �J O�'s�` ., ''�"IYPESWATER SUPPLY � DESI6'�i 1�5TEWATER FLOW l6PD1 3 im� i�N SI,TE � REPAIR SITE
5Y5TEId SPECIFICATIDNS: TRhU( SIZE ��0� 6AL. P9�IP TRM{ Y 6AL. TRENCH WIDTH J� ROCK DEPTH 2�� LIt�AR FT. 3U'C� `
p,
ar�R .� . ; .
`�, �
REQUIRED SITE MODIFICATIONS/CONDITIONS: �
5EE
IIT IS SUbJECT TO REVOCATION IF SITE PL.ANS OR.THE INTENDED USE CHANGE.
PERMIT BEFORE IN5TALLING THE SYSTEM. '
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L� � ��'`�---
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YDUR WASTERWATER SYSTEM CONTRRCTOR h0.1SST
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IMPROVEMENT PERMIT`BY� � �
+�*CONTACT A i�PRESENTRTIVE OF TNE DAVIE (�INJTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM E�ETWEEN �
6:30-9:30 A.M. OR 1:�-1:30 P.M. ON THE DAY OF INSTALLATION, TELEPHONE A I5 t704) E34-8768.
�ERATION PERMIT
SYSTEM INSTALLED �BY ���`
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AUTHORIZATION N0. ���� O�+ERATI�N PERMIT BY �•C��"`-"""' DATE I�����
�+�THE ISSUA�ICE OF THIS OPERATION PERMIT SHALI INDICATE TF�1T THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTi�LED IN COM�I.IRFICE WITH
AATICIE 11 OF G.S. CHAPTER 130A, SECTIOM .19� "5EWF�E TREATMENT AND DISPOSAL SYSTEMS°, BUT SNAII. IN NO WAY BE TAKEN AS A
GUARANTEE THAT T}IE SYSTEM WILL fIArCTIOM SRTISFACTORILY FOR AMY 6IVEN PERIOD � TIM�.
DCHD 10/95
, �� , - . . . _ "F �:..
� ��Y .� . .. e!
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Davie County Health Depart�ent
ENUIRDNMENTRL HEALTH SECTION
P.O. Box 665
Macksville, N.C. 270P8
AUTHDRIZATIOdi fDR WASTEWRTER SYSTEN CON5Ti�JCTI�1
(Issued in cu�pliance with Articie 11 of
G.S. Chapter 13aA, Wastewater Syste�s)
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✓Xa
+�*+�This Authorization For Waste►+ater 5yste� Construction �ust 6e issued by the Dav:e County Environ�ental Health 5e�tion prior to
issuance af any Building Persits.-"This Far�/Ruthorizatian Nueber should be presented to the Davie County B�1ilding Inspectior�s
Office when applying for Building Per�its.+�� �"ry- �`�
NAME � • Q � �``Q 'N DATE � — � p � J � ALfTHORIZATION MJP'�ER
i�n 6��� <
,
NRME ON IlQROVEMENi PERMIT fIf different than above) �
SITE LOCATION _ \ ) � P � '�\ � A �
COM�NTS/COr@ITI�lS ON RU'iHDRIZATION TD CONSTRUCT IaRSTEWATER SYSTEM
..
�-�,
,.
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f+�NOTICE� THIS AUTHORIZflTIDN F R WASTEWRTER SYSTEM CON5TRliCTIO IS VALID FOR R F�ERIDD DF FIVE t�) YEARS.
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- : avir�a. �a.n� �ctc�isr na�
DCHD 10/95 �
0
r`. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER
Davie County Heaith Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
I � � � � V �
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1. Appiication/Permit Requested By �• �� �� I� n
Mailing Address � 0• �b K � ��l� Home Phone /0`i"' a 07' �lp� /
(�Q� Q QQi� Q'� �N o Q� � Business Phone ��7 ��'J3� �
2. Name on Permit if Different than Above
3. Application for:
❑ General Evaluation
4. System to Serve: C�]' -rlouse
❑ Business . ❑ Industry
5. If house, mobi�e home: Subdivision
No. of People �
No. of Bedrooms J
No. of Bathrooms � �'a-'
Dwelling Dimensions
�Septic Tank Installation Permit
❑ Mobile Home ❑ Place of Public Assembly
p Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
❑ Unknown
Section Lot #
No. of Showers Water Usage Figures
7. Type of water supply: � Public ❑ Private
8. Property Dimensions ��^"'� Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? O Yes
If yes, what type?
❑ BasemenUPlumbing
D�semenUNo Plumbing
CY I�Vashing Machine
C�shwasher .
❑ Garbage Disposal �
(� .
O Community ,
'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.
Directions to Property:
N �� (�o� s�
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r�cvrt�ciy inrr��cnv�iivnr x��ui«tu:
Tax O,f,f "sce PIN: #' �%`f � ��� �/��
���n � PROPERTJ A��RESS, as ,foilows:
R d N ' 1Ji� J` �
oa ame. (,� n C •
�Z._-�-. �G ss ed Pq �Q rn��- .
�Lt�: Moc�sv� I I�e.
SU$�1ZT A PLAT WITH THZS ttPPLICttTION.
Revisions effective October 1� 1995.
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
�.0 I a3 ��i C� �.�. C1,4.Q�
ATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: �. I OWN the property. O 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and dis osal system.
� 3 G -�i �p- c�..��
DATE SIGNATURE
DCHD (1/93)
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• ' - ' UAVIE COUNTY HEALTH DEPART�IIENT
- ' r � Environmental Health Section
Soil/Site �Evaluation
NAME �• � • �\\� � DA TE EVALUA TED � � � � �7 � � -!� ^9�
ADDRESS � P�4 PROPERTY SIZE ��`�
PROPOSED FACIILTY �a v S�` LOCATION OF SITE �-�`�� `�'�'��
Water Supply: ` �On-Site Well _ Community
Evaluation B�'C. V Auger Boring � Pit
FACTORS
Landscape position
Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLaSSZFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LDN G-TERM
REMARKS: _
DCHD (01-90�
TA�ICE RATE: � �
Y
Public "
Cut
EVALUATED BY: �s�»"
OTHER(S) PRESENT: � �' N�
END
Landscape Position
R-Rid�e S•-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
Texture
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Si1tY �:lay loam� SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR- V+_.-y friable FR-Friable FI-Finn VFI-Very firrn EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plasiic
Structure
.iC--Sin�le grain M-Massive CR-Crumb GR-Granular ABK-AnIIular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Minernla�!y
1:1, 2:1, Mixed
Notes
Fiorizon depih - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil w etness - Inches from land surface to free wate�' or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable}, PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
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� �Davre Coun�jv ,��ealt/r� ?�Ppdrt`ment
and �fnme �lealtF� ��'�qerrcy
210 HOSPITAL STREET I P.O. 80X 665
MOCKSVILLE. N.C. 27028
, PHONE: (704) 634•5985
Rhillip D. Allen
c/o Rotts Realty
P. 0. Box 11
Advance, NC 27006
May 18, 1994
Re: Site Eval�aation
Rean Road/5 Acre Tr•act
De�r Mr. Allen:
As req�.►ested, � representative fr�om this office visited the aforementioned
site on May 16, 1994. Based �.�pon the information provided on the
application for a site eval�.�ation and after the evaluation was completed, the
site was found to be provisionally suitable for� the installation af an on—site
sewage disposal system.
If yau h�ve any questions, please feel free to contact this office.
CL/wd
En�losure
Sincerely,
�� �.. ���,
Charles E. Little, F.S.
Environmental Healtn 5ection
APPLICATION FOR SITE EVALUATION/IMPROVEMENT" PER ' '�:��
� Davie County Health Department � t� �� 1; �u' �` �'
Envi�onmental Health Section MAY 12 �Qa�
P. O. Box 665
Mocksvilie, N.C. 27028 _ . � :�., _ _ _ .
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1, Permit Req
2. Address _
3. Rroperty Owner if
,i
Address �
4. Permit To: a) Install �f"A er R
5.
Home Phone
Business Phone ���'���
b) Privy Conventionai �Other Type �
Ground Absorption
c) Sub-Division Sec. � L '�L� No. � S'�'
System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of peopie �
6. ay If house or mobile home, state size o home and number of rooms.
House Dimensions � U� '
i
Bed Rooms � Bath Rooms a' en w/Closet
b) Ii Business, Industry ar Other, State; Number of persons served
What type business, etc,
Estimate amount oi waste daily (24 hours)
7. Number and type of ter-using fixtures;
commodes � ' urinals . garbage disposal
lavatory � shawers � washing machine �
dishwasher sinks �
8. aj Type water supply: Public Prfvate � Community
b) Has the water supply system been approved? Yes ✓No
9. a) Property Dimensions _�� C•
b) Land area designated to building site t" � v'� � G T%�
c) Sewage Disposal Contractor �
10. Do you anticipate any additions or expansions of the facility this sewage system is interded to serve? a% �•
What type?
This is to certify that the information is correct to the best of my knowledge.
''r'
..� � �- ` ` o (✓�'�
�
ate wner Sign ure
OWNER IS SOLELY RESPONSIBLE FOR COMPI.IANCE WITH ALL STATE AND LOCAL LAWS
Al�ow 5 days for processing
Directions to property:
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