492 Bear Creek Church Rd (2)Davie County, NC ' ' Tax Parcel Report Wednesday, October 12, 2016
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: E200000022 Township: Clarksville
NCPIN Number: 5811171538 Municipality:
Account Number: 5350000 Census Tract: 3705�801
Listed Owner 1: BEAR CREEK BAPTIST CHURCH Voting Precinct: CLARKSVILLE
Mailing Address 1: 268 BEAR CREEK CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: QAVIE COUNTY R-A,R-20
State: NC Zoning Overlay:
2ip Code: 2702&0000 Voluntary Ag. District: No
Legal Description: 53.42 AC BEAR CREEK CH Fire Response District: WILLIAM R. DAVIE,SHEFFIELD - CALAHALN
Assessed Acreage: 53.39 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 10/1988 Middle Schooi Zone: NORTH DAVIE
Deed Book / Page: 001450464 Soil Types: MnC2,MnB2,MdD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value:
Land Value:
Total Assessed Value:
1060640.00 Outbuilding 8 E�ctra 1930.00
Freatures Value:
344450.00 Total Market Value: 1407020.00
1407020.00
9" °'�' Davie County,
°a�N�� NC
,.
,.: , .:. . ._ _
^I -AUTHO�'vIZATION NO=. � �`� � , DAVIE COUNTY HEALTH DEPARTMENT � ✓XO 1
'�-y i" Environmental Health Section PROPERTY INFORMATION
,
Permittee s ^ � P.O. Box 848
Name: ������ �' ',e'�j Mocksville, NC 27028 Subdivision Name:
�' ,�. Phone #: 704-634-8760 �.,,,
Directions to property: � r--%�� ['�:� ��r~' ���" ;�f Section: �'� S==r�( Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#'�.�`� : - � - ,���
SYSTEM CONSTRUCTTON �—
',f ,' s ��..�� �
Road Name ,r"�,4<�.y '#" '� � : +k � �.Zip: ��l�,.'� �
**NOT'E** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building InspecUons
Office when applying for Building Pernuts.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
;% � - �- ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
—�—"-i'� �, %�. r%% _�• r'' �`Y `� �'� . i' �r .' �:ij : IS VALm FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
. a�._v�. � .. _ r, o� �4�,�� i , e � . . .-. .. , . . . . . ., _.. , ��,n� G ..
� •�l � �' DAVIE COUNTY HEALTH DEPARTMENT _�
� " � ��f " �^ ° : , IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
, � : Permiffee's � i � /� �-G f � i
�
Name: f' 7-�%"r'xr`r_'��� !��'�, ���..���?or`C:�j Subdivision Name:
,�
��Dire`ctions to PrQpertY: r , � ' ,'%°'--' �i` Section: _-��--�~ Lot:
- Il1IPROVEMENT ,,
PERMTI' Tax Office PIN:#'�"�;' - 'T r� _ - ,�`'" �� £" _,�
Road Name. `� ,. .��;� , t<.� fa �,�,r� �j t,�. �♦ ��
_Zip: ,�� /� • : � ,�
**NOTE** This Improvement Pernut DOES NOT authorize the construction or installa6on of a septic tank system or any wastewater system. An
ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Department prior to the
-: constiuction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
' ,�� ***NOTTCE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SI1'E
j ; � •'. � . ; ; , ',. ;; , , %..,, „ � r;::' PLANS OR TEIE INT'ENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TfII.S PERMTI' BEFORE
INSTALLING Tf� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE � i i# BEDROOMS # BATHS `�-s� # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFTCATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFI' # 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 ,- C-.- ROCK DEPTH ,/ � LINEAR Ni'.�x�
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IIMPROVEMENT PERMIT LAYOUT
� �-�---._.:� :a
___.--
**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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
i
OPERATION PERMIT 1,�
���
�O�
SYSTEM INSTALLED BY:
' �� C�. I � � �"�
� �� �
•_�_.--�- ,; �
AUTHORIZATION NO. � OPERATION PERMIT BY; /�f �/ DATE: _��
�
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 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 WII.L FUNCTION SATISFACTORILY FOR ANY GNEN PERIOD OF TIME.
DCHD OS/96 (Revised)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT
Davie County Health Department
Environmental Health Section �,
P.O. Box 848
Mocksville, NC 27028
� (704) 634-8760
!�
****IMPORTANT**�`� THIS APPLICATION CANNOT BE PROCESSED Ulvl
THE REQUIRED INFORMATION IS PROVIDED.
�1. Name to be Billed �a �e � S G��Contact Person t/ ��,.h�i� ��-e �-aG�j�
;/ Mailing Address r� ��i ,U�2� h l:vK �� ���cbCh � Home Phone ���— 3 75� %
j City/State/Zip �� /�S�i ���-C ,Q .�% �o �� Business Phone �yU -` 7 %�% e�-
2. Name on PermibATC if Different than Above
Mailing Address City/State/Zip
3. Application For: .[�Site Evaluation [�J Improvement Permit & ATC [] Both
4. System to Serve: [] House [] Mobile Home [] Business [] Industry [�Other 7`/�OGc���2� ����� �L 1/'!•��
5. If Residence: # People # Bedrooms # Bathrooms �� [] Dishwasher [] Garbage Disposal
[] Washing Machine [] Basement/Plumbing [] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks� # Commodes �
# Showers # Urinals � # Water Coolers�_
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: j/�County/City [] Well [] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes (�jj�No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** ��iYJ�\TY'OF THE PROPERTY MUST BE
� SUBMITTED WITH T,�S APPLICATION.
' �- �+� � �s
Property Dimensions: � J� � WRITE DIRECTIONS (fmm
Tax Office PIN: #_���� - �_ - �SJ� � ; � " � -�L-/
Property Address: Road Name l)�a% ���°r1i �'h- �9 � /hltil't `. 6 Y� �r
City/Zip �0 e�'�S Yi �f�<c ,�� � (� %D � � ; � vrl i 1� � � �
If in Subdivision provide information, as follows: �
�
Name: �
�
�
Section: Lot #: ;
TO PROPERTY:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are
subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or
changed. I, also, understand that I am responsible for all charges incurred from this application. 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,� OGIJt- �'YP�%" •%�'i. . �o conduct a�l testin�cedur�� necessary to determine the site suitability.
/
DATE �%" /�" % _%
SIGN
Revised DCHD (06-96) V
THIS tIIZE�I �U4� $E USE"b �OR �2Z�l1UINC� JOULZ SZTE YL.ttN:
� '
�• , ,
• ,+� � ; DAVIE COUNTY HEALTH DEPARTMENT
�' Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT' S NAME �/� P,Qr'�� �� DATE EVALUATED ?l �� ���
PROPOSED FACILITY � z-L PROPERTY SIZE �t'� c'
SUBDIVISION ROAD NAME �CJt',y✓' �r�•�' ��
Water Supply: On-Site Well
Community
Evaluation By: Auger Boring Pit
Public
Cut
�
LONG-TERM ACCEPTANCE RATE: -
REMARKS:
DCHD (O1-90)
_..___.___�..�_ � ,,_�
OTHER(S) PRESENT:
LEGEND
Landscape Position
R- Ridge 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 - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C- Clay
CONSISTENCE
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely frm
Wet
NS - Non sticky SS - Slightly sticky S- Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P- Plastic VP - Very plastic
Structure
SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineraloev
1:1, 2:1, Mixed
Notes �
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable) '
Soil wetness - Inches from land surface to free water 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 - gallday/ft2
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DAVIE COIP1'�i I-�ALTIi D:�: �"�.�'I't�i�1T
� S%�c�TIC TANi{ Pr+�.r`'��.�T
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No, of Becirooms ; �ate � _� _���_ ��
,
,,; =
:_ i.: � 1�!:Y'T_lJ_t is gr,�ted to for the installation
;+ :_ �cr,�:ic T k a1, �he Iresidence of f�� ��i� � ��dcsess
� � 1 "Z' - �� . �i'�-'�....!
;
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B� �:�� dino Cont� actor. _�__. Addre� s___ �_____ _
. __ �
S::j"��..c i�nk ;�necifica�tions: Length t�i�dth De_r,t,1 __r��C�.paci-l-,y aTi Ga1„
� - � __._�.._.. __,___�.__ _ . ._ ._..._
- � _. . ,
_ ...,. ._. . ...
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i�Tanuf�i,cturert s T1ar�.e . _ _ __ _ . .. ---- .__'"-- �ddress
_,.. _ ._ . ..� , _ _
, ._.._ .... _<.
No. of ]a..nes I T�didth_'�n. Total length ft, No. of Sq.Ft. G�
„
'I`ype:of filter material l� Total tons used
r�Iinimum Requirements:
House Trailer
Two-Bedroom House
Three-Bedx'oom House
Tank Capacity
£300
£300
goo
Square Ft. of Line
1�00
=—h0�„
I10 one shall install a septic t ank in Davie County w ithout a perrnit from the
Health Of.ficer or his agent.
.Da�;� of i in�:; approbal Signed: _
Sanitari.an
:i hereb T certify that the above septic tank has been installed according �o
�
cJx�n�.,1.1.1Cci ul0'_7S �
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Signed _ v�
Septi Tan1��Cor.tr �.tot
ilote: i•iake sketch of disposal system on baclr of ::�heet ar,cl r!.a,il to �h� IIea1��:
C�nter in I�iacksville.