653 Bell Branch Rd Davie County,NC 'fax Parcel Report Friday, September 23, 201 f
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: B20000003101 Township: Clarksville
NCPIN Number: 5814306614 Municipality:
Account Number: 82530991 Census Tract: 37059-801
Listed Owner 1: WILSON ERIC LEE Voting Precinct: CLARKSVILLE
Mailing Address 1: 653 BELL BRANCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 1.687 AC BELL BRANCH RD Fire Response District: COURTNEY
Assessed Acreage: 1.45 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 7/2009 Middle School Zone: NORTH DAVIE
Deed Book/Page: 008010937 Soil Types: MnC2,MnB2,MdB
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 152110.00 Outbuilding&Extra 20280.00
Freatures Value:
Land Value: 17840.00 Total Market Value: 190230.00
Total Assessed Value: 190230.00
All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�'pUN.t NC or arising out of the use or Inability to use the GIS data provided by this website.
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' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990004079 Tax PIN/EH#: 5814-30-4694
Billed To: Eric Wilson Subdivision Info: 6-053
Reference Name: Location/Address: AQ Bell Branch Road-27028
Proposed Facility Residence Property Size: See Map
ATC Number: 4494
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Al•�4� Date: O�
CERTIFICATE OF COMPLETION ,
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improv ent/Operation Permit
has been installed in compliance with Article I 1 of G.S.Chapter 130A,Section.1900"Se a Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will fun on satisfactorily for any
given period of time.
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Environmental Health Specialist's Signature: Dat.) / Div
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
•.. Environmental Health Section
' P.O.Boa 848/210 hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 990004079 Tax PIN/EH M 5814-30-4694
Billed To: Eric Wilson Subdivision Info:
Reference Name: Location/Address: 719 Bell Branch Road-27028
Proposed Facility: Residence Property Size: See Map
ATC Number: 4494
**NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with
Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type �j �� #People _ #Bedrooms --7L #Baths
Dishwasher: Fr Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ i
Lot Size Type Water Supply Design Wastewater Flow(GPD) Q Site: New) Repair❑ '
t�
System Specifications: Tank Size L05AL. Pump Tank GAL. Trench Width7� Rock Depth OJ A Linear Ft.3 D
S
1 r� I
Other: 5 WAS 1(111 yyW�t W�, ott �n d\ -� ntt rw 7 N�vtyu-S m 1 r
Required Site Modifications/Conditions: V 0 Sv�0., OVA S
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUEN ILTER RISER(S)IF 6°G BELOW
FINISHED GRADE. ****NQTICE:_Contact a representative of*k-nav+esol Ith Department for final inspection of this
system between 8:30 a.�to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on y� ...., of installa 1 n. Telephone#is(336)751-8760.****
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Environmental Health Specialist's ignatu Date:
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DCHD 05/99(Revised) 9-S A.4. S Vo ld
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Davie County Health Department
1 2006 ` Environmental Health Section
P.O.Box 848/210 Hospital Street
Mocksville NC 27028 COUNn � ..�
(336)751-8760/Fax (336)751-8786
Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) 2-goth
***IMPORTANT***THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
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APPLICANT INFORMATION
Name to be Billed J=r i C W i I So h Contact Person
Billing Address '71 el (3 e l l Q ,an Ch Road Home Phone S96—11 to 3-a/6, 1
City/State/ZIP MoCKSYMe, 1VV_ 270a8 Business Phone 33[0 - JPga - ,7&.o& mobile;
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION
NOTE: A survey'plat or site plan must accompany this application.
(Permit is valid for 60 months with site plan,no expiration with complete plat.)
Street Address '7 /C) 6 e d Oraneh Roelof City vi 11 e Tax PIN# 5.ff1 y 3 D q l0 9 y
Subdivision Name Section/Lot# Lot Size
Directions To Site: From Moek1svi 11c, - tooltJ 4-0 1 eFf-I CW0Jaapi� ; qo -la S*Dj2 S1yi ;�m Jrft
ave (3ctt ey-Arid, r-oad `
Date House/Facility Comers Flagged $ -ot/ -D
If the answer to any of the following questions is"yes",supporting documentation must be attached.
Are there any existing wastewater systems on the site? ❑Yes 0610
Does the site contain jurisdictional wetlands? ❑Yes Ao
Are there any easements or right-of-ways on the site? ❑Yes L60
Is the site subject to approval by another public agency? ❑Yes 21�o
Will wastewater other than domestic sewage be generated? ❑Yes 1!nqo
IF RESIDENCE FILL OUT THE BOX BELOW
#People 3 #Bedrooms J #Bathrooms A Garden Tub/Whirlpool ❑Yes Q'No
_ Basement: ❑Yes [9, o Basement Plumbing: ❑Yes Qflo
IF NON-RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building #People
#Sinks #Commodes #Showers #Urinals
Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: #Seats
Type system requested: AConventional ❑Accepted ❑Innovative ❑Alternative Zotherr,hCun6Qr!2i$ rY1
Water Supply Type: ❑ County/City Water C9*New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B to
If yes,what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if
the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred
from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to
conduct necessary inspections to determine complianc with applicable laws and rules on thabove escribed prop located in
Davie County and owned by
Site Revisit Charge
Property owner's or owner's legal repitsentativAignatu6i
Date(s):
7-a l-,�b Client Notification Date:
Date S u4 W/ �,�G w 1'tc:� EHS:
Sign given es ❑No +Cti � ��✓\5� "' b�� Account#
Revised 2/06 0 Z�l -Vol -\41� V0i (,` Invoicel,#11 w
IPS
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Davie County GIS Viewer Page 1-of 1•
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Rec 1
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Parcel
Number 6200000031 Visible
k
PIN ❑ Address Points
Number 5814304694
❑ Driveways
Account 000080192500 Cit..-�--�-..� � Y Limit Lines
Number
Listed ux ,f � El5 Ft. Contour
Owner#1 WILSON MELVIN LEE �� �- . ❑ RailroadHos
Listed Streets
Owner#2 WILSON VIRGINIA G F
Property
IMailingDimensions
Address 1 719 BELL BRANCH ROAD f�
Property Lines
Address 2 � 1 ❑ Aerial Photos
City MOCKSVILLE El Subdivisions
State NC ,'' ElCensus Tracts
I Zip Code 27028 �,� ,f' ❑ Emergency
Legal
4 ,y' Service Zones
Description 6.92 AC BELL BRANCH R[. �� �'f ❑ Flood Zones
Acreage 6.517 % 110N Flood Map
Deed Date 019771028 �,f f Panels
Deed Book' n ,� � D Streams
and Page 001030166 N:
! f, ' ❑ Water Bodies
Plat Book ' ' ���' `.' Middle School
Plat Page ` ,ff ❑ Districts
Building ❑ Elementary
Value 91020 School Districts
Outbuilding ❑ Soil Types
and Extra
Features 10080 ❑ Township
Value ❑ Voting Precincts
Land Value 34670 Click a button below,then si
Tn4�1 _e click on the map to get info
a t Get Parcel Info
New Search Hein Get All District Info
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/maps.co.davie.nc.us/website/mapviewer/viewer.htm?name=Davie&Cmd=Start 08/01/06
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990004079 Tax PIN/EH#: 5814-30-4694
Billed To: Eric Wilson Subdivision Info:
Reference Name: Location/Address: 719 Bell Branch Road-270,28
Proposed Facility: Residence Property Size: See Map Date Evaluated: Ef
Water Supply: On-Site Well ✓ Community Public
Evaluation By: Auger Boring LZ Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope% o Z
HORIZON I DEPTH
Texture groupL L
Consistence
Structure Ls�^
.Mineralogy /;
HORIZON H DEPTH j
Texture group '(r
Consistence r r' 7171
Structure
Mineralogy / `
HORIZON III DEPTH f
Texture group .
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE /
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPT CE RATE: ' � OTHER(S)PRESENT: 6
REMARKS:
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 firm
}�'et
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
Mineralogy
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-gal/day/ft2 DCHD 05105(Revised)
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Davie County Health Department
Environmental Health Section
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760/Fax(336)751-8786
Improvement Permit
September 11,2006
Mr.Eric Wilson
719 Bell Branch Road
Mocksville,NC 27028
Re: 719 Bell Branch Road
Tax PIN#5814304694
Dear Mr.Wilson,
This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S.Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if
site plans or the intended use change.
System To Serve: &4 5 Wastewater Design Flow(GPD): ? O Valid: KYears ❑No Expiration
System Type: PConventional /Accepted ❑Innovative ❑Alternative ❑Other
Site Modifications/Permit Conditions: A
a pied Systems may also bo use
661A Z
Site Plan
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hvironmental Health Specialist Date
i.p.letter 7/06