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191 Camellia LnDa�ie County, NC Tax Parcel Report Wednesday, October 12, 2016 0 WAK1V11V(s: '1'lil� la iVU'1' A �UKVLY Parcel Information Parcel Number: F300000095 Township: NCPIN Number: 5820579938 Municipality: Account Number: 29076750 Census Tract: Listed Owner 1: GHOLSON AMY Voting Precinct: Mailing Address 1: 191 CAMELLIA LANE Planning Jurisdiction: City: MOCKSVILLE Zoning Class: State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: Clarksville 37059-801 CLARKSVILLE Davie County DAVIE COUNTY R-A Legal Description: 9.010 AC OFF DANNER RD Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 9.03 Elementary School Zone: WILLIAM R DAVIE Deed Date: 10/1999 Middle School Zone: NORTH DAVIE Deed Book / Page: 003170809 Soil Types: PcC2,RnD,ChA,CeB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: Building Value: 44410.00 Outbuilding & Extra Freatures Value: Land Value: 55600.00 Total Market Value: Total Assessed Value: 100010.00 DAVIE COUNTY 100010.00 No � �� �,\'/ All data Is provided as is without warranty or guarentee of any kind eithar expressed or implied including but not limited to the 9 �",° F Davie County� Implied warranties of inerchantability or fitness for a particular use. All users of Davie Countys GIS website shall hold harmless tha County of Davie, North Carolina, its agents, consultants, contractors or emp�oyees (rom any and all clalms or causes of action due to �O�,�yq" NC or arising out of the use or Inability to use the GIS data provlded by this websitc. . . T: , �.. �� �4-:.. ' _ .. . . . � _ � ' . . . 1 „:�� .. . •. • 2 • -• .i ` .... . . ' . . . .. - � . . . ...._ � A t. � .�. . . . � . .: .; .. :.' _.: . � . . � . .. . .._ . .:, . _ � ,!t -� ,�- � � � AUT�CQ��[�A'�'ION No. O �% O DAVIE COUNTY HEALTH DEPARTMENT `' '�� �sN�"����ti �_- -- ' Environmental Health Section PROPERTY.���11�1TION ,3 : 3� Permitte ' . � .�.. ' P.O. Box 848 � Name: '�1M 1�0. 1� �1� ���R� �D `�`ti Mocksville, NC 27028 Subdivision Name: \ Phone #: 704-634-8760 Directions to property: �-,�' i�� '��. \�'x� Section: Lot: AUTHORI7ATION FOR �~> ;, .c . r� -'_'�� �e�.. � t.-�` Gr. � c,4r� ��'�11'•: rJ�SYSTEM CO TRUCTION Tax Office PIN:# � r�.��,b - `: � - ��= O�, �'.�.�r��. . Road Name: � Zi � 0� `� P� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Buiiding Permits. This Forn�/Autfiorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (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 �� �`N .,�, <;-`_`,�::a�� �• �:,.. }�.1�;�-:a ' � . . IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED , � rr ,� , a -; ' , �;- � � ` ���a� �� ��� ,z; � ��,� , ' DAVIE �COUNTY HEALTH DEPARTMENT � l' �' `"' � .. , ^�,�' ---}c. ;. `�� ,: IMPROVEMENT-AND OPERATION PERMITS PROPERTY OR1�TION 2. 3� Pernutt�~S ✓ _,,� � � � r � � > . 1!t .i .�., �.. 4 I1lanie: � f'�:: t�� !� 6�'� t� �� 1'R1 4D P� Subdivision Name: . .- D'uections to property: 4 y� ''� `�, �`t� � Section: Lot: , . .;� IlVIPROVEMENT � ��� � n , ^i� i,.. `t z .. � ^ `>.,3, > PERMIT Ta�c Office PIN:# r `- � ! =' - ' i - i .� t � , ,�-- �^ , � RoadName:�,--'_;,_,��'��Zip: h E:„'`I **NOTE** This Improvement Pernut DOFS NOT authorize the construction or installation of a septic tanlc system or any wastewater sysEem. An ' u AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/'mstalladon 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*** TfII.S PERNIIT IS SUBJECT TO REVOCATION IF SITE ,' ', _, _ � _ � � ��:, ° � `�� ��';�$ ; PLANS OR THE IlVTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSiJ�D . SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING Tf� SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No i COMMERCIAL SPECIFICATION: FACILTTY TYPE � # PEOPLE S� # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or� LOT SIZE C�.c �^_ TYPE WATER S[jPPLY �"� DESIGN WASTEWATER FLOW (GPD) � t` � NEW SITE � REPAIR SITE y ~� 1 1i / � SYSTEM SPECIFICATIONS: TAN SIZE �� UGAL. PUMP TANK GAL. TRENCH WIDTH .~) ROCK DEPTH � LINEAR FT. (���� n (� '''(' � OTHER `o �Via�.�. \ VSc�;•.... ` " J REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ( , � S� �l; s . -------�---- ^„'_-----� �� _„�, r **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 kv Fv j ,. SYSTEM INSTALLED BY: � �.wl�X�- �v�N / 9� � .� . AUTHORIZATION NO.�/ `�� OPERATION PERMIT BY: DATE: ��1 � 1� **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 WILL FUNCTION SATISFACTORII,Y FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) •. W . ' 1 r ' . . .� . � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department � � �� Environmental Health Section �' ��, � ��� p P. O. Box 848 �� L Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed �W►A � �� b � A11 Contact Person � Mailing Address (�� eA LVIP L ��, �Q„h � Home Phone % O �i �� a. � g�� City/State/Zip �� � S� ��t I( P , n�.�,'1(�2� Business Phone 7� � `i 35b � 2. Name on PermidATC if Different than Above Mailing Address `S' A {� City/State/Zip 3. Application For: 4. System to Serve: 5. If Residence � Site Evaluation ❑ House ❑ Mobile Home # People ❑ Improvement Permit & ATC i� Business # Bedrooms ❑ Industry ❑ Other # Bathrooms �Both ❑ Dishwasher ❑ Garbage Disposal �� Washing Machine ❑ Basemen lumbing ❑�a� ent/No Plumbing , /►� � � �.� b 6. If Business/Other: Specify type �,� I.F.Lre � People G # Smks ,,,� ,� �ri�. # Commodes # Showers # Urinals /f� # Wat�Coolers —� —� —'fL— � If Foodservice: 7. Type of water supply: # Seats ❑ County/City Estimated Water Usage (gallons per day) � S � i� Well 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community � ❑ Yes �No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE �� �� o( /`�L SUBMITTED WITH THIS APPLICATION. ' �-t" Property Dimensions: � G -�� Q- � � e`�`� i W E D I R E C T I O N S ( from � 3/�� � Moc ksvi l le) T O P R O P E R TY: Tax Office PIN: # s$o� - � Z - 7 3 7`� � �Q' �o r�'h (�QS� �' �� /� �J�� 1 Property Address: Road Name 1-/1 �lIC/!/vc Q�/1e � . , � R�4 h� oh�e,r�ner�d. c�cy�z�p U 1 ��G a-��� ' i �r. � oYl ,�3 N1 P� L�l a iat.� If in Subdivision provide information, as follows: 1 � (�'o �o �hd o� IroA� Name: � I Section: Lot #: � I 1 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 inforrnation submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incuned from this application. I, hereby, give consent to the Authorized Represe�tative of the Davie County Health Department to enter upon above described property located in Davie County and owned by as necessary to determine the site suitability. DATE I �� `� � �C� SIGNATURE Revised DCHD (06-96) conduct all testing procedures r � . < - ,�. 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M1�, _ � # - .;.� - , r� .e `�- .:� _ .�- r A ; . � w<;�``n`��t` _ .�.� `s`� �� �. � •'' If ,� '-'y� .:�o ... � . . 3 :a-. . x _ ..� _ �, k ", �� � s � � �° , �-.� � �{� t � _ j� ��� � . �' , 5 .21 C._ . . �� � M . , _ �� . �,. ,� _ -;._ '4 � �� F � � .' . � ' DAVIE COUNTY HEALTH DEPARTMENT .- ' Environmental Health Section SECTION LOT � SoiUSite Evaluation APPLICANT'S NAME DATE EVALUATED �-t. �� J l v PROPOSED FACILITY ���l ��g� PROPERTY SIZE �� �-�-� SUBDIVISION ROAD NAME �: P�`z\�1'E� hA N� Water Supply: Evaluation By:<, �, � On-Site Well Auger Boring ' Community, � Pit Public Cut _ n�ri «�rmurrrc.c. SITE CLASSIFICATION: � �S• LONG-TERM ACCEPTANCE RATE: �� REMARKS: DCHD (01-90) EVALUATION BY: C��.,o�-� ���'�-9. OTHER(S) PRESENT: N �� �' ���-...-�.. ��,�.�� � 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 Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky 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 - gal/day/ft2 ■■ ■■ ■■ ■■ ■■ ■■ �� ■■ ■��■�p=� ■���■/�■■ ■��■■I��■ ■�■■��■■ ■�■■�■�■ ■■■��i■■■ ■■■�u��■ ■���u■�■ ■■■■7■�■ ■■■t���■ ■■■����■ ■■■�■■■■ ■■■�■��� ■■■�■��■ ■■■�■%■■ ■���%��■ ■■/%■�■■ ■■II�■�■■ ■■I��■�■■ ■■1\�■�■■ ■■��■■■■■ ■■��■�■■ ■������■ ■■���::�■ ■■��■��� ■■��■�■� ■■��■�■■ ■■��■�■■ ■���■�■■ ■■�■■■■■ ■■■■■ ■���■ ■■■■■ ■���■ ■���■ ■■■�■ ■�■�■ ■��■ ■�■■ ■�■■ ■�■■ ■■■■ ■��■ ■�■■ ■��■ ■�■■ ■��■ ■■�■ ■■�■ ■■�■ ■■�■ ■■■■ ■��■ ■■�■ ■■�■ ■■�■ ■■�■ ■�■■ ■��■ ■■�■ ■■■■■�����������■I��■�■■�■■■■■■■�■■ ■���������������■�������\��������■ ■■���■�■���������■�■��\�\!■■■■■■■■ ■�■■■�■�■■\�■����■���■\1�■\�������■ ■���■�����������■n�������■a■■■■��■ ■■■■■�■■■■������■�■■■■■►�■■�■■�■■■■ �■����■■■�� ����■■�►���������►������■ ■■����■���-:�r�■��►����■�►�■■���■�■■ ■■�■���������►�������■■■■��■■■►�■■�■■ ■�■■■�■■■��■���ni■��►�■■■���■■����■■ ■�■�■■■■■■■■■■►\I,i1 ■■��■■■■�►�■■■�■�■■ ■■�■■■■■■■�■■■\,V`f�7�\I��■�■\1���11���■ ■�■■��■■■��■■��►�S"a�������\'�����\■■ ■■■��■■■■■■■■■■11■i■■����■■■�■■■�■�■ �■■■■■■■■■■■�■�■■■■11��■��■��■�■�■ ■�■■�■��■■■�■�����1�����������■�■ ■■■��■�����■��������1���■����■■�■�■ \�■■■■��■■�■�■��■■■■■■�■■■■■■■�■■■ ■■\'\�■����■��������������■�������■ ■���������������■��■�■■■■■■■■■■■■■ ■����\�������■■■■■■�■■■■■■■�■■���■ °a■■■■■\�■■�■�■�■■■■�■■■����������■ �■��■■a■■■■■■■■■■■■■■■■■■■■��■�s■ ■������■■�■■�■■■�■■■■■■■�■��■��■ ���������������■■�■��■■����������■ ■►���■■■■���■■�■■■■■■■■■■■�■■�■��■ ■■��■��■■■��■■�■■■��■■■����■■�■■■■ ■�■��■�■�����■■■►��■■�■■■■■■■■��■■�t■��■ ■��������►�����■■�����■�■�■■■����■■�■��■ -■:�_....���■■■■■����■■■■■■�■■���■�����■ ■�■�■���■►���������■■■�■���■■���������■ • • ' . . . . . � . �avie County �CeaCth �epartment " and�.�-Come .�L�eaCth �t.gency ( �nvironmentaC.�Cealth Section � P.O. BOX 848 / 21O HOSPITAL STREEf �( COURIER::09-40-06 MocKsvt�LE, N.C. 27028 PHONe: (704) 634-8760 December� 2d, 1996 Ir�agination Statian Attn: Amy Gholsan 191 Camellia Ln. Mocksville, NC �7��'8 RE: Site Evaluation/C�r�ellia Ln. Tar, Office RIN: #JB��—J.T—%37L Dear Client: As requested� a repr,esentative fr�ar� this office visited1 the aforementioned site on De�ember i9, 199b, aasEd upon the inforr�ation provided on the applic�tion for, site ev�Iuation and after the evaluation was completed, the site was found to be provisionally suitable for� the inst�llation of �n on—site sew��ge dispos�l system. . If you h�ave any questions, please feel free to cantact this office. � Sincerely, � ' C; ��� �. Charles E. Little, R.S. Environmental Nealth Section CEL/wd Enclosur,e (s) STATE OF NORTH CAROLINA AGREEMENT CONCERNING SEPTIC SYSTEM COUNTY OF DAVIE This Agreement for Water Access (hereinafter "Agreement") is made this the � day of�, 2007 by and between P&R REAL ESTATE INVESTMENTS, LLC and AMY GHOLSON and husband, BRUCE GHOLSON WITNESSTH: Wf-�REAS P&R Real Estate Investments, LLC is the owner of the property located at • 205 Camellia Lane, Mocksville, North Carolina, 27028, as more particularly described in Deed Book 738, Page 0038 in the Davie County Register of Deeds (hereinafter the "P&R Real Estate Property") and WHEREAS, the Gholsons are the owners of the properly located at 191 Camellia Lane, Mocksville, North Carolina, 27028, as more particularly described in Deed Book 317, Page 809 and adjoins the Property; and WHEREAS, during a recent survey of the P&R Real Estate property it was discovered that the septic system to the P&R Real Estate property infringes over the property line of the Gholsons; and WHEREAS, P&R Real Estate does not want to move the septic system, even if possible, and desire to have the septic system remain infringing on the Gholson's property as it has existed over previous years; and WHEREAS, P&R Real Estate is desirous of reaching a mutual agreement with the Gholsons that provides for a continuing septic system. �� THEREFORE, for P&R Real Estate Investments, LLC, their heirs, successors and assigns and for the Gholsons, their heirs, successors and assigns, the parties agree as follows:. 1. The Gholsons agree to allow P&R Real Estate to keep the septic system as it exists in its current state on Gholsons property at no expense to the Gholsons. 2. P&R Real Estate agrees to pay for any costs or expenses associated with repair or maintenance of said septic system. 3. The parties agree that this Agreement shall be perpetual or until an alternate septic system is made available to the P&R Real Estate property. � ,,:; - �� /, 4. The parties agree to notify the other party if ar,y repair or maintenance is required and the timing thereof. IN WITNESS WHEREOF, the parties have caused this Agreement to be duly executed as of the date first written above. P&R REAL ESTATE INVESTMENTS, LLC BY: �,�„��r�� (Seal) TITLE �r�s� oe��- M ��,ac, �12 ; �.� (Seal) AMY GH SON ��"�t,te�e. (Seal) BRUCE GHOLSON STATE OF NORTH CAROLINA COUNTY OF �Ors' � I hereby certify that the following person(s) personally appeared before me this day each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated: PHILIP CROUSE, MEMBER- MANAGER OF P&R REAL ESTATE INVESTMENTS, LLC, DATE: \a- di1—O� � ._ _ � � I � 1 r ,_ ,. � �. , f' , .. .,; � ..,;nri, ., ��,` .� , iF rt:. ' � H i,� � / {' 1�rnj�—iU��Q���� '�' ', C�mmi sion F pi� �— l-A �_ .w,.- _: � �•�..,P ..,.— ��:.��:�.-x.-���.� � (Seal) � STATE OF NORTH CAROLINA COUNTY OF v �W �,1,.�.� �.� �• �l .� �J Signature of Notary Public ,��i��►tQ� � r ('1 AY�1`iS�V`+ Printed Name of Notary Public My Commission Expires: �-1 �i "� l� I hereby certify that the following person(s) personally appeared before me this day each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated: AMY GHOLSON AND BRUCE GHOLSON. DATE: I a.- �,��� � � '._ _ �d .. i ,. • � ._ _ � _ , ....., .. ...';L��_� �.'J' - � .. � - ;: ''. � i , * �,��;,� �1 � ^�,� �, � � J, j i)�`� �mmi rrn ` i 3'�,� .�.t1Q ij (Seal) . ��r .. _ - .�. ..,. a..�.- �.�. .--�"� I r.�,� � v-�c� i�..�, � ;r,�..z4�--� Signature of Notary Public ��`�.����-,a 1,�,,;� f � .�0. �,�5=�� .x1 Printed Name of Notary Public My Commission Expires: �.'i� ����Q ���, v `�o � IPF �, . __ f'/1//J/�J ��`�/� _.��1 �T G/H�OL�SLO/'N�, �+A/�/,�! �l�L [X!l/LJN7 TAX PARCEL 5820671378 D_B. 317, PG. 809 ZONING• R—A N 2U =30'-25' E -- 1 r TAX PARCEL 5820671378 / ZONING• R—A r 43573 Sq.Ft. � 1.000 Ac. � HEA T PUMP � P,OLE l \ � A� GUY WIRE so� 50't/— EASEMENT �� H�� SEE D.B. 572, PG. 327 -- TO CAAIELLIA LANE IPF NOTE THIS PLAT IS SUBJECT TO ANY EASEMENTS. AGREEMENTS OR RIGHTS-OF—WAY PR[OR TO THE DATE OF iHIS PLAT, WHICH 1NERE NOT YISIBLE AT THE TIME OF MY INSPECT[ON. DECLARATION [S MAOE TO THE ORIGINA� PURCHASER OF THE SURVEY. [T IS NOT 'IRANSFERABLE TO ADDITIONAL INSTI7UTIOPIS OR ONMERS. �� ' < � ��� � r�t�i 'S':. � "1�~ .. � ".a ,._ I. pla� was ,�;certify that ar`i actual field v direction and 3163 �� — IPF lran Pipe Found — FC Face of (1�rb — tltF tron Rod Found — CH Chord — !P Iron Placed — R Radlus — P/L ProPertY Line — L lsngth of Qirve — R/W Right—of—WaY — xFMR Oectriod Tronaformar — C/L Gntarline — /Ul AeAd UtNity — FP Edge of Paving — C11 Concrote Monument — P8 PuU 8ox — PT Poiot _ uu u,... N,� IRF . \ �� o\ � s� �'�-� '�- ONE STDRY M£T.4L � BUILDING� �� �? S£PTIC TANK HEA T PUMP 6RAVFL PARKING w � fFNCE (TYP.) � S 20'-31'-39" W 175.69' 6A YLE JfOHNSON MITCHELL TAX PARCEL 5820666948 2005E0305 ZONING.• R—A t���:k�vt��. NOTF.• ALL AR£AS BY CDORDlNATFS. VICINITY MAP NTS ��NER �'�AD �~ SITE J = Q v . A E,bp�.RST . qUF ��P i US yiyy B01 N � IPF _ —___— ....__.... ... �T �� iK[W� � .� TDYINSHIP COUNiY STA7E DAiE JOB N0. CXARKSVILLE DAVIE NC 10-19-07 2007138 BEING A BOUNDARY SURVEY OF THE PROiPERTY DESCRlBEO IN D.B. 572, G. 32bL ALSO KNONN AS TAX PARCEZ 5820671378. McAnally- Land Surveying, P.C. 1001 S. Marshall St 8ox 84 Vlfinston—Salem, N.C. 27101 Phone � 336-631-9805 sc.�i� �' — 40� 40 20 0 40 80