3134 Cornatzer RdDavie Co�nty, NC
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Tax Parcel Report
Wednesday, October 12, 2016
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WARNING: THIS IS NOT A SURV�Y
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E Parcel Inforination
Parcel Number: G800000016 Township: Shady Grove
NCPIN Number: 5880016627 Municipality:
Account Number: 45082340 Census Tract: 37059-804
Listed Owner 1: LE BLEU CORPORATION Voting Precinct: EAST SHADY GROVE
Mailing Address 1: PO BOX 2093 Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A,I-1,R-20
Statc: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag. District: No
Legal Description: 8.87 AC SOUTHERN RR Fire Response District: ADVANCE
Assessed Acreage: 9.24 Elementary School Zone: SHADY GROVE
Deed Date: 4/1985 Middle School Zone: WILLIAM ELLIS
Deed Book / Page: 001260528 Soil Types: WeC,WeB,Pc62
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 1379140.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 221750.00 Total Market Value: 1600890.00
Total Assessed Value: 1600890.00
h�'! All data Is provided as fs without warranty or guarantee of any kind either expressed or Implled Including but not limited to the
9�.,e F Davie County� Implied warranties of inerchantability or fitness for a particular use. All users of Davfe 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 aetion due to
�'pt�N.�~ N� or arising out of the use or Inability lo use the GIS data provided by this websfte.
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_. Ai�Tx��Z�'r�oN No: DAVIE COUNTY HEALTH DEPARTMENT" �' ` � �'
�' r � t �'.' • Environmental Health Section PROPERTY INFORMATION
' Pertnittee's , �.�-�'('�,,,� '-^�-^ P.O. Box 848
Name: �_�+�-=�_T �„ �'-�k. ��'�'"' Mocksville, NC 27028 Subdivision Name: �
� Phone #: 704-634-8760
Directions to property: � � ! � = ��� ��'� Section: ---•- Lot:
; AUTHORIZATION FOR �
;. () t �� " �.� `w , ~, �,`,.,+'�'�'�; r�°i.,. `�. k���, WASTEWATER s'��, � r
`. �1� SYSTEM CONSTRUCTION Tax Office PIN: I'���� -'C31 -�-��� �
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��` .`-r�• 2� ��`3� � U . Road Name: i._ �;t��_,,ht,���.Zin:` �`�°'��5�:�
**NOTE** This Authorization for Wastewater System Constrvction MUST BE ISSLJED 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 Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Secdon .1900 Sewage Treatment and Disposal Systems) �
;%�`�. � .\ � t� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
'�'` �~'� ���`°�� ��. }� ��`� j. ' Q� a IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �
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'�' •' �";. j t �� -- IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
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_ �Perjnittee's � -
�* Nar�e. _ � � 4'� ��� � �;r:.��t, �" .;•,:`...
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. ' `Directions`to property: -�� ' � � ''� � w
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IlNPROVEMENT
PERNIIT
' Subdivision Name: � ^ �
Section: . ,. Lot:� ��M-__.
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Tax Office PIN:�-i: ��� �_ t..�it _�,r_, �
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Road Name '�- � � ti-- : �- , s� �.Zip: '� ���
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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 pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Sec6on .1900 Sewage Treatment and Disposal Systems)
-'� z. �- � ***NOTICE*** TEQS PERMIT IS SUBJECT TO REVOCATION IF SITE .
' ��- � ' ' : � ` � • '� I PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
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ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONT'RACTOR MUST SEE THIS PERMIT BEFORE •'
INSTALLING TFIE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
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COMMERCIAL SPECIFICATION: FACILITY TYPE��`+. # PEOPLE # PEOPLFJSHIFT �� # SEATS INDUSTRIAL WASTE: Yes �Ng�
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LOT SIZE� TYPE WATER SUPPLY �✓' • DESIGN WASTEWATER FLOW (GPD) ��� NEW SITE � REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE OC� GAL. PUMP TANK GAL. TRENCH WIDTH t ROCK DEP'TH � LINEAR FT. trO�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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IMPROVEMENT PERMIT LAYOUT
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**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. '
OPERATION PERMIT
SYSTEM INSTALLED BY:
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AUTHORIZATION NO. OPERATION PERMIT BY: /�� DATE: '' �
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*'�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 SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OSN6 (Revised)
A
.` ' APPLICATION FOR 5ITE EVALUATION/IMPROVEMENT PERMIT & ATC
' . ' ' Davie County Health Department
• � � Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
� (704)634-8760
****IMPORTANT****
THIS APPLICATION CANNOT BE PROCESSED 1
THE REQUIRED INFORMATION IS PROVIDED.
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1. Name to be Billed L� � �� � U � �✓1 G'� , Contact Person �,1 �c_ /' /` `/ � fI'! ! � �
Mailing Address ��.3 � Cn �� ct �2 � 1� /'� D�t'� Home Phone c
City/State/Zip �G71 l�a � r�_�, /1r � C � � 7 � a � Business Phone � g � ' c� � � �
2. Name on Permit/ATC if Different than Above S,Q-� P
MailingAddress S Q� m� City/S[ate/Zip ��'/�'� �
3. Application For: [] Site Evaluation �Improvement Permit & ATC (�(� Both
4. System to Serve: [] House [] Mobile Home �Business [] Industry [] Other
5. If Residence: # People # Bedrooms # Bathrooms [] Dishwasher [] Garbage Disposal
[ ] Washing Machine [ ] Basement/Plumbing , [ ] Basement/No Plumbing
6. If Business/Other: Specify type C�1i� �2(S� . # People�"� #Sinks � # Commodes �
# Showers # Urinals � # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: �County/City [] Well [ J Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes �] No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***,��� OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: �� 7� ��'�� �'
Tax O�ce PIN: # � �S � 6 - (3 / - "�� ,�
Property Address: Road I�ame � /�� ����i��� � . �C
City/Zip ��Y��Ct . N L ' �-�"� � ; �
If in Subdivision provide information, as follows: �
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Name: �1U�- �
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Section: Lot #: ;
CE DIRECTIONS (from Mocksville) TO PROPERTY:
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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 chazges 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 �'�. ���Lt--1 Z� ,�o cRpd�,►�t �test}�g proced�s as neces�sa�y to�igtermine the site suitab}lity. ,�
DATE l6—�rI %%
Revised DCHD (06-96)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
SoiUSite Evaluation
APPLICANT' S NAME Il -2, `� 1�,�
PROPOSED FACILITY � �'�J�-a
SUBDIVISION
Water Supply: On-Site Well
Evaluation By: °���, Auger Boring
FACTORS
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
HORIZON II DEPTH
Texture group
Consistence
Structure
HORIZON III DEPTH
Texture group
Consistence
Structure
HORIZON IV DEPTH
Texture group
Consistence
DATE EVALUATED }� � � � � ` ��
PROPERTY SIZE � • 1 `6 Ou�
ROAD NAME C �s*��°.�..,� �'-�v��
Community
L') Pit
1 2 3 4
O-g� O-£-�
L C �-
= T �'L
R
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t '• 1 I \', �
Public V
Cut
5 6 � 7
.
SOIL WETNESS 5 S SS
RESTRICTIVE HORIZON —
SAPROLITE - -
CLASSIFICATION `e .s Q S
LONG-TERM ACCEPTANCE RATE � �
SITE CLASSIFICATION: �' � EVALUATION BY: \ �.�s�aa ������
LONG-TERM ACCEPTANCE RATE: '� OTHER(S) PRESENT: �r ��!� C�L�
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REMARKS: � ""'� �` � �, �'''�"�''r�-- �, ��
� 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
Mineraloav
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of iill - 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 wi[h chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gaUday/ft2
DCHD (01-90)
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All data is provided as Is without warra�rty or guarantee of any kind either expressed or implied including but not limited to the implied �, -� .�,y
���T �� warraMiea ot merchaMability orfitness for a particufar use. All users of Davie County's GIS website shall hold hartnleas the CouMy of � � U K�
Davie, North Carolina, ks agerMa, consuMants, co�rtractors or employees from any and all claims or causes of action due to w arising out of P ri nted: M ay 17, 2013
S Me use or InaDility to use the GIS dah provided by this webske.
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All data is provided aa is wtthout wartanty or guarantee ot any kind either expressed or implied including but not limited to the implied
wamnties of inerchanWbility or (Itness Tor a particular use. All users oT Davie County'n GIS webs'rte ahatl hotd hartnless the CouMy ot
Davie, North Grotina, its ayeMs, consuttants, coMradors or employees from any and all cWims or wuses of action due to or a�iaing out ot
the use or inability to use the GIS data provided by Mis website.
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