3146 Cornatzer RdDavie Countv, NC Tax Parcel Report Wednesday, October 12, 2016
0
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WAK1V11V1J: 11-11� l� 1VU1 A�UKVLY
Parcel Information
G80000001701 Township:
5880025183 Municipality:
82525177 Census Tract:
PEACOCK KELLY W Voting Precinct:
PO BOX 295 Planning Jurisdiction:
ADVANCE Zoning Class:
NC Zoning Overlay:
27006-0295 Voluntary Ag. District:
.878 AC CORNATZER RD Fire Response District:
Land Value:
Total Assessed Value:
°�^°'F Davie County,
�O�,N�; NC
0.89 Elementary School Zone
9/2005 Middle School Zone:
006270661 Soil Types:
Flood Zone:
Watershed Overlay:
82050.00 Outbuilding & Extra
Freatures Value:
26130.00 Total Market Value:
110250.00
Shady Grove
37059-803
EAST SHADY GROVE
Davie County
DAVIE COUNTY R-20
ADVANCE
SHADY GROVE
WILLIAM ELLIS
WeB,PcB2
DAVIE COUNTY
2070.00
110250.00
No
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Permittee's: �el �;y �'eQ�� DAVIE COUNTY HEALTH DEPARTMENT �
Name: i�-'" #��� �'''" `:'' ��` Environmental Health Section PROPERTY INFORMA Nj� ti�
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• � P.O. Box 848
Directions to property: �'•�4"`' `�� 1�" ��`�` W��� ��'''-� Mocksville, NC 27028 Subdivision Name:
- ��; � 4�, � l,: r ,,�. .;.� ��o<.at - ��� �'��+.s�� �� Phone #: 336-751-8760
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AUTHORIZATION NO:
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AUTHORI7.ATION FOK
WASTEWATER
SYSTF,M CONSTRUCTION
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Tax Office PIN:#� �r'�_` �� �=� -- � ` =�'
Road Name: .�`i�� i�; .�,' i:.i Zip: 7<•.:'�!,^
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv Environmental Health Section prior
to issuance of any Building Permits. This Fonn/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, Section .] 900 Sewage Treatment and Disposal Systems)
j1 ***NOTICE*** THIS AUTHORI7_ATION FOR WASTEWATER CONSTRUCTION
' `•.' (�.i�ti L'' `+r ��'" IS VALID FOR A PERIOD OF FIVE YF.ARS.
ENY��20NMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE p� # BEllROOMS � # BATHS �'- # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFI' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE '� ��ra`�� TYPE WATER SUPPLY CU� DESIGN WASTEWATER FLOW (GPD) ��`« NEW SITE REPAIR SITE �""^�
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SYSTEM SPECIFICATIONS: TANK SIZE ��d � GAL. PUMP TANK GAL. TRENCH WIDTH -' G' ROCK DEPTH � Z LINEAR FT. ���
OTHER �ft7lltC.Cti^��G,� S��S � - N G.J �nv - G��it�� V'���i �' �� �nII �'� -W�S•��� ��/5y�-t...
REQUIRED SITE MODIFICATIONS/CONDITIONS: AS stated in 15A NCAC 18A.19S9(5)
-�L"�C�CL'�gy STF:TiTa-TTTdy-dTs�;;t
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
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AUTHORIZATION NO. �SPS�'4' OPERATION PERMIT : DATE: �_ I���
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"'THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S DESCRIBED ABOVE HA EEN INSTALLED IN COMPLIANCE.-
WITH ARTICLE I 1 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 02/02 (Revised)
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Pe�nittee s , � DAVIE COUNTY HEALTH DEPARTMENT
.,• ,.� _i y�.'.�'1 ; n�'f�,� i. 4. � ����
'�--�_'Name: .. - r-~- • Environmental Health Section PROPERTY INFORMA� � Nj�`
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, �� .. f P.O. Box 848
- Directions to property: ° � � � ," �� `� ' - Mocksville, NC 27028 Subdivision Name: -
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' " - ' - Phone #: 336-751-8760
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Section: Lot: �'
_ - ,. AUTHORI7,ATION FOK
s, ! . , , . i V1'ASTEWATER Tax Office PIN:# - '�' �y _ �> �- w i � ''
_ __ • SYSTF.M CONSTRUCTION -
AUTHORIZATION NO: � � � �' � � A Road Name: : � � � � Zi�: - � ' ```
**NOTE** This Authorization,-for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pennits.
(In comptiance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
� ***NOTICE*** TH1S AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION
_ __ ;•; � �-;1.'.` (" ' � ` �� �" • IS VALID FOR A PERIOD OF FIVE YEARS. ,
ENVII�ONMENTAL HEALTH SPEC(ALIST DATE ISSUED
RESIDENfIAL SPECIFICATION: BUILDING TYPE �'�L' # BEllROOMS -� # BATHS � # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
LOTSIZE '�'� ���1;n� TYPEWATERSUPPLY f���
# PEOPLE _ _ _ __ _ # PEOPLFISHIFT
DESIGN WASTEWATER FLOW (GPD) �� �
# SEATS INDUSTRIAL WASTE: Yes or No
. NEW SITE REPAIR SITE ='�
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �' �I ROCK DEPTH � r� LINEAR FT. '
�I�UU " �^ Z `✓�T'�
OTHER ��'�f �It�rt},��..�t <:,��c�'�t�--- - Plt.,._� ���,.� - . ��;!% i^,<� �c� inl� :J ,{.,�,'� `�c.., �y(a-i.�
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REQUIRED SITE MODIFICATIONS/CONDITIONS: AS St8t0d in 15A NCAC 18A.1969(5)
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IMPROVEMENT PERM[T LAYOUT
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FOR FINAL INSPEGTION OF THIS SYSTEM PLEASE CALL BETWEEN 830 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE ii IS (336) 751-8760.
OPERATION PERMIT
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AUTHORIZATION NO. ��z� OPERATION PERMIT : ' DATE: ����
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**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S - DESCRIBED ABOVE HA EEN 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 SATISFACfORILY FOR ANY GIVEN PERIOD OF TIME.
DC[-ID OZ/02 (Revised) �. .
' , DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section �, '(p
PO Box 848/210 Hospital Street ^, 6/
Mocksville, NC 27028 � ��
Phone: (336)751-8760
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) REPLACEMENT ❑ REMODELING o RECONNECTION �
Name: _ �� Phone Number: �'I l. � (f.� � � (Home)
Mailing Address• � r �_(, �t' �i �` �C� �� (��
C�.�-Q�.�. �.�—�L� _ �L� aa � _. � ,* ., � � l �-� �6 7 ��a� �
Detailed Directions To
Property Address:.
Please Fill In The Following Information bout 1'he Existing Dwelling:
Name System Installed Under: � 1 l+� �� �bC— Type Of Dwelling:�
Date System Installed(Month/Day/Year): �� Number Of Bedrooms:�Number Of People: �
Is The Dwelling Cunently Vacant? Yes d No �If Yes, For How Long?
Any Known Problems? Yes ❑ No If Yes, Explain:� �ill ��UDII Lat`L,f� �� � �" �/ �/`��
Please Fill In The Following Information About The New Dwelling:
Type Of Dwelling:�� Number Of Bedrooms: Number Of People: �
�Zequested By:.
(Signature)
- Approved�
Comments:
Environmental Health
For Environmental Health Office Use Only
ved ❑
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'�The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a
guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash 0 Check ❑ Money Order ❑# Amount: $ Date:1p ' 2'0 4
Paid By: Received By:
Account #:�� Invoice #: 5y��
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'This ermit Void if sewage system described below is not;installed within 5 years from date of issue.
This permit is subject:to revocation if site plans-or the intended use change,. '
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Improvements permit by _ ._
'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 day of completi.on,. Tel.ephone Number-:704-,634-5985.
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Final Installation Diagram: System Insfalled by _�'����%%����` ��! ��%�' �`�
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Certificate of Completion < < '� ( Date <� ` 'f °'� '%'
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"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO,.way be taken as a guarantee that 4he system will function
satisfactorily for any'given period of time.
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DA1ilE COUNTY HEALTH DEPARTMENT ''`;i :�.��, �}��
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Articie I I of G.S. Chapter 130a
Sanitary Sewage Systems , .
Name ;.; _ ',;, , , ;�" ti � .. �;_ ��,� � � `� � - �� Date r�� - , _
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Permit Number
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Subdivision Name Lot No. Sec. or Block No.
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Lot Size a`� �� ` - House Mobile Home _�-�' Business � Speculation
No. Bedrooms "� .No. Baths `-' _ No. in Family 'a _
Garbage Disposal YES ❑ NO p%�;� Specifications for System:
Auto Dish Washer YES ❑ NO 0� i f-, - t
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Auto Wash Ma :hine YES �' NO ❑ i :.;, "
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Type Water Supply ,j'• . ---
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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Improvements permit by '__ . - _:_ '`.'. �'`_=
'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 day of completion. Telephone NumbPr 704-634-5985.
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Final Installation Diagram:
System Installed by
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Certificate of Completion Date ��' �� �� � �
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"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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1. Application/Permit
Mailing Address _
Home Phone ��
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
�
Davie County Health Department
Environmental Heaith Section
P. O. Box 665 �'�;J r'� ��� �
Mocksville, NC 27028
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2. Name on Permit if Different than Above
3. Application/Permit for:
4. System to Serve: ❑ House
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People �
��No. of. Bedrooms
No. of Bathrooms �
Dwelling Dimensions _ �� � ��
Business Phonc�"��9X� �% ' ���o � �
❑ General Evaluation
L� Mobile Home
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes
No. of Lavatories
No. of Showers
No. of Urinals
No. of Water Coolers
Water Usage Figures
�f� Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown
Section Lot #
❑ BasemenUPlumbing
❑ BasemenVNo Plumbing
[��Washing Machine
p Dishwasher
❑ Garbage Disposal
7. Type of water supply: C� Public ❑ Private 0 Communiry
8. Property Dimensions � �� � Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes C�YNo
If yes, what type?
*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:
Cor�a+zer
fld�at���
Rd . o��ross -�'�o� �hac� �' ��ve �` �oo
y
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible all charges
incurred from this application.
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DA E SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: C�1. I OWN the property. ❑ 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 f t e Davie C_oJuP� Healt DepartmQnt to enter upon above described
property located in Davie County and owned by i�� ,t��1� `� �i�/%c� �,�����!�/�
to conduct all testing procedures as necessary to determine ai�s s tability for a ground absorption sewage treatment
and disposal system. ^
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DA E
DCHD (12-90)
,
�'�', DAVIE COUNTY HEALTH DEPARTMENT
' • Environmental Health Section
, Soil/Site Evaluation
NAME _����... �s�.�-�.._..^�s��_ DATE EVALUATED �- � -�1 ' � �
ADDRESS S�A'�+*" PROPERTY SIZE �� ci� G,��.,
PROPOSED FACIILTY ���. ��- LOCATION OF SITE ���� al� P��Ze-a
Water Supply: On-Site Well Community Public `�
Evaluation By:�Z�,., AugerBoring ✓ Pit Cut
FACTORS 1 2 3 4 5 6 7 �
Landscape positio
Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralo�y
HORIZON III DEPTH
Texture Aroup
Consistence
Structure
Mineraloqy
HORIZON IV DEPTH
Texture group
Consistence
Structure
MineraloQy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
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SITE CLASSIFICATION: _ Q• S EVALUATED BY: ��.�������-
LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: __ � 6�
REMARKS: �� �sx�w-'�3 — �� ��.�i,�-�- �-�+�+dv.��,�� ac+` a�.
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� EGEND
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
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Strt�cture
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-AnBular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
MineraloKY
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 watet 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/ftz
DCHD(01-901
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