248 Dalton Rd�
�avie Coixntv. NC Tax Parcel Report Wednesdav, October 12, 201E
WAKNINU: 1'H1S 1S NUT A SURVEY
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� Parcel Information
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Parcel Number: J600000033 Township: Mocksville
NCPIN Number: 5757190454 Municipality:
Account Number: 19548000 Census Tract: 37059-805
Listed Owner 1: DALTON H MATTHEW Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 127 VIRCASSDELL LANE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Ciass: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag. District: No
Legal Description: TRACT 1 DALTON S/D Fire Response District: FORK,MOCKSVILLE
Assessed Acreage: 3.40 Elementary School Zone: CORNATZER
Deed Date: 5/2007 Middle School Zone: WILLIAM ELLIS
Deed Book / Page: 007141018 Soil Types: WeB,RnD
Plat Book: 0009 Flood Zone:
Plat Page: 032 Watershed Overlay: DAVIE COUNTY
Building Value: 38680.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 27080.00 Totai Market Value: 65760.00
Total Assessed Value: 65760.00
9A��l� Davie County,
°�UN�� NC
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AUTHORi�A'rION NO. �� � 4 DAVIE COUNTY HEALTH DEPARTMENT ����� r N
a► ', Environmental Health Section PROPERTY INFORMATION �����
Permittce:S� , ' ��` � C,� ,,.,_ P.O. Box 848 ___ _
Name: �. ;���4'c� �?.��_ �. ������-`-':C`� Mocksville NC 27028 Subdivision Name:
� � � Phone #: 704-634-8760
Directions to property: �� �� " t��� Section: � Lot: �-"�
AUTHORIZATION FOR
� �'-:; :��^��• �:�� " � ��s c.. �'�.,?..u�i� WASTEWATER �' l.�C 1�
,
r' SYSTEM CONSTRUCTION Tax Office PIN:# �� bl -�-�� 1 J 1
., n "�
Road Name ���:� � `.T' ..�'.c; c,� 1� Zip: �^ ►,- �-� :.
**NOTE** This Authorization for Wastewater System Construction 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 Pernuts. `
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
• x, � :;�..�),�. h��-�' ***NOTICE*** Ti�S AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�'+<:�. .-�. �~"�3£�.r:. :=-_ 4.>,? �..�.. ��..�,�'� "�w� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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�" ' ' " ' DAVIE COUNTY HEALTH DEPARTMENT 1 � . � �� ^
`� - , ;, � . r
�ti� �s� �;� �' ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
, Permittcse's �rf. �� `� � �-• _..
.
;Name-' _ ,; ,� �
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�- Directions to pri�perty: �-� i� M�� �'~
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Subdivision Name:
Section: Lot:
IlVIPROVEMENT
PERNIIT Tax Office PIN:#� �', `�:� _ � ,.l _`�_. � s '�'"�
.. �� r .
Road Name + . - � Zip: - � � {
**NOTE** This Improvement Pemut DOFS NOT authorize the conshuc6on or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCITON must be obtained from this Department prior to the
' s construction/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)
-, ..-•4, ***NOTICE*** TFIIS PERMIT IS SUBJECT TO REVOCATION IF SITE
�.,` ,i: ,,,A.';;. �,.� M.,,�.� ti� PLANS OR TI� INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONM�NTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TfII.S PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFTCATION: BUILDING TYPQn •�`Y # BEDROOMS �# BATHS ��. # OCCUPANTS � GARBAGE DISPOSAL 'es'or No
COMMERCIAL SPECIFICATION: FACILITY TYPE ` # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WAST'E: Yes or No
LOT SIZE�' C�u�T` TYPE WATER SUPPLY 1 DESIGN WASTEWATER FLOW (GPD) t_ t+� '� NEW SITE V REPAIR SITE
i �
SYSTEM SPECIFICATIONS: TANK SIZ �Ob GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH .��, LINEAR FT. �J�
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. 11TL.1AD .
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
�
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNfY 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
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SYSTEM INSTALLED BY:
�
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AUTHORIZATION N0. �/ �� OPERATION PERMIT BY: i'C��'� ` DqTE: � l` �`''/ /
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAP'fER 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 TINIE. �
DCHD OS/96 (Revised)
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DAVIE COUNTY HEALTH DEPARTME
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�._ ,. . ` . ..NT � __ ,, , � �
»-_:;� _���;.' �? � � ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION �r.�� _cf �
, PermittEe's- - f --;+; J . ..... 1�J�"'�
y.; Name: ��" `- � i� Subdivision Name:
A � � - . ... •ti r � � . .
" ` Directions to.prbperty: f '> ' ! '" � Section: � Lot:
IMPROVEMENT
� . ,. PERNIIT
Tax Office PIN:#' � i - ; �� ``"'
Road Name• � , s Zip.;
**NOTE** This Impmvement Pernut DOFS 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 permit
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
• ,..�, ***NOTICE*** TIIIS PERNIIT IS SUBJECT TO REVOCATION IF SITE
_ .,..
, ..,
��;; ., �,.; " � f PLANS OR TI� INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENT'IAL SPECIFT�ATION: BUILDING TYP� �^tia. # BEDROOMS �_ # BATHS �-�` # OCCUPANTS ` V GARBAGE DISPOSAL es�or No
'' COMMERCIAI. SPECIFICATION: FACILTTY 1'YPE # PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No
� f _ ,\.,.
LOT SIZE �-�.` �-�-�``' TYPE WATER SUPPLY ��ti_s� DESIGN WASTEWATER FLOW (GPD) �' ct�� NEW SITE � REPAIR S1TE
� � �.
SYSTEM SPECIFICATIONS: TANK SIZE����� � GAL. PUMP TANK GAL. TRENCH WIDTH �' ROCK DEPTH �„%: 7 LINEAR Ff. ���
����i
, �
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
��.
-�
**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
..^
SYSTEM INSTALLED BY: �,/..-� �' j�,
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AUTHORIZATION NO. /� OPERATION PERMIT BY: Cf� 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 WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OS/96 (Revised) '
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APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
, Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
M (704) 634-8760 !
I
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed ' � Contact Person _��LLJ Z�=>Ci�' /t� > -.�
Mailing Address Home Phone CC.�— ��o�� �1
City/State/Zip l�-ri� ��'�( ���jL'`�� Business Phone �/�'1,;— g rl ��
2. Name on PermidATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [] Site Evaluation [] Improvement Permit & ATC [l� Both
4. System to Serve: [] House [�Iobile Home [] Business [] Industry [] Other
5. If Residence: # People� # Bedrooms� # Bathrooms '1 [�}-Dishwasher �] Gazbage Disposal
[�]'Washing Machine �sementlPlumbing [ ] 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: [�.County/City [] Well [] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [G]�
If yes, what type?
EZZHEIZ A PLftT OR SZTE PLtiN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A=�'I�'�'OF THE PROPERTY MUST BE
y SUBMITTED WITH T�ItS APPLICATION.
�L
Property Dimensions: ��3� � WRITE DIRECTIONS (from ocksville) TO PROPERTY:
Tax Office PIN: #ur 51 - �_ - � � ; �
Property Address: Road Name � A�� o N �c; � � �-
� ���.Ne '�
City/Zip � o L. 5 U � ;
If in Subdivision provide information, as follows: �
Name: -- �
�
�
Section: Lot #: --`— '
�
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 falsifed 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
DATE SIG
Revised DCHD (06-96)
to conduct all testing procedures as necessary to determine the site suitability.
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DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section SECTION
SoiUSite Evaluation
APPLICANT'S NAME � C~��\
�
PROPOSED FACILITY �,� �ca c��
SUBDIVISION
Water Supply: On-Site Well Community
Evaluation By:� �� Auger Boring � Pit
%a
FACTORS
I DEPTH
�0�
0����
�.�� � � � �
������
Texture rou � C.L, S
Consistence F �'- � ?
Structure �,
Mineralo '� �`.\
HORIZON II DEPTH � `'
Texture rou �,
Consistence
Structure
Mineralo � `.,\ '�'.�
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS SS
RESTRICTIVE HORIZON
SAPROLITE —' --
CLASSIFICATION . S_
LONG-TERM ACCEPTANCE RATE �
SITE CLASSIFICATION: � . —�'
LONG-TERM ACCEPTANCE RATE: �
REMARKS: _ �\ \ ��'�
DCHD (01-90)
0
0
��
LOT
DATE EVALUATED � ' �� � � �
PROPERTY SIZE �,_ 0�7�9—
ROAD NAME � O_�
Public
Cut
4 I 5 I 6 I 7
EVALUATION BY: \o��
OTHER(S) PRESENT: � O � �
�1.1_�i. d- c� � w�t�X.
" a' � 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 frm 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
Structure
SC - Single grain M- Massive CR - Crumb GR - Granulaz ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineraloev
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fll - 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 - gaUday/ft2
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