933 Danner Rd �avie County, NC , Tax Parcel Report a�3 Monday, October 3, 201 f
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WARNING: THIS IS NOT A SURVEY
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Parcel Information
Parcel Number: � F30000008201 Township: Clarksville
NCPIN Number: 5820276359 Municipality:
Account Number: 12664300 Census Tract: 37059-801
Listed Owner 1: CAMPBELL MARK T � Voting Precinct: CLARKSVILLE
Mailing Address 1: 126 GREENE CT Planning Jurisdiction: Davie Counry
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,I-1-S
State: NC Zoning Overlay:
Zip Code: 27028-6167 Voluntary Ag.District: No
Legal Description: 3.276 AC DANNER RD Fire Response District: WILLIAM R. DAVIE
Assessed Acreage: 2.74 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 10/2003 Middle Schooi Zone: NORTH DAVIE
Deed Book/Page: 005180778 Soil Types: PcC2,Ce62
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 164140.00 Outbuilding&Extra 3000.00
Freatures Value:
Land Value: 68500.00 Total Market Value: 235640.00
Total Assessed Value: 235640.00
��t All data is provided as Is without warranty or guarantee of any kind elther expressed or Implled Including but not Ilmited to the
�1RJ6� Davie County� Impiled warrantles of inerchantabllity or fltness for a particular use.All users oi Davie County's GIS website shall hold harmless the
1�T County of Davie,North Carotina,its agents,consultants,contractors or employees from any and all ctaims or causes ot action due to
�o��N�� 1�C 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
q�;s�t� Environmental Health Section '�I,.��� , ,
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. ._�, , `'�, P.O.Box 848
, �. , �
. .� � � ;5,�, 210 Hospital Street ���I� '
�U, ��. Courier# : 09-40-06 � �n��
. Mocksville, NC 27028 �
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Phone:(336)-753-6780 �' Fax:(336)-753-1680
ON-SITE WASTEWATER CER,�.I3'ICATION
� � (Check One) Replacement Remodeling Reconnection -
Name: �1/�/''-JC �'AmO�Ec �- PhoneNumber 3�6 � �d�' �6� �L�
Mailing Address: /Zu G jLFE�� ��"" �3� ��Z -Z�� Z (Work)
Y�--oG�,f✓���r �'C 2 �o `2-g Email Address:
DetailedDirectionsToSite: �A��►nf��l< �'v.4TeN�s , � �'3 (7j9i✓,✓��2 /LQ � /�OGlcfc/�[-�C
s"C `Z7G?-.�i , C�v�ivr�2 v� -t�i�i✓�c�' �2J /�."�D (��.� G'O/
Property Address: � 3 y ��n/n!G-� �OAQ
Please Fill In The Following Information About The EXIST G Facili • �
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Name System Installed Under: /1'I �-,� T C'�� � Type Of Facility: /Nl�
Date System Installed(Month/Date/Year): 2�QO? ��2 Number Of Bedrooms: .�"-'� Number OfPeople: 6
Is The Facility Currently Vacant? Yes � If Yes,For How Long?
Any Known Problems? Yes � If Yes,Explain:
Please Fill In The Following Information About The NEW F�cility:
Type Of Facility: 1��h r���2 fTd(L.�-6� �'Y`��ber Of Bedrooms: � Number of People .�i`
'Pool Size: �' " Garage Size: ZO�� S� �_ Other: �
Requested By: ��� i� C Date Requested: � � � S� — l�
(Signature)
For Environmental Health Office Use Only �
prove Disapproved
Comments: �
Environmental Health Specialist Date: �s �—
*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 Check Money Order # Amount:$ Date:
Paid By: Received By:
Account#: Invoice#:
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All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied
warranties of inerchantability 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 or arising out of the use or
� inability to use the GIS data provided by this website.
, , , � .: , . DAVIE COUNTY HEALTH DEPARTMENT ����/�'G
, � Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001193 Tax PIN/EH#: 5820-37-0250
Billed To: Ronnie Bamette Subdivision Info:
Reference Name: Ronnie Bamette Location/Address: Danner Road-27028
Proposed Facility: Business Property Size: 18 Acres ►(�,
�� � �
ATC N p�b r: 2431 � ``
**NOTE** �hls�mprovement/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 11 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 r// i� �/lv "' #People .S #Bedrooms #Baths
Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑
Commercial Specification: Facility Type������#People �#People/Shift f #Seats Industrial Waste: �
Lot Size Type Water Supply��// Design Wastewater Flow(GPD) / �� Site: NewU Repair❑
.
System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width���Rock Depth� Linear Ftp�J
Other:
Required Site Modifications/Conditions:
IA'IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 u BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis
system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.****
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Environmental Health Specialist's Signature: Date:_�$' —��(�
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DCHD OS/99(Revised)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Heaith Section
P.O.Boa 848/210 Hospital Street
Mceksville,NC 27028
(33G)751-8760
Account #: 990001193 Tax PIN/EH#: 5820-37-0250
Billed To: Ronnie Bamette Subdivision Info:
Reference Name: Ronnie Bamette Location/Address: Danner Road-27028
Proposed Facility: Business Property Size: 18 Acres
ATC Number: 2431
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). T'his 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 WASTEWATE ONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: �� Date: ,�;��'��
CERTIFICATE OF COMPLETION
**NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on ImprovemendOperation Permit
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.
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Septic System Installed By: ����i'[�Ci2iI21�q't_�.�i"n'
Environmental Health Specialist's Signature: /� Date: � --,/5/CO�
DCHD OS/99(Revised)
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APPLJCATION FOR SifE EVALUATION/IMPROVEMENT PERMIT&ATC
. Davie County Health Department � � 9 2000
Environmenta/Hea/tfi Se�clion
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 Et�VIROhtAENTAI HEALTH
(336)751-8760 DAVIE COUNTY
***I1�ORTANT*** THIS APPLICATION CANNOT HE PROC�SSED UNLESS ALI� THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed /ttJ��� Contact Peraon��,ifi/fil� �/K���%
Mailing Addreae � � Home Phone 3 ��� 7�'%�`//�/
City/State/2IP /p!/J�j�l' ,�.�1� /�'�v�� Businesa Phoae ��(�-'y"/��l'/�
2. Name on Permit/ATC if Different than Above
Mailinq 1lddreea City/State/Zip
3. Appiication For: ❑ Site Evaluation ❑ Improvement Permit/ATC �] Both
a. syat� to se�ice: ❑ House ❑ Mobile Home �Business ❑ Industry ❑ Other
s. �f Ftesidence: � People t Bedrooms � Bathrooms
❑ Dishvasher ❑ Ga=bage Diapoeal ❑ waehinq Machine ❑ Basement/Plvmbinq ❑ Basement/No Pltambiag
6. If Suainesa/Induatry/Other: Specify type /j�RG�Gl�/(' .��1�0 � People N 3inka �_
# Co�odes � i Shoxera # Vrinals �k Water Coolera
IF FOODSERVICE: # S�StB Estimated Water US8c,�@ (gallone per day)
�. Type of water suppiy: � ❑ County/City E�Tell ❑ Community
s. Do you anticipate additions or eapansions of the facility this system is intended to serve? ❑Yes ❑No
If yes,w6at type?
***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Eit6er a PLAT or SITE PLAN MUST BESUBMI7TED by the client with THIS APPLICATION.
Property Dimensions: !-r� ,.�Gh,�S WRITE DIRECI70NS(from Mocksville)to PROPERTY:
Taa Office PIN: # ����� 3����� 7�0 /��i'�'<'v O�— (r���, E'��
Property Address: Road Name�� d�`�l� f.3�-/'� ���iPi�i'�'0/b' �.�c�''—����('.G�%
City/Zip //�?l.�'"...1i�'��L� �____=���� ?�t3 .�9�.0 �Q�% /�jE'. ��,L�dy�.e'�
' /
If in a Subdivision provide information,as follows: /'.,� � �-�l��,� [ �J� �9✓.'�PI��
Name:
Section: Block: Lot: Date Property Flagged: ��l�, ��-e��
This is to certify t6at the iaformation provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revacation,if the site plaus or intended use change,or if the information
submitted in this application is falsified or changed. I,also,understand that I am responsible jor all charges incurred jrom
this appl}cation. I,hereby,give consent to the Authorized Representative of t6e Davie County Health Department
to euter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE SIGNATURE -�''���
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the foltowing: Eaisting and proposed
property lines and dimensions, structures, setbacks, and septic locations).
�;�5,_�� � Site Revisit C6arge I
�
� � ����y Date(s):
� C �� � � Client Notification Date: �
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EHS:
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o � W � Account No. �
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Revis DCHlll�07/99)� Q � � ��� Invoice No. /
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� , ' ,� ~. � DAVIE COUNTY HEALTH DEPARTMENT
Environmentol Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990001193 Tax PIN/EH#: 5820-37-0250
Billed To: Ronnie Bamette Subdivision Info:
Reference Name: Ronnie Qarnette Location/Address: Danner Road-27028
Proposed Facility: Business Property Size: 18 Acres Date Evaluated: �-r2 -2 ��
Water Supply: On-Site Well ✓ Community Public
Evaluation By: Auger Boring (,� Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition
Slo e%
HORIZON I DEPTH
Texture rou
Consistence
Swcture
Mineralo
HORIZON II DEPTH " �
Texture rou
Consistence / l
Structure i
Mineralo
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION -
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: ,y� EVALUATION BY: .
LONG-TERM ACCEPTANCE RATE: � ' OTHER(S)PRESENT:
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
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-Angulaz blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralo�v
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 OS/99(Revised)
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