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2165 Davie Academy Rd�avie Cs�untv.'NC Tax Parcel Renort Wednesdav, October 12, 201 E WAIZNIN(�: '1'H1515 NU"1' A SUlZV�Y �-�..�.�.��.� ,.�,��,_�� .�a «�w �2 ��,� t..��,�,s, .,��e�,.�� m�a�.�,_ .. , ,�� --�--�— _ _ � Parcel Information �:� _,. ��_ ��,�..��_ �.;. �.. �� ti�� .��,a ..�� ,,, ..,��,�, _ �,� �� . ��,.�. Parcel Number: J10000005301 Township: Calahaln NCPIN Number: 5708237307 Municipality: Account Number: 12416500 Census Tract: 37059-801 Listed Owner 1: CALVARY BAPTIST CHURCH Voting Precinct: SOUTH CALAHALN Mailing Address 1: 2273 DAVIE ACADEMY ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 4.11 AC DAVIE ACADEMY RD Fire Response District: COUNTY LINE Assessed Acreage: 3.85 Elementary School Zone: COOLEEMEE Deed Date: 4/1988 Middle School Zone: SOUTH DAVIE Deed Book / Page: 001430121 Soil Types: PcC2,CeB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 506490.00 Outbuilding & Extra 17110.00 Freatures Value: Land Value: 36580.00 Total Market Value: 560180.00 Total Assessed Value: 560180.00 9"°�'F Davie County, °�UN�� NC _ _ �. , : _ _ . : . , ,. .. , , _ .,. . , , . � ; _.... _ ' '- � AUTHOR�ZArtION NO: �� ' � DAVIE COUNTY HEALTH DEPARTMENT ��XO � Environmental Health Section PROPERTY INFORMATION Permittee's �z�-�; � P.O. Box 848 � Name: �7��t��i� ti ��t 1�j�f `'�ttiTG � Mocksville, NC 27028 Subdivision Name: /' Phone #:704-634-8760 _ Directions to property: � �`�9 d� �(c ��1��` Section: Lot: /� ' AUTHORIZATTON FOR �Cd(��MY f�.rz ,'�7 v: r� ( L� , �� J�^ � WASTEWATER Tax Office PIN:# �'J�lUc� _ �7j - = ��"� . •--� SYSTEM CONSTRUCTION t?1J (. �:.� ,i��`1i: f� �'L � r� l �,tr Road Name: �� :r..�ip; `� i� . **NOT'E** This Authorization for Wastewater System Construction MUST BE ISSLIED by the Davie County Environmental Health Section prior to issuance of any Building Pemuts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance witl} Article � 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) . � / r, . � � �� ti� dS'�'� DATE IS U D c_..._.. ***NOTTCE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALm FOR A PERIOD OF FIVE YEARS. ; . __. _ , , . ¢ . . . . .. . V� �.� �i'. � � �i' � . . - r � � xO . . . ., ;..^ ,�, � : � DAVIE COUNTY HEALTH DEPAkTMENT ,- .- '�� _� ,TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION :Per�nitte�'� ;`_ _. , Name.'- _.�y`�l.1rr��': L, �"s E"� t�" ;l:�i '.�r. � t c? 'G` "`� Subdivision Name: .�'"'�Di�ections to property: `.{� F� ;'; �-� j�: � d Section: Lot: — '� ,,,, � . Il�IPROVEMENT s ry ' nE;� �`;.'�,;.,�,�' ��.r.. �c,�r1 �,�} ;�,,�! PERMI'I' ` �. :.{ ., _�c. .,.,y � '� 1 t•- Tax Office PIN:# - � s_ � � . __ f .... r5 �'� �` � . � 4.� �. '<�_ . r. _'• � l j - l r ` !, l�. � �'`` j { � , A. i J t- i �: . � ,r � � . :" � -�% F� Road Name � . ., t � � - `�ip: ,r;, it : � **NOTE** This Improvement 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 pernut. (In compliance with Article � 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) . � ,� '+' i� �` ***NOTICE*** THLS PERMIT IS SUBJECT TO REVOCATION IF SiTE �ti ;'! . • ,f P ` ... 1 �� - -"' ? <l ; •:, � PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ��ENVIRONMENTAL HEALTH SPECIALIST `' DATE IS U D SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE c .. INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No �-��w�JN�� COMMERCIAL SPECIFICAT'ION: FACILITY TYPE �L # PEOPLE.�Q # PEOPLF/SHIFf # SEATS INDUSTRIAL WASTE: Yes o 10 LOT SIZE l� LS Z'ypE WATER SUPPLY �GL1.._ DESIGN WASTEWATER FLOW (GPD) � NEW SITE �REPAIR SITE ii SYSTEM SPECIFICATIONS: TANK SIZE �� GAL. PUMP TANK GAL. TRENCH WIDTH �^ ROCK DEPTH lZtt LINEAR FT. �� OTHER � C�1�'1-� 1 �JTlon� �-� ! REQUIREDSITEMODIFICATIONS/CONDITIONS: I'�-�G� St�S�T�M � G(�rF rT��T�>�� ,�pl.t� L1r.}i; U�p�� UR11�� M/,�i�.JiA�,"I /D` S�('qz?eT�,�,J O(-F �TLuE';;2�Y �.-�►�L IMPROVEMENT PERMIT LAYOUT � ��'� ZZs' �c T�t..�:�'rEc�a::. � ��' �� F �'�t� ";:'� /� ��J � 7�i � � 1-� la �. i.- F�cr�� G��t ��v, �.x�ST�►.�� aaC_TvAQ'f � �c�b k v�''u /Z �i .\a *"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: �'T�� jv �� ,�� ,�A�. � �1,� roo'x.�z "��" 9�,' �� ou r� � � ; �� , .., � �i. �.c�51� � P N��-�- ' �2�t' l AUTHORIZATION NO. "�� OPERATION PERMIT BY: / DATE: Z 9 9' � **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBE VE 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 WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) ��- �� = APPLICATIOP�T FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC _ Davie County Health Department �� 0� n� Environmental Health Section D V P.O. Box 848 Mocksville, NC 27028 NOU 2 51997 (704) 634-8760 � . ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCE5SED 1 THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed 5�� Cfi�n 5'�-� �� `�' n Mailing Address �" %7 S h� � i�Of fS l�d � City/State/Zip ,� (.L' � S (% � ( �i n L' � 7�2 d' 2. Name on PermidATC if Different than Above �a- /�0.1� �� ; L Contact Person � / !YM �in s �,) HomePhone �_��'>' /S �� ► Business Phone �1/� '� � l ,� p�� L�ltiu —c G� ' �--�^� oc ksv" . c� `� �,8 Mailing Address A 1�i �� CC� City/State/Zip 3. Application For: [] Site Evaluation [] Impro ent Permit & ATC �Both f 4. System to Serve: [] House [] Mobile Home [] Business [] Industry [] Other ��clJ S,�r P l�� 5. If Residence: # People # Bedrooms # Bathrooms [] Dishwasher [] Garbage Disposal [] Washing Machine [] Basement/Plumbing [] Basement/No Plumbing 6. If Business/Other: Specify type �2-%��iU � �! � ►A� � � # People�Z #Sinks� # Commodes � # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [] County/City [�ell [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [� 10 If yes, what type? i,: . EZZHER tt PLttT OR SZTE PI�LN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***�AC,k'.L��C OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: / v �/ �� WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #_ 7 ��-�_ -� ; N a V �n �l �> T S� f� Property Address: Road I�jame �U►N NC�i ��rn� � (7� • � �svi�f' �� l� rny �C�� r City/Zip ��4^�5(Jir��P o� %�%�-� ; n ('� ? Y1� � � �P r ��1 GGr'�C % If in Subdivision provide information, as follows: ��'` �-^� • 1—P �j�w S N�� (1 Name: � ��. in � n ��C'\ � � 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 �f to conduct all testing procedures as ne ssary to determine the site suitability. DATE /� � 01 a' / SIGNATURF 1"�i��i�_� y� " Revised DCHD (06-96) �, THZS A Ett ti1t1J 13E USEb �'OR blZttli�ZNG JOUR SITE PLAN: � �� ' .�'_ 0• .�_ �jv�l�si�.� .� s � ,�..� —� � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME ��-��'�T�G' �`"� DATE EVALUATED 1ZIZIcI�I PROPOSED FACILITY �f�-�� l i l� ��- PROPERTY SIZE %� �-�-�' SUBDIVISION ROADNAME I•Wv1� �C4��M� Water Supply: On-Site Well Community Evaluation By: Auger Boring � Pit 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 lc Public Cut 3 4 5 6 7 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ,� LONG-TERM ACCEPTANCE RATE D• p. � SITE CLASSIFICATION: . �" S LONG-TERM ACCEPTANCE RATE: �' I REMARKS: � `"� �`� . I • 1 � So �^�- fivL�R-�2 LEGEND DCHD (01-90) EVALUATION BY: ��- �cJGrL/�� OTHER(S) PRESENT: 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 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 Mineralogv 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 - gaUday/ft2 ■■■■�■ ■�■■■■ ■��■ ■■�■�■ ■■■■�■ ■■��■ ■■��■ ■■■■■■ ■■��■■ ■■��■ ■��■ ■■��■■ ■■��■■ ■■■■■■ ■��■■ ■�■■■■ ■�■■�■ ■�■�■ ■■■�■ ■■■■■ ■■■�■ ■■��■ ■��■ ■■■■■ ■■■■■ ■■��■ ■■■■■ ■��■ ■■■■■ ■�■■■ ■��I�■ ■��I■■ ■�■�1■■ ■■■�1■■ ■��I�■ ■��■ ■■■■ ■��■■ ■■��■■ ■��■ ■■■■ ■ ■■■��■ ■■■■■■■ ■��■■ ■■■■■■■ ■■■■■■■ ■��!■ ■■�I►7J■ ■�il��■ ■■■■■■■■■■��■■ ■■�■■��■�■■■ ■■��■ ■�■■ ■■■��■ ■�■■ ■■��■��■ ■�■��■■■■■■■■■ ■�■■��■ ■��■■��■■■ ■■��■�■■��■ ■■■��■�■��■ ■■��■■■■ ■■■■ ■■■■■■■■ ■■■■��■�■■■■■ ■■■■■■■■��■ ■■�■■��■ ■��■��■��■ ■�■��■��■ ■�■■■■��■ ■��■■■■■��■■ ■■�■H■��■�■■■ ■■�■■■■ ■��■ ■��■■ ■■■��■ ■��■�■ ■■■■■■■ ■■■■■�■ ■■■■■�■ ■��■��■ ■�■��■■ ■■■■■■■ ■��■ ■��■■■ ■■■��■ ■�� ■��■ ■�■�■�■ ■■■■■■■ ■��■ ■■■�■�■ ■■��■■ ■■■■■�■ ■��■��■ ■■�■��■ ■�■■�■■ ■��■ ■��■■■■ ■��■�■■ ■��■�■■ ■��■�■■ ■��■�■■ ■■��■■■ ■�■■■■■ ■��■■■ ■��■■■ ■�■■■■�■■■�■■I■G►7��■■�■■■■■■■■��■■■■■■■■��■�■��■■■��■■■■��■ ■�■�■�■�■��■�I��■!!■■■■■��■��■�■■�■��■■■■■■��■��■��■■��■ ■■■�■��■■��■�I��li�i■■■■■■�■■��■��■��■■■■■■■��■��■��■■■ ■�■��i��■�I■■LV■■��■��■■■■■�■■��■■��■■■■�■��■��■■■ ■��■■■■■■■w��i■��■��■■■■■■■�■��■��■■��■■��■�■■■��■ ■■��■��r.��i■��■■■�■��■�■��■��■■■��■��■■■�■■■■��■■��■■ ■■t��,.ar�■■i�■�r�■■��■�■■■■�■■ ■��■�■��■�■■�■��■■�■�■■■■�■■ ■■�■■i�1�i'�I��J\�1;�1\a■��■■■■■��■■��■■■�■■��■■�■��■�■■■■■��■■■■ , �.,�� DAVIE COUNTY HEALTH DEPARTMENT �.~ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION .: ., � . . �• *.NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) � Permit Number Name �� '� ` ��( Date %� f., ;� •;�_ _ .•, i., ,�� , " , - , � . .� . . ��. Location ' / f '' . / � .<=•. , i' l ' � i' _ ,• , ;-��=± � . , -r-----=— Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business — Soeculation No. Bedrooms Garbage Disposal Auto Dish Washer Auto Wash Machine Type Water Supply , _ No. Baths f' No. in Family %c' /,' r' YES ❑ NO ❑ Specifications for System: YES ❑ NO � ,', ' . ., , , - . t r' , � ,"� , YES ❑ NO �❑ � _- - : �",� � �,,�r , ,� `This permit Void if sewage system described below is not installed within 36 months from date of issue. 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 Number: 704-634-5985. Final Installation Diagram: , ; �� System Installed by '', % -�1-�� C /ls''�� .�;' i � � I C._ � � �-''_.._ _ � � �� . , � i � �. , � I � `�� _-- ;%,, �� . , � . Certificate of Completion _�J �-�`-��'��. Date �� ' �'� � ��-'= "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. . , � �PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT � � � � � / Davie County Health Department �, � � Environmental Health Section ' /�� P. O. Box 665 � Mocksville, N.C. 27028 � G' � - '� �1 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. e � ��a- �-� � q ,,I, Home Phone 1. Permit Re uested By �A�VQi4 �-{�t�t C`h�`�-� �c�T�V�� lc�t��Business Phone 2. Address �� -��'K �� -� ��c�vi1��, t�G �.iC�.�Fi 3. Property Owner if Different than Above C�� varti ��5�., �vxc% Address 4. Permit To: a) Install� Alter Repair. b) Privy Conventional ✓ Other Type Ground Absorption c) Sub-Division Sec. Lot No. G�µ� 5. System used to serve what type facility: House Mobile Home Business Industry Other � b) Number of peopte ISo �a.,�-c..�, 2��-C tia�,,...� �,...1-� - ro K: }��- n�w 6. a) If house or mobile home, state size of home and number of rooms. ��. �t IC'. �a-•- �� °'�� ` `�"�" House Dimensions Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served � � What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes � urinals lavatory — dishwasher showers sinks 8. a) Type water supply: Public Private ✓ Community b) Has the water supply system been approved? Yes No `� 9. a) Property Dimensions 5ee d�ugran. %eiow- b) Land area designated to building site 37�rD � �'� , c) Sewage Disposal Contractor garbage disposal washing machine 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. �_ 2�-8�� ' , Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ��,, i • �'� ,��- �z�- 5��-�-. �J%�- / f�v� ' S'c.c� i'Clti�jy-� e DCHD (6-82) S_b,�cJU �{- �/t Y! t �" �1_ _�- � U'�/r� t/ lE'l� (sk �i y3�