395 Deadmon Rd�avie County, NC � Tax Parcel Report Wednesdav, October 12, 201 E
WARNING: THIS IS NOT A SURVEY
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' Parcel Information "
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Parcel Number: K500000019 Township: Mocksville
NCPIN Number: 5747443077 Municipality:
Account Number: 25224500 Census Tract: 37059-805
Listed Owner 1: FELTS KEITH ALAN Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 395 DEADMON 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: 38.28 AC DEADMON RD Fire Response District: JERUSALEM,MOCKSVILLE
Assessed Acreage: 36.70 Elementary School Zone: CORNATZER
Deed Date: 5/1992 Middle School Zone: WILLIAM ELLIS
Deed Book / Page: 001630861 Soil Types: Mr62,PaD,GnB2,EnB,GaD,CeB2,ChA,MsD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 489950.00 Outbuilding & Extra 61420.00
Freatures Value:
Land Value: 230850.00 Total Market Value: 782220.00
Total Assessed Value: 592300.00
9" �'A Davie County,
`'oUN�� NC
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Au�O �IZ�TION'N�: ���� DAVIE COUNTY HEALTH DEPARTMENT
>'-,� �`� , Environmental Health Section PROPERTY INFORMATION
Pemiittee's *'"� ,r ,l � •�r� P.O. Box 848
Name: ���' t`��" J C"a' f��+*"�'�'�,'''��'°' �r;,�;�,'".,,,r' Mocksville NC 27028 Subdivision Name:
� i � e Phone #: 704-634-8760
Directions to property: ����/�;�7:"- ��� Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTTON
Tax Office PIN:# ''�`"�-'-'" "'��� ,-�t� '" �
�.- ��
Road Name: � ` Zi a � �
p: :� `� � - �'
**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
O�ce when applying for Building Pernuts.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
��
;1,/' �/,.�5 ,r,.-=;-�'�-'f' �
ti,�*,,
RONMENTAL HEALTH SP CIA
%� ,,r� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
_ �` �'%� IS VALID FOR A PERIOD OF FIVE YEARS.
/ DATEISSUED
�
i ' � � y 1q � i:. , i � � ��r�'��` �
`" ':Q r� �-;�. � ' , «� " �"� T � �� �;� DAVIE COUNTY HEALTH DEPARTMENT �"
�°�'=`� *.� ' TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
,'
Perm�tteers °;r" � °° �'� ' � .�,.' '�� �
Name t.� t c. �; r�F f r'�"�: �""'� J�� � '��w ��' Subdivision Name:
' � �. � � , '' • e „�,.,�+ � . .
' . .... . , . � ., �q .I� . . : ' 1.
,. Directions to property: f;_` •,' fr� Section: Lor.
. IlVIPROVEMENT
PERMIT Tax Office PIN:#..;4'r''"�-' �t= "�: : :' G� `:' �'
� � ��-. • ..
. . ��e'� ! .. �.
. � � . . a�]'y't � J � � A � ' 1 , i�
Road Name .�' w. � �'; � ,� �t . ��''Lip: '-'M° f/ �-•` � R :,
I**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 CONSTRUCTTON must be obtained fivm 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, Section .1900 Sewage Treatment and Disposal Systems)
i F; r �, f.: ` --- �.� �`.;='` "**NOTICE*** TEffS PERMIT IS SUBJECT TO REVOCAITON IF STI'E
,, .' f,�' ���,�, . r �:��. :'-�'``�i; ,�....�� r",r+�` ,� ,.s PLANS OR TI� IlVTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST /� DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMTf BEFORE
\
{ INSTALLING TI� SYSTEM.
RESIDENTIAL SPECIFTCAT'ION: BUILDING TYPE e'�it # BEDROOMS �,.,•`'��# BATHS �# OCCUPANTS � GARBAGE DISPOSAL: Yes or No
�
COMMERCIAL SPECIFICATION: FACILTfY T'YPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ���'� ` TYPE WATER SUPPLY �r/% DESIGN WASTEWATER FLOW (GPD) ��=�°�(� NEW SITE J./" REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE �r �r.) GAL. PUMP TANK GAL. TRENCH WIDTH �� � ROCK DEP'I'fi �_ LINEAR FT.. �I�� �
REQUIRED SITE MODIFICATIONS/CONDTTIONS:
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.
OPERATION PERMTT
SYSTEM INSTALLED BY:
t—
_ � — � �—� -
AUTHORIZATION NO. � OPERATION PERMIT BY: DATE:G ��
**THE ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED N C�MP I�CE
WITH ARTICLE 11 OF G.S. CHAP'TER 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)
.� `" APPLICATION FOR SITE 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 UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed C�'o � a� �<� (3� •(��' �� c Contact Person � Q��'1 � r�
Mailing Address 1 � �/ �w ..i �S � � s Home Phone g Qi ��5�8'"t y
City/State/Zip '�'� va-n t,t, �'V L aZ oD 4 Business Phone q' �i O-a 3�1/
2. Name on PermidATC if Different than Above 11i c�� � T-- a�� ��'S
MailingAddress 3$ S �ccss � r�o.— Roo� City/State/Zip (�%o� �s �`1 t�
3. Application For: [] Site Evaluation [�Improvement Permit & ATC [] Both
4. System to Serve: [�iouse [] Mobile Home [] Business [] Industry [ J Other
5. If Residence: # People�_ # Bedrooms� # Bathrooms� [vj'Dishwasher �Garbage Disposal
[�Washing Machine �Basement/Plumbing [ ] 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 [] No
If yes, what type?
�
E Z THER tt PLAT OR S I TE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT **'��IE�A�`I' OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: .3.s ���cS ; WRITE DIRECTIONS (from Mocksville) TO PROPERTI':
Tax Office PIN: #� - `��I-30 - "r % ;
Property Address: Road �ame ����o ��ua d �
City/Zip � G�s.. � ��G ;
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 falsified 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 entey�npsy► abyv�d�e�roperty located in Davie County and owned
by
DATE
to
Revised DCHD (06-96)
THIS ttRE,1 �lttlj $E USEb �OR 1�RA�VINC� 1jOUR SZTE PLAN:
necessary to determine the site suitability.
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department �
Environmental Health Section D
P. O. Box 848
Mocksville, NC 27028 1
(704) 634-8760 �` i
*'��*IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED i�1
ALL THE REQUIRED INFORMATION IS PROVID�
1. Name to be Billed 'f�P t`tv i�� ��� Contact Person
� c� � a��
SEP 2 6 ,�:;;; !�
� �
MailingAddress ��J`— JJ.P��'Vin/1 �OGt� HomePhone �.��- �/.Tc4'
City/State/Zip �'1LY+�V1 �fQ� e, o'270c�g BusinessPhone '1D'�/-�.��'cSliS 7
2. Name on PermidATC if Different than Above
Mailing Address
3. Application For: � Site Evaluation
4. System to Serve: L�7 House ❑ Mobile Home
5. If Residence: # People
_ City/State/Zip
❑ Improvement Permit & ATC
❑ Business ❑ Industry
# Bedrooms
❑ Other
# Bathrooms
❑ Both
❑ Dishwasher ❑ Garbage Disposal 0 Washing Machine ❑ Basement/Plumbing ❑ BasementlNo 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 ❑ No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: �� . � C�L C"�S
Tax Office PIN: # rJ�%y� -'�y 3� - �1 "1
Property Address: Road Name �� �PCic�Ma►� �a� •
c�ry�z�P Moc-ksvill-e 1�[,C `�����
� If in Subdivision provide inforrnation, as follows:
Name:
Section:
Lot #:
WRITE DIRECTIONS (from
Mocksville) TO PROPERTY:
(ob� S. �.Ctrrl � e�'
I �ind�iihan ,�' . , t 1 ��
2 a � /e++.
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter
aze 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 �� G1►��j �i YIC� f'Q �� to conduct all testing procedures
as necessary to determine the site suitability.
DATE 9�c2 �(0 SIGNATURE �JL1ua CC ��p J�J�Q
Revised DCHD (06-96)
p��Q.0.5e L���� ��ti�1 �u h�? Can �o w�4�� Y�u .
,� . � , ; DAVIE COUNTY HEALTH DEPARTMENT
• . � _ , Environmental Health Section
�
Soil/Site Evaluation
NAME �Pi 1� �� c,�;�� DATE EVALUATED / b-� � J�
ADDRESS �J���'� PROPERTY SIZE �� ��
PROPOSED FACIILTY �� �"� p LOCATION OF SITE �-�-+�"�'�'°��
Water Supply: On-Site Well � _ Community Public
Evaluation By4��AugerBoring Pit Cut
FACTORS 1 2 3 4
Landscape position S s _ �__ � � � ___ ___
Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
MineraloAy
Texture grou
Consistence
Structure
Mineraloev
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RAT
0
�
�
SITE CLASSIFICATION: � 1' '
LDNG-TERM ACCEPTANC RATE: —
REMARKS: ��_ �����;
DCHD (01-901
0
�
�
�
EVALUATED BY: � �
OTHER(S) PRESENT: �\�S��� ��.��0
. _�� _
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-Si1tY •:lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-V+�-y friable FR-Friable FI-Finn VFI-Very firm EFI-Extremely firm
Wat
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
,iC--SYn�le grain M-Massive CR-Crumb GR-Granular ABK-MQular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mi neralaic�►
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 wate�' 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
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section /� �
P. O. Box 665 , ������
Mocksvilie, NC 27028 �I'
1. Application/Permit Requested By �`� ey � tire v `�r ��s �� ����
Mailing Address ���i • � 4� �7� � � �I � � � V� ld C �P /t� �'� �� %bb �
Home Phone � ��— �.� � �- Business Phone ,�'7 �7� ' i % 3�
2. Name on Permit if Different than Above �'( �► T� "�e- /��S
—
3. Application/Permit for: C�General Evaluation �eptic Tank Installation
4. System to Serve: �House ❑ Mobile Home ❑ Place of Pubtic Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
No. of People �
No. of Bedrooms 3
No. of Bathrooms �--
Dwelling Dimensions v� �" �5-�--
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks _
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: ❑ Public ❑ Private
8. Property Dimensions Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? � Yes
If yes, what type?
�'BasemenUPlumbing
❑ BasemenUNo Plumbing
C�' Washing Machine
�Dishwasher
❑ Garbage Disposal
■ .
❑ Communiry
*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:
� £ �l � Ic� b /� c�
�ti le�-�,
- > • �
�S � e
/ e �� � �-� > >e �o ��� �e��
/� -��/� C 1� e c�
LI
�
1
This is to certify that the information provided is correct to the est of my
incurred from this application.
�-�.�^ q�
DATE
SI
I understand I am responsible for all charges
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. I OWN the property. p 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 of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE
DCHD (12-90)
SIGNATURE
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
, Soil/Site Evaluation
NAME
�/J - �l ' `- � "-�� DATE EVALUATED `�� �_S '��
ADDRESS • PROPERTY SIZE /r�-�C
PROPOSED FACIILTY ��'�1�� LOCATION OF SETE �i�iT?'�✓
Water Supply: On-Site Well Community Public �
Evaluation By: AugerB�ring i� Pit Cut
FACTORS 1 2 3 4
Landsca e osition .C� L� -� -!
Slo e 7. � s �
HORIZON I DEPTH �
Texture rou /
Consistence
Structure
Mineralo
HORIZON II DEPTH �'" �' -��'" 1��
Texture rou � (` l'
Consistence � t -C:- i
Structure /„�' �/� � /.L �iyii
MineraloQy /, �/ %� /f % .�. 7
HORIZON III DEPTH
Texture group
Consistence
Structure
MineraloRY
HORIZON IV DEPTH
Texture group
Consistence
Structure
MineraloRy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LDNG-TERM ACCEPTANCE RATE:
REMARKS: �1'1�_.�i''C�/%�
DCHD(01-90�
� i - � i
EVALUATED BY: ��''"
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
Textvre
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
Moiat
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
Structnre
SC-SYngle grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
F�Iincralo�zy
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - tn inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free watef 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
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✓ • , '
� `� X.
.; �.
Keith 1=elts
cio l�ilb�r�t Naqer
Yft. 1� �{OX ,:iE+y-H
HdvancE, N� �7�v�b
llear Reaitar�:
�D�ine Cvunfy .�fealtFi ?�eparhneiit
and �fome ..�fealt�r .�1"�ency
210 NOSPITAL STREET I P.O. BOX 685
MOCKSVILLE, N•C. 27028
PHONe: (704) 634•5985
PiPr�l l til�[.�� �7y4
Fte: �ite Evaluation
Ueadmon Raad
Ns requested, a r-•epresentative from this o1�l�ice visited the aforemen�ioned
site on �pril �3, 1y�3c. I'he site was fio�md pr,ovisionaily suitable for the
installation of a gro�md absarption sewage system.
Yh you have ar�y questions� please feel free to contact this office.
Sincerely,
��� l
,,,�;�;� ;,-�x�����,� ` �..
Hobert li. Hal l, Jr. , Ft. 5.
�nvironmental He�ltl� Section
KH/wcJ
tnciosur�c
.,
` .` , .
, •
Mr. Gilbert Boger
Rt. 1, Box 569-A
Advance, HC 27006
Dear Mr. Boger :
JQHH T. BROCK
County Attorney for Davie Co
P. 0. Box 347
Kocksville, KC 27028
July 1, 1992
Re: Site Evaluation/Bobby Bodford - 550.00
Billed 04-23-92
Site Evaluation/Keith Felts - 550.00
Sevage System Check/Cabe-Felts -.550.00
Billed 04-30-92
According to our records, you are in arrears in the amount of 8150.00
on your account with the Davie County Health Department for environmental.
health services provided by our agency on your behalf. These fees were due and
payable at the time the service rras provided and are nov past due. Please
arrange to complete payment of the above amount vithin 10 days from the date of
this letter; othervise, I will be compelled to take action to collect the said
amount. Please send payment to the Davie County Health Department, P. 0.
Box 665, Mocksville, N.C. 27028.
itespectfully yours�
��� �
John T. Brock
County Attorney for Davie County
JTB:eh
S
�-w - : - 27avie County �CeaCth �eparttnent
. ' and .�-Come .�CeaCth �'.gency
�nvironmentaC�L'eaCth Section
P.O. BOX 848 / 21O HOSPRa� STREEr
COURtER #i09-40-06
MxKSVILLE, N.C. 27OZB
PHONE: (704) 634-8760
October 8, 1996
Keith A. Felts
385 Deadmon Rd. .
Mocksville, NC 27@�8
Re: Site Evaluation
Deadmon Road/38.� Acres
7ax F'IN: #5747-44-3�77
t�
De�r Clientp�'
�
Rs req��ested, a representative ft�om this office visited the
aforementioned site on October 4, 199E. 8ased upon the inform�tion
provided on the application for site eval�iation and after the evaluation
was completed, the site was found to be provisionally suitable for the
inst�llation of an on—site sew�ge disposal system.
If you h�ve any questions, please feel free to cont�ct this office.
Sincerely,
�....�� �- - ,�
�.
Charl es E. Litt le, R. S.
Environmental Health Section
CL/wd
Enclosurets)