254 Deer Haven TrailDavie Countv, NC
Tax Parcel Report
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WARNING: TI3IS IS NOT A SURV�Y
Parcel Information
Parcel Number: K5150A0015 Township:
NCPIN Number: 5746290683 Municipality:
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Jerusalem
Account Number: 43736000 Census Tract: 37059-807
Listed Owner 1: LAGLE JEFFREY A Voting Precinct: JERUSALEM
Mailing Address 1: 237 DEER HAVEN TRAIL Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-6682 Voluntary Ag. District:
Legal Description: 8.544 AC E OF HWY 601 Fire Response District: JERUSALEM
Assessed Acreage: 9.07 Elementary School Zone: CORNATZER,COOLEEMEE
Deed Date: 10/1995 Middle School Zone: SOUTH DAVIE,WILLIAM ELLIS
Deed Book / Page: 001830629 Soil Types: GnB2,GaD,ChA
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Building Value: 0.00 Outbuilding & Extra
Freatures Value:
Land Value: 44460.00 Total Market Value:
Total Assessed Value: 82420.00
9� °'F Davie County,
�o�,x�ci NC
DAVIE COUNTY
37960.00
82420.00
No
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A�iTxOR�LATION NO: `� ��� DAVIE COUNTY HEALTH DEPARTMENT
" Y"` �- Environmental Health Section PROPERTY INFORMATION
Periittee',s '
.,�'t/fi � P.O. Box 84$
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N.�1e:� r �� Mocksville, NC 27028 Subdivision Name:
' � � Phone #: 704-634-8760 ,,,,�
Directions to property: �r�Pf ,/�/.; :✓<�2 Section: -��—�-» �-;� Lot:
,� � , ` AUTHORIZATION FOR
� ���� ,�'' t- ��s , _ /. ��'�T"� �� ! WASTEWAT'ER Tax Office PIN:#.., � � `�* ��' _ �� tr' '���
� » �� � SYSTEM CONSTRUCTION `� ' '* �� 'f
� Road Name: I�}c� E: �'"' ���1��t �'1 Z� r� r�<..-�5 g
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED 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 Inspecaons
O�ce when applying for Building Pernvts.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
�,f � fV .-i"r` J �✓ '' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTTON
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,` , � i. � 11, �����✓;J'.� IS VALID FOR A PERIOD OF FIVE YEARS.
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ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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�� r'" •`� `'.� TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
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Directions to property: .� r�r ~` �'� .x'y % °:_ �,,� �.
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Subdivision Name:
Section: � --�� �"-� Lo't:
IMPROVEMENT � �_
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PERMIT Ta�c Office PIN:#:. ��»¢ a'�`w-� -��.;,�` - f` � 4 �":�..
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Road Name: ��` �-C,. t�;':'� �. �::.. a Zip r:� �! --� ,
**NOTE** This'Improvement Pemut DOFS NOT authorize the construction or installation of a septic tanlc system or any wastewater system. An
ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUC'TION 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
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ENVIRONMENTAL HEALTH SPECIALIST
� DATEISSUED
***NOTICE*** THIS PERNIIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR TI-IE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE TI�IIS PERI�IIT BEFORE _
INSTALLIlVG THE SYSTEM.
RESIDENTIAL SPECIFICAT'ION: BUILDING TYPE �t # BEDROOMS -�, # BATHS �_ # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE ' # PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No �
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LOT SIZE d�/�C TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ��+� NEW SITE �✓� REPAIR SITE r
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SYSTEM SPECIFICATIONS: TANK SIZE f��� GAL. PUMP TANK GAL. TRENCH WIDTH •-�� ROCK DEPTH ,� �, _ LINEAR FI'. �`�'�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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**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
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INSTALLED�Y: _
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AUTHORIZATION NO. � ✓' OPERATION PERMIT BY: / -��l 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 `'�
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P.O. Box 848 ��
Mocksville, NC 27028
(704) 634-8760 ��
'�'�'�'�IMPORTANT**** THI5 APPLICATION CANNOT BE PROCESS�1
THE REQUIRED INFORMATION IS PROVIDED.
.�--Q. �f j –�- �(�
1. Name to be Billed �� 'e-'li �r-c.�i Gv� �- ��"t�. I� Contact Person �l 'e.��CY'�.► �G1 �
Mailing Address��� � �X L a�o Home Phone o� 0��'�P 3��
City/State/Zip �sp�l P� ��-� � V � �"(U� � Business Phone �(Z,� D ` '7 35,
2. Name on PermidATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [ Site Evaluation [�Improvement Permit & ATC [] Both
4. System to Serve: [] House [' obile Home [] Business [] Industry [] Other
5. If Res'dence: # People� # Bedrooms� # Bathrooms,�� [�shwasher [] Gazbage Disposal
[�shing 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 [� Vell (] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes �j No
If yes, what type?
EITHER tt PLtIT OR SITE PL�tN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT **'�Yt��.h�'fI' OF THE PROPERTY MUST BE
SUBMITTED WITIi THIS APPLICATION.
Property Dimensions: �' I%C �V � WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax O�ce PIN: # �� - �_ - � ; �o � � S . �'U 1' n lCL O h �
Property Address: Road N�ame Q P� �r' �Qv�v� �i0.� `� l � rUSS y h. U 1'�
City/Zip M O('. �S V I I� ; U V� � ��1" iV2
If in Subdivision provide information, as follows: ��Y �� � 1 L �� � d� �(' 0 CE O� _
Name: �
�
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Section: Lot #: ;
This is to certify that the information provided is conect to
subject to suspension or revocation, if the site plans or inte
changed. I, also, understand that I am responsible for all �
Representative of the Davie County Health Department
by v vt a �rrti . to
DATE a " ^ � � SIGNATUR
Revised DCHD (06-96)
of my knowledge. I understand that any permit(s) issued hereafter are
�hange, or if the information submitted in this application is falsified or
THIS AI.' .0. AItIJ $E USEb �OR blZfIWINC� JOUR SITE PLAN:
i from this application. I, hereby, give consent to the Authorized
above described property located in Davie County and owned
as necessary to determine the site suitability.
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.;_��-y; � y,�� �`� �`� � °�
j�� /! �' APPUCATION FOR SITE EVALUATION/IMPROVEMENTS
Davie County Health Department
' � Environmental Health Sectio
P. . Box 665 �' � e
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1. Application/Permit Requested By
�.�-- �
� ���oa� �.
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� JUL I 0 19� �
ENVIRONMEMTAL NF�,�3 `
DAVIE COUNTY
/-�'G�-.��'�= /2/2.�
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Mailing Address .� - Home Phone c��—� ��
Cc�o 1 e e m e e._ Business Phone ��`{ '�-S y y
2 Name on Permit if Different than Above -_�--� �tQ �e � +�'�h
3. Application for:
4. System to Serve
❑ Business
� _'1,� . , �- •
� General Ev�juation, y�„ �►" �' Septic Tank Installation Permit
�use �U�S�� r.�6bile Home
❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms -�� �
No. of Bathrooms �
❑ Other
Dwelling Dimensions
6. If business, industry, piace of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: � Public � Private
8. Property Dimensions ��'�o � 1�i �''� eS • Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
p Place of Public Assembly
� Unknown
Section Lot #
❑ BasemenUPlumbing
,� BasemenUNo Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
p Yes ❑ No
❑ 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: � �' S
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M� ��S �`'""�
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This is to certify that the information provided is correct to t e best of my
incurred fr m this application. �
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DATE
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, and I understand I am responsible for all charges
SIGNAI�YJRE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 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 the Davie ou�}�Y Health Department to enter upon above described
property located in Davie County and owned by '��in� Q_� C'.(�t,c.,"�.�.,
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal ystem. �, ..
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D TE SIGNATURE
pCHD (1�93)
� � .. �- � � rDaine Corrnty �ealifr� �epar�merrt
� `. � " and .�lome .i�ealtfi� .�'yenc��
I • 210 HOSPITAI STREET I P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
July 20, 1995
Jeff Lagle
P. 0. Box 606
Cooleemee, HC 27014
Re: Site Evaluation
Holy Cross Road
Dear Mr. Lagle:
As requested, a representative from this ofiice visited the aforementioned
site on July 19� 1995. Based upon the information provided on the application
for site evaluation and after the evaluation was completed, the �ite was found
to be provisionally suitable for the installation of an on-site sewage disposal
system.
If you have any questions, please feel free to contact this ofiice.
Sincerely,
�'"„ ��G�, " ' " �,
�
Robert B. Hall� Jr. , R. S.
Environmental Health Section
RH/wd
Enclosure(s)
. ,,; � �� ' DAVIE COUNTY HEALTH DEPARTMENT
" : � Environmental Health Section
. ; Soil/Site Evaluation
NAME E DATE EVALUATED � �%��
ADDRESS PROPERTY SIZE %�/IG
PROPOSED FACIILTY ��� � LOCATION OF SITE ��A`�/t! �->�t,f' %/��
Water Supply: On-Site Well _ Community Public
Evaluation By: Auger Boring � Pit Cut
SITE CLASSIFICATION:
EVALUATED BY: ,���
LANG-TERM ACCEPTANCE RATE: z OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape Position
R-Ridge 5-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
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
,iC--Sir.�le grain M-Massive CR-Crumb GR-Granular �K-MBular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mi neralagy
1:1, 2:1, Mixed
Notes
fiorizon 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 - gai/day/ftz
DCHD(01-90�
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