269 Drum LnDavie C�untv, NC Tax Parcel Report Wednesday, October 12, 2016
WAK1V11V1T: 1ri1J 1J 1VV1 A�UKVLY
. : ParcelInformation
Parcel Number: K700000079 Township:
NCPIN Number: 5767645422 Municipality:
Account Number: 82522775 Census Tract:
Listed Owner 1: KING WILLIAM H SR Voting Precinct:
Mailing Address 1: 269 DRUM LANE Planning Jurisdiction:
City: MOCKSVILLE Zoning Class:
State: NC Zoning Overlay:
Zip Code: 27028-7160 Voluntary Ag. District:
Legal Description: 3.001AC OFF DRUM LANE Fire Response District:
Assessed Acreage: 3.00 Elementary School Zone
Deed Date: 5/2004 Middle School Zone:
Deed Book / Page: 005520305 Soil Types:
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Building Value:
Land Value:
Total Assessed Value:
9��°'�' Davie County,
`'o�,N�j NC
79680.00 Outbuilding & Extra
Freatures Value:
19560.00 Total Market Value:
Fulton
37059-804
FULTON
Davie County
DAVIE COUNTY R-A
No
FORK
CORNATZER
WILLIAM ELLIS
Pc62,PcC2
DAVIE COUNTY
750.00
99990.00
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AUTxoFu�A'riON No: O 6 Z 3 DAVIE COUNTY HEALTH DEPARTMENT
'' , Environmental Health Section PROPERTY INFORMATION
Permittee's , P.O. Box 848
Naffie: �/`„�Q�'Y! �� Mocksville, NC 27028 Subdivision Name:
' Phone #: 704-634-8760
' Directions to property: �.t�:��r� ni .�i;•.•, � Section: Lot:
', AUTHORIZATION FOR �//
WASTEWATER Tax Office PIN:#�7� 7- l�7 � -(� `T6��
SYSTEM CONSTRUCTION
Road Name: �,�I�'���ij �. i;t. Zip: v� r%o�i c�
**NOT`E** This Authorization for Wastewater System Construction MUST BE ISSLTED 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)
��� ��� ,, /�,� j'r'� �f„ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�'�' %�� �_!, ..,;��:'i�t` ,�--t <``°''1. �r" 7 �• IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEAL�'fH SPECIALIST DATE ISSUED
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z._,��.;� ' DAVIE COUNTY HEALTH DEPARTMENT
�..-;�- .
;, �-:;�' -� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
q
Permittee's` �—� � -' /
Nari9e:' -� � �'<.�"„�i' f,t�ii!�S� ,�"���,�'r�
�i
Direcdons to property: �'
Subdivision Name:
Section:
Lot:
�PERNII'rME� Tax Office PIN:# .� i �f - � '� - � r�� � �
Road Name: ��'`7 � �, � �'�.� Zip:/ '; '%l �T.
**NOTE** This Improvement Pernrit DOFS NOT authorize the construction or installation of a septic tanlc system or any wastewater system. An
AiTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCITON 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)
',� ;.. �. ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
� ,:',' r",.r,�- y >,;�'; f PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SpECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
� INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE �# BEDROOMS �# BATHS �� # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILTI'Y TYPE # PEOPLE _ # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE �+' � TYPE WATER SUPPLY .�;%"!/•� DESIGN WASTEWATER FLOW (GPD) /�l' NEW SITE [/� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE J�� %�GAL. PUMP TANK GAL. TRENCH WIDTH �r • ROCK DEPTH _� LINEAR FT. ��r�) '
OTHER
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 830 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON Tf� DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
I OPERATION PERMTT
�
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SYSTEM INSTALLED BY: ��� �K�''�
`TL�►�1L j�A�TC
4�5 ��
AUTHORIZATION NO. 6 6�� OPERATION PERMIT BY: ��'�% DATE: �` � Y�
**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 SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OSN6 (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 �i �-- ��' '�� �� ��J L. Contact Person � n g�l T ST"o+Jc?
MailingAddress L�� � Q� ►�1 A L-A+JL
City/state/Zip �' ��- � �►►-�-� , l�i C- 2 7 d Zc'3
Home Phone `1� � n " `3S t3 • �� �5
9�0- 958-�[733
Business Phone 70� '(0 3�l - y 7� S
2. Name on PemudATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation Ud Improvement Permit & ATC ❑ Both
/ �Jn v3u:
4. System to Serve: ❑ House ❑ Mobile Home ❑ Business ❑ Industry O" Other 1-1 � Q �?
5. If Residence: # People �O # Bedrooms `� # Bathrooms 2
0 Dishwasher ❑ Gazbage Disposal C� Washing Machine ❑ Basement/Plumbing ❑ BasementlNo Plumbing
6. If Business/Other:
# Commodes
If Foodservice:
Specify type
# Showers
# Seats
# People # Sinks
# Urinals
Estimated Water Usage (gallons per day)
# Water Coolers
7. Type of water supply: ❑ County/City G� Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes G�No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: S �t �- � B�= l� � i a�CYi� Jt�
Tax Office PIN: # � % �P � - � - � �% � �
Property Address: Road Name � 2-v ✓1� �—�'' N �_
LoT 34.or
,ry�P iL-.-1 City/Zip /1�0 �x.s�� L�� , 1J C- 2702�
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
WRITE DIRECTIONS (from
Mocksville) TO PROPERTY:
5��� a:�a,c�'�c�
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 enter upon above described property located in Davie County
and owned b /l1 �1 `,� 2� ���� to conduct all testing procedures
Y --,��_
as necessary to determine the site suitability.
DATE I Z' Z7 '�7 L SIGNATURE
Revised DCHD (06-96)
,
�= DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME �'l v DATE EVALUATED �� g�
PROPOSED FACILITY PROPERTY SIZE _'��9�
SUBDIVISION ��,� ROAD NAME �/`u� .C�t-ii,�
Water Supply:
Evaluation By:
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
On-Site Well Community
Auger Boring Pit
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
LONG-TERM ACCEPTANCE RATE
1
/,'
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE: � �1
REMARKS:
DCHD (O1-90)
Public
Cut
3 4 5 6 7
r
EVALUATION BY:
OTHER(S) PRESENT:
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
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
Mineraloev
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
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