123 Fireside Ln:)a
vie County, NC Tax Parcel Report Wednesday, September 28,
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9 �v fF Alldata Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability 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
�DUN� NC or arising out of the use or inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
ParcelInformatiori`
Parcel Number: _
L507OA001602
Township:
Jerusalem
NCPIN Number:
5746167535
Municipality:
Account Number:
25984000
Census Tract:
37059-807
Listed Owner 1:
FORTUNE BARRY DALE
Voting Precinct:
JERUSALEM
Mailing Address 1: -
347 AVON ST
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
DAVIE COUNTY CZOD
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
0.49 AC OFF FAIRFIELD RD
Fire Response District:
JERUSALEM
Assessed Acreage:
0.49
Elementary School Zone: COOLEEMEE
Deed Date:
11/2011 q
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
008750158
Soil Types:
CeB2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
0.00
Outbuilding & Extra
Freatures Value:
0.00
Land Value:
6590.00
Total Market Value:
6590.00
Total Assessed Value:
6590.00
9 �v fF Alldata Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability 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
�DUN� NC or arising out of the use or inability to use the GIS data provided by this website.
9. �._. ,..,,. .;:� M1 µ ..`. a d;� per :.�+�;�,. ...,;:.-; a', -y.?•,+• ;i-.,,_ 1.. _ - �:-i:v+.s, , _. ,-� .n ,, dl. ::r.. ,�(-x _
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**NOTE** This iaproyement permit DOES 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 permit.
(In compliance with Article 11 of G.S. Chapter 136A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME ^ ;"-e hac- /U,we PROPERTY ADDRESS I IIrC-S PIE -f—%1 - � � r/0'qo DATE
s� // X` res ►cle.
DATION ,-�• F- ii'
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE% # BEDROOMS # BATHS # OCCUPANTS , GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE /" TYPE WATER SUPPLY (y DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE Ze& GAL. PUMP TANK GAL. TRENCH WIDTH .1�'' ROCK DEPTHLINEAR FT.�:"�
OTHER
REQUIRED SITE M(DDIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY .'11Y�!
**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
C
f--
1'), HorvN 4�
AUTHORIZATION NO. O ..L OPERATION PERMIT BY j 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 AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
Davie County Health Department
�,�..- �r �•1'' ENVIRONMENTAL HEALTH SECTION
P.O. Box 665
'1. Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
';G.S. Chapter 130A, Wastewater, Systems)
***This Authorization', For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.***
.01 AUTHORIZATION MF3ER
NAME /"� f ,O�,,, &,Ae DATE ;V—IiK Z- N2 0 2 PS
,4 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS @ v 1
Davie County Health Department
Environmental Health Section 2 9 1996
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By E R / C 1)y q/v 4,4 ,t1e 4�
Mailing Address 29-7 Ps 0 QN s k Home Phone 76 V C 3 y ! 6 Sly j2 qj
0 c -K s 1& N C 2 7o -x k Business Phone -7 Y 6 3 C 3 S 14 /
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve: ❑ House
❑ General Evaluation
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions��
RrS"'eptic Tank Installation Permit
Mobile Home ❑ Place of Public Assembly
❑ Other ❑ Unknown
Section Lot # _
❑ Basement/Plumbing
6. If business, industry, place 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 -7❑ Private
8. Property Dimensions Va QW11,10 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ No
❑ Community
'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
PROPERTY INFORMATION REQUIREb:
Tax Office PIN: #�.5i�i�" "75&S1
/ tr� / j --:-r PROPERTJ ADDRESS, as follows:
%� -
��• 0 ' f` ts/ 4 Road Name: Fags/%iL /--),x
/Y-cucr-b -5" City:
SUBMIT A PLAT WITH THIS APPLICATION.
Revisions effective October 1, 1995.
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
3 1-7 • 9 6 v
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: Al"11. I OWN the property. ❑ 2. 1 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 SIGNATURE
DCHD (1193)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME e
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE �i4c
LOCATION OF SITE`l�:no/>1i0��✓
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring LI -1 Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe Z .�
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC .
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: L� EVALUATED BY: e&ZZ
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 r.lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vc.-y friable FR -Friable FI -Film VFI-Very firm . EFI-Extremely film
Wet
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic
Structure
.3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineralog
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 (01-901