361 Fork Bixby Rdnnt,IP rnl lnh, mr- .. t Tnv Darr -al Ronnrf I ( .I . 4 � IAiea—A— (2--f—k-00 on19
a
Parcel'Ioformation`:
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
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
Parcel Number:
J70000009201
Township:
Fulton
NCPIN Number:
5778210587
Municipality:
Account Number:
5193000
Census Tract:
37059-804
Listed Owner 1:
BEACH DANA D
Voting Precinct:
FULTON
Mailing Address 1:
1024 BEACH LANE
Planning Jurisdiction:
Davie County
City:
YADKINVILLE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27055-8737
Voluntary Ag. District:
No
Legal Description:
1.05 AC FORK BIXBY RD
Fire Response District:
FORK
Assessed Acreage:
1.05
Elementary School Zone:
CORNATZER
Deed Date:
6/1992
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
001640031
Soil Types:
PcB2
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
WS-IV-P
Building Value:
0.00
Outbuilding & Extra
9000.00
Freatures Value:
Land Value:
21730.00
Total Market Value:
30730.00
Total Assessed Value:
30730.00
a
Davie County, NC
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
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
°U H�
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
, t
" DAVIE COUNTY HEALTH D PARTMENT
AUTHORIZATION I`1t7: U" J� Environmental Health Section PROPERTY INFORMATION
` , t P.O. Box 848
Permittee's �,
Name: i 'I, C\ '�^ �� Mocksville, NC 27028 Subdivision Name:
Phone # 336-751-8760
Directions to property: 4t ` t`' #� Section: Lot:
AUTHORIZATION FOR
} WASTEWATER . Tax Office PIN:#
1 SYSTEM CONSTRUCTION
Road Name 'rC %K 7tyc1', p:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This FormlAuthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In complianc"ith Article 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
J ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
411 IS VALIDFOR A PERIOD OF FIVE YEARS.
ENV1R ISI N ffCL HEALTH SPECfALIST iSSUED
n
A DAVIE COUNTY HEALTH D PARTMIENT -------
IMPROVEMENT
_ � � ..--. -- -IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Fermis ee's
%r.
'l~Name:- - - .; ^,�` i-1 Subdivision Name:
Di>< lions tD property: � /-� I "° a :l; Section:
IMPROVEMENT
Lot:
'i t ;-, i 4,>,4 t PERMIT Tax Office PIN:# - -
.,
Road NEfinO: t 1 `, �._ ' p. ; ! .Zip: r
**NOTE** This Improvement 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 Articled l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONME
' r SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
NTAL HEALTH SPECIALIST ATE ISSUED
p INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE M 1-1 # BEDROOMS _.�-- # BATHS I # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT / # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY�t--t_`r DESIGN WASTEWATER FLOW (GPD) "`�ry NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZJ U(0 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
OTHER 2.- -P1 ',51 ILI E» JTI o 1 ,
REQUIRED SITE MODIFICATIONS/CONDITIONS: r l�VL G^� 'J-IUV (<<= .� 04--u—
IMPROVEMENT PERMIT LAYOUT.:APPFGVED EFFLUa2T FILTERS *RISEIt(S) IF 6" L'ELDU FIMS4ZID GRADE*
r_ .4y�T
-1
".+..� i�OT
"CONTACT A REPRESENTATIVE OF THE DAV f N EALT TMENT FOR FI L SPE ISN OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. QR 1:00 - 1:30 P. ON THEY OF I TALLATION. TELE O # IS 03j7fi.B9S0;
1 (33L-0 151-8760
OPERATION PERMIT LP
1 40
AUTHORIZATION NO. OPERATION PERMIT BY:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL Ir
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI9
DCHD 05/96 (Revised)
r.
t
t
SYSTEM INST ED : 1)ilV 3^
IA
ja3
�h- DATE: Z. /OO
TE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
AGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
DRILY FOR ANY GIVEN PERIOD OF TIME.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittees
= Name: Subdivision Name:
Directions to property: Section: Lot:
IMPROVEMENT
PERMIT
Tax Office PIN:#
Road Name: 3 3 d<' " Zip:
**NOTE** This Improvement 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 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
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 rel H # BEDROOMS #BATHS #OCCUPANTS %' GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY—^t ��ty� DESIGN WASTEWATER FLOW (GPD)'��� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIA Ui Q GAL. PUMP TANK GAL. TRENCH WIDTH (-' ROCK DEPTH 1 r LINEAR FT. •�
x
OTHER s l : '� ^;T �- t G• +_IT 1 , . , -..` v ��
REQUIRED SITE MODIFICATIONS/CONDITIONS:, rs, lhl. t-
IMPROVEMENT PERMIT LAYOUT*A;%1pR0VED EFFLUENT FILTERK .41RISER(S) IF 6" PEL010 FINISHED GPPPDE*
......I..: - -- --
lit
YnL�
"CONTACT A REPRESENTATIVE OF THE DAV T HEALT � TMENT FOR F L SPE ~IiON OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. R 1:00 - 1:30 P. ON TH Y OF I TALLATION. TELE O # IS 9)`7
$§1
I$tGiO.' rk
OPERATION PERMIT (,+�
SYSTEM INST ED�
1
f
3
V
I
AUTHORIZATION NO. �w" OPERATION PERMIT BY: / DATE: Z jq)co
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE StEM 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 05/96 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION /��fG //J t
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT-/
NAME �4��_ ��� C PHONE NUMBER Y'3310! 7&J
ADDRESS /6.2 y �eae---4 �SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED-'
NAME SYSTEM INSTALLED UNDE
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED1/ /1GU INFORMATION TAKEN BY
z*00 k.o,J.
I , 6 / Z,—, L)
7 -3'6e -"-S'
Gr-.r-jE Lu --s Wek.L- lefty loo! ^%, rn�L+� 5 _ 33o 1
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME HONE NUMBER
ADDRESS 3(O 1--0 �-I� I�� IX �D SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED.
('p►'ila 71
AME SYSTEM INSTALLED UNDER
01 11zTYPE FACILITY V� • 4()'&—e -NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY PECIFY PROBLEM OCCURRING 5)i?A4Gf JCS
CA4-
DATE REQUESTED &
NFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
for all charges incurred from this application.
P1 ef1 / a1
¢
1
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
Application/Permit Requested By 'h X-� f ►GL �2/QGY)
Mailing Address �� 457-� mOClCsylIle 0 C� 67%D �j
Home Phone q19 y63- 5630 Business Phone
2. Name on Permit if Different than Above _
3. Application/Permit for:
4. System to Serve: ❑ House
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People - 4 3
No. of Bedrooms _2
No. of Bathrooms
❑ General Evaluation
p'Mobile Home
❑ Other
Dwelling Dimensions wcpro 1a03' 60
6. If business, industry, place of public assembly, other: Specify type
No. of People Served -2 4 3
No. of Commodes
No. of Lavatories
J
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers / Watterr Usage Figures _
7. Type of water supply: ElPublic Lvl Private
8. Property Dimensions acre-' /l,7oleor AK Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
E'�Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes Z?No
❑ Community
"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: 6y a" 4 Fort'
pro 4er ly orl /e7c/- . �/I%ai�6a��� ¢
o -k, e e -I
M
P'' 74
4 v eNra rr- -S4/0
c�,o�ier �ob.�e
�iur1B des/fje G1�/S�r�Cf
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.
6- 18- q.? - ok-,� zeCA
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: P -l. 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 Af the Davie Co4nty Health Department to enter upon above described
property located in Davie County and owned by mai-' dr/7
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 (12-90)
[ ' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �Cz��� DATE EVALUATED
ADDRESS PROPERTY SIZED
PROPOSED FACIILTY . 23 LOCATION OF SITE
Water Supply;
Evaluation By
On -Site Well
Auger Boring
Community
Pit
Public—
Cut
ublic_Cut
FACTORS
1
2
3
4
Landscape position
L
L
L
Z_
Slope %
x-12--
�/
4/
L/
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
A,/
-
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
--
CLASSIFICATION
77T 1
797
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: 0 EVALUATED BY: _ /�� C f
LONG-TERM
REMARKS:
DCHD(01-901
TAN E RATE:
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
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 FR -Friable FI -Finn VFI-Very firm EFI-Extremely firm
Vet
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NP -Non plastic 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
Mineralopy
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
■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■.■■n■■■■■■■■■■■■■■■■■■■■�■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■.■■■■.■■■■■■■■■■■■■■RAW■■■■■t1■■■■■■■■■■■■.■■■■■■■■■■■■■
■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
ON mom
■■..■■■.!■■■■■■■■■■■■■■■.■■■..■■�M■.■■.l.■■■■■■■■■■■■■■■■■■■■■ ■■■
■■.■■■■■..■■0110■■O■OON■■.■■■■■.■ .■■.E■11■■■■■■.■■■■■■■E■.■■■■■..■
■■■■.■■■■■■■■■■.i.■■■e■■■.■■■■■■.999!■-■='====::::■■■■■■.■■.■■■■C■■■■■■■■
ONEEME EMMOME� ■■■■■■ ■■■■■■ MEMNO■■M■■N MEMNON■■■■■■ ■MEMNON
■■■■■
■■■.■■■■■■.■■■■.!■■.■■■■11■■■■■■■■■■■■■■■■■■■��■■■■■■■■■■■■ ■■■■■■■■
■■■■■■..■.■■.■.M■■E■■■.■1.■�■■w■Neo■===■■■.www■■■■■■ .■■■■■■■■■■■■■
■■■.■■.■■■■■.■//■N■■■■■■■!.N■■■E■..■■■■■■■.�t■■■■■1�
No ■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■.■■■■■■■■■.■■■■■■■■.■.■■■■■.9.■.■ ommu 1\L■ WM■■E■MM
NOME MANSOMMI MMEMAME MWEEM
MEMEMEM 0 ON
■.■■■■■■ ■■■ ■■■■■��■■■■■■■■■■■■■■■■■■■■■■■■11■■■.■MI■■■■M■H■MM ■■
■■■■■■■.■■■■■■■■■■■■■■■■.■■.■■■■ .■■■■■■ .11■■!■■■■■■■■■■MEMO OMEN
■EEEOONN.■OONNM■■.■■■M■N.ONMOO■■N■.00H■M.EO■.■■■N.■O■■■.■N■HO!■E
■■■■NM.■■■■■■.ON■■■■ NNE■■■■■■■■ ■■■■.■ONMEI�N!■.■■■.ENN■■ON■ON■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■.■■■■■■■■O.■■EO■■■■■■■■■■■■N■■■�N■■OO■.O■EOE■.■.M■■■■N.■■■.■■..■
■■■O■..O■.■■■O.O..OM■O■■.■.EN..■ ■.EEN.E■■E■■■.O■■.NEE■.E■EO■■N.■
r
a,' _ • . -.. T��-�. -�.f.....,,.c._.�ti a��..,-:-.:-::r,-v....r +r'�.`�✓.' .-"`t^r:.�' ..y -y'-,- _. �-t.-•eti-••�. `-`_i....y.... __, =.xssxV-,�...;«-J,, Y).y_ � ".-t.r+,�.-,. ,,r'-e_$>.4....,...y •.F ..", �-µe —_
'fix°
50.0 0
DAVIE COUNTY HEALTH DEPARTMENT l ; p a
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION.
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Rysterns 7 U Permit Number
Name t�N Q Date N_ 7169
_ r.
Location ��- o x Li 5 r o Os's 'J,
e 1 N �. d 8
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile HomeBusiness __' Speculation
�.
No. Bedrooms No. Baths — "�` No: in Family _
Garbage Disposal YES ❑ NO ({"
Specifications for System:
`Auto Dish Washer YES'❑ NO
Auto Wash Ma^hine YES NO 5
Type Water Supply a
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
f
�. 14 'ra NN
� t
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 G�
Certificate of Completion �\� Date -2S -93
'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.
- •. r a. '. r L. v
DAVIE COUNTY HEALTH DEPARTMENT ) f ; o 6
',;,IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
x Sanitary Sewage Systems Permit Number
Name _ _ Date 7169
Li
Locatio
Subdivision Name Lot No. Sec. or Block No.
I
Lot Size House —�— Mobile Home T Business -- Speculation
No. Bedrooms No. Baths No. in Family —
Garbage Disposal YES ❑ NO ❑ . Specifications for System:.. ; r
Auto Dish Washer YES ❑. NO ❑
Auto Wash Ma thine YES EJ NO 1-1_
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
rTT' a
_ c
kl-
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
S\�6W\--)
Certificate of Completion -" " ' 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.
VA- _,�.n �
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME PHONE NUMBER
ADDRESS !J �s X yS�\ I SUBDIVISION NAME
h e \K-5 a l l a i 1�' LOT #
DIRECTIONS TO SITE - I-, ` rl� �� ' A
DATE SYSTEM INSTALLED 7 7 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY . �4 "- �" NUMBER BEDROOMS !a NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED 3 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledg Zsndthat I understand I am responsible for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT.r��
Rev. 1/93