546 Four Corners Rdt
Davie County, NC Tax Parcel Report Wednesday, October 12, 2016
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WARNING: THIS IS NOT A SURV�Y
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Parcel Information
Parcel Number: B300000053 Township: Clarksville
NCPIN Number: 5823395757 Municipality:
Account Number: 36656000 Census Tract: 37059-801
Listed Owner 1: HOLT MICHAEL SHANE Voting Precinct: CLARKSVILLE
Mailing Address 1: 546 FOUR CORNERS ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,R-20
State: NC Zoning Overlay:
Zip Code: 27028-6217 Voluntary Ag. District: No
Legal Description: 9.68 AC FOUR CORNERS RD Fire Response District: COURTNEY
Assessed Acreage: 10.60 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 7/1993 Middle School Zone: NORTH DAVIE
Deed Book I Page: 001690465 Soil Types: MnB2,MdB,ChA,MdC,WATER
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding & Extra 6910.00
Freatures Value:
Land Value: 71150.00 Total MarketValue: 78060.00
Total Assessed Value: 78060.00 �
9�se�F All data Is providod as Is without warranty or guarantce of any kind either expressed or fmplied Including but not Ilmtted to the
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Davie County� Implied warranties of inerchantability or fitness for a particular use. All users of Davfe 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 causas of actton due to
npt x,�i NC' or arfsmg out of the use or mability to usa the GIS data provided by this website.
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;,: a��xo��zaTiorr rro: Q$ Q � DAVIE COUNTY HEALTH DEPARTMENT
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Environmental Health Section PROPERTY INFORMATION
Permittee's P.O. Box 848
Name: _���i��� y�;�_ Mocksville, NC 27028 Subdivision Name:
"' ,� 1 Phone #: 704-634-8760
Directions ta property: �, "C:�. ✓ a✓.,_.1 �"""-^�� Section: Lot:
� AUTHOWZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Tax Office PIN:#��- � - �� _ - '`� .�-��r
Road Name: (�r, �= f >1 ��l �� Zip: �'��
**NOTE** This Authorization for Wastewater System Conshvction MUST BE ISSUED by the Davie County Environmental Health Section prior.
to issuance of any Building Pernuts. This Forn�/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)
,�' /' � r,,;' �~; % � �; � � ***NOTICE**� THLS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
.,� 3 r �,..; ,,�� .� �r�-�``�� ,�•c�"' �,., . , ; . A; .
`,,� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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. r,; � z� ""�'�:� � DAVIE COUNTY HEALTH DEPARTMENT ��� 's `' � �}y �
.�'='�'��=�. � IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
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�ermittee's- . � �
� Name: � �`��i ��_ ��;?. "�.� -
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D'uections to property: '" � �' � ��-� �.- �
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Subdivision Name:
ecrion: Lot:
Il�IPROVEMENT ,�
PERMTI' Tax Office PIN:# �� '� '� _ " ,`i -�-. �.�,%;.,•
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Road Name: i ��-•- i r=:�= �����
**NOTE** This Improvement Pemut DOFS NOT authorize the construction or installa6on 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 pemut.
(In-compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, SecUon .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT LS SUBJECT TO REVOCATION IF S1TE
'; : �` s .''� . =,; `;r� PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THLS PERNIIT BEFORE
INSTALLING TI� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE %�7 ��h # BEDROOMS _'_i # BATHS �% # OCCUPANTS GARBAGE DISPOSAL: Yes oi{�o )
COMMERCIAL SPECIFICAITON: FACILTI'Y T'YPE # PEOPLE # PEOPLFJSHIFf # SEATS _ INDUSTRIAL WASTE: Yes or No
LOT SIZE � TYPE WATER SUPPLY t I� DESIGN WASTEWATER FLOW (GPD) � NEW SITE 4� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE %� GAL. PUMP TANK GAL. TRENCH WIDTH �'•'' '" ROCK DEPTH /_� � LINEAR FT. �?-?�
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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
I OPERATION PERMIT
SYSTEM INSTALLED BY:
-
AUTHORIZATION NO. � OPERATION PERMIT BY: �� 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 WII.L FUNCTION SATISFACTORILY FOR ANY GNEN PERIOD OF TIME.
DCHD OS/96 (Revised)
� APPLICATION FOR SITE EVALUATION/IMPROVEMENT
Davie County Health Department �
' Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
� (704) 634-8760
PERMIT `" ��
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****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE�H'0`NLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed I, 1,C�Qe� S. ��_�� Contact Person
Mailing Address �U D C c�►-i�� u��, ��,.t� Q�_ Home Phone �i a- U6 3-�'s �
City/State/Zip Y��1k�n�,�]�e�, ►J •[, a7oS�" BusinessPhone '� �� y63 -S6A�
2. Name on PermidATC if Different than Above
Mailing Address
3. Application For: [] Site Evaluation
City/State/Zip
�(] Improvement Permit & ATC [ ] Both
4. System to Serve: [ ] House [�Iobile Home [ ] Business [ ] Industry [ ] Other �, �
5. If Residence: # People # Bedrooms � # Bathrooms � [� Dishwasher [] Garbage Disposal
[a-Washing Machine [ ] BasementlPlumbing [ ] 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? j�.]'�'es [] No
If yes, what type? ��� �1 {� �c-e nY�� d�v
EZTHER A PLrtT OR SITE PLtIN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** ��rOF THE PROPERTY MUST BE
SUBMITTED WITI-I T,H�S APPLICATION.
Property Dimensions: � 9%� 4���s _ � WRITE DIRECTIONS (from ��locksville) TO PROPERTY:
Tax Office PIN: #,�,� - �— - ��'� � �,(1 n � �T� � 1 C �� 'li'� ��� . � Sf / ��'
Property Address: Road N me our�' a. � r �
`�i`�o c 5� y� �
City/Zip � ' ;
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 enter upon above described property located in Davie County and owned
by �15���-1 �• � I to conduct all testing procedures as necessary to determine the site suitability.
. /.� ��
DATE �� I�' C1 7 SIGNATURE_�_�,�Q � Nc,�x.V�'
Revised DCHD (06-96)
THIS rlREtt MtIJ f3E USEb �Otz �I�IWZNG �OUIt SZTE PLrIN:
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
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1. Application/Permit Requested By ���c..) 0. Y-CI �� � L� _
Mailing Address ��• � �v�- � -I � � oC-f�5 Y -
Home Phone �7 Q � - � � � � Business Phone
„_ , � i �l L � / � �
2. Name on Permit if Different than Above
3. Application/Permit for:
4. System to Serve:
❑ Business
❑ House
❑ Industry
5. If house, mobile home: Subdivision
�,General Evaluation
❑ Mobile Home
❑ Other
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions
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 �'Private
8. Property Dimensions ���'�� �� 0.C-1Z�5 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 #
❑ BasemenUPlumbing
O BasemenUNo Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ No
❑ Community
RNOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revoca4ion, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property: / - /` s,�
�Od� /Y � -/O �Ql-S � .�`� O?ti �bzf,�%��� �/�I . ��. � � h'�SS � l�'��-%.� I
C�' / ' � 7� S \►C� 1��`�1� ���,�1 � � �'�' �/ �
i r�" /'Q� � 0 3ti 1 e-� s� `��` / � /,,
. J�"�' //` l-..�� r�� (�� (J� Q h %'�/� i" 1�-
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/� ,�e��'� d / n g • S� � � ✓�1 • d n � .
C� �
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. '/%
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DATE SIGNATURE
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 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 suitabiliry for a ground absorption sewage treatment
and disposal system.
DATE
DCHD (12-90)
SIGNATURE
�"'" , �. DAVIE COUNTY HEALTH DEPARTMENT
. � Environmental Health Section
Soil/Site Evaluation
NAME _ ,/3/' �' ` C- DATE EVALUATED !� � � �
ADDRESS PROPERTY SIZE �� � �� �
PROPOSED FACIILTY �c� !r''' ����� LOCATION OF SITE � r�� �':"' �� i-
Water Supply: On-Site Well �/�� Community Public
Evaluation By: Auger Boring � Pit Cut
FACTORS
Landscape position
Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineraloqy
HORIZON III DEPTH
Texture group
Consistence
Structure
MineraloAy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASS.LFICATION
LONG-TERM ACCEPTANCE
1 2 3 4
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SITE CLASSIFICATION: _ ��
LDNG-TERM ACCEPTANCE RATE: _�/
REMARKS:
DCHD (01-901
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EVALUATED BY• fLl�%
OTHER(S) PRESENT:
LEGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slop� 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
Moist
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 plarstic
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangularblocky PL-Platy PR-Prismatic
MineraloQy
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 watet 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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�������������������������������u������i�������0������������������
�Davie County .�lealtir �e ar�tmerri
and .�lome .�fealtf �i yency
210 HOSPITAL STREET I P.O. BOX 683
MOCKSVILLE, N.C. 27028
PHONE: (704) 834-8985
February 5, 1993
' Edward Peele
Rt. 5, Box 399
Mocksville, NC 270�8
Re: Site Evaluation
Courtney Church Rd. — 14+ acres
Dear Mr. Peele: �
As requested, a representative froA this office visited the aforementioned
site on February 3, 1993. The site was found provisionally suitable for the
installation of a ground absorption sewage system.
If yot� have any questions, please feel free to contact this office.
Sincerely,
��!��• ��'� ��
Rober�t B. Hal l, Jr. , R. S.
Environ�ental Health Section
RH/wd
Enclosure
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