295 Hearthside Ln ,
Davie County,NC Tax Parcel Report b ��� Tuesday, October 4,2016
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WARNING: THIS IS NOT A SURVEY
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�__. _ .._.. Parcel Information,
Parcel Number. H60000008101 Township: Shady Grove
NCPIN Number. 5759813309 Municipality:
Account Number. 14416500 Census Tract: 37059-804
Listed Owner 1: CAUDILL JOHN P . Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 295 HEARTHSIDE LANE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overiay:
Zip Code: 2702&7223 Voluntary Ag.District: No
Legal Description: 3.5 AC OFF CORNATZER RD Fire Response Dlstrict: CORNA7ZER-DULIN
Assessed Acreage: 3.05 Elementary School Zone: CORNATZER
Deed Date: 10M992 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 001650856 Soil Types: WeC,PcB2,RnC,RnD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 214280.00 Outbuitding 8�Extra 2580.00
Freatures Value:
Land Value: 34890.00 Total Market Value: 251750.00
Total Assessed Value: 251750.00
9[.�l� All da[a is pmvided as is wRhout wartanty or yuanMce oT any Idnd either e:pressed or impikd(ncluding but not Iimited to the
Davie County� ImpUed warraMles ot macMaMabpKy o►Mness for a particular usa All usera ot Oade CouMy's GIS vrebsRe ahatl hold harmless the
County o/Oavle,North Camlina,lts ayaRs,consulfnrts,coninetors or anployeea hom any and all ddms or puses of�ctlon due to
np d�� NC w arlslny out M tbe use or InablRty tn use the qS data provided by th(s websk4
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av�rxo�uzATTON rro: Q�5 s, DAVIE COUNTY HEALTH DEPARTMENT �
� � �� Environmental Health Section PROPERTY INFORMATION
Pernutt�E'��y --1 + P.O.Box 848 ,
Name: '�l0/7,/✓ �,7.1� �_� Mocksville,NC 27028 Subdivision Name:
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p p y q�9S.•» PaJ� � ,� Phone#:704-634-8760
Directions to ro ert : �', o r � Section: Lot:
AUTHORIZATION FOR
' �'I��'�!f� ��� ,�vL / SYSTEM CO STRUCTION T�Office PIN:# - -
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Road'�ame: �A�ia ld.�.Z"ip:�rf po�0
**NOTE**This Authoriiation for Wastewater System Construction MUST BE ISSLJED 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 Permits:
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
,%� ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �
�,`�-� i�i71�'�•!,r��� .���, ' �;�/�i IS VALID FOR A PERIOD OF FIVE YEARS.
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ENVIRONMENTAL HEALTH SPECIALIST . DAT'E ISSUED , .
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; :rw�� �;��_��.u.��``�;� =`,- -' - -•. IMPROVEMENT AND OPERATION PERMITS �.�OPERTY INFORMATION
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Na�ne ;.._ r F�.,D .�, - : �, . -. ,
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�•Duecuonstoproperty:�/��.� ,�'�'('1�,������� � Section: Lot:
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�7,+,� ! <�r.�flr �y� f!` PERMIT Tax Office PIN:# _ _
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**NOT'E**This Improvement Pemut DOFS NOT autliorize the construction or installation of a septic tank system ar any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCIZON must be obtained from this Department prior to the
construction/'uistallation 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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i � -,. ***NOTICE***THLS PERMIT TS SUBJECT TO REVOCATION IF STTE'
'""�� ��. ,'1 :.,"-i 4' �;,.;� �/��'.�� :� PLANS OR Tf�INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �'sTEM CONTRACTOR MUST SEE THLS PERMPf BEFORE
INSTALLING THE SYSTEM.
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RFSIDENTIAL SPECIFICAT'ION:BUILDING TYPE� #BEDROOMS "� #BATI-IS�_#OCCUPANTS 3 GARBAGE DISPOSAL:Yes or No
COMbfERCIAL SPECIFTCATION: FACII.ITY TYPE #PEOPLE #PEOPLE/SFIIFf #SEATS� INDUSTRIAL WASTE:Yes or No
LOT SIZE /Qt1 C TYPE WATER SUPPLY LUe�/� DESIGN WASTEWATER FLOW(GPD) '�� NEW SITE REPAIR S1TE L��
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK �ODI)GAL. TRENCH WIDTH .�,1 • ROCK DEPTI-�� LINEAR Ff.�
OTf�R�.J(!�/ !C<4/� l�t.E/v f C� Cf ���� — /.S�Y
REQUIItED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LA�' UT
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**CONTACT A REPRESENTATIVE OF Tf�DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BET'WEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLAT'ION.T'ELEPHONE#IS(704)6348760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
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� AUTHORIZATION NO. v w v OPERATION PERMIT BY: DATE: �1.L
**THE ISSUANCE OF THIS OPERATION PERMTf SHALL INDICATE THAT Tf�SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ART'ICLE 11 OF G.S.CHAP'TER 130A,SECT'fON.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT Tf�SYSTEM WII.L FUNCfION SATISFACTORII,Y FOR ANY GIVEN PERIOD OF TIlvIE.
DCHD OS/96(Revised)
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��« � DAVIE COUNTY HEALTH DEPAR�MENT
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,, ,, ;_ , "�X ::.. ,..,��"�'� � IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
� ,Perinit�e�"`--�.:'_ . � � l �
'N�ne: '�.d�'�,�,� :�,� Subdivision Name:
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,."Directions to ro �ert r � :. �,r,�j � .. ;
P P Y��, �� ,U����'�;;,�}�9�' { Section: Lot:
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; ,{.�:;,; , ; ;,� �.%`� PERMIT Tax Office PIN:#
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**NOTE**This Improvement Pernut DOFS NOT authorize the conshuction or installatiQn of a septic tanlc system or any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
conshuction/installation of a system or the issuance of a building pernrit. �
(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 Tf�INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST nATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNII'P BEFORE
INSTALLING THE SYSTEM.
RFSIDENTIAL SPECIFICATION:BUII.DING TYPE� #BEDROOMS "�`� #BATHS�,�#OCCUPANTS...�GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICAT'ION: FACILTfY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS• INDUSTRIAL WAST'E Yes or No
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LOT SIZE �"(' TYPE WATER SUPPLY� DESIGN WASTEWATER FLOW(GPD) '�/SyD 'NEW SITE REPRIR•$ITE l��
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK �GDI GAL. TRENCH WIDTH ,_s�l � ROCK DEP'Tfj� LINEAR Ff. 't d%lJ
OTI�R ,/9(!✓l s'C��: L'c'{�v!� C_:.+� CJ' �•.��l�/r� — �y'�f"jA�C�I�"v'
REQUIItED SITE MODIFICATIONS/CONDTTIONS:
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IMPROVEMENT PERMIT I.�C UT .
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**CONTACT A REPRESENTATIVE OF Tf�DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9.30 A.M.OR 1:00-130 P.M.ON TI-IE DAY OF INSTALLAT'ION.TELEPHONE#IS(704)634-8760.
OPERATION PERMTT
SYSTEM INSTALLED BY:
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AUTHORIZATION NO. � ���OPERATION PERMIT BY: DATE: ��'�
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**TE�ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WI1'H ARTICLE 11 OF G.S.CHAPTER 130A,SECI'ION.1900"SEWAGE TREAT'MENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS.A.
GUARANTEE THAT THE SYSTEM WII.,L FUNCTION SATISFACTORII,Y FOR ANY GIVEN PERIOD OF TIME.
DCHD OS/96(Revised).. �
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l�'!� ..i�ic` `� ' ' s# ��d
� *",_ �-� r • DAVIE COUNTY HEALTH DEPARTMENT ���'•°°
• `' � IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION .
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
-� Sanita Sewage S _stems o9f,fjS/ra-���� �a�L�� Permit Number
Name �o�� �} � ��au�.....� Date 4 �1 �� No 7�.:�2
Location �'."� h' ��`� � `a� "� � � �v e. �,,« � '� .C. h�_�c.)C�10
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• Subdivision Name Lot No. Sec. or Block No.
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Lot Size 1 U ' `'-� = House v Mobile Home _T Business Speculation
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No. Bedrooms ' �N�Baths 3 No. in Family j _
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Garbage Disposal YE� p�''NO [j� Specifications for System: .-
Auto Dish Washer YES d NO ❑ , J o����� �,�� �"""��,�a,_ - � �.J � �,:, ;.z:,�..
Auto Wash Ma:hine YES � NO p � �U `x _� � y r�`\�� '.,Jt,-Y��.;`,.
Type Water Supply ���� __—
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'This permit Void if sewa�qe sy,�terrl_described_below�s not installed within 5 years from date of issue.
This permit is sotbject to revocation if site plans or the•intended�e change.,
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Im rovements ermit b \—�` ��`�' � '`'�'`'�� '
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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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by— ti
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Certificate of Completion `' '�f p` Date ,�����-�J
'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.
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��,� i�,�ii,�y� AoPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI
� y ' l Davie Counry Health Department �(!�;��;i��;�����
Environmental Health Section .
P. o. BoX 665 ��q� 191993
Mocksville, NC 27028 -
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1. Application/Permit Requested By U ��✓� � ���Q%�l �
Mailing Address ��• � � ��a '� G ��� �l1- C , Z�bo� �
Home Phone g9�1- S s�L/ Business Phone 7/(o- 6�-�''� �e,,�ei �' _c�gS�
2. Name on Permit if Different than Above ���
3. Application/Permit for: p General Evaluation �eptic Tank Installation
4. System to Serve: �House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other . . p Unknown
5. If house, mobile home: Subdivision /��� � Section Lot#
- : asemenVPlumbing
No. of People � ❑ BasemenUNo Plumbing �
No. of Bedrooms � 0-bVashing Machine
No. of Bathrooms � ishwasher
, , .
Dweliing Dimensions ��x-�� ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type ���
No.of People Served No. of Sinks
No. of Commodes � No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: p Public �'Private O Community
8. Property Dimensions ./'�' s a�-�-J Sewage Disposal Contractor u^a��'/�w� �`��'�*^-e
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes �No
If yes, what type? -
'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: �� �,��� �� ,nll� �%o-„o/ a�. d/
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This is to certify that the information provided is correct to the b t of knowledge, and I understand I am responsible for all charges
incurred from thi applic tion. ,���
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D TE 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
properry located in Davie County and owned by
to conduct all testing procedures as necessary to determine sai ite's suitability for a ground absorption sewage treatment .
and disposal yste . � �uk/�"'
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DATE SIGNATURE
DCHD(12-90)
�, �1 � ' . . 3':Ja �� ^�''����.�.Yi�,�Jl'l " .
• � .; .. ' � DAVIE COUN'fY_H�'�.�r,LTH DEPARTMENT
� ' ' Environmental..�-iealth Section
Soil/Site'Ev�luation �
NAME _ �o�� C P V ���\ ,. DATE EVALUATED �'" `�- 9 3
ADDRESS S 'p' ��' .• :,,�,,� PROPERTY SIZE I D •5 C��'
PROPOSED FACIILTY �aJ s�' ' :' LOCATION OF SITE ��, ��+���-"�"''�'�,�
Water Supply: On-Site Well 1� Community Public
Evaluation By:C�,L AugerBoring ✓ Pit Cut
FACTORS 1 2 3 4
Landsca e osition S
Slo e R —� — 36° ' 3a
HORIZON I DEPTH �J�t°' �IFs' » )�^
Texture rou C S � S� S c
Consistence .� 3�1 F.� �
Structure G� � � � �2
Mineralo t � I � � :� i: 1
HORIZON II DEPTH �� � "
Texture rou S C �- S C L
Consistence ',F� �S
Structure �, � �
Mineralo � � (:►
HORIZON III DEPTH
Texture rou
Consistence
Structure •
Mineralo
HORIZON IV DEPTH
Texture rou ,
Consistence
Structure
Mineralo
SOIL WETNESS .S S ' ,s ' S
RESTRICTIVE HORIZON W.�,_ �v.� • —
SAPROLITE �.
CLASSIFICATION S
LONG-TERM ACCEPTANCE RATE S V-S , y �
SITE CLASSIFICATION: �EVALUATED BY: �-�� ��
L.UNG-TER ACCEPTANCE RATE• OTHER(S) PR ENT: �a�N \C�U O��`
REMARKS:�GssLr'�' CS�� • •.�. � �=.c� �� � � ��.1��.�.2 1f S
�►o0 8���'� �,,.�, �j�. LEGEND S � � p ,
Landscape Position D �J e�r,�W ���c� N �`
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Coacave slope CV-Convex slope T-Tenace 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 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
Stn�cture
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangularblocky PL-Platy PR-Prismatic
MineraloAy �
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•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 - gal/day/ftz, � •
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