213 Houston Rd Davie County,NC • Tax Parcel Report g 1�� Thursday, September 29, 2016
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WARNING: THIS IS NOT A SURVEY
' ; , .; ParcelInformation .= , : . . � .
Parcel Number: M60000003001 Township: Jerusalem
NCPIN Numberc 5755554233 Municipality:
Account Number: 78960000 Census Tract: 37059-807
Listed Owner 1: WILKIE GERALD B Voting Precinct: JERUSALEM
Mailing Address 1: 213 HOUSTON ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE 2oning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-6702 Voluntary Ag.District: No
Legal Description: 1.90 AC HOUSTON RD Fire Response District: JERUSALEM
Assessed Acreage: 1.67 Elementary School Zone: COOLEEMEE
Deed Date: 9/1995 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 001830063 Soil Types: PaD,PcB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 151650.00 Outbuilding&Extra 4920.00
Freatures Value:
Land Value: 25180.00 Total Market Value: 181750.00
Total Assessed Value: 181750.00
9��!E, All data Is provlded as is wlthout wartanty or guarantea of any kind eithe►expressed or Implied Includtng but not Iimited to the
Davie County� Implied warrontles of inerchantablllty or fltness for a paRfcular use.All users oi Davie Countys GIS website shatl hold harmlesa the
1�T!� County of Davie,North Carotina,Its agents,consultants,eontractors or employees from any and all ciaims or causes of action due to
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�'oUN�S� 1�l. or adsing out of the use or Inability to use the GIS data provided by this website.
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` � �.%� � _ -' DAVIE COUNTY HEALTH DEPARTMENT
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� ,. . -`-- _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
�� Sanitary Sewage Systems ..:` �j��:� /y' `" �� Permit Number
Name ��•��•'�s_1 %�/, i/�,f' --;�/,�,�'/, � : ij��Date �1L��-S N� 8 1 3 8
/ ,, � _ J ' �:,-? � �/ �-- -t (�
Location �%-�/..1�-- /r' ���'�` r�' �'�-��-��.��'_ i�. �� __ � ��` �,V; fi�
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Subdivision Name Lot Na Sec. or Block No.
Lot Size ,:��L�" _ House _ Mobile Home _� Business __ Industry
No. Bedrooms �—.No. Baths _�- No. in Family�__ Public Assembly Other
Garbage Disposal YES ❑ NO []� Specifications br System:
Auto Dish Washer YES Q NO p a �-�':(}�''
Auto Wash Ma^hine YES [�j O [� �����'��` �
�
Type Water Supply _� � --------- `��UD.��.�X��
'This permit Void if sewage system described below is not installed withm 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
� SYSTEM.
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. 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.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of compietion.Telephone Number.704-634-5985.g/�(J
Final Installation Diagram: System Instalted by —�y��•.n S //�.���
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Certiticate of Completion �1� __ Date �y�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 br any given period of time,
" � . , , � APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER � � � U �
�,e . .
; r Davie County Health Department � 2 7 �
`ti ' Environmental Health Section
. P. O. Box 665
_.. .___.:_ _ . ..__..._ ---._ ._._ ..____.
Mocksville, NC 27028 - __.._ _._ __.. ..__ . __
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DaVtE UA11Y
1. Application/Permit Requested By��n�� - �� t���P_
Mailing Address �..1� �'f"�n 1�'� • Home Phone Q�O-qq���_
'�(�g�g�f'���e ����jp�� Business Phone�L�Q- ��L>
2. Name on Permit if Different than Above ��.;1Q�- ��\ �P�
3. Application for: ❑General Evaluation �Septic Tank Installation Permit
4. System to Serve: O House 6�'Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
� O BasemenUPlumbing
No. of People � ❑ BasemenUNo Plumbing
No. of Bedrooms � C'Washing Machine
No. of Bathrooms � Q'bishwasher
Dwelling Dimensions ❑ 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: L�Public ❑ Private ❑ Community
8. Property Dimensions S�C�� �c�-��p� Sewage Disposal Contractor<�_cs���t� - u
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? � Yes Ca'Flo
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:
(�l S (���S. -�'� `�jec���u: rJ � �on� L.��`-C.
�, �t�'�� � �Ou.s�r � o� 6Z�s��-
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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 bONE ON AB VE DESCRIBED PROPERTY
MUST CHECK ONE: � 1. I OWN the property. O 2. I DO NOT OWN the property.
If you checked Box#2, the rest of this form M T be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representativ of the vie'C_o4nty,,H�alth Department to enter upon above described
property located in Davie County and owned by �trc� (�CJ,�,(��
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system. )..
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DATE SI NATURE
pCHD�(1�93)
# �
• :� �•' � ' � DAVIE COUNTY HEALTH DEPARTMENT
,� • � Environmental Health Section
. Soil/Site Evaluation
NAME �������f'��� DATE EVALUATED �//f..S/
ADDRESS . PROPERTY SIZE
PROPOSED FACIILTY �� LOCATION OF SITE --�i��j
Water Supply: On-Site Well _ Community Public f�
Evaluation By: AugerBoring � Pit Cut
FACTORS 1 2 3 4
Landsca e osition � �-
Sloe � �
HORIZON I DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH �'f t �Y �"
Texture rou �. C
Consistence �- '
Structure l S' ��
Mineralo / � /�`
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence '
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON �
SAPROLITE
CLASS.LFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATED BY:
LDNG-TERM ACCEPTANCE RATE: � � OTHER(S) PRESENT:
REMAR KS•
LEGEND
Landscave 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-Silt,y <:lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-V��.-y friable FR-Friable FI-Finn VFI-Very firn► 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
Structure
,iC--SYn�le grain M-Massive CR-Crumb GR-Cranular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralo�+
1:1, 2:1, Mixed
Notes
F{orizon 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 - ga1/day/ft2 ,
DCHD(01-901
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•.C1 � �`�.�,p ENYIRONMENTA�HTM�� Courie # : 09-40-06 �(1r'"��, d �
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Pliaie:(336)-753-6780 ' • rvc:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
�
Name: � �' ��i� PhoneNumber 3�l' ��9��03 C (Home)
Mailing Address: .2! .3 �-�o��o�, (Work)
.���f��1/�.�L ��o � g �
Detailed Directions To Site: t�ol S �-� o,J �C.�C�ow,✓ � %L �r1,�P �?'�'v„/
��v L'S��"y.J ��? �v1.�� 6�� �".
� $7�'— L ?
Property Address: � / � L ,s o,.7
Please Fill In The Following Information About The EXISTING Facility:
�
Name System Installed Under: ' Type Of Facility: �s • �
Date System Installed(Month/Date/Yeaz): �'Vl i G� �S Number Of Bedrooms: � Number Of People:
Is The Facility Currently Vacant7 Yes � If Yes,For How Long? '
Any Known Problems? Yes � If Yes,Explain: ;
Please Fi11 In The Following Information About The NEW Facility:
Type Of Facility: LIYZI, r�L�t�i}i� � �n ��S : �ln Y Z� Number of People
Requested By:, !, � Date Requested: 5 �2�� �O
ignature)
�--- For Environmental Health Office Use Only � �'�'� r.�st;, S'
Approved� 'sapproved
Comments:
Environmental Health Specialis Date:_��viD
*The signing of this form by the Environmental Health Sta f is in no way intended,nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: as Check Money Order # Amount:$ �60 2d Date: L.. Z -�8
Paid By: /Y1�G,�ji� C'���.,,�j.��,.:, Received By: �ffT
Account#: .3,�ZZ � Invoice#: 7�S$G