193 Ashley Lane, Lot 3 Davie County,NC Tax Parcel Report Tuesday, October 18, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: F50000000205 Township: Mocksville
NCPIN Number. 5831927274 Municipality:
Account Number: 8305311 Census Tract: 37059-806
Listed Owner 1: THOMPSON MARK W Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 193 ASHLEY LANE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: LOT 3 ASHLEY PLACE Fire Response District: WILLIAM R.DAVIE
Assessed Acreage: 5.03 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 7/2015 Middle School Zone: NORTH DAVIE
Deed Book/Page: 009960274 Soil Types: MrC2,MrB2,MsC,MsD,WATER
Plat Book: 0007 Flood Zone:
Plat Page: 100 Watershed Overlay: DAVIE COUNTY
Building Value: 242030.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 41360.00 Total Market Value: 283390.00
Total Assessed Value: 283390.00
9 :�FAll data Is provided as is without warranty or guarantee of any Idnd 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,consulhnts,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
APPUCUION FOR SITE EVALUMION/IMPROVEMENT PERMIT do All
�., Davie County Health Department
Envlronmenfal Xealffi SWlfon
P.O. Box 848/210 Hospital Street
Mookaville,' NC 27028 MAR 1 U 1999
(336)751-8760
ENV140MENTAL
***ZHPOItTANT"** THIS APPLICATION cuncDT BE moccSSED UNLE33 ALL :9j-
INFORMATION I3 PRO—VOIDED. Refer to the INFORMATION BULLETIN for--instructions.
1. llama to be Billed tJ i�� /,� ��CCG/ 1 � Contact Person
Mailing Address 0 */ o! Home Phone
City/State/LIP / L • 9769E Business Phone
Z. !lame on Permit/ATC if Different than Above
Nailing Address // City/State/Lip
3. Application For: W Site Evaluation 0 Improvement Permit/ATC 0 Both
4. System to service: 18'House 0 Mobile Home 0 Business 0 Industry 11 Other
a. If Residence: # People , # Bedrooms 3 # Bathrooms Z
Dishwasher 0 garbage Disposal !tushing Machine 0 Basement/Plumbing t/No Plumbing
6. If Business/Industry/other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Nater Coolers
IF FOODSERVICE: # Seats Estimated slater Usage (gallons per day)
7. Type of water supply: 0 County/City lIwe11 0 Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes "0
If yes,what type'
"AIMPORTANT"*CLIENTS MUST CVAfPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: wJ 19
cYCS WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tai Office PIN: # S83l--5�/-5"7 7 40/ hl -14 6,141 Ad Than 9
Property Address: Road Name-t9h sell All PJ / 44&
City/Zip 47, 6m 1. e) 7`
if in a Subdivision provide information,as follows:
Name:
Section: Block: Lot: Date Property Flagged: �, L'a_ elf back�i�c �• +�
This is to certify that the information provided Is correct to the best of my knowledge. 1 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 responslblefor all c/hwges Incurred from .
this appU aadon. 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 the site suitability.
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE P ;7(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Account No. 7" /
Revised DCHD(07/98) Invoice No. 1�
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`' `•' DAVIE COUNTY HEALTH DEPARTMENT
y • Environmental'Health Section SECTION LOT 3
Soil/Site Evaluation
APPLICANT'S NAME DATE EVALUATED 111P11W
PROPOSED FACILITY PROPERTY SIZE Jb Z 3 At
SUBDIVISION ROAD NAME
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit V Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope% -
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH s
Texture group
Consistence
Structure AiW - b
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 1 2 1 1
SITE CLASSIFICATION: fEVALUATION BY: ICS G
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 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-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 plastic
Structure
SC-Single grain M-Massive CR-Crumb GR Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogy
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(O1-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Al93
Account #: 990003029 Tax PIN/EH#: 5831-92-7274
Billed To: Melissa Agrillo Subdivision Info: Ashley Place Lot#3
Reference Name: Location/Address: Ashley Lane-27028
Proposed Facility: Residence Property Size: 5+acres
ATC Number: 3650
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 a Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWA N CTI IS ALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature Date:l/s
k7e—oo
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the tem seri on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S.Chapt 1 OA S ioo 11900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guarant hath sys will function satisfactorily for any
given period of time. 1S
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Pus �f4,y k
A( 14—04tA( 14— `9 Septic System Inst d By: 1 LLts
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Environmental Health Specialist's Si ature A e:
fo�m `
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
• P.O.Boz 848/210 Hospital Street
Mocksviille,NC 27028 (� /
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003029 Tax PIN/EH#: 5831-92-7274
Billed To: Melissa Agrillo Subdivision Info: Ashley Place Lot#3
Reference Name: Location/Address: Ashley Lane-27028
Proposed Facility: Residence Property Size: 5+acres
ATC Number: 3650
**NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type &)SE #Peo le #Bedrooms � #Baths :2 3/
y
Dishwasher: GT/ Garbage Disposal: ❑ Washing Machine: 132" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift c#Seats Industrial Waste: ❑
Lot Size �(V t._.ype Water Supply WLI Design Wastewater Flow(GPD)4 6)n Site: New G� Repair❑
System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width���
Rock Depth 17-" Linear Ft. 906
Other: l9 U� l Q.1 eof l 0'�3 �j�- bo"an � !ALIK
Required Site Modifications/Conditions: L—d 5'oFr— r6;G,-_ Vcd ,'Sd cz� PSD, V— r L-6 P-o", Lze —
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie C my Health Department for final inspection of this
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on t ayia la 'on. Telephone#is(336)751-8760.****
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�C nvironmental Health Specialist's Si ature: Val- Date:
N
CHD 05/99(Revised)
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D A C
APPLICATION FOR SITE L•VALUATION/IhIPROVUIEW PERMIT&J•�
Davie County Health Department U L �(j�.: '004 {
Enyironmenta/Hea/t/l Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 EtJ`✓tROidb'";?' ,
DAl'iECUUi'(yEALTN
(336)751-8760
***XbIPORTANT*** TIiIS APPLICATION CANNOT BE PROCESSED UNLESS ALL HE REQUIRED I
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed ^`m-&�k- o Contact Person
CIO
Nailing Address 143 ?ay,,,•'PfQO%L �L��^ `% Nome Phone >& .q
14.._.
4_ _ _.
City/State/ZIP AAAJa---C—� Business Phone _ /O ,7Q� {.jSW ...._..
2. Name on Permit/ATC if Different than Above _--
Mailing Address City/state/Zip
3. Application For: ite Evaluation Xmprovement Permit/ATC ❑ Iloth
4. System to Service: House ❑ Mobile Home ❑ Businebs ❑ Industry ❑ Other _
S. Type system requested:XConventional ❑ conventional modified ❑ innovative
G. If Residence: it People _ It Bedrooms II Bat.:hrocmw
>lpi'swasher ❑Garbage Disposal K7ashing Machine ❑DasemenL•/Plwnbing ❑Basement•/No Plumbing
7. If Business/Industry /Other: verify type It People If Siul's
K Commodes It Showers It Urinals it Water Cooler:
IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day)
8. Type of water supply: ❑ County/CityWell ❑ Colunrunity
9. Do you anticipate additions or cX11allsions of tic rlciiity this system is inten(le(l to sL'1. c? ❑ A'" KNo
If)'Cs,)VIlat t)'I)C?
***lItIP01ZT11tYYk**CLIENTSD1UST C0AIPLETETI1L REQUIRED PROPERTY INFORMATION REQIJI?STE'D '
BELOW. I:itllcr a PLAT or SITE PLAN i11UST BESUHAf1TTED by the client witIC1'IIIS APPLICATION. `
Property Dimensions: -k WRITE DIRECTIONS(frons Mocksvillc) to PROPERTY:
Tax Odie PIN: ��_ S 3 lei 2-7274 tf S�3 L�o� L.a uakR
Property Address: Road Nanic OY1 SOy
City/Zip 0' U I/O C
If in a Subdivision provide infornlation,as follows: AYL
Nanlc: y1, LN'
Sccfiol: Block: Lot: Date Mollie corners 11a9ged: Z
This is to certify that file information provided is correct to the best ofnly knowledge. I understand that any pernlil(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 aul responsible fur till charges incurred.jrnul
this application. I,hereby,give consent to the Authorized Representative of the Davie County Ilcaltll Delmr(Illent
to enter upon above described proper(ylocated in Davie County and owned by
to conduct all test•lig pi cedures as necessary to determine (lie site suitability.
DA'Z'E 2 01 SIGNATURI;
TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Inc ude all of the following: Existing:old proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Ch:u ge
Client Notification Date:
EIIS.
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Sign given �� Account No. �' 1
RevisedD�`jI (O5/03 Invoice No. 3� 3S ,
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