1167 Williams Rd Lot 2 Davie County,NC Tax Parcel Report Wednesday, October 19, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: 170000004903 Township: Fulton
NCPIN Number: 5778179362 Municipality:
Account Number: 82528848 Census Tract: 37059-804
Listed Owner 1: DAVIS LOU H Voting Precinct: FULTON
Mailing Address 1: 1167 WILLIAMS ROAD Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: LOT 2 BAILEYS RUN Fire Response District: FORK
Assessed Acreage: 0.86 Elementary School Zone: CORNATZER
Deed Date: 10/2007 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 007340066 Soil Types: PcB2
Plat Book: 0007 Flood Zone:
Plat Page: 135 Watershed Overlay: DAVIE COUNTY
Building Value: 43860.00 Outbuilding S Extra 1100.00
Freatures Value:
Land Value: 20790.00 Total Market Value: 65750.00
Total Assessed Value: 65750.00
All data Is provided as Is without warranty or guarantee of any kind 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 Countys GIS website shall hold harmless the
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
moo N NC or arising out of the use or Inability to use the GIS data provided by this website.
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990001496 Tax PIN/EH#: 5778-27-1347.02
Billed To: William Shrader Subdivision Info: BAILEYS RUN Lot#2
Reference Name: Location/Address: Williams Road-27028
Proposed Facility: Residence Property Size: 3/4 acre
ATC Number. 2644
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 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATFR CONSTRUCTION IS VALID F R A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: - Date:,
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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.
Septic System Installed By: ��,�
Environmental Health Specialist's Signature:_ LZZ11 Date:
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
•. P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001496 Tax PIN/EH#: 5778-27-1347.02
Billed To: William Shrader Subdivision Info: BAILEYS RUN Lot#2
Reference Name: Location/Address: Williams Road-27028
Proposed Facility: Residence Property Size: 3/4 acre
ATC Number: 2644
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS
PERMIT IS SUBJECT TO REVOCATION 1T'SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type 4Zje #People #Bedrooms #Baths _
Dishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial)Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply ro Design Wastewater Flow(GPD) Site: New Repair❑
System Specifications: Tank Siz%GAL. Pump Tank GAL. Trench Widthc2Rock Depth Linear Ft fo/
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County 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 the day of installation. Telephone#is(336)751-8760.****
F
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Environmental Health Specialist's Signature: Date:
DCHD 05/99(Revised)
1
- APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC D
Davie County Health Department N0�
Environmental Heal fi Section 4 2n,'n,
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Bille y ,1 F) ' v— Contact Person nA S4-0 W
Mailing Address �1 p ll�ll ,Qpp \ \' 1 1�,p Home Phone —F1 'e- O
City/state/ZIP r(�17�1� V 1 rl�C UV 1 4, U W�usiness Phone /—
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both
4. System to Service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other
S. If Residence: # People _ # Bedrooms _ # Bathrooms
Dishwasher ❑ Garbage Disposal Washing Machine '�I Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: 10 County/City ❑ Well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes o
If yes,what type?
***IMPORTANT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Z
rty�HinTensi ns: '� WRITE DIRECTIONS(from Mocksville).te PROPERTY:
ffice PIN: # '77 8 a7— 13 ` 7. c) &n 4E7
.�
L74 lkl-
Pro
ress: Road Name
City/Zip ( 0 /'� (�c� 1 l ► �tmr Kc(
If in a Subdivision provide information,as follows: -ey-
Name: a t L-"J=E PL4-e-01
Section: Block: Lot: �` Date Property Flagged: °T '
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
to conduct all testing procedures as necessary to determine the site suitability.
DATE 'A — b O SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
t^cA ` 'TL EHS•
e f f
Account No.
Revised DCHD(07/99) Invoice No. ` L/
a f)Qs �°
-
w
175.00
174.98
® St•y � W
' 0 AREA.=
Off" N
AREA= .
N 972 AC. INCLUDES
0
INCLUDES S.R. 1610 R/W -V
r" f AREA. 47
0.971 AC. o�
1 "
/ INCLUDES S.R. 1610 R W 4.
.836 AC.
ACC
1610 R W Q t�EGATrvE E�_ t (P
cu
NEGATIVE Co 175,00 30 30
"
1298
OTAL S u ffjLr +
S
j
D
2 • 16
/ O
71 . S.R
0530' 30-
We, hereby certify that we are the owners of
the property shown and described hereon and
I, hereby certify that the Davie County Health that we hereby adopt this plan of subdivision
Deportment has evaluated the subdivision with our free consent, establish minimum set—
entitled : BAILEYS RUN back lines and dedicate all streets, aIle
with respect to criteria and conditions established parks and other sites and easements to� walks,
ubc
by state law or promulgated thereunder and the or private use as noted. Futhermore, we hereby
some is found to comply with such criteria and dedicate any and all sanitary sewer, storm sewer
conditions EXCEPT as set forth in such evaluation. and water lines to Davie Coun
For details of this evaluation and for limitations, ty(if applicable).
see the written report on file at said department.
IMPORTANT NOTICE: THIS CERTIFICATE DOES NOT OWNER
CONSTITUTE A PERMIT OR APPROVAL OF INDIVIDUAL
LOTS IN SAID SUBDIVISION FOR INSTALLATION OF
SEWAGE FACILITIES.
OWNER
ATE DAVIE COUNTY HEALTH OFFICER I, hereby certify that the subdivision plat shown
hereon has been found to comply with the Davie
CERTIFICATE OF APPROVAL BY DAME CO. COMISSIONERS County.Subdivision Regulations with exception of
I, Bobb such variances, if any, as are noted in the
y Knight. Chairman minutes of the Planning Board and it has been
of the Davie County Board of Comissioners hereby approved for recording in the Office of Deeds.
certify that said board has approved this plat It is hereby noted that such approval for
entitled : BAILEYS RUN recordation does not include approval for the
on this the day of ,2000 construction or occupancy of buildings or structures.
CHAIRMAN DAME COUNTY BOARD OF COMISSIONERS DIRECTOR
DAME COUNTY PLANNING DEPARTMENT
`
REVIEW OFFICER'S CERTIFICATE CERTIFICATE OF APPROVAL BY THE P
I. John Gallimore, Review officer of Davie County, CANNING BOARD
The Davie County Planning Board has hereb .S
certif th the ma or
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT D
y' Davie County Health Department 13
Envltnnmenf&Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 :a; �w3e' : s
(336)751-8760 i.
***n1PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed � n('.,.1 c}.r�l1 ' Ck S S i C( I Contact Person �' t G l Cc S.5lC N
Mailing Address � {V I IIc Q 6("\Y L�C�(1e • /�1\ l/ Home Phone � c� ' - 2(-o C\�
City/state/ZIP M. LAC�1., i 1 (e- (V (v '116 U ?�1 Business Phone � l � � �C'o
2. Name on Permit/ATC if Different than Above MY b1Ie- ��
Mailing Address city/state/Zip
3. Application For: (Site Evaluation ❑ Improvement Permit/ATC ❑ Both
4. system to service: X House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People � # Bedrooms .� # Bathrooms �-
Dishwasher O Garbage Disposal Washing Machine ❑ Basement/Plumbing U Basement/No Plumbing
6. If Business/Industry/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 ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes K No
If yes,what type?
***IMPORTANT***CLIENTS MIST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: �GS� S WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PIN: # 1�1-I wGl L-e- X 1 1 t����
Property Address: Road Name 1 (CL W\,S CI I D 11 r
City/Zip Ag C e- 11 Ci CA n 0 0 r D L
To-f fYNa? 1# 49 60(,
If in a Subdivision provide information,as follows: Y 11 �C I
Name: lav/ ,'1.6 ,c,r t L) V\ 11 1��
Section: Block: Lot: Date Property Flagged:
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. 1,also,understand that 1 am responsible for all charges Incurred from
this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department-
to
epartment'
to enter upon above described property located in Davie County and owned by�M c s 14 ' q e[P to J C&S S << 3
to conduct all testing procedures as necessary to determine the site suitability.
DATE CD SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
I' Site Revisit Charge
���� G TTGZ C 1"1 P 4 . �- I n Date(s):
5t,z � veN be Con-.�IeEec� 4tvLC� wilt h�
Client Notification Date:
Coe C� ?(e-Ci S (� V 2 Q Cl ✓,a 11 c C. {� 1 t C
1 _ EHS:
e c�611A . c�6 ,
Account No.
Revised DCHD(07/99) Invoice No.
z
1
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION L LOT
Soil/Site Evaluation
APPLICANT'S NAME C r_ DATE EVALUATEDry
PROPOSED FACILITY /T PROPERTY SIZE
SUBDIVISIONE � ti S �i9I�Y ROAD NAME A/
Water Supply: On-Site Well Community Public C__1
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position .LL
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH J�F�
Texture group
Consistence
Structure _-541( --r-
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 n
SITE CLASSIFICATION: /J EVALUATION BY:
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(01-90)
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4 r
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. Box 848/210 Hospital Street
Courier #09-40.06
Mocksville, NC 27028
Phone #: (336)751-8760
July 12, 2000
Helen J. Cassidy
270 McClamrock Road
Mocksville,NC 27028
Attention: Ms. Cassidy
Re: Site Evaluations— 4 Sites
Williams Road/Baileys
Tax Office PIN: #5778-27-1347
Dear Client(s):
As requested, a representative from this office visited the aforementioned sites on
July 12,2000. Based upon the information provided on the Application(s)for Site
Evaluation(s) and after evaluations were completed, sites 1 thru 4 were found to be
provisionally suitable for the installation of an on-site sewage system.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked on each site.
If you have any questions,please feel free to contact this office.
Sincerely,
AAW44.19WWAS
Robert B. Hall,Jr.,R.S.
Environmental Health Specialist
RH/mp
Enclosure(s)