809 Main Church Rd Lot 8 Davie County,NC Tax Parcel Report Wednesday, October 19, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: G409OA0008 Township: Mocksville
NCPIN Number: 5739496216 Municipality:
Account Number: 82523338 Census Tract: 37059-806
Listed Owner 1: CANNON JILL A Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 809 MAIN CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: LOT 8 BARNHARDT ACRES Fire Response District: MOCKSVILLE
Assessed Acreage: 5.04 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 2/2006 Middle School Zone: NORTH DAVIE
Deed Book/Page: 006470877 Soil Types: MsC,ChA
Plat Book: 0008 Flood Zone:
Plat Page: 032 Watershed Overlay: DAVIE COUNTY
Building Value: 119750.00 Outbuilding&Extra 6870.00
Freatures Value:
Land Value: 28340.00 Total Market Value: 154960.00
Total Assessed Value: 154960.00
101 All data is provided asis 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.Ail users of Davie 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 causes of action due to
NCor arising out of the use or inability to use the GIS data provided by this website.
DAVIE CO ALTH DEPARTMENT �u,
Environmen d' Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account M 989900158 (. ANN�''� Tax PIN/EH M 5739-49-9635.08
Billed To: Richard Hendricks Subdivision Info: Barnhardt Acres Lot#08
Reference Name: Location/Address: Main Church Road-27028
Proposed Facility Reisdence Property Size: 5 acres
ATC Number: 4147
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 1 I of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YE RSA
Environmental Health Specialist's Signature: Date: 7A�; ,A25
&d(ao
lo
J CERTIFICATE OF COMPLETION
u **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
u has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and
c�S 0. ellDisposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
G%`t given period of time.
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Septic System Installed By: 1 ` LAtLe,°'
Environmental Health Specialist's Signature: te:
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 M 989900158 Tax PIN/EH#: 5739-49-9635.08
Billed To: Richard Hendricks Subdivision Info: Barnhardt Acres Lot#08
Reference Name: Location/Address: Main Church Road-27028
Proposed Facility Reisdence Property Size: 5 acres
ATC Number: 4147
**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 IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type #People _ #Bedrooms #Baths o�
Dishwasher Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing:7r, Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply L/ Design Wastewater Flow(GPD) Site: New e Repair❑
ri ',�� 11
System Specifications: Tank SizeGAL. Pump Tank GAL. Trench Width Rock Depth� Linear Ft.60
Other: 15A NCAC 18A.1969(5)
�s�1110 m iso a use
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.****
Environmental Health Specialist's Signature: Date: QS
DCHD 05/99(Revised)
Cal
PLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&
Davie County Health Department �it
it O
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
PL8
1 (336)751-8760 jUt 5'
***IMPORT(ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL14LTHE
INFORMATION IS PROVIDED. Refer to/,theme, INFORMATION BULLETIN for i H
1. Name to be Billed // r >Z£/��/-�-moi- Contact Person
kMailing Address � 2y/ //.�► ,. , �if((r Home Phone 3J .�- 7S/- 3;"y-Pe
City/State/ZIP �C�rb.',/e_ .���.1_ >6��� Business Phone 336- 94 P
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: 1t-Site Evaluation E3Improvement Permit/ATC tv" ❑ Both
4. System to Service: M/House ❑ Mobile Homo ❑ Business ❑ Industry ❑ Other
5. Type system requested: l.-60nventional ❑ conventional modified ❑ innovative MaCCepted
6. If ;Residence: # People y # Bedrooms # Bathrooms —
ODiahwasher ❑Garbage Disposal ,clashing Machine lGbasement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: ElCounty/City 2 Well ❑ Community '
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 2' 0
If yes,what type?
***IMPORTANT"**CLIENTS MUST COdfPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client ivitli THIS APPLICATION.
Property Dimensions: q�e��S. WRITE DIRECTIONS(from Mocl(svilic)to PROPERTY:'
Tax Office PIN: # ,1732- It l (O 3 5 151< Xiin e151'.� /:-d
Property Address: Road Name IhAo I dwe,4 3 iC? lei 0/1 le f+
CitylZlp/l�U :���t.� /V e, J-12le L-16 r 4 Adrl AILS b
If in a Subdivision provide information,as follows:
Name: _ �l r► 4"7
Section: Block: Lot: y Date home corners flagged:
This Is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
issued hereafter arc 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 I am responsible for all charges incurred frons
this application. I,hereby,give consent to the Authorized Representative of the Davie County IIealth Department
to enter upon above described property located in Davie Comity and oi7q by
to conduct all testing procedures as necessary to determine the site sui ab'it
p
DATE � S S SIGNATURIJ Z//z
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).
y Site Revisit Charge
f ,�oma- Datc(s):
Jfjv Client Notification Date:
1;13 70
MIS:
oQ
0
Sign given Account No.
Revised DCIiD(05/03 Invoice No. ---E�—
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OPERTY IS EXEMPT F.-ROM DA.tE COUN7 t = D�O.•RpItSSrpy+,, L '
VOI. RECULATIOMS BY SECTION 154.01 L 3163 1 REVEWO.MCER•S CEPTIFICATE -
DAr,E COUNTY COD_ =�(
4 yOR:V4"t`/OFFICER OF DAYIE COUNTY �j p
�,SUBY4,7'v ♦+ CERTIFY THE PLAT TO t'+ilC-i HiS
CERTIFICATION 7$ATTACH :� L x7163 i T
MAL iS REOUIP.ED BY THE 'O.�2fF ' " \ass'♦ J).-ET, 7HE c'AiU ORY P.E�a2"trENTS FOrT PECO°DI.nG. r� !6-D *- rJ
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DATE
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FUlry
RIBBON PAtiEMENT SR 2 1405 PUBLIC 1
q-__-1247 52'-5T' ".8
+wJ .E — N 53'-11-10 E — N 54'-Ol'-t0" C_ — 904.06' 70TATAL C�
a� y 17x.25' 73.21` '172.33 125.G566.8f' 13203' i25.00' 150.63' 175.00' 200.20 733.00' �~ C3
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I C Da 176 PC too
wf / / TAX PARML . j
1
h. (11D7 5 6 7 8 9 0 clo <_33D4 /
/ i ^ h� o u 2 w tA �' N 63-399Z7'
cq.Ft. a 41 v ti r . c o $ T-eAP.FCJNO / 5-40-F aAR fottra
h n C i i I m L5 - //63' X0.75'
TAc. 219386 Sq.Fi. W W I 1 i x 40 Li ct225330 SG.Ft. 0 4$'50'F` �3A.R FCVIC
y h °' En 5.174 Ac. h C 1
5.013 Ac. h J O O O "� O Or 1
r ( 226092 Sq.Ft.�o (f O o o i _ ;
' 5.190 Ac. j I j I ( m m j m w i
235316 Sq-Ft. i
5.403 Ac. v i
ti Ati/
y to •^ �'� 1,n ;' ea _r ♦ ----..-.
i r 1L4 ta Nf 1; i
217906 Sq.Ft. 1217867 ScFt. 218655 S^,.Ft. 303362 Sq.FI.
5.002 Ac. 5.002 Ac. 5.024 Ac. / 6.955 Ac.
217927 Sc.Ft. 213001 Sq.F'. }"") / 213.30' 2 564.62' f
�? 5.003 Ac. 5.000 A.C. j�� �- �. -c SAMIA 1
N,rf N 52'-30'-50 E 777.91' TOTAL h. 00P15 r BA
DaCF 117 1
�•.?.T' / PI.RT T../
i sot 1 221141 Sq.FLd%`•;o
5.077 Ac 6'A
v0 �9 ?O! "04' � J3hi' n!Fa•M1D h
4_.97 . _ _ 795.03' 220.27'
23653• 2'15.50185.53' _ . immo r-a_
AR Fairt7__
---- ---- -__•X c 51'-1d-2O 'Y! X 1.0 TOTAL �•FC'.tr.D — S 52'-_34'-10_ IN "000.83' 70TA� 54'-0-'-30- 'NF77TOTAL— S . .34' ,� = S 52-30'-50" N 353.30 COr!RDL MRrrR
a fD aV _1 itrJ`J
care_ eD=r:Ei CONTROLLED ACCESS ` CM FCIJND 1 LOWE Lle.trt!ON
N 79"0326.34 !• D°53 r•, til
f�*,,��A� t 'j 7ix PA3M
9 'it E 15332t 3.16 S f�i � L 1 S S 1 1 E A. c s-ze
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DUAL LANE COMCR= - R.330't PA.!ZV_NT
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMAJION PROPERTY INFORMATION
Account #: 989900158 Tax PIN/EH#: 5739-49-9635.08
Billed To: Richard Hendricks Subdivision Info: Barnhardt Acres Lot#08
Reference Name: Location/Address: Main Church Road-27 28
Proposed Facility: Reisdence Property Size: 5 acres Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut_
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH a /
Texture groupL
Consistence ('
Structure
Mineralogy -
HORIZON II DEPTH
Texture group (i
Consistence
Structure <
7-
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 e
SITE CLASSIFICATION: 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
Textus@
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
a'IQ1St
VFR-Very friable FR-Friable F1-Firm VFI-Very firm EFI-Extremely firm
)3.e' t
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
1YQtcs
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 05105(Revised)
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DAME COUNT�ALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 989900158 Tax PIN/EH#: 5739-49-9635.08
Billed To: Richard Hendricks Subdivision Info: Barnhardt Acres Lot#08
Reference Name: Location/Address: Main Church Road-27028
Proposed Facility Reisdence Property Size: 5 acres
ATC Number: 4147
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YE RS.
Environmental Health Specialist's Signature: /1 Date: S
T�
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
v 2 has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and
;1✓. y12 Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
d �Y
i�
Septic System Installed By: 1 ` LA V-(
Environmental Health Specialist's Signature: Z/-
te: A1041
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760 /Fax: (336)751-8786
April 19, 2007 '
Jill Cannon
809 Main Church Road
Mocksville,NC 27028
Re: Septic System
Dear Mrs. Cannon:
This letter is to address problems with the septic system that serves your residence. On December
28,2006,we received a call regarding the septic system stating that"when it rains it floods." A visit to
the site on January 4,2007 revealed sewage surfacing at the beginning of the lowest drain line. As a
result,two actions were taken:
1. A surface water diversion ditch was installed uphill from the drainfield, and
2. Because the house is served by a private water supply, a meter was installed to gauge water
consumption in the residence.
The surfacing condition was improved at a visit March 5,2007. The water diversion ditch had
evidence of water movement. Average daily water consumption in the residence was within design flow
of the wastewater system through the first 5 weeks of readings.
A return visit to the site on April 17, 2007 found sewage surfacing, again from the area of the
lowest drain line. A heavy rainfall event(>1")had occurred two days prior. Due to the intermittent nature
of this failure,the description from the initial contact with our office, and assessments made on site, one
of two things may be contributing:
1. Underground lateral water movement is filling up the drain lines, and/or
2. An underground spring may have popped up in the area of the drain field.
I recommend that a french drain be installed uphill from the drainfield, in the area of the surface
water diversion ditch. The drain shall be at least six feet deep and shall extend ten feet beyond the limits
of the septic system, including the tank. There should be adequate fall to discharge the drain toward Main
Church Road. A diagram of a french drain is attached.
If this is not successful in correcting the surfacing condition of the septic system, an Improveftient
Permit will be issued to repair the system. Please feel free to contact us with any questions.
Sincer
Jeff Beauchamp,R.S.
Environmental Health Section