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178 Deacon Way Lot 4 r Davie County,NC Tax Parcel Report Monday,December 19, 2016 {' r_ 246 V r ' `fF 226 !{ r i {' 206 f _ ttiu'{' 309 312 ON►,,�y = 194 LIJ 2391ye 217 ,'r' 178 �v r rf 19 3 fr, 162 _ fxf 277 6 o `-161 260 127 WARNING: THIS IS NOT A SURVEY _ Parcel Information Parcel Number: K503OA0004 Township: Mocksville NCPIN Number: 57475765 Municipality: Account Number: 21036130 Census Tract: 37059-805 Listed Owner 1: DEVEREAUX MARK D Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 178 DEACONS RIDGE 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 4 DEACONS RIDGE Fire Response District: JERUSALEM Assessed Acreage: 3.56 Elementary School Zone: CORNATZER Deed Date: 7/1996 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 001880859 Soil Types: PaD,PcC2,CeB2 Plat Book: 0006 Flood Zone: Plat Page: 060 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 161 All 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,consultants,contractors or employees from anyandaddaimsorcausesofactiondueto NCor arising out of the use or inability to use the GIS data provided by this website. •, DAVIE COUNTY HEALTH DEPARTMENT ` .� IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT-PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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) 717 a PP � Mum ,�� 01aRT�Y�ADDRESS r ea C a'l,. WA a 70�DATES LOCATION SUBDIVISION NAME !S' LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS fL/ # BATHSaW# OCCUPANTS o2 GARBAGE DISPOSAI.t:q/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE 1&0 REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE GAL. PUMP,TANK GAL. TRENCH WIDTH ROCK DEPTH 1.2 LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. t e IMPROVEMENT PERMIT BY **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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY m ART'I a S.7, �U �o ,off to ao wHSi AUTHORIZATION NO. 0q�p '7 OPERATION PERMIT BY Q, DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM RIBED ABOVE 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. DCHD 10/95 k r rya _ r x y Davie County Health Departsent .c17 ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Z t Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in cosP liance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fors/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Buildin Permits. ea AUTHORIZATION UK NAME _1-00MA Ag-- x DATE 8�/S N2 01,167 NAME ON IMPROVEMENT PERMIT (If different than above) Z� r, Oladeree79T SITE LOCATIONCY S COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ***NOTICE*#* THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS., ENVI AL HEAL CIALIST DATE,= DCHD 10/95 .., 11, _,,..i�°•'ya - y+^•.r4a ti"a:. n�=« .a � ..Y? _ ✓!,.tw _v - aw,_. ` . 'ax�a. ate.=4; �r..''� .�. :,. + ... . , • APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County Health Department ' Environmental Health Section P.O. Box 848 Mocksville,NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVnIDED. 1. Name to be Billed hu / /i 11 a55h) rNcl� Contact Person 4 Mailing Address 21 S5- 050"Se-Sc- 1 Ayif. Home Phone City/State/Zip S N• C• aZ 7IA7 BusinessIMne )-7SY- Y299 2. Name on Permit/ATC if Different than Above� �r�J Azz etll -e' Lz Mailing Address City/State/Zip 3. Application For: [ ]Site Evaluation [XImprovement Permit&ATC [ ]Both 4. System to Serve: House [ ]Mobile Home [ ]Business [ ]Industry [ ] Other 5. If Residence: #People #Bedrooms q #BathroomsQ, ) [K Dishwasher A Garbage Disposal [Washing Machine [ ]Basement/Plumbing [X]Basement/No Plumbing 6. If Business/Other:Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: N County/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes M No If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE U SUBMITTED WITH THIS APPLICATION. Property Dimensions: x 9-0x 39gz?WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 7 Property Address: Road Name � d City/zip M' =JAJ ;Ake.) Nc- A DzQ �'y! r.tn"�,:�� Gist 4 �d If in Subdivision provide information,as follows: Oe d"'s 914c 04 Le Name: Dec'Lm4s V L't Section: 1 Lot#: 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 /76 M6. D. QIc.>'' AOX, to cond tall to 'n rur s cessary to determine the site suitability. DATE3 9 L SIGNATURE 11�• L i cs+3� ' 3 6 S'f 1 Revised DCHD(06-96) 8 Zzo rt � �, sv 41 v qs� i r i i6'o. ys q Deo�co�is AeX M;kA,..\N c,,.vsN-,,T-rjc Lglo) `7 35-4i.Aqq `/� = 11 ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / SoiUSite Evaluation NAME C�'R C2 b a DATE EVALUATED ADDRESS PROPERTY SIZE lo��G PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Publicy Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position �- L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure f "t- Mineralogy - HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1 77- LONG-TERM ACCEPTANCE RATE pp , JJ // SITE CLASSIFICATION: 0--� EVALUATED BY: AV" JZ LANG-TERM ACCEEPNCE RATE: OTHER(S) PRESENT: REMARKS: 4r A P EGEND 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(01-901 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME � DATE EVALUATED ADDRESS PROPERTY SIZE f�G' PROPOSED FACIILTY LOCATION OF SITE , xjy/—2wr Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z AVL 12 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH �- Texture group Consistence r Structure----- 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 SITE CLASSIFICATION: �_) EVALUATED 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-Vc.-y 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 Structure .3C--Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mi neraloQy 1:1, 2:1, Mixed Notes Horizon depth - 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Ou MMIIM ENEMIM ■ONMM■■■M■M./■■OM■MMM■.M■■N■■.■�■■■ ■ MEMNONN ■■.E/MMES■■..MOM■E...E..M.E..M.M�EE=�i= MMMmMMMMMmMMMMMmEXXON somm�mm M.M...ME.. mom■■EEE■/ N ■■.■M.rm MEEME■O■■OMME■ ■MMMM■M■■■ ■ME ■I�MMNMM■ ■OMENS 0■MEN■ ■ MMMMMMMm MMMMMMMMMM'MOMMMEMEMEMEN .': MEN ON:.:::�..:::�::::MMMMMMM .................................................................. ■E.M.EEEONMEMEE/■..E.EEMM■EEO■■■■■■EE■N■■■.M■■.NOMN■.■.MM■.■■■.■ mMMMMMMMM MONO ■■E....■EEE.......■■■■■■■E■=■■.■■.■.■..MM■■■.EE■.M.ME■..■..E.■...■ OXEN M ■NNE■ ■..■NE..■■.....■....N..N.■■.■ ■ ■M■■.N..E■.■..E.....■..■ %\'Da le ounty Health Departmekt n nmental Health SeAM q ` P.O. Box 848 / R 210 Hospital Street UG zp�� , t�U Courier# : 09-40-06 Mocksville, NC 27028 Plione:(336)-753-6780 Fax: (336)-753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection �QK� Name: ;4ffiy N-yE-REAwe Phone Number 3310 9q0-b 82(o. (Home) Mailing Address: (-IR DEACON wp"t -751 - $003 (Work) tA-oCKs vi L-LG- N C 2102% Detailed Directions To Site: 601 S LE-F-1 ON DENZNON Rb ' N Mi. TURN LEFT OtJ "TURPeNTitf1= Ct+uRCt4 RD. , "��`ln+�. LEFT 'jrM0 D1^ACoNS RIDGE_/DSWoNWM 3'@b do t)SG ON R t GNT J/f 1'� Property Address: DEACON WAV Please Fill In The Following Information About The EXISTING Facility: /9C�x/yI iTCf;EtL ($u�tOER Name System Installed Under: /SARK bFVFt'EAUX Type Of Facility: Date System Installed(Month/Date/Year): l aT Number Of Bedrooms: Number Of People: 5� Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes No If Yes,Ekplain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: b ET(NC"'Er--,- G R RACE Number Of Bedrooms:_ )25 Number of People Pool Size: air X YO I ^Garage Size: 2� X Z S+ Other: Requested By: ,{J,,Q/L/�QiZe1� Date Requested: g//i�/O (Signature) For Environmental Health Office Use Only �^ Approve Disapproved Comments: Environmental Health Specialist Date: f j *The signing of this form by the Environmental Health St ff 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: ash Check Money Order # Amount:$ (,�•()C� Date: Paid By: T ( Received By: Lond/-cl ,f {M Accnuflt fi- 615lno Tnvnine#• tP