239 Deacon Way Lot 14 Davie County,NC ` ' Tax Parcel Report Monday,December 19, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: K503OA0014 Township: Mocksville
NCPIN Number: 5747555974 Municipality:
Account Number: 82530757 Census Tract: 37059-805
Listed Owner 1: JENNINGS KEVIN D Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 239 DEACONS WAY Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAME COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: LOT 14 DEACONS RIDGE Fire Response District: JERUSALEM
Assessed Acreage: 3.12 Elementary School Zone: CORNATZER
Deed Date: 5/2009 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 007910968 Soil Types: Ce132
Plat Book: 0006 Flood Zone:
Plat Page: 061 Watershed Overlay: DAVIE COUNTY
Outbuilding&Extra
Building Value: Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
Fo-
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
NC County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
or arising out of the use or inability to use the GIS data provided by this website.
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P.O.Box 848/210 Hospital Street
} Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
c
Account #: 990005817 Tex PIN,EN#: K502OA0014
f Billed To: Kevin Jennings Subdivision Info: :��pOON S �jd8e, �
Reference Name: SYSTEM EXPANSION Location/Address:' 239'Deecon Way-27028
Proposed Facility: Residential Expansion Properly Size — 112-'Acres
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
AT(3 WffWAPci5Sj i 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.
System Type: S.T.Manufacturer h Tank Date `� Tank Size
Pump Tank Size e:�
1 System Installed By: �(' LAyLA E.H.Specialist: CQbate: b/7
GPS Coordinate:
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DCHD 11/06(Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
. Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005817 Tax.PIN,EH#: K502OA0014
Billed To: Kevin Jennings Subdivision Info:
Reference Name: SYSTEM EXPANSION -LocatiortlAddress: 239 Deacon Way-27028
Proposed Facility: ❑
Residential Expansion Proper
�$�� �Ft����air �xpansion
Ale,:
ATVgQHbbrThiS&?dhorization to Construct(ATC)MUST BE ISSUED.by the Davie County Environmental
Health Section prior to.issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. ,This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specifications: #Bedrooms #Bathrooms #People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility).
Lot Sizel�a C. Type of Water Supply: ❑County/City ❑Well ❑Community Well
i
• System Specifications: Design Wastewater Flow(GPD) Tank Size4 AL.Pump Tank GAL.
Trench Width Max. Trench Depth�fE Rock Depth i Linear Ft._,6 M,(
Site Modifications/Conditions/Other: As stEted In 15 &A , p r
�y.4tCft1S ,iIc)y assn hf+ lei*
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—J130a.m.on the day of installation. Telephone#(336)751-8760.
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Environmental Health Specialist 012 Dater lJl Z
DCHD 11106(Revised) ///
Davie County Health Department
11� s 1 Environmental Health Section ,
P:o.Box 848
210 Hospital Street
O �'C Courier# :09-40-06 1911
Mocksville,NC 27028
Phone:(336)-753-6780 ON-SITE WASTEWATER CERTIFICATION Fax:(336)-753-1680
(Check One) Replacement Remodeling Reconnection
Name: I ZfylA leyj1l//lgf Phone Number l33% -Moine)
0
M :line /, / DQ
Address: � QCO/1 qyy !alp ik�
AOCXSV111,f /VC 2700 Email Address:
Detailed Directions To Site: (lJV S. .r E e- W i 1y
Property Address:
Please Fill In The Following Informatioo�Jn About The EXISTING Facility:
Name System Installed Under: ! (�f 1 L%UK. Type Of Facility: Gage' —S—;lv4 le r 7 InI/E
,r}
Date System Installed(MonthMate/Year): Number Of Bedrooms: Number Of People:
Is The Facility Currently Vacant? Yes 0 If Yes,For How Long?
Any Known Problems? Yes If Yes,Explain:
Please Fill In The Following Inf rmation About The NEW Facility:A
��'tmi•��t?Cf!•�pi✓� � gds
Type Of Facility: J(p/�jU/O/t) Agn, / Number Of Bedrooms: / Number of People
Pool Size: Garage Size: Other:
, tequested By: i gate Requested:
(Signatur
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental'Health Specialist Date:
*The signing of this-form by the Environmental Health Staff 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: Cash heck oney Order # Amount:$ , Date:
Paid By: Received By:
Account#: :/ Invoice#:
a
a'-A
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION )}` '•° D&
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a � �
Sanitary Sewage Systems ._ tr c Permit Number
Name .- A Date NB 8148
Location
—
Subdivision Name l c c, r� � �� }. Lot No. 14
Sec. or Block No.
t
Lot ,Size ,- --_House — t f Mobile Home ---_ Business -- Industry
No. Bedrooms No. Baths —=^-- No. in Family — Public Assembly Other
Garbage Disposal YES p NO p' Specifications for System:
Auto Dish Washer YES ;; NOJr
Auto Wash Ma^hine YES Q` NO ❑ t�
(7`0
Type Water Supply -
'This permit Void if sewage system described below is not installed within 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 INSTAW NG THIS
SYSTEM. i`'f' )
/do�
.1
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 completion.Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed
iy
1pN _
h v V 'Q 1
AA A
Certificate of Completion _ r -- Date
'The signing of this certificate shall in hat the system deas been installed in compliance with
the standards set forth in the above regul o 1. t s aif n FT0 way be take}ht as a guarantee that the system will function
satisfactorily for any given period of time.
t APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department g�z/
-� Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By
Mailing Address 30e) S / Home Phone
ce l Business Phone ",;*)�2,
2. Name on Permit if Different than Above 24�
3. Application for: a General Evaluation IF-Septic Tank Installation Permit
4. System to Serve: 91H-ouse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision e-2C6 `e Section_L Lot #
❑ Basement/PlumbingNo. of People ❑ Basement/No Plumbing
No. of Bedrooms 011washing Machine
No. of Bathrooms / t!9 Dishwasher
Dwelling Dimensions_3� ,k b ❑ 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: Public ❑ Private ❑ Community
8. Property Dimensions �, - 0G>eV-9 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ya'No
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:
SeA
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t
�This is to cerfy that the information provided is correct to the best f my knowledge, and I understand I am responsible for all charges
incurred fromhis application.Au. d �h`DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD(1/93)
DAVIE COUNTY HEALTH DEPARTMENT ��
Environmental Health Section
Soil/Site Evaluation
NAME1!2fi0 Z— WQ1 \ q�� DATE EVALUATED 4": 95
ADDRESS S A t`M� PROPERTY SIZE 2 ��C 4•
PROPOSED FACIILTY oV.5 LOCATION OF SITE �itii"l /,A b t
Water Supply: On-Site Well Community Public /__�
Evaluation By: Auger Boring Pit !/ Cut
FACTORS 1 2 3 4
Landscape position ,L
Sloe % G - 0- E-
HORIZON I DEPTH
Texture group C �^
Consistence
Structure
Mineralogy
HORIZON II DEPTH /fit p f' L y
Texture group
Consistence #.
Structure k,<,
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS S --s-S
RESTRICTIVE HORIZON
SAPROLITE -
CLASSIFICATION 7777
LONG-TERM ACCEPTANCE RATE L ,t
1�
SITE CLASSIFICATION: � EVALUATED BY: A Zz
LANG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: O NQ�
REMARKS: S2 e 197Q�N
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
Mineralo"
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
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