256 Deacon Way Lot 9 WDavie County,NC Tax Parcel Report Monday,December 19, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: K503OA0009 Township: Mocksville
NCPIN Number: 5747565613 Municipality:
Account Number: 8304329 Census Tract: 37059-805
Listed Owner 1: SEAMON CLETUS DANIEL JR Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 256 DEACON WAY 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 9 DEACONS RIDGE Fire Response District: JERUSALEM
Assessed Acreage: 2.49 Elementary School Zone: CORNATZER
Deed Date: 11/2014 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 009730238 Soil Types: Ce132,MsD
Plat Book: 0006 Flood Zone:
Plat Page: 061 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding 8r Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
OAll 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 any and all claims or causes of action due to
�o NC or arising out of the use or Inability to use the GIS data provided by this website.
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•' HEALTH DEPARTMENT RELEASEFor office Use Only
*CDP File Number 1194331 - 1
� = d Davie County Health Department
210 Hospital Street County ID Number:
P.O. Box 848
Evaluated For. HDRNVWC
Mocksville NC 27028
Phone: 336-753-6780 Fax:336-753-1680 PERMIT VALID 0 6 1 0 a l a 0 a 0
UNTIL:
Applicant: Susan Seamon Property Owner: Susan Seamon
Address: 256 Deacon Way Address: 256 Deacon Way
City: Mocksville City: Mocksville
State2ip: NC 27028 State0p: NC 27028
Phone#: (336)682-1244 Phone#: (336)682-1244
Property Location&Site Information
rAddresSL256 Deacon Way Subdivision: Deacons Ridge Phase: Lot: 9
# Mocksville NC 27028SINGLE FAMILY Township:
cture: Directions
#of Bedrooms: 3 #of People: Hwy 601 South,left on Deadman Rd.Left on Turrentine Rd,then left
Into Deacons Ridge
'Water Supply: PUBLIC
Basement: r]Yes❑No Type of Business:
Total sq. Footage: No.Of Employees:
'Proposed Improvement:
Pool
'Release Conditions `
- r
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps.Signature Required? OYes ONo
Applicant/Legal Reps.Signature: *Date:
*Issued By: 2140-Nations,Robert *Date of Issue: 0 6 / 0 a / a 0 l 5
Authorized State Agent:
**Site Plan/Drawing attached.`*
®Hand Drawing Olmport Drawing
HEALTH DEPARTMENT RELEASE ' . ` ' 194331 - 1
sTd Davie County Health Department CDP File Number:
210 Hospital Street
County File Number:
P.O.Box 848
Mocksville NC 27028 Date: 0 5 / 0 2 / 2 0 1 5
0Inch
Scale: OBiock
Drawing Type: Health Department Release QN/A
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Page 2of2
• Davie County Health Department
i std' environmental Health Section
Zq P.O.Box 848 :
ti 210 Hospital Street
+� Courier# : 09-40-06 .�9
Mocksville,NC 27028 r
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: Sus, N Leo an Phone Number✓/� (Home)
Mailing Address: aNe Q (Work)
/r/'1 LX)� Email Address:
Detailed Directions To Site:
Property Address:
Please Fill In The Following Informa/tion About The EXISTING Facility:
Name System Installed Under:�Q�%7'rQ�(/Li;E'- ? a—S Type Of Facility:
Date System Installed(Month/Date/Year): Number Of Bedrooms: 3 Number Of People:
_ js-he-Facillt.,,_C„rrentl3VacanO Yec '/No I Tf Yes,For How Long?_
Any Known Problems? Yes 5 If Yes,Explain:
Please Fill In The Flo] wing Information About The NEW Facility:
Type Of Facility: p/ Number Of Bedrooms: Number of People
Pool Size:_ Garage Size: Other:
Requested By Date Requested: 5. 11
(Signature)
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
(ext d or limited)that the on-site wastewater system will function properly for any given period of time.
Paymen Cash Chec Money Order # Amount:$ -d �,Doate: //16
I If
Paid By: Sia Received By: 6(.lN,fllj`�/�
Account Invoice#:
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE:lss.u'ed in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
NaME Date No 7553
Location
,Zn& Ommem ww_
Sec.or Block No.
Subdivision Name Lot No.
Lot Size House Mobile Home Business___Industry_
No. Bedrooms
.)_No. Baths No. in Family Public Assembly Other
Garbage Disposal YES ❑ NO C3'
Specifications for System:
Auto Dish WasherE)
YES NO
Auto Wash Ma-hine YES NO E:]
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.
Improvements permit by
*Cbntact 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 by
Certificate of Completion Date1d—f
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation,but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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Printed:May 29, 2015
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the 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 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.
DAVIE COUNTY HEALTH DEPARTMENT
• IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary/Sewage Systems / Permit Number
Name Date �Zz?/9s� N� 15 5 3
Location —
_ 5!0 eOA)
SubdivisionName S ��" Lot No. Sec. or Block No.
Lot Size 11�11 .��� House I— Mobile Home — Business _— Industry_
No. Bedrooms No. Baths No. in Family _ Public Assembly Other i
Garbage Disposal YES ❑ NO [?-'
Specifications for System: "
Auto Dish Washer YES NO ❑ /Cjd,�j,,-,�.�,.r / ��.J
Auto Wash Ma^hine YES NO ❑ t
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.
Improvements permit by 46'a
*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.
i
Final Installation Diagram: System Installed by —
1�
t Certificate of Completion __y� Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. i
ti APPLICATION FOR SITE EVALUATION/IMPROVEME
;. Davie County Health Department
Environmental Health Section I ��(' —2
P. O. Box 665 J
Mocksville, NC 27028
1. Application/Permit Requested Byia 411' b'y a
Mailing Address '3O0 6. 14,JhA 51� Home Phone
&10 e t` S"" --e 41- 70,x-$ Business Phone 91f 0— 70o S
2. Name on Permit if Different than Above ie
3. Application for: ❑General Evaluation jiYS"eptic Tank Installation Permit
4. System to Serve: 9?"Pouse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry El Other ❑ Unknown
5. If house, mobile home: Subdivision 12
e;p eon 5 Section Lot # 91
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms ("Washing Machine
No. of Bathrooms A 12 Dishwasher
Dwelling Dimensions X d ❑ 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 0, Q 9 e Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2"o
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:
JSRoad 6k\
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK 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:
1 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(1193)
• DAVIE COUNTY HEALTH DEPARTMENT '.01I ,
Environmental Health Section
Soil/Site Evaluation
NAME DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE � '�7�2�,
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit I---- Cut
FACTORS 1 2 3 4
Landscape position
Sloe Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
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: 50�0' OTHER(S) PRESENT:
REMARKS: � C� ��� ar 26 le 4 41 '."a (l.
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-Anoular 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 I7'/9 �'S� DATE EVALUATED � �_R
ADDRESS PROPERTY SIZE <fC
PROPOSED FACIILTY LOCATION OF SITE 0
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring �� Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralo
HORIZON II DEPTH
Texture groupC
Consistence
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: KIZ
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 ;lay 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
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