259 Gordon Dr Lot 4 Davie County,NC f Tax Parcel Report Tuesday, January 3, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: D7010B0004 Township: Farmington
NCPIN Number: 5862540856 Municipality:
Account Number: 8303557 Census Tract: 37059-802
Listed Owner 1: BRANYON GEORGE C Voting Precinct: SMITH GROVE
Mailing Address 1: 259 GORDON DRIVE Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: LOT 4 GORDON HEIGHTS Fire Response District: SMITH GROVE
Assessed Acreage: 1.12 Elementary School Zone: PINEBROOK
Deed Date: 6/2014 Middle School Zone: NORTH DAVIE
Deed Book/Page: 009590647 Soil Types: GnB2
Plat Book: 0007 Flood Zone:
Plat Page: 085 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
91,E 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 any and all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
4
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street 1 (1
Mocksville,NC 27028 2(I
(336)753-6780/Fax#(336)753-1680
V"
OPERATION PERMIT
Account M 990005758 Tax PIN/EH#: D7010B0004
Billed To: Jamey Crotts Subdivision Info: Gordons Heights Lot#A
Address: 245 Knoll Crest Road Location/Address: 259 Gordon Drive-27006
City: Mocksville Property Size: 1.005
Reference Name:
Proposed Facility: Bedroom/Bathroom Ad
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 1 I of G.S.Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems,"
but shall in NO be taken as a guarantee that the system will function satisfactorily for any given period of
time. /
System Type: �S.T.Manufacturer ` Tank Dater—t'�— Tank Size��
Pump Tank Size_
System Installed By: UKj, E.H. Specialist: Date:
GPS Coordinate: 1
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DCHD 11/06(Revised)
i
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 #: 990005758 Tax PIN!EH#: D7010B0004
Billed To: Jamey Crotts Subdivisioti,lnfo: Gordons Heights Lot#4
Reference Mame: LocationiAddress: 259 Gordon Drive-27006
Proposed Facility: Bedroom/Bathroom Ad Property Size x1.'.005
ATC Number: 5832 Site Type: ❑New ❑Repair AExpansion
**NOTE**This Authorization 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 Size Type of Water Supply: J(County/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD) Tank Size ,.Pump Tanko GAL.
it Trench Width 3LL Max.Trench Depth Rock Depthnyg Linear Ft. j6
Site Modifications/Conditions/Other: —r• {( n
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760.
t
ell
-a,
Environmental Health Specialist Date:G
DCHD 11/06(Revised)
v j ErF—IMAfVounty Health Department
p1836SEP 2 61 o Fli 'n onmental Health Section
P.O. Box 848
210 Hospital Street
O �41 Courier# : 09-40-06 1911
Mocksville, NC 27028
Phone:(336)-753-6780 ON-SITE WASTEWATE ERTIFICATION Fax:(336)-753-1680
- (Check One) Replacement emodelin Reconnection
Name: J n M'0GO+1-s Phone Number 33�-CI40-4 09 Z (Home)
Maifing Address: 2TZ (rho Ll eresi- iN . 3,3(0- -S99-b1-1'z (Work)
NIo r.k:s V e lI C- 2-70-0a Email Address: ��,, �nn.e sic On, reVP%
Detailed Directions To Site: Q DD�b�C. mL On 15 $
lura Le 4 ori Re&`J Rd.
I
GO -�7DDrvj. I .' M,', Ogedia Rd, � rRU oa rOEAVA Q( . VO
.J
M;,
� - Oil
Property Address: 2-69 CoorA,A T-)c,i\ < 07or-don FZU�z Lol
Please Fill In The Following Information About The EXISTING Facility:
Name.System Installed Under: 7-ILA 1'K4j l Type Of Facility: lr` NO MP
Date System Installed(Month/Date/Year): y j �0 Q Number Of Bedrooms: 3 Number Of People:
Is The Facility Currently Vacant? Yes If Yes,For How Long?
Any Known Problems? Yes No If Yes,Explain: �(L1 �� j I?>Q 0-0A
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: e4otu f3cA ro0rAl- Number Of Bedrooms:__L _Number of People
Pool Size: Garage Size: Other:
Requested By: Date Requested: cI-2
jignatul)
For Environmental Health Office Use Only
Approved D' approved
eats: IBF1 (`
2
Environmental Health Specialist Date:
*The signing of this form by the Environmental Healt 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• C�ashl-heck Money Order # Amount:$ Date: q-
Paid By: jr q�, s Received By: a"aAl
Account M �/X71{/ Invoice#:
DAVIE COUNTY HEALTH DEPARTMENT 'od
Environmental Health Section
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001076 Tax PIN/EH#: 5862-54-0856
Billed To: Judith Tuthill Subdivision Info: Gordon's Heights Lot#4
Reference Name: Judith Tuthill Location/Address: Gordon Drive-27006
Proposed Facility: Residence Property Size: 1.126 Acres
* 383
*NOT * 1"his�lmprovement/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 IT SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type M. [IDM r #People _ #Bedrooms 3 #Baths -.2—
Dishwasher:
Dishwasher: Glr' Garbage Disposal: ❑ Washing Machine: M'- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industria13l Waste:
Lot Size +,N Ial
Type Water Supply�Ot9 Y Design Wastewater Flow(GPD) Q Site: New Repair❑
System Specifications: Tank SizelQQ�GAL. Pump Tank GAL. Trench Width Rock Depth �Z" Linear Ft.,3L0'
Other: r11-.0Ty0A lr�slull, p►J cA�-feor-
Required Site Modifications/Conditions: 1YaP �� a ���• (,,, ! , eP �1 �F M• No �
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6 u 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.****
Qes-
............
L.
APP�2t�x 100'
'TiD P4v'r�'Lt u�1►'
Environmental Health Specialist's Signatur : Date: go
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account M 990001076 Tax PIN/EH M 5862-540856
Billed To: Judith Tuthill Subdivision Info: Gordon's Heights Lot#4
Reference Name: Judith Tuthill Location/Address: Gordon Drive-27006
Proposed Facility: Residence Property Size: 1.126 Acres
ATC Number: 2383
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 Tre t and Disposal Systems). THIS
AUTHORIZATION FOR WASTE CO ION I ALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signa re: ate:
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.
Tq
AT ► Q)
Septic System Installed By: '� ✓ 1 �r,)
Environmental Health Specialist's Signatur Date: 5 ►
DCHD 05/99(Revised)
j APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT D L5
Davie County Health Department
Environmental Health Section MR 3 1 20M
P.O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 ' " '%am, i1q,
***.IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. rRefer �t10- the INFORMATION BULLETIN for instructions.
1. Name to be Billed �1A&( '►1n t'i TU[T�1��1 `1, Contact Person 0�&�TIJI t
Mailing i+ddresa IS/}Irl W, 1"Ik)LI A)1 Q Home Phone 33b-qq8-183rb
City/state/ZIP U�/Qh(Q, , I3 b t)t) Business Phone 33Ip- rJ-7LJ-r13q P7
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation M Improvement Permit/ATC ❑ Both
4. system to Service: ❑ House 0 Mobile Home ❑ Business ❑ Industry ❑ Other
S. If Residence: # People # Bedrooms 3 # Bathrooms .17—_
Df Dishwasher F1 Garbage Disposal (1l1Washing Machine 11 Basement/Plumbing II Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodea # Showers # Urinals I Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: 2-**C*ounty/City ❑ Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes "o
If yes,what type?
***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION.
. 1026 c��S
Property Dimensions: 'i�X1 D `t( �g; WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PIN: # J•v —5 `7/- OYS7� WWII 51 ea-5f +T) Red I anti Rd
Property Address: Road Name 2,5q C orl on Or 64 nn 'Rea lam VA *b
City/Zip adra aC A16 ,'Z��06 ��T M &lyd mfl 7-r.
If in a Subdivision provide information,as follows: PJ b�1E�_ a npyrlyL 114 m l.e nn
Name: C-,Ord im 1AQlak}5
Section: Block: Lot: _ Date Property Flagged: ��—�O
This is to certify that the information provi ed is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspensio o ev tion,if the site plans or intended use change,or if the information
submitted in this application is falsified o c6 ppge I,also,understand that 1 am responsiblefor all charges incurred from
this application. I,hereby,give consent to e A th rued Representative of the Davie County Health Department
to enter upon above described property locat d i D vie County and owned by U eLi�h >;, Tu ti
::r ccaduc.a::testing proeedures as necessary d er ine the site suitability.
DATE �' 31-DD S NATURE C�/1�-�Gi('
l
THIS AREA MAY BE USED FOR DRAWING YO ITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, n septic locations).
{jc Site Revisit Charge
fv Date(s):
Client Notification Date:
EHS:
J�f
Account No. AO
Revised DCHD(07/99) .til 16 Invoice No.
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APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC
0 ( Davie County Health Department
, v� `7 Environmental Health Section
I0 ;\ \� P.O.Box 848
Mocksville NC
27028
�F
y
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
� THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed � AL=ZU 1192 CC)tiaM-7/u.ContactPerson R tc/C 5 TA.JLL�/
Mailing Address /e2 o (2Ani Ae,a or, Pod& CC A7 Home Phone
z7� 3
City/State/Zip (.J.4r)5-7g,.✓ — 5:44" .v,['_ Business Phone
2. Name on Permit/ATC if Different than Above SA 1777!!
Mailing Address _ City/State/Zip
3. Application For: �4 Site Evaluation [ ]Improvement Permit&ATC [ ]Both 6c, C CJ 7:5
4. System to Serve: [ ]House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other _ /IMAIIJ f,,�L 7-GjL
5. If Residence: #People #Bedrooms #Bathrooms [ ]Dishwasher[ ]Garbage Disposal
[ ]Washing Machine [ ]Basement/Plumbing [ ]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: County/City [ ]Well [ ]Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes 1--4 o
If yes,what type?
E Z T11 11 A PLAT OR SZTE PLAN
PROPERTY INFORMATION REQUIRED:***IMPORTANT**#CAIFLAT OF THE PROPERTY MUST BE
Amt L 517-&S (f Co) SUBMITTED WITH THIS APPLICATION.
Property Dimensions: WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
Tax Office PIN: # S S 6,Z - S`- - / ; _,�J� S 70e'/SSL/�5 7-
Property
Property Address: Road Tame ur(AJu.✓ 2 C'i1U g L-b ��c4 WIA-{� y v
City/Zip Al.C
If in Subdivision provide information,as follows:
Name v.r s�,,,,�5 �'!r�/l 7J• 7-
Section: OZ 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 C4 = to conduct all testing procedures as necessary to determine the site suitability.
DATE —L ?— SIGNATURE e—
Revised DCHD(06-96)
T111S AINTA MAID LSE I151:1) rolr L)RAIVING I/011lt SZTE• PLAN:
' F
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION_LOT,
Soil/Site Evaluation
APPLICANT'S NAME U'`i4 V'_ �.Jr�. DATE EVALUATED• S'�`/Ql
PROPOSED FACILITY 1 PROPERTY SIZE
SUBDIVISION � (»,- 1Y�.%J�Iii�l ROAD NAME VOJx L�
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 44C 5 6 7
Landscape position
Slope% k C/10
HORIZON I DEPTH
Texture groupC
Consistence
Structure
Mineralogy ,
HORIZON II DEPTH yd r
Texture group
Consistence
Structure h-
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: C� 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)