263 Gordon Dr Lot 5 r
Davie County,NC' Tax Parcel Report Tuesday, January 3, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: D7010B0005 Township: Farmington
NCPIN Number: 5862541857 Municipality:
Account Number: 8301488 Census Tract: 37059-802
Listed Owner 1: ROGERS WILLIAM THOMAS SR Voting Precinct: SMITH GROVE
Mailing Address 1: 373 MAE ZIMMERMAN DRIVE Planning Jurisdiction: Davie County
City: LEXINGTON Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27295 Voluntary Ag.District: No
Legal Description: LOT 5 GORDON HEIGHTS Fire Response District: SMITH GROVE
Assessed Acreage: 0.93 Elementary School Zone: PINEBROOK
Deed Date: 10/2012 Middle School Zone: NORTH DAVIE
Deed Book/Page: 009050468 Soil Types: GnB2
Plat Book: 0007 Flood Zone:
Plat Page: 085 Watershed Overlay: DAVIE COUNTY
Outbuilding&Extra
Building Value: Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
1:01
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
rCounty 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 webs@e.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
OPERATION PERMIT
Account #: 990005967 Tax PIN.,EH'#: D701 OB0005 r
Billed To: Will Rogers Subdivisiory info: Gordon Heights Lot#5
Reference Name: ::r Location/Address: Gordon Drive-27006
Proposed Facility: Residence :+r PrOpdrly Size: 1 Ac
ATC Number: 5992
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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.
t
System Type:_T Z--Z-/ S.T.Manufacturer. Tank Date P5 TankSize i
Pump Tank Size i Bedrooms:_ /
System Installed By:A1' lal AA t.*f r Installer# Date: /s 7
GPS Coordinate:
4
U
Environmental Health Specialist Date:
DCHD 11/06(Revised)
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 #: 990005967 Tax PIS€%)WH#: D7010B0005
Billed To: Will Rogers Subdivision;Info: Gordon Heights Lot#5
Reference plane: LocationiAddress: Gordon Drive-27006
Proposed Facility: Residence property?Size: 1 Ac
ATC plumber: 5992
Site Type: IPNew ❑Repair ❑Expansion
**NOTE**.This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
Health Section prior tq 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 SizeC A Type of Water Supply: ACounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD) 7 w Tank SizeffLCQGAL.Pump Tank / GAL.
Trench Width 3(9Max.Trench Depth,3_Gl:_ Rock DepthJQ 19 Linear Ft. i-/DO' c2s%b
Site Modifications/Conditions/Other: m/I
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.
a
N. ,yam
c�
Fs
Environmental Health Specialist Date:
DCHD 11/06(Revised)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
G E IV Davie County Environmental Health p
< P.O.Boz 848/210 Hospital Street q
OCT 2 3 2012 Mocksville,NC 27028 U<.�1
(336)753-6780/Fax(336)753-1680 z�y ` A.
Applicatio��P rte valuation/Improvement Permit ❑Authorization To Construct(A
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing m Facility
***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPT.TCANT INFORMATION
Name u V!rs Contact Person ik/,
Address 923 Home Phone
City/State/ZIP LF4 , A&. .72-9 S- Business Pho q _ 23 9 - 3&5"7
EmailI d rr -41 eV /6x Conte
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE:_ A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan,no expiration with complete plat.)
Owner's Name' ' G�i//.it w �• Er Phone Number
Owner's Address E City/State/Zip WCC' 144e-
Property
.eProperty Address 6a oll City_P oc%ru�/t(-
Lot Size Tax PIN#
Subdivision Name(if applicable) Section/Lot#
Directions To Site:
If the answer to any of the following questions is•"Yes",supporting documentation must be attached:
Are there any existing wastewater systems on the site? Yes No
Does the site contain jurisdictional wetlands? _Yes �-No
Are there any easements or right-of-ways on the site? Yes =No
Is the site subject to approval by another public agency? ^Yes -No
Will wastewater other than domestic sewage be generated? Yes No
TF RESIDENCE FIT J,OI JT THF,BOX RRLOW
#People #Bedrooms #Bathrooms Z Garden Tub/Whirlpool ❑Yes Cho
Basement: ❑Yes ?No Basement Plumbing: ❑Yes P-No
TF NON-RESIDENCE FIT 1,OUT THE BOX.BELOW
Type of Facility/Business Total Square Footage of Building #People
# Sinks #Commodes #Showers #Urinals
Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: ❑ County/City Water ❑New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑No
If yes,what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if
the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative
of the Davie Co Health Department to conduct ne essary inspections to determine compliance with applicable laws and rules.
I understand tha am responsible for proper ide 'fication and labeling of property lines and comers and locating and flagging
or stakin a ase/facility location, o sed location and the location of any other amenities.
Property owner's oowner's egal represen iv signature Site Revisit Charge
Date(s):
Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No AQpauat4
Revised 11/06 �
!6 , Invoice#
CJS U • .�3Za
No�f P414 �/rr�Gterrs
' Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax(336)753-1680.
IMPROVEMENT PERMIT
Account #: 990005711 Tax PIN/EH#: D701060005
Billed To: Jerod Stanley Subdivision Info: Gordon Heights Lot#5
Address: PO Box 57 Location/Address: Gordon Drive-27028
City: Advance
Property Size: 1 Ac
Reference Name: t.
Proposed Facility: Reside#
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to
revocation if site plans,plat or the intended use change.
Permit Type: 15New ❑Repair ❑Expansion Permit Valid for: JX5 Years ❑No Expiration
Residential Specifications: #Bedrooms_ #Bathrooms Z #People z Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): 3&0 Type of Water Supply: ACounty/City ❑Well ❑Community Well
Site Modifications/Permit Conditions:
System Type LTAR
Initial 461, 3
Repair 2.�5% `o
Site Plan
N
Fla0
Environmental Health Specialist Date��
i.p.11-06
APPLICATION FOR SITE EVALUATION/IMPIaE T & ATC .
` �f" alth Davie County Environment et
P.O.Boz 848/210 Hospital t
OCT 0 � 2012 Mocksville,NC 2702s
(336)753-6780/Fax(336)753-1680
Application For: VSite EvaluationAmprovement Permit ❑ Authorization To Construct(ATC) ❑ Both C�
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPI.TC'ANT INFORMATION
Name Je.M8 "Wad
ea Contact Person znS(q,�Q\/
/-e<
Address DO Bvk ,S:1 Home Phone QC)R G91
City/State/ZIP /\rAL1aAM ALC. -tJo()r. Business Phone x C2, ZGf(7
Email i
Name on Permit/ATC if Different than Above i
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facili Comers Flagged Q /2 /Z
NOTE:. A survey plat or site plan must accompany this application. Included: Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan,no expiration with complete plat.) Q,
Owner's Name' t rn pkV Phone Number
Owner's Address ?0 R(UL 5-1 1 City/State/Zip UO�W2MC, 1�tXl�
Property Address G p rc(n/-. b r. City Aj uo,,m
Lot Size I OLCre_ T PIN# T)70/0&0()S
Subdivision Name(if applicable) r on HeM k SectionlLot#
Directions To Site: - r M&
If the answer to any of the following questions is•"Yes",supporting documentation must be attached:
Are there any existing wastewater systems on the site? Yes ZNo
Does the site contain jurisdictional wetlands? Yes./No
Are there any easements or right-of-ways on the site? Yes v/fio
Is the site subject to approval by another public agency? _Yes ✓No
Will wastewater other than domestic sewage be generated? Yes✓No
TF RF,STDF,NCF,FIT J,OT JT THF,BOX BF,T,OW
#People L #Bedrooms _ 3 #Bathrooms 2_ _ Garden Tub/Whirlpool ❑Yes S&o
Basement: ❑Yes o Basement Plumbing: ❑Yes AO
-TF NON-RFSTDF,NCF FTLT,OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building #People
# Sinks #Commodes #Showers #Urinals
Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: 9(conventional ❑Accepted ❑innovative []Alternative ❑Other
Water Supply Type: County/City Water ❑New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 6YNo
If yes,what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if
the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative
of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules.
I understand that I am responsible for the proper identification and labeling of property lines and comers and locating and flagging
or6sg /f i ation,proposed well location and the location of any other amenities.
Propov rWR5!f;,W oro r'4egal representative signature Site Revisit Charge
Date(s):
to/9A Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account# 7 /1
Revised 11/06 Invoice# .
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990005711 Tax PIN/EH#: D7010B0005
Billed To: Jerod Stanley Subdivision Info: Gordon Heights Lot#5
Reference Name: Location/Address: Gordon Drive-270 8
Proposed Facility: Residenct Property Size: 1 Ac 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
Sloe% c °d
HORIZON I DEPTH
Texture group G
Consistence eg
Structure K
Mineralogy
HORIZON H 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: EVALUATION BY:
ATJUL,� MAA"A/
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: it h
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 loamL-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
3Yet
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
1YQS�
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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r C( APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT &ATC
j Davie County Health Department
Environmental Health Section
l0 � ;� \ '1" P.O.Box 848
v" V G� Mocksville NC 27028
1 , . y
.1 (704) 634-8760
****IMPORTANT**** ) THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed &ATlu ti/1( :z&45r,c7ic4/Contact Person /1? is/C 5 zw'14 Lam/
Mailing Address /0 0 C-Am Ae,,n e.d A.a2 Ccz„/z7 Home Phone
City/State/Zip 5:4t” .v, Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: Site Evaluation [ )Improvement Permit&ATC [ ]Both CJ 7:S
4. System to Serve: [ ]House [ ]Mobile Home [ ]Business [ ]Industry [ J Other YMAIU ziF'L 7t.1/2
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. 0
If yes,what type?
EIMER ,1 PLAT 01% SITE PLAN
PROPERTY INFORMATION REQUIRED:***IMPORTANT**-Ik'A`FDAT OF THE PROPERTY MUST BE
l A S �Co� SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 'WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
Tax Office PIN: # S e e.Z S`- - / .ObS� sJ. S
Property Address: Road]Tame l C' Ax caNw d1Vn � JS�i/r v d
✓4 n c� ;
City/Zip Aloper?ft" dC.r.c.//7 ux'ov./
If in Subdivision provide information,as follows: GCD
r
Name: <f;v.r Z1, Ile---4l.-/ Z-2- yY/ ��F 7-
Section:
Section: f 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 C47,K-:2- to conduct all testing procedures as necessary to determine the site suitability.
DATE -L 1— SIGNATURE
Revised DCHD(06-96)
T11IS ,t1�F l MA.11 LST.: 1151-1) I-OR bRAII'INC, !/oLIR SIZE M-AN:
' �' ► DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTIONZ _LOTS
Soil/Site Evaluation
APPLICANT'S NAME //ft/'� of DATE EVALUATED S/
PROPOSED FACILITY l / PROPERTY SIZE Z�
SUBDIVISION _ ' z� ROAD NAME
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring C"� Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position .4—
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH p r
Texture group
Consistence i
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: 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 Imd,surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification-S(suitable PS(Erovisionallsuita e) U(unsuitable)
LTAR-Long-term acceptance rate-gal/day/ft2
DCHD(01.90)