178 Iris LnDavie County, NC
Tax Parcel Report 6�J�— Thursday. September 29. 2016
WARMING: THIS IS IVUT A SURVEY
Parcel Information .
Parcel Number:
G700000106
Township:
Shady Grove
NCPIN Number:
5769984169
Municipality:
Account Number:
6753250
Census Tract:
37059-804
Listed Owner 1:
BLACK DAVID LEE
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
178 IRIS LANE
Planning Jurisdiction:
Davie County
City: ADVANCE
Zoning Class:
DAVIE COUNTY R A
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
5.165AC OFF FORK BIXBY RD
Fire Response District:
ADVANCE
Assessed Acreage:
5.23
Elementary School Zone: SHADY GROVE
Deed Date:
10/1984
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
001240667
Soil Types:
EnB,ChA
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
134780.00
Outbuilding & Extra
Freatures Value:
4300.00
Land Value:
49000.00
Total Market Value:
188080.00
Total Assessed Value:
188080.00
101
All data is provided as Is without warranty or guarantee of any kind 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.
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Au i8R,, *ACTION NO: DAVIE COUNTY HEALTH DEPARTMENT 160-60�
4. Environmental Health Section PROPS TY INFO�tMATION
Permitte P.O. Box 848 AL'(z�R 17 -AS 5ySrim
5
n,v� 1a�1 " 1.
Name: t" Mocksville; NC 27028 Subdivision Name: '~� ... TEij -of
t Phone #: 704-634-8760 t 3fG
Directions to property: ' b� Section: Lot:
AUTHORIZATION FOR q
.r *-,� • WASTEWATER Tax Office PIN:# 1, -*_ =LAIC1
SYSTEM CONSTRUCTION
, , _s�� c► �- C r. ..` Road Name�si 5 Zip: 10 ri
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(Incompliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
"***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
'1
a� DAVIE COUNTY HEALTH DEPARAT
MEN T
IMPROVEMENT AND OPERATION P PROPERTY INFORMATION
P8rrmt e?s
Narrie¢" Subdivision Name:
Directions to property: _ U VE Section: Lot:
a+� IMPROVEMENT �_-
S, PERMIT � Ct1
Tax Office PIN:# w
c Road Name t : °l 5 st) Zip:
**NOTE** This Improyeent 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)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
sem' t�� �f;S` t PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
45% INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE �WA*_# BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY\)� DESIGN WASTEWATER FLOW (GPD) NEW SITE V REPAIR SITE
--SYSTEM SPECIFICATIONS: TANK SIZE Lono GAL. PUMP TANK GAL. TRENCH WIDTH 3 ROCK DEPTH LINEAR Fr. bD
e OTHER
REQUIRED SITE M6DIFICATIONSICONDITIONS:
IMPROVEMENT PERMIT LAYOUT
B
"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.
1
OPERATION PERMIT
SYSTEM INSTALLED BY: SAF
f.Cb
F14, j t`
AUTHORIZATION NO. OPERATION PERMIT BY: TE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED A E HAS B ENI LED 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 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
/J Davie County Health Department
Environmental Health Section
1�jA,q�lzrL clof- ice" P.O. Box 848
Mocksville, NC 27028 251997
() 634-8760704 II,,"
U
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed IJY iV `) `J �J� _ Contact Person J! L/ L l�
Mailing Address /2,1 Home PhoneQj�X ' [
City/State/Zip i �` . Business Phone (en -34 (3 11 Si
2. Name on Permit/ATC if Different than Above �-VY'IV t 1_1 0 LA4y-4e---'
Mailing Address .SA M L.._ City/State/Zip
3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC [moth
4. System to Serve: [ ] House [ ] Mobile Home [ ] Business [ ] Industry [ 4.06er .S1e��- POC -6 G
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: [ J County/City [L+NV@l [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** ACOF THE PROPERTY MUST BE
SUBMITTED WITH T tS APPLICATION.
Property Dimensions: Lo X -19S- -X 3Q WRITE DIRECTIONS (from ocksville) TO PROPERTY.
Tax Office PIN: #,6-16-9 -// ,,, ''
Property Address: Road Name /5S SUS C_AeA
City/Zip/4-j�/A C t� ij!( 2,700 -� 221e.� 2i5
-7 � ,p
If in Subdivision provide. information, as follows: fitlb C J�/�(tt�l Gt�GfiL 07C�
Name: ;
Section: 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 ZWi t% -60ZL,. to conduct all testi ures cessary to determine the site suitability.
DATE,5 71�'- � SIGNATU
Revised DCHD (06-96)
THIS A1tEA AtAy BE USED j=olt DRAWINC7 JOUII SITE PLAN-
S�
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME O O
PROPOSED FACILITY e _
SUBDIVISION
DATE EVALUATED 7 -:aq- 9
PROPERTY SIZE '� 06' X
ROAD NAME
Water Supply: On -Site Well ✓ Community Public
Evaluation By: �Cc:U Auger Boring Pit Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture groupL°
Consistences
Structure.
C P�
Mineralogy�\
HORIZON II DEPTH
2
'�
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
oc,
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: _ R S -
LONG-TERM ACCEPTANCE RATE: o�
EVALUATION BY:
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)
LIAR - Long-term acceptance rate - gal/day/ft2
DCHD (01-90)
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