247 Knoll Crest Rd Davie County,NC � Tax Parcel Report ���— Tuesday, October 4,2016
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WARNING: TffiS IS NOT A SURVEY
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, Parcel Information
Parcel Number. K60000001103 Township: Jerusalem
NCPIN Number. 5757012730 Municipality:
Account Number: Census Tract: 37059-807
Listed Owner 1: Voting Precinct: JERUSALEM
Mailing Address 1: Planning Jurisdiction: Davie County
City: Zoning Class: DAVIE COUNTY R-A
State: 2oning Overlay: -
Zip Code: Voluntary Ag.District: No
Legal Description: 5.00 AC OFF DEADMON RD Fire Response Dlstrict: JERUSALEM
Assessed Acreage: 4.90 Elementary Schooi Zone: CORNATZER
Deed Date: 12/2013 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 2013E1221 Soil Types: MrB2,WeB,PcC2,CeB2
Plat Book: Flood 2one:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 147930.00 Outbullding 8�Extra 0.00
Freatures Value:
Land Value: 32210.00 Total Market Value: 180140.00
Total Assessed Value: 180140.00
9►.�Y�1�, M data is proWdM u Is wNhout wam�Ry or guanMee ot any Idnd elther e:pressed or Impiled Indudln9 but not pmited to the
Davie County� impUed wamMles of inereharAablltty or Btness tor a particular use.M users of DaNe Courrt�s GIS website shall hold harmiess tbe
CouMy aT Davie,North Grolina,its agents,conwlt�Ms,coMnctors or employces from any and aN dalms or uuses ot actlon due W
np�N.� rJC or arisfng out ot Me use or Inabllky to uu tha GIS data pmvided by W s webslte.
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� AUTHOR=zAT�oN No: . DAVIE COUNTY HEALTH DEPARTMENT
" ��" " ' ' - " - Environmental Health Section PROPERTY INFORMATION
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Permittee's, : P.O.Box 848 �
Name:' ' ��j�����Pr�r�Ty�,�'� ` Mocksville;NC 27028 Subdivision Name:
.�.-- Phone#:704-634-8760
Directions to property:��, % �i�- / Section: Lot:
: AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# �- �,�,�
SYSTEM CONSTRUCTION� ' ���-���� `
Road Name: .! i" i���
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Counry Environmental Health Section prior
to issuance of any Building Pernufs.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article l l of G.S.Chapter 130A,.Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
�
` � ,: ***NOTICE***THLS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�' ,�� �` �� ° f- - : IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL H ALTH S CIALIST `:-DATE ISSUED _
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.� � �.- �„��-= � `f�, N DAVIE COUNTY HEALTH DEPA �M,�TT �
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,»� ;�.,�'M �, ,�, IMPROVEMENT AND OPERATION 1��1�VIITS PROPERTY INFORMATION
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' Name� � . � � �' {,�n -� �� Subdivision Name:
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Directions to property: �;, %� ��" �.-�;� ��' Section: Lot:
, '' IlVIPROVEMENT
� • � PERNIIT Tax Office PIN: �''"-��1r -�
J� �r .
Road Name: �0 . J`''�' iP: `���.�
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**NOTE**This Impmvement Pernut DOFS NOT authorize the construction or installation of a septic tanlc system or any wastewater system.An �-
�. AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCITON must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
� '`��� � t',7 '""�' �f q, r� ***NOTICE***THI.S PERMIT IS SUBJECT TO REVOCATION IF STl'E
,! �.``a i�� 6' �c:+°�'���'�-� .� r', :..•' �` PLANS OR Tf�INTENDED USE CHANGE.YOUR WASTEWATER
- ENVIRONMENTAL HEALTH S �C� IALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING TI�SYSTEM.
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RESIDENTIAL SPECIFTCAT'ION:BUILDING TYP� #BEDROOMS,�#BATHS � #OCCUPAIV'fS -� GARBAGE DISPOSAL:Yes or No
/�.!�" i,'
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLFJSHIFf #SEATS INDUSTRIAL WAS.3'E:Yes or No
LOT SIZE� TYPE WATER SUPPLY �l�/ DESIGN WASTEWATER FLOW(GPD) ��v NEW SITE �' REPAIR SITE
.. /Up o ,, ___./
SYSTEM SPECIFICATIONS: TANK SIZE�GAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH� LINEAR Ff. ��U
OTHER �
REQUIRED SITE MODIFICATIONS/CONDTfIONS:
IMPROVEMENT PERMTf LAYOUT
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**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.T'ELEPHONE#IS(704)634-8760.
OPERATION PERMTf �
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SYS INSTALLED BY:
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AUTHORIZATION NO. fl 4'�- OPERATION PERMIT BY: ��� . DATE: `�0 !��
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WTfH ARTICLE 11 OF G.S.CHAPTER 130A,SECI'fON.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OS/96(Revised)
_ , APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE � Q�n�
;• ' Davie County Health Department V
. Environmental Health Section JAN I 2 �Qgg
P.O. Box 848
Mocksville,NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
T QUIRE NFORMATION IS PROVIDED.
1. Name to be Billed � Contact Person
Mailing Address Home Phone �lG-p9�G.�G�'
City/State/Zip , d Business Phone�/D�— �����'S 9
2. Name on PermidATC if Different than Above
Mailing Address , City/State/Zip
3. Application For: [ Site Evaluation [ ]Improvement Permit&ATC [�J Both
4. System to Serve: [ ]House [ Mobile Home [ ]Business [ ]Industry [ ]Oth
5. If Residence: #People —� #Bedrooms ✓ #Bathrooms 2 ishwasher[ . Gazbage Disposal
[�ing 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 [ ell [ ]Community
�
8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [�
If yes,what type?
EITHER tt PL,4T OR SITE P1.ttN
' PROPEItTY INFORMATION REQUIRED:***IMPORTANT**'�.��'OF THE PROPERTY MUST BE
SUBMITTED WITH TffiS APPLICATION.
Property Dimensions: ��('/l�•t� �WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
Tax Office PIN: #�- �� - o�_�� ! l d�.f' �-��i� �l.aA`rus—�— %/�'1��-
Property Address: Road l�ame �/L���il,Ca� � ,�,�vr v/� �s� — �S� o'/-`Gf!<-, L�9rs'G Cli1�
City/Zip /Yld�i/C ?i?� ?f' ; �'laiz u�C- - G���i �. ��'} �5��e�s.� q�'
If in Subdivision provide information,as follows: � ����t�tG[ l h� Cd%[ ��� /�/1uJ
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Name: �
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Section• Lot#• �
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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 ��conduct a � ing ced s as nece to determine the site suitability.
DATE �"a? ' �� SIGNATUR � �
Revised DCHD(06-96)
THIS ARE�I 1�IAJ $E USEb �OR bRttWINC JOUR SZTE PLtIN:
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Scals:l"_ '••`"•••"" January 06,199810:36 AM
DEED BOD�PAGE� � , .`•.
Exhibit "A° ���S Z �
. Lying and being in Jerusalem Township, Davie County, North Carolina, and beginning at S 7. �� • •
an iron found, said iron found being the Northeasternmost corner of Charles M. Davis,
Jr., Deed Book 91, page 734 and 735, parcel 52, tax map K-5, and being a Southeast corner l f/
of Max Lee Johnson, Deed Book 83, page 514, parcel 54, tax map K-5; thence with said - 7�
Johnson corner, North 10 degrees, 32 minutes East 380.37 feet to an iron placed, said
iron placed being in the Southern line of Hugh D. Graves, Deed Book 62, page 184, parcel •
51, tax map K-5; thence with said Graves line, South 66 degrees, 03 minutes East 380.00 ••
. � feet to an iron placed; thence South 12 degrees, 44 minutes West 609.69 feet to an iron '
placed, said iron placed being located in the Northern line of Ernest Boblee Loy, Deed -
Book 169, page 784, parcel 11.01; thence with said Loy line, North 58 degrees, 35 minutes,
20 seconds West 228.48 feet to a point; thence with said Loy line, South 80 degrees, .
55 minutes West 84.52 feet to a point; thence with said Loy line, South 78 degrees, 58
minutes, West 57.16 feet to an iron placed, said iron placed being located in the Eastern ;
line of said Charles M. Davis, Jr.; thence with Davis line, North 10 degrees,. 32 minutes �
� East 285.02 feet to the POINT AND PLACE OF BEGINNING and containing 5.006 acres as
surveyed by C. Ray Cates September 22, 1993.
Grantor also conveys herein and reserves a 30 foot wide easement, said easement beginning
at the Southwest corner of hereinabove described property and running along the southern
portion of hereinabove property as follows: BEGINNING at an iron stake; thence North
78 degrees, 58 minutes East 57.16 feet to a point; thence North 80 degrees, 55 minutes,
East 84.52 feet to a point; thence South 76 degrees, 54 minutes East 63.12 feet to a
. point; thence South 51 degrees, 52 minutes, 40 seconds East 169.72 feet to an iron stake,
said iron stake being the Southeast corner of the hereinabove property, said easement
being 30 feet wide being 15 feet on each side of above described centerline and together •
with a 10 foot wide easement of ingress, egress and regress leading from said property
in a northwesterly direction to Deadmon Road. �
Dwellings on hereinabove described property to be no less than 14X70 feet.
' Easements to be maintained by grantees and adjoining property owners.
Prepared by Wade H. Leonard, Jr.
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` �i "' ° APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT t/
., Davie County Health Department ,�,�j"�l
Environmental Health Section �
P. 0. Box 665
� .�� Mocksvilie, N.C. 27028
� ,
f � I�S'^ �ONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
� � � .��NQ• '
�����d �� Home Phone
�� 1. Permit f�equested By_..,�� L°� �• � � rg �� Business Phone 9����
2. Address
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair :'�s�,,q�. �v, ' _
b) Privy Conventional_�Other Type
Ground Absorption
' c) Sub-Division Sec. Lot No,
5. System used to serve what type facility: House Mobile Home B�s
� Industry Other
b) Number of people
6. ar If house or mobile home, state size of ome and number of rooms.
House Dimensions l d�
Bed Rooms�Bath Rooms�Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes �" urinals garbage disposal
lavatory �v showers � washing machine l
dishwasher sinks 1
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes �o
9. a) Property Dimensions �� �� -3 b d � Z�O
b) Land area designated to building site �
c) Sewage Disposal Contractor �
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? ��
What type?
This is to certify that the 'nformation is correct to the be f my knowledge.
�� �� = -g � � �,
Date Owner Signatur
OWNER IS SOLELY RE PONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL IAWS
Allow 5 days for processing
Directions to property:
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°; ' ' � DAVIE COUNTY HEALTH DEPARTMENT
t '" ' Environmental Health Section
�, Soil/Site Evaluation .
NAME DATE EVALUATED _ c����y
�
ADDRESS. PROPERTY SIZE
PROPOSED FACIILTY �.,�' � LOCATION OF SITE �C�- � 2
Water Supply: On-Site Well !/ Community Public
Evaluation By: Auger Boring v Pit Cut
� FACTORS 1 2 3 4
Landsca e osition
Slo e R
HORIZON I DEPTH �' O '� �"
Texture rou .Cr .L �
Consistence
Structure
Mineralo
HORIZON II DEPTH � °4�`O
Texture rou _
Consistence � �
Structure ,�
Mineralo l- '
HORIZON III DEPTH
Texture rou
Consistence
5tructure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSTFICATION
LONG-TERM ACCEPTANCE RATE � L
SITE CLASSIFICATION: EVALUATED BY:
LDNG-TERM ACCEPTANCE RATE:
G 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-Tenace 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 �
Structnrt
� SC-Single grain M-Massive CR-Crumb GR-Granular ABK-MQular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralo�r
1:1. 2:1. Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
5aprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free wate�' 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(O1-9o1
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' � , •
'� ,. . ' rDavie County .�fealtF� �e artment
Y
and �fome .�ealffi� �. �ene��
210 HOSPITA�STREET I P.O. BO% 665
MOCKSVILLE,N.C. 27028
PNONE:(704)834•5985
March �5, 1994
Jack 0. Morgan
�otts Realty
F. Q. Pox 11
Advance, NC 2700E
Re: 5ite Ev�luation
Deadmon Road
De�r Mr�. Mor,gan:
As requested, a representative from this office visited the aforer�entioned
site on March 24, 1994. Based upon the information provided on the
�pplication for a site evaluation and after the evaluation was completed, the
site w�s found to be provisionally suitable for the instal�ation of an on-site
sewage dispo5al system. �
If you have any questions, ple2se feel fr�ee to con�act this office.
Sincerely!
��,�,�c������
Robert P. Hal l, Jr. , R.S.
Environmental Health Section
RH/wd
Enclos�me