1583 Liberty Church RdDavie County, NC
Tax Parcel Report A LW Monday, October 3, 2016
EelAll 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.
WARNING: THIS IS NOT A SURVEY
Parcel Information _
Parcel Number:
C200000034
Township:
Clarksville
NCPIN Number:
5812192036
Municipality:
Account Number:
13277500
Census Tract:
37059-801
Listed Owner 1:
CARTER ELIZABETH JOSEPHINE
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
2621 LOCKWOOD DRIVE
Planning Jurisdiction:
Davie County
City: WINSTON SALEM
Zoning Class: DAVIE
COUNTY R-A,R-20
State:
NC
Zoning Overlay:
Zip Code:
27103-0000
Voluntary Ag. District:
No
Legal Description:
73 AC LIBERTY CHURCH RD
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
59.26
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
12/1997
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
1998EO080
Soil Types: MnC2,MnB2,ChA,WATER,MdE
Plat Book:
12
Flood Zone:
Plat Page:
108
Watershed Overlay:
DAVIE COUNTY
Building Value:
42940.00
Outbuilding & Extra
Freatures Value:
290.00
Land Value:
321270.00
Total Market Value:
364500.00
Total Assessed Value:
364500.00
EelAll 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.
DAVIE COMITY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**NOTE** This improvement 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)
NAME A PROPERTY ADDRESS 1 � t� �i'11 % i� . i?ci� � '70 % DAA
LOCATION
SUBDIVISION NAME
LOT NUMBER
SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS _� # OCCUPANTS `? GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE'7
Li�?L TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE ,s / REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIIE 4LL GAL. PUMP TANK GAL. TRENCH WIDTH . r; ROCK DEPTH" LINEAR
L
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
I- ' I—P
IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:80-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 534-8760.
OPERATION PERMIT SYSTEM INSTALLED BY �/°1• r�`_1r.�r.�.�.
AUTHORIZATION N0. OPERATION PERMIT BY DATE 5?li
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 FRICTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 8481
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT****. THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed `�� r 6/Cl;, Contact Person
Mailing Address �aql C QiQ0Ur(.LbC'Z>.%die Home Phone 9/0 ?63'1,660
City/State/Zip%/NSTO�/ w IVC 97/D3 Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: [ ] Site Evaluation
City/State/Zip
improvement Permit & ATC
4. System to Serve: [House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other
[ ] Both
5. If Residence: # People --2— # 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 V<ell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
r�J, SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 30� Or / 7 %%r WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax Office PIN: # -1�91_
Property Address: Road Name
City/Zip
E '
If in Subdivision provide information, as follows:
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 to
DATE -7L( 0 �6 SIGNATURE
Revised DCHD (06-96)
all testing procedures as necessary to determine the site suitability.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME p//X/�/!7/%� DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTYLOCATION OF SITE .C_/ �,✓
Water Supply: On -Site Well t/ _ Community Public,
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3 4
Landscape position
L
L
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
r
Structure
/
:577/
/l
Mineralogy
el -'l
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:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
EVALUATED BY:
OTHER(S) PRESENT:
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-Silt,v .lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V�_.-y friable FR -Friable FI -Finn 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
.3C --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 watef 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
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Davie County Health Department
_ ENVIRONMENTAL HEALTH SECTION
P.O. Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
A
(Issued ip compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***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.***
AUTHORIZATION NV3ER
NAME ZI r / ��l; -'.
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
COMENTS/CONDITIONS ON AUTHORIZATION TD.CONSTRUCT WASTEWATER SYSTEM
**WICE*** THIS AUTHORIZATION FD WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONMENTAL HEALTH CIALIST DATE
DCHD 10/95 t