152 M & D LnDavi County. NC
Tax Parcel Report 10 0— Friday. Sentember 30, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1
City:
State:
Zip Code:
Legal Description
Assessed Acreag
Deed Date:
Deed Book/Page
Plat Book:
Plat Page:
Building Value:
WAK1V11V1i: bila 1N 1VU1 A NUKVLY
Parcel Information
L50000001309A Township: Jerusalem
5736959631 Municipality:
24074500 Census Tract: 37059-807
ELLIS FRED O JR Voting Precinct: COOLEEMEE
145 Riverdale Road Planning Jurisdiction: Davie County
Mocksville Zoning Class: DAVIE COUNTY R -A
NC Zoning Overlay: DAVIE COUNTY CZOD
27028-0000
Voluntary Ag. District:
2.770 AC OFF GLADSTONE RD
Fire Response District:
e: 2.71
Elementary School Zone
3/2008
Middle School Zone:
007500515
Soil Types:
Flood Zone:
Watershed Overlay:
44340.00
Outbuilding & Extra
Freatures Value:
Land Value: 18900.00 Total Market Value:
Total Assessed Value: 64910.00
No
JERUSALEM
COOLEEMEE
SOUTH DAVIE
CeB2
DAVIE COUNTY
1670.00
64910.00
Davie County,
All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
101
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County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ail claims or causes of action due to
or arising out of the use or inability to use the GIS data provided by this website.
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11 . av x
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NO: DAVIE COUNTY HEALTH DEPARTMENT
i I Environmental Health Section PROPERTY INFORMATION
Permittee's~..�� -�-- /// P.O. Box 848
Name: j'zq /,�4a iii 19 Mocksville, NC 27028 Subdivision Name: _
Phone #: 704-634-8760
Directions to property: /, ii'r`/")�.= c
Section: Lot:
AUTHORIZATION FOR
WASTEWATER
Office
SYSTEM CONSTRUCTION Tax PIN:,{
Road Name: `L'Zi '
**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.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�. r.
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALT SPECIALIST DATE ISSUED
DAVIE COUNTY HEALTH DEPAT�TMENT '' =r' IMPROVEMENT AND OPERATION PERMITS
_,. ,
Permittee's, f e
Name:'
Directions to property:
�n.Gr iz('O
11%,00
PROPERTY INFORMATION
Subdivision Name:
Section: Lot:
IMPROVEMENT
PERMIT
Tax Office PIN:#..:f
Road Name:'' 1 .:...#i. p
**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)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH'SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE AW # BEDROOMS -7 # BATHS ':P, # OCCUPANTS—'? GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE A C TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) `���' � NEW SITE 1/� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE 1�4 GAL. PUMP TANK GAL. TRENCH WIDTH r (� ROCK DEPTH ,l-? "'LINEAR FT ?e U
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**CONTACT A REPRESENTATIVE OF THE PATI
BETWEEN 8:30 - 9:30 A.M. OR 1!0C 1:30
OPERATION PERMIT
Fad 1110
Dy.H H- )EPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
�0
iM INSTALLED BY:
UkN
N. 14G 1y\ %z.
AUTHORIZATION NO. �2' OPERATION PERMIT BY: DATE:
**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 FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
• � Davie County Health Department ,
Environmental Health Section" "
P.O. Box 848 7 1997
j
Mocksville NC 27028 SEP
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS19W
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed FSJC�.iCfJ c h S d
Mailing Address £'
V11 City/State/Zip l r
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: [ ] Site Evaluation
Contact Person� I'll M- r` d�
Home Phone 2 1 1 '
Business Phone
City/State/Zip
improvement Permit & ATC [ ] Both
[ ] Other
[i4Dishwasher [ ] Garbage Disposal
v�
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 [i4W"'ell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [✓] No
4. System to Serve: [ ] House [Mobile Home [ ] Business [ ] Industry
5. If Residence: # People # Bedrooms # Bathrooms
[Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
If yes, what type?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT **#QPFMT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: I ; WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
,f
Tax Office PIN: # 5 7 3 - r� - Kyr' S.0/0}�
Property Address: Road )�ame G'14 Si'Vy 7Z7 r �� 1° cG h
City/Zip O,7 � �� e r JP_ '�J 1 !✓!° E' 1
If in Subdivision provide information, as follows: 1 �9 h : e� 4 �!s �(/'GC TO Ille a lP P V
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
•!' l e-rN i i
by J e- SS,- r • I bhh to conduct
DATE 91/ % A SIGNATURE
Revised DCHD (06-96)
THIS AREA MA II $E 11SEb FOR DRAWING 1101121 SITE PLAN:
as necessary to determine the site suitability.
S�U'APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P T
Davie County Health Department
14 �'(/ G/ Environmental Health Section
P. O. Box 665 23 10
J„(e Mocksville, NC 27028
1. Application/Permit Requested By `� C�� nb`� Y� j� /��r CI 5 r / r %
Mailing Address if b�jc�- Gj Q '- A �0 n e Home Phone `1 ` (0`l b 2
(-igd ce me r- 18C C' % i Business Phone (o -7 -/-
2. Name on Permit if Different than Above
3. Application for: General Evaluation. 49LptIc Tank Installation Permit
4. System to Serve: ❑ House 060bile Home
❑ Business ❑ Industry ❑ Other
5. If house, mobile home: Subdivision
No. of People
No, of Bedrooms
No. of Bathrooms
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures .
7. Type of water supply: ❑ Public �iC1 Private
8. Property Dimensions %D t ae Z-7� Sewage Disposal Contractor
❑ Place of Public Assembly
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
P'Vrashing Machine
❑ Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes, what type?
�ommuni
Qd�� �1
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
Lo Q - (L
S 2
-hO L 5 e
C" �q Pr� SN
1 n+C Pe.,\Q E 5 o
-�a
c�-
4t -o ft.`. t L -c ff) A � k 5 1 A v-\cl A v\cA A-
1 ray v\cA 1), , -1 Z v4) c Le S .
A, r
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this appli ion.
2 �A ��t'k ru
DATE SIGNATURE
CONSENT FOR SITE EVALVATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: V11. I OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 conduct all testing procedures as necessary t e e e s 'd site's suitability to ground absorption sewage treatment
and disposal system.
DATE SIG T RE
DCHD (1/93)
r T DAVIE COUNTY HEALTH DEPARTMENT
i Environmental Health Section
Soil/Site Evaluation
NAMElr
ADDRESS
PROPOSED FACIILTY ,, ��'D e
Water Supply: On -Site Well _
Evaluation By: Auger Boring /I /
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Community
Pit
Public L--*"
Cut
FACTORS
1
2
3
4
Landscape position
L
L—
4-
Z_
Slope Z
—
"—
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture group
Consistence
Y7
i
Structure
S /'(1
-
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 RATEl
I
I,
SITE CLASSIFICATION: EVALUATED BY: 1_ Y _&
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 ;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 -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
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 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(01-901
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" Davie Coan�v NealtFr Department
and .dome NeallFr qenq
210 HoSPITAI STREET I P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634.5985
March 30, 1995
Brian & Robin Nichols
P. 0. Box 993
Cooleemee, HC 27014
Re: Site Evaluation/Closest to Gladstone Road
Dear Mr. & Mrs. Nichols:
As requested, a representative from this office visited the aforementioned
site on March 29, 1995. Based upon the information provided on the application
for site evaluation and after the evaluation was completed, the site Was found
to be provisionally suitable for the installation of an on-site sewage disposal
system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosures