108 Camden Court Lot 10 Davie County,NC Tax Parcel Report Wednesday,November 9,2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: G703OA0010 Township: Shady Grove
NCPIN Number: 5860836247 Municipality:
Account Number: 82516977 Census Tract: 37059-803
Listed Owner 1: ZINSMEYER RICHARD T Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 108 CAMDEN COURT Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: LOT 10 CAMDEN YARDS Fire Response District: ADVANCE
Assessed Acreage: 0.67 Elementary School Zone: SHADY GROVE
Deed Date: 5/2001 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 003720368 Soil Types: Gn132
Plat Book: 0006 Flood Zone:
Plat Page: 169 Watershed Overlay: DAVIE COUNTY
Building Value: 107150.00 Outbuilding&Extra 2850.00
Freatures Value:
Land Value: 30000.00 Total Market Value: 140000.00
Total Assessed Value: 140000.00
161 All data is provided as Is without warranty or guarantee of any Idnd either expres ed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or Mess for a particular use.All users or 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.
AUTHORMATION NO: 0 5 7 O DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee s/ _..w P.O.Box 848
Name` i 40 C° Mocksville,NC 27028 Subdivision Name: �'.✓ S�
.�! Phone#:704-634-8760
Directions to property: �/ �l r� f�tf Section: Lot:
AUTHORIZATION FOR d
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
Road Name: MY?lnr'L'jq ip: P+1DO6
**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) .
// 11 f ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION,
11 V--�d It., -0,2� dr,( IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL1HALTH SPE ALIST DATE ISSUED
. DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Subdivision Name: Ix
D irections
j,,Directions to property: 144 r: iI c. Section: Lot: hi
✓ ,
IMPROVEMENT
PERMIT Tax Office PIN:#SQ
Road Name: 1/nr'&:"Zip:
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
APTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
cbbnstruction/mstallation 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 SPE IALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TIRS PERMIT BEFORE
INSTALLING THE SYSTEM..
RESIDENTIAL SPECIFICATION:BUILDING TYPE #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 REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE AWO GAL. PUMP TANK GAL. TRENCH WIDTH /ROCK DEPTH &LINEAR FT. � J
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPA E FOR 91NAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00 1:30 P.M.ON THE DAY OF INST L N.IMXPHONE#IS(704)634-8760.
OPERATION PERMIT
SYSTEM INST B
of
r-
AUTHORIZATION NO. OPERATION PERMIT BY:�.0_dOyl� DATE:-
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised)
• . APPLICATION FOR SITE EVALUATION/IMPROVEM '
` Davie County Health Department
[.l J
Environmental Health Section
P. O. Box 665 - 1996
Mocksville, NC 27028 J
1 Application/Permit Requested By
- AA26n�
Mailing Address 1.257 �1 6� w Home Phone 9C/g- 202-0
7
-V/ LL Business Phone
2 Name on Permit if Different toan Above
3.•Application for: General Evaluation ❑Septic Tank Installation Permit
4. System to Serve: E House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry Qier ❑ Unknown
5. If house, mobile home:Subdivision Section Lot # /0
❑ Basement/Plumbing
No.of People ❑ Basement/No Plumbing
No.of Bedrooms ❑ Washing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal j?
6. If business, industry, place of public assembly, other: Specify type 1'
No. of People Served No. of Sinks I.
t
No. of Commodes No. of Urinals
No.of Lavatories No. of Water Coolers '
No:of Showers Water Usage Figures
7 ,Type of water supply: bCPubli ❑ Private ❑ Community
eli✓ ��� l
`8 Property Dimensions � Sewage Disposal Contractor
t'
9. iDo you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes KNo ;
If yes,what type?
i
'NOTE: Improvements Permits are subject to {;
revocation, if site plans or the intended use change. Effective October 1, 1989.
I +.i
Directions to Property:, PROPERTY INFORMATION REEQUIRED:
+ Tax Office PIN #
Road Name&L-77 � F
Box # (if available) i~
City A /✓Q/1�-C'Q—
I This is to certify that the information provided is correct tot e o le e a d I understand I am responsible for all charges j
incurred from this application. i
q
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. P-'2. I 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 th avie Cou ty Health Qepartment to enter upon above described
property located in Davie County and owned by -
to conduct all testing procedures as necessary to determin said si ui bili for a ground absor • n sewage treatment
f and disposal system. s
DATE SIGNATURE ]
i
DC HD(1/93)
f
t
DAVIE COUNTY HEALTH DEPARTMENT */0
• Environmental Health Section
Soil/Site Evaluation
NAME &V h DATE EVALUATED
ADDRESS /� PROPERTY SIZE .�4
PROPOSED FACIILTY Atg_Zlf-t LOCATION OF SITE 1 q1r -
Water Supply: On-Site Well Community Public_f�
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 7-
Texture
Texture rou
Consistence
Structure i
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: EVALUATED BY:
LONG-TERM ACCEPTANCE ATE: '" 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-Very friable FR-Friable FI-Firn► 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/fti
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of
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC
Davie County Health Department
Environmental Health Section
P.O.Box 848
Mocksville,NC 27028
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL THE REQUIRED INFORMATION IS PROVIDED. / F/
1. Name to be Billed N C C- . Contact Person
CO-
Mailing Address 12— .5 7Cl > �� `� �✓� Home Phone 7-7b'" Z o 2
City/State/Zip /'�/o l� , '. 1 _ c Z�7 o Z Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: U—Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms 3_ # Bathrooms Z-
ishwasher 2-(iarbage Disposal IIWashing 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: 0-County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes a--N—
If yes,what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 1 WRITE DIRECTIONS(from
1 Mocksville)TO PROPERTY:
Tax Office PIN: #
1
Property Address: Road Name C�4
1
City/zip 1
1
1
If in Subdivision provide information,as follows: 1
Name:
1
Section: Lot #: l / O 1
1
1
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 c to conduct all testing procedures
as necessary to determine the site suitability.
DATE A SIGNATURE
Revised DCHD(06-96)
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