209 Meadow Glen LnDavie County, NC
Tax Parcel Report d l V I Fridav, September 30, 2016
WARNING:THIS 1S NOTA SURVEY
Parcel Information
Parcel Number:
D20000003807
Township:
Clarksville
NCPIN Number:
5812130183
Municipality:
Account Number:
82527134
Census Tract:
37059-801
Listed Owner 1:
SHERDEN ANNETTE M
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
209 MEADOW GLEN LANE
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
11.032 AC LIBERTY CHURCH
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
11.16
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
10/2006
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
006850565
Soil Types: MnB2,GrB,MdB,MdD,ChA
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
134860.00
Outbuilding & Extra
Freatures Value:
13460.00
Land Value:
94970.00
Total Market Value:
243290.00
Total Assessed Value:
243290.00
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
l+pC NAY NC or arising out of the use or inability to use the GIS data provided by this website.
---All IWORIZATIONtNO: 0769 DAVIE,COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permitt6e'9 P.O. Box 848 `�� a fe t% %'fir 1� "•
Name: ►�� s� Y1,G Jr J
� '�, �' Mocksville, NC 27028 Subdivision Dame: t��l t �+
` Phone#:704-634-8760 N'd��"�
Directions to property: � � C� / f� - �` � Section: Lot:
AUTHORIZATION FOR d
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
Road Nam
**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)
(� • . *� c� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
- 11."7 IS VALID FOR A PERIOD OF FIVE YEARS. k
ENVIRONMENTAL HEALTH SPECIALIST. DATE ISSUED y
DAVIE COUNTY HEALTH DEPARTMENT �' ' "`' � rt�
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
yPermjttee
Name- : r ' C: �• i±�' L';'_ Subdivision Name
Directions to property: / i - t ` c - Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
t Road Name..
**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/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
} °. }•� f..^F 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 N M)7— # BEDROOMS -'�- # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes O&C-,
COMMERCIAL SPECIFICATION:, FACILITY TYPE # PEOPLE # PEOPLE/SHIFI' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) e� t! NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE �b GAL. PUMP TANK
1
—)1
GAL. TRENCH WIDTH - %
/`
ROCK DEPTH
l
LINEAR FE -9
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
.Y1 G
eel
pj
**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.
OPERATION PERMIT
SYSTEM INSTALLED BY:
I
Fvlt.�
Eut 1J )ODI g
AUTHORIZATION NOy3 � 1 OPERATION PERMIT BY:(1�� DATE: O
**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
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed n ✓1 e --He yY1 L v,4 k e r Contact Person S cc me—
Mailing Address 0110 - 2 CheS4.er4--011 Po cxj Q Home Phone '1 )0 — &0
City/State/Zip i�C - 2`)1 b f Business Phone DO
2. Name on Permit/ATC if Different than Above
Mailing Address
City/State/Zip
3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC
4. System to Serve: [House [ 1 Mobile Home [ ] Business [ ] Industry [ ] Other
Both
5. If Residence: # People # Bedrooms a # Bathrooms [ ] Dishwasher [ 1 Garbage Disposal
[
V1 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 [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ( ] Yes [v] No
If yes, what type?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** XIMAIVOF THE PROPERTY MUST BE
y
SUBMITTED WITHTIHItS APPLICATION.
Property Dimensions: 1 CLCrtS
WRITE DIRECTIONS (fr 1 ocksville) TO PROPERTY:
Tax Office PIN: #
°[ I g S
; W 1 O 1 �i'c ,{ � U1 i.� �S
Property Address: Road NameMeadow
% (en La rie
/� pD
OYt'� UbetAj �t L'Lf' �' F'F
�
City/Zip N D�S Vl 1(
! UC 39Da o
n�
I'1 4' o�� 3 YYV1 ICS 421V'vi
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 properjlocated in Davie County and owned
by.
DA
Revised DCHD (06-96)
q to
duct all testing procedurrps as neces o d t ine the site suitability.
SIGNATURE ( i/VILLt i?►/ �r �/1
THIS AREA MAY 13E USED FOR DRAWIN(5 YOUR SITE PLAN:
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER OCT _ 2 2`3
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
FtJ 1u1u�gL� -Lt-4E P-
1. Application/Permit Requested By ��� u k ��� Awxobm _�
Mailing Address 3�>p S I 42-- Home Phone ((''
Business Phone
2. Name on Permit if Different than Above 1—t [V W VA t
3. Application for: General Evaluation
4. System to Serve: House
❑ Business ❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms 1�
No. of Bathrooms L
Dwelling Dimensions Q l�eeaE'
❑ Septic Tank Installation Permit
❑ Mobile Home ❑ Place of Public Assembly
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: ,Public ❑ Private
8. Property Dimensions �� X t3 Z �', Sewage Disposal Contractor
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
VWashing Machine
V Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 1 No
If yes, what type?
❑ Community
'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.
J!KUJ hi.'lY LN1 U1Q1N1:1UN lii::lUlhi:ll:
Directions to ,Property: Tax Office PIN �1 tJ�)Z ' 1� • `� l 0�
Road Naine DIFE )—k1>E-12-W Q .
Box # (if available)
city
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-cation.
• q�—
DATE N SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. X2. 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 representati a of the Davie County Health Department to enter upon above described
property located in Davie County and owned by Rte /. D -�, e 1k-V--LL-i �— �SX31A321V—ln
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (1193)
21. 6'
Fred M. Lashmit v'
95'7 ACRES D.B. 116 -124
\ Z \ .1
n9
s
�t ry
76335 %~�
41,3 i4 \\
2• 5i
Parcel 38.01 o y`a0� C1
Stephen S. Rich
s D.B. 175 — 715
0
0
A.9.
ACRES �' b 8 "
�
I o 0
N I
n
Pond a
S7,3.1 /y 75\ (approx. location)- y
ry° 6?7 CO74 S f 43 9625' f S 84�40,.E . Ev
\ I 01' P
2 V Iq 54.29' N6 g�.�v _
757.006 ACRES FIP Nq
EIP
Sf
7088.90.
1038.90• 088.90.
n
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b �,
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RES��e ````� J*Bs.
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0
2.617 ACRES 2 11.032 ACRES 15.928 ACRES
0
0
13'20"W 1364.26' NIP 285.46' 314.73'
�p NIP 302.71' Elp 135.16' UP 161.50-
N 86°30110' 617.44'
N 86°47'20"W N 86'18'20" on. round
20
Hanes Parcel 20
I John C. Hanes I o
340 n
D.B. 100 — 689 a)
I
N=I oI .i I � m
NUoO N
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r..ord.d ti leek in Po" 377. ft.) (~). tld t. WrAge o not
'urvey.d Or..I..iy k+dle04d e. drOOn rlO,n kdenneeon teund ti loek
Pop. U+.! tir totle W pr.oYen r eOlaleb0 M t:t0A00: that —
pet .e. pnip , 1.9 .. da — WM o.3. 47-30 m .nw,dd M7tn... ny odpk,d
.Ivn.k... r"W"l...... w Ow ..d
Logo
tld. Z�dq of �� A.D. .
Seal or Stamp >.
2623 e�` ��'il l- ,t ��.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
Annette Luther
NAME
5812-1.5-9185 (Mocksville)
ADDRESS
PROPOSED FACIILTY House
DATE EVALUATED / 0-
11.032
-11.032 Acres
PROPERTY SIZE
LOCATION OF SITE Off Liberty Church Rd
Water Supply: On -Site Well Community Public
Evaluation By:t' Auger Boring Pit Cut
FACTORS
1
2
3 4
Landscape position
5
S
Slope 7.
16 °
HORIZON I DEPTH
''
"
t'
Texture groupL
C1_..
L
Consistence
F'Z
Structure
C
Mineralogy
HORIZON II DEPTH
Texture groupC
Consistence
_
Structure
k
A
MS
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
—
—
—
SAPROLITE
—
—
-
CLASS.IFICATION
.S
,S
LONG-TERM ACCEPTANCE RATE.
5 -
SITE CLASSIFICATION: °ate ' _'�) " EVALUATED BY: CC
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:��.�- N� .\ o,`,s�- -�' 75z`�N"s
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 -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
Ilorizon 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 County Health Department
and Home .health Agency
Environmenta(Health. Section
P.O. Box 848 / 210 HOSPITAL STREET
COURIER #09-40-06
MOCKSZLE, N.C. 27028
PHONE: (704) 694-8760
October 8, 1996
Annette Luther
c/o Howard Realty
Attn: Connie Kowalske
330 S. Salisbury St.
Mocksville, NC 27028
Re: Site Evaluation
Liberty Church Road
Tax PIN: #5812-15-9185
Dear Client:
As requested, a representative from this office visited the
aforementioned site on October 3, 1996. 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 'Pis office.
Sincerely,
Charles E. Little, R.S.
Environmental Health Section
CL/wd
Enclosure(s)