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404 Oak Grove Church Rd r Davie County,NC Tax Parcel Report Thursday, February 23, 2017 UUjj -� ------ .z—L—A ~1980 UU j7E '�• 1975 128 126 7 94 8 0 344 324 x•343 12 5.1.111 _ ; '19491949 1951 7.947. 1353 r 1938 191 -361 , 1925 1930 376/ 1917 3901 1903 141143 404 —�--- 391 � Q )( ~ 18 a: 123i J 281 138 ; 133 ; 149 ', ---` r I IN � t �' 231 2425'2627279 �� SAI ¢ 5 �� 152 i66 - 'D Z ' 194 294' r� SA/ hj 312.2 < 116 ', ......................................_�.....]........:_..._............_..M..................................................................................................................,...,.........................................................._ ,........................... ..._115...............�'r.... WARNING: THIS IS NOT A SURVEY 7-7 Parcel Information Parcel Number: H50000002907 Township: Mocksville NCPIN Number: 5749357941 Municipality: Account Number: 51384000 Census Tract: 37059-805 Listed Owner 1: MOCK MARY DEE LITTLE Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 390 OAK GROVE ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,H-B-S State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag.District: No Legal Description: 9.178 AC SAIN ROAD Fire Response District: MOCKSVILLE Assessed Acreage: 8.70 Elementary School Zone: MOCKSVILLE Deed Date: 4/1997 Middle School Zone: SOUTH DAVIE Deed Book/Page: 001930903 Soil Types: PaD,WeB,PcB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 33590.00 Outbuilding&Extra 4500.00 Freatures Value: Land Value: 94450.00 Total Market Value: 132540.00 Total Assessed Value: 132540.00 O :�AAll 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 nDUN� NC or arising out of the use or Inability to use the GIS data provided by this website. ' OPERATION PERMIT orice se ny Davie County Health Department *CDP File Number 201899-1 f r 210 Hospital Street H50000DO2907 P.O. Box 848 County ID Number. Mocksville NC 27028 Evaluated For NEW Phone:336-753.6780 Fax:336-753-1680 Township: Applicant. Cory Matthew York Property Owner: Mary Dee Mock Address: 1168 Chickadee Lane 'Address: 370 Oak Grove Church Road - City: Woodlee City: Mocksville StatefZiP: NC 27054 State/Zip: NC 27028 Phone#: (336)469-6589 Phone#: (336)277-1177 Property Location & Site Information CAddress/Road;9: Subdivision: Phase: Lot: 404 Oak Grove CHurch Road Mocksville NC 27028 Directions structure:. SINGL I= FAMILY 158 E to Sain Rd to Oak Grove Church Rd 404 on left about 400 feet from corner #of Bedrooms: 3 #of People: 5 *Water Supply: PUBLIC *Sys tem Classification/Description: *IP Issued by. TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS *CA issued by: 2140-NaUons,Robed Saprolite System? QYes (&No Design Flow: 3 6 0 * GRAVITY-SERIAL Pump Required? Distribution Type: QYes ( No Soil Application Rate: 0 - 3 *Pre Treatment: Draln field r cation Field 1 2 0 0 Sq• g• *System Type: INFILTRATOROUICK4 STANDARD rain Lines 3 Installer: Randy W11er ' Total Trench Length: 3 0 0 8• Certification#: 1128 Trench Spacing: — 9 Inches O.C. ()Inches O.C. *EH S: 2140-Nations.Robert Trench Width: 3 Inches Feet Date: 1 1 / 0 4 / 2 0 1 1 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Approval Status;; Inches Maximum Trench Depth: 3 6 ® Approved❑ Disapproved Inches Maximum Soil Cover. 2 4 Inches CDP File Number 201899 ` 1 County ID'Number: HSW00002907 Septic Tank Manufacturer. Shoal Lat. STB: 760 Long: Gallons: 1000 Installer: Randy Milter Date: fi g / @ 5 / a0 1 6 Certification#: 1128 THS: 2140-Nations,Robert *Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter ST Marker: [3Yes ® NO Date: 1 1 / 0 4 / x 0 1 6 Approval Status Reinforced Tank: ❑ Yes ® No 1 PTank: ❑ Yes ( No Cl Approved❑ Disapproved iece Pump Tank Manufacturer. Installer PT: Certification#: -Gallons: THS: -Date: / / Date: RiserSealed ❑ Yes ❑ No Riser Height: ❑ Y6s _ ❑ N6�(Min.6 in.) Approval Status 5,2 Reinforced Ta Q Yes ❑_.No_ p�Approved❑ aisapprovec! - - 1 Piece Tank: O ❑_.Yes._- _..��_.❑ Nr. T Supply Line Pipe Size: inch diameter Installer. Pe`Length: feet Certification#: *Schedule: THS: Pressure Rated ❑ Yes ❑ No Date: f„ Approved fittings ❑ Yes ❑ NoApproval Status O'A'[)prolsa ved❑ Dppr©ved uRequirgment Pump Type: Installer. Dosing Volume: — Gal Certification#: Draw Down: Inches *EHS. *Chain: / Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Status, PVC unions ❑ Yes ❑ No ❑ Approved❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ NO 201899 - 1 H50000002907 CDP File Number County ID Number: Electric Equipment NEMA 4X Box or Equivalent [__1 Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ NO 'EHS: Pum p M an ually 0 perable ❑ Yes ❑ NO I / *Activation Method Date: - -AP rovat Status Alarm Audible ❑ Yes ❑ No Approved❑ Disapproved Alarm Visible ❑ Yes ❑ No 140•Nations,Robert "Operation Permit completed by: Authorized State Age : Date of Issue: 1 1 0 4 1 2 0 T1 6 _ Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for-. Sewage Treatment and Disposal,-15A NCAC 18A .1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE III G. sewage septic system. Rule A961 requires that a Type rn'E III G. septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCedified Operator: NIA Reporting Frequency By Certified Operator:NIA Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator ora private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entry prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 201899- 1 Davie County Health Department CDP File Number: 210 Hospital Street H50000002907 P.O.Box 848 County File Number: Mocksville NC 27028 Date: ! / Q Inch Scale: . OBlock Drawing Drawing Type: Operation Permit ON/A, C ( oI I 1 1 a�� 7-1 —7--- 17- 1 - CONSTRUCTION For office Use Only • AUTHORIZATION "CDP File Number 201899-1 Davie County Health Department County ID Number:H50000002907 210 Hospital Street Evaluated For. NEW, P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 3 / 1 7 / a 0 a 1 Applicant: Cory Matthew York Property Owner: Mary Dee Mock Address: 1168 Chickadee Lane Address: 370 Oak Grove Church Road CRY: Woodlee City: Mocksville StatefZip: NC 27054 StatefZip: NC 27028 Phone#: (336)469-6589 Phone#: (336)277-1177 Property Location & Site Information Address/Road #: Subdivision: Phase: Lot: 404 Oak Grove CHurch Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY 158 E to Sain Rd to Oak Grove Church Rd 404 on left about 400 feet from corner #of Bedrooms: 3 #of People: 5 `Water Supply: PUBLIC ' System Specifications Minimum Trench Depth: a 4 rDesign ification: Provisionally Suitable Inches System? Minimum Soil Cover. 1 a y QYes ®No Inches w: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . 3 Maximum Soil Cover: a 4 Inches 'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: _ 1 0 0 0 _ Gallons 'Proposed System: 25%u REDUCTION 1-Piece: QYes @No Pump Required: QYes ®No OMay Be Required Nitrification Field 1 a 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1-Piece: QYes ONo Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH Trench Spacing: — 9 WeetInches C C O . Dosing Volume: Gallons Trench Width: 3 Inches Feet Grease Trap: Gallons _ _ Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01 011 0111 01V Dann � �f Z CDP Fite Number 201899 - 1 County ID Number.H50000002907 ❑ Open Pump System Sheet Repair System Required:@Yes ONO ONO, but has Available Space rrDesign System Trench Spacing: 9 E113 Inches O.C. ification: Provisionally Suitable Feet O.C. Trench Width: Inches w: 3 6 0 — 3 . S Feet Soil Application Rate: 0 - 3 Aggregate Depth; inches Minimum Trench Depth: 2 *System Classification/Description: Inches TYPE IIA.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover. 1 Inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 1 2 0 0 Sq.ft. Inches No. Drain Lines 3 *Distribution Type: GRAVITY-SERIAL Total Trench length: 3 0 0 � Pump Required: QYes �No OMay Be Required Pre Treatment: ONSF OTS-I OTS-II Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued at the same time the Improvement Permit issued(NCGS 130A-336(b)}If the Installation has not been completed during the period of validity of the Construction Permit,the information submitted In the application for a permit or Construction Authorization Is found to have been incorrect,falsified or changed,or the site is altered,the permit orConstruction Authorization shall become Invalid,and may be suspended or revolted(.1937(g)).The person owning or controlling the system shall be responsible forassuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature* Date:, *Issued By: 77777-Bonnie Lanier Date of Issue: . 0 3 / 1 7 / 2 0 1 6 Authorized State Age . Malfunction Log QYes Q Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 201899 - 1 Davie County Health Department CDP File Number: 210 Hospital Street 210Box ita8 County File Number: H50000002907 Mocksville NC 27028 Date: 0 3 / 1 7 / 0 1 6 11 Q Inch Drawing Drawing Type: Construction Authorization Scale: . OBlock Q NIA I l I � l I Q i 1� CONSTRUCTION AUTHORIZATION + ' Davie County Health Department 210 Hospital StreetCDP File Number: 201899 - 1 P.O.Box 848 H50000002907 Mocksville NC 2702$ County File Number: Date: 0 3 / 1 3 / 2 0 1 6 Click below to Import an image from an external location: Drawing Type:Construction Authorization t 1" �l 4. U6 46� a 1S L J 5 � f"rGp4 t • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: 7 Site Evaluation/Improvement Permit C Authorization To Construct(ATC) ❑Both Type of Application: ❑New System ❑Repair to Existing System :)Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION 1 14l00t`f 51-11 V1 Name _C'Orctyvr a-0 k e w Yor/r Contact Person (C,712�f V&,-Ir- 3?6_gc79-463 q Address 116Y GhielaaJee L-fV Home Phone 336—q69 -6Sk City/State/ZIP Lyoc;.l ectjo N.G. 2-70S0 Business Phone 3 36—U69—6tr 3 9 Email_CdhEmail: Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facilit Comers Fla e 6/b #61 1 e,5 /(�4ere_ NOTE: A survey plat or site plan must accompany this application. Included:LSite Plan uPlat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.)mr Owner'sNaeMaq Dec /?loch Phone Number Owner's Address *590 Oak GrovE G A w)ch City/State/Zip eVgW&jV1111 c /1/.G• 2T o g Property Addr SSL401-1 1-1 0 A IC G s rove G k circ k Cit rS Lot Size I IN- Tax PM# -4 36 Subdivision Name(if applicable) Section/Lot# Directions To Site: 1;W tvv hm lfC. C`1 L_ If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes VNo Does the site contain jurisdictional wetlands? _Yes%/No Are there any easements or right-of-ways on the site? _Yes dINo Is the site subject to approval by another public agency? _Yes ✓No Will wastewater other than domestic sewage be generated? Yes✓No IF RESIDENCE FILL OUT THE BOX BELOW ~' #People b #Bedrooms *_ #Bathrooms_' Garden Tub/Whirlpool I IYes I Basement: DYes P'No Basement Plumbing: DYes %4o IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:`gConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: County/City Water ❑New Well El Existing Well C Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?C Yes VNo If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. 1 understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I unders that I am resp i e for the proper identification and labeling of property lines and corners and locating and flagging or stak' g th house/fa 'li l a'on,pro d well location and the location of any other amenities. Property a or owner's legal r esentative signature Site Revisit Charge Date(s): Client Notification Date: Date \ EHS: Sign given I Yes❑No Account# Revised 11/06 Invoice# 01 DAVIE COUNTY ENVIRONMENTAL HEALTH ci • P.O.Box 848/210 Hospital Street Mocksville,.NC 27028 (336)753-6780/Fax#(336)753-1680 ✓� AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005630 Tak.PIN/EH 5749-35-7941 Billed To: Amanda Gillespie Subdivision Info: Reference Name: Location/Address: Oak Grove Church Road-27028 Proposed Facility: Residental Prbperty:Size: .Acre Site Type: ew ❑Repair ❑Expansion ATC Number: 5733 **NOTE**This Authorization to Construct(ATC)MUST'BB ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance.with Article-11'of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms #Bathrooms #People 4 Basement❑ Basement plumbing❑ Non-Residential Specifications:,Facility Type #People #Seats ' Square Footage(or Dimensions of Facility) . Lot Size h Type of Water Supply: ❑County/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow(GPD)G Tank Size)COWAL.Pump Tank GAL. o Trench Width Max.Trench Depth?L( Rock Depth Linear Ft. 000 /fb� Site Modifications/Conditions/Other: - G� Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. Environmental Health Specialistu"6�J4 Dat DCHD 11/06(Revised) Davie County Environmental Health P.O.Box 848%210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005630 Tax PIN/EH#: 5749-35-7941 Billed To: Amanda Gillespie Subdivision Info: Address: 2361 US Hwy 601 S. Location/Address: Oak Grove Church Road-27028 City: Mocksville Property Size: 1 Acre Reference Name: Proposed Facility: Residental **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: $New ❑Repair ❑Expansion Permit Valid for: *5 Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms 2 #People Y Basement❑ Basement pluinbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: KCounty/City ❑Well ❑Community Well Az stated in 15A NCaC 18A.1909(5 Site Modifications/Permit Conditions: accented Systems malty also be use S stem Type LTAR Initial Repair Site Plan pl h Environmental Health Specialist Date G 1 i.p.11-06 MOIV.N . J0q_0&3t1 f 9i m5 OW APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street 4 Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Applicatioer' i�aluj�ion/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name i C� Contact Person Address (AW Home Phone 3A 8(O City/State/ZIP rY w!)C ksu;l l(_ I r)C gQ70a.$ Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 mo the rth site plan,no expiration with complete plat.) Owner's Name AlH/ AC-1 Phone Number Owner's Address 3q0 Od-k- rnye(fit.R_V City/State/Zip Property A dress City Lot Size AC/'e�. Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is`•`Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? -Yes �i Does the site contain jurisdictional wetlands? Yes _ Are there any easements or right-of-ways on the site? _Yes Is the site subject to approval by another public agency? _Yes Will wastewater other than domestic sewage be generated? Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms A #Bathrooms_� Garden Tub/Whirlpool ❑Yes ?Qro Basement: _04e s o Basement Plumbing: ❑Yes ko IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People # Sinks # Commodes # Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: Z'County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 2'N0 If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. 1 understand that I am responsible for the proper identification and labeling of property lines and corners and I o t' and fl gin or king t house/facility location,proposed well location and the location of any other amenities. Propertyor owner's legal representative signature Site Revisit Charge Date(s): / V r o­i) Client Notification Date: Date P P EHS: lI t�l���) 4. ltl'11 A Sign given ❑Yes ❑No Account# ` Revised 11/06 Invoice# � ' 1 Appraisal Card " Page DAVIE COUNTY NC 1/24/2011 11:23:46 AM MOCK MARY DEE LITTLE & LITTLE MARTHA CECILE HS-000-00-029-07 AIN RD UNIQ ID 13113 51384000 ID NO:5749357941 7 COUNTY TAX,FIRE TAX CARD NO.1 of 1 7 eval Year:2009 Tax Year:2011 9.178 AC SAIN ROAD 8.680 AC SRC=Inspection Appraised by 19 on 07/14 2008 06004 ELISHA CREEK TW-06 C-EX- AT- LAST ACTION 20100922 CONSTRUCTION C, DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE TOTAL POINT VALUE �11D Eff. BASE _ BUILDING UArea UAL RATE RCN EYE,AYB CREDENCE TO ADJUSTMENTS 9 %GOOD DEPR.BUILDING VALUE-CARD TOTAL ADJUSTMENT TYPE:Vacant EPR.OB/XF VALUE-CARD :7 FACTOR MARKET LAND VALUE-CARD 94,33C 11 TOTAL QUALITY INDEX STORIES: TOTAL MARKET VALUE-CARD 94,33( -1 TOTAL APPRAISED VALUE-CARD 94,33 TOTAL APPRAISED VALUE-PARCEL 94,33C TOTAL PRESENT USE VALUE-PARCEL TOTAL VALUE DEFERRED-PARCEL TOTAL TAXABLE VALUE-PARCEL 94,33C PRIOR UILDING VALUE BXF VALUE ND VALUE 74,15 RESENT USE VALUE DEFERRED VALUE TOTAL VALUE 74,150 PERMIT CODE I DATE NOTE I NUMBER AMOUNT ROUT:WTRSHO: SALES DATA FF. RECORD DATE I DEEDINDICATE SALES BOOK IPAGE 114. R I TYPE /U I PRICE 0193 903 14 1199A WD U V HEATED AREA NOTES @ OAK GROVE CH RD SUBAREA ODEDESCRIPTIONLTH HUNIT UNIT PRICE RIG W.CONDBLDG#L/B Y EYB NN DEP RATE V O*CON OB XF DEPR.VALUE TYPE S ARE RPL C OTAL OB XF VALUE FIREPLACE - SUBAREA TOTALS UILDING DIMENSIONS ca U LAND INFORMATION HIGHEST THER ADJUSTMENTS TOTAL ND BEST USE LOCAL FRON DEPTH/ LND COND NP NOTES-S. ROA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES .� RURAL AC 0120 824 1050 1.1730 4 1.1300+03+20+00+00-10 PNl 8200.0000 8.68 AC 1.32 10865.666 94330 SHP TOTAL MARKET LAND DATA •8.682 94,33 TOTAL PRESENT USE DATA i http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=H50000002907 1/24/2011 1\,4,ap Prame Page 1 of 1 Davie County, NC - GIS/Mapping System r _• Click Here To Start Over �} Quick Search:(County ID or Owner Ni active Layer. R Use"^!ap Tlps Ma PARCELS(Map Tips Available) Addre Q{� U r �1 � o? 13 SA t rd F:o r l I I 1 0 123ft http://maps.co.davie.nc.us/GoMaps/map/mapframe.cfm?CFID=4129&CFTOKEN=61640881 1/5/2011 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005630 Tax PIN/EH#: 5749-35-7941 Billed To: Amanda Gillespie Subdivision Info: Reference Name: Location/Address: Oak Grove Church Road-27028 Proposed Facility: Residental Property Size: 1 Acre Date Evaluated: t�1 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 S 6 7 Landscape position L Sloe % D HORIZON I DEPTH �g Texture group Consistence Structure Mineralogy HORIZON II DEPTH ..3 Texture groupC L C Consistence AR Structure Mineralogy HORIZON III DEPTH Texture group ` Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralo SOIL WETNESS , RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: _„� OTHER(S)PRESENT: •J t` ' REMARKS: 4 !� 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 clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTEN _ . lYIlzis� • ,.. VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 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 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) TTA R _T ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■e■■■■■■■■■■■■■sass/■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■ ■■■■/■■■■ee■■■■I■■■■■■■►iii/■■■■■■■■■■■■■■■■■■■IISI�■■■■■■■■■■■I■■■■■■■■■■ ■■■■■■■■■s■■e!■■■/■■■■■■■■■■//■■/■a/■■■■■■■■■■■■■■■■■e■n■■■■■■■■■■ MENNENiiiiii MENNENiiiiiiMENNE iiiiiii ■■■a■■■■e■■e�l■■■■■■e■■■■■■■■■■Ire:�,�■■■■■■■■■■■e■■■e■■■■■�1■■■■■■■■■■ ■■■e■■■■■■■■■■■■■■■■■■■■�■■■1■a■■■�■■i■■�iniiiiliiiliiiiili■■■■■■■■■■■ ■■■■■■■■e■■■e■■■■■■■r�a►,■■n!.*,�r■ Irl■■rrn��■■■■■■■■■■■■■■■■■■■■■■■■ APPUCATION FOR SITE EVALUMION/IMPROVEMENT PERMIT&ATC ?n�� Davie County Health Department AEnOwnmental Health Sectfon P.O. Boz 848/210 Hospital Street �b ✓� Mocksville, NC 2^028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL UHE REQUIRE INFORMkTION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ! e�CF/�LI ` I+ ��/G�({�i 9 i�/ It-Contact Parson I- n-yAr L"JC, Mailing Address5 SIU_1��i►)1�'C, l�lnV(.�. Hose Phone City/stats/ZIP J` a�1 S b Lt r l 1 h 0- ?�11 Bnsine s Phone ��/ _::.�a_Y_-?..q-7-4 2 6X` 2. Name on Permit/ATC if Different than Above JC CA M e J - Cwt Mailing Address SCA M v City/state/Zip ern -t, 3. Application For: Site Evaluation ❑ Improvement Permit/ATC ❑ Both e. system to Service: House ❑ Mobile Home 0 Business ❑ Industry ❑ Other 5. If Residence: i People i Bedrooms i Bathrooms ❑ Dishwasher ❑ Garbage Disposal Mashing Machine C1 Basement/PlumbingBasement/No Plumbing 6. If Business/Industry/Other: specify type 6 People # sinks # Commodes # showers # Urinals • Mater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gal-lons per day) 7. Type of Mater supp17: County/City ❑ well ❑ Community e. Do you anticipate additions or f expanjions oMy facility this syntem Is intended to serve? ❑Yes A No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUES"T9n HEL_OW. Either a KXF or SITE PLAN;VUST BESUBMITTED by the client wifh THIS APPLICATION. Property DinxensioFir I 'C t.-�GLW BITE Dlei r't'!�*Ny Strom Mocbville)to PROPERTY: -Tax OMcePINs 0 S7 t -3 J411 L53 Sc,.;n 11 OGGL )eLL - Property Address: Road Name()"e,,rove Chum h'(?a o r ) t^�K Co I oyc CJ-) . city/zip m e Ksl;r 11c. nC ar)eal 10� ir)" ry4SS 4:i rS Sin a Subdivision provide information,as follows: hOIASt Or) �C-4- .Name: Section: Block: Lot: Date Property Flagged: Z) 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 puns or intended use change,or if the Information submitted in this application Is falsified or changed 1,also,understand that I ant responsible for all charges incurred front 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 conduct all tes0ng procedures as necessary to determine the site suitability. DATE S ,-I- td Ttb t _�0 THIS AREA MAYBE USED FOR DRAWING YO SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, aseptic locations). Site Revisit Charge Date(s): C71ent Notification Date: EHS: 1 i0"SZ� � 00 :r' ouni,bio. Revised DCHD(07/99) Invoice No. 10 A� a� - -. �`. K�� 'q;`ter y,•>:+' 5�'>'r � -� �(�,... ��' - -- - R - - -�-�- 64 . 44 �' `� � 1..) M 1:1 I. ° `I • .�• � 1r • X1,1 �1 ��}v n 000000 J�e,y�•~ �� •: * " Y..L 111111• 1 � "W��`N�'i� •R` �• o IILYAJ9N��, 1� w LIAM�(��Lir`�Y. �s 1• \ �+l..0 � .. _ \~Y71.1},.L� � 1 � .•�� /�v,tom- L 1 h r Y 357'"r a o e 1 e 11 a .� ..d - '�. j.. :�+�H ( � .. a• , 'l' ��� .a � �..� . —71 •lip, �•� ... '• e,�.,rlbgAj�.,� � b �!�-': f��a.... �► .0,.`.-: e ' i • lY ' 'R r J l- • 111111 •1. : e io`-� 1�.. � .� �1„ .�•., �\ +c eeoaao• o a � T � 0000ao •1: rj�•, I - 4%' h + e o . `�•° � X, rte. •' ' . „��" . '�• \�,. '�, �'. \ �! �•• D - o 'r�!•� Ile000 ° o » `-� \.�'� ` �f , .y. 1 ^ • .vryR..: �L � /. 1 . 0 1010 •0 • 1 ` 530 � �\ ^- , 1 • ��Y r ;�.. � r�N, y• \ D D . ! .. J !�il. \3+•S� � •1 � 1 . 000010 •/• �'y , ��1TT'T �' ✓•yi b � �� � � ' e0ee11 °e .5 C• , ' s , s. �. APPLICATION FOR PRIVATE WELL PE 4 ` Davie County Environmental Health �� P.O. Box 848/210 Hospital Street 1� arc�d' Mocksville, NC 27028 'd (336)753-6780 /Fax (336)753-1680 ***IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. E APPLICANT INFORMATION Name VT-R a w^1 oy►ti2,S Contact Person S,-�-2 4 e�.. A 14e r jr Address S 1 Z-i c-Vtc;-A o-YA �4 w V Home Phone I aY� 97 fa :S8 a G City/State/ZIP-rx%o4't-.MQLA Mc- °Z 8--A!o (o Business Phone Email Si•eP1neH. jAk<e.r C& V-y ee yLl --k4G VK2 Name on Permit if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: /Site Plan /Plat(to scale) Owner's Name Phone Number Owner's Address_ 8 l3 i 2 a City/State/Zip 'h a cK 9 U 31C.Q 14c, 2 7OZ61'roperty Address"t'(gyp e rcSa 4 f Qi r City Y1n c>c1CSV i 1 Le ' Lot Size 2&-y3 14S Tax PIN# k4-2 J6 70 867 7 Subdivision Name(if applicable) Section/Lot# Directions To Site: DEVELOPMENT INFORMATION Permit Type: New Well Well Repair Well Abandonment Other(specify) Facility Type: Residential— Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO_ Do You Intend To Install A New Septic System On This Site? YES_ NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions,the specific location of the facility and any existing or future appurtenances,the location of any existing septic system,sewer lines,water lines,any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property lines and corners. The applicant is responsible for making the site accessible. The plat or map of the site must include,to scale,showing the locations of.all property boundaries,at least one of which is referenced to a minimum of two landmarks such as identified roads,intersections,streams or lakes within 500 feet of proposed well or well system;(B)all existing wells,identified by type of use,within 500 feet of proposed well or well system;(C)the proposed well or well system;(D)any test borings within 500 feet of proposed well or well system;and(E)all sources of known or potential groundwater contamination(such as septic tank systems;pesticide,chemical or fuel storage areas;animal feedlots,as defined by G.S.143-215.1OB(5);landfills or other waste disposal areas)within 500 feet of the proposed well. By signing this application,the applicant signifies that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. 0 AA Applicant's ignature Date lr�^ Pr erty owner or Owner's legal representative Site Revisit Charge Date(s): Client Notification Date: EHS: 11/7/2016 Account# Invoice# r ( • a A +{`C�»� 'fit • '�h 4. J 10000004701 �'X-� 1� i i ,• STROUD BO•BBY�GENE WRYE RUSSE7L 17. tae 15.31ac ` x + �' J1'00000048 HOCHSTE--DEER DALE _ '`•kms. r�C . �'. V,�. 25.16 � }7 J J10000001904-t -STROUD REBEKAH,C.I_ u r s w 11�0000001903 �'•' ♦ y STROUD DRUID B1 �'� J10000004703 • STROUD DAVID B - ° �4 .,,,,',�• 13.21 ac %7 4. , J100000011906 - - ,"' J10000004702 CHRISCOE RACHEL SUZANNE STROUD - i • 7.017ac J10000002906` STROUDJAMES�LEE 2613ac a . J100000063 • STROUD'JQMES RAt` +AL J100000020 ,' GODBEY L'OREN_ E,G 3.633 c y X' J1,0000002902 +'� P. CLENDENIN JOHANAN fir. J100000025- ' TROUD CAROL K iJ10000002910 1.19ac IRELAND MARTHA STROUD ETAL � <� �G J100000029U3�., �t. {,., 6 ..,'++, WARNERDAVIDAEVERH�`ARDT 14.2ac � 1 � J10000002'904 1.48ac 'Q �S.ta ' BARNEY6ASTLE PAM SLA �. J100000Q29 7 1.97ac ,�� . J 0000002 �' STR•UD ROBERT E JOHNSON DAVI' `Tt 96.9 ac i H500000029U7 i a i i N A9C ern DAME COUNTY HEALTH DEPARTMENT - - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001360 Tax PIN/EH#: 5749-35-7941 Billed To: Michael &Amanda Gillespie Subdivision Info: Reference Name: Amanda Gillespie Location/Address: Oak Grove Church, oad- 7028 Proposed Facility:,, Residence Property Size: see map Date Evaluated: 3 ©L 1 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring / Pit Cut FACTORS 1 2 1 3 4 5 6 7 Landscape position Slope% v HORIZON I DEPTH D -I Texture group S.C.t_ CL_ Cl- Consistence LConsistence S S Gr SS S Structure 01- Mineralogy Mineralo HORIZON II DEPTH 2- to- To \'z Z Texture group Consistence 5' Structure l� Mineralogy ; I HORIZON III DEPTH - Z Texture groupL L Consistence Structure SN Mineralogy HORIZON IV DEPTH 2r - -F 32-`/ Texture group5 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION oq LONG-TERM ACCEPTANCE RATE ((�-� SITE CLASSIFICATION: T J EVALUATION BY: JC44 Aa LONG-TERM ACCEPTANCE RATE: �r> 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 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 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 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 05/99(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■11■■ ■■■■■■■■■■■■■■■■■■■■Ile■■■■■■■■■■ ■■■■■■■■■■■■■■■■e■■■ecce■■■u��ll■ee■e■■■■■■■■■■e■■e■/■■■1l■■■ee■■e■/■ ■■■/■■■■■■■■■■emec��s■■��a■■■■■11■■I�1■■■e■■■■■e■■■ee■■■/eu■■■■■■■■■■■ ■■■■■■■■■■■e■■■■■■e■■e■■■iii■■■■■■■■■■■■■■■■■■■■■■/■e■11■■■■■■■■■m■ MEN SOON■/■■Eno riar5reaNON aFirs ONrem arm amaire/vaiONarursrawEno■■son 11Mom■■■■■■■■ ■■■■■■■■■■■■e■IIm■■■e■■■e■■■■■■eye■■■■e■■■■■■■■■■■■■■■■11■■■■■■■■■■■ ■■■■■■■e■■■■■■11■■■a■■e■■tatlwwr.■N■■■e/■■■ee/■■e■e■■/mee/11■em■e■■■/■■ ■■■■■■■■■■■■■■Ills■■■■■■■■t::t►�'n�■�t�r�■■■■■■■■■e■■■■■■■■■■■■II■■■■■■■■■■■ ■■■■■■■■■■■■■■II■■■■■e■■■■ru�near.�■1�1■■■■■■■■■■■■■■■■■■■■IIe■e■■■■e■■■ iiiiiil�iiiiini■�iiiiiii■.::::::n : ::n somolliMENNEN ■■■■■■■■■■■■■■■■■■■■■■eee/■■�■■■■■■■■■■■■■■■■■■■/■■■■■■11■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Iii■■■■■■■■■■■e■■■■■■■■tl■e■■■■■■e■■ ■ee■eeeeee■ee■ee■e■■ecce■■eee■e■■ee■■e■■■e■■ee■ee■ee■ell■ee■e■■■■■■ ■■■■/■■■/■■■e■■/■■■■■/■■■■■■■■■■/■■■■e■■■■■■■e■■e■/■■ell■■■■/■■■■■■ ■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■larae■■■■■e■■■■■■■■11■■■■■■■■e■■ ■■■■m■■■■e■■■■■e■■■■■ee■■■■■e■■■ ■■i�ee/■■■■■e■e■■■■e/11/■■■■■e■ee■ ■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■■Ile■■■■■■■■■■ ■■■■■■■■■■■■e■■■■■■■eee■■■■■■■■■�■■I■■■e■■■■■■■■■■■■■■Ile■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■ ■■1>t■■■■■■■■e■e■■■■■■II■■■■e■■e■■■ ■eee■■■■■■e■■■■■■■■■■■■■�":�■■■■■l:�T�l�'�■■■■■■I i Davie County)Y'ealth Department Environmental Aealth Section Po sox 848/210 Hospital street Mocksville,NC 27028 Phone: (336)751-8760 August 23,2000 Michael and Amanda Gillespie 3135 Statesville Blvd Salisbury,NC 28147 Re: Site Evaluation- 2 Acre Tract/Oak Grove Church Road . . Tax PIN#: 5749-35-7941 Dear Mr.and Mrs. Gillespie: As requested,a representative from this office visited the above site on August 23, 2000. Based on 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. Based on the evaluation, a three-bedroom residence would require approximately 400 linear feet of septic drain line. This is subject to change and actual dimensions of the septic drain field will be determined at the time an improvement permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at(336)751-8760. Sincerely, Jeff G. Beauchamp, R. . Environmental Health Section enc(s)