184 Old March Rd Davie County,IVC , Tax Parcel Report Friday,November 18, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: B300000090 Township: Clarksville
NCPIN Number: 5813685013 Municipality:
Account Number: 82529409 Census Tract: 37059-801
Listed Owner 1: DILLARD SCOTTY-TYRONE Voting Precinct: CLARKSVILLE
Mailing Address 1: ' P O BOX 82 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: 1.000 AC LEISURE LN Fire Response District: COURTNEY
Assessed Acreage: 1.00 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 3/2008 Middle School Zone: NORTH DAVIE
Deed Book/Page: 007510581 Soil Types: MdC,MdE
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding 8r Extra 6820.00
Freatures Value:
Land Value: 10310.00 Total Market Value: 17130.00
Total Assessed Value: 17130.00
O Aaya�� 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
/-r County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�obCl� NC or arising out of the use or Inability to use the GIS data provided by this website.
09/15/2016 10:481-IM 336-998-3546 MBR PAGE 02/03
Davie County Health Departipent
4�i8 - .0 .. Environmental Health Section
_ P.O.Box 848
RECEIVED
�,� .��• 210 Hospital Street . •
�'-- Courier 4:09-40-06 c;
Mocksville,NC 27028
Phone:(836)-758-6780 F=(836)-758-1680
ON-SITE WASTEWA + CATION
(Check One) Replacement Remodelin Reconnection
Mrhv wi/di
Phone Number (Dome)
Mailing Ad ess: 19'f o/J wt�c G fit, .7n. � --a L� M:a,.§,)(Work)..
/�oCy ,„)tom 7ito�lo
Email Address: C`um.•Q'- 14.114 4C44-
Detailed Directions To Site: +w .90t o� eo fir �' _ L. �- �., K,�►1c�
09j,7'
Property Address. 15M M;g ids g:goyt
Please Fill In The Following Information About The F.Xl'STING Facility:
_ -.Name System Installed Under: Type OfF'acility: 9'F
Date System Installed(Month/Date/Year): Number-Of Bedrooms: 3 Number Of People: Z--
. Is The Facility Currently Vacant? Yes If Yes,For How long?
Any Known Problems? Yes . If Yes,Explain:
Please FID In The Following Information
"Abot The WFacilitys•
Type Of Facility: ��rQ 1lZ(�f ���� Number Of Bedrooms: Number of People
Pool Size: Garage Size: Other. cqz/,x/'R
Requested By: Date Requested:
(Signature)
For Environmental Health Office Use Only
Appr ved Disap rorove�d /
omments: L�GL-c Gv��
t�
Environmental Health Specialist Date: !`d 17 /:
*The.signing of this form by the Envirbrunental health Staff is in no way intended,nor should be taken as a guarantee
-- (extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order # Amount:$ Date:
Paid By Receiyed By
Accoutit Invoice M
09/15/2016 .10:48AM 336-998-3546 MBR PAGE 03/03
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MILLER BUILDING &REMODELING,LLG
/%; \ \ \ r,• 550 Beauchamp Road
/ �• \\�- '�',� \ \\ Advance,NC 27006
(336) 998-2140
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I, GRADY L. TUTTERDW, CERTIFY THAT UNDER �
MY. DIRECTION AND SUPERVISION, THIS MAPWAS
MADEDBYWN FROM TUTTEROWNACTUAL SURVEYINGIELD \
COMPANY, (�A,R�� \ \ 'r c_
_ i SEAL PLAT OF SURVEY FORS ANTHONY
4 =
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REGISTER
LANDSURVEYORL-2527 's and wife /
TUTTEROW SURVEYING COMPANY %�q,�tio SURA '',Q�� scAlM _ »' APKCVU gn
c11 iORIZA __ 1645 DAVIE�OUNTY HEALTH DEPARTMENT
a
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name. ST �,�)C,
. Subdivision Name:
Directions to property: t c "1/ l U 1 .?a' ^� Section: Lot:
ni
J(• , .IMPROVEMENT r,
tf*�J i L'-^t +t:u jt t a itt tC r-> PERMrf Tax Office PIING•# � r ;e,,;
Road Name:,gL�.,�{.�! kC
_ **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 I I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
i ***NOTICE***THE PERMIT IS SUBJECT TO REVOCATION IF SITE
_ _ r -� �;'✓�" I `+ ? PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
`-'ENVIROh1MENTAL HEALTH SPECIALIST DA E ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS�_#BATHS_—#OCCUPANTS GARBAGE DISPOS :Ye or No
-. COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No
j,,5?yj&>->IXZZS YZ>I'
LOT SIZE TYPE WATER SUPPLY LAST DESIGN WASTEWATER FLOW(GPD) NEW SITEy . x"REPAIR SITE
It rr r
SYSTEM SPECIFICATIONS .TANK SIZE�l/1/VAGAL. PUMP TANK ^�GAL. TRENCH WIDTH_ROCK DEPTH ►Z LINEAR FT.3C i
OTHER_ klM1STP.I l�j-IJTIJ� `fJr7Y
REQUIREDSITEMODIFICATIONS/CONDITIONS: Ir�STAu_ 0C�/�11C()2 K- 1 I^f fIcJ r-ea, IOl oFF.
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IMPROVEMENT PERMIT LAYOUT
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"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(336)751-8760.
OPERATION PERMIT
--
SYSTEM INSTALLE Y:
poemd
AUTHORIZATION NO. OPERATION PERMrr BY: � DATE: / of
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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(ReA d)
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DAME OUNTY HEALTH DEPARTMENT
tAv �.""` IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name. ' ' �`�" � -�� r�, kC. Subdivision Name:
Directions to property: ' ) ,'� rt l t;1 t t'�=a- Section: Lot:
t j •,,,.. IMPROVEMENT
L , ..1 1 I i� Ll � rx"G 1{ r PERMIT Tax Office PIN:#
f {
Road Name:0 LD AA V 4 'Zip
*NOTE**This AUTHO Improvement Permit O DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
R 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 1.1 of G.&.Chapter 130A,:Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
,.....-�- ***NOTICE***TIM PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER "
ENVIRODtMt I'rCL HEALTH SPFCCIALIST DATE IS UED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS _#BATHS #OCCUPANTS GARBAGE DISPOSA :Ye or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
�1YI V'XzZ.S�XZ �
LOT SIZE'n TYPE WATER SUPPLY rDESIGN WASTEWATER FLOW(GPD)—�(Qf) NEW SITE +r' REPAIR SITE
I1 rr
SYSTEM SPECIFICATIONS: TANK SIZE I GAL. PUMP TANK GAL. TRENCH WIDTH 02 ROCK DEPTH Z LINEAR FT.2�
OTHER
1A�?TQ.1I tt
REQUIRED SITE"MODIFICATIONS/CONDITIONS: I r�SwrALL 0 5 I CS--3-1O04 K[L .S 1 (26
IMPROVEMENT PERMIT LAYOUT
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SIU vS
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**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 (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLE Y:
AUTHORIZATION NO.A 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 SYSTEM
S", SHALL IN NO WAY BETAKEN AS A`
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 051%(Revised) ;
✓ Fnc-'• - APPLICATION FOR SITE,EVALUATION/IMPROVIa1IENT PERMIT&
/t Davie County Health Department
Gy Environmental Health Section
P.O. Box 848 n p,' _
Mocksvillee�NC 27028 JM 8 i
(76�
3 �7G0
l s ENVIRONMENTAL HEAUJI
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED DAVIE COUNTY
ALL THE
/REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed. D4/C& NDC14B O4)(.FLUS%--T C : Contact Person -AUG il/
Mailing Address �a?S �ING- 4 t/�-JV LA/. Home Phone ' 7s 7 l
City/State/Zip �&,2C1--S VIC4-6- N.C .270o2 f Business Phone rlgg-7a79
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4, System to Serve: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms _-3 # Bathrooms Z-
Dishwasher X 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 ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No
If yes,what type?
E Z THER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A Pt*q)MTHE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: R47- A14V gg/V CC-O.Sc, 1 WRITE DIRECTIONS(from
1 Mocksville)TO PROPERTY:
Tax Office PIN: # S-7 g - - - •1 9% 1
•day p� s8 7r-.> 8,0/ - 7 A)
Property Address: Road Name
City/Zip ADy gAxc_e. Al C d-7Co o(0 1
1 7Z12,V Lf=T- Q/V
1
If in Subdivision provide information,as follows: 1
1 K Ab
Name: 00,4"Q CN L(JOo lis I
Section: Lot #: 1
1 '(U OW /2r .
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.1,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
H.
and owned by ��/-<�l! Woo 7-r, to conduct all testing procedures
as necessary to determine the site suitability.
DATE 6 '' — SIGNATURE
Revised DCHD(06-96)
YOU MAY USE THE $ACK OF THIS FORM FOR DRAWING YOUR SITE PLAN. �CC l,
SIDNEY F. H00
ha ti D.B. 175 Pg.
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DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section SECTION__LOT
Soil/Site Evaluation
APPLICANT'S NAME /`tom n DATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION ROAD NAME
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Ll_� Cut
FACTORS 1 2 3 4 5 6 . 7
Landscape position
Sloe%
HORIZON I DEPTH
Texture Eroup
Consistence
Structure
Mineralogy
HORIZON II DEPTH s�
Texture Eroup
Consistence
Structure ,C 4 .
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: EVALUATION BY:
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 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(01-90)