193 Pete Foster Rd Davie County,NC Tax Parcel Report Friday, September 23, 201E
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CROTTS RD JOHN CRO�fTS RD
WARNING: THIS IS NOT A SURVEY
Parcel Information 7777
Parcel Number: 1500000051 Township: Mocksville
NCPIN Number: 5748858980 Municipality:
Account Number: 8304721 Census Tract: 37059-805
Listed Owner 1: FOSTER THOMAS F Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 193 PETE FOSTER ROAD Planning Jurisdiction: Davie County
City: Mocksville Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 40.61 AC PETE FOSTER RD Fire Response District: MOCKSVILLE
Assessed Acreage: 40.61 Elementary School Zone: CORNATZER
Deed Date: 2/2015 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 009790617 Soil Types: GnB2,GnC2,PcC2,EnB,GaD,CeB2,MsD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 209840.00 Outbuilding&Extra 8620.00
Freatures Value:
Land Value: 199420.00 Total Market Value: 417880.00
Total Assessed Value: 244620.00
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
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yNC or arising out of the use or Inability to use the GIS data provided by this website.
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31Permitteets�-�---� . i �J � —DAVIE COUNTY HEALTH DEPARTMENT
Name: 't} t ��j T -' t Environmental Health Section PROPERTY INFORMATION
f :. 1(� P.O. Box 848 ✓'' tai
Directions to property: t Mocksville,NC 27028 Subdivision Name:
Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
AUTHORIZATION NO: 002755 A Road Name: �` t=��'T� Z
**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'Aitic'1 11 17 G.Sre'trapt� 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
NViI�N 'T` L HE J THIS ALIS,) DAT IS ED
RESIDENTIAL SPECIFICATION:BUILDING TYPE . #BEDROOMS z #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TY�P�E%�� #PEOPLE #PEOPLE/SHIFT j� #SEATS INDUSTRIAL WASTE:Yes or
No
LOT SIZE TYPE WATER SUPPLY VL��-�-1 DESIGN WASTEWATER FLOW(GPD) `� NEW SITE REPAIR SITE ✓
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 117— LINEAR Fr. �J
OTHER ��fiIOJ �C
^l\ ' J
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. 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 01N2(Revised) xr fz& - �O,
.v-fi . �1.1�/� �.:. _ c '-a � a�..•.a s ' �• `' ;� - .. _ - ... h _ .�r�w a-4'•a,.,y-..•"- ,t•t.,-. -..�. _
e•, `, r,r .,-i, ,•S:Ya �snf y M S .e `.=�,,..-.''^^+'s,.,•r- 57 ,. :t,rwr '�^�(]��+' � l.f:.;�.. �.>y.:'-`-"�-•e•'••'" � '� 4`i'i'y�*�:.;t
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Petztufteeq$ y d )i`�` .DAVIE COUNTY HEALTH DEPARTMENT
Name:::. "` � :_.1 �� �— (--� +=- f Environmental Health Section PROPERTY INFORMATION
,,� t _ P.O. Box 848
Directions,to property.. _ — ''�� Mocksville,NC 27028 Subdivision Name:
--f ;�- � Phone#: 336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER -
SYSTEM CONSTRUCTION Tax Office PIN:#
It
t r
AUTHORIZATION NO: 002755 A Road Name: =' `� `" ('�p
**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-tImpter 130A.Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
P
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
-ENViItONM LHE LTH S �C�ALIS7`r' DATE ISS ED
RESIDENTIAL SPECIFICATION:BUILDING TYPE tJ61'-'1E- #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) � � .; 1--l"� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -7(0 ' ROCK DEPTH 12- „ LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: i N,�TAIJ (WN C_ QJ 1 t'-)J L � ,F AL:..-( liaL
IMPROVEMENT PERMIT LAYOUT
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ILL,;
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT \
SYSTEM INSTALLED BY:
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AUTHORIZATION NO. OPERATION PERMIT BY: 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 NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORIL,Y�FOR ANY GIVEN PERIOD OF TIME.
DCHD 02/02(Revised) %`� e-
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-7)
AP TE EVALUATION/IMPROVEMENT PERMIT & ATC
T" avie County Environmental Health
D P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751=8760/Fax(336)751=8786
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Appli tion "IE� ion/I ent Permit 2-Authorization To Construct(ATC) ❑ Both
Type o Applicata n:D s em pair 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 to be Billed ��Vm a s Contact Person S'-4/1-71dF
Billing Address /93 Home Phone33e; 2S% —3?.;;7
City/State/ZIP /YJDCr�S�1.�/�_.�L� 7�? 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 months with site plan,no expiration with complete plat.)
Owner's Name Phone Number
Owner's Address City/State/Zip
Property Address City
Lot Size Tax PIN#
Subdivision Name(if applicable) Section/Lot#
Directions To Site: lvi - rf L d
70— FUS" /zIce( ,
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? es ❑No
Does the site contain jurisdictional wetlands? Dyes 2N-o
Are there any easements or right-of-ways on the site? Dyes 2156
Is the site subject to approval by another public agency? Dyes 011q,0-
Will wastewater other than domestic sewage be generated? ❑Yes 2<6�
IF RESIDENCE FILL OUT THE BOX BELOW
#People / #Bedrooms - Q, #Bathrooms�_ Garden Tub/Whirlpool Dyes RNo---
Basement: Dyes �o Basement Plumbing: Dyes M6 v
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:. Rlfonventional ❑Accepted ❑Innovative ❑Altemative ❑Other
Water Supply Type: ❑ County/City Water ❑New Well xisting Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes R1io
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 pemiit(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 understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging
or staking the house/facility location,proposed well location and the location of any other amenities.
' -r�"— Site Revisit Charge
Property owner's or owner's legal representative signature
Date(s):
0 Client Notification Date:
Date EHS:
Sign given Dyes ❑No Account# as�
Revised 11/06Invoice#
r'
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR "
�`��t~� ;�i? :7'f',�; DATE PERMIT
LOCATION �� tti� f / `/ . i -l. ~1 ,. 'f rr, ; ►- ,. �/ NO 1012
;, fr S.R. NO,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE aRr MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS f NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO [a- Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES +❑ NO ❑
SITE SUITABLE YES ❑ NO ❑ .:;:, G : � { _� c .�m_ r. t•.
SIZE OF TANK gal. 1
( llC
4
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES: /.—W/tt u �c-
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY _ V\--\A CJ- INSTALLED BY k�j%k
CERTIFICATE OF COMPLETION � By Dates_d d-76
(8/16/73) *Construction must Amply with all other applicable State and local regulations
LOT AREA C C=am bo Ix X •,� "�
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UJB <
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage' D/isposal System - G.S. Chapter 130-Article 13C)
OWNER. OR CONTRACTOR r� �ti"7�' / DATE Vit'^ t�(� PERMIT
LOCATION , t � h4- Rc /
N9 1012
S.R. N0,
SUBDIVISION NAME LOT NO. SECTION OR BLOCK- NO.
HOUSE MOBILE HOME C3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS f NO. BATHROOMS _ Two Bedroom ,House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Q' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO j}- Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO ❑ �
SITE SUITABLE YES [3 NO ❑ ..}tia�C E,,� :,�1r►i� 1't
SIZE OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES s -1'f /xw./0 u rR
WATER SUPPLY: -Individual P`'Public` ❑
IMPROVEMENTS PERMIT BY _. "'1f� �:4 O INSTALLED BY i 1 ( �•� L�a,�Q
CERTIFICATE OF COMPLETION
By_�e�-Q- �tN-�O Dates'd.d -76
(8/16/73) *Construction must Amply with all other applicable State and local regulations
LOT AREA 1 wl . r At { �I
15 A
.. T7
(72,3) a.
60
P�o
ETE FOSTER ROAD
4
El
Ill (524) (234)
DAVIE COUNTY HEALTH DEPARTMENT
" Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
e-*-�Tt�
w5l 2_1
Water Supply: On-Site Well ve-ool- Community Public
Evaluation By: Auger Boring / Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position t
Slope%
HORIZON I DEPTH 1
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH Z-
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence Ar
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
TC�C�����
-C{o�ncave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
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
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
rlotgs
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 05105(Revised)
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