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Davie County,NC Tax Parcel Report � �� Wednesday, October 5,2016
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, _ Parcel Information
Parcel Number: F600000100 A Township: Farmington
NCPIN Number: 5850980583 Municipality:
Account Number: 57444000 Census Tract: 37059-803
Listed Owner 1: POLLARD J D Voting Precinct: SMITH GROVE
Mailing Address 1: 234 POLLARD LANE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 2702&7755 Voluntary Ag.District: No
Legal Description: 121.583 AC OFF HOWARDTOWN Fire Response District: SMITH GROVE
Assessed Acreage: 110.36 Elementary School Zone: PINEBROOK
Deed Date: 6/1961 Middle School2one: NORTH DAVIE
Deed Book/Page: 000640168 Soil Types: MrC2,MrB2,RnC,EnB,ChA,RwA,MsD,WATER
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Buiiding Value: 64590.00 Outbuilding 8 Extra 11310.00
Freatures Value:
Land Value: 423070.00 Total Market Value: 498970.00
Total Assessed Value: 146180.00
9�,��, All drta Is provided as is wkhout warraMy or guarantee of any Idnd eitha expressed or Imptied Including but not Iimlted to the
Davie Counly� Implled warraMles of inerchaMa6111ty or fltness for a pardcular usa All users of Davie CouMy's GIS rvebsite ahatl hold hartnless the
Cowky ot Davlq Nortl�Carolina,lts�gmts,conwltaMs,coMrac[ors w employees hvm any and a9 clalms or wuses of actlon due to
np�N.�� NC or arising out of tha uu or inab(Iity to use the GIS data proNded 6y this website.
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AUTHbRIZATION NO•` ,� ! �� E�l j�+ �o'!.J
,��,�4 �,, : ,4 • D V COUNTY HEALTH DEPARTMENT : -
� Environmental Health Section PROPERTY INFORMATION
`�Pezr'nittee's � a ; P.O.Box 848 .
Mame`�' /�/� ` � GZ' Mocksville,NG27028 : Subdivision Name:
,� Phone#:704-634-8760 .
Directions to property: /'O�/t��� !'?,:c'" Section: Lot:
� . AUTHORIZATION FOR , �0�I� l � _ ��Q.�
WASTEWATER Tax Office PIN:#
' SYSTEM CONSTRUCTTON
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� Road Name: /0 f i Gt r� ��1 Zip:'_�
**NOTE**This Autl:orization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts:This Form/Authorization Number should be presented to the Davie Counry Building Inspections
O�ce when applying for Building Permits.
(In compliance with Article 11 of G.S.Chapter 130A;Wastewater Systems,Section:1900 Sewage Treatment and Disposal Systems)
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� `a� ' `%� ' � ***NOTICE***THIS AUTHORIZATTON FOR WASTEWATER CONSTRUCTION
.�c.•-;�"C.a' ` � .. .. ��Q!J��i"`,�'"�, . : IS VALID FOR A PERIOD OF FIVE YEARS.
\ ENVIRONMENTAL`'HEALTH SPECIALISI',� DATE ISSUED
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�.. '� ��� DAVIE COUNTY HEALTH DEPAR ��� T~� ---_._.___
"�"'��.-� �� s� ° IMPROVEMENT AND OPERATION PE�I�� PROPERTY INFORMATION
Pe`�m`itfe�'�s � - , ' ' j
Name: ",�� �,;�Q'/^" Subdivision Name: � w "rf�
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Directions to property: ��='%f�'%.'�r"r` �r'� : ` Section: Lot:
' II1�II'ROVEMENT r''��J� c�1�r C�.�Y.�
PERMIT Tax Office PIN:#�y � � ,
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Road Name: �[3�C� ,�'�'! ��i,Zip: � G�,=
**NOTE**This Improvement Pernut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained fmm this Department prior to the
construction/installa6on of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,SecUon.1900 Sewage Treatment and Disposal Systems)
� :' ,� '" �' .s; �� ***NOTICE***TEIIS PERMIT IS SUBJECT TO REVOCATION IF SITE
�''`'(��t�'^ .�'"�.�c:`�r:%r'"��"'r;i��r� �+:�:..�'�s'�i---J��"f,��.' PLANS OR TI�INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST nA�tssuED SYSTEM CONTRACTOR MUST SEE TEIIS PERIVIIT BEFORE
INSTALLING TI�SYSTEM.
,RESIDENTIAL SPECIFICATION:BUILDING TYPE � #BEDROOMS �l #BATHS r�sl #OCCUPANfS � GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICAT'ION: FACILITY TYPE #PEOPLE #PEOPLFJSHIFI' #SEATS INDUSTRIAL WASTE:Yes or No
sLOT SIZE /Yl TYPE WATER SUPPLY �f'// DESIGN WASTEWATER FLOW(GPD)� NEW SITE � REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE/aD� GAL. PUMP TANK GAL. TRENCH WIDTH-��'� /�ROCK DEPTH �� LINEAR Ff. . 0O/
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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 1:00-130 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)6348760.
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OPERATION PERMIT Q� �
�l14 I—� �Z v 0� SYSTEM INSTALLED BY:__�rLJ1,r'Y�d�.-�., �G(Mn�.�
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AUTHORIZATION NO.���5 OPERATION PERMIT BY: ��""�'' DATE: G��'� ��
**THE ISSUANCE OF THIS OPERATION PERMTT 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 OS/96(Revised)
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• APP�ICATYON FOR SITE EVALUATION/IMPROVEMENT PERMIT�i ATC �``i �
-==�� ' ~N Davie County Health Department � �
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� �Environmental�Health Section; r��, ,r' ' D
:�_.. ; P.O. Box 848 .
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L�•. Mocksville,NC 27028=.�. ' � . `' � 1�9 f )
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****IMPORTANT'�*�* THIS APPLICATIC)N CANNOT BE PROCESSED ,,
THE REQUIRED INFORMATIQN IS PROVIDED. �"-��' ., �
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1. Name to be Billed ,/�c.c✓�r �� �l�d�� � Contact Person � ��/l� �/i�! �iti dc�C-
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Mailing Address �,�� ,�'�I�/�{,(��!/l��c/ Tfa/�� �/' Home Phone �`'�U � �� � 3
City/State/Zip �i�.��2'/r`/t'�', ,�. .�i. , —��i Business Phone �-���,�� -`
2. Name on PermidATC if Different than Above
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Mailing Address City/State/Zip
3. Application For: [ ] Site Evaluation [']Improvement Permit&,ATC , �"� (�i}'Both
4. System to Serve: [�jf House (fiJ�Mobile Home [ ]Business [ ]Industry [ ]Other
5. If Residence: #People� #Bedrooms�_ #Bathro�s� �L [/��Dishwasher[ ]Gazbage Disposal `
(/]Washing Machine [�]Basement/Plumbing [U]Basement/No Plumbing 1
6. If Business/Other:Specify type #�People �l#Sinks #Commodes
#Showers #Urinals #Water Coolers -( �
If Foodservice:#Seats Estimated Water Usage(gallons per day) � ,
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7. Type of water supply: [ ]County/City [J]Well [ ]Community ,�
8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes �;/�No
If yes,what type? �
% ; , - ' EZTHER A PLt1T OR SITE PLAN
' PRUPERTY INFORMATION REQUIRED:***IMPORTANT**'�CF.Y�4'OF THE PROPERTY MYJST BE
u' ' SUBMITTED WITH THIS APPLICATION.
Property Dimensions: �(�� ` ��0 � ��' � �WRITE DIRECTIONS(from Mocksville)TO PROPERTI':
Tax Office PIN: # ��'—s�—-—1�3�� � ��� /��1=��.�/' .i.� �c�,i{_����TiY�t ��
Property Address: Road l�ame Z 3 f ,�c7lli,��Cn. /�1/ � C4,..� ,t,cc,r�� �.-�it T/�r_ ��-, i t-/, Gv�r�-c._
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c�ty�z�P /1rf v�4.'s���%/�. �G���� � =�. 7 2 � ;/K ;�f°�R`L
If in Subdivision provide information,as follows: � ��u- � � l� .� •.v �`
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Name: � /�c� l����fi' �G.lJ .�e,�.�� Y.'�� .�
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Section: Lot#: ; Tr.�r�--� �.�-�-- �uv'��
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This is to certify that the information provided is correct to the best of my knowledge. I understand that any pertnit(s) issued hereafter aze
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 chazges incurred from this application. I, hereby, give consent to the Authorized
Representative of the Davi o He th Department to enter upon above described property located in Davie County and owned
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by GLl�I� to conduct a testin ocedu s sary etermine the site suitability.
DATE �Z �O• � � SIGNATURE �
Revised DCHD(06-96) �
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THIS ,4REA AIA� $E USE1� �OR bRttWZNC yDUR SITE P1�lN:
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. �-- ' DAVIE COUNTY HEP�LTH DEPARTMENT '��
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. Env'�nmental�Health Sectipn;-,�,_., ��' SECTION LOT �,
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�''y " � SoiUSite Evaluation � � ���'
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APPLICANT'S NAME Df/�� ,�� , . r� - DATE_EVALUATED ���� ��
PROPOSED FACILITY ��� PROPERTY SIZE ��-''
SUBDIVISION ROAD NAME ,��1l����✓��
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition
Slo e%
HORIZON I DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH ��� �
Texture rou e �'
Consistence � �
Structure h�� /�:—
Mineralo � �/t/
HORIZON III DEPTH
Texture rou
Consistence ' �+'- .
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE .3
SITE CLASSIFICATION: � EVALUATION BY: _ '�
LONG-TERM ACCEPTANCE RATE: i� OTHER(S)PRESENT:
REMARKS:
LEGEND
Landscane 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-Granulaz ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
MineraloEv
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-gaUday/ft2
DCHD(OI-90) - � �
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