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250 Potts Rd Davie County,NC - ' . Tax Parcel Report (��,3 Wednesday, October 5, 2016 ` ' F I j � , , � , 1 rr fr 1 _- `� rf� I r r _ J. ! __' f /�' _" / I -_�_'_ �l ! Q�/ --"_� - . _ _���a-������-���.�_�`___- �f LJ_ - :�; P� ' l f � r �� % I __ 1 r — �_� � I f i r i 250--�r CP��� �___, 244 i i � � � I � � --------� WARNING: THIS IS NOT A SURVEY , _ .-. t. �_ _ , . .____ _ .,_ . ,: _ ___ _ _ . .. _ . _ _ _ Parcel Information Parcel Number. F80000012203 Township: Shady Grove NCPIN Number. 5880157312 Municipality: Account Number: 15994250 Census Tract: 37059-803 Listed Owner 1: CLINE RICHARD EUGENE ETAL Voting Precinct: ' EAST SHADY GROVE Mailing Address 1: 250 POTTS ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A State: NC 2oning Overlay: Zip Code: 27006-0000 Voluntary Ag.District: No Legal Description: 1.086 AC OFF POTTS RD Fire Response District: ADVANCE Assessed Acreage: 1.06 Elementary School Zone: SHADY GROVE Deed Date: 6/1998 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 002030241 Soil Types: WeC,PcB2,RnD Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 0.00 Outbuilding 8�Extra 0.00 Freatures Vatue: Land Value: 15360.00 Total Market Value: 15360.00 Total Assessed Value: 15360.00 q�,�E, All data b provtded as is wMhout warta�Ry or guaraMee of any Idnd either expressed or Implied including but not Iimlted to the Davie County� Implled warrarAlea of inerchaMabllity orfitneas fw a particular usa All users oT Davie Cou�s GIS webaRe shall hold harmless the Nr County oT Davie,Nath Grolina,ib ageMs,eonwltaMs,contractors or employees ttom any and ap daims or wuses of actlon due to �'p��.�� t� or aAsing out of the use or inability to uu the GIS data provided by thia websita <, . R 5+�'i�'%"hr '�,1�'`ti: +r�tsr"�'� a^z"�+" � '' v *';���' i . . Y . �.. ��[� '• " �c^ "� � •'= ` '='xR'F }� " ' �'/`v ,. . - �:= f ,. "�,� ,,� .,. �.�r, � i:r?g.«.� r ,{ ' , , . v ,. , . � {�e�. N�� .ar . ,,a•�!. Ki� "C. ', r . . ,t . q i.'-'�A . . — . _. . . . . . � - . � � . . ' . . . i '/��. AUTHORIZATIONNO O 6 3�� DAVIE COUNTY HEALTH DEPARTMENT �;,,',.�'�- � Environmental Health Section L�� PROPERTY INFORMATION "Permrttee's� ; • P.O.Box 848. � Name:`�`_�� ArA� ,�n L- Mocksville,NC 27028 .� Subdivision Name: ,Q Phone#:704-634-8760 C�' ���-'�-� , Directions to property: .��S�t" G�(� Section: .beC" AUTHORIZATION FOR r�►c! � ' WASTEWATER Tax Office PIN:#�8 0 �-�_ ��� SYSTEM CONSTRUCTION. Road Name: /�U r/S C� , Zip; 05 7d��' **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Counry Environmental Health Section prior to issuance of any Building Pernuts.This Forn�/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems;Section.1900 Sewage Treatment and Disposal Systems) ' ,,,.,`) ..;-s / . ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION . ! J,,��',t�. �'"�f�l--C��!'�7 -'. _C',� IS VALID FOR A PERIOD OF FIVE YEARS.. - ENVIRONMENTAL HEALTH SPECIALIST '. bATE ISSUED " ' - . fidt.._�..i-"�.�,• 4 i�.. �c� � ritiv' S ,-,`•^�s; ,� ti �sc%xti � .zt.�w� - .,,. , ��4 � i i,H 't T�`E.�i u,E,.,�-� �� -�' _ r �r - 't..-,� }��. " .. •�1'i` �q.�Z,,.,,r_t ;..,'i.y r ��v y, � ""`~�-- ���A'� - ,�..,,.�^� DAVIE COUNTY HEALTHYDEP�R1i��ENT} ' I ��,� �,-�• " � IMPROVEMENT AND OPERATION PERMI�'5:.� PROPERTY INFORMATION � ,�'Permittee'���.- / � / y:��,��;� - N me.� . 'i C/IF,�'� ��✓�h � ' . �`'�Subdivision Name: _ �,, , �J, ,,,,•j., � Diiections fo property:_ � .'" .i%'' ��( '�'` � Section: .I�t� IMPROVEMENT . PERNIIT ' Tax Office PIN:#��u`��-�- '��� ' Road Name: �C.��...,:. �C..� , Zip: "�i /vd � **NOTE**This Improvement Pernut DOFS NOT authorize the construc6on or installatian of a septic tank system or any wastewater system.An ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUGTION must be obtained from this Department prior to the construcdon/'uistallation 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) r' �' ,r r.- ,,,� ***NOTICE***THLS PERMIT IS SUBJECT TO REVOCATION IF SITE ;"1f�zr�4ti � ;%` r ��'��-r" ,✓`'r�% ;i-�»/",` ••J,1 PLANS OR Tf�INTENDED USE CHANGE.YOUR WASTEWATER �ENVIRONMENTAI.HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING THE SYSTEM. _ RESIDENTIAL SPECIFICAT'ION:BUILDING TYPE�� #BEDROOMS�#BATHS � #OCCUPANTS .� GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLF/SHIFf #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE �/I C TYPE WATER SUPPLY� DESIGN WASTEWATER FLOW(GPD) 1/� NEW SITE� REPAIR SITE SYSTEM SPECIFICATTONS: TANK SIZE'�G�7p GAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH �% ' LINEAR FT. � �'�'�' OTHER . , REQUIRED SITE MODIFICATIONS/CONDITIONS: _ , : r IMPROVEMENT PERMIT LAYOUT � **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: IfJOL�/'lG'� , � AUTHORIZATION NO._��OPERATION PERMIT BY: .l U DATE: � **Tf�ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TE�SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WTfH ARTICLE 11 OF G.S.CHAP'TER 130A,SECI'ION.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) , , , eAPPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC ----- � ,, � ° Davie County Health Department � �(2 a(\/]� ' Environmental Health Section D LS v P.O.Box 848 Mocksville,NC 27028 � � � ���Qg"�" (704)634-8760 I��� � ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS D UNLESS ALL THE REQUIRED INFORMATION IS PRO ED. �'� � • 1. Name to be Billed �C�Q��/ �/� ''►� Contact Person_�/�e7���-1 ���' Mailing Address „�� � � �� �U� Home Phone ��d "���d City/State/Zip ./'k?'UE�h�'� �� r����+° Business Phone t 19�' �G3`J �� �� � �� � ��?��- l�b � 2. Name on PermidATC if Different than Above �, +L C�v-�+ • rt� � Mailing Address /"�b' �� ��� City/State/Zip�f�G�'��h C' � /�- �� 3. Application For: -rd`�Site Evaluation � ❑ Improvement Permit&ATC �Both 4. System to Serve: ❑ House �Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People �_ # Bedrooms c�' # Bathrooms � ❑ Dishwasher ❑ Garbage Disposal �Lt'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 �ell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ��10 . If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: � Q��Q � WRITE DIRECTIONS(from � Mocksville)TO PROPERTY: Tax Off'ice PIN: # s� � � - �_ - 1 '`� ' 1.� � '' f �, .� d �'� .��Xi� - Property Address: Road Name / bT�/� � � -' ' ; � � r� `� a �. � city/Zip /! /J ��'� nI C' _ i v�'� /� �"/ / � r If in Subdivision provide information,as follows: 1 ,r � �^,,) ' �� � ' 1 �l•� LX.. Name: � �` c� ��d/� l,� � /u Section: �' �� /_ G�� /��'l. �...� ,� �`� This is to certify that the information provided is correct to the best of my knowledge.I understand that any permit(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 charges incurred from this application.I,hereby,give consent to the Authorized Repres ntative of the Davie County Health Department to enter upon above described property located in Davie County 1 � and owned by �`" to conduct all testing procedures . �-. as necessary to determine the site suitability. � DATE I " l � -' �� SIGNATURE /L� ) .� Revised DCHD(06-96) 3=�- � ��� , , . � �c : �- - � , � � ,.;� ——-__._,`„� , � 2' b�nt iron lound "_'�--.. �S Ot' 18'07"E 13.54' - trom 1.5° iron tound • S 6 .. c'��, . � , jjl S0�f ! ' ' ';, , � new� tron . � - i`; . , S ' �c'•33� � 1�4��9,:.� � y AU L��: POTTS . ; .8. t�52- Py'. ,63 2t' PoPlor ,�' � �' � ' � _ . ti; � .��� . 3; �� �� 'C' � • Q � D ,. , o rorti, � �� ' ��4. Ir°^ SQ.5p Mb`�� ' plocb �+.'�;� . . . . . . . � .� . � � � •V � � . � . ti AREA -= 2.591 AC .... � � � ' � ~ N E ;,W `.��j ?�e.,� � . , �` � o o �, � S - .� do 0 . N _ � ` o ^ ` 2 ` � � ti � � � � Iron plcosd � N 15'47'37 E 211' . from 0.3' iron found 29.00 237.00 2" iron found • fo�d. �— N 87•43'36' 4/ 266.00 70TAL -'"-'———--——-----—-. � � � � AMY TaLBERT BAILEY � � / , . D.B. i 71 Pg. 121 / .. � f , j aEVI � . - 1 � ;. � � � ` a . �`:� ; � � TtJTl�ltOlf 3U�G CO]�ANY �� � ,,. .�;. . ;. 60 120 180 ' 127 :LIBERTY CHURCH ROAD . ' , " M�CKSVILLE, N.C� 27028 . I N FEET ; C 704) 492-56i 6 ;� , - <: - - . - T. .:; r '�1 , k i ' � � � . , , ,,' � DAVIE COUNTY HEALTH DEPARTMENT s�'�� . � Environmental Health Section sECTioN r e�' SoiUSite Evaluation APPLICANT'S NAME �lt�� DATE EVALUATED I-/.�'�7 PROPOSED FACILITY PROPERTY SIZE li1� SUBDIVISION ROAD NAME ��'.�� Water Supply: On-Site Well ''� Community Public Evaluation By: Auger Boring t� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition ,L L L Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �'1 �• �' ,� �� Texture rou � L' Consistence � ,. � Structure $� Ji:- ���C S� Mineralo ,' i ,' HORIZON III DEPTH Texture rou Consistence Structure i Mineralo HORIZON IV DEPTH Texture rou Consistence Structure " Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE .__. w SITE CLASSIFICATION: EVALUATION BY:��� LONG-TERM ACCEPTANCE RATE: . / 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineralogv 1:1,2:1,Mixed otes 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 ncrm�oi-9o> ■���■■���■■�■e■���■■■���■■�����■■■■�����■�����������■■■■����vw��■■ ■■�■■■��■■■�■�■■��■■��■�■■■����■■■■����■■■��■■��■s��■■■■���■����■■ 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