413-415 Potts Rd Davie County,NC Tax Parcel Report Tuesday,November 8, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: F8000001.1101 Township: Shady Grove
NCPIN Number: 5880175735 Municipality:
Account Number: 82512946 Census Tract: 37059-803
Listed Owner 1, -OSCAR JUDITH S : . Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 413 NORTHEAST POTTS ROAD Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A
State: - NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: 6.77 AC POTTS RD Fire Response District: ADVANCE
Assessed Acreage: 6.61 Elementary School Zone: SHADY GROVE
Deed Date: 7/1999 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 003080015 Soil Types: PaD,PcB2,PcC2,WATER
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 130200.00 Outbuilding&Extra 19090.00
Freatures Value:
Land Value: 80290.00 Total Market Value: 229580.00
Total Assessed Value: 229580.00
161 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
NCor arising out of the use or inability to use the GIS data provided by this website.
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AUTHORfZiATION NO: 0597 ' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittees,,,, rr }� "/" P.O.Box 848
Name: 6��� r .td -rG�/ti'r' Mocksville;NC 7028 2 Subdivision Name:
�j Phone#:704-634-8760
Directions to Property: Section: Lot:
,� AUTHORIZATION FOR p r
WASTEWATER H�Gt� j q�
Tax Office PINp#
SYSTEM CONSTRUCTION
Road Name:. f O 71 I�CL•Zip: d�W
**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.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
• �/�. � �,y ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS. ,
ENVIRONMENTAL HEALTH SPECIALIST
DATE ISSUED
� yM-�`„y gw.,.{,.y^>ri"' y� ag..i'r. .r iYh `4. �,,,`y "'t. . ,>,..f:y..-, .�,: M ,'i_ ¢ y '•tr•�,r ,,j.:Fy,.:r.. �, , ... t tf,.., i1 _...kk�..Y x...:- -,�'� e^.�T
14L - - , N DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name: ;�xlr' .lr":w ` r :, Subdivision Name:
Directions to property: Section: Lot:
IMPROVEMENTTax Office PIN:# t�4 �
f
PERMIT .,t q 1�
f Road Name: PC KI,Zip: 4 76,0
**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 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
"+i�r` ,;t Jt..•. ��. f� r ;f ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS_ s' #BATHS_ #OCCUPANTS_;LL GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZEVie— TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD)—.--?/, J NEW SITE �` REPAIR SITE'
SYSTEM SPECIFICATIONS:WANK SIZEZUi9O GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH,� LINEAR Fr.yoi
:OTHER
,< REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
E7_
, fi .t
"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:
F
00( ' V4 N
AUTHORIZATION N0.6 l� OPERATION PERMIT BY: DATE: 1 1
"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 05/96(Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
Davie County Health Department
Environmental Health Section NOV 18 im
P.O.Box 848 ti I
Mocksville,NC 27028
�mEUILTH(704)634-8760 DAVIOM
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL THE,,R77EQUI`RED INFORMATION IS PROVIDED.
1. Name to be Billed fid '` yvh��h /�D� I Contact Person
Mailing Address 4rAe S /�d. L4'f /� Home Phone 11O. /ZQ
� ,,,6 T_
City/State/Zip Gy, lil„�7'n n S�lC i,1 �f •C- c� 7�d Business Phone Ile-
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: Ur Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: ❑ House t. Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People L_ # Bedrooms 3 # Bathrooms
Dishwasher ❑ Garbage Disposal dWashing Machine UrBasement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage(gallonsper day)
7. Type of water supply: ❑ County/City O Well ❑ Community
8. Do you anticipate additionsor expansions of the facility this system is intended to serve?
J Yes ❑ No
/�
If yes,what type? �� �U�I� 3 �d rry �+ f 3 �ju�l✓yor► 1 P66e- /�'/l► / GfSe—M e°2 t
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: ��fG 1 WRITE DIRECTIONS(from
S� D - ,,.r -
� D I Mocksville)TO PROPERTY:
Tax Office PIN: # K Q ,�, I iv't go/ A tIol'�
Property Address: Road Name / ��� '(�/`v 1 // �)
1 e � 7 /►'1/l�iS uSC 1.7d
City/Zip 17C,&
1
tUAn �e7f04 AlS �d
If in Subdivision provide information,as follows: 1 �
fs'0 e k t 4 o-Z
Name:
Section: Lot #: 1
I
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.I,also,understand that I am responsible for all charges incurred from this application.I,hereby,give consent to
the Authorized Representatiivvee of the Davie County Health Department to enter upon above described property located in Davie County
and owned by /7 h ��h els to conduct all testing procedures
as necessary to determine the site suitability.
DATE I, -X0 SIGNATURE
Revised DCHD(06-96)
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' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation `
NAME DATE EVALUATED
ADDRESS / PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On-Site Well Lam_ Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH �-
Texture group e4L'..-
Consistence r v
Structure /1 S s
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: EVALUATED BY:
LANG-TERM ACCEPTANCE RATE: _ '13 OTHERS) 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 ;lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-V+:.-y friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely fine
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
3C-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
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