151 Sam Cope RdDavie County, NC
Tax Parcel Report b 3 t� Thursday, October 6, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WARNING: THIS IS NOT A SURVEY
Parcel Information
G8130B0007 Township: Shady Grove
5789379758 Municipality:
82530914 Census Tract: 37059-804
NELSON SEAN C Voting Precinct: EAST SHADY GROVE
151 SAM COPE ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
Land Value:
Total Assessed Value:
NC
Zoning Overlay:
27006-0000
Voluntary Ag. District:
0.6887AC LT 1 SAM COPE RD
Fire Response District:
0.68
Elementary School Zone:
10/2000
Middle School Zone:
2000E0249
Soil Types:
0009
Flood Zone:
352
Watershed Overlay:
105380.00
Outbuilding & Extra
Freatures Value:
19740.00
Total Market Value:
125120.00
ADVANCE
SHADY GROVE
WILLIAM ELLIS
PcB2,PcC2
DAVIE COUNTY
125120.00
No
0.00
9hel«�E,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
C+p C,N�i NC or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**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 B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME XZ14 e PROPERTY ADDRESS �� m C8— e d - ` A DATE
LOCATION
v
SUBDIVISION NAME LOT NUMBER
SEC./BLOCK NUMBER
vX0
RESIDENTAL SPECIFICATION: BUILDING TYPE 114"1 jr,- # BEDROOMS ,� # BATHS -:2 # OCCUPANTS __!�/ GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE s` TYPE WATER SItY-(ice// DESIGN WASTEWATER FLOW )GPD) �G NEW SITE -'� REPAIR SITE
441' 119 00
SYSTEM SPECIFICATIONS: TANK SIZE c GAL. PUMP TAW GAL. TRENCH WIDTH I,z ROCK DEPTH ''' LINEAR FT. j!
OTHER C 8 - fy - 5L
REI)IIfED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY
**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.`a TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BYsL3c= osc�•
M
AUTHORIZATION NO.
(; 0s P
4--u a )J
OPERATION PERMIT BY DATE % ' I I A
**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 10/95
ti'4# Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
P.O. Box 665
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
issuance of any Building Permits. This Fore/Authorization Number should be presented to the Davie County Building Inspections
Office when a lying for Building Permits.***
NAME � P DATE b �AUT}ORIZAT O NUDBER
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION -dT e i ��, 1e -,5K111
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
*HNOTICE*** THIS AUTHORIZATION FOR WqSTEWATER SYSTEM CONSTRUCTION IS VVIDF A ERIOD OF FIVE (5) YEARS.
ENVIRONMENTAL HEALL CIALIST DATE
DCHD 10/95
1. Application/Permit
Mailing Address
;APP ATION FOR SITE EVALUATION/IMPROVEMENTS PI
Davie County Health Department
Il Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
2. Name on Permit if Different than Above
Home Phone 9 / F � / 7—
Al, Business
,I,bW - Ne
3. Application for: ❑ General Evaluation Septic Tank Installation Permit
4. System to Serve: [�' bu' se mckta(Ii�nMobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other Th Unknown
IhLAT3 RL
5. If house, mobile home: Subdivision" 13. Section Lot # f C)
No. of People
No. of Bedrooms
No. of Bathrooms !21= Tom►)
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
7. Type of water supply: ❑ Public
8. Property Dimensions
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usa-Figures
Private
❑ Basement/Plumbing
❑ Basement/No Plumbing
ashing Machine
ishwasher
❑ Garbage Disposal
Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
If yes, what type?
❑ Community
"o
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:�7 .09 %7
9.0 /(%,, e = �o m Cote F(f
City / 4dlak �
ea' v - O
This is to certify that the information provided is correct to the best o my knowledge, and I understand I am responsible for all charges
incurred fro this application
s- Z � �
SIGNAVRE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposals stem.
�!?-6
DATE SIGNATURE
DCHD (1/93)
T�`
14
70� 4E
oc
t
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY __T ��s-� LOCATION OF SITE JrJ✓�_ C ���i ��
Water Supply: On -Site Well �� _ Community Public_
Evaluation By: Auger Boring v Pit Cut
FACTORS
1 2 3 4
Landscape position
L L
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
-�
Texture group
Consistence
Structure
_5�/ .
Mineralogyi'/
•/
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: ///
t�
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
EVALUATED BY: /`Va 11
OTHER(S) PRESENT:
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
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 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
3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
MinernloEfy
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
■�������������������������������������� ������� �������� ve�����
■�����������_�������■�N�����������■���� �_�����■ ����������������
iiiiiiiiiiiiiiii�iiuiiiii�iiiiii�iiiiii�� ��i�iii ii�iiiii�ii�°iii
ii�iiiiiii�iiii�iiii�iiiiiiiiiiiiiiiii�i��iiii�i��=����������■�����
■���u■������� ����
��������������������������u��������_�����n=�=�������������������
■����H���������/������������������������������■���������������
■��/����������������������������i�■ ���
■���/������\�����/����������/��\���� �����/���������v�u������
■����������������������������//� . N��■��� �������
/�����������/�����������������/��u������� ■ �����u�������
:::::::::::::::::::::::::::�:::::::�:: �:::_� �:_ ::::a::::::::
■����������■�����������������/��������� �� ��� ■ ����N �v�����
:::::�:::::::......................... �..� =..��C.■.�■.
........... ............ . .. .... ..
■������������■������������_����������n���������� �u����n���u��
■�������������������������������������������/�/��q����/��������
�����������■�■��������/�������� ■��H■ N �■/� ����■����/�����
■����\�����■������������������/��������� ��� � ��NN�������
■��������������������������������■������ �����������������u����
■��l��������u�■���������������� ��� �N�� ���� ����� ■ �����/�
:C::a:::::C:::::::::":C::::::::_.�.....0 ... ....C::�...�
.................... � .....■.■.'�::�:C.. 'CS C�C
..................... .......
��������/��������������h�������������N���NW�������/������
��������A���������U��n�������� ���N� ■ \�n��������� ��
�������� ������ �����N������������/������N� �� �����/�u�
...............�........................�.�.... . _.._�.�...�
...s........... ........................ . ... . ... . ...
.....................................�. ....�� . ... .....
................................... .�..... �. .�C......
�����N������n��������������v����■�� n__H�� ■ �■ � ������
■���������■��� �����������fi, ���� �u� ■ ��������
■�H������������ ���������\����t��■� ���u� �� �������
����v���aH�������������tHW���H�n����C �������
���� ���������n�����uu�������.�u� ��a�m ■ �������_
■�������������uu��■�����■�Uu ■ ��� �����
■���a����������� ■ ���� �� n��
������u��������i��i=�����ii� ■ ■ ���_����
�������u�� ��������NO���//� ��� �� �� ������
/�����/��� ������� N����i��..�.... ������ .
fli������ �/���� �v�u ■�' N ������
�������n� ����u�� I �����.�■� � �� �������
.....u..."' ........u.��...s�.. . C ... ' � ::::::::
............ ...........��... ....
................ .. � .. . . . u... .
................s="�:"�'��:�� . �.�.�:
C::::::C:........:�..��....._ _.....��
...■■.■■■■..■■■■■■......■`i::... ......�:�::.■
�������������������u�u� �u�
��������� ■ iu���� �u ■ �� u�
��■���������v�uNu���u��� H���� �
����������/������Uu�� ��� ■ N ■ n�����
������u�u���u�N�/���� �u ■ ������
■������������ ■ �� ��� u ��U�
��■������ �A
�������������q������� � ����%�
..._... ... ..�.'.:C=:.. ::
iiiiiii �� �iii�un���uiu�� ■ �na�
���������������������������nu��i �� ■ u
���������N����������������� p h.��
�����/�A��n�������u� �� �� ■
����v��������������������■���� ■ �����
������������■�����u��■��/�/� �O�O���
�������������,�����q�N��u��u ����0�
..... CC...... ...... ..... .. ::. .�' .....
..... ■...�..�......C.....�.. . .........:......
...... .�. ... .�............ .. _. . ...............�
���� �� �������� �/���v��� �� ����� ���v�a/■��0��
���������■�����N������������v�� ��� ���� �������v���/�
■����������H����v������/���v����/�� ������■�■���u��N������
���������� ����w��� ����■n�����■�� ����������������iu����
�����o�/����������������������u//�/��p������������u���nv�����
����� �������������u���������������N���N�W��v���n�������
.....0.................................. .........................
.... ...................... ..........�......................._.
..�...........................�.... ....................... .
.............................. ...... .. .... .................
..... .............................. ._. .C.................