142 Son Shine WayDavie Countv, NC Tax Parcel Report b b � Mondav, October 3, 201 E
Plat Book: 0009 Flood Zone:
Plat Page: 258 Watershed Overlay: DAVIE COUNTY
Building Value: 47390.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 23570.00 Total Market Value: 70960.00
Total Assessed Value: 70960.00
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9 inrs F
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WARNING:
THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
G50000004801
Township:
Mocksville
NCPIN Number:
5840427966
Municipality:
Account Number:
8304219
Census Tract:
37059-806
Listed Owner 1:
SHORT RICHARD C
Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1:
142 SON SHINE WAY
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
TRACT 1 2.556AC SMITH S/D
Fire Response District:
SMITH GROVE, MOCKSVILLE
Assessed Acreage:
2.54
Elementary School Zone:
MOCKSVILLE
Deed Date:
10/2014
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
009700783
Soil Types: WeC,RnD,ChA,WATER
Plat Book: 0009 Flood Zone:
Plat Page: 258 Watershed Overlay: DAVIE COUNTY
Building Value: 47390.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 23570.00 Total Market Value: 70960.00
Total Assessed Value: 70960.00
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9 inrs F
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Davie County,
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All data is provided as Is without warranty or guarantee of any kind either expressed or implied Including but not limited to the
Im lied warranties of merchantability or fitness for articular use. All users of Davie County's
p ty p 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
or arising out of the use or Inability to use the GIS data provided by this website.
Davie County Health Department 7
Environmental Health Section
P.O. Box 848
210 Hospital Street
Courier # : 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 6780 Fax: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: �i?—, L-0 -S4 a r --f-- Phone Number T D� b Tod --q (Home)
Mailing Address: 144,�- S6),) SS, ^jz &)a (Work)
tTJC-5t 1 V e N L- J- %bya- Email Address: �S'%a - /b 14 60G/M
Detailed Directions To Site: 46 Sam If. CJG N
-01
Property Address:�49 9 b a v t
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: /C , c,.ktj
< r Sk t C -t'- Type Of Facility: t" -P 14 a M
Date System Installed (Month/Date/Year): 144511"Number Of Bedrooms:^3 Number Of People:
Is The Facility Currently Vacant? Yes &
Any Known Problems? Yes 0 If Yes,
If Yes, For How Long?
Please Fill In The Following Information About The NEW Facility:
Number Of Bedrooms: O Number of People
Type Of Facility: ^�-6 «. �-�,
Pool Size:Gara a Size:, [���(� D Other:
Requested By: _ Date Requested:
( ignature
For Environmental Health Office Use Only
ApprovedJ Disapproved
i) \ /
A „ i i /
-EP
i
Environmental Health Specialist
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order
Paid By:_
Account #:
Amount:$
Received By:_
Invoice #:
WV+ --..
(E ppU��
s Printed:Oct 14, 2015
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the 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 or arising out of the use or
inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT v//Yrr
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**NOTE** This improyement 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)
NAME PROPERTY ADDRESS (� 7d�
DATE I :� -1-55
LOCATION 1 s) y E
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE o v S # BEDROOMS _::� # BATHS D� # OCCUPANTS GARBAGE DISPOSAL: Yes No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No_
LOT SIZEa TYPE WATER SUPPLY ` 'DESIGN FLOW (GPD) ��� NEW SITE. REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIIE QV GAL. PUMP TAME{ SAL. TRENCH`WIDTH �} ROCK DEPTH �LINEAR FT.�
OTHER
REQUIRED 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.
F
14 00s'2
"\ Go'
da
a` IMPROVEMENT PERMIT BY
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPAR OR FINAL INSPECTION THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-87E8.
OPERATION PERMIT . SYSTEM INSTALLED BY
� d
Al. h 0 �e
F
AUTHORIZATION NO. OO $r> OPERATION PERMIT BY C. a-zna. DATE a`1� 9 b
**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
Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
r„ P.D. Box 665
Mocksville, N.C. 27L
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
_ (Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems) r b,
***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.***
}� AUTHORIZATION NUMBER
NAME A \'.1� S rn. ` h DATE
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION i S 2 )
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
a t "
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE
DCHD 10/95"
�e�~ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE ��IEIN
nAV 1 Davie County Health Department
Environmental Health Section I�
P. O. Box 665 NOV
Mocksville, NC 27028
yj
1. Applicatetmit Requested By
Mailing Address u 2S I +Wt Home Phone�/ -
# YN a Ck/S 0 r// C-, A C, -`Z,i Business Phone3 O
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve:
❑ Business
0 General Evaluation Aseptic Tank Installation Permit
House ❑ Mobile Home ❑ Place of Public Assembly
❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms 3
No. of Bathrooms
Dwelling Dimensions
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes _
No. of Lavatories _
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: Public ❑ Private
8. Property Dimensions / `7. 73 cuSewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Unknown
Section Lot #
❑ Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ No
PROPERTY INFOFI-IATION REQUIRED:
❑ Community
Directions to Property: Tax Of f ice PIAT ;k5g-Lin —1 G 6
�oe<r - Road Name L10j'Y /je
�� Box #(if available) a ��
City
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: I-
I OWN the property. El2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this f m MUST be completed by the owner or a person authorized by.the owner:
I hereby give consent to the authorized representa ' of the av' County ealth Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to de said site's suitability for a ground absorption sewage treatment
and dis poral ystem.
//
Lea—
bATE SIGNATURE
DCHD (1/93)
_ DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation p{�
NAME \ " ' �l `� (E`M� DATE EVALUATED
ADDRESS _ �A �� PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITES p
Water Supply: On -Site Well _ Communit
Public
Evaluation By: Auger Boring V Pit V Cut
FACTORS
1 1
2
3
4
Landscape position
r
Sloe R
15
- b
- `d
HORIZON I DEPTH
'
is"
''
u
Texture group
L
C L
L
t.
Consistence
)L
' 1
Structure
Z
C
Mineralogy
HORIZON II DEPTH
5�
b''
'6
Texture group
C
C.
Consistence
F1
Structure
Mineralogy)�
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
S
RESTRICTIVE HORIZON
—
---
SAPROLITE
Z
CLASSIFICATION
1SLONG-TERM
ACCEPTANCE RATEt
SITE CLASSIFICATION: _ 1 EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:_ �UGN
REMARKS: & \ •\ S C. � C_\Z-q%, �. 1�1
L GEN
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 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
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
DCHD(01-901
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