177 Vanzant RdDavie County, NC , f Tax Parcel Report Tuesday, October 11, 2016
WAKIVINCT: "1'H15151VU'1' A SUl�V1:Y
Parcel Information
Parcel Number: H2O000004301 Township: Calahaln
NCPIN Number: 5719124312 Municipality:
Account Number: 82517424 Census Tract: 37059-801
Listed Owner 1: POTTS LAWRENCE WESLEY Voting Precinct: NORTH CALAHALN
Mailing Address 1: 177 VANZANT ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE
State:
Zoning Class: DAVIE COUNTY R-A,R-20,H-B-S
NC Zoning Overlay:
2ip Code: 27028-0000 Voluntary Ag. District: No
Legal Description: 12.72 AC VANZANT RD Fire Response District: CENTER
Assessed Acreage: 12.22 Elementary Schoot Zone: WILLIAM R DAVIE
Deed Date: 8/2001 Middle School Zone: NORTH DAVIE
Deed Book / Page: 003850334 Soil Types: PaD,PcC2,ChA,CeB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 141450.00 Outbuilding 8� Extra 0.00
Freatures Value:
Land Value: 80960.00 Total Market Value: 222410.00
Total Assessed Value: 161240.00
9"�'�' Davie County,
`'��N�� NC
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`, ' IM�ROVEMENTS PERMIT AND CERTIFICA7E OF COMPLETIdN
_ *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
" �-�� � Sanitary Sewage Systems ���. —�-�- � <-- _ �y, . f �, Permit u[fiber
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Name �` Date NO
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Location '
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Subdivision Name ��� � � Lot No, Sea or Block Na
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Lot Size 4 '• House Mobile Home _�,. Business __ Speculation
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No. Bedrooms .No. 8aths `— _ No. In Family _.
Garbage Disposal YES Q NO �j
� Specitications;for�Sy,sfe�; ~ ��- C�'; c.�;.
Auto Dish Washer ,. YES [� NO Q - `� ' ^
Auto Wash Ma :hine Y S NO � � v u ��� y� �? �� ���-��-'�
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Type Water Supply ___
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if slte plans or the intended use change.
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Improvements permit by ._�. _
'Contact a representative of the Davie County Health Department for final inspection ot this system between 8:30•
9;30 A.M, or 1;00-1;30 P,M, on day of completion. Telephone Number 704-634-5985,
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Finai Installetinn Diagram; System Installed by''�� �r'=%.C`%..�:.�.? -�° ��r�1 • r�,�. �
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Certificate of Completion �,.�—. � Date �' � ��'� ' `-` "'
'The signing of this certificate shall �ndicate that the system described above has been installed in compliance with
the standards set forth in the above regu�ation, but shall in NO way be taken as a guarantee that the system will tunction
satisiectorily for any given period of time,
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� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT �/-�- 9�'
Davie County Health Department
. Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requ
2. Address �
3. Property Ow
Address —
4. Permit To: a) Install � Alter Repair
b) Privy Conventional � Other Type
Ground Absorption
c) Sub-Division ---- Sec. Lot No.
5. System used to serve what type facility: House M�ome Business
Industry Other
b) Number of people ��
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensi ns � --� X �
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Bed Rooms� Bath Rooms�— Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc. `'"—
Estimate amount of waste daily (24 hou
7. Number and type of water-using fixtures:
commodes
uri
lavatory � � showers -.3
dishwasher � sinks �
8. a) Type water supply: Public Private �/ Community
b) Has the water supply system been approved? Yes No�
9. a) Property Dimensions 1/ ,� � a' {�_ �
b) Land area designated to building site
c) Sewage Disposal Contractor "—
garbage disposal
washing machine
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10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type? 11--n
This is to certify that the information is correct to the best of my knowledge.
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Date Owner Signature �
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD (6-82)
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Heaith Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
V/� �I ��� I n (office use only)
JJ
� no 1. I am the owr�er of thE above described property.
yes no 2. I am not the owner of the above described property, however, I certify that I
have consent from
, owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. I hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above describe� property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system. (
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DATE S NATURE
4. I hereby authorize the Davie County Health epartment to release site
evaluation results from the above described property to the following:
Owner only
�Owners designated representative
_ Anyone requesting results
— Only those listed below
—�%
DATE
DCHD (11 /84�
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ATURE
Name—
Address
1) Topography/Landscape Position
2) Soil Textuce..�2-36 in.) Sandy,
Loarrly, Clayey; (note 2:1 Ciay)
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3) Soil Structure (12-36 in.)
Clayey Soils
4) Soil Depth (inches)
5) Soil Drainage: Internal
External
6) Restrictive Horizons
7) Available Space
8) Other (Specify)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
AREA 1
S
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U
_S
U
��P`�S
U
P, S
U
-�_
S
PS
U
S
PS
i--� U
AREA 2
\r" 1
U
�� :
U
�S i
U
,P
U
Cpg
U
G�S
U
,�
PS
U
S
PS
Date � �� g /
Lot Size�_� �
S
US
S
US
S
PS
U
S
PS
U
S
PS
U
S
US
S
PS
U
S
PS
U
AREA 4
S
US
S
PS
U
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
9) Site Classification I�,��\ I �J � I I
U—UNSUITABLE S—SUITABLE PS,� Provisional{y Suitable
Recommendations/Comments:
Described by �-- Title •��-�-� Date �� � I
SITE DIAGRAM
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� , . " . ' DAVIE COUNTY HEALTH DEPARTMENT �
'. �' , IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
, �
"NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rule (10 NCAC 10A .1934-.1968) Permit Number
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Name �; t� "_a ,.� .� �<, - e�.? �)�-��.�,�, �, � � ` Date cf _ _ _. �:� � � - ., . i..
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Location ;' '' t- �� � ; ,,� � � i �.�,ti, �� r:, �_ `�:� � e `� � —
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Subdivision Name Lot No. _ Sec. or Block No.
Lot Size ��-��� House !� Mobile Home _ Business __ Speculation
No. Bedrooms `_ No. Baths _"� No. in Family k? _.
Garbage Disposai YES ❑ NO 1]' Specifications for System:
Auto Dish Washer YES p NO �j - ?•
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Auto Wash Machine YES Q� NO 0 -_ �
Type Water Supply '� � � - --- .__ '.. � _ '� i .
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements 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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion _ Date __
"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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�� , ' � ' DAVIE COUNTY HEALTH DEPARTMEI�T
•. ' � � • Environmental Health Section
Soil/Site Evaluation
NAME "�` �`''���� �0�.� DATE EVALUATED � r � f��
ADDRESS 5�� 4 PROPERTY SIZE I 1 OvC�9.�
PROPOSED FACIILTY � 6�`�- LOCATION OF SdTE v�'�h o � � c��
Water Supply: On-Site Well ►� Community
Evaluation By � �'LAugerB�ring ✓ Pit
Public
Cut
FACTORS 1 2 3 4
Landscape position S S S J.S'_ � _ � � �
Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture qroup
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
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SITE CLASSIFICATION: _ Q . � EVALUATED BY: \ �5��., � ��_
LDNG-TERM ACC�EPT�ANCE RATE: �� OTHER(S) PRESENT:
REMARKS: �\�s.�- ���,. 5�.��R ` � `•� - �� ��c.,.7�. ��v'S� _�,..�
� �LEGEND
Landscr�pe 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
Moiat
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightiy sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plarstic
Structurc
SC-SYngle grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
A�Iineralot�y
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 - tnches from land surface to free wate�' or inches from land surface to soii colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ftz
DCHD(01-901