267 IJames Church Road Lot 4Davie Countv. NC Tax Parcel Renort Wednesdav- Decerrifier ?.R- 70 16
:2:) Z44
276 268
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IJAM 1JAML
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CFIURClq �D IJANIE� CHURCH RD
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r--- %. k 11-237 L225
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2 51'
287
�-295
7
�u
301 12257
0 243
279-
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All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or litness for a particular use. Ali 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
101 NC or arising out of the use or Inability to use the GIS data provided by this website.
WARNING: TIIIS IS NOT A SURVEY
Parcel 'Information
Parcel Number:
G3060B0004
Township:
Mocksville
NCPIN Number:
5820315189
Municipality:
Account Number:
8305692
Census Tract:
37059-806
Listed Owner 1:
EVANS MARY
Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1:
267 IJAMES CHURCH ROAD Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 4 FOREST BROOK
Fire Response District:
CENTER
Assessed Acreage:
0.77 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
10/2015
Middle School Zone:
NORTH DAVIE
Deed Book I Page:
010030851
Soil Types:
PcC2,CeB2
Plat Book:
0006
Flood Zone:
Plat Page:
137
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or litness for a particular use. Ali 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
101 NC or arising out of the use or Inability to use the GIS data provided by this website.
.fJ�°"�r �k3`�.,,� �`i3' �."i 7''`'i�, t ♦�.:1��" ^"y't.,.,
41 DAVIE OUNTY HEALTH DEPARTMENT t
�Ferm tee's ,
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMA'TiON
Ngg
ame: ' u4clSubdivision Name:
Directions to property:if`( f "It.
Section: Lot;
IMPROVEMENT
fA t �r' ! L' t c '� Gl !i4PERMIT. 1. T Off ce PIN:#< - 11 -
I Road Name t
**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'pernut.
M comphance,w�'Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
,i + ***NOTICE***THIS PERMIT.IS SUBJECT TO REVOCATION IF SITE
� 1. a ' PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER:
ENVIRONME14Tp JHEALTH SPECIALISE' DA ISS ED . SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING:TYPE} �c BEDROOM,S, BATH #OCCUPANTS ��GARBAGE DISPOSAL:Yes o
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE 1W x3-�!I'YPE WATER SUPPL J�1"1 DESIGN WASTEWATER.FLOW(GPD) low NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE�L GAL. PUMP TANK GAL: TRENCH WIDTH_ ROCK DEPTH LINEAR FT,
OTHER
REQUIRE \ .
D SITE,MODIFICATIONS/CONDITIONS: �t�STAU, ON w►`�1(1(,�c�' ,y- G
:�P• L t
IMPROVEMENT PERMIT LAYOUT
Nt�s tw�G,: .$AGS
S>z�
o v
S )v cPj
i;2 ry' `'a'
of
106
2�! - tot)'
r
**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 INSTALLATI,ON.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT,
SYSTEM INSTALLED BY:.:--
C4
Y:
y _
1—'
� tGlr
AUTHORIZATION NO. O OPERATION PERMIT BY: DATE: l !/�
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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 03/96(Revised)
APPI.IrAlrION FOR SHE 1EYAWA11ION/1111PROVENEW PERMFF & A I
Davie County Health Department
En Wivamental Health SftWon
P.O. Box 848/210 Hospital Street OCT -638
Mockaville, NC 27028
(336)751-8760 —rary I Dnm urm-YA109: A I T14
***ndOPCRrANrk** THIS APPLICATION CAMOT BE PROCESSED UNLEsS ALL THE REQUIRED
INFORIMTION IS PROVIDED. Refer to the IMPWATION BULLETIN for instructions.
eT
1. Name to be Billed AtAon
Contact Person voonar—
Hailing Address 14 QA L SA - Phone 757/ —0)
city/state/zip 1'1pcJcj u; 11-e 4jC,. =I -2W -OS- 7 3Y T-
1 Business Phone
2. Nam an Pe=It/ATC If Different than Above
Mailing Address
3. Applicatlon For: Ll Site Evaluation
11-*�
City/state/zip
1911�M�Zovewent Permit/ATC
4. System to Service: use 11 mobile Ho= a Business 0 industry 0 Other
5. If Residence: People Bedroom 3 # Bathrooms
6"61shlasher 0 Garbage Disposal 0"WashIng Machine 13 Basement/Plumbing 11 Basement/No PZU=blng
6. if Businesx/Industry/Other: Specify type # Peop'.ke 0 Sinks
I? # Urinals # Water Coolers
# Commodes a # Showers 2-
ir r=szRvxCz: # Seats Rativiated Water Usage (gallons per d!X,
7. T"m of water supply: g'&unty/city 11 Well . 11 Comminity
v. Do you anticipate additions or expansions of the facility this system Is intended to jerve? 0 Yes 0-ke
If yes, what type?
*"IMPORrANT"k CLIENTS JIUSTCOMPLEW THE REQUIRED PROPERTY INFORMATION R171QUEFrt1-)
BELA)W. Ellber a PLAT or SITE PLAN.41USTBESUBMIZTED byThe client wl1bTMSAPPLICA-T1ON.
I %' �1JOY-0,(O'7 �. JC)0'
Property Dimensions: 01 L,04, ViRMDIRECTIONS (frosw MocUAlle) #A PRC%PEY7,!'�
F evfi�)'
Tax Office PIN: N SE20 Z�0 A) o -A 4o
LN
PropertyAddress: Roadftme�z;�3' rJaw-c-
City/Zip co --7 C e— ct4l
If In a Subdivision provide information, as follows:
Name: F6"'ej+ 8,00L.
Section: Block: Lat: Z-/
."_J Z7T.�ei
Date Property Flaned: /(3 -6-9j,
This Is to certify that the information provided Is correct to the best of mi y knowledge. I understand That any permit(s)
ismed 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 orcbanged. I, also, unAffwandtkatIaw raponsiblefor all charges incurredfivm
this appUcation. 1. hereby, give consent to the Authorized Representative of the Davig Countl Health Department
to enter upon above described property located In Davie County and owned by M-M!� e I CL- K� 0 0t;2 -
to conduct all testing procedures as necessary to determine the site sul.- ... �J
Z
DATE RD - (0 t� SIGNATURE
THIS AREA MAY BE USED FOR DRAWERG YOUR SITE PLAN (Inc ode all 046vfollowing: Exisftg and,
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
Account No. 19VA
Invoice No. -9,07
**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 Fonrt/.Authorization Number should be presented to the Davie County Building Inspections
applying fAr Building Permits..
Office when
(In comptimP w th Artipik I I ofF.S. Chapter 130A, Wastewater Systems, Section . 1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
L
V IS VALID FOR A PERIOD OF FIVE YEARS.:.
4S 'A
ENVIRON ALT PECI
_U111 DATOSSUtD
�141
0
�AUIHORIZATION:NO:
DAVIEi
UNTY HEALTH DEPARTMENT
Environniental Health Section
PROPERTY INFORMATION
P ee s
P.O.. Box 848
Name:
Mocksville, NC 27028
Subdivision Name:
Directions to property: �MAI -1c C;
Phone # 336-751-8760
Se, ction: Lot: 4
AUTHORIZATION FOR
WASTEWATER
T PIN :#
SYSTEM CONSTRUCTION
�ffie
Road Name�� 94i.:
**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 Fonrt/.Authorization Number should be presented to the Davie County Building Inspections
applying fAr Building Permits..
Office when
(In comptimP w th Artipik I I ofF.S. Chapter 130A, Wastewater Systems, Section . 1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
L
V IS VALID FOR A PERIOD OF FIVE YEARS.:.
4S 'A
ENVIRON ALT PECI
_U111 DATOSSUtD
R-20
-04
(tie)
s 83* 48- 38' E
60.04 S 830 48' 38- E
2.3, 1 E
total)
RIR SMf t 197 74 07- E '32* 2"' 05
s 87 15.11 5 0
woo'
115,
C31
100.00 — q ---
49.9 totw 1 %0 2 r
E 77700.00,c> C%#
-S 63* 48' �Q —92.26 —7.74 %0
I C>1 100.00 — q — 11P
— 100.00 q 99.96—. In C> cw-m_a
50.000 to c%j coma
,a cm C%j 0 -7
W�i -- j C%j
—CIj . — — , — - I I J-- r
C\j
ts. rn
0.845 ALS. ,,
re)
co
100.00
N 82' 52' 13'
0.849 Acs. "'
=1
0.890 ACS.
108.79
CaVTROL
CWR
LU
6) j Le-
z
3r.
Lt-
, m
u d
RUTH 'AM* PAATI
I)j. 134 pr,. 692
t 2-
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zoned RA OnO
3r.
24 5
, v
CD
cn
1:
C>
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0
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0
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—
04
Lf)
n 80
k
00
1.113 Acs.
N
4D
110 q-
W)
to
0.859 Acs.
Acs.
0.851 —
L157
i
0.845 ALS. ,,
re)
co
100.00
N 82' 52' 13'
0.849 Acs. "'
=1
0.890 ACS.
108.79
CaVTROL
CWR
LU
z
u d
3S'
100.00
N 82' 52'13" W
F
0
345-20
FOREST B -R--
075'
ff
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS
Davie County Health Department
Environmental Health Section
17 V:�5
P. 0. Box 665
Mocksville, NC 27028
p 7
)AVIE COUN'TY
L
1. Application/Permit Requested By I -, �) t h ie t i
_' to C_ � S 0
Mailing Address OTL�L CA 6 M)
Home Phone CI. 1-1 1) 1)- q Business Phone
2. Name on Permit If Different than Above
3. ApplicationlPermit for: V I I General Evaluation
4. System to Serve: House 0 Mobile Home
\R . Fo P, (��t
0 Business 0 Indus" 0 Oth r
5. If house, mobile home: Subdivision w3
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions
6. If business, Industry, place of public assembly, other: Specify type
No. of People.Served
No. of Commodes
No. of Sinks -
No. of Urinals
C' -� 16, �_ r
0 Septic Tank Installatioi
El Place of Public Assembly
El Unknown
Section Lot # Ll
El BasementlPlumbing
0 Basement/No Plumbing
0 Washing Machine
0 Dishwasher
0 Garbage Disposal
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: Public 0 Private
6. Property Dimensions -Sewage Disposal Contractor
9. Do you anticipate additions/expapsion of the facility this sytern is Intended to serve? 0 Yes
if woo whnf ivn07
0 No
*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:
IV 01 r
(X- V�
C C
V C � e C�
lJo a
I -- I' N i' r. 1 )" r-�Y-
Y * .6
ct
U
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
I urred from this application.
DAtE e1i SIGNATURE
CONSEN FOR SITE RVAIJUATION TO BE DONE ON ABOVE PJESCRIBEQ PQOPERTY
MUST CHECK ONE: 0 1. 1 Q�AL
N the property. V2. I pQ NQT QWb! the property.
If you checked Box #2, the rest of tills form MUST be completed by the owner or a person authorized by the owner:
m
1(
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 k<� 1r, V) . r) A
to conduct all testing procedures as necessary to determine said site'A suitability for a ground absorption sewage treatment
and disposal system.
SIGNATURE
DOID (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME DATE EVALUATED
/ C)
ADDRESS PROPERTY SIZE C' 0
PROPOSED FACIILTY LOCATION OF SITE Q,
Water Supply:
On -Site Well
community
Public t__1
Evaluation By:
AugerBoring
Pit L/
Cut
FACTORS
1
1 2 3 4 7
Landscape position
-5
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
FT___
P-1
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
-:9.5
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
EVALUATED BY: VL%�4�
OTHER(S) PRESENT:
L
LEGEND
Landscape Position
R -Ridge S7Shoulder 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 Aay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vtry friable FR -Friable FI -Firm VFI-Very firm EFI-Extrernely 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-Anitular 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
mmom
MEMO