339 IJames Church Road Lot 13I
Davie County, NC
Tax Parcel Rennrt
Wednesday, December 28, 2016
WARNUN T: TMS IS Nt)'1' A SURVEY
Parcel Information
Parcel Number: G3060B0013 Township: Mocksville
NCPIN Number: 5820216228 Municipality:
Account Number: 82512961 Census Tract: 37059-806
Listed Owner 1: MAXIE MICHAEL Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 339 IJAMES CHURCH ROAD Planning Jurisdiction: Davie County
City• MOCKSVILLE Zoning Class: DAVIE COUNTY R -A
CENTER
WILLIAM R DAVIE
NORTH DAVIE
PcC2,CeB2
DAVIE COUNTY
Is
E01All 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 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 ail claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
State:
NC
Zoning Overlay:
Zip Code:
270284823
Voluntary Ag. District:
Legal Description:
LOT 13 FOREST BROOK
Fire Response District:
Assessed Acreage:
0.80
Elementary School Zone:
Deed Date:
8/1999
Middle School Zone:
Deed Book / Page:
003100647
Soil Types:
Plat Book:
0006
Flood Zone:
Plat Page:
137
Watershed Overlay:
Outbuilding 8r Extra
Building Value:
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
CENTER
WILLIAM R DAVIE
NORTH DAVIE
PcC2,CeB2
DAVIE COUNTY
Is
E01All 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 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 ail claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
59 1A
AUTHORIZATION NO: DAVIE COUNTY HEALTH DEPARTMENT
(^ ��� Environmental Health'Section PROPER 4NFORMgTION'
Permittee's P.O. Box 848
Name: Mocksville, NC 27028 Subdivision Name:
12S' Phone # 336-751-8760
DNretions o ropertt �V . AUTHORIZATION FOR Section:
... ,, . WASTEWATER
SYSTEM CONSTRUCTION Tax PI111- t,
Road Name: Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by 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 apply' g for Building Permits:
(In comp fan apply*
1 of G.S. Chapter 130 W tewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
,. ENVIRON NTAL HEALTH SP IST DATE ISSUED
60
A DAVIE COUNTY HEALTH DEPARTMENT
k - IMPROV ENT AND OPERATION PERMITS PROPERTY INFORMATION
�Permittee`s� � �� � •
hh1
lame: { 1'�` .t U�.l. Y 1 Subdivision Name
Directions to property: (I� rj - Section: Lot:
IMPROVEMENT PERMIT �i " .G L , f / •^
1'T (�.4 rL t_:L(� :� Tax Office PIN:#`
Road Name:—b, vUZip
**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 110 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
`,.-• y;' '°"""'--;� .***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
raw 1 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
. ki
ENVIRON ENTAL EALTH SPECIALIST DATIOSSAD SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE t-Lj�t # BEDROOMS_ # BATHS,< # OCCUPANTS GARBAGE DISPOSAL: Yes o(5-to-\'
COMMERCIIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
FI
LOT SIZE A� �' kPE WATER SUPPLY'dk>'' / y DESIGNYWASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
/t �1 t
SYSTEM SPECIFICATIONS: TANK SIZE 1�AL. PUMP TANK GAL. TRENCH WIDTH >�_ ROCK DEPTH 2 LINEAR FT.5
OTHER�TQr.Ii0TiOr-
REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 `V LL ON ) 6 red, L"Ns, �+Y
IMPROVEMENT PFUrrLAYOUT *AppROVED EFFLUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE*
4 ► -3 �/ yam'
41 Ste' '7ov5gO1 10
`
Nj ( /� 11
tA CIS'
zo'
**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 (%4 X0* MX
(336)751-8760
OPERATION PERMIT SYSTEM INSTALLED BY:
14
3f
TL -j
1.-9 gel:"
& codec
AUTHORIZATION NO. t � OPERATION PERMIT BY: DATE: t0
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT HE S M DESCR BE�VESBEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900"SEWAGE TREATME AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
,APPUCAMON FOR SITE EHAUJAMON/IMPROVEMENT PERMIT I A1101
r Davie County Health Depatfinent O
CAU- , Environmentallfealtfl SeWon
P.O. Box 848/210 Hospital Street uA
Mockaville, HC 27028 MAY 2 0 1999
(336) 751-8760
***ZHFORTANr*** THIS APPLICATION CZM'tOr BE PROCESSED UNLESS XI,L THE tannin- 1
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Same to be Billed fi)1c14&-Ly' CsrWW-f�1RAy�Contaet Person (,&z,--; n o,-,-
Nailing
2 LnyprV�
Nailing Address 9CC .rS0 7 - /�J 1D* ,6; N%CD Name Phone 4: o 9 /�-6 ! l S
City/State/ZIP c� 1 H' ✓-Z G ' �AL�'. Zg snusiness Phone �O! - W a6 -O s /7 �%S
Z. Name on Permit/ATC if Different than Above
Nailing Address
S. Application For: Ws"ite Evaluation
City/State/Lip
Improvement Permit/ATC
moth
a. system to service: W House 0 Mobile Home ❑ Business 0 Industry ❑ Other
S. If Residence: # People 0 # Bedrooms # Bathrooms I/a2
Dishwasher O garbage Disposal 8/washing Machine O Basement/Plumbing O Basement/No Plumbing
6. If Business/Industry/other: Specify type
# People # Sinks
# Commodes # Shovers # Urinals # Water Coolers
IF rOODSERVICE: li Seats Estimated Water Usage (gallons per day)
7. Type of water supply: iy County/City 0 Well ❑ Commaunity
e. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes Clio
If yes, what type'
*"IMPORTANT•" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: , .q_��. 60029,0015 .WRITEDIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: # 5 0 dQ -- C — " &0/ N
Property Address: Road Name 3 3 9es Cd 1'c- la'
ra / e 77 b n I J'Qme-S
City/Zipmac 5VWE 27�8 CaU01-tic E0 0d
If in a Subdivision provide information, as follows:
Name: f�nR -P—e,+ A rook
Section: Block: Lot: Date Property Flagged: �) /
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 irrarrred from
this application. 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 the site suitabi ity.
C, e
DATE S ZD r SIGNATURE
THIS AREA MAY BE USED FOR DRAWERG YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/98)
Account No.
Invoice No. ��2
ennett, et al
) PG 792
LEGEND
Pipe
ae
�ipe
ary
1
r,
Center Line
— Center Line
EP— Edge of Pavement
FC — Face of Curb
PP — Power Pole
ht Pole
H n Hole
— Radius
U— Chord Distance
0 — Part of
— Sight Easement
DB — Deed Book
PB — Plat Book
CB — Catch Basin
FP — �ence Post
14
FOREST BROOK
12
FOREST BROOK
PB 6 PG 137
P: Point in Cl +/- of SR 1307
Tie Line
N 09018'00"E
25.07'
Ijames Church SR 1307
Road � o
Vicinity Map (Not to Scale)
Survey for:
Michael L. Maxie
and Xife
Linda J. Maxie
Lot 13
FOREST BROOK
Plat Book 6 0 Page 137
0.861 Acres +/- by coordinate computation
SCALE TOWNSHIP
er Lie I declare that on ,
19 � DATE
BoC -�ack o� Curb � - 1 � COUNTY STATE
we surveyed the property shown on 1" = 60' Colahaln Davie North Carolina 5-11-99
so 120 iso this plate
SUR,,, Stone Land Surveying Company ,toe No.
MT.BL _
G S6799
George Robert Stone, PLS L 3162
MAPPED: 113 Drum Lane Phone (336) 998-4733 MAP N0.
FEETMAPPED:
Mocksville, N.C. 27028 56799 I
am
.. r � ^. �M;l� ��
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS lPt-���i
�'�" • Davie County Health Department > '
Environmental Health Section
P. O. Box 665 ! I 10 i 7 101), � J
�,
Mocksville, NO 27028
1. Application/Permit Requested B�yr ) e tt�n
Mailing Address L� C�! I Y t (� c"a ( I ► C) C" �.� U 1 C
Home Phone . D �'� Business Phone �.
2. Name on Permit if Different than Above _.
3. Application/Permit for: General Evaluation
i
4. System to Serve:] House ❑ Mobile Home
❑ Business '❑\ Industry r01- e ❑ Oth r
5. If house, mobile home: Subdivision. * O 4
Lfttl�� COU1dTY �tL;,;_,r...'.11rry?•I !�:."
t
❑ Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown ) 3
Section _ lot # /
Basement/Plumbin
❑ g. i
No. of People __ ❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing Machine f
No. of Bathrooms ❑ Dishwasher j
Dwelling Dimensions ❑ Garbage Disposal
6 If business indust lace of ublic assembl other: S ecif t pe
rY. P P y. P y y
No. of People.Served No. of Sinks _
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: Public ❑ Private
8. Property Dimensions _ 'Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
It Una whit Iona?
❑ 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 Pr�o%perty:
`� V 01
U
(jC C. --116 �- ( (: e-�—
U
This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges ,
I n urred from this application.
DATE l SIGNATURE
i
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE f!ESCRIBEP P O� PERTY
MUST CHECK ONE: ❑ 1. I OWN the property. ff 2. I 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 byt_pr 1 .. ^ Y'. _ L t_.
to conduct all testing procedures as necessary to determine said site'. suitability for a ground absorption sewage treatment
and disposal system.
Dc1#ID t12 -90t
,TORE
❑ 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 Pr�o%perty:
`� V 01
U
(jC C. --116 �- ( (: e-�—
U
This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges ,
I n urred from this application.
DATE l SIGNATURE
i
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE f!ESCRIBEP P O� PERTY
MUST CHECK ONE: ❑ 1. I OWN the property. ff 2. I 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 byt_pr 1 .. ^ Y'. _ L t_.
to conduct all testing procedures as necessary to determine said site'. suitability for a ground absorption sewage treatment
and disposal system.
Dc1#ID t12 -90t
,TORE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section �Ufi
Soil/Site Evaluation , V
S
NAME \, . �. ���\} DATE EVALUATED - /'4Q
ADDRESS PROPERTY SIZE �D ' )Q5 751'
PROPOSED FACIILTY d9-- LOCATION `OF SITE
Water Supply: On -Site Well _ Comm uni Public
Evaluation By:Okj1 Auger Boring Pit Cut
FACTORS
1
2 3 4
Landscape position
Sloe Z
S
HORIZON I DEPTH
1�y
Texture group1.
Consistence
Structure
Mineralogy��►
HORIZON II DEPTH
Texture groupC
Consistence
Structure
Mineralogy
4
HORIZON III DEPTH
Texture grou2
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
S
RESTRICTIVE HORIZON
--•
SAPROLITE
---
�.
CLASSIFICATION
,
LONG-TERM ACCEPTANCE RATE
6
SITE CLASSIFICATION: - .ISEVALUATED BY:
LONG-TERM ACCEPTANCE RATE:: "LA OTHER(S) PRESENT: (Fs�
REMARKS: �al`�. �t ,\ %,,&& I'
LEGEND -
Landscape Position
R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope
CC -Concave slope CV -Convex slope T -Terrace 'EFP-Flood plain H -Head slope
_Texture
S -Sand LS -Loamy sand SL-Sandy,loam .r •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
w
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