431 IJames Church Road Lot 19Davie Countv. NC
Tax Parcel Rennrt
Wednesday, December 28, 2016
WARNING: '1711515 NUT A SURVEY
Parcel Information
Parcel Number:
G3060B0019
Township:
Mocksville
NCPIN Number:
5820114451
Municipality:
Account Number:
8303794
Census Tract:
37059-806
Listed Owner 1:
SHEPHERD SANDRA S
Voting Precinct: NORTH
MOCKSVILLE COUNTY
Mailing Address 1:
PO BOX 353
Planning Jurisdiction:
Davie County
City: CLEMMONS
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27012
Voluntary Ag. District:
No
Legal Description:
LOT 19 FOREST BROOK
Fire Response District:
CENTER
Assessed Acreage:
0.72
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
712014
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
009630036
Soil Types:
CeB2
Plat Book:
0006
Flood Zone:
Plat Page:
138
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding 8r Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
QED
All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to theDavie 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
NC or arising out of the use or Inability to use the GIS data provided by this website.
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.AUTHdRIZATION NO: 0997 DAVIE COUNTY HEALTH DEPARTMENT
"• b: Environmental Health Section PROPERTY INFORMATION
Perm}t[_e�e's ,.►�' � P.O. Box 848
Name: �, ' 1 4� + Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760
Directions to property: %'t a' Section: Lot:
AUTHORIZATION FOR -
WASTEWATER Tax Office PIN:# F�
SYSTEM CONSTRUCTION
Road Name:. 4.. ! C� Y?1 E'er `. '1 Zip: �"� 0
**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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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00,
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
-Perm's-
-_Name: Subdivision Name:
Direciionrto property: ' . r " i Section: Lot: '
IMPROVEMENT
PERMIT Tax Office PIN:#Q � -
Road Name: e.5 (� 3 Zip:
**NOTE** This Improvement Permit DOES NOT authorize the constriction 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.
M compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
✓ ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
''X r' % PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS _ # OCCUPANTS r GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY �Q_ DESIGN WASTEWATER FLOW (GPD) NEW SITE—j!!:`_ REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE 4,L94,GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fr. -'?liU
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
**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 (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: -
w
AUTHORIZATION NO. 7 OPERATION PERMIT BY: ,�e� DATE:
**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 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
✓l. Name to be Billed & rdaSo2 N'- ", JeL-
Mailing Address
t,"W
y�f v
City/State/Zip i' lyc-690/
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: [ ] Site Evaluation
-O'Contact Person
r/ Home Phone
Business
// City/State/Zip
[fi]'Improvement Permit & ATC [ ] Both -
4. System to Serve: House [KMobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People --.1— # Bedroom!K # Bathrooms V ] Dishwasher [ ] Garbage Disposal
[ ] Washing Machine [ ] Basement/Plumbing [ J Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: LA"C"ounty/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AXMVCOF THE PROPERTY MUST BE
�i SUBMITTED WITH T APPLICATION.
Property Dimensions: ��' ��� WRITE DIRECTIONS (from Tr
TO PROPERTY:
Tax Office PIN: # -- �� - =�' rCAl c'=;�
Property Address: Road Name :Zqi 'dr Gil
City/Zip ;
If in Subdivision provide information, as follows:
Name:
Section:
Lot #• I�
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 incurred 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
DATE SIGNATURE
Revised DCHD (06-96)
THIS AI?EA MAY 13E USED F011 DRAWINC7 JOU1t SITE PLAN:
procedures as necessary to determine the site suitability.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PEIHIf�
•c,•-� Davie County Health Department !
Environmental Health Section
P. O. Box 665i NW 1 7 1 5
Mocksville, NC 27028 J
1. Application/Permit Requested By �> Y -, Q. 1 ��
Mailing Address C! 0. I 5 U I
Home Phone `t . a " �'� Business Phone
2. Name on Permit it Different than Above
DAVIE COUNTY rii.i:i.?.1 [l�
3. Application/Permit for: General Evaluation
4. System to Serve: House ❑Mobile Home
❑ Business ❑ Industry, �oRe ❑ Oth r
5. It house, mobile home: Subdivision 0,(3
r
No. of People _
No. of Bedrooms
No. of Bathrooms _
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of Peopie.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: IB' Public ❑ Private
8. Property Dimensions _ -Sewage Disposal Contractoi
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If vac what Iona?
❑ Septic Tank Installation I
1;
❑ Place of Public Assembly 44
i`
❑ Uhknown
Section _ Lot #
❑ Basement/Plumbing. gg
❑ Basement/No Plumbing
❑ Washing Machine {
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ 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:
cit
C >act 0!thCC 11 6t
1 V)e_.eAy.0 �ecI
-lei L
1
�►✓ /r/cvurr,�iJ��rr - .l�2-oce, G�Izc�' I
w
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for an charges
intjurred from this application.
DATE �SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBEP P Off, PERTY
Laond
ECK ONE: ❑ 1. 1 OWN the property. 22. I DO NOT OWN the property.
cked Box #2, the rest of this form Q5_1 be completed by the owner or a person authorized by the owner:
ve consent to the authorized representative of the Qavie County Health Department to enter upon above described
cated in Davie County and owned by �� • > f�, �` ^ r _.� t
all testing procedures as necessary to etermine said site'A suitability for a ground absorption sewage treatment
al system.
�—DATE—`E
DCII0(12.90)
DAVIE COUNTY HEALTH DEPARTMENT j
Environmental Health Section �(st r
Soil/Site Evaluation c�
NAME �• _ Sy$e`r\ DATE EVALUATED I I� a��- h�
ADDRESS IN `Cn s. PROPERTY SIZE
PROPOSED FACIILTY'9 LOCATION OF SITE
Water Supply: On -Site Well _ Community Public V
Evaluation By: Auger Boring Pit ✓ Cut
FACTORS
1
2 3 4
Landscape position
:57 -
Slope R
'Ib
HORIZON I DEPTH
Texture groupL
Consistence
I
Structure
C
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
t -
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
—
CLASSIFICATION,g-
E7�..E
LONG-TERM ACCEPTANCE RATE
.14 1 1
SITE CLASSIFICATION: '-�>' EVALUATED BY:
LDNG-TER�AC�C,EPTANCE RATE: '� OTHER(S) PRESENT: N
REMARKS: \m7� '�'\ a.� �s9► 1=�. d
LEGEND
Landscave 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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