110 Sumter Road Lot 6Davie County, NC Tax Parcel Report Tuesdav, November 15. 2016
WARNMG: 'fH1S 1S NOTA SURVEY
Parcel Information
Parcel Number:
F3010A0006
Township:
Clarksville
NCPIN Number:
5811726405
Municipality:
Account Number:
82529996
Census Tract:
37059-801
Listed Owner 1:
NEEDHAM RAYMOND D
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
110 SUMTER ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 6 CHARLESTOWNE GRANT
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
1.30
Elementary School Zone: WILLIAM R DAVIE
Deed Date:
8/2008
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
007670918
Soil Types:
MnC2,MnB2,MdD
Plat Book:
0009
Flood Zone:
Plat Page:
124
Watershed Overlay:
DAVIE COUNTY
Building Value:
246350.00
Outbuilding & Extra
Freatures Value:
9080.00
Land Value:
28000.00
Total Market Value:
283430.00
Total Assessed Value:
283430.00
10:1
Davie County,
1� 7�T C
l data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the
implied warranties of merchantability or fitness for a particular use. Ati users of Dade County's GIS website shall hold harmless the
County of Dade, 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 prodded by this websfte.
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Permitt
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COUNTY HEALTH DEPARTMENT
I0 ANM4 A/ � p� 10vtEnvironmental Health Section PROPERTY INFORMATION
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AUTHORIZATION NO:
P.O. Box 848
wo Mocksville, NC 27028
// �a �� f �% Phone #: 336-751-8760
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WASTIEWATTER ZATION OR
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SYSTEM CONSTRUCTION
0029,50 A
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Subdivision Name:( 6`Ci e Lr -5 /GN
Section: r Lot:
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Tax Office PIN:#8 ' -
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Road Name: Zip:
-
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**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 Fonn/Authorization Number should be presented to the bavie County Building Inspections
Office when applying for Building Permits. `r
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
— ,.iOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
f/ IS VALID FOR A PERIOD OF FIVE YEARS.
Eld IRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE ✓ ` # BEDROOMS # BATHS l # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE r TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE V
SYSTEM SPECIFICATIONS: TANK SIZE G Y GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTHLINEAR FT.,
REQUIRED SITE MODIFICATIONS/CONDITIONS: vuk—u pi < c- G U �b Q 7 ,G i -E' i 1l 'j "� I ✓�
IMPROVEMENT PERMIT LAYOUT G1 U Q W Q i X .r- Jn e ok t o G f
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
W
AUTHORIZATION NO. OPERATION PERMIT BY:
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 TI%ME.
DCHD 02102 (Revised) Z�'0 tv V , IG' 3
ats�
,
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Permittee's P , DAVIE COUNTY HEALT14 DEPARTMENT
Name: GSL► xb*�-r ►rC `� ��`l1+hR�y YJ -e 'eO)OslEnvironmental Health Section PROPERTY INFORMATION
- - �r ( N _ �- C' P.O. Box 848 ` �'' , ;r�
Directidt►s to property: C h4ocksville, NC 27028 Subdivision Name: 1 Cr ,� %/yi tC. t.
(, t s i 4 (1 G1 y �- ( ,_ j <, y .g r r f f �j r Phone #: 336-751-8760 Section: j Lot: t -n
w r ! P+ + I . AUTHORIZATION FOR
L 1G WASTEWATER.
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I --- --- ---- SYSTEM CONSTRUCTION Tai �f e PIN:#
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AUTHORIZATION NO: 002950 A r Road Name: Zip: �L' a
**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.
AL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT // # SEATS INDUSTRIAL WASTE: Yes or No
rli
LOT SIZE � � TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZEr._ L GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1 /} LINEAR FT.
OTHER !� %{
REQUIRED SITE MODIFICATIONS/CONDITIONS: ekU AA � ✓`i pi < < r� Ct (.q � b � "1 G d 'F J i 1 'S -t t� � � � ✓�
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A;M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
00
AUTHORIZATION NO. OPERATION PERMIT BY:
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 WGILL FUNCTION SATISFACTORILY FOR ANY GIVENPERIODOF TI/ME. j
DCHD 02102 (Revised) �A 4 _1 i U �l . ►C1f J
. • .,ir
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002721 Tax PIN/EH #: 5811-72-7635.06 CC
Billed To: Chad Correll Subdivision Info: Charleston Grant Lot # 6
Reference Name: Location/Address: Wagner Road -27028
Proposed Facility: Residence Property Size: 2.2 acres
ATC Number: 3444
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CFTION IS VALID FOR A PERIOD OFFIVEYEARS.
Environmental Health Specialist's Signature: Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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.
lax VS
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
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'7110
Z DAVIE COUNTY HEALTH DEPARTMENT ��
• Environmental Health Section
• P. O. Bog 848/210 Hospital Street sem- �— �' `�.2
• Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002721 Tax PIN/EH #: 5811-72-7635.06 CC
Billed To: Chad Correll Subdivision Info: Charleston Grant Lot # 6
Reference Name: Location/Address: Wagner Road -27028
Proposed Facility: Residence Property Size: 2.2 acres
ATC Number: 3444
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS'
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRAC. OR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type #People �_ #Bedrooms _ #Baths
Dishwasher: -El"' Garbage Disposal: ❑ Washing Machine: Ja Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply_ Design Wastewater.Flow (GPD) � Site: NewEr'-'Repair ❑
System Specifications: Tank Size4U GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width �� Rock Depth 1�` Linear Ft��
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
If yes, what type?
k"IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #22-
Property
2-Property Address: Road Name ,/t a
City/Zip
If in a Subdivision provide information, as folio vs:
Name: l
Section: Block: Lot: _
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Date home corners flagged: ~0
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 frons
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 suitabil, I
DATE �o ��3 SIGNATURE
THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN nclude 711ofthefollowing: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Sign given
Revised DCHD (07/99)
4
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. ���
Invoice No.3-eMJK— '"
V
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
BllV onmenta/Hea/th Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for
instructions.
Cwti� CO-1Zk
1.
Name to be Billed u. -e Contact Person
_
Mailing Address V.1 i.gX� � r-'), Home Phone �'/`G-
j/j
- y,06
,, ``6ec
�cuyae Business Phone
City/State/ZIP l�D
2.
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3.
Application For: Site Evaluation Improvement Permit/AT Both
4.
System to Service: House Mobile Home Business Industry Other
2
i
Z �--
S.
If Residence: # People # Bedrooms
# Bathrooms
Dishwasher Garbage Disposal ashing Machin Basement/Plumbing
Basement/No Plumbing
6.
If Business/Industry/Other: Specify type # People
# Sinks
# Commodes # Showers # Urinals
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons
per day)
7.
Type of water supply: County/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?
k"IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #22-
Property
2-Property Address: Road Name ,/t a
City/Zip
If in a Subdivision provide information, as folio vs:
Name: l
Section: Block: Lot: _
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Date home corners flagged: ~0
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 frons
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 suitabil, I
DATE �o ��3 SIGNATURE
THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN nclude 711ofthefollowing: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Sign given
Revised DCHD (07/99)
4
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. ���
Invoice No.3-eMJK— '"
V
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMR & ATC
Davie County Health Department
Envirlvamental Health Section
• P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IWORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed J���/
C_O[�EGC_
Contact Person Jrf/J
60P,R6: L
Mailing Address X132
/ZfC.Elr.>6 eta
Some Phone 4,7%Z
'��� O
City/State/ZIP Mora
7, �
Sy/L L` , A15-- Z7C a/
Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
City/State/Zip
3. Application For: X Site Evaluation 0 Improvement Permit/ATC ❑ Both
4. system to Service: A House ❑ Mobile Home 0 Business 0 Industry 0 Other
5. If Residence: # People # Bedrooms # Bathrooms
H Dishwasher 1.1 Garbage Disposal 1.1 washing Machine I] Basement/Plumbing 11 Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Shavers # Urinals # Nater Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: County/City 0 well IJ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 'KNO
If yes, what type?
***IMPORTANT*** CLIENTS hfUST CauPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN AfUST BESUBAHITED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: # �6 ��� 7�
Property Address: Road Name WACy1C2 Z,4 J>
City/zip o1 z,eL1ie-c.•E 2-7o Z('
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
o l N% o L/REZT�1 c<i 4�>
Le,C7-r o L/s r a!o yM/re
If in a Subdivision provide information, as follows:
/�
Name:
Section: Block: Lot: 4j1,i/C/ ,, A 50
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 responsiblejor all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of theDpvi_e- Count Health Department
to enter upon above described property located in Davie County and owned by �CP • �le�Eu . ��
to conduct all testing procedures as necessary to determine the site suitability.
DATE �— % '-7 d SIGNATURE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT tP
Soil/Site Evaluation
APPLICANT'S NAME �[ �- �`{%��—� DATE EVALUATED V?Gy
PROPOSED FACILITY PROPERTY SIZE 11,010 V^. gO *-Z&
SUBDIVISION — QQ / ROAD NAME WhRf� Ct- e/
Water Supply:
Evaluation By:
On -Site Well Community/
Auger Boring Pit 1/
Public
FACTORS
1 2 3 4 5 6 7
Landscape position
L_
Sloe %
HORIZON I DEPTH
Texture groupC
Consistence
r
Structure
Mineralogy
HORIZON II DEPTH
�(
Texture groupC
Consistence
Structure
Mineralogy
`
HORIZON III DEPTH
Texture group
Consistence
—r SzoV
Structure
Ac
Mineralogy(
;
HORIZON IV DEPTH
— 1}
Texture group
Consistence
Structure
Mineralogy�•
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
IRE
SITE CLASSIFICATION: D S
LONG-TERM ACCEPTANCE RATE: D• T✓
REMARKS: SDi�, �-� Sly
LEGEND
DCHD (O1-90)
Landscape Position
EVALUATION BY: Jef-r-
OTHER(S) PRESENT:
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
CONSISTENCE
Moist
VFR - Very 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
SC - 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
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