115 Levin Court Section 3 Lot 2Davie County, NC • Tax Parcel Report Tuesday. January 17. 2017
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
1614OA0055
Township:
NCPIN Number:
5758749495
Municipality:
Account Number:
82530732
Census Tract:
Listed Owner 1:
WARD JEFFREY A JR
Voting Precinct:
Mailing Address 1:
115 LEVIN COURT
Planning Jurisdiction:
City: MOCKSVILLE
Zoning Class:
State:
NC
Zoning Overlay:
Zip Code:
27028-7379
Voluntary Ag. District:
Legal Description:
LOT 2 HICKORY HILL SEC 3
Fire Response District:
Assessed Acreage:
0.74
Elementary School Zone:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
4/2009 Middle School Zone:
007900347 Soil Types:
0009 Flood Zone:
010 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
Shady Grove
37059-804
WEST SHADY GROVE
Davie County
DAVIE COUNTY R-20
CORNATZER - DULIN
CORNATZER
WILLIAM ELLIS
GnB2,GnC2,GaD
DAVIE COUNTY
No
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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 all claims or causes of action due to
�OUty� NC or arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
OPERATION PERMIT
Account M 990005240 Tax PIN/EH M 5758-749495
Billed To: Jeff Ward Subdivision Info: Hickory Hill Lot # 2
Reference Name: Jeffrey A. Ward, Jr. Location/Address: Levin Court -27028
Proposed Facility: Residence Property Size: 0.70 Ac.
ATC Number: 4961
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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.
l
System Type: lei S.T. Manufacturer �Qu Tank Date T— Tank Size
Pump Tank Size
System Installed By: A.Orn C V C AA E.H. Specialist: /.ate:
DCHD 11/06 (Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
ATC Number: 4961
Site Type: ❑'New ❑Repair ❑Expansion
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTfiORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms # Bathroomsl__-!�# People '�-Basement2"ffasement plumbingZ""'
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size 6 Type of Water Supply: 2 ounty/City ❑Well ❑Community Well
System Specifications: . Design Wastewater Flow (GPD)3 eC Tank Sized GAL. Pump. TankGAL.
fitTrench Width 36" Max. Trench Depth36<< Rock Depth�inear Ft. 3-,- ,0+
i n
Site Modifications/Conditions/Other:
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. k -,a/
Q
O o-
Ze
Environmental Health Specialist (';7��/�I��%lL_ Date: ✓ 1_3
DCHD 11/06 (Revised)
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990005240
Tax PIN/EH #:
5758-74-9495
Billed To:
Jeff Ward
Subdivision Info:
Hickory Hill Lot # 2
Reference Name:
Jeffrey A. Ward, Jr.
Location/Address:
Levin Court -27028
Proposed Facility:
Residence
Property Size:
0.70 Ac.
ATC Number: 4961
Site Type: ❑'New ❑Repair ❑Expansion
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTfiORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms # Bathroomsl__-!�# People '�-Basement2"ffasement plumbingZ""'
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size 6 Type of Water Supply: 2 ounty/City ❑Well ❑Community Well
System Specifications: . Design Wastewater Flow (GPD)3 eC Tank Sized GAL. Pump. TankGAL.
fitTrench Width 36" Max. Trench Depth36<< Rock Depth�inear Ft. 3-,- ,0+
i n
Site Modifications/Conditions/Other:
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. k -,a/
Q
O o-
Ze
Environmental Health Specialist (';7��/�I��%lL_ Date: ✓ 1_3
DCHD 11/06 (Revised)
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
IMPROVEMENT PERMIT
Account #: 990005240 Tax PIN/EH #: 5758-74-9495
Billed To: Jeff Ward Subdivision Info: Hickory Hill Lot # 2
Address: 135 Lakeview Road Location/Address: Levin Court -27028
City: Mocksville Property Size: 0.70 Ac.
Reference Name:
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to
revocation if site plans, plat or the intended use change.
Permit Type: 9N'e"w- DRepair ❑Expansion Permit Valid for: ears ❑No Expiration
Residential Specifications: # Bedrooms # Bathrooms P" # People BasementD-B—asement plumbing Q---
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): Type of Water Supply:ounty/City ❑Well ❑Community Well
Site Modifications/Permit Conditions:
S stem Type LTAR
Initial - } 0. 1 -7 to
Repair r t 0_,)-75_
Si
e Plan
5
Or
Environmental Health Specialist/�'/D/��� Date—/—/— 3 —�
i„ii_nr,
J
Type
ew System
SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (3 751-8786
provement Permit Authorization To Construct(ATC) ❑ Both
❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMT0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed
Billing Address
�' t� G�E`���
❑Yes DR -o
Contact Person --1 e
Home Phone 3 J 0 91 S 4'S
31
Arethere any easements or right-of-ways on the site?,
City/State/ZIP
Is the site subject to approval by another public agency?
C
Business Phone
Name on Permit/ATC if Different than Above —J e
Mailing Address City/State/Zip
AJ -
PROPERTY INFORMATION *Date House/Facility Corners
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name -��e -t'f, Phone Number
Owner's Address City/State/Zip
Property Address . &r Vi N a City.
Lot Size Tax PIN#7'j-��{-�y��
Subdivision Name(if applicable) Z i Section/Lot# 2
Directions To Site:
If the answer to any of the following questions is "yes", supporting documentation must be attached.
Are there any existing wastewater systems on the site?
❑Yes DR -o
Does the site contain jurisdictional wetlands?
❑Yes [Wo-
adoAre
Arethere any easements or right-of-ways on the site?,
❑Yes Cq(o
Is the site subject to approval by another public agency?
❑Yes Jho
Will wastewater other than domestic sewage be generated?
❑Yes�io
TF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms 3 # Bathrooms , Z � �-- Garden Tub/Whirlpool [I Ves ❑No
Basement: C�es ❑N—o Basement Plumbing: ❑Yes ❑No
TF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: [Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: ❑ .t eTnty/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes
If yes, what type? _
❑ No
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if
the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative
of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws an rules.
I understand that I am responsible for the proper identification and labeling of property lines and comers and locating and,11agging
or staking the ,,�ouse/facility location, proposed well location and the location of any other amenities.
Site Revisit Charge
Prop owner's or owner's legal representative signature
/ � Date(s):
J Cf � Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account # 52- b
Revised 11/06 Invoice # 6
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APPLICATION FOR SITE EVALUATION/16IPROVEMENT PERMIT
Davie County Health Department U
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksvilla, NC 27028
(336) 751-8760
***IMPORTANT*** TIiIS APPLICATION CANNOT 13E PROCESSED UNLESS A L TIIE
INFORIdATION IS PROVIDLD. Refer to the INFORMATION BULLETIN f
1. Name to be Billed LAMP✓,� k% �It/✓PsT/%%PI(% )<s
Mailing Address _% 9M 1/4 ,Tu/ 1pQ S
City/Stato/.'.IP I&OL'$(/, 'Itle
2. Name on Permit/ATC if Different than Above
Mailing Address
SCE E
D r C — 1 LU05
HEALTH
ry
Contact Person _ RAeKA- %Ql! a 4& - C r(
Itome Phone - 7$2 '-•3Y4-
Business Phone 5 Awls`
J City/State/Zip
J. Application For: u Sitc Evaluation ❑ Improvement Permit/ATC ❑ Doth
9. System to Service: 0�11ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S. Typo system roquestod: Conventional ❑ conventional modified ❑ innovative ClaCCepted
6. If -Itesidence: it People r-/ ft Bedrooms 1 _ 11 Bathrooms L
Dishwasher ❑Garbage Disposal Ishing Idachino ❑Basement/Plumbing ❑Basement/No Plumbing
7. If- Buoiness/Induat-ry /Other: verify type 9 People it Sinks
11 Commodes It Showers 9 Urinals 1t Water Coolers
IF FOODSERVICE: it Seats Estimated Water Usage (gallons per day)
8. Type of water supply: bounty/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is llltellded to serve? ❑ Yes 0,No
If yes, 11 -hat type?
***L1fP0R7! INT*** CLILNTS,41USTCOr1IPLE7'I3TIIE REQUIRED PROPERTY INFORi1•IATION REQUESTED
IIE'LOW. hither n PLAT or SITE PLAN JlfU.ST B SURHI77ED by the client with riIIS APPLICATION.
Property Diluensions:
Tax office PIN: li
Property M(lress: Road Nanlc
City/til)
wRITE D1REcrioNS (frons iwoci(svillc) to PROPERTY:
If in a Subdivision provide information, as follows: /
Section: Block: Lot: Date Monte corners flagged: > L
This is to certilj, that the inforlllatiou provided is correct to the best of nl3, knowledge. I understaN(I that any pernlit(s)
issuc(I hereafter arc subject to suspension of- rcvocatioll, if the site plans or intended use cllauge, or if file inforulation
sl(b(llittc(I ill this application is falsified or cllallgcd. I, also, t1 iderstait/l that I am responsible fol• all charges hicurred froth
this application. I, hereby', give cOtlsellt to the Authorized Rept•escllt:ltivc of the Davic County IIealth Dcparhncut
to enter upon above described property located in Davie County and owned.by
to conduct all testing proce(lures as accessary to detcrlllitle the site5llit. b?7A
DA'I'I, . � � SIGNATURL;
TIIIS AREA MAY BE USED FOR DIZA WING YOUR SITE P (Include all of the following: Existing :uld proposed
property lines and dilncllsious, strut r ,set ac (s, an scpti�tions).
IQ
Slgll given Vy
Revised DCIII) (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EI -IS:
'Accoulit No. --4-0�
fWqIuvoicc No.
DAVIE COUNTY HEALTH DEPARTMENT
,. Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003814 Tax PIN/EH #: 5758-74-9624.02
Billed To: Lakeview Investments Subdivision Info: Hickory Hill two Lot # 01
Reference Name: Location/Address: Lakeview Road -27028
Proposed Facility: Residence Property Size: see map Date Evaluated:
Water Supply: On -Site Well
Evaluation By: Auger Boring
Community
Pit
Public
Cut
FACTORS
1 2
1 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
�� l
Texture group_(
Consistence
V�
Structure
K
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy/
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
JA
Structure
Mineralogy
(}
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
f <
SITE CLASSIFICATION: L
LONG-TERM ACCEPTANCE RATE: ". C
REMARKS: J 2°t0 1;7/Ail 74� '1171P/If
E'VAkATION BY: e ` 41 /�
OTHER(S) SENT:
'LEGEND
Landscape 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 � v /�`'j`
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 1 `
SC - Sandy clay SIC - Silty clay C - Clay
Moist
VFR - Very friable FR - Friable FI - Firm VE - Very firm EFI - Extremely firm
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
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 05105 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #: (336)751-8760
Januray 24, 2006
Lakeview Investments
1800 US HWY 601 South
Mocksville, NC 27028
Re: 5758-74-9624 Lots 2-4 Lakeview Road
Hickory Hill, Section II
Dear Mr. Ward:
As requested, a representative from this office visited the aforementioned site on
January 6, 2006. Based on the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
provisionally suitable for the installation of an on-site sewage disposal system.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
Environmental Health Specialist