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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 9bI�, 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 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) n Y A V U r 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 GoMAPS -,Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System +$ �. �+vr- 'I O ss: 'L' Click Here To Start Over Quick Search: (County ID or Owner Nz &I,.� Active Layer. OUsetl.ap Tps `- Q D PARCELS (Map Tips Available) v; �t Addre http://maps. co.davie.nc.usIGoMaps/map/Index. cfm?maimnapservice=gomaps&CFID=412... 3/23/2009 �►j *Tµ bM, 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