146 Lakeview Road Section 2 Lot 7Davie County, NC Tax Parcel Report Tuesday, January 17, 2017
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City: MOCKSVILLE
WAK1V11VG: 'l'HIS IS NUI A JUKV hY
Parcel Information
16140A0043 Township: Shady Grove
5758730866 Municipality:
8300631 Census Tract: 37059-804
GROFF KEVIN Voting Precinct: WEST SHADY GROVE
146 LAKEVIEW ROAD Planning Jurisdiction: Davie County
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 7 HICKORY HILL SECTION 2
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
0.93
Elementary School Zone:
CORNATZER
Deed Date:
1/2012
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
008810011
Soil Types: GnC2,GaD,WATER
Plat Book:
0005
Flood Zone:
Plat Page:
026
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Building Value:
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
91,�v �� 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 Counttrs GIS website shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ag daims or causes of acdon due to
r'pU N�4 Nl./-+ or arising out of the use or Inability to use the GIS data provided by this website.
AUTHORIZATION NO. 1175 DAVIE COUNTY HEALTH DEPARTMENT Lake 4 ✓ ,
Environmental Health Section PROPERTY INFORMATION
Permittee'sf,- r' "� i P.O. Box 848 f i . •,%
aTL"52
tMocksville,NC 27028Name:'Subdivision Name:�•:'�riri
Phone #: 704-634-8760`
Directions to property: ^%i"� j'' .' .� Section:
r Lot:
AUTHORIZATION FORS.. _
WASTEWATER .e�'N�r• - s
Tax Office PIN:.
SYSTEM CO �UCTION
Road Na e
**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
� DAVIE COUNTY HEALTH DEPARTMENT
"t IMPROVEMENT AND OPERATION PERMITS
N am—
Subdivision Name: ✓' f c. : "� !
a -Ir.
Section: f� Lot:
&-qke,''V1r(J GjX�
PROPERTY INFORMATION
Y I
Directions to property:
E%IPROVEMENT
PERMIT
GIl
Tax Office PIN:.}_
Road N e•i � i1L .1 (:-
**NOTE**
:
**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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** TILS PERMIT IS SUBJECT TO REVOCATION IF SITE
A! , x , E ./ . , ?,f/ E �' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
l . ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE /;� # BEDROOMS,—_? # BATHS= # OCCUPANTS 4 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) -%L) NEW SITE-4,,"'� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZEZ/�L!} GAL. PUMP TANK ��PhAL. TRENCH WIDTH TC �'ROCK DEPTH -Z,L LINEAR FT. �D
OTHER C ^
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**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.
..r
OPERATION PERMIT 1
SYSTEM INSTALLED BY: �� �►`'-Sai�
fly ' `rA AJ W- �'TT
PT J� 1-7
0
�4 HooSc`
-JO A -r
i— % _ )
AUTHORIZATION NO. ' (� � OPERATION PERMIT BY: � DATE: o /Y�
**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 EVALUATION/IMPROVEMENT PERMIT & AT n
Davie County Health Department Q �J
- D
._ Environmental Health Section
P.O. Box 848 ,lAN 6 I�Z;J
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED L7IQLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed Neff Li iz dd// Contact Person J�% e
JG�t
Mailing Address 2,2-45- Gil L°�o L
�ee e`i2P Home Phone 13 "ZZ3 '4 [` 3
City/State/Zip &%i f✓� < vil? Sta f f)f?,t,271h � Business Phone 'IsZ�
2. Name on Permit/ATC if Different than Above 7Z J; SZ d '
Mailing Address
City/State/Zip
3. Application For: [ ] Site Evaluation Improvement Permit & ATC
4. System to Serve: jjcr House [ ] Mobile Home !! [ ] Business [ ] Industry [ ] Other
5. If Residence: # People Z # Bedrooms # Bathrooms
p Z..5r CiC] Dishwasher M Garbage Disposal
[M Washing Machine [k] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
[ ] Both
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: [x] County/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes D4 No
If yes, what type?
r -LMP -K A rLAI UK J1
PROPERTY INFORMATION REQUIRED: *** IMPORTANT **1I3' OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: / -7TH' .64 117<Y. x 17 WRITE DIRE1CTIO>NS (from M1ocksville) TO/ PROPERTY:
Tax Office PIN: #�,51 - _1- D $ 6� /�� �0.c 7 Yo ��� �/' /alt 4.c/
Property Address: Road fame Aad
City/Zip
If in Subdivision provide information, as follows:
Name:%��c�_'/%c
Section: Z Lot #: 7 ;
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 all testing procedures as necessary to determine the site suitability.
DATE SIGNATURE_,;%�&w
Revised DCHD (06-96)
THIS AIZEA MAY 13E USEb F01? bRAIVINC YOUR SITE PLAN:
Zo
1A 01W
W 1L1 W
W w UA
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000
of ON
IN
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS
Davie County Health Department
Environmental Health Section
P. O. Box 665
Q� Mocksville, NC 27028
Application/Permit Requested By :TasOn rowbrlC= 4 Marla A. Mafr1SCIno
Mailing Address 4155 CountN Gab Rd 1 41 I�3T .{ Home Phone6M765-N24
W 1nStio - S L I -M , N C Z7104- Business Phone 1792
2. Name on Permit if Different than Above pvvo
3. Application for:
General Evaluation
Tank Installation Permit
4. System to Serve: / House ❑ Mobile'fl`bme ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision hobN 1 5 . � n kb'lm (int"b Section Z Lot # 7
No. of People 2 -
No.
No. of Bedrooms . 5
No. of Bathrooms 2 -
Dwelling Dimensions 000 •1
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
7. Type of water supply: ❑ Public
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Private
❑ Basement/Plumbing
❑ Basement/No Plumbing
JZ( Washing Machine
Dishwasher
gGarbage Disposal
8. Property Dimensions •`13 QCrfl_S Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
If yes, what type?
❑ No
❑ Community
'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:
Roup 158 West i wardS Mocl suint; , I fft atito Bat,-hrnort, Rd- T0,Kf- io -end, Tak,
onto Corner Rd. @ 3-5 milts to Itfj ►nfio k-ticKory tiill Subdiv&OI-)
-Thir�1 property oh r�gh�-C��ooded)
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. X2. 1 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 Day ieCount�H alth Department to enter upon above described
property located in Davie County and owned by EI�(),)(�}`j � Shxml Rr) f n S
to conduct all testing procedures as necessary to determine said site'6 suitability for a ground absorption sewage treatment
and disposal system.
� 1
31nP_ 211 105 6
DATE SIGNATURE
DCHD (1193)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME n'71� (10,
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITEIV
Water Supply: On -Site Well Community Public L--'
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3 4
Landscape position
LIL.L
Slope %
d -
HORIZON I DEPTH
Texture group
GL
C
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC
C
Consistence
Structure
i
51zle
S4/11
Mineralogy
A.
'
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: A EVALUATED BY: //"/,Z
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
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
Ti-_xture
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--ry 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
a
f
Davie County Nealb De artment
X
and .�vme ealt§yen ey
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
July 6, 1995
Jason Trowbridae & Maria Matriscino
4755 Country Club Rd. Apt. 113 I
Winston-Salem, N.C. 27104
Re: Site Evaluation
Hickory Hill II Lot 7
Dear Mr. Trowbridge and Ms. Matriscino
As requested, a representative from this office visited the aforementioned
site on July 5, 1995. Based upon the information provided on the application
for a site evaluation and after an evaluation was completed, the site was found
to be provisionally suitable for the installation of an on-site sewage disposal
system. The area that is classified provisionally suitable is along the front
portion of the lot. A pump may need to be used in order to keep the lines at
an acceptable depth.
When the house placement is determined, contact this office and at that
time a permit can be issued.
Please advise should have any questions.
Robert B. Hall, Jr., R.S.
Environmental Health Section
Enclosure(s)
1. Permit Ri
2. Address
3. Property
Address
4. Permit Ti
b) Privy Conventional her Type
Ground Absorption
c) Sub-Divisio Zcv,_t, Sec. Lot No. _
5. System used to serve what type fac lity: House Mobile Home ' Business
Industry Other
b) Number of people -5
'APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT `2 $
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of "ter -using fixtures:
commodes of!- urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public_ Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions .93 C,
b) Land area designated to building site
c) Sewage Disposal Contractor _
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is corre the b y knowledge.
-:77 �Z
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)
L E/,
• • DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
p SOIL/SITE EVALUATION %
Name_ B `f Date
Address Lot Size 'P
FACTORS APPA 1 APPA 9 ARFA A AQGA A
1) Topography/ Landscape Position
S
S
S
S
PS
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
P
CP
fps
S
PS
U
U
3) Soil Structure (12-36 in.)
Soils
(PS)
jT
PS
SClayey
U
U
1) Soil Depth (inches)
S
S
PS
i) Soil Drainage: Internal
p
`rtf
PS
S
S
PS
U
ExternalS
�
P
U
S
PS
U
i) Restrictive Horizons
Available Space
S
S
C
S
S
PS
U
U
o) Other (Specify)
S
PS
S
PS
RS
S
PS
U(�
U
U
U
1) Site Classification
.S'
P -f
U—UNSUITABLE
Recommendations/ Comments:
S—SUITABLE PS—Provisionally Suitable
Described by �%� Title
SITE DIAGRAM
r
DCHD (6-82)
Date
•
•
%
fe
pavie (aunty Pealth Department
anb PC= 'Veult4'1.gentv1
P. O. BOX 665
f ocksuille, Yort4 Carolina 27028
CONNIE L. STAFFORD, SA, MPH August 3, 1988 TELEPHONE
Health Director (704) 634.5985
(704) 834.5881
Roy Potts
Potts Realty
P. 0. Box 11
Advance, NC 27006
Re: Site Evaluation
Hickory Hill/Sec. 2 -Lot 7
Dear Mr. Potts:
On August 2, 1988, this office evaluated Lot 7, Section 2 of Hickory
Hill. The lot is classified provisionally suitable along the front portion;
however, a pump may need to be used in order to keep the lines at an
acceptable depth.
When house placement is determined, contact this office and at that
time a permit can be issued.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health
RH/wd
Enclosure
STATEMENT
DAVE COUNTY HEALTH DEPARTIVWENT
r
' ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P.O. BOX 848
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-8760
Payment Due Upon Receipt of this Bill.
Detach and Mail a Copy of Bill with your Check.
Your cancelled check is your receipt.
January 21, 1998
5.cvpMin FruciIt
2L15 Chcrol;ee Ln.
Winp
nston—salo
, Iv a 2/10-;
01-2-1-98 jR::rmit/',iC ;117::/fAicl;cry Hill 'Al—Lot 7 ( t5 .4'67
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