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1053 Country LnDavie County, NC Tax Parcel Report I _ Tuesday, September 27, 2016 6913 734 349 215 215 PB11 PG239 E,$1053 -i 55C 7581 CV M IIi M f / ; �-...__.- ............. 215 , "1 N Deed Date: 6/2005 WARNING: THIS IS NOT A SURVEY Deed Book / Page: �.. . Soil Types: SeB,EnC,MsC arceftnformaion I Parcel Number: H500000074 Township: Mocksville NCPIN Number. I 5749055562 Municipality: Outbuilding & Extra Account Number: 82524670 Census Tract: 37059-806 Listed Owner 1: COCKMAN MISTIE CLONTZ Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 1053 COUNTRY LANE Planning Jurisdiction: MOCKSVILLE City: MOCKSVILLE Zoning Class: DAVIE COUNTY,MOCKSVILLE R-A,OSR State: NC Zoning Overlay: DAVIE COUNTY OD Zip Code: 27028-4721 Voluntary Ag. District: No Legal Description: 1.000 AC OFF COUNTRY LN Fire Response District: MOCKSVILLE Assessed Acreage: 1.00 Elementary School Zone: MOCKSVILLE Deed Date: 6/2005 Middle School Zone: SOUTH DAVIE Deed Book / Page: 006120437 Soil Types: SeB,EnC,MsC Plat Book: Flood Zone: X Plat Page: Watershed Overlay: - Building Value: 203750.00 Outbuilding & Extra 22520.00 Freatures Value: Land Value: 15380.00 Total Market Value: 241650.00 Total Assessed Value: I 241650.00 101 Davie County, NCimplied All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the 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 or arising out of the use or inability to use the GIS data provided by this website. •._ 6, DAVIE COUNTY HEALTH DEPARTMENT .� Environmental Health Section ` P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: Billed To: Reference Name: Proposed Facility 990003631 Johnny Clontz Residence ATC Number: 4159 Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: /03 5749-05-6913 Country Lane -27028 1 acre 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 CONS CTI IS VALID FOR A PERIOD OF FIVE YEAR/S. Environmental Health Specialist's Signature: Date: W10,J 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. r- A��/�/f1j�G�'%�' Septic System Installed By: Environmental Health Specialist's Signature: �y1� Date: DCHD 05/99 (Revised) r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003631 Billed To: Johnny Clontz Reference Name: Proposed Facility Residence IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5749-05-6913 Subdivision Info: Location/Address: Property Size: Country Lane -27028 1 acre p ATC Number: 4159 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Typehl- #People #Bedrooms #Baths^ Dishwasher:/ Garbage Disposal: ❑ Washing Machine: 2(11, 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) .(-M_ Site: New ZRepair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Widt1:S�Rock Depth IX Linear Ft Uv Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: 404S DCHD 05/99 (Revised) DECEOW� CATION FOR SITE EVALUATION/IMPROVE&IENT PER&IIT & ATC MAY 2��5 Davie County Health Department 2 Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 13MONMENTALHEMB (336) 751-8760 DAVIE COUNTY - ***I PORT11NT*** CLIEN LUST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BEL Either a PLAT or SITE LAN AfUST BESUBMITIED by the client with TIIIS APPLICATION. Property Dimensions: 121 1) X 1210 Tax Office PIN: l# Property Address: Road Name "O UAr" Lane- City/Zip MO e_ke_ 'N 1 J `e 9-�o a g If in a Subdivision provide information, as follows: Name: Section: BIock: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Turin o�T �L W I58 E ani-& Cou.nl-y 3'� d w h+ G.an ,e rive cam, � � i a Q�Iaa� S 1 CA-� 0?Date Home corners Ragged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 aa: responsible for all charges incurred fi•on1 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 ��-3C o- / SIGNATURE _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). -PS 6.1i S Sign giv n Revised D HD In AA Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. d-� g ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to INFORMATION BULLETIN for instructions. /1. 2. Name to be Billed TI fi C- Mailing Address / �t� City/State/ZIP %YV\ O �CS V Name on.Permit/ATC if Different than Above /t►he, ContactI, ZJ Contact Person J l�rV Home Phone +��- Business Phone J 3 C Q) 3. Mailing Address Application For: Site Evaluation Cittate/Zip �S 13mprdvement Permit/ATC ❑ Both 4. System to Service:' House ❑ Mobile Home. ❑ Business ❑ Industry ❑ Other S. 6. Type system requested:. Conventional ❑ conventional modified ❑ innovative If Residence: # People # Bedrooms_ # Bathrooms �J_ 1 �� Nd a Stat ern I Dishwasher )Duarbage Disposal 9Washing Machine ❑Basement/Plumbing ems -ant/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply: 'K County/City ❑ Well ❑ Community, 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes kfNo If yes, what type? ***I PORT11NT*** CLIEN LUST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BEL Either a PLAT or SITE LAN AfUST BESUBMITIED by the client with TIIIS APPLICATION. Property Dimensions: 121 1) X 1210 Tax Office PIN: l# Property Address: Road Name "O UAr" Lane- City/Zip MO e_ke_ 'N 1 J `e 9-�o a g If in a Subdivision provide information, as follows: Name: Section: BIock: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Turin o�T �L W I58 E ani-& Cou.nl-y 3'� d w h+ G.an ,e rive cam, � � i a Q�Iaa� S 1 CA-� 0?Date Home corners Ragged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 aa: responsible for all charges incurred fi•on1 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 ��-3C o- / SIGNATURE _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). -PS 6.1i S Sign giv n Revised D HD In AA Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. d-� g 715 9.86A 1900 349 5.01A 4442 co w w 5.18A 8447 A f61;j (5.57A) 1872 a ssa � t3 ----------- (923) y APPLICANT INFORMATION Acpount #: 990003631 Billed To: • Johnny Clontz Reference Name: Proposed Fagility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/04M 5749-05-6913 Subdivision Info: Location /Address:'. Country Lane -27028 Property Size: 1 acre Date Evaluated: 6�`/V Water Supply: On -Site Well Community Public t.--' Evaluation By: Auger Boring t/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH e r Texture group <"4 6- Consistence -C/- r lStructure Structure l i" Mineralogy HORIZON 1I DEPTH Ile Texture grou2 Consistence Structure Mineralogyi HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture grou2 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ` LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: 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 T- 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 inclies 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 DCI ID 05/99 (Revised) ■■//■■■■■/..■.//■■■■■../.■■■.e■■eR■ISIS...//■/./SISI■■.■//■////�/■.■.■ ■///////■.■■/■./.■■■./..■/■/../■�....a■////ee■■■■■■..■.■.a ■■ ■■■ ■.e.■e■M.■se.■.■e■ecce.N■R..■■eeeerM■.R■.■■.e.M■MMrr.■.....■ ■ ■r■ ■■.■..■e■■...■■■eee.■tIS.....■■...■...NRR......■MM.sM■■..■..■ MINIM ............................................................ 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