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178 Dakota Ln�avie C�untv. NC Tax Parcel Reoort Wednesdav. October 12. 201 E WAKNIIV(T: '1'H15 l� iVU"1' A SUKVr:Y _,r.,,-„P,, �,m� .�r � � a ._ r ��..� . _,.,__.� . � .,�._._ �_ � _ _, �.m,� _ _—� »�._._ _ �.� m.� __�.�, ° Parcel Informahon ' Parcel Number: G30000003401 Township: Clarksville NCPIN Number: 5820434339 Municipality: Account Number: 52370000 Census Tract: 37059-801 Listed Owner 1: MUNDY WILLIAM D Voting Precinct: CLARKSVILLE Mailing Address 1: PO BOX 791 Pianning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,R-12 State: NC Zoning Overlay: Zip Code: 27028-0791 Voluntary Ag. District: No Legal Description: 5.008 AC OFF HWY 601 LOT 1 Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 5.00 Elementary School Zone: WILLIAM R DAVIE Deed Date: / Middle School Zone: NORTH DAVIE Deed Book / Page: Soil Types: PcC2,CeB2 Plat Book: 0006 Flood Zone: Plat Page: 074 Watershed Overlay: DAVIE COUNTY Building Value: 52600.00 Outbuilding & Extra 1310.00 Freatures Value: Land Value: 39260.00 Total Market Value: 93170.00 Total Assessed Value: 93170.00 °��'�' Davie County, °�UN�'' NC : . �� ;,. , . _ . _ : _ , , _. . . . . ,- , � `a,AUTHORIZATION NO: O 5 8 O DAVIE COUNTY HEALTH DEPARTMENT �.��• "' Environmental Health Section PROPERTY INFORMATION Permitt e'sM � ` y� P.O. Box848 , Name: �� ti�,�� >'F�t � �. ��:' �'•.�11'' � ,'�U °(�1 �'�� Mocksville, NC 27028 Subdivision Name: � U 1 t,' _} t�� Phone #: 704-634-8760 Section: Lot: Directions to property: ►" 1� t AUTHORIZATION FOR C� ��,, � �-�. '�.., �, " `;; ,.�,;j (�.�,� WASTEWATER Tax Offce PIN:# !r?�-� - �� i,; - SYSTEM CONSTRUCTION � = '�J' *°�; :� , � � _, .-,z: -�-� �•��, � �'. ` -��-"."s` � ��. ` ,C�,�, k�. Road Name: � t. ��,.vi A h t > Zip: ��' 1-�< �: **NOTE** This Authorization for Wastewater System Construction MUST BE ISStTED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Forn�/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts.° � (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) j` `^� �.�y . `� � ` ,y�� '. �' .� Y ��,.:.',1�� :.L c�_ .'ti��-. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. _ _ _ __ . ,; ,�: � �� ..:_ . . ;, ; '� 4 �� , �, DAVIE COUNTY HEALTH DEPARTMENT ,.�;,� "� _. �.� µ�� IMPROVEMENT AND OPERATION PERMITS . . Permi�t� � ��` ��:. , t'^, . �� PROPERTY INFORMATION Name: ��? '�:* '�= ` '��r- -"�� J � �" °�r � � SubdivisionName: 'i �� i � � � «..r � �� ' � � Directions to property: !�� t. '=�"�. Section: Lot: �-, , �,�_ � `. µ INIPPERMIT � Tax Office � r� �'", �.._ � ,�, �_, ; . - ` y. � . PIN:# '� y t !.� . , �, � � •�, ,�,. . • r.r ' , i r ,� "'. ' ' ' �.. >. ` _ -�. , ;, Road Name: _ � s- � Zip: , **NOT'E** This Improvement Pernut DOES NOT authorize the construction or installatian of a septic tanlc system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construc6on/installation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) :' ..,,:..,,__ s F..; . ***NOTICE*** THIS PERMIT LS SUBJECT TO REVOCATION IF SITE -- . �. ., , ,':. � 1, ;.. j;.,9 - PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYP�. �'��'�= # BEDROOMS � # BATHS +�.'_ # OCCUPANTS � GARBAGE DISPOSALi Yes o No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT S� ��9{-' TYPE WATER SUPPLY �' DESIGN WASTEWATER FLOW (GPD) ��-� �� NEW SITE � REPAIR SITE � + t! SYSTEM SPECIFICATIONS: TANK SIZE �� GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH !�! LINEAR FT, � r� ��' REQUIRED SITE MODIFICATIONS/CONDII'IONS: I IMPROVEMENT PERMTf 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. I OPERATION PERMIT GI AUTHORIZATION NO.� �J � OPERATION PERI�u i n i:_ SYSTEM INSTALLED BY: _ ��`� ��Sl�ii� � DATE: ! l ��J � / � **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 WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) , ,.. ' • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT , ''` ,' Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 (704)634-8760 _ ��"� r� � �s F''" i r; --- rf, � , ; i� . . / i . -• ; � � _ __ __�! I NOV � l ��::� i! ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. NametobeBilled ��LLfNI%� �, �2 e�t,t'tc� (/, /�UIUii�/ ContactPersonl��' mU��ic� Mailing Address ?L � cx 7�l � Home Phone y�1 Z-- Z� � � City/State/Zip !%�OC��S� %%iT� z�70Z� Business Phone y�7-7�D�c� qyv—�5v 2. Name on PermidATC if Different than Above r� m Mailing Address 3. Application For: 4. System to Serve: 5. If Residence: S,ra v,-� E City/State/Zip 5� m£ ❑ Site Evaluation �� , �� Improvement Permit & ATC ❑ Both �,,�a��-}f o�G ❑ House � Mobile Home ❑ Business ❑ Industry ❑ Other # People �_ # Bedrooms _ � # Bathrooms % � Dishwasher ❑ Garbage Disposal �( Washing Machine . ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice 7. Type of water supply: # Seats � County/City Estimated Water Usage (gallons per day) ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes � No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. I Property Dimensions: � �'o-�Z�� Tax Office PIN: # d� 2U _ y� _ y�3 C] Property Address: Road Name �p%n7 A�_�n2 City/Zip m o ��5 �� r� . n_ c.,��o z� � If in Subdivision provide information, as follows: Name: Section: Loc #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: [vur n� — r dN 1�� %v �P T Ln 5 7� rv 2��.. � �E 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 ��L�i�r''� /./ ��f��rL �! �l �� to conduct all testing procedures as necessary to determine the site suitability. DATE �� 1�� SIGNATURE Revised DCHD (06-96) �''1 ,.` �� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER L5 Cy L�', C� �I �' � �'�{� ��" Davie County Health Department � f,1r 1,� � � � 2 � Environmental Health Section �tf+� � $ �� /(� � � �h� .�/ �� P. O. Box 665 a�'� " �If P l�l �"� t��, Mocksville, Nc 2�028 �� /� �1 1. Application/Permit Requested By �;T �� - �i ).�1)11 � Mailing Address 1"• n• � �X �g � Home Phone %�S'-S'l2' ��o� m�� s' �), ( �.Q � � Business Phone %O �/� S'�i� ' ?Ln � 7' 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business td'General Evaluation � use ❑ Industry 5. If house, mobile home: Subdivision U� ❑ Septic Tank Installation Permit obile Home 0 Place of Public Assembly ❑ Other No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private 8. Property Dimensions ��Z"�� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Unknown Section Lot # ❑ BasemenUPlumbing p BasemenUNo Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ No � Communiry "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: �� I � � a M;�{s �� Le-�' I v�✓� o� ��„Je. i�r�� nJ� � � �l�- Ll�-►�, � � ,� e w � S f } c . ��I ��: � �a �,.� e. �a 1-� �o-r� a� �� }•1- ��c l� S � L�'� C��1 �(�� n t� S j� (y1 .e t> n e UJ � � ti 1�'t' YV o- r�.z �-b ��c-�-t- i�sPf • � �'4�ot..� s�Q�;�;� e�a��• � f�� . �. 7a�i- �� -- ��3 �f 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. ,� �P�J1 � 1 �S , ,. ATE � SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: O 1. I OWN the property. ❑ 2. I 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 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 said site's suitability for a ground absorption sewage treatment and disposal system. C�/��/ �s� ATE OCHD (1/93) �• J � Y )( ; _ ' . " _..: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation DATE EVALUATED �/�� G l .� � PROPERTY SIZE �� LOCATION OF SITE ��9 %/v NAME ADDRESS PROPOSED FACIILTY ,5�y[C� S-r° Or /7j ,� Water Supply: On-Site Well _ Community Evaluation By: Auger Boring Pit Public � Cut FACTORS 1 2 3 4 Landscane vosition L � � _ Slope 7. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPT �1'exture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CL�SSIFICATION LO;IG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � � .�G f-- S6 i ^ C i � �� n EVALUATED BY: LDNG-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 Texture 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��-y friable FR-Friable FI-Finn 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 .iC-•Siny�le grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular biocky PL-Platy PR-Prismatic Mineralaicy 1:1, 2:1, Mixed Notes Fiorizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil w etness - Inches from land surface to free wate�` 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/ftz DCHD (01-901 ■��■��-��■ �a �c�� iiiiiiiiiiii=iiiiiiiiiiiiiiiiiii��iiiiii�i��iiiii�iiiiiiiiiii�iiii ■��■■�■��■��■��■��■��■��■■■ ■��■��■��s��■��■��►��■ ��■��■��■��■ ■■�■��■��■��■��■��t��■��■��■��■ ■��■��►��■�■��■ ..................................1.........�■.._.... ............. .................................�......... ... ■... ............. ..............................................■...._ ............. ■��■��■��N��■�� ■�■�■ ��\�� N�� iiiiiiiiiiiiiii�iiiiiiiiii�iiiiii=iiiiiiii�iii=�i��=iii��iiiiin�iiiii iiiiiiiiiiiiiiiiiiiiiiiii�=iiiii��iiiiiiii��ii��iiiiiiiiuiiiiii ■��■■��■��■��■��■R�!�C1��■��■�� ■■��■■��■��■��►\��■�■u.��NI��H�■��u�� ■��\��\1��1��.��1�� . ��■�■�� 1��!�u�.:r1�� ■��■��■��i=�■�e��i��a�� n.��ir�■ ��_ iiiiiiiiiii■iiiiiiiiiii■�i�ii�iiiii�■i�iii��i�►�.aat,.��iiiiii�S=ii= ■��■��■■��,��s�� ucr�e�v�� ■��■��N��s�� er�w i�� ■��■��■��■��a■��■��i��.a�c�� =ri��r��■�■�� ■��■�u��■��■��■■��i��.�� ■. .�■u�i��■ ..................................i........n..i . .��.u......0 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■►■■■■■■■■��■..G�i.■ �.�■■ ■■■■■■■ ■��a��■��■��■�� r��i��Ei.:�■�� _��■�� ................ ....u......... �....�. -�.�•..u•w...C........ ■�N��/��/�� /��N�� ■��%��r� ��■■■�� ■��■■��■��■��■�\��II � �� ■ ■ �� Hh■��A%�� ■ �� \�� ■��■� ��\��L' ■\� �� ■■■�■�� /��\ �� N ■u�. ��■�� . ■■��.■N��■.��■��!�� v --_�� ■■��l�A�■��.!!�CD�:iiiin��ll�l� �� ' �N�■ �� ■��■��■\�I��C� � � �� ■■ ��vh��l��t�' �ii • �■ �H��■ ��d��HN��vu�� n� �� f ■.■�� ■�■��■�� Wv�■��■I� 11 ■ �■�� ■ ■��Nu�m�U ��Ivrl ■ ■ N��■� ■��■��..■��1�l1 N �� h�■�■�� 1�l1 � �W�u� ■��W��N��v��ll ■ ��u��n�� N��q��N� ..._... C::' ::::::�:::C=:.':�� !. .: ..:C �': :::.::: . .C�.............. ..��..0 .. .�...�. ..........�....................�.... . . ... ..... .■■.■...■■■■■■■■■■■■.■.■■�■.■■I�■■■. ■■� ■■ ■■■■.■■■■.■■■.■■■■.■.■■■■■�■■.i.��■■■� ■ � �■�■��■ ■��v��■■��■��I� �� N�� ■��IN■� ■■ ■��\��N��Il�tlu�� ■ u�%�� :�:::��a....... ...... ....,.. ,.. ... .� ...... .:::� .:...:_:::�......C....�■.��.. . . . .■_.._....... �� ■��i��i�iiiiiiiiiii�'�■� ii �=i��i�ni iiii��=��:iii ��u��■��ni��■��■��i��_■��_�■��■�_��i�� ■��■�vs.��i■-:�7�■�■��I�■r�� ■�� N��■ ■��w�iu��i��rr��■��i��u��i� ■��■��r��■��r�� ■��■iiii�?.:.��J��\I��N��v�ii::i��iiii� ■��■��■��■��■■��■��■��\��■ ��N��\��:��v�� ■��■��■��i�riM�� ■■ ��■��■��■ �� ■��i�ru��■�� ■ ��i��■�■�■ � � � / . �� .� . �; ; I)avie Courrty .�lealtfr� 2�epartmerrt • ' and .3fome ..7�ealiFr .�1'yerrcy 210 HOSPITAL STREET I P.O. BOX 665 . MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 July 11, 1995 Cheryl Mundy P. 0. Box 791 Mocksville, HC 27028 Re: Site Evaluation Highway 601 North/5 Acres Dear Mr. Mundy : As requested, a representative irom this office visited the aforementioned site on July 10� 1995. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions. please feel free to contact this office. RH/wd Enclosure(s? Sincerely� �� .�� .� Robert B. Hall� Jr. , R. S. Environmental Health Section _ _ __ __ _ __ ___ _ __ _ _ :.;a � . � Wil-I-IAM �AVIP �001�, 5R, I '. ,:j � pp, 9a P4. 79a , ; �s ei � 29 473 ( �� 49 3i6 27 57B � � a9 2A3 � YI . �� 1 ! � tl l OU' 1�- u�" E—" 7e] 21 fOTAI. � i s�+M•�ra+.w�s . '� :} 2lSOl 9Jf�tl I i � �ww 1 �' � ��U � `�� „o I� J. �17 � . . 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O�� r` � ' II . � y` } � 3 ' � f ' ,`��vT /� � ` U1 ��:G� �.�n�i�,c� � n �� 1� - �, s"°` •�'; d ��d / ro�°� � � � =��, � � �95.� a / , N N W� 1 � �� ,,� � � . �� / / , ,� $ � a � �� / �' �� " � � . � �:; ., , � � ; • '�• , ,n . . ' �: ,` , . . �:�-. �; , . � , , ;. ` , . . � �— �_ - ---- - _ _-- -- - J_ �_-�,�- _