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395 Deadmon Rd�avie County, NC � Tax Parcel Report Wednesdav, October 12, 201 E WARNING: THIS IS NOT A SURVEY ,� �_..�_..� __� �...,��..�._��_ _ -�., ..__..� __.�n_.....� __ ' Parcel Information " .,.��� ��..�_.�.._�.,�.�� �„�. a.�,.�..�ti�.._��,a�..�..,�.,� _�.�3 __m�_ _ ,��__ , A.�..���...._..o�� .�� Parcel Number: K500000019 Township: Mocksville NCPIN Number: 5747443077 Municipality: Account Number: 25224500 Census Tract: 37059-805 Listed Owner 1: FELTS KEITH ALAN Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 395 DEADMON ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 38.28 AC DEADMON RD Fire Response District: JERUSALEM,MOCKSVILLE Assessed Acreage: 36.70 Elementary School Zone: CORNATZER Deed Date: 5/1992 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 001630861 Soil Types: Mr62,PaD,GnB2,EnB,GaD,CeB2,ChA,MsD Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 489950.00 Outbuilding & Extra 61420.00 Freatures Value: Land Value: 230850.00 Total Market Value: 782220.00 Total Assessed Value: 592300.00 9" �'A Davie County, `'oUN�� NC tV f � 1 ;�, . , , . � b��o Au�O �IZ�TION'N�: ���� DAVIE COUNTY HEALTH DEPARTMENT >'-,� �`� , Environmental Health Section PROPERTY INFORMATION Pemiittee's *'"� ,r ,l � •�r� P.O. Box 848 Name: ���' t`��" J C"a' f��+*"�'�'�,'''��'°' �r;,�;�,'".,,,r' Mocksville NC 27028 Subdivision Name: � i � e Phone #: 704-634-8760 Directions to property: ����/�;�7:"- ��� Section: Lot: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON Tax Office PIN:# ''�`"�-'-'" "'��� ,-�t� '" � �.- �� Road Name: � ` Zi a � � p: :� `� � - �' **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections O�ce when applying for Building Pernuts. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �� ;1,/' �/,.�5 ,r,.-=;-�'�-'f' � ti,�*,, RONMENTAL HEALTH SP CIA %� ,,r� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION _ �` �'%� IS VALID FOR A PERIOD OF FIVE YEARS. / DATEISSUED � i ' � � y 1q � i:. , i � � ��r�'��` � `" ':Q r� �-;�. � ' , «� " �"� T � �� �;� DAVIE COUNTY HEALTH DEPARTMENT �" �°�'=`� *.� ' TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ,' Perm�tteers °;r" � °° �'� ' � .�,.' '�� � Name t.� t c. �; r�F f r'�"�: �""'� J�� � '��w ��' Subdivision Name: ' � �. � � , '' • e „�,.,�+ � . . ' . .... . , . � ., �q .I� . . : ' 1. ,. Directions to property: f;_` •,' fr� Section: Lor. . IlVIPROVEMENT PERMIT Tax Office PIN:#..;4'r''"�-' �t= "�: : :' G� `:' �' � � ��-. • .. . . ��e'� ! .. �. . � � . . a�]'y't � J � � A � ' 1 , i� Road Name .�' w. � �'; � ,� �t . ��''Lip: '-'M° f/ �-•` � R :, I**NOTE** This Improvement Pernut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained fivm this Department prior to the construction/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) i F; r �, f.: ` --- �.� �`.;='` "**NOTICE*** TEffS PERMIT IS SUBJECT TO REVOCAITON IF STI'E ,, .' f,�' ���,�, . r �:��. :'-�'``�i; ,�....�� r",r+�` ,� ,.s PLANS OR TI� IlVTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST /� DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMTf BEFORE \ { INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFTCAT'ION: BUILDING TYPE e'�it # BEDROOMS �,.,•`'��# BATHS �# OCCUPANTS � GARBAGE DISPOSAL: Yes or No � COMMERCIAL SPECIFICATION: FACILTfY T'YPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE ���'� ` TYPE WATER SUPPLY �r/% DESIGN WASTEWATER FLOW (GPD) ��=�°�(� NEW SITE J./" REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE �r �r.) GAL. PUMP TANK GAL. TRENCH WIDTH �� � ROCK DEP'I'fi �_ LINEAR FT.. �I�� � REQUIRED SITE MODIFICATIONS/CONDTTIONS: 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. OPERATION PERMTT SYSTEM INSTALLED BY: t— _ � — � �—� - AUTHORIZATION NO. � OPERATION PERMIT BY: DATE:G �� **THE ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED N C�MP I�CE WITH ARTICLE 11 OF G.S. CHAP'TER 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 OS/96 (Revised) .� `" APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC - � ' Davie County Health Department _. Environmental Health Section ���,•�� P.O. Box 848 �� �' Mocksville, NC 27028 (704) 634-8760 '�***IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C�'o � a� �<� (3� •(��' �� c Contact Person � Q��'1 � r� Mailing Address 1 � �/ �w ..i �S � � s Home Phone g Qi ��5�8'"t y City/State/Zip '�'� va-n t,t, �'V L aZ oD 4 Business Phone q' �i O-a 3�1/ 2. Name on PermidATC if Different than Above 11i c�� � T-- a�� ��'S MailingAddress 3$ S �ccss � r�o.— Roo� City/State/Zip (�%o� �s �`1 t� 3. Application For: [] Site Evaluation [�Improvement Permit & ATC [] Both 4. System to Serve: [�iouse [] Mobile Home [] Business [] Industry [ J Other 5. If Residence: # People�_ # Bedrooms� # Bathrooms� [vj'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: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: �„County/City [] Well [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [] No If yes, what type? � E Z THER tt PLAT OR S I TE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **'��IE�A�`I' OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: .3.s ���cS ; WRITE DIRECTIONS (from Mocksville) TO PROPERTI': Tax Office PIN: #� - `��I-30 - "r % ; Property Address: Road �ame ����o ��ua d � City/Zip � G�s.. � ��G ; If in Subdivision provide information, as follows: � � Name: � � � Section: Lot #: ; 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 entey�npsy► abyv�d�e�roperty located in Davie County and owned by DATE to Revised DCHD (06-96) THIS ttRE,1 �lttlj $E USEb �OR 1�RA�VINC� 1jOUR SZTE PLAN: necessary to determine the site suitability. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department � Environmental Health Section D P. O. Box 848 Mocksville, NC 27028 1 (704) 634-8760 �` i *'��*IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED i�1 ALL THE REQUIRED INFORMATION IS PROVID� 1. Name to be Billed 'f�P t`tv i�� ��� Contact Person � c� � a�� SEP 2 6 ,�:;;; !� � � MailingAddress ��J`— JJ.P��'Vin/1 �OGt� HomePhone �.��- �/.Tc4' City/State/Zip �'1LY+�V1 �fQ� e, o'270c�g BusinessPhone '1D'�/-�.��'cSliS 7 2. Name on PermidATC if Different than Above Mailing Address 3. Application For: � Site Evaluation 4. System to Serve: L�7 House ❑ Mobile Home 5. If Residence: # People _ City/State/Zip ❑ Improvement Permit & ATC ❑ Business ❑ Industry # Bedrooms ❑ Other # Bathrooms ❑ Both ❑ Dishwasher ❑ Garbage Disposal 0 Washing Machine ❑ Basement/Plumbing ❑ BasementlNo Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �� . � C�L C"�S Tax Office PIN: # rJ�%y� -'�y 3� - �1 "1 Property Address: Road Name �� �PCic�Ma►� �a� • c�ry�z�P Moc-ksvill-e 1�[,C `����� � If in Subdivision provide inforrnation, as follows: Name: Section: Lot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: (ob� S. �.Ctrrl � e�' I �ind�iihan ,�' . , t 1 �� 2 a � /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 aze subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsifed 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 �� G1►��j �i YIC� f'Q �� to conduct all testing procedures as necessary to determine the site suitability. DATE 9�c2 �(0 SIGNATURE �JL1ua CC ��p J�J�Q Revised DCHD (06-96) p��Q.0.5e L���� ��ti�1 �u h�? Can �o w�4�� Y�u . ,� . � , ; DAVIE COUNTY HEALTH DEPARTMENT • . � _ , Environmental Health Section � Soil/Site Evaluation NAME �Pi 1� �� c,�;�� DATE EVALUATED / b-� � J� ADDRESS �J���'� PROPERTY SIZE �� �� PROPOSED FACIILTY �� �"� p LOCATION OF SITE �-�-+�"�'�'°�� Water Supply: On-Site Well � _ Community Public Evaluation By4��AugerBoring Pit Cut FACTORS 1 2 3 4 Landscape position S s _ �__ � � � ___ ___ Slope 7. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure MineraloAy Texture grou Consistence Structure Mineraloev SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RAT 0 � � SITE CLASSIFICATION: � 1' ' LDNG-TERM ACCEPTANC RATE: — REMARKS: ��_ �����; DCHD (01-901 0 � � � EVALUATED BY: � � OTHER(S) PRESENT: �\�S��� ��.��0 . _�� _ 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-Si1tY •: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 Wat NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure ,iC--SYn�le grain M-Massive CR-Crumb GR-Granular ABK-MQular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mi neralaic�► 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 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/ft2 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section /� � P. O. Box 665 , ������ Mocksvilie, NC 27028 �I' 1. Application/Permit Requested By �`� ey � tire v `�r ��s �� ���� Mailing Address ���i • � 4� �7� � � �I � � � V� ld C �P /t� �'� �� %bb � Home Phone � ��— �.� � �- Business Phone ,�'7 �7� ' i % 3� 2. Name on Permit if Different than Above �'( �► T� "�e- /��S — 3. Application/Permit for: C�General Evaluation �eptic Tank Installation 4. System to Serve: �House ❑ Mobile Home ❑ Place of Pubtic Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # No. of People � No. of Bedrooms 3 No. of Bathrooms �-- Dwelling Dimensions v� �" �5-�-- 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks _ No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? � Yes If yes, what type? �'BasemenUPlumbing ❑ BasemenUNo Plumbing C�' Washing Machine �Dishwasher ❑ Garbage Disposal ■ . ❑ 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: � £ �l � Ic� b /� c� �ti le�-�, - > • � �S � e / e �� � �-� > >e �o ��� �e�� /� -��/� C 1� e c� LI � 1 This is to certify that the information provided is correct to the est of my incurred from this application. �-�.�^ q� DATE SI I understand I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. I OWN the property. p 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. DATE DCHD (12-90) SIGNATURE �_ �, ,„. r�"Yu?"R"� S � ��5�'.i +; '7�' . r 1� az'^ t (S) : i U . � � .. - .&� r � a{ . . . k . �. + . � S �yt;�' �r'� -� ° C�y . . �(Q: �' ' � � ;�q),'k.� �.�� �*<�yl�'ii� ��t`% i�� . +C.,i:' . ±'Q�.. O ��;4 �r�,�;�� .. � �a;i � `� �2' 7!�,,,, , ��� 9 �q,� n"-��"� � f�: � '"� � ��, 5 "'t�b►,, y„�d' i ,�',,j��y,. � � Rd.,. 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Slo e 7. � s � HORIZON I DEPTH � Texture rou / Consistence Structure Mineralo HORIZON II DEPTH �'" �' -��'" 1�� Texture rou � (` l' Consistence � t -C:- i Structure /„�' �/� � /.L �iyii MineraloQy /, �/ %� /f % .�. 7 HORIZON III DEPTH Texture group Consistence Structure MineraloRY HORIZON IV DEPTH Texture group Consistence Structure MineraloRy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LDNG-TERM ACCEPTANCE RATE: REMARKS: �1'1�_.�i''C�/%� DCHD(01-90� � i - � i EVALUATED BY: ��''" OTHER(S) PRESENT: _ 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 Textvre 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 SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moiat 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 Structnre SC-SYngle grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic F�Iincralo�zy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - tn inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free watef 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 ■�����������������■���■����■■������■�o■■��������■��■�����■ �� �e■ ■�■������■■■■�������■�o��■���■��s��■������■��■������■�����������■ ■■��■�■��■���������������������■ ■��������■������������■������ ■■ ■■��■��������■■���►����■■�a����n •�i���n�������������■■�����■�����e■ ■����■■�■■■■�������►■■��`a�ir������������!���■����������■�������������■ 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Keith 1=elts cio l�ilb�r�t Naqer Yft. 1� �{OX ,:iE+y-H HdvancE, N� �7�v�b llear Reaitar�: �D�ine Cvunfy .�fealtFi ?�eparhneiit and �fome ..�fealt�r .�1"�ency 210 NOSPITAL STREET I P.O. BOX 685 MOCKSVILLE, N•C. 27028 PHONe: (704) 634•5985 PiPr�l l til�[.�� �7y4 Fte: �ite Evaluation Ueadmon Raad Ns requested, a r-•epresentative from this o1�l�ice visited the aforemen�ioned site on �pril �3, 1y�3c. I'he site was fio�md pr,ovisionaily suitable for the installation of a gro�md absarption sewage system. Yh you have ar�y questions� please feel free to contact this office. Sincerely, ��� l ,,,�;�;� ;,-�x�����,� ` �.. Hobert li. Hal l, Jr. , Ft. 5. �nvironmental He�ltl� Section KH/wcJ tnciosur�c ., ` .` , . , • Mr. Gilbert Boger Rt. 1, Box 569-A Advance, HC 27006 Dear Mr. Boger : JQHH T. BROCK County Attorney for Davie Co P. 0. Box 347 Kocksville, KC 27028 July 1, 1992 Re: Site Evaluation/Bobby Bodford - 550.00 Billed 04-23-92 Site Evaluation/Keith Felts - 550.00 Sevage System Check/Cabe-Felts -.550.00 Billed 04-30-92 According to our records, you are in arrears in the amount of 8150.00 on your account with the Davie County Health Department for environmental. health services provided by our agency on your behalf. These fees were due and payable at the time the service rras provided and are nov past due. Please arrange to complete payment of the above amount vithin 10 days from the date of this letter; othervise, I will be compelled to take action to collect the said amount. Please send payment to the Davie County Health Department, P. 0. Box 665, Mocksville, N.C. 27028. itespectfully yours� ��� � John T. Brock County Attorney for Davie County JTB:eh S �-w - : - 27avie County �CeaCth �eparttnent . ' and .�-Come .�CeaCth �'.gency �nvironmentaC�L'eaCth Section P.O. BOX 848 / 21O HOSPRa� STREEr COURtER #i09-40-06 MxKSVILLE, N.C. 27OZB PHONE: (704) 634-8760 October 8, 1996 Keith A. Felts 385 Deadmon Rd. . Mocksville, NC 27@�8 Re: Site Evaluation Deadmon Road/38.� Acres 7ax F'IN: #5747-44-3�77 t� De�r Clientp�' � Rs req��ested, a representative ft�om this office visited the aforementioned site on October 4, 199E. 8ased upon the inform�tion provided on the application for site eval�iation and after the evaluation was completed, the site was found to be provisionally suitable for the inst�llation of an on—site sew�ge disposal system. If you h�ve any questions, please feel free to cont�ct this office. Sincerely, �....�� �- - ,� �. Charl es E. Litt le, R. S. Environmental Health Section CL/wd Enclosurets)