575 Fairfield RdDavie County, NC N Tax Parcel Report I 66� Wednesday, September 28, 2016
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IC
Davie County, NC
WARNING: THIS IS NOT A SURVEY
Parcel Iriformation
Parcel Number:
L500000091
Township:
Jerusalem
NCPIN Number:
5746669595
Municipality:
Account Number:
79842500
Census Tract:
37059-807
Listed Owner 1:
WILLIAMS WAYNE A SR
Voting Precinct:
JERUSALEM
Mailing Address 1:
575 FAIRFIELD ROAD
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-5214
Voluntary Ag. District:
No
Legal Description:
.82 AC FAIRFIELD RD
Fire Response District:
JERUSALEM
Assessed Acreage:
0.80
Elementary School Zone:
COOLEEMEE
Deed Date:
6/1990
Middle School Zone:
SOUTH DAVIE
Deed Book I Page:
001540560
Soil Types:
PcC2,CeB2
Plat Book:
Flood Zone:
x
Plat Page:
Watershed Overlay:
Building Value:
11980.00
Outbuilding & Extra
0.00
Freatures Value:
Land Value:
13630.00
Total Market Value:
25610.00
Total Assessed Value:
25610.00
IC
Davie County, NC
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
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 or arising out of the use or inability to use the GIS data provided by this website.
AUTHOWIWION NO: 1�55 5 DAVIE BOUNTY HEALTH DEPARTMENT
;Environmental Health Section PROPERTY INFORMATION T' B
Permittee's P.O. Box 848 7 qj7
Name: '/ . /` F rJ `" Mocksville, NC 27028 Subdivision Name: b�
.5,
'' /Phone # 336-751-8760
Directions to property: y 5 i Section: Lot:
i AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# ;7,;7
SYSTEM CONSTRUCTION ,*
Road Name: .l i' / Gib! : 'Zip:
**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
F` au DAVIE COUNTY HEALTH DEPARTMENT -� a
► y ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION -1-'
Permrttee's'Aj
Name-- 1r q'Z 1.%,F
�t, '"
Subdivision Name:
Directions to property: 0 , Section: Lot:
IMPROVEMENT �,'✓
PERMIT Tax Office PIN:#-.� .;. ,'r
Road Name#r;'l'i'! r. Zip:
a --
**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.
QA compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
- ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
f'J PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE Z # BEDROOMS _ 0-- # BATHS _I # OCCUPANTS �' GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE VW TYPE WATER SUPPLY U DESIGN WASTEWATER FLOW (GPD) "''" NEW SITE 1/ REPAIR SITE
�4
SYSTEM SPECIFICATIONS: TANK SIZE,/ --1L16-1/ GAL. PUMP TANK GAL. TRENCH WIDTH .- rlf ROCK DEPTH zj LINEAR FT. 420
*"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 (336)751-8760.
OPERATION PERMIT SIJ % sus
SYSTEM INSTALLED BY:
q
AUTHORIZATION NO. I "'-� OPERATION PERMIT BY: DATE: eq/ahs
BO E HAS BEEN I
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH SYSTEM DESCRIBED ANSTALLED 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)
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTV AND OPERATION PERMITS
Permittee's
Name: l f '� .� :inF , `'`' Subdivis:
.k"0
PROPERTY INFORMATION -t—
i Name:~�
Directions to property: Section: Lot:
IMPROVEMENT ,
PERMIT Tax Office PIN:# ` -111';K-'--
,--.
rr=
Road Name: /' f : I a ; I - rf � /� Zip: �j � ' `,
**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*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS ;0-_ # BATHS _I # OCCUPANTS f GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY 4 DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE,/ --(,,GAL. PUMP TANK GAL. TRENCH WIDTH f ROCK DEPTH ,/�,% LINEAR FT.
nTUFu ,.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
f BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
OPERATION PERMIT fi/�.J cicl 11
� SYSTEM INSTALLED BY: I-"
AUTHORIZATION NO. ' OPERATION PERMIT BY: { - DATE: e A
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH 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)
' l APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT &rr F r a U 5
Davie County Health Department !1
Environmental Health Section
P. O. Box 848 JULI
Mocksville, NC 27028
(336)751-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED U LESS
/' / / ALL THE REQUIRED INFORMATION IS PROVIDED.
9 4
1. Name to be Billed y4/CE 54 Contact Person
r
Mailing Address �7� /-a �/ ' ` Home Phone SS
City/State/Zip N6Y,15l/, /lam °2702 Business Phone
2. Name on Permit/ATC if Different than Above SGS rex E
Mailing Address City/State/Zip
3. Application For:
4. System to Serve:
5. If Residence:
❑ Dishwasher
6. If Business/Other:
# Commodes _
If Foodservice:
Site Evaluation
❑ House O"Mobile Home
# People
❑ Garbage Disposal
Specify type _
# Showers
# Seats
❑ Improvement Permit & ATC
❑ Business ❑ Industry
❑ Other
❑ Both
# Bedrooms # Bathrooms
Ul"Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
# People # Sinks
# Urinals
Estimated Water Usage (gallons per day)
# Water Coolers
7. Type of water supply: k County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes O—No
If yes, what type?
EITHER A PLAT OR SZTF. PIAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PA?6�5M THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: / 00 E 13v 300 1
Tax Office PIN: # 9-74& - '7 7
Property Address: Road Name %�A t 2 fr a/ (�
City/Zip 0 c 61, , (�e 7 od
If in Subdivision provide information, as follows:
Name:
Section:
Lot #:
WRITE DIRECTIONS (from
Mocksville) TO PROPERTY. f
1,01 -50A 4 F"q'n Cld
RSI RPI°leo/. 1.5 M,i 1 e -s
of\ 1-44 i"n SK AP'o
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 AeO WN i , /? W< ll(AM s to conduct all testing procedures
as necessary to determine the site suitability.
DATE .5 - S ' 9 V SIGNATURE
Revised DCHD (06-96)
THIS FORM FOR DRAWING YOUR SITE PLAN.
yo, 00110
r` ol) ff
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME �'`f DATE EVALUATED
PROPOSED FACILITY !� PROPERTY SIZE O d U
SUBDIVISION ROAD NAME
Water Supply: On -Site Well
Community,
Evaluation By: Auger Boring I,--" — Pit
Public t__/
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence i
Structure jL
Mineralogy
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: f
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-90)
LEGEND
Landscape Position
EVALUATION BY:
OTHER(S) PRESENT:
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 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 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
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