4082 Hwy 601S4+Y ..+r 3 h}ap' :1'x. E,i S"1 n"'i:£N'l F'F C 'A Y.1 !�A,L�SNf F„•Yp R.S� � f 1r E'A f'rnJ Y�'! ''.�2.�. \�3i Y'F.,� R 11'IY1'>hk_.-• w'»�-!` �k., { i"'Y_St `s.+,`'Aw�E,.I `{''1y,.+. �N.tvi."4+.1 'd
AUTHORIZATION NO. Q 9 9 4 DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section CQIFTY INFORMATION
.Permittees *. P.O. Box. 848 '
Name Mocksville, NC 27028 Subdivision Name: A00 ri
Phone #: 704-634-8760
Directions to property. i Section: Lot: w
AUTHORIZATION FOR //�� v
WASTEWATER Tax Office PIN:#41.0 �d
SYSTEM CONSTRUCTIONDQ a Q
RoaS Name:— Zip: A 10AQ
**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 BuildingInspections
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_
ENVIRONMEN AL HEAL H SPECIALIST DATE ISSUED
l:"40rtt r *...ro5,�,x rr+a Mt 7tr`r^ ,nx' -+.4i,;;.' '��fi a�`R "',.:'.s �S''�:hty 1s#-c--r"i24_.a, r•w'S�w-'fu av a^',�c,rt i •!ti^i a',e v.. r,11.,;: tr �: F4, t'r"e'yr`yy_.�r.
.� } r .�} `; 3%�� , T' ►oto
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
"Permi`te s
• h
Subdivision Name: o -6R
C
00
,0 Directions to property: �`-? `fir"✓ a - Section: Lot: W
r , i IMPROVEMENT E., J
PERMIT Tax Office PIN:#
Road Name: Zip:
*NOTE** ibis Improvement Permit DOES NOT authorize the constriction 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 abuilding permit
Up 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 /'l A/ # BEDROOMS _ # BATHS ^ # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL$PECIFICATION: FACILITY TYPE - # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE — REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE Z&P GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1,9 LINEAR FT. 3� p
OTHER
REQUIRED SITE MODIFICATIONS/CONDMONS:
IMPROVEMENT PERMIT LAYOUT
L10
dl�j'�
i
DCHD 05/96 (Revised)
• APPLICATION FOR SITE EVALUATIONAMPROVEMENT PEI MIT & ATC
• Davie County Health Department
1E@1EaW[E
i Environmental Health Section D
P.O. Box 848 JUL 1 81997
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
Name to be Billed Contact Person
Mailing Address %Q `=1C) 2 11h /IIe a�G� Home Phone 6 V,5--
City/State/Zip 1//Dl)/tGpi{P //. Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [ ] Site Evaluation [Improvement Permit & ATC [ Both
4., System to Serve: [ ] House [vKMobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People # Bedrooms_ # Bathrooms [ ] Dishwasher [ ] Garbage Disposal
[,J -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 11L ,
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 AMMOF THE PROPERTY MUST BE
6 SUBMITTED WITH TJILS APPLICATION.
1
Property Dimensions: /tel ��6 WRITE DIRECTIONS (from , ocksville) TO
Tax Office PIN: # -5 f7 Z1:i -
Property Address: Road Names, l// & Dl �ll
city/Zip 7?0 '_ / ll p e . 01�%�
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 enter upon above described property located in Davie County and owned
by 1 l�. to con�uc 05A tes n pros dure s necessary to determine the site suitability.
DftEPM7 SIGNATURE_ C7�G?�c' ���J
Revised DCHD (06-96)
THIS AREA MAY BE USED F01t DRAW I NCS JOUR SITE PLAN:
MIA
hluJ • A/ct7��` Gc /Y7� • ,
(114f
(0.52A) I
5108 (630) _ t21
2 A '3
2123
n7sy
x9
(15.98A)
5916
(2797) --..
i
2478
f90)
G.3 `
110 V
4684
4573
273
(1.45 A) t
3452
273
4245
273 '
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME
PROPOSED FACILITY G :�
SUBDIVISION
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit
DATE EVALUATED
PROPERTY SIZE��
ROAD NAME
Public
Cut
FACTORS 1 2
3 4 5 6 7
Landscape position
Sloe %
"
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH 1
f
Texture group
Consistence
Structure
/ /c
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
r
SITE CLASSIFICATION: �� �✓"�/`�d�
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-90)
EVALUATION BY: iC /�✓ �j
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
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 I 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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L c Rey Cutis. certify that thla plot woe dlm under ny
Mow In � sa Po" a actual 0. etc.) (~ gnat 11» eo� not
„xwyed am clearly indicated as dia f rn Womlation found In Boon ea noted
Po" j trot the natio of pr.ol.loe as calculoled to 1:10.000. that We
signature. rogweation nun,°.. and «d 47-J0 as o�»„d.e. rn�+� "r original � � � t 9 � t ► f
3rd June 1997 ` "t+`'`r(0 CAq
tide day of A.D. -,.�'' .......a..1
Seal or Stamp :EAL
,7
r: - -2623
2623 i •7{�
0 0a4 •....••,.
GRAPHIC SCALE — FEET
THIS SURVEY IS SUBJECT TO ANY FACTS THAT MAY BE DISCLOSED BY A FULL
AND ACCURATE TITLE SEARCH. NOT FURNISHED TO W AS OF THIS DATE.
NOTC THIS PLAT IS SUBJECT TO ANY EASEMENTS, AGREE►fNTS, OR
RIGHTS OF WAY OF RECORD PRIOR TO THE DATE OF THIS PLAT.
John A. Spillman etal 3 �5
D.B. 127 — 399 N 2303
(/S. So aaktn (t�ve�
I,
site 60 I �Eh
I
Location Map n.t.s.
LEGEND
NIP
In
C0
Ut to
W N
o CD
_
Lit
LA
NIP T
m
R/W r, Fpyht—of_Way
— Center Line
k
RR Vt°"n9 roe, a.a�
Z
CM Z Concrete Monument
Iron Pleced
We
NI New
P4— Property Line
M1 Mel
R — Radlue
Gpy��.� Accpa
CH — Chard Distance
RCP — ReWorced Concrete Pipe
P/0 — Port s1
—_ Eoeement
CIS — Corrtgated Petal Pipe
CCP— t AIcBou Pape
pppSE
p�pee9eeM��
to d
-i- t00 year Hoed Boundary
0 yew
.plat
watt
D.B. 163-440
Parcel 29.01.
wlliam C. Sanderson
D.B. 192 — 895
Z
Co In
Oo
Jerry Daniel et al
tJ 03
v LJ
Ln P 1D 1`2
Jerry Daniel et al
v tr .p
Ln
1TI
W
O o
0
at
� O
v
Parcel
Par 29
Parcel J5.1
John A. Spillrnan,
2200•+— to South YadJdn Raver
et al
NIP
R/W aJ claimed by the
N.C. Highway Commission
----- NIP
W W
O �
J
to 103.00,
point . S 0 °00'05'W point
601
33,100 Sq.
Ft.
Plat For
Jerry Daniel
Part of Parcel 29,31 ac 35.16, Davie County Tax Map 0-6
SCALE
TOWNSHIP COUNTY STATE
DATE
1" = 50'
Jerusalem Davie North Carolina
06-03-1997
07-17-1997(north line)
C. Ray Cates
SURVEYED:119
Depot Street
JOB NO.
3182
CRC
Mocksville, NC 27028
MAP NO.
MAPPED:
Phone (704) 634-3735
3182-7—A
CRC
k'r-syi.'; lc.'"Ve1v'- as" r,, ',ry.�'.n� A * f,ry. $`Rr..a nC+f.a. r !7 ��.. •1^4uti;iY.,;"u'F"y ;F�F;A. ,q- . e .!'.i,.r y,�`s:,(Nw- *pz,��EtS.e+ a -t'i.kiay?X'Lf,P�J*"'p7,e�i7WY '4i 4` F;;+frti N'.q ^,.li i•^."'C�f"ti«a,• �s=.YY�u.;•yi;,
tL
" Ui,4®l q. kTi& NO: 0887 DAVIE COUNTY HEALTH DEPARTMENT da '
Environmental Health Section PROPERTY INFORMATION
Permittee!fiy P.O. Box 848
Name:.�..� 4 Mocksville,
NC 27028 Subdivision Name:
Q t Phone #:
Directions to property: to i s Section: �"Lot:
AUTHORIZATION FOR `
j�. WASTEWATER Tax Office W59 -
SYSTEM CONSTRUCTION j
Road Name: 9n (.✓ 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. Chapterj30A, 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
„
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department 6
O M E 1
Environmental Health Section D
P.O. Box 848 MAY 1 61997
Mocksville, NC 27028
(704) 634-8760
'I
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNE ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed Q 'e
Mailing Address
City/State/Zip O ��
2. Name on Permit/ATC if Different than Above
Mailing Address
Contact Person
Home Phone lfc�� SSS Sa
Business Phone
City/State/Zip
3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC
4. System to Serve: [ ] House [t ?54obile Home [ ] Business [ ] Industry [ ] Other
[Both
5. If Residence: # People—AL # Bedrooms_ # Bathrooms_'2 [ ] 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: [&xCounty/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ LJNo
If yes, what type?
EITHER A PLAT On SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A42LWMF THE PROPERTY MUST BE
y SUBMITTED WITH T,�II�S APPLICATION.
Property Dimensions: ll ��� 1f �d �� - WRITE DIRECTIONS (from �Iv ksville) TO PROPERTY:
Tax Office PIN: #S�5---v - _ - [ 0270-.czeC
Property Address: Road Name
City/Zip —/ &IIJ f'
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 enter upon above described property located in Davie County and owned
by - 6rnOS S �Qrrki nSiiP, to co duct all testin proced es as necessary to determine the site suitability.
DATE SIGNATURE GC &A J
Revised DCHD (06-96)
THIS AREA MAY BE USEib FOR DRAWINC7 YOUR SITE PLAN:
If
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME Z MSO`+-`�.�
PROPOSED FACILITY
SUBDIVISION
Water Supply: On -Site Well
Community
Evaluation By: 4� Z,"L Auger Boring V Pit
3 -oil
DATE EVALUATED NOW
PROPERTY SIZE O X 3 y o
ROAD NAME S OyNAN
Public
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
1-1
Sloe %
0
100.
d
HORIZON I DEPTH
j
Texture grou
SS - Slightly sticky S - Sticky VS - Very Sticky
C L
Consistence
Structure
Bi
Structure
M - Massive CR - Crumb GR - Granular ABK - Angular blocky
Mineralogy'
HORIZON II DEPTH
h
141D "I
Texture group�-
Consistence
Fi
Structure
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: V .S
LONG-TERM ACCEPTANCE RATE:
EVALUATION BY:
OTHER(S) PRESENT:`"'
REMARKS: . a> );?.r.,x \ 9. • �' 1 a -4' J."�' ""��
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 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
I 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
DCHD (01.90)
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19th June
A. 1997
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Parcel 35.13
19th June
A. 1997
Jerry j . Daniel
TOWNSHIP COUNTY STATE
A.H. Inc.
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D.B. 181 - 796
Plot For
06-19-1997
b." IV. RAP 3 (~I ..N 11-1
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Jerry J. Daniel
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19th June
A. 1997
SCALE
TOWNSHIP COUNTY STATE
DATE
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V - 100,
Jerusalem Davie North Carolina
06-19-1997
GRAPHIC SCA! -E FEET
Stomp
S.01 Or
623
C. Roy Cotes
SURVEYED,.
CRC
119 Depot Street
JOB NO.
3182
-
2623 ...... U153
UAPPED:
Mocksville. NC 27028
Phone 634-3735
MAP N
3182-16
r.
j
CRC
(704)
Parcel #: 060000002902
Davie County, NC - Basic Estate Search
Basic Search Real Estate Search Tax Bill Search Sales Search Q
View Property Record for this Parcel View Man for this Parcel View Tax Bill Information
Parcel#:060000002902
Account #:72036500
Owner Information
Tax Codes
Buildin :
UMMERS KEITH EDWARD & SUMMERS SHERRY KAY
ADVLTAX - COUNTY T
5,64
082 HIGHWAY 601 SOUTH
READVLTAX - FIRE TAX
arket:
OCKSVILLE NC 27028
ssessed•
Information
Township
EressProperty
(Units/Type): 1.000 LT
JERUSALEM
:4082 S US HWY 601
Deed Information
Local Zoning
ate: 09/1997 Book: 00197 Page: 0446
Plat Book: Page:
Legal Description
PIN
1.905 AC OFF HWY 601
5754234991
Property Values
Buildin :
23,77 0011
BXF:
5,64
Land:
21,00
arket:
50,41
ssessed•
50,41
Deferred,
Sales Information
No. Book Page Month Year Instrument Qua]/UnQual Improved Price
1 00197 0446 09 1997 WD Unqualified Vacant 0
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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Davie County Web Site
All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be
consulted for verification of the information. All Information contained herein was created for the Davie County's internal use. Davie County,
Its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
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If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1461562 8/3/2016