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1167 Williams Rd Lot 2 Davie County,NC Tax Parcel Report Wednesday, October 19, 2016 r 1195 ~' r 1197 1167 1 5 5 5 r'~r 1151 � I 1165 1141 II 5 1 L �l 1 , n LLL \LL\ til N111..L1ANq'S I. 5 � I L � L M1�5 I l\ L' l I 5 L � WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: 170000004903 Township: Fulton NCPIN Number: 5778179362 Municipality: Account Number: 82528848 Census Tract: 37059-804 Listed Owner 1: DAVIS LOU H Voting Precinct: FULTON Mailing Address 1: 1167 WILLIAMS ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag.District: No Legal Description: LOT 2 BAILEYS RUN Fire Response District: FORK Assessed Acreage: 0.86 Elementary School Zone: CORNATZER Deed Date: 10/2007 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 007340066 Soil Types: PcB2 Plat Book: 0007 Flood Zone: Plat Page: 135 Watershed Overlay: DAVIE COUNTY Building Value: 43860.00 Outbuilding S Extra 1100.00 Freatures Value: Land Value: 20790.00 Total Market Value: 65750.00 Total Assessed Value: 65750.00 All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie Countys 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 moo N NC or arising out of the use or Inability to use the GIS data provided by this website. pa� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001496 Tax PIN/EH#: 5778-27-1347.02 Billed To: William Shrader Subdivision Info: BAILEYS RUN Lot#2 Reference Name: Location/Address: Williams Road-27028 Proposed Facility: Residence Property Size: 3/4 acre ATC Number. 2644 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 WASTEWATFR CONSTRUCTION IS VALID F R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: - Date:, 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. Septic System Installed By: ��,� Environmental Health Specialist's Signature:_ LZZ11 Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section •. P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001496 Tax PIN/EH#: 5778-27-1347.02 Billed To: William Shrader Subdivision Info: BAILEYS RUN Lot#2 Reference Name: Location/Address: Williams Road-27028 Proposed Facility: Residence Property Size: 3/4 acre ATC Number: 2644 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION 1T'SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type 4Zje #People #Bedrooms #Baths _ Dishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial)Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply ro Design Wastewater Flow(GPD) Site: New Repair❑ System Specifications: Tank Siz%GAL. Pump Tank GAL. Trench Widthc2Rock Depth Linear Ft fo/ Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)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.**** F l Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) 1 - APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC D Davie County Health Department N0� Environmental Heal fi Section 4 2n,'n, P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Bille y ,1 F) ' v— Contact Person nA S4-0 W Mailing Address �1 p ll�ll ,Qpp \ \' 1 1�,p Home Phone —F1 'e- O City/state/ZIP r(�17�1� V 1 rl�C UV 1 4, U W�usiness 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 Service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People _ # Bedrooms _ # Bathrooms Dishwasher ❑ Garbage Disposal Washing Machine '�I Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 10 County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes o If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Z rty�HinTensi ns: '� WRITE DIRECTIONS(from Mocksville).te PROPERTY: ffice PIN: # '77 8 a7— 13 ` 7. c) &n 4E7 .� L74 lkl- Pro ress: Road Name City/Zip ( 0 /'� (�c� 1 l ► �tmr Kc( If in a Subdivision provide information,as follows: -ey- Name: a t L-"J=E PL4-e-01 Section: Block: Lot: �` Date Property Flagged: °T ' 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 to conduct all testing procedures as necessary to determine the site suitability. DATE 'A — b 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). Site Revisit Charge Date(s): Client Notification Date: t^cA ` 'TL EHS• e f f Account No. Revised DCHD(07/99) Invoice No. ` L/ a f)Qs �° - w 175.00 174.98 ® St•y � W ' 0 AREA.= Off" N AREA= . N 972 AC. INCLUDES 0 INCLUDES S.R. 1610 R/W -V r" f AREA. 47 0.971 AC. o� 1 " / INCLUDES S.R. 1610 R W 4. .836 AC. ACC 1610 R W Q t�EGATrvE E�_ t (P cu NEGATIVE Co 175,00 30 30 " 1298 OTAL S u ffjLr + S j D 2 • 16 / O 71 . S.R 0530' 30- We, hereby certify that we are the owners of the property shown and described hereon and I, hereby certify that the Davie County Health that we hereby adopt this plan of subdivision Deportment has evaluated the subdivision with our free consent, establish minimum set— entitled : BAILEYS RUN back lines and dedicate all streets, aIle with respect to criteria and conditions established parks and other sites and easements to� walks, ubc by state law or promulgated thereunder and the or private use as noted. Futhermore, we hereby some is found to comply with such criteria and dedicate any and all sanitary sewer, storm sewer conditions EXCEPT as set forth in such evaluation. and water lines to Davie Coun For details of this evaluation and for limitations, ty(if applicable). see the written report on file at said department. IMPORTANT NOTICE: THIS CERTIFICATE DOES NOT OWNER CONSTITUTE A PERMIT OR APPROVAL OF INDIVIDUAL LOTS IN SAID SUBDIVISION FOR INSTALLATION OF SEWAGE FACILITIES. OWNER ATE DAVIE COUNTY HEALTH OFFICER I, hereby certify that the subdivision plat shown hereon has been found to comply with the Davie CERTIFICATE OF APPROVAL BY DAME CO. COMISSIONERS County.Subdivision Regulations with exception of I, Bobb such variances, if any, as are noted in the y Knight. Chairman minutes of the Planning Board and it has been of the Davie County Board of Comissioners hereby approved for recording in the Office of Deeds. certify that said board has approved this plat It is hereby noted that such approval for entitled : BAILEYS RUN recordation does not include approval for the on this the day of ,2000 construction or occupancy of buildings or structures. CHAIRMAN DAME COUNTY BOARD OF COMISSIONERS DIRECTOR DAME COUNTY PLANNING DEPARTMENT ` REVIEW OFFICER'S CERTIFICATE CERTIFICATE OF APPROVAL BY THE P I. John Gallimore, Review officer of Davie County, CANNING BOARD The Davie County Planning Board has hereb .S certif th the ma or APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT D y' Davie County Health Department 13 Envltnnmenf&Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 :a; �w3e' : s (336)751-8760 i. ***n1PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed � n('.,.1 c}.r�l1 ' Ck S S i C( I Contact Person �' t G l Cc S.5lC N Mailing Address � {V I IIc Q 6("\Y L�C�(1e • /�1\ l/ Home Phone � c� ' - 2(-o C\� City/state/ZIP M. LAC�1., i 1 (e- (V (v '116 U ?�1 Business Phone � l � � �C'o 2. Name on Permit/ATC if Different than Above MY b1Ie- �� Mailing Address city/state/Zip 3. Application For: (Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: X House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People � # Bedrooms .� # Bathrooms �- Dishwasher O Garbage Disposal Washing Machine ❑ Basement/Plumbing U Basement/No Plumbing 6. If Business/Industry/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 a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes K No If yes,what type? ***IMPORTANT***CLIENTS MIST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: �GS� S WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 1�1-I wGl L-e- X 1 1 t���� Property Address: Road Name 1 (CL W\,S CI I D 11 r City/Zip Ag C e- 11 Ci CA n 0 0 r D L To-f fYNa? 1# 49 60(, If in a Subdivision provide information,as follows: Y 11 �C I Name: lav/ ,'1.6 ,c,r t L) V\ 11 1�� Section: Block: Lot: Date Property Flagged: 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. 1,also,understand that 1 am responsible for all charges Incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department- to epartment' to enter upon above described property located in Davie County and owned by�M c s 14 ' q e[P to J C&S S << 3 to conduct all testing procedures as necessary to determine the site suitability. DATE CD 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). I' Site Revisit Charge ���� G TTGZ C 1"1 P 4 . �- I n Date(s): 5t,z � veN be Con-.�IeEec� 4tvLC� wilt h� Client Notification Date: Coe C� ?(e-Ci S (� V 2 Q Cl ✓,a 11 c C. {� 1 t C 1 _ EHS: e c�611A . c�6 , Account No. Revised DCHD(07/99) Invoice No. z 1 ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION L LOT Soil/Site Evaluation APPLICANT'S NAME C r_ DATE EVALUATEDry PROPOSED FACILITY /T PROPERTY SIZE SUBDIVISIONE � ti S �i9I�Y ROAD NAME A/ Water Supply: On-Site Well Community Public C__1 Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position .LL Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH J�F� Texture group Consistence Structure _-541( --r- 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 n SITE CLASSIFICATION: /J EVALUATION BY: LONG-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 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 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Box 848/210 Hospital Street Courier #09-40.06 Mocksville, NC 27028 Phone #: (336)751-8760 July 12, 2000 Helen J. Cassidy 270 McClamrock Road Mocksville,NC 27028 Attention: Ms. Cassidy Re: Site Evaluations— 4 Sites Williams Road/Baileys Tax Office PIN: #5778-27-1347 Dear Client(s): As requested, a representative from this office visited the aforementioned sites on July 12,2000. Based upon the information provided on the Application(s)for Site Evaluation(s) and after evaluations were completed, sites 1 thru 4 were found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked on each site. If you have any questions,please feel free to contact this office. Sincerely, AAW44.19WWAS Robert B. Hall,Jr.,R.S. Environmental Health Specialist RH/mp Enclosure(s)