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256 Deacon Way Lot 9 WDavie County,NC Tax Parcel Report Monday,December 19, 2016 i i i i i 256 262 i` 1 246 265 + r + i ` r 226 259 Ch I 206 - - 247 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: K503OA0009 Township: Mocksville NCPIN Number: 5747565613 Municipality: Account Number: 8304329 Census Tract: 37059-805 Listed Owner 1: SEAMON CLETUS DANIEL JR Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 256 DEACON WAY Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag.District: No Legal Description: LOT 9 DEACONS RIDGE Fire Response District: JERUSALEM Assessed Acreage: 2.49 Elementary School Zone: CORNATZER Deed Date: 11/2014 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 009730238 Soil Types: Ce132,MsD Plat Book: 0006 Flood Zone: Plat Page: 061 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: OAll data is provided as Is without warranty or guarantee of any Idnd 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 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 �o NC or arising out of the use or Inability to use the GIS data provided by this website. !( i •' HEALTH DEPARTMENT RELEASEFor office Use Only *CDP File Number 1194331 - 1 � = d Davie County Health Department 210 Hospital Street County ID Number: P.O. Box 848 Evaluated For. HDRNVWC Mocksville NC 27028 Phone: 336-753-6780 Fax:336-753-1680 PERMIT VALID 0 6 1 0 a l a 0 a 0 UNTIL: Applicant: Susan Seamon Property Owner: Susan Seamon Address: 256 Deacon Way Address: 256 Deacon Way City: Mocksville City: Mocksville State2ip: NC 27028 State0p: NC 27028 Phone#: (336)682-1244 Phone#: (336)682-1244 Property Location&Site Information rAddresSL256 Deacon Way Subdivision: Deacons Ridge Phase: Lot: 9 # Mocksville NC 27028SINGLE FAMILY Township: cture: Directions #of Bedrooms: 3 #of People: Hwy 601 South,left on Deadman Rd.Left on Turrentine Rd,then left Into Deacons Ridge 'Water Supply: PUBLIC Basement: r]Yes❑No Type of Business: Total sq. Footage: No.Of Employees: 'Proposed Improvement: Pool 'Release Conditions ` - r This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps.Signature Required? OYes ONo Applicant/Legal Reps.Signature: *Date: *Issued By: 2140-Nations,Robert *Date of Issue: 0 6 / 0 a / a 0 l 5 Authorized State Agent: **Site Plan/Drawing attached.`* ®Hand Drawing Olmport Drawing HEALTH DEPARTMENT RELEASE ' . ` ' 194331 - 1 sTd Davie County Health Department CDP File Number: 210 Hospital Street County File Number: P.O.Box 848 Mocksville NC 27028 Date: 0 5 / 0 2 / 2 0 1 5 0Inch Scale: OBiock Drawing Type: Health Department Release QN/A I 7—7-7 I E r r w ! l l { i 1 i I""t Nz _ _ kitG.,c. i I I I i � � I -�_, I Page 2of2 • Davie County Health Department i std' environmental Health Section Zq P.O.Box 848 : ti 210 Hospital Street +� Courier# : 09-40-06 .�9 Mocksville,NC 27028 r Phone:(336)-753-6780 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: Sus, N Leo an Phone Number✓/� (Home) Mailing Address: aNe Q (Work) /r/'1 LX)� Email Address: Detailed Directions To Site: Property Address: Please Fill In The Following Informa/tion About The EXISTING Facility: Name System Installed Under:�Q�%7'rQ�(/Li;E'- ? a—S Type Of Facility: Date System Installed(Month/Date/Year): Number Of Bedrooms: 3 Number Of People: _ js-he-Facillt.,,_C„rrentl3VacanO Yec '/No I Tf Yes,For How Long?_ Any Known Problems? Yes 5 If Yes,Explain: Please Fill In The Flo] wing Information About The NEW Facility: Type Of Facility: p/ Number Of Bedrooms: Number of People Pool Size:_ Garage Size: Other: Requested By Date Requested: 5. 11 (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (ext d or limited)that the on-site wastewater system will function properly for any given period of time. Paymen Cash Chec Money Order # Amount:$ -d �,Doate: //16 I If Paid By: Sia Received By: 6(.lN,fllj`�/� Account Invoice#: DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE:lss.u'ed in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number NaME Date No 7553 Location ,Zn& Ommem ww_ Sec.or Block No. Subdivision Name Lot No. Lot Size House Mobile Home Business___Industry_ No. Bedrooms .)_No. Baths No. in Family Public Assembly Other Garbage Disposal YES ❑ NO C3' Specifications for System: Auto Dish WasherE) YES NO Auto Wash Ma-hine YES NO E:] Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by *Cbntact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion Date1d—f 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation,but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. 400 5613 r 7554 tx �f r rr r i' { ,• J. i Printed:May 29, 2015 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. DAVIE COUNTY HEALTH DEPARTMENT • IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a Sanitary/Sewage Systems / Permit Number Name Date �Zz?/9s� N� 15 5 3 Location — _ 5!0 eOA) SubdivisionName S ��" Lot No. Sec. or Block No. Lot Size 11�11 .��� House I— Mobile Home — Business _— Industry_ No. Bedrooms No. Baths No. in Family _ Public Assembly Other i Garbage Disposal YES ❑ NO [?-' Specifications for System: " Auto Dish Washer YES NO ❑ /Cjd,�j,,-,�.�,.r / ��.J Auto Wash Ma^hine YES NO ❑ t Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. Improvements permit by 46'a *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. i Final Installation Diagram: System Installed by — 1� t Certificate of Completion __y� Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. i ti APPLICATION FOR SITE EVALUATION/IMPROVEME ;. Davie County Health Department Environmental Health Section I ��(' —2 P. O. Box 665 J Mocksville, NC 27028 1. Application/Permit Requested Byia 411' b'y a Mailing Address '3O0 6. 14,JhA 51� Home Phone &10 e t` S"" --e 41- 70,x-$ Business Phone 91f 0— 70o S 2. Name on Permit if Different than Above ie 3. Application for: ❑General Evaluation jiYS"eptic Tank Installation Permit 4. System to Serve: 9?"Pouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry El Other ❑ Unknown 5. If house, mobile home: Subdivision 12 e;p eon 5 Section Lot # 91 ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ("Washing Machine No. of Bathrooms A 12 Dishwasher Dwelling Dimensions X d ❑ Garbage Disposal 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 ❑ Community 8. Property Dimensions 0, Q 9 e Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2"o If yes, what type? '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: JSRoad 6k\ 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 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: 1 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 SIGNATURE DCHD(1193) • DAVIE COUNTY HEALTH DEPARTMENT '.01I , Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE � '�7�2�, Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit I---- Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence 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: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 50�0' OTHER(S) PRESENT: REMARKS: � C� ��� ar 26 le 4 41 '."a (l. 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-Anoular 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(01-901 _ . , ' '. ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME I7'/9 �'S� DATE EVALUATED � �_R ADDRESS PROPERTY SIZE <fC PROPOSED FACIILTY LOCATION OF SITE 0 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �� Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralo HORIZON II DEPTH Texture groupC Consistence 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: EVALUATED BY: KIZ 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 ;lay 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 DCHD(01-901 ■■■■■■■■■■■■■■■.■■■■■■■..■.■.■■■ ■■■■■■■■■■■■■■e■■■■■■■■■■■..O■■ iiiiiiiiiiiiiiiiiiiiiiiiii■iiiiiiiiiiiii'■.�iiii■i�iiii'ii■iiiiiii�ii ■■■■■.■.■.■■■■■■.■■■■■■■■■■■■■■. ■■■■■■■■...■■■■e.■■■■■■■■■■.■■■■ ■■■.■..■■..■■■....■■■■..■■..■■■■■..■.■.■...■■../.... 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