801 Sain Rd Lot 2 Davie County,NC Tax Parcel Report Monday, December 19, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: H607OA0002 Township: Mocksville
NCPIN Number: 5759130713 Municipality:
Account Number: 82517437 Census Tract: 37059-805
Listed Owner 1: POTTS LINDA B Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 801 SAIN 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: LOT 2 DUTCHMAN ACRES Fire Response District: MOCKSVILLE
Assessed Acreage: 0.54 Elementary School Zone: MOCKSVILLE
Deed Date: 8/2001 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 003850595 Soil Types: GnB2,MsD
Plat Book: 0006 Flood Zone:
Plat Page: 005 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding 8s Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
9 hI� 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.Ali 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
NC or arising out of the use or Inability to use the GIS data provided by this website.
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DAVIE COUNTY HEALTH DEPARTMENT YD
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# IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in'Campliancle With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name :�� u :,� ✓;'C f �)IAyJ�Date �–,g� N2 7 5 3 4
Location r
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House _ _ Mobile Home —T Business -- Industry
No. Bedrooms No. Baths _ _ No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for Syste ,��11
Auto Dish Washer YES NO ❑ , C
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Auto Wash Ma^hive, YES � NO ❑ f � ,�v� y ""'�(/" �,
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.
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Improvements permit by
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*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.
Final Installation Diagram: System Installed b
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Certificate of Completion Date S
'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.
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department ---- _
Environmental Health SectionLii2
P. O. Box 665
Mocksville, NC 27028 A1 1"
1. Application/Permit Requested By
Mailing Address 1,--F 9 ,� 3� Home Phone Q b
0�h Business Phone r'�,3yr�C��
2. Name on Permit if Different than Above
3. Application for: ❑General Evaluation &6eptic Tank Installation Permit
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry\— ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision �u�rc' c-s' Section Lot #
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms p'Washing Machine
No. of Bathrooms E�Dishwasher
Dwelling Dimensions b� ❑ 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: �' lox
❑ Private ❑ Community
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8. Property Dimensions o X QSo ' D Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes VNo
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:
This is to certify that the information provided is correct to the best of my knowledge, and
I understand 1 am res onsible for all charges
incurred from this application. ,
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DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 4X 1. I 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:
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 SIGNATURE
DCHD(1/93)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name 1-1�1'�/y�A7►� �� Date
Address Lot Size l/D Xo2fl)
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position
PS PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S _ P
Loamy, Clayey, (note 2:1 Clay) rD
U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils P 0
U U
4) Soil Depth (inches)
P
U U U U
5) Soil Drainage: Internal & v r
Cp '
U rtpfUfg
External S
4 & (TF
U U U
6) Restrictive Horizons _
7) Available Space 05
U U U
8) Other (Specify) S S S S
PS PS PS PS
U U� U U
9) Site Classification -
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by 141&
Title v Date AV
SITE DIAGRAM
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UCHD(6-82)