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956 Main Church RdDavie Countv. NC Tax Parcel Report 16 '))1 Friday. September 30. 2016 WAR1 ENG: THIS 1S NOTA SURVEY Parcel Information Parcel Number: G40000003417 Township: Mocksville NCPIN Number: 5739294293 Municipality: Account Number: 8302272 Census Tract: 37059-806 Listed Owner 1: SHORES JAMES DEAN Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 956 MAIN CHURCH ROAD 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: 1 AC MAIN CHURCH RD Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.00 Elementary School Zone: WILLIAM R DAVIE Deed Date: 4/2012 Middle School Zone: NORTH DAVIE Deed Book / Page: 008870416 Soil Types: GnB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 12610.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 17010.00 Total Market Value: 29620.00 Total Assessed Value: 29620.00 161 Davie County, 1�TAll l� C 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 harmlessthe 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. tv "Irl - 'i 7/13 Davie County Health Department Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 C Mocksville, NC 27028 Phone: (336) - 753 -.6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection Name: e [_ 7- 1:�� O i- C2 Phone Number �/2 (Home) Mailing Address:_U/Ck7 yid 356 %39'I'-.30ee9 (Work) Email Address: Detailed Directions To Site: Y-10 0 7 /? ;?;)if C,rrCA-- Property A dress: t.. L ' /Please Fill In Inf G Facility: --Name System Installed Under: �j 71 67 , r, ?- 2 G 2'^.-12 5' Type Of Facility: sr= ,r? 7'1,e- Date "ie- Date System Installed (Month/Date/Year): j l Number Of Bedrooms: Number Of People: C. Is The Facility Currently Vacant? Ygc,, No If Yes, For How Long? 7^'1 l'1 7 3 Any Known Problems? Yes C�o If Yes, Explain: • i Please Fill In The Following Informatioon About The NEW Facility: ` + Type Of Facility: '1 0 1,4 K NuMbeer Of Bedrooms: Number of People t Pool Size: / lj -Garage Size: q d .G .�,�, U Other: r ! i' `'i i Requested By:__�� 3� S c r� S%t �, Y� 5 Date Requested: % ,.� U 1,2 (Signature) v . -�- �--- !-for Environmental Health Office Use Urily/'+ t (Approved Disapproved Goinments: Environmental Health Specialist ( ,� ���f`'i�t{�r,C Date: *The signing of this form by the Environmental Health Staff is in no way; intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system;will function properly for any given period of time. Payment: Cash Peck Money Order # i Amount:$ ()O, V V Date: 3 Paid By: �.1 3, i- 4 { P5 1+. ' Received By. l/ / / c, Account #: 5 i5 J y Invoice #: GoMAPS - Davie County NC Public Access ***WARNING: THIS IS NOT A SURVEY!*** Monday, March 12 2012 This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. WATERSHED STRUCTURES WATER BODIES COUNTY BOUNDARY Ft ADDRESS / DRIVES J STREETS RAILROAD CENTERLINE PARCELS CITY—LIMITS BERMUDA RUN COOLEEMEE DAVIE COUNTY MOCKSVILLE nccounties DAV I E <all other values> ***WARNING: THIS IS NOT A SURVEY!*** Monday, March 12 2012 This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. I, C. Ray Cates, cer" that thls plat was drown under my supervision from an actual r.nvey supervision under my supesion (deed description recorded In Book 71, Page 251, etc.) (09w); that the boundaries not surveyed are clearly Indicated as drawn from Ydaxrnotion found In Book Papa_g!._octad that the ratio of precision as colculated to 1:10,000; that this _ Plat was prepared In accordance with C.S. 47-30 as amended. Witness my prig ec' p dgnature, registration number and seat i � CAR0/ Rye` this 24th Se t. day t>< P A0�`�9% _ � �r'��a °•�,cJTe. `• '6' • r • ,c V 6• ° Seal or Stamp m° 1 e SEAL °� s L-26232623 �o • e Registration Number J "� IY Parcel 34 NIP S 63°36'10"E 252.15' I j �O � GO M Location Map NOTE _ THIS PEAT IS SUB R IGPT ` OF WA'r OF RE:. C:kD Parcel '39 �j Richard l Sh o ores, S. Jr. N o cD N � l z �Z, N I � Parcel 39.01 N f D•8e 78;7 Sumrriers 1-1 rTl rebor found 2.000 Ac res by a". .I 173, 0g• N s7°?3rs parcel 34.01 orinie Shores D'F3. 148 — 139 50 Q 50 100 150 ERAP20-GLE _ _ _ --- -- - — EEE LEGEND- _ R/W -Right-of-Way EIP---.-Existing Iron Pipet EIR - Existing Iron Rebar � -Center Line - enter l,i e P - dge of �ovement P - Point CLI - Concrete Monument _ ace o Curb ower Pole NIP - New Iron Placed Pit - Property L Ime � p -fight Pole LIH - Hole R - Radiuu Radius C A - Controlled Access CH - Chord Distance RCP - Reinforced Concrete Pipe P/O - Part of CLIP - Corrugated Metal Pipe SE - Sight Easement CCP- Corrugated Plastic Pipe P _ Reed Book . rebor fr,und TH13 SURVEY IS SUS,.ECT TO Al+D ACG/RAIE TFTIE SEARCH M -F- 100 year Flood Boundary -0- -0- Overhead Utilities - once Posta rebar founds - 1' NIP -X- Fence -S- ewer Line 1 L.1 I El p r nail do cap �8 21 °sound 35.50' Point _. nail do cnrt AI c. ei.�.�.-..- .. . BK852PG31b E,' � ibii A BEGINNING at a new iron pin, a new corner with Richard Shores, Jr. and the grantors and grantees; running thence South 57 degrees 20 minutes 45 seconds East 172.97 feet to a New Iron Pin; running thence -South 27 degrees 16 minutes 14 seconds West 225.77 feet to a new iron pin; running thence South 27 degrees 16 minutes 14 seconds 30.13 feet to a nail and cap in the right of way of State Road 1405; running thence.North 57 degrees .20 minutes 4.5 seconds West 169.00 feet to a nail and cap in the right of way, a new corner with Richard I. Shores, Jr.; running thence North 26 degrees 23 minutes 09 seconds East 30.1:8 feet to anew iron pin (in this line is a 20 foot easement, 10 feet on this property said easement retained by the grantors); running thence North 26 degrees 23 minutes 09 seconds East 256.30 feet (with the same'easement) to the point and place of Beginning. This description from a survey by Grady L. Tutterow, Registered Land Surveyor, dated February 7, 1980 and containing by his computer 1.00 acres. This tract taken from the property df grantors and for back description see Deed Book 71, page 251. Save and except the 20 foot easement, 1'0 foot on this property retained by the grantors. -AUTHORIZATION NO: t .0 3 7 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION "mermittee's P.O. Box 848 r' Name: Mocksville, NC 27028 Subdivision Name: a Phone #: 704-634-8760 Directions to property: `i ll,'& ` Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#0 SYSTEM CONSTRUCTION �— Road Name: 4ir 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. ENVIRONMENI`AL HEALTHSPECIALIST DATE ISSUED "9` DAVIE COUNTY HEALTH DEPARTMENT ,, �- SRT • IMPROVEMENT AND OPERATION PERMITS Jermiifee's Name: �_r Directions to property: 5; PROPERTY INFORMATION Subdivision Name: Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:#= r -'• -�" Road Name: '& l 1,L.fl ,� � . � s I Zip: **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 fmm 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) t _ s ***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 »-? # BATHS --:9--# OCCUPANTS a GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZ �J / A) TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)2- ') NEW SITES REPAIR SITE i SYSTEM SPECIFICATIONS: TANK SIZE?)GAL. PUMP TANK GAL. TRENCH WIDTH �° ROCK DEPTH /i LINEAR FT. I i OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "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 (704) 634-8760. OPERATION PERMIT TEM INSTALLED BY: AUTHORIZATION NO. Ai2 OPERATION PERMIT BY: /(` T � DATE: �f "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE 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) t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION Soil/Site Evaluation APPLICANT'S NAME1 4re5' PROPOSED FACILITY & /V SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit DATE EVALUATED PROPERTY SIZE ROAD NAME Public Cut LOT FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure i 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: 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 Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD (O1-90) MOON ■■■■ ■O■■ ■ON■ ■■■■ ■■M■ ■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■M■■■MMMNMMMM■MM■■ ■MM■■■■■■MM■■■MM■■ ■■■■■ ■■MM■ ■■N■■ ■■■■■ ■■■■■ ■■M■■ • APPLICATION FOR SITE EVALUATIONAMPROVEMENT 22 Davie County Health Department L5 0 Environmental Health Section D P.O. Box 848 FAUG4 1997 �l Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ze: n n 1'e- c rte) Contact Person Mailing Address 9,rC &1,;A ! 1"244011 Home Phone 6 7 V .S City/State/Zip 11-10 C /V vf��� 4/,L, g7o,2Z Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [1I -Site Evaluation City/State/Zip [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [k]'Mobile Home [ ] Business [ ] Industry (] Other 5. If Residence: # People .Z # Bedrooms # Bathrooms % [ ] 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: [ ] County/City [LJ -Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [1-T'No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** XMWOF THE PROPERTY MUST BE r7 SUBMITTED WITHI,S APPLICATION. Property Dimensions: G { V WRITE DIRECTIONS (I i ocksville) TO PROPERTY: Tax Office PIN: #- Property Address: Road Name/"t r` �. G , C�s �N��C �� c f Ci o .Ll f a Sri.. �. ✓ G t/ �'� City/zip n-LC,,C k5'vi'lle- �'[' 7cd F ; 611• C, If in Subdivision provide information, as follows: L -/;Z) l d yC le X? Y Name: Section: Lot #: IeLr -e III 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 % - A h i'&- -52c 7'&) to conduct all testing procedures as necessary to determine the site suitability. DATE 5' — C, - 2 7 SIGNATURE 1, r✓N^ trc P.. � ��,/� Revised DCHD (06-96) THIS A$EA MAY 13E USED FOR DItAIVINC JOUI? SITE PLAN: