118 Camden Court Lot 9 Davie County,NC Tax Parcel Report Wednesday,November 9, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: G703OA0009 Township: Shady Grove
NCPIN Number: 5860837289 Municipality:
Account Number: 82532228 Census Tract: 37059-803
Listed Owner 1: VISSER JEAN G Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 118 CAMDEN COURT Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: LOT 9 CAMDEN YARDS Fire Response District: ADVANCE
Assessed Acreage: 0.67 Elementary School Zone: SHADY GROVE
Deed Date: 9/2010 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 008360411 Soil Types: Gn132
Plat Book: 0006 Flood Zone:
Plat Page: 169 Watershed Overlay: DAVIE COUNTY
Building Value: 120400.00 Outbuilding&Extra 900.00
Freatures Value:
Land Value: 30000.00 Total Market Value: 151300.00
Total Assessed Value: 151300.00
9 A1� 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 orfitness for a particular use.All users of Davie County's GIS webske 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
t+�U N'�� NC or arising out of the use or Inability to use the GIS data provided by this webstte.
AbTHQ�RIaTION NO: 18 4. DAVIE COUNTY HEALTH DEPARTMENT
,,gym,- Environmental Health Section PROPERTY INFORMATION
Permittee;s P.O.Box 848
Name: Z"
Mocksville,NC 27028 Subdivision Name: '" `
/ Phone#:704-634-8760 /
Directions to property: Section: f Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# �✓O �_
SYSTEM CONSTRUCTION
Road Name:t..1�X11F��1Y t.t.Zip; t dV�G
**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 Fonn/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.
ENVIRONMENTAL HEALTH SPE IALIST, DATE ISSUED
1 1 8 4 DAVIE COUNTY HEALTH DEPARTMENT «
IMPROVEMENT ANUOPERATION PERMITS PROPERTY INFORMATION
Permittee,' , j
Name:,.,—,�'� r r� ,rr� .:_r°�f. #y"lfLa h, �"1 f c"a"+.: .. Subdivision Name:
Directions to property: ! �✓ a .' �'�+r'° Section: Lot:
IMPROVEMENT ,r -
a PERMIT Tax Office PIN:# " -
Road Name:[.-.b)I)Jk�Is/ 6r•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 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)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
/' �, / ,., �i• f 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 3 #BATHS Tim#OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTErYes'or No
4
LOT SIZE ? JT TYPE WATER SUPPLY C v DESIGN WASTEWATER FLOW(GPD) NEW SITE Ie-- / REPAIR SITE-
SYSTEM SPECIFICATIONS: TANK SIZE ) )GAL. PUMP TANK GAL. TRENCH WIDTHROCK DEPTH,� LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
"CONTACT A REPRESENTAT11 E OF E D VIECOUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A. .OR :00-1. op.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760.
OPERATION PERMIT
YS INSTALLED BY:
I
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AUTHORIZATION N0._ $l OPERATION PERMIT BY: / r, '�"�u DATE: /J
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE T THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWA 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)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE STT& ATC
Davie County Health Department
Environmental Health Section D
P.O. Box 848 JAN 2 9 l? S
Mocksville,NC 27028
(704) 63 4-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
LL THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed C-_ :- - Contact Person
Mailing Address u S IJ✓ Home Phone
City/State/Zip ✓W— /U_ C.. Z z Sr Business Phone (2/ � � 3 y - 2 o U (o
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [*,B fe Evaluation Improvement Permit&ATC [ ]Both
4. System to Serve: PTIrfouse [ ]Mobile Home [ ]Business [ ]Industry [ ]Other
5. If Residence: #People 2- '1 #Bedrooms 3 #Bathrooms Z [41fishwasher[LI-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: [ 4-e<6unty/City [ ]Well [ ]Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [4.Af6-**'
If yes,what type?
' EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED:***IMPORTANT**"OEUILT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
Tax Office PIN: # 5-15(- 0 - fs 3 _ i f! ¢:_. 'e
Property Address: Road]Name C L,I
I
city/zip %.�,� _ -.2-7 O k
If in Subdivision provide information,as follows:
Name: ;
Section: -T 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 C - - - , - - to conduct all testing rocedures as necessary to determine the site suitability.
DATE 1 Z y y SIGNATURE_
Revised DCHD(06-96)
THIS AREA MAY BE USED FOR DRAIVINC� YOUR SITE PLAN:
1 s l `7
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APPLICATION FOR SITE EVALUATION/IMPROVEMENTS-PEW
11 i
• , Davie County Health Department
Environmental Health Section
P. 0. Box 665 ; - {OBJ
Mocksville, NC 27028 JA►J
1 ,.Application/Permit Requested By
Mailing Address I tj Home Phone
Business Phone
2.'Name on Permit if Different than Above
3. Application for: General Evaluation ❑Septic Tank Installation Permit
4. System to Serve: YiHouse ❑ Mobile Home ❑ Place of Public Assembly.
❑ Business ❑ Industry her ❑ Unknown
5.. If house, mobile home:Subdivision ea e-m Section Lot#
❑ Basement/Plumbing
No. of.People ❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal j"
6. If business, industry, place of public assembly, other: Specify type j
No.of.People Served No. of Sinks r;
�.
No. of Commodes No. of Urinals
No.of Lavatories No. of Water Coolers
No. of.Showers Water Usage Figures
7 ,Type of water supply:. b'Publi ❑ Private ❑ Community
Sri ��d . -�
8. .Property Dimensions Sewage Disposal Contractor
9i Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes KNo
If yes,what type?
`NOTE: . Improvements Permits are subject to E
revocation, if site plans or the intended use change. Effective October 1, 1989. 1
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Directions to Property: PROPERTY INFORMATION REEQUIRED:
Tax Office PIN #
Road Name ,
1 Box # (if available) j~
City �GY ✓Q/1�-C(2— !;
r
1
This is to certify that the information provided is correct
to a ole �Iunderstand I am responsible for all charges 4
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. P'r• 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 ofth avie Cou ty Health epartment to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determinp,said si ' ui bilitV for a ground absorn sewage treatment
and disposal system.. „
/- -9� z�A
DATE SIGNATURE-
WHO(1193)
IGNATUREWHO(1193)
I
{
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
rr Soil/Site Evaluation /
NAME �72� d DATE EVALUATED 0
ADDRESS 'J PROPERTY SIZE ,>
PROPOSED FACIILTY —,i� sl LOCATION OF SITE f
Water Supply: On-Site Well Community Public 4,"
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe R
HORIZON I DEPTH
Texture group 124-
Consistence
Structure
Mineralogy
HORIZON II DEPTH �-
Texture group
Consistence i
Structure e g1/"
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: �� 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-V?--.-y 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
3C--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
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