430 McCullough RdDavie County. NC
Tax Parcel Renort ) 6aq Friday. September 30. 2016
WAK ING: THIN IS INUT A NURVLY
Parcel Information
Parcel Number:
L5010A0009
Township:
Jerusalem
NCPIN Number:
5746075855
Municipality:
Account Number:
82527873
Census Tract:
37059-807
Listed Owner 1:
WOOTEN MAX S
Voting Precinct:
COOLEEMEE
Mailing Address 1:
430 MCCULLOUGH ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOTS 17-18 MORRIS&HENDRIX
Fire Response District:
JERUSALEM
Assessed Acreage:
0.71
Elementary School Zone:
COOLEEMEE
Deed Date:
4/2007
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
007070380
Soil Types:
GnB2,CeB2
Plat Book:
0001
Flood Zone:
Plat Page:
043
Watershed Overlay:
DAVIE COUNTY
Building Value:
118290.00
Outbuilding 8r Extra
1300.00
Freatures Value:
Land Value:
13180.00
Total Market Value:
132770.00
Total Assessed Value:
132770.00
101
Davie County
7�T/'�
1\ C
All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Im lied warranties of merchantabili or fitness fora articular use. All users of Davie Coun� P tY P ty's GIS website shalt 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.
AUTHORIZATION NO:1528 DAVIE CUNTY HEALTH DEPARTMENT ,; v3rQ
1'Environmental Health Section PROPERTY INFORMATION
Permi`ttee's1 r' h P.O. Box 848
Name: ) ;.��- Ci i `"t Mocksville, NC 27028 Subdivision Name:
C Phone # 336-751-8760
Directions to property: ��Ul ' �� Section: Lot:
AUTHORIZATION FOR , f
WASTEWATER Tax Office PIN:# _ I'7t -7
SYSTEM CONSTRUCTION
�C UN Road Name Zip: n
**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
/�` f -t�' L�• - - l.� FS IS VALID FOR A PERIOD OF FIVE YEARS.
�--ENWR61 S L HEALTH ECIADSf DA E ISSUED
**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
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
`•-__ENVIRbNMIT HEALTH`SPEC LIST DA ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
LINSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS 2 # OCCUPANTS GARBAGE DISPOSAL: Yes or(!
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE &I ' —' WTYPE WATER SUPPLY CCLW' DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Z LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: R(,-1At_tr
IMPROVEMENT PERMIT LAYOUT I M10,
10 ,
7 X.D ,c i z
-�s
-75-'
-7S '
17'o. C.
Is
T
L ' "7C
�yy!Yc'oX Zti
Q,�E To 1`d`•
"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 (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:_�� 6�.' e—u
t
Jk x �
01
�
r
Fwr2'
9' ►zJ
No�sz
AUTHORIZATION NO. "SZ" OPERATION PERMIT BY: DATE: 2 99
'*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH 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)
DAVIE
OUNTY HEALTH DEPART11yItENT
'tea
TMPRO
EMENT AND OPERATION PERMITS PROPERTY INFORMATION
`Per r; it e's'
Name: �.. 4��
1 "'�
Subdivision Name:
Directions to property:
Section: Lot:
IMPROVEMENT
PERMIT ty r
Tax Office PIN:# '"'If
_tYKi l
Road Name �ri,_ LL,! . Zip:
1
**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
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
`•-__ENVIRbNMIT HEALTH`SPEC LIST DA ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
LINSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS 2 # OCCUPANTS GARBAGE DISPOSAL: Yes or(!
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE &I ' —' WTYPE WATER SUPPLY CCLW' DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Z LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: R(,-1At_tr
IMPROVEMENT PERMIT LAYOUT I M10,
10 ,
7 X.D ,c i z
-�s
-75-'
-7S '
17'o. C.
Is
T
L ' "7C
�yy!Yc'oX Zti
Q,�E To 1`d`•
"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 (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:_�� 6�.' e—u
t
Jk x �
01
�
r
Fwr2'
9' ►zJ
No�sz
AUTHORIZATION NO. "SZ" OPERATION PERMIT BY: DATE: 2 99
'*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH 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)
1.
2.
3.
4.
- APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
Davie County Health Department
Environmental Health Section
E O. Box 848
Mocksville, NC 27028
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UAIL�t►%+VIE COUNTI%"'""
ALL THE REQUIRED INFORMATION IS PROVIDED.
Name to be Billed RqndtlContact Person 0 e
Mailing Addressl� % Q NI P/� f Z 1- Home Phone W-- �
City/State/Zipi.1 V1 P. �� �� Business Phone Z� Z z _
Name on Permit/ATC if Different than Above
Mailing Address am City/State/Zip ,//�OC/�Jy/ < ��, / V 6 Z 7LI28
Application For: bI Site Evaluation WImprovement Permit & ATC ❑ Both
System to Serve: a House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
2
� F-6
5. 5. If Residence: #People # Bedrooms 3 '7lZZ�� # Bathrooms
Dishwasher ❑ Garbage Disposal M Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other:
# Commodes
If Foodservice:
Specify type
# Showers
# Seats
# People # Sinks
# Urinals
Estimated Water Usage (gallons per day)
# Water Coolers
7. Type of water supply: 0/County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes WIN o
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: /M X 30 1 WRITE DIRECTIONS (from
/7 1 Mocksville) TO PROPERTY:
Tax Office PIN: #
Property Address: Road Name
Z'
City/Zip
1end
r
1
If in Subdivision provide information, as follows:
I ✓
Name: 1
1 �
Section: Lot #: 1
1
1
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
j� D�/ t j
and owned by1 Lk'( 81 (/ 1-0h- M l�- to conduct all testing procedures
as necessary to determine the site suitability.
DATE SIGNATURE
Revised DCHD (06-96)
&' ' �I
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
(�
APPLICANT'S NAME CH+u P (31'
PROPOSED FACILITY 5S
SUBDIVISION
Water Supply:
Evaluation By:
On -Site Well Community.
Auger Boring Pit
DATE EVALUATED U
PROPERTY SIZE i DO >'-3co
ROAD NAME WCt7C.LWto14
Public
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
L1_
(�
Sloe %
0
7
HORIZON I DEPTH
- 14
Texture group
CL
GL
Consistence
r1r 5S
r�SS
Structure
G(L
Mineralogy'
HORIZON II DEPTH
Texture groupG
Consistence
r
Structure
__56 k
Mineralogy
;
;
HORIZON III DEPTH
4Z-Clyl
Texture groupC4
Consistence
r
r
Structure
A
Mineralogy
HORIZON IV DEPTH
t$ct
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS: �� C�.L y I
DCHD (01-90)
EVALUATION BY: c� Lk4 lA�
OTHER(S) PRESENT:
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
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