423 Potts Rd Davie County,NC Tax Parcel Report Tuesday,November 8, 2016
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WARNING: THIS IS NOT A SURVEY
�� Parcel Informationz �
Parcel Number: F800000145 Township: Shady Grove
NCPIN Number: 5880178749 Municipality:
Account Number: - 6608580 Census Tract: 37059-803
Listed Owner 1: BEVERLY MARK A ! Voting Precinct: EAST SHADY GROVE
Mailing Address1,• 421 POTTS ROAD Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006-7873 Voluntary Ag.District: No
Legal Description: LOT 2 MARK BEVERLY PROP Fire Response District: ADVANCE
Assessed Acreage: 1.02 Elementary School Zone: SHADY GROVE
Deed Date: 8/2007 . . Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 007250038 Soil Types: PcB2,PcC2
Plat Book: 0008 Flood Zone:
Plat Page: 231 Watershed Overlay: DAVIE COUNTY
Building Value: 61530.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 17480.00 Total Market Value: 79010.00
Total Assessed Value: 79010.00
161 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.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
NC or arising out of the use or inability to use the GIS data provided by this website.
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AUTHORIZATION NO ,,13,10 DAVIE COUNTY HEALTH DEPARTMENT {
Environmental Health Section PROPERTY INFORMATION
erd,tiee,s, /' P.O.Box 848.
v.
ame:""`� "�r,C Mocksville,NC 27028 Subdivision Name:
Phone#:704-634-8760
Directions to property: SCIS f* c> Section: Lot:
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:#
�C•Zo-X/ YI Road Name. / Zip: 06
**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.
ENVIRONMENTAL HEALTH SPLtIALIST DATE ISSUED
a a:? ol
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DAVIE COUNTY HEALTH DEPARTMENT
" , ► ��
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
ems
' ame Subdivision Name:
Dlfectifions oproperty:� 'O � ���{ Section: Lot: f i
IMPROVEMENT Mr f
PERMIT Tax Office PIN:# ''irk"fit
?1/ N Road Name Yi'',% /` "'Lt jg�Zip: A F10
**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***THUS PERMIT IS SUBJECT TO REVOCATION IF SITE
(� F•? tom" , / 1,r' J I PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SP CIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS_ #BATHS _#OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAIL SPECIFICATION: FACILITY TYPE,/I #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE ¢� �`S� TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) �lfNEW SITE ,i'' REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE AMLGAL. PUMP TANK GAL. TRENCH WIDTH �� /ROCK DEPTH LINEAR FT.
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
SYSTEM INSTALLED BY:.
/
AUTHORIZATION NO. v OPERATION PERMIT BY: 'L— DATE: �V _
(n
"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)
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• ••, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PER
• - " j' Davie County Health Department
Environmental Health Section
s� / P.O. Box 848 SEP 2 9 1997
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT****' THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed A A lt. 9 S•V g&j=y Contact Person
Mailing Address 1143 c r e s t e-,d- Home Phone 716
City/State/Zip ifi►t— �e+►1 /� C- �!�-� Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [w�Site Evaluation [ ]Improvement Permit&ATC [ ]Both
4. System to Serve: [ ]House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other
5. If Residence: #People #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 [ ]Well [ ]Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No
If yes,what type?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED:***IMPORTANT***NMT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: -°/SoZ ACr•e-S ;WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
Tax Office PIN: # 9T D - 7 - `3 7
I$17 U[ �L
Property Address: Road Dame P b�'S &po�-d Ga Ab.Zr � NL` --s -q,ZtC a $n 1
city/zip Adv a A? O o 4 fio Po-tl�s k o 0%.-1 o ry
If in Subdivision provide information,as follows:
Name: ;
Section. 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 / to conduct all testing procedures as necessary to determine the site suitability.
DATE g Z`fl Q!7 SIGNATURE �-
Revised DCHD(06-96)
THIS AREA MAY BE USED FOR DRAIVINC7 YOUR SITE PLAN:
• � lel a
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/219
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to Lk % _
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�„ �� / JAMES SANDERS P°
D.8: 154 PG. 829 W
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6.7705 ACRES
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a D.B. I l l PG. 69 } � • S•
UftS 43026'11 IN 79.03'
ri s 43'29'1>"W 37.00'
0) 1 ` 1 00 0 loo 200
N
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S 35°52'28"W
fourro, N ; 2'•45"W : _ GRAPHIC SCALE r rtf
.P OTTS ROAD
MAP
u.
s 2 71 JOHN RICHARD :HOWARD certify that ..r*�t1�CAAp�'�"''4.. EOR KEIT L: & DEBQRA K. J
DAVIE COUNTY HEALTH DEPARTMENT
~ .* Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME SIL '/t%��YLL� DATE EVALUATED D17
&1
PROPOSED FACILITY ? PROPERTY SIZE
SUBDIVISION ROAD NAME
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L
Sloe% '3 42,
HORIZON I DEPTH Z 0 /
Texture group SC-L- SGL- GL
Consistence Cr 5n,S J65 r SS S
Structure C-0-
Mineralogy 1 ► 1
HORIZON II DEPTH - 12 ILIX22
Texture group 5 C-
Consistence S P 5
Structure k -525L
Mineralogy 1
HORIZON III DEPTH -K) n-1 ZZ-Z
Texture aroup 5c-+&
Consistence EC S IF
Structure
Mineralogy1 : 1
HORIZON IV DEPTH t }
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE S S
CLASSIFICATION S
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: C>. 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 I 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
Mineralogv
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(01-90)
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Davie County Health Department
andHome Heafth.Agency
Environmenta(Heafth Section
P.O.Box 848/ 210 HOSPITAL STREET.
COURIER#09-4-06
MOCKSVILLE,N.C.27028
PHONE:(704)634-8760
0 t, L, , 1997
Mart: Boveriy
1163 Crescent Gt.
Winston-Salem, NG 27127
Re: Site Evaluation
Fut t!:: Toad
Tax FIN; ;5880-17-8787
Dear Client(s) :
As requested, a representative rrpm this office visited the
aforementioned cite an October ?, 1997. _ Brazed upon the information
provided on the application for cite 'evaluation and after the evaluation
was completed, the site• was found to-ii-• Provisionally suitable for the
installation of an on-site sewage cystem.
If you have any questions, plerast .feel free to contact thic office.
C, y.,n: manl
,
r
3eff Berauc ,trap, b.S-
E::vir onmental Health Specialist
JB/wd
Enclosure(s)
1
' Davie County Health Department
and Home Health Agency
Environmenta(Heafth Section
P.O.Box 848/ 210 Hospim STREET
COURIER#09-4-06
MOCKsvIUE,N.C.27028
PHONE:(704)634-8760
- October'8, 1997
Mark Beverly
1163 Crescent Ct.
Winston—Salem, NC 27127
Ree .. 2 Site Evaluations
Potts Road/2.9521 Acre Tract
Tax PIN: #5880-17-8787 -
Dear Client(s) :
As requested, a representative from this office visited the aforementioned
sites on August 6, 1997, and October. 2, 1997. Based upon the information
provided on the application(s) for..site evaluation(s) and after the evalua,.a ns ' "
I .. were completed, the sites were found to be provisionally suitable for-che
installation of an on—site sewage d1-sposal system on each site.
Before any permit (s) can be issued the appropriate application(s) must .be
filled out and the house/mobile hoii locations) staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr. , R.S.
Environmental Health Specialist
RH/wd
Enclosure(s)
cc: Zoning Office
I
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