829 Wagner Rd (2)Davie County, NC
Tu� Parcel Report
Tuesday, October 1 l, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City: MOCKSVILLE
State:
WARNING: THIS IS NOT A SURVEY
Parcel Information
F30000002205 Township:
5810793818 Municipality:
6028000 Census Tract:
BECK ROBERT W Voting Precinct:
829 WAGNER ROAD Planning Jurisdiction:
Zoning Class:
NC Zoning Overlay:
2ip Code: 2702&0000 Voluntary Ag. District:
Legal Description: 1.000 AC WAGNER RD Fire Response District:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
9 �'F Davie County,
���„�� NC
0.82 Elementary School Zone:
5/1998 Middle Schooi Zone:
002020253 Soil Types:
Flood 2one:
Watershed Overlay:
4786p.00 Outbuilding & Extra
Freatures Value:
15190.00 Total Market Value:
64660.00
Clarksville
37059-801
CLARKSVILLE
Davie County
DAVIE COUNTY R-A
WILUAM R. DAVIE
WILLIAM R DAVIE
NORTH DAVIE
MnC2,Mn62
DAVIE COUNTY
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No
IUI dah is proWded as Is without warrarrty or guanntee of any kind either expressed or Implied Including but not Iimked to the
Implied wamntles of inerchaMabflity w fitness for a particular use. All users oT Davle County's GIS website sha�l hoid harmless the
CouMy of DaWe, North Grollna, lts agerrts, consultarrts, contnctors w employees from any and eIl daims or esuses ot actlon due to
or arlsing out of the use or Inabllity to use the GIS daU proWded by this xrebska
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. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
' APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME �T I� r� PH�ONE NUMBER �Z"��(Av
ADDRESS ��Z-.1 ����n�� � _ SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED �� NAME SYSTEM INSTALLED UNDER ��i`�^'� r�
TYPE FACILITY �''" �'�'r► NUMBER BEDROOMS � NUMBER PEOPLE SERVED �
TYPE WATER SUPPLY hl�-L� SPECIFY PROBLEM OCCURRING �S/,������ �
L� d� �� U� �? .
DATE REQUESTED � Z g d� INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE ,OF OWNER OR AUTHORIZED AGENT
Rev. 1/93 ��,-�i / �_�
L�'
�� `,1 , � �� . . ! � � � . _ . .. _ �'D. �a � i��C p
�' uTxo��a�'ioN No: � DAVIE COUNTY HEALTH DEPARTMENT �. N
. • ! �ry � ```�:I'v .
.� , Environmental Health Section PROPERTY INFORMATION b q�q
Permittec,"�S `,�%�,d� 2.� ,�r,� ;�r P.O. Box 848 � g�
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Name: �' -�'� �'`'r�' '� Mocksville, NC 27028 Subdivision Name: �
,,.� � � � r` l� �,�' �, ;, Phone #: 704-634-8760 ,,�
Directions to property: /-:>�%�l' F'� � r ��� ,�/r i., Section: Lot: nil !( �' �
AUTHORIZATION FOR , z'���
,%. l ;" � �;;,! r �' .: ; f`� ''`�,ri�, � ` WASTEWATER Tax Office PIN:# � ��� - � � - �-�;� � t�.t � � �
� ?--=t— SYSTEM CONSTRUCTION � ;, —�--T—
f ,' .:;~ / Road �ame i "�}''� �� ���M ��� t .-'� r � r� ��
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**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts.
(In compliance with Atticle 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
. ` % � ,� ^",,� ,,,r-'" ***NOTICE*** THIS AUTHOWZATION FOR WASTEWATER CONSTRUCTION
,�-ti,!°:� % � �_l�r ., � �'�✓ �'�`�.: ., � "�� IS VALm FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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t =- w�.' ;� �'� t'� �� DAVIE COUNTY HEALTH DEPARTMENT !,�� dY
�}.:�',, �--:� '.� �.�� TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION -�i4
�
Permittee,"'s '" ' ,,' ,,,_;' 4 .!;t r r
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� Name: " " '',' � ,^ �.1,� `� c`� ., ' �
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Directions to property: rr ,; ,,
�:' �
, Il�IPROVEMENT
', . , PERMIT
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Subdivision Name: �� �
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Section: Lc�t: ��� !l�r�'�
e j�a � �j' �(' � f �; rf,✓��'��'
Tax Office.PIN:# }��"�.�� _ r� �� -�•y �`i �;
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�•9� � �� �4�� l�' 4 ).7 1
Road�ame: �'- �•�j'�i �.. < � ti,� Zlp .; i � �.: ;: �x �
**NOTE** This Improvement Pernut DOES NOT authorize the c�nstcuction pr installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTE� CONSTRUCI'ION, must be obtained from this Department prior to the
construction/installation of a system or the issuance of�a (idilding pernut. ;�
(In,compliance witli Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
... ; ' � " �' , ,_ ,, - �,. � r, w � ***NUTICE*** THIS PERNIIT IS SUBJECT TO REVOCATTON IF SITE
:. t � y'% .�" ;� {� ,� � _� 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 � # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE f f{� TYPE WATER SUPPLY �"�f l� DESIGN WASTEWATER FLOW (GPD) �'��� NEW SITE �—�'�� REPAIR SITE
/�
SYSTEM SPECIFICATIONS: TANK SIZE ��''��GAL. PUMP TANK GAL. TRENCH WIDTH _r"ir J ROCK DEPTH : ff % LINEAR FT. � t'` ��
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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-,�„,�...,,�.-�.----�--�-----
._-^----�------- .
�
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 930 A.M. OR 1:00 - 130 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
AUTHORIZATION NO. � OPERATION PERMIT BY: / V���Z� DATE: '� �
**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 OS/96 (Revised)
. •,',•.
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APPLICATION FOR SITE EVALUATION/IMPROVEMENT
Davie County Health Department
Environmental Health Section
P. O. Box 848
Mocksville, NC 27028
(704)634-8760
������
t^,"�281997
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL THE REQUIRED INFORMATION IS PROVIDED.
� �
1. Name to be Billed C�r1 A L� �(1 ct ti' �1 �t1JS "[J c' P��inc� Contact Person �� .�►'�cr �^�'
Mailing Address I�.� �' L�%� f.� V C�n t' a _ Home Phone �%%z "'SG 3�l
City/State/Zip MoC�.Sv��� � ��,� �-.� 0�- g Business Phone ���— ���
2. Name on PermidATC if Different than Above
Mailing Address
3. Application For: ❑ Site Evaluation
4. System to Serve:
5. If Residence:
❑ Dishwasher
6. If Business/Other:
# Commodes �
If Foodservice:
7. Type of water supply:
❑ House � Mobile Home
# People �
_ City/State/Zip
❑ Improvement Permit & ATC
❑ Business ❑ Industry
# Bedrooms Z
� Both
❑ Other
# Bathrooms �
❑ Gazbage Disposal � Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
Specify type
# Showers _
# Seats
❑ County/City
# People # Sinks
# Urinals
Estima[ed Water Usage (gallons per day)
�I Well
# Water Coolers
❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes .� No
If yes, what type?
INFORMATION REQUIRE� *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: � Q-��-a � WRITE DIRECTIONS (from
� Mocksville) TO PROPERTY:
Tax Office PIN: # �R / I - �� - � �''S��I �
, ��� .�Yf� �
Property Address: Road Name ,.f �CG'�/Jro� /��i � � l �� �
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c�cyr��P ' �� � �
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If in Subdivision provide information, as follows: 1 9
� �i'�7ts�l. 7� C��'iv�[ �
Name: � •
� QN L��t �� i c'
Section: Lot #: �
1
1
This is to certify that the information provided is conect to the best of my knowledge. I understand that any permit(s) issued hereafter
aze subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is
falsiiied 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
/,
as necessary to determine the site suitability.
DATE Z� '1 SIGNATURE
Revised DCHD (06-96)
conduct all testing procedures
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• DAVIE COUNTY HEALTH DEPARTMENT
� Environmental Health Section SECTION i.oT
SoiUSite Evaluation
APPLICANT'S NAME �e ����
PROPOSED FACILITY
SUBDIVISION �1,��
Water Supply:
Evaluation By:
FACTORS
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
HORIZON II DEPTH
Consistence
HORIZON III DEPTH
Texture group
Consistence
Structure
HORIZON IV DEPTH
Consistence
Structure
On-Site Well � Community
Auger Boring � Pit
SOIL WETNESS
RESTRICTIVE HORIZON
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-90)
1 I 2
�t���
r��t!�
���
% Q�
�' �e�
DATE EVALUATED �r ��%
PROPERTY SIZE J� � �C
ROAD NAME /�c% � /'lG°'/''
�
Public
Cut
3 4 5 6 7
EVALUATION BY: ,�� /
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
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 - gaUday/ft2
. • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
+ � - APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME ���� �fi�/� PHONE NUMBER �/�— ����
ADDRESS �� 7' �� �%��'� ��`�'- SUBDIVISION NAME
i� " ��G`� _c���G�� ��C ol��L'ir LOT #
DIRECTIONS TO SITE � �% I
IK��►��
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REC�UESTED INFORMATION TAKEN BY
Thia is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93