455 Mr Henry Road Lot 1Dav
?016
9svle
SOD 4
WARNING: THIS IS NOT A SURVEY
All data Is provided as is withom umnanty or guarantee of any kind eXher expnmsed or Implied Including but not limbed to the
Implied marantles of merchantability orthttess for a patti"laraaa All users of Davie County's GIS webage shall hold hannleas the
County of Davis, North Carolina, its agents, "nwbams, contmem s or employees from any and all claims or "uses of action due to
oradsing out of the arae or Inability to use the GIS daft provided by this website.
Parcel Infonnatton
Parcel Number:
K30000000309
Township:
Calahaln
NCPIN Number:
5717508525
Municipality:
Account Number:
82527777
Census Tract:
37059-801
Listed Owner 1:
GRIFFIN JASON L
Voting Precinct:
SOUTH CALAHALN
Mailing Address 1:
455 MR HENRY ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 1 BYERLY CHAPEL EST
Fire Response District:
SCOTCH - IRISH
Assessed Acreage:
1.54
Elementary School Zone:
COOLEEMEE
Deed Date:
312007
Middle School Zone:
SOUTH DAVIE
Deed Book I Page:
007040879
Soil Types:
GnB2
Plat Book:
0007
Flood Zone:
Plat Page:
185
Watershed Overlay:
DAVIE COUNTY
Building Value:
61270.00
Outbuilding & Extra
2460.00
Freatures Value:
Land Value:
22040.00
Total Market Value:
85770.00
Total Assessed Value:
85770.00
9svle
SOD 4
Davie County,
NC
All data Is provided as is withom umnanty or guarantee of any kind eXher expnmsed or Implied Including but not limbed to the
Implied marantles of merchantability orthttess for a patti"laraaa All users of Davie County's GIS webage shall hold hannleas the
County of Davis, North Carolina, its agents, "nwbams, contmem s or employees from any and all claims or "uses of action due to
oradsing out of the arae or Inability to use the GIS daft provided by this website.
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department
SEnvironmenla/Heralth Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS 7
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN :
1. Nome to be Billed �, rl . �r'li Contact Person,
Meiling Address Home Phone
City/state/ZIP j Business Phone
2. Name on Permit/ATC If Different than Above
Mailing Address - City/State/Zip
p �C[�M�
rJUN 1 pnr� j
3. Application For: .Site Evaluation ❑ Improvement Permit/ATC ❑ Both
ty
4. System to Service: fp House � L�L�ob .1 Home ❑Business ❑ Industry ❑Other
5. It Residence: # People ? # Bedrooms 3 #Bathrooms
❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine D Bassment/Plumbinq ❑ Basement/No Plumbing
6. I£ Business/Industry/Other: Specify type
# Commodes
# Showers
# urinals
# People # sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: ❑ County/City Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes i6o
If yes, what type?
***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: V((/ / xIJ 1'�pp�0vX702 I WRITE
DIRECTIONS (from Mockksville) to PROPERTY:
Tax Office PIN: # 5(7
Properl
If in a;
Name:
Section
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 Davje County Health Departmept
to enter upon above described property located in Davie County and owned by ` Zoe, y /%1Q,{�(/ (( Jn //P(/
sja
to conduct all testing procedures as necessary to determine the sm bility. ;,17 , _ . A Ar
DATE I�nInI SIGNATU$E/
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN((include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. 1-71(
Revised DCHD (07/99) Invoice No. 3 3�
Slope %
HORIZON I DEPTH
Texture •
-ConsistenceMineralogy
®®®®®®
HORIZONStructure
DEPTH
groupTexture
Consistence
Structure
MineralogyTexture
HORIZON III DEPTH
group
®®®®0®®
Structure
MineralogyL
HORIZON IV DEPTH
®®®®®®®
Texture
groupConsistence
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
®®®®0®®
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE s
SITE CLASSIFICATION:' EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:,
REMARKS: ;...
LEGEND
Landscape Positiolli
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:
r,
CONSISTENCE
VFR - Very friable FR - Friable 'FI -Firm, VFI - Veryfirm EFI - Extremely firm
Wet'
NS - Non sticky SS -Slightly sticky S - Sticky VS -Very Stick
y•
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
Structure
SC - Single grain M -Massive CR - Crumb OR - 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)
LIAR - Long-term acceptance rate - gal/day/ft2
DCHD 05/99 (Revised)
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Wayne and Mary Waller
548 Mr. Henry Road
Mocksville, NC 27028
Re: Site Evaluations/Byerly Chapel Estates, Lots 1 and 2
, Tax Office PIN: #5717-50-8867
Dear Mr. and Mrs. Waller:
As requested, a representative from this office visited the aforementioned site on,
June 5,2001. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the sites were found to be
provisionally suitable for the installation of on-site sewage systems.
Before an Improvement PermitlAuthorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
ZQbert B. Hall, Jr., R.S.
Environmental Health Specialist
RBI-I/dfi
Enclosure(s)
...... .
DAVIBOUNTYA'P��
.......
Environmental Health Section
P. O. Box 848/210 Hospital Street
Courier 09-40-06
Mocksville, NC 27028
77�
June 6, 2001
Wayne and Mary Waller
548 Mr. Henry Road
Mocksville, NC 27028
Re: Site Evaluations/Byerly Chapel Estates, Lots 1 and 2
, Tax Office PIN: #5717-50-8867
Dear Mr. and Mrs. Waller:
As requested, a representative from this office visited the aforementioned site on,
June 5,2001. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the sites were found to be
provisionally suitable for the installation of on-site sewage systems.
Before an Improvement PermitlAuthorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
ZQbert B. Hall, Jr., R.S.
Environmental Health Specialist
RBI-I/dfi
Enclosure(s)