204 Essex Farm Road Lot 52Davie County, NC Tax Parcel Report Tuesday, December 20, 2016
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All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fftness 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.
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
F803OA0052
Township:
Shady Grove
NCPIN Number:
5870643458
Municipality:
Account Number:
82528109
Census Tract:
37059-803
Listed Owner 1:
PSC DEVELOPMENT COR INC
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
P O BOX 5967
Planning Jurisdiction:
Davie County
City: HIGH
POINT
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27262-0000
Voluntary Ag. District:
No
Legal Description:
LOT 52 ESSEX FARM PHASE 1
Fire Response District:
ADVANCE
Assessed Acreage:
0.69
Elementary School Zone: SHADY GROVE
Deed Date:
5/2007
Middle School Zone:
WILLIAM ELLIS
Deed Book 1 Page:
007130818
Soil Types:
GnB2,EnC
Plat Book:
0009
Flood Zone:
Plat Page:
290
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
161
All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fftness 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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
YID Davie County Environmental Health
i P.O. Bos 848/210 Hospital Street
Date:
Mocksville, NC 27028
(336)753-6780/ Fax (336) 753-1680
Application For: A'Site Evaluation/Improvement Permit > Authorization To Construct(ATC) C Both
Type of Application: kew System Repair to Existing System=Expansion/lvlodification of Existing System or Facility
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed S �_ I Nom -t—S Contact Person LZL
"�(
Billing Address ,5()a Home Phone
City/State/ZIP cbr-,)cic Business Phone 7j� (n- 9,41- to 1,9 CIO jL ?,(.
Name on Permit/ATC if Different than
Mailing Address
rr�vrt rcr r riNrvruvttvr rvtN '-Late t7iousen"actiiV corers Ylagged
NOTE: A survey plat or site plan must accompany this application. Included: Site Plan ❑Plat(to scale)
(Permit is lid fo 60 months with site plan, no expiration with complete plat.)
Owner's Name 5 ino_—j Phone Number 33rD'rS4/
Owner's Address L City/State/ ip - Oro i`"C_ -L-
Property
Property Address f7 City 04 vaince,
Lot Size Tax PIN# Z>
Subdivision Name(ifapp cable) F Section/Lot# �.
Directions To Site: a 5 � n ( n
1 m 1-t 0 r nct fL�tr . L i C I An I—e
If the answer to any of the following questions is "yes", supporting documentation must be attached.
Are there any existing wastewater systems on the site? L7 Yes
Docs the site contain j urisdictional wetlands? Dyes
Are there any easements or right-of-ways on the site? F] Yes o
Is the site subject to approval by another public agency? ❑ Yes
Will wastewater other than domestic sewage be generated? .'Yes r o
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms 9 # Bathrdoms Garden Tub/Whirlpool (,Yes ^No
Basement: Basement Plumbing: ❑Yes No
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: Xonventional CAccepted Clnnovative ❑Altemative COther
Water Supply Type:xcounty/City Water ❑ New Well CExisting Well G Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? Yes
If yes, what type?
�N.
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand
that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use
changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized
Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I understand that I am responsi a for the proper identification and labeling of property lines and comers and
Ick`.. -_ n,-��:�� . v:� rt tm c' c' i location, proposed well location and the location of any other amenities.
P o Ir
ea own r owner leg I representative signature Site Revisit Charge
Date(s):
Client Notification Date:
Date t EHS:
,-) oo�
Sign given -Yes -No Account#
Revised 11/06 Invoice #
3 LIO N FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
^uG 2 Davie County Environmental Health
I P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
fh„f,�ty??•l µ�LjN (336)751-8760/ Fax (336)751-8786
,cation For: O'Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT
Name to be Billed Asc T eat, i.Je- Contact Person %cRRY &f 7r,
Billing Address 3fo Home Phone
City/State/ZIP _�Joerirui� r4G Z 702 B Business Phone 7S/ . 7300
Name on Permit/ATC if Different than
Mailins Address
PROPERTY INFORMATION *Date House/Facility Comers Flagged
NOTE: A survey plat or site plan must accompany this application.
Included: 0 Site Plan R'Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name D �SC 4mmo olf reii c�� lAct
Phone Number 737 - 73---oOwner's
Address eo jog
City/State/Zip .,�w,r ,yG 27oZ8
Property Address
t
City
Lot Size 10, Tax PIN#
- Z
Subdivision Name(if applicable) Es =
�2
Sectio ot# Q
Directions To Site: C S G
2 Z'T" 041
S -0-f4
&d1&1'1ha
If the answer to any of the following 4uestionsfis "yes", supporting documentatiogg must be a hed.
Are there any existing wastewater systems on the site?
Dyes t7N
Does the site contain jurisdictional wetlands?
Dyes C7No
Are there any easements or right-of-ways on the site?
❑'res ❑No
Is the site subject to approval by another public agency?
(Dyes ff I
Will wastewater other than domestic sewage be generated?
❑Yes QNo
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms !;6 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No
Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sin's # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: a onventional ❑Accepted ❑Innovative []Alternative ❑Other
Water Supply Type: D'County/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand
that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use
changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized
Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and
locating an ging or staking the house/faciliV location, proposed well location and the location of any other amenities.
Site Revisit Charge
Prope r s or o er's legal representa re
Date(s):
7 Client Notification Date:
Date EHS:
Sign given Dyes ❑No
Revised 11/06
Account #
Invoice #
-il� 73
LEGEND EIP Uj
These standard symbols and lines LtJ N�Z--
may be found in the drawing. !=I M
• IRON PIN I Oto
0 RAILROAD SPIKE OR NAIL ! Z
• POINT (NOT SET) I I __-
PROPERTY UNE
TIE
EXISTING
LINERIGHT OF WAY S 89-4'1,q' W
- - OLD TRACT LINES 2 .26I �_„
NOT SURVEYED I S 9,973 19 W
0 UTILITY POLE I EIP I 545.44'
IPS IRON PIN SET I
EIP EXISTING IRON PIN I I y
NTS NOT TO SCALEDB DEED
I R
PG PAGE BooK I I
SF SQUARE FEET
HTR HOUSE TRAILER I GRAVEL
NCGS MONUMENT I . -k— • — —
I• \ �.
zo
I a I I• wELL � � SHED
1 ST RY FRAME
HOUSE METAL SNEO
I N CARPORT
I d' C
I�
I O
I 0 ; HE
I CL
O/H UTILITY UNE • . . . . . .
I p IPSq
FILED FOR REGISTRATION Al -O'CLOCK -M.
, 2008 AND RECORDED
IN PLAT BOOK PAGE .
JONATHAN BOLMER
DB 207 PG 914
PLATBOOK 8 PG 283
NC PIN 5833333895
LOT 1
PORTION OF: DB 76 PG 492
224230.9 S FT.
5.15 ACRES
N82.1 z 6
W
382.44'
EIP VICINITY MAP (NTS)
I (WE) HEREBY UNDERSTAND THAT THIS PLAT IS APPROVED AS EXEMPT FROM THE SUBDIVISION ORDINANCE OF DAVIE
COUNTY. THIS IS A FAMILY SUBDIVISION AND IS FOR THE EXCLUSIVE PURPOSE OF CONVEYING LAND AMONG FAMILY
MEMBERS WITHIN THE THIRD DEGREE OF LINEAL KINSHIP. THESE LOTS/TRACTS SHALL NOT BE USED FOR THE
PURPOSE OF SALE OR BUILDING DEVELOPMENT. EITHER NOW OR IN THE FUTURE, EXCEPT FOR THOSE FAMILY
MEMBERS. ADDITIONAL APPROVALS MAY BE REQUIRED BY DAME COUNTY OR ITS SUCCESSOR AGENCY BEFORE ANY
SUBSEQUENT SALE OR BUILDING DEVELOPMENT MAY OCCUR.
Tw
0
N M
0O N
IPS
W
N O
1�LOT 2 z
0 M PORTION DB 76 PG 492
0 100139.2 SQ. FT.
2.30 ACRES
JIMMY RAY ALLEN DATE
I FURTHER ACKNOWLEDGE THAT MY LINEAL FAMILY MEMBERS WHO WILL BE CONVEYED THE NEWLY CREATED FAMILY
LOTS ARE:
1. MICHAEL RAY ALLEN SON LOT 2
NAME RELATION9HIP
I. , REVIEW OFFICER OF
DAVIE COUNTY CERTIFY THAT THE MAP OR PLAT TO WHICH
THIS CERTIFICATION IS ATTACHED MEETS OR EXCEEDS ALL
STATUTORY REQUIREMENTS FOR RECORDING.
REVIEW OFFICER DATE
"NO APPROVAL REQUIRED BY THE DAVIE COUNTY PLANNING DEPARTMENT"
PLANNING DIRECTOR DATE
WE HEREBY CERTIFY THAT WE AR THE OWNER OF THE PROPERTY DESCRIBED HEREON, WHICH
IS LOCATED IN THE SUBDIVISION JURISDICTION OF DAVIE COUNTY AND THAT I HEREBY
ADOPT THIS SUBDIVISION PLAN WITH OUR FREE CONSENT, ESTABLISHED MINIMUM BUILDING
SETBACK LINES AND DEDICATE ALL STREETS, ALLEYS, WALKS, PARKS, AND OTHER SITE
AND EASEMENTS TO PUBLIC OR PRIVATE USE AS NOTED.
OWNER JIMMY RAY ALLEN
OWNER MICHAEL RAY ALLEN
JONATHAN BOLMER
W DB 207 PG 914
PLATBOOK 8 PG 283
NC PIN 5833333895
nD M
N N
I S AHT IPS
rF
Y I Z
_/ I N 89--32 9" W
I I I 794 E — _ _ — EIP�� — 620.51' (NTS) IE P
I I N V C10VE�::1 I
I I I KAVA ES A1Y
EGRESS I
I I I I IPS � � 30 INGR
EASEMENT
794
•4 DO 118 I I N 79
I I AIL 1 m n TY UN � .9� �
KEVIN J. JOHNSON
E DB 176 PG 293
�r
ti LUTHER W. WEST JR. NC PIN 5833313701
RAILROAD SPIKE DB 120 PG 509
10 I NC PIN 5833229548
I I, D. CLIFT BODENHAMER, JR., PROFESSIONAL LAND SURVEYOR, L-4388 CERTIFY THAT THIS PLAT
CREATES A SUBDIVISION OF LAND WITHIN THE AREA OF DAME COUNTY THAT HAS AN ORDINANCE�N CAq
I, D. CLIFT BODENHAMER JR., CERTIFY THAT THIS PLAT WAS DRAWN UNDER MY SUPERVISION FROM AN Q� ...•.. 0�
IACTUAL SURVEY MADE UNDER MY SUPERVISION DEED DESCRIPTION RECORDED IN BOOK 78, PAGE 492; THAT REGULATES PARCELS OF LAND.Aa�O••OFESS1O•••�y
THAT THE BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED AS DRAWN FROM THE INFORMATION
FOUND IN BOOK—. PAGE ----;THAT THE RATIO OF PRECISION IS AS CALCULATED 1:10000 +; THAT � � SEAL
ITHIS PLAT WAS PREPARED IN ACCORDANCE WITH G. S. 47-30 AS AMMENDED. WITNESS MY ORIGINAL PLS III L-4388 L-4388
SIGNATURE, REGISTRATION NUMBER AND SEAL THIS 10TH DAY OF MARCH, A.D. 2008. k/�'�
I •s `C-
0' '4
50' 100' 150' 'B(jS�R NP�'`,�
PLS -4388 DEN
Grr4rrrrrrer,eooatr
DATE
�Lv: 1
NOTES
1. AREA WAS COMPUTED BY COORDINATE GEOMETRY
2. AREA DOES INCLUDE RIGHT OF WAY
3. THIS SURVEY IS SUBJECT TO ANY FACTS OR RECORDS
THAT MAY BE DISCLOSED BY A FULL AND ACCURATE
TITLE SEARCH, THAT WAS NOT FURNISHED AT THIS TIME
4. THIS PROPERTY MAY BE SUBJECT TO EASEMENTS AND OR
RIGHT OF WAYS APPARENT QR UNAPPARENT.
5. THIS PROPERTY IS ZONED RA, SETBACKS ARE F -40'.S-15',
R-30'
8. THIS PROPERTY MAY BE LOCATED IN A WATERSHED,
DEVELOPMENTAL RESTRICTIONS MAY APPLY
7. RIGHT OF WAY DIMENSIONS AS PER NCDOT
8. NO NCGS MONUMENTS FOUND WITHIN 2000'
OF THIS SURVEY
9. THE LOCATIONS OF ALL UNDERGROUND UTILITY LINES ON
THIS MAP ARE APPROXIMATE
10. PROPERTY OWNER ADDRESS:
JIMMY RAY ALLEN
308 NORTH PING ROAD
MOCKSVILLE, NC 27028
SURVEY FOR:
MICHAEL RAY ALLEN
DRAIIN
DATE
COUNTY ID :5933239254
TOWNSHIP: FARMINGTON
DCB
03/09/08
UNTY- DAVIE
STATE: NORTH CAROUNA
APPROVED
DATE
D. CLIFTON BWENHAMER, JR. PLS
P. 0. BOX 1222
DCB
3112./08
CLEMMONS. NORTH CAROLINA 27012
PHONE NO. (338) 928-2085
SCALE
SHEET
PROJECT N0.
1 " = 50'
1 OF I
MALLEN I
R—A SETBACKS:
FRONT: 45'
SIDE: 15'
SIDE: 25'(STREET)
REAR: 30'
1
52
147.53'
SETBACK 54
0
I
a
I O
O
NI
I O
47.53' 53
K
10' UTILITY EASEMENT
�._
N 07032'00" E
ESSEX FARM ROAD
50' R/W (PUBLIC)
GRAPHIC SCALE
40 0 20 40 80
( W FEET )
1 inch = 40 &
PRELIMINARY
PLOT PLAN FOR:
RSP BUILDERS
LOT 52 OF ESSEX FARMS, PHASE 1
P.B. 9 PG. 290
Flaming 69imacringi Inc.
8518 Triad Drive Colfax, NC 27235
Phone: 336.852.9797 ,a Fax: 336.852.9766
NCBELS C-0950 DATE: 02-16-2016
Ku : MV0 \ I oo i —w i \uwg \rar-nrm%m.uwy
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Account #: 990004425
Billed To: PSC Development Corp. Inc.
Reference Name: Brad Coe
Proposed Facility: Residence Property Size:
Water Supply:
Evaluation By:
On -Site Well Community
Auger Boring Pit
PROPERTY INFORMATION
Tax PIN/EH #: 5876=6j4-2Zfi55
Subdivision Info: Essex Farm Lot # 52
Location/Address: Cornatzer Rd -27006
0.735 Ac. Date Evaluated: C1 — l<6 — 0 %
Public LI-l"
FACTORS
1 r
i7 4 5 6 7.
Landsca e position
V
L
• Slope %
3
HORIZON I DEPTH
— �.
- t{ T-
0-- i{
Texture groupC
C
Consistence
r
TI -f
Structure
O (�
Mineralogy
�-
b ayP
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure.
Mineralogy
SOIL WETNESS
/
�—
RESTRICTIVE HORIZON
SAPROLITE
l
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
O . -7
SITE CLASSIFICATION: ` a i0 j
LONG-TERM ACCEPTANCE RATE: a
REMARKS:
LEGEND
EVALUATION BY: _L
OTHER(S) PRESENT.
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
Moist
VFR - Very friable FR - Friable FI Firm VE - Very firm EFI - Extremely firm
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 horiion - 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)
la
LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revisedl
a N
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
Account #: 990004425 IMPROVEMENT PEIJ'$IN/EH #: 5870-64-2265.52
Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 52
Address: PO Box 340 Location/Address: Cornatzer Rd -27006
City: Mocksville Property Size: 0.691 acre
Reference Name: Brad Coe
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to
revocation if site plans, plat or the intended use change.
Permit Type: 56ew ❑Repair. � ❑Expansion Permit Valid for: 65 Years ❑No Expiration
Residential Specifications: # Bedrooms L # Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): Type of Water Supply: MLounty/City ❑Well ❑Community Well
'A�,— StMed in 15A NCAC 18A.1969(5)
Site Modifications/Permit Conditions:-rcEerrted Systems m,,),, nly) hA us pa
System Type LTAR
Initial ctccfmAlco CT ,X75
Re air Cat cc .*cl 0. X7 S`
Plan
Environmental Health Specialist
).00.0
iSo.o5,
Date 16— /6 — D 7
. o
0ow6e-
� a
Environmental Health Specialist
).00.0
iSo.o5,
Date 16— /6 — D 7