333 IJames Church Road Lot 12Davie Countv, NC '
Tax Parcel R ennrt
Wednesdav, December 28, 2016
WARNING: THIS 1S NUT A SURVEY
Parcel Information
Parcel Number:
G3060B0012
Township:
Mocksville
NCPIN Number:
5820217227
Municipality:
No
Account Number:
33735000
Census Tract:
37059-806
Listed Owner 1:
HAYES KATHY F
Voting Precinct:
NORTH MOCKSVILLE COUNTY
Mailing Address 1:
PO BOX 1002
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
002100474
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 12 FOREST BROOK
Fire Response District:
CENTER
Assessed Acreage:
0.78
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
311999
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
002100474
Soil Types:
PcC2,CeB2
Plat Book:
0006
Flood Zone:
Plat Page:
137
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
101
All data is provided as Is without warranty or guarantee of any Idnd either expressed or implied Including but not limited to theDavie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless theCounty 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 inabft to use the GIS data provided by this website.
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7
". DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
,i •� ��
Petmittee's
► e C Subdivision Name:
Directions to property Z,:74'.";1 �a { -- Section: Lot: AV
IMPROVEMENT
PERMITTax Office PIN:# � / - at r r
'-
#,. ` '
Road Name: 01 1;.,. � (-11). Zip: Md -Aly
7 **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
✓' r,�/ 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 S # BATHS OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE STYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE 4 REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE10C)GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1LINEAR Fr. _ l
OTHER .7 STR� l�lJ t 1 O
r�=
REQUIRED SITE MODIFICATIONS/CONDITIONS: 4-t.L�1' of* ot;5 s.. "'f � o' D P12--�P utfJV
"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 /y
SYSTEM INSTALLED BY: 4&014a(•v
f
AUTHORIZATION NO. POPERATION. PERMIT BY: 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 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PER
r ♦ Davie County Health Department
Environmental Health Section D
P.O. Box 848 JUL 1 51997
Mocksville, NC 27028
M (704) 634-8760
}
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed 7e L%W2. /�.`��rprn MAJiJ 7L/
Mailing Address
City/State/Zip IM CK:5-odle , N.C.4 '1' %QZy
2. Name on Permit/ATC if Different than Above
Mailing Address
Contact Person e*7r!-I ` 1r7u )U 7
Home Phone / w 7 q 2 Zd61
Business Phone 70 y 7&
City/State/Zip
3. Application For: [ ] Site Evaluation W Improvement Permit & ATC [ ] Both
4. System to Serve:[}' House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # -People # Bedrooms_ 9- # Bathrooms_ _ [Dishwasher [ ] Garbage Disposal
[)(] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
7.
8
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
Type of water supply: [ County/City [ ] Well [ ] Community
Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes
If yes, what type?
[� No
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** 1'OF THE PROPERTY MUST BE
y
SUBMITTED WITH IrS' APPLICATION.
/ /
Property Dimensions: ��D %� ,��s
WRITE DIRECTIONS (from ocksville) TO PROPERTY:
Tax Office PIN: #5R;20 - �L_
- 722 %
;
N o /41-4
Property Address: Road NamP� I: A A'e 5 �'/4u
rc ( ;?b
�t `,
?` U �' .1 JA /� 5 C_ /'w • P b .
City/Zip d 2oc te5 c" lie
&0-
Anp
l v 1-eT '
If in Subdivision provide information, as follows:
40
1
Name: ror.257 lrx)k
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 jupon above described property located in Davie County and owned
U44 r Cf/,/e6it& t �ri t��inn cedures as necessary to determine the site suitability.
DATE STGNATUR --
Revised DCHD (06-96)
THIS AREA MAY BE USED FOR DRAWINC7 JOUR SITE PLAN:
:�5op,es Cu *n. 106 r
APPLICATION FOR SITE EVALUATION/IMPROVEMENTSIPE T PC3 P"; II
• �" :w -- Davie County Health Department I 1 ---
Environmental Health Section
P. O. Box 665 ! J.r W 17 11
Mocksville, NC 27028 - J
1. Application/Permit Requested By�-
Mailing Address 1� v 0.t Rbod y U c_ '-'o I l c
Home Phone `1(�: a Business Phone _
2. Name on Permit if Different than Above
3. Application/Permit for: General Evaluation
4. System to Serve:House ❑ Mobile Home
IFo R2�v
p Business ❑Indust j� ❑ Oth r
5. If house, mobile home: Subdivision
DAME CUUNTY'riE`:�?;!
❑ Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown
Section _ Lot #�
❑ Basement/Plumbing
No. of People
❑ Basement/No Plumbing
No. of Bedrooms
❑ Washing Machine
No. of Bathrooms
❑ Dishwasher
Dwelling Dimensions
❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People.Served
_ No. of Sinks _
No. of Commodes
No. of Urinals
No. of Lavatories
No. of Water Coolers
No. of Showers
Water Usage Figures
7. Type of water supply: IR/Public
❑ Private
8. Property Dimensions
Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
It yes, what type?
_
❑ Community
❑ No
'NOTE: .Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the Intended use change. Effective October 1, 1989.
Directions to Property:
(�� \ l ,
I 1 L1.
J0 a h C C_ rA 6{-j C e b C q i e_. �- 1 ��1� F. E
1 �� e . C. C� b, C_.k \Jk C � e CI
yal_q ,4 ftliiad - 06 MazV 9f
aMr"41- P A"
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
I n urred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBE P Obi PERTY
MUST CHECK ONE: ❑ 1. I OWN the property. 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 l V . > IV._ )V 0Y' .'t {
to conduct all testing procedures as necessary to determine said site'. suitability for a ground absorption sewage treatment
and disposal system.
DCHD (12.90)
E
- `- "DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation Q
NAME DATE EVALUATED ~� T
ADDRESS S p- q -T, PROPERTY SIZE
PROPOSED FACIILTY \� dy` LOCATION OF SITE ps
Water Supply: On -Site Well _ Communit Public V
Evaluation By:`%"� LAuger Boring Pit Cut
FACTORS
1
2 3 4
Landscape 2osition
-15
Sloe %
91-1490
HORIZON I DEPTH
1tI
1V
Texture group
L
L..
Consistence
VIM
Structure
Mineralogy
HORIZON II DEPTH
t,
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—
CLASSIFICATION
.S
LONG-TERM ACCEPTANCE RATE
v
SITE CLASSIFICATION: �� _ EVALUATED BY:
LONG-TER����/� J\/���CCCEPTJApNCE_ RATE:` 11 OTHIHER(S) PRESENT:
N
DFMADYC. \\�.T ♦ Ci • l.z\. c,C 1 i��n..... 'J�♦\ra
LEGEND
Landscape Position
R -Ridge S7Shoulder 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 :lay loam• SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vc-y 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
.3C --Single grain M -Massive CR-Ciu`m� 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
DCHD(01-901
1
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S.R. 1307
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'APPLICAIION FOR SITE EVALUATION/IMPROVEMENT PERMIT do ATC M
Davie County Health Department
EnWivamenb/ Health SaVon FEBP.O. Box 848/210 Hospital street B � o
Mockaville, NC 27028
(336)751-8760 FNviPnti4—rmTAi uriv II
***XWORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION I3 PROVIDED. Refeerr to the INFORMATION BULLETIN for
--instructions.
1. dame to be Billed �Tp%W4CL'e / L� a!+�f �/ `e Contact Person X1 /1 `cel
Hailing Address , Po .6 d 6a 1) d O/ Al' Some Phone
City/state/ZIP /%DC/�Sy///K A/Z V741-9 J Business Phone �d 6 ,7
Z. Name on Permit/ATC if Different than Abwe
Mailing Address City/state/Zip /
3. Application For: U Site Evaluation 0 Improvement Permit/ATC lif Both
4. system to service: Ur -House 0 Mobile Home ❑ Business 0 Industry 0 Other
3. If Residence: r People / Bedrooms _ r Bathrooms
B"Dishwasher 0 garbage Disposal H'Naahing Machine 0 Basement/Plumbing U Basement/No Plumbing
5. If Business/Industry/other: specify type
• Commodes / showers
t# Urinals
f People A sinks
f Nater Coolers
IF FOODSERVICE: 11 Seats Estimated hater Usage (gallons per day)
7. Type of water supply: 9--County/City 0 well 0 Community
e. Do you anticipate additions or expansions of the facility this system Is Intended to serve! 0 Yes W<O
It yes, what type?
***IMPbRTANT*** CLIENTS AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client with THIS APPLICATION.
r
Property Dimensions: f eii'J X 3 ed
Tax Office PIN: #
Property Address: Road Name I- JS07,9!!!�
City/Zip d�� a°° $
If in a Subdivision provide information, as follows:
Name: l0/ll �S7 �YDej�
Section: % Block: Lot:
WRITE D`RtEtMONNS (from Mochsville) toj�PROPERTY-
b d / A, —;rr2h Di1 TN�/7I�S
3fyf M/ ar 4 ill
Date Property flagged: a— I?— q
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(,)
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 respons0lefor all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Dayie County Health DeRa,rtment
to enter upon above described property located in Davie County and owned b e-')l-)Je;4 - b�Yd�lo
to conduct all testing procedures as necessary to determine the site suita lih.
DATE ' SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLS R Include all or the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic Mentions).
Account No.
Revised DCHD (07/98) . Invoice No.