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395 IJames Church Road Lot 15Davie County, NC ' 0 Tax Parcel Report Wednesday, December 28, 2016 I r i IJAMl S C HURC14 Rte 334.1 CHURCH I?I7l 437 431 1 423 1 1 'l 403 ; i i � � 395 t i 411 359 -__' 339 43c' i r+� Q r 5 w k s 1 rA WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: G3060B0015 Township: Mocksville NCPIN Number: 5820119396 - Municipality: Account Number: 19521000 Census Tract: 37059-806 Listed Owner 1: DALTON CHARLES R Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 395 IJAMES CHURCH 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 15 FOREST BROOK Fire Response District: CENTER Assessed Acreage: 2.57 Elementary School Zone: WILLIAM R DAVIE Deed Date: 11/1998 Middle School Zone: NORTH DAVIE Deed Book / Page: 002070455 Soil Types: PaD,PcC2,ChA Plat Book: 0006 Flood Zone: Plat Page: 138 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: FQ-D 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. Ali 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 orcauses of action due to NCor arising out of the use or Inability to use the GIS data provided by this webske. � �'.�i4^'.,`�°r.tY'if'fi�riw yi!'�"Jss3wr x'TMY•��' M,i+�+�;;;li`�r"r-yx:^k`�'x1�'!.�'�Z tG,y-i%�'t"Y�.�d�Spt'?CI �C `4'�+l''"�.. '...,Yci�: ate:.�w,i-.}�.i3.r,-�r-'-e�,,,s _ --... -r `d.•�-:-.... �w�..,, �ya ko- AUTHORIZATION NO: 1,805 DAVIE COUNTY HEALTH DEPARTMENT .Environmentall-IealthSection PROPERTY INFORMATION Permittee's % ,/ �,. P.O. Box 848 Name:Mocksville, NC 27028 Subdivision Name:5�✓4/� Phone # 336-751-8760 Directions to property: s i Section: / Lot: AUTHORIZATION FOR WASTEWATERp_ ( Tax Office PIN:# - SYSTEM CONSTRUCTION Road Name: ip %Cf IR 8 **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 Ll of G.S. Chapter 130A, Wastewater Systems, Section .1900 SewageTreatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION -', IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST, DATE ISSUED ,�A♦ Y� ,,;,t,.+`t7 a�.+-.k+-�l rr c,. : ,v,;:- 7 a tr.3l.•�+,.a1hq "�. y �y t-V G•.'„r .tS•.. i _'. w,� ,..� ,., '. ”. yaoa ,'� , DAVIE COUNTY HEALTH DEPARTMENT' 1/xO IMPRdVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perinittee's Name: . s r Subdivision Name: , 'ras`l rood` Directions to property: +` r Section: Lot: / IMPROVEMENT ' PERMIT' Tax Office PIN:# q . Road Name: _ G a es IM; *"*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 t• r •1..� rc � C'j ~' ° +:. 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 AhL #BEDROOMS #BATHS�_#OCCUPANTS _GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOTS _ TYPE WATER SUPPLY V DESIGN WASTEWATER FLOW(GPD) NEW SITE � REPAIR SITE SYSTEM"SPECIFICATIONS; TANK SIZE GAL..PUMP TANK GAL. TRENCH WIDTH�6 ROCK DEPTH A, LINEAR FT.X& OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT a� **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEP T ENT FOR FINAL INSPECTION OF THIS SYSTEM'. BETWEEN 8:30-9:30 A.M'.OR 1:00-1:30 P.M.ON THE DAY OF INS AL ATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT J SYSTEM INST$ ED APQ �Y Iv NL►�2f� i K � q_ZL -1c- '301 � 3o' 1JO m T B AUTHORIZATION NO. 1 V� OPERATION PERMIT Y•. DATE: i z Z ag **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY DESCRIBED A OVE 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) s ', APPUCA110N FOR SIZE EVAUKHON/IMPROVEMENT PERMIT & ATC � O Davie County Health Department EnWtonmenfa/ SWIM Section P.O. Box 848/210 Hospital Street NOY 2 0 1998 Mocksville, NC 27028 1336) 751-8760 _.. ***II1P0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for iin(struc(/tions. 1. Name to be Billed f' ,Ip r r Contact person I gh ^.)G,. Mailing Address3 Rome Phone City/State/ZIP filo k�U(� f JV t c, .mac 02- �1 D Business Phone (S S2 p s Z. Name on Permit/ATC If Different than mr"e e Mailing Address �G%`7" (2r�t �. ( /\C�� City/state/Zip 3. Application For: U Site Evaluation VoImvrovement Permit/ATC 0 Both 4. system to service: ❑ House Gl' Mobile Home 0 Business 0 Industry 0 other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher 0 Garbage Disposal 04ashinq Machine 0 Basement/Pluabing 0 Basement/No Pluabing 6. If Business/Industry/other: Specify type # People # sinks # Commodes # shovers # Urinals # hater Coolers IF FOODSERVICE: i1 Seats Estimated crater Usage (gallons per day) 7. Type of Mater supply: 0 County/City 0 Well ❑ Comsainity e. Do you anticipate additions or expansions of the facility this system Is Intended to serve! 0 Yes uxor/ If yes, what type' ***IMP0RTAN7%** CLIENTS MUST COAWLETE THE QUIRED PROPERTY INFORMATION REQUESTED e BELOW. Either a PLAT or SITE PLAN MUST BESU ITTED by the client with THIS APPLICATION. ol Property Dimensions: r / / eAJW WRITE DIRECTIONS (from Mocksvilie) to PROPERTY: Tai Office PIN: # 451$�� II ( Property Address: Road Name 3-15�✓S �J('c�l1 l ��• City/ZI&I& e NL lan If in a Subdivision provide Information, as follows: Name: f;(-e5� V ro af� Section: fflevk: Lot: Date Property Flagged: This is to certify that tk 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 responsiblefor all charges incurred from this appUcadon. I, hereby, give consent to the Authorized Representative of the Davie ntvHea t Department �a � to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suita 1t?. DATE f/ 1ti2D qT SIGNATURE THIS AREA MAY Bit USED FOR DRAWING YOUR SITE PLAI"b dall of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locati Revised DCHD (07/98) Account No. Invoice No. 31-7 ...,.� irA. R-201 eapq 'k. .� `4°ti p� 6 C3 0ti 60. `�' N kid Ot Li 100.0p^— -F 8 g� 100.4# �- y �� 1 1 1 I D�ItC Ita�IER PMM. $ 100.00 , I �_ ' fn#LC 4401 HURoff i o IL H © h IL •• i o •. N I $ o - g (OfOREst NNW shoot 2 es.6o cnvl�oic 8 - N ##• 04. 100 00 - •� ,' 3Pz„ I EUt; $I'ENNM ET AL . - L APPLICATION FOR SITE EVALUATION/IMPROVEMENTS int Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1. Application/Permit Requested B�yr ) t V N Mailing Address 1 t� 0.t 0 Cd C S U t C Home Phone `I b �� �-� Business Phone �. 2. Name on Permit if Different than Above _ 3. Application/Permit for: General Evaluation 4. System to Serve:] House �. ❑ Mobile Home ❑ Business ❑ IndustryU,,,.— � J� ❑ Oth r 5. If house, mobile home: Subdivision PSV 17 I'D ❑ Septic Tank Installation ❑ Place of Public Assembly ❑ Unknow[` Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing j No. of Bedrooms ❑ Washing Machine r No. of Bathrooms ❑ Dishwasher i Dwelling Dimensions ❑ Garbage Disposal V 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: M Public ❑ Private ❑ Community . 8. Property Dimensions Sewage Disposal Contractor + l C 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No , If yes, what type? '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: 0 fj i 1 V) b'ckk k ec' ff I C.' t C t ct -I e'_. J_ 1 14'\ e_'. _( E :( 0. 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 incurred from this application. C' 'Z DATE �' SIGNATURE j CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBER PQOPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 2. I DO NOT OWN the property. If you checked Box //2, the rest of this form jvIUST 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 �� . >��_t�._ �` r) r- 1 <� to conduct all testing procedures as necessary to determine said site'A suitability for a ground absorption sewage treatment and disposal system. V_T E S!G ATURE y DC11D (12.90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section p Soil/Site Evaluation NAME C� - \� ` S�s� DATE EVALUATED ac6 " ADDRESS A4 PROPERTY SIZE PROPOSED FACIILTY s�`n= LOCATION OF SITE .L a t • iZ�_ Water Supply: On -Site Well _ Communit Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S Sloe R _ d° HORIZON I DEPTH �,�' v Texture group1. 1 - Consistence z IF-1- ZStructure Structure C Mineralogyr, �1 HORIZON II DEPTH 3 61 Texture group Consistence Z Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH - Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON — -- SAPROLITE — CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERMACCEPTANCERATE: `� OTHER(S) PRESENT: N ons REMARKS:kr- qs�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 ;lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V, ---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 -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic ' Mineralogy 1:1, 2:1, Mixed Notes llorizon 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 l ■■■..■■..■...■■■■■.■■■■■.....■...■..■■.I►1■■■■■.■■■.■■■■■■■■ NOON■ ■■.■■.....■■..■■■■■■■.■■.■■...■■..■�i/..NOON ■■■■■■■■■■■■■■■■■■.■■ ................................. .■..■..■.■E■ONE■■�■■E■NMEME■E■■■ ...........................�......,■■■■■■.■.■.■■_..■ ■■■■■■...■■■. ........................... ................... 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