437 IJames Church Road Lot 20Davie County, NC Tax Parcel Report Wednesday. December 28, 2016
No
E01
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. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consuitarts, contractors or employees from any and all claims or causes of action due to
NCor arising out of the use or InabiCdy to use the GIS data provided by this website.
WARNING: THIS 1S NOTA SURVEY
Parcel Information
NC
Parcel Number:
G3060B0020 Township:
Mocksville
NCPIN Number:
5820113461 Municipality:
Account Number:
82528801 Census Tract:
37059-806
Listed Owner 1:
ELLIS DANIEL D Voting Precinct: NORTH
MOCKSVILLE COUNTY
Mailing Address 1:
437 IJAMES CHURCH ROAD Planning Jurisdiction:
Davie County
City: MOCKS LLE Zoning Class:
DAVIE COUNTY R -A
No
E01
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. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consuitarts, contractors or employees from any and all claims or causes of action due to
NCor arising out of the use or InabiCdy to use the GIS data provided by this website.
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
Legal Description:
LOT 20 FOREST BROOK
Fire Response District:
CENTER
Assessed Acreage:
0.71
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
10/2007
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
007321018
Soil Types:
CeB2
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:
No
E01
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. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, its agents, consuitarts, contractors or employees from any and all claims or causes of action due to
NCor arising out of the use or InabiCdy to use the GIS data provided by this website.
AUTHORIZATION NO: 1107 DAVIE COUNTY HEALTH DEPARTMENT
_ - Environmental Health Section PROPERTY INFORMATION
Permittec.'sP.O. Box 848 � Q
Name:'bk�C��,N z� Mocksville, NC 27028. Subdivision Name:
+` Phone #: 704-634-8760
Directions to property:. N i.\ Section: Z Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:t -� -
SYSTEM CONSTRUCTION:
;.Y Road Name:z 64e4e � Zip: `!r
**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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
if
�.., DAVIE COUNTY HEALTH DEPARTMENT -
'`s,,�.e IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Dram `i ��' _ ..s C� ' t' .. Subdivision Name:'?.%"
Duectio'ns to property:'- ''' Section:
Lot:i
IMPROVEMENT
'�,.,�1 ..�sa ,:, • �� '� `�^�� PERMIT Tax Office PIN:# - L—_
"^
Road Zip:
**NOTE** This Improvement Penmit 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
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! Ll # BEDROOMS # BATHS # OCCUPANTS CL GARBAGE"DISPOSAL: Yes No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZETYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD).3 VO NEW SITE REPAIR SITE
4
SYSTEM SPECIFICATIONS: TANK SIZE I D00 GAL. PUMP TANKr GAL. TRENCH WIDTH ROCK DEPTH LINEAR'FT.3�
OTHER
s
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
"CONTACT A REPRESENTATIVE OF THE 1
BETWEEN 8:30 - 9:30 A.M. OR 1:00 -
OPERATION PERMIT
VIE COUNTY HEALTH
30 P.M. ON THE DAY Ol
RTMENT FOR FINAL INSPECTION OF THIS SYSTEM
ALLATION. TELEPHONE # IS (704) 634-8760.
SYSTEM INSTALLED BY: c's`�`�''� w���s�l•
AUTHORIZATION NO. b l OPERATION PERMIT BY:
"*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICA
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEN
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC'
DCHD 05/96 (Revised)
DATE:
NSTALLED IN COMPLIANCE
LL IN NO WAY BE TAKEN AS A
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
"PeAilt
;:n Subdivision Name:
Difectifts to property: 10, Sectio 7r,
Section Lot:
IMPROVEMENT
PERMIT
Tax Office PIN:#-,
"6
Road Name': Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic Link 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.
(Incompliance 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
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 TYPEL41'�_-A # BEDROOMS #BATHS "-)- # OCCUPANTS GARBAGEDISPOSAL: Yes o13
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZEWa-� TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) LO NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE L1_)=GAL. PUMP TANK —GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
lei
3E N
**CONTACT A REPRESENTATIVE OF THE VIE EPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
0 A.M.1. P.M. 0
.00
BETWEEN 8:30-9:30MOR 1:00- :30P.M.ONTHEDAY6 INSTALLATION. TELEPHONE# IS (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
i,
ool
)01
AUTHORIZATION NO. 0, OPERATION PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION PERM .- IT SHALL INDICATE THAT THE D SYSTEjjtSCRIB ABOVE HAS BEEN INSTALLED IN COMPLIANCE
I
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION, 1900 "SEWAGE TREATMENT AND DISPOS SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIODIF TIME.
DCHD 05/96 (Revised)
°Lx '°t^i � �r17i''� ;.�'I'dti'fl F tom'= i .r �t �+ v r.r.. .a`� �'^F? * t^ ';,:+4' �� �'"9t,-j e 1,,, . +v- ,-• .,�r' < y, :i `n'a, >4, 3 t4:ty i`C, i.i' s f' , r°s` _ r ,, ,
to
k,..J
.%ZQTI6N NO. 0963 DAVIE COUNTY HEALTH DEPARTMENT.
Environmental Health Section PROPERTY INFORMATION
Permittee's P.O. Box 848
Name:,+��?"' Mocksville, NC 27028 Subdivision Name:Ys°,t.,�'
Phone #: 704-634-8760
Directions to property: Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#��J -
SYSTEM CONSTRUCTION
Ro 4t YYI
ad Name. �i .
P b
**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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
z;F A2
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH sp&4ALIST DATE ISSUED
t`N .rY°l.5l," Vti- iMRaa �µs�''�'�..•,�.• 4F"�! .. 11 l 7 f�,' i - 4�,':.: ,.�._ ,. �'f �l:'�/-•.. n,Y""�
a x'O
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
�Pertrntt
Name: • }",/' _` ie"' Subdivision Name: �+► ,r�+ "�
"Directions to property: Section: Lot:
+ - IMPROVEMENT',,
PERMIT Tax Office PIN:#� - r
4
"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
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 1ST` # BATHS --,a— # OCCUPANTS Z GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE �4D0 TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) sfeL6 NEW STTE_ .� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE /_ _ 61,4 GAL. PUMP TANK GAL. TRENCH WIDTH ,10/ ROCK DEPTH —/--72yLINEAR Fr. /
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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
SYSTPKINSTAI.
AUTHORIZATION NO.. IT -0 OPERATION 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 PERMIT & ATC
- Davie County Health Department IS@ IE O W R
Environmental Health Section D
P.O. Box 848 JUL 2 21997
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL
S Ti TPPJR F
G—s /FORMATION IS PROVIDED.
1. Name to be Billed Z/� G Contact Person
//
MailingOAZ� s/''+'//'a ,= 41J .5�n ,, Home Phone
Cittyy`/State/ZiN!/G w 10*-4e15eZd !`�U 3 �. 4dEusiness Phone 4
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [ ] Site Evaluation [improvement Permit & ATC [ ] Both
4. System to Serve: [ ] House [bile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People 2- # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal
[[shing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: County/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes "Io
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AVELM 'cOF THE PROPERTY MUST BE
SUBMITTED WITHAPPLICATION.
Property Dimensions: ,/%> U 3 % S WRITE DIRECTIONS (from ocksville) TO PROPERTY:
l �
Tax Office PIN: # 5,0'7-6 - Z d I
Property Address: Road Name,///�/'�/C•s li� AO : �, al{%
City/Zip Ory<� ���'_Ai r/ ; ow dSS
If in Subdivision provide information, as follows: C 0�0-26 ff
Name: e! 5 Tl�,eltd.1� l
Section:
Lot #: .� d
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 upon above described property located in Davie County and owned
by F/VG �_!%—4� to conduct all testing procedures as nec ssary to determine the site suitability.
DATE SIGNATURE
Revised DCHD (06-965/
THIS AlaA MAY BE USED F01t DRAIVINC7 JOUI? SITE PLAN:
A " Moto
now"we !wn s my -m
A -I
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS
��"•� • `• EVALUATION/IMPRObEMENTS"ETho
Davie County Health Department
. �
" Environmental Health Section
P. 0. Box 665 11av>r 17
Mocksville, NC 27028
I1 DAVIE COUNTY
1. Application/Permit Requested By �> e t'
Mailing Address � 1 0 C.l C I r U C. S o t C_
Home Phone TW_ _ Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: General Evaluation
i
4. System to Serve:House ❑ Mobile Home
❑ Business ❑ Industry �oR� ❑ Oth r
5. If house, mobile home: Subdivision
C .D 16,�_�'
f
P
i�
g'
1• ;
❑ Septic Tank Installation
❑ Place of Public Assembly
❑ Unknown 0
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: Public
El 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?
❑ No
❑ Community
'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:
�C lU - ._1 . { (i v1%, - S t_ ('i. tr. G.' r �-, I .
1 U �
n11cC. e-
V, C
_VUC
I 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
.,
ingurred from this application.
DATE elf SIGNATURE ) j
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DES_ CRIBED P Obi PERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ff 2. 1 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:
1 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 v )` ^ r A {
to conduct all testing procedures as necessary to determine said site''Asuitability for a ground absorption sewage treatment
and disposal system.
RE
J/ — /_7"
DCND (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
l�t '-' as
FACTORS
1
V aZ
- �Ils
NAME_ 1=. 9sc\
DATE EVALUATED
Sloe %
15
ADDRESS
PROPERTY SIZE
bol
X�3 qs l l
Texture group
---tl
LOCATION
C1
Ra
PROPOSED FACIILTY ���
OF SITE
Structure
Water Supply: On -Site Well
Community
Public
HORIZON II DEPTH
_
Texture group
Evaluation By: Auger Boring
Pit L/)
Cut
FACTORS
1
2 3 4
Landscape position
Sloe %
15
HORIZON I DEPTH
Texture group
L
C1
Consistence
F3
Structure
C
Mineralogy
HORIZON II DEPTH
t'
Texture group
C
Consistence
'•_r_
Structure
K
K
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
—
r--
SAPROLITE
CLASSIFICATION
_
LONG-TERM ACCEPTANCE RATE
,
SITE CLASSIFICATION: S
LONG -TERM -ACCEPTANCE RATE: \V
REMARKS:
DCHD(01-901
EVALUATED 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 ;lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- Vf---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
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
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