270 Pleasant Acre Drive Lots 100-101Davie County, NC I Tax Parcel Report Thursday, November 3, 2016
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Parcel Information
Parcel Number:
M5120A0004
Township:
Jerusalem
NCPIN Number:
5745877438
Municipality:
Account Number:
8304866
Census Tract:
37059-807
Listed Owner 1:
HAGAN JESSE KALEB
Voting Precinct:
JERUSALEM
Mailing Address 1:
270 PLEASANT ACRE DRIVE
Planning Jurisdiction:
Davie County
City:
Mocksville
Zoning Class: DAVIE
COUNTY R -20,R-8
State:
NC
Zoning Overlay: DAVIE COUNTY CZOD
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOTS 100-101 BOXWOOD ACRS
Fire Response District:
JERUSALEM
Assessed Acreage:
0.66
Elementary School Zone:
COOLEEMEE
Deed Date:
3/2015
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
009840015
Soil Types:
Ce132
Plat Book:
0006
Flood Zone:
Plat Page:
011
Watershed Overlay:
DAVIE COUNTY
Building Value:
71850.00
Outbuilding & Extra
Freatures Value:
0.00
Land Value:
15750.00
Total Market Value:
87600.00
Total Assessed Value:
87600.00
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Davie County, implied warranties or merchantability or fitness fora particular use. Ali 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.
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DAVIE COUNTY HEALTH DEPARTMENT
-•` -�`` IMPROVEMENTS PERMIT. AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Swage Systems �J Permit Number
Name 7` �O Date ��e N2
.6-770
Location
Sac or Rlnrk No
Lot Size of House —Z Mobile Home _T Business Speculation
No. Bedrooms No. Baths No. in Family_
Garbage Disposal YES ❑ NO p- Specifications for System:
Auto Dish Washer YES NO ❑`OaC7�� �,�
�
Auto Wash Ma^.hine YES T NO E]
Type Water Supply � _ ,
A>
*This permit Void if sewage system described below is not installed within 5 years from date of issue..
This permit is subject to revocation if site plans or the intended use change.
-11
Improvements permit by_
7/h .
*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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion( �' / Date r/
"The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
-+• (r v. j . p.Y r '., e' ,rt ..k: rr .. ,.,,f :.. : 'p. .b .. r .. - - ,... c. - ,. - . ,
,.DAVIE COUNTY HEALTH DEPARTMENT ,, _ o
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G . Chapter 130a
Sanitary Sewage S stems Permit Number
Name �� N J' - Date ;$f/ NO
Location c,r%_%S� /, 1 l� r %/,��' (.�!'e .-r -- ,ref ��� -/r — 6770
/�
Subdivision Name 4�/„�/�->!��/�' l Lot No. Sec. or Block No.
Lot Size �� �� ef House __1Z Mobile Home Business Speculation
No. Bedrooms —1.!E No. Baths —._ No. in Family
Garbage Disposal YES ❑ NO p'' Specifications for System:
Auto Dish Washer YES NO ❑ /
Auto Wash Ma^hine YES NO �❑ /
Type Water Supply �'``�
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
U
Improvements permit by —7
*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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installed by
10
Certificate of Completion 1� �'� Date '
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665 Ism
Mock,aville, NC 27028 �%
1. Application/Permit Requested By A,,,/ --
Mailing Address
n
Home Phone 7D�l– Business Phone, e-
2.
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: lC) General Evaluation
S. System to Serve: House u Mobile Home
0 Industry u Other
6.
If house, mobile home: Subdivision
No. of People
No. of Bedrooms --
No. of Bathrooms
Washing Machine
ES/Tank Installation
Business
0 Unknown
Sec. Lot#
Dwelling Dimensions �I`1X e-19
7. If business, industry, other:
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
Basement/Plumbing
T/Basement/No Plumbing
J Dishwasher 0 Garbage Disposal
Specify type
No.
No.
No.
of Sinks
of Urinals
of Water Coolers
8. Type of water supply: Public 0 Private 0 Community
9. Property Dimensions X00/ 394
10. Sewage Disposal Contractor
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 Yes U/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.
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.
Z;60
h -
Date —'_ Signature
Directions to Property:
Pie
DCHD (10-89)
Ole-f4lf"111
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
(office use only)
yes no 1. 1 am the owner of the above described property.
/yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from a f/i'.J _ 6 ,. ar' 4.41 _P , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
-a-'go
DATE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
DATE
DCHD (11 /84)
— Owner only
— Owners designated representative
—Anyone requesting results
Only those listed below
SIGNATURE
r
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Y�app� `�� �' �I Date
Address f�o7L u/� �� /`�� Lot Size
E
FAr..TnRC AREA 1 ARFA 9 AREA 3 AREA A
I) Topography/ Landscape Positiony�
9)
�
S&
S6
U
U
U
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)j
S
P
PS
I) Soil Structure (12-36 in.)
Clayey Soils
S
(
S
U
S
U
g Soil Depth (inches)
U
U
�) Soil Drainage: Internal
�
�
S,m
S�
U
U
External
PU S
�) Restrictive Horizons
Available SpaceS
S
PS
PS
S
S
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U�
Site Classification
{'
U -UNSUITABLE S—SUITABLE PSS Provisionally Suitable
Recommendations/ Comments:
Described by / Title Date
SITE DIAGRAM
DCHD (6-82)
30
14
9�
)00
0-
11
• Fvm IIIA -N, 424-2
(f-i'i•71)
UNITED STATES DEPARTMENT OF AGRICULTURE
Farmers Horne Administration
PROPOSIM INSTALLATION OF INDIVIDUAL SEWAGE -DISPOSAL AHD/OR WATER SUPPLY SYSTEM
Name of Property Owner
Property Address
(If this property 1s in a development, give lot no. and block no.
Number of bedrooms proposed LY_. Approximate area of lot square feet.
House is to be set back feet from the boundary. I propose to conatruct on
the above -captioned property an individual type savage -disposal system ,
well .This installation will be constructed so as to meet all t e require-
ments ofthe local Health Department and the State Board of Health.
WELL: Site location approved by Health Department ( ) yes ( ) no.
Type . Size of storage tank
(Drilled, Driven, Bored, Dug)
Makes Type and capacity pumps
Septic system to be installed to accommodates Garbage Grinder ( ) yea (ef`no
Washing Machine ('yes ( ) no
Date:
(Signature of PropertyOwner)
SEPTIC TANK: Working capacity =a gallons
NOTE. If tank has not been specifically approved by the State Board of Health,
submit plans and specifications.
PERCOLATION TEST RESULTS (If considered necessary by local Health Department)
Hole No. —2 4„_(Minutes per inch of fall)
SUBSURFACE ABSORPTION FIELD
No. of nitrification lines-; total length feet; width inches;
total nitrification lines bottom area a`square feet.
A representative of thed,` ,,j/,� Health Department has
inspected this site and finds it suitable T unsuitable for the
proposed installation.
Well :lite location Approved by Health uepartment ( ) yes ( ) no.
Date: (Signature)'
(Title) ern /IX ,j'a e'.^.
If there 1:, any pertinent information which the Health Departmentdesires to convey
to the reviewing officials, which is not covered above, use the back of this
application.
Return ori.O nal and one copy to Farmers Hone Administration County Office.