149 Cedarwood Place Lot 4Davie County, NC Tax Parcel Report Tuesday January 10- 2017
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WARNING: 'PHIS 1S 1NU'1' A SURVEY
Parcel Information
J7080B0004
Township:
Fulton
5768107233
Municipality:
CORNATZER
8306250
Census Tract:
37059-804
OSTLUND MATTHEW W
Voting Precinct:
FULTON
149 CEDARWOOD PLACE
Planning Jurisdiction:
Davie County
MOCKSVILLE
Zoning Class: DAVIE
COUNTY R-20
Land Value:
Total Assessed Value:
NC
27028
LOT 4 HERITAGE OAKS PHASE ONE
0.68
4/2016
010160426
0007
005
Zoning Overlay:
Voluntary Ag. District:
No
Fire Response District:
FORK
Elementary School Zone:
CORNATZER
Middle School Zone:
WILLIAM ELLIS
Soil Types:
Gn132
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
Davie County,
All data is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
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, consultants, contractors or employees from any and all claims or causes of action due to
r'op tyi�
NC
or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
ri' i�j g rD �e P. O. Boz 848/210 Hospital Street
� ,� pTMocksville, NC 27028
� ` f (336)751-8760 � M L"ood PV
Account #:
989900624
Tax PIN/EH #:
5768-10-7233.04
Billed To:
Larry Everhart
Subdivision Info:
Heritage Oaks Lot # 4
Reference Name:
Larry Everhart
Location/Address:
Cedarwood Place -27028
Proposed Facility:
Residence
Property Size:
163 X 187
ATC Number: 2470
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWA4T&CQNSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature:
CERTIFICATE OF COMPLETION
Date:
6'D
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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.
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:
DAME COUNTY HEALTH DEPARTMENT �� � /6, 1 ` o
Environmental Health Section
' P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #:
989900624
Tax PIN/EH #:
5768-10-7233.04
Billed To:
Larry Everhart
Subdivision Info:
Heritage Oaks Lot # 4
Reference Name:
Larry Everhart
Location/Address:
Cedarwood Place -27028
Proposed Facility:
Residence
Property Size:
163 X 187
**NOTEC* Thmbfr: 2470
is mprovement/Operation Permit DOES NOT authorize the construction 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building TypeZL�#People #Bedrooms #Baths a-
Dishwasher: Garbage Disposal: ❑ Washing Machine:tg----Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size V19 Type Water Supply Design Wastewater Flow (GPD) &0 Site: New 9 Kepair ❑
System Specifications: Tank Size fib GAL. Pump Tank GAL. Trench Width Rock Depth f Linear Ftl-13-00
-
Other:
fo
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
y -100. UXE-5
40
100,
KT�TL
5Q
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date: 42 o7
APPLICATION FOR SITE EvAminON/IMPROVEMENT PERMIT &
Davie County Health Department
Environmental Health Section
P.O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
N�_N9W
Lim2 12000
ENVIRONMENTAL HEALTH
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1.
Name to be Billed f
o— Lpy— 14 AJ � 1.3 +.e ,.p N/ Si'
S Contact Person A"� AeK76/�[c3
Mailing Addreas
p v ty(t.
Home Phone Oq� ✓ /�1,/2
City/State/ZIP
/�
U
9/�
t�
Business Phone J 3 lO / Q 7 T
2.
Name on Permit/ATC
if Different than Above
Mailing Address
City/State/Zip
3.
Application For:
❑ Site Evaluation
►0"Improvement Permit/ATC ❑ Both
4.
system to service:
P-910use ❑ Mobile Home
❑ Business ❑ Industry ❑ Other
S.
If Residence:
# People #
Bedrooms_ # Bathrooms
P-bishwasher ❑
Garbage Disposal WeWashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6.
If Business/Industry/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
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 9AO---
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: / 6 3 l ? XA� WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: # a (9 (- 2 a 5
Property Address: Road Name
City/Zip
If in a Subdivision provide information, as follows:
�/
Name:
Section: Block: Lot: Date Property Flagged:
D
J° cb 6 boil
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
to conduct //all testing procedures as necessary to determipe the site suitability. y�
DATE !p �- d U SIGNATURE _' --D (7� 1a
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS•
Revised DCHD (07/99)
Account No. l�
Invoice No. /
ti1Gb :)k1 HILL
,OAF rOURSE SITE
e
i
tlW, 04
i
Mt ,C h :;v,4E
f0 i
VICINITY MAP
NOT TO SCALE
EIP PK NAIL
GRID COORDINATES
N 779.633 7954
E: 1.561,687 7652
30 44'
NCC,'-:) MONUMENT — �t
:m
K)
N
zo
cv
0�
r4
NCGS MONUMENT
11 HICKORY"
N: 779,813.3879
E: 1,559,696.9922
n
'{ Igo4
LOT 1
1 e9 5E'
MIX
LOT 59
N/F
�^
DALLAS WAYNE JONES & <w
CONNIE LEE HENDRIX JON
DB. 181, PG. 619
1cU6 53' +01 AL
N U3 i'40" W
11 76.0+'
2 I+>' "q Y i C5"3
L1�T 2 a LO f 3
NORTH CAROLINA. STOKES COUNTY
I, DENLSE M. GUPTON A NOTARY PU
COUNTY AND STATE AFORESAID, CE
GUPTON REGISTERED LAND SURVEYO
APPEARED BEFORE ME THIS DAY AN
EXECUTION OF THE FOREGOING INST
WITNESS MY HAND AND OFFICIAL 97
---- DAY OF ------ ------ i
11
NOTARY PUBLIC
MY COMMISSION EXPIRES 6/16/99 -
LOT 6 L(T 7
� N N
. 456' L -1534r
!62 l8'
172.3t!' t6T.48'
N 01.54.37 M!17997 -
t
--- -- X9033' .,.._- --•—'_._--- 594. L.120.55' L. 15138' ---�..
156 2v
3t
--- -62 4V
,7, 7t• Cte6 � b /
qI y� 7� LC?
OT �T 56 u LCT `�5 I t :l„L L: T
LOT 58 i I .
` • DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS �J
PROPOSED FACIILTY
Water Supply: On -Site Well
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Community
Public
Evaluation By: Auger Boring Pit �/ Cut
FACTORS
1 2 3 4
Landscape position
L 2 -
Slope
Slo e %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
f f
Texture group
Consistence
Structure
it
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: L
LONG-TERM ACCEPTANCE RATE: ` OTHER(S) PRESENT:
REMARKS:
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- Vl---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
DCHD (01-901
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One)i REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑
Name: Phone Number: (Home) II,
Mailing Address: �7 /9` � (Work)
Detailed Directions To Site:
Property Address:
Please Fill In The Following Information About The Existing Dwelling:
Name System Installed Under: -1,41-14, ,� �G/ ,Or' y� Type Of Dwelling:
Date System Installed(Month/Day/Year): �'f� "�� Number Of Bedrooms:_%J�_Number Of People:
Is The Dwelling Currently Vacant? Yes ❑ No.B" If Yes, For How Long?
Any Known Problems? Yes ❑ NoZ If Yes, Explain:
Please Fill In The Following Information About The New Dwelling:
Type Of
Requested By:
Of Bedrooms: Number Of People:
For Environmental Health Office Use Only
Approved El�D�is/aproved ❑
(�nmmcnfc• /�7Y/Y�di�% .LJ/l�i/ / !l / Cid/%Ci �/� !i //l�� //ai
Reques
.► i
7 3
Environmental Health Specialist Akl Date
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a
guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ Date:
Paid By: Received By:
Account #: *0 3 Invoice #: -5 5 Z7
Permittee s'�' DAVIE COUNTY HEALTH DEPARTMENT
Name: i���� r� Environmental Health Section PROPERTY INFORMATION I
Directions to property: C
v
AUTHORIZATION NO: Q 0 2 G C 3 A
P.O. Box 848
Mocksville, NC 27028
Phone #: 336-751-8760
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Subdivision Name:r"
Section: '� Lot:
Tax Office PIN:#S %W /D -
Road Name'. r�! ;I f ";: t . , ,/ Zip...
**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 Fonn/Authorization Number should be presented to the Davie County Building Inspection.)
Office when applying for Building Permits.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
r irl 5t�� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE & # BEDROOMS,? #BATHS#OCCUPANTSGARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)` �^� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPT LINEAR Fr: "`''�
OTHER KV11l /I%"A-
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. 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 02/02 (Revised)
t. Permitee s. *=
t'y DAVIE COUNTY HEALTH DEPARTMENT
Name: - "-'" Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Dt ctions to property:Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
- "-` �=• Section: � Lot:
AUTHORIZATION FOR
AUTHORIZATION NO:
WASTEWATER Tax Office PIN:# 52 br /D - ��
SYSTEM CONSTRUCTION
002663 A
l
Road Name
**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)
**=Nu l 1UL*** I HIS AU I HORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE // # BEDROOMS& # BATHS _ # OCCUPANTS GARBAGE DISPOSAL: Yes or No
.COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
y LOT SIZE TYPE WATER SUPPLY C) DESIGN WASTEWATER FLOW (GPD) " 44 NEW SITE REPAIR SITE lir~
SYSTEM SPECIFICATIONS: TANK SIZE /GAL.PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH,.�/� LINEAR
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
r
i
4
AUTHORIZATION NO. 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 02/02 (Revised)