192 Hawthorne Road Section 1 Lot 10 (Old Lot 6 )Davie County, NC ` ► Tax Parcel Report .Tuesday, January 17, 2017
WA"IT4G: THIS 1S AUT A SURVEY
Parcel Information
Parcel Number:
J605000006
Township:
Fulton
NCPIN Number:
5758804825
Municipality:
Account Number:
82519384
Census Tract:
37059-804
Listed Owner 1:
KISER WENDY COMBS
Voting Precinct:
FULTON
Mailing Address 1:
192 HAWTHORNE ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 10 HICKORY HILL SECTION 1
Fire Response District:
FORK
Assessed Acreage:
0.59
Elementary School Zone:
CORNATZER
Deed Date:
1/2012
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
008800744
Soil Types: GnC2,GaD,WATER
Plat Book:
0004
Flood Zone:
Plat Page:
105
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
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. AN users of Davie County's GtS webstte 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
nOUNS NC or arising out of the use or inability to use the GIS data provided by this website.
AUTxiORIZ TION NO:DAVIE COUNTY HEALTH DEPARTMENT `I
,..
=,p Environmental Health Section PROPERTY INFORMATION
Permittee's ° �f P.O. Box 848
E S Subdivision Name:
,
Phone # 336-751-8760
f Y' n
Directions to property: < // Section: Lot:, "
AUTHORIZATION FOR
WASTEWATERS-
y'i�fr� SYSTEM CONSTRUCTION Tax Office
Road Name: 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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I I 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
2 4
DAVI&COU,NTY HEALTH DEPARTMENT-
' TMPROWMENT AND -OPERATION PERMITS: PROPERTY INFORMATION
# 'Pe
S6d' i"Vision Name'I �� ✓ ,
�r
Direct ons to,property
y Section �a Lot:
IMPROVEMENT !i M
PERMIT" Tax Office PIN'#�-
•
4
... • 'j��
y Rad Name Zip:
**NOTE** This Improvement Permit DOES NOT authonze.t{he construction or installation of aseptic tank systemJor any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM.CONSTRUCTION must be obtained um this�Department,prior to the
construction/installadon of,a system or the issuance of a building.permit:
(Inicompliance'with Article 11. of G:S. Chapter•130A; Wastewater Systems Section .1900 Sewage Treatment,and Disposal Systems)
i
' ***NOTICE*** THLS:PERMIT IS SUBJECT TO REVOCATION IF SITE
d , ! PLANS OR THE INTENDED'USE CHANGE.1'OUR WASTEWATER '
` '—`� SYSTEM CONTRACTOR MUST SEE TIIIS PERMIT .BEFORE
ENVIRONMENTAL":HEALTH SPECIALIST DATE ISSUED,
INSTALLING THE SYSTEM
RESIDENTIAL SPECIFICATION: BUILDING TYPE i BEDROOMS #'BATH9� # OCCUPANTS i� GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS-,, INDUSTRIAL WASTE: Yes or No
LOT SIZE,, 'r TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)`. NEW SITE ' - REPAIR SITE
—1,A
' - �
SYSTEM: SPECIFICATIONS: TANK SIZE GAL. PUMP TANK `+GAL:`' TRENCH WIDTH ( ROCK DEPTH r� LINEAR Fr. u
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: �P
IMPROVEMENT PERMIT LAYOUT : .
*APPROVED EFMuEKT FILTER* *-RISER(S) ..IC b OEL II[I ''f> 11DE+►
Ow
*"CONTACT AREPRESENTATIVE 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 #1S (336)751=8760.
OPERATION PERMIT
3�'
AUTHORIZATION NO: 'OPERATION PERMIT BY. II `DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THESYSTEM'DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
' WITH ARTICLE I 1 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. ` U
DCHD 05%96 (Revised) �;'
APPUC41110N FOR SITE EVALUA110N/IMPROVEMENT PERMIT do ATC
Davie County Health Department
EnvironmenfofHealth SftWon
P.O. Box 848/210 Hospital Street (�
Mockaville, VC 27028
(336)751-8760
AR - 8 1999 1 E.
***nV0RTAN1'*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TH SOIRLd!I� E COUP+fTY
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed ►,�r�," ��rn�S —�-\SFS Contact Person W�<-�v� CS—•Sz-
Nailing Address`� �� c�. C �r�c c leS C� Home Phone (,tel 1
City/State/ZIP a " ) A Business Phone `7 (e G — I (o LA
2. Name on Permit/AXC if Different than Above
Nailing Address City///state/zip
3. Application For: U Site Evaluation 91-15 prcvement Permit/ATC 0 Both
4. system to Service: [douse U Mobile Home 0 Business 0 Industry 0 Other
s. It Residence: # People 3 # Bedrooms 3 # Bathrooms
U -1 -Dishwasher 40//0bags Disposal M Washing Machine Uldasement/Pinabing 0 Basement/No Plumbing
6. If Business/Industry/other: Specify type
# Commodes # Shavers
# People # Sinks
# Urinals # pater Coolers
IP FOODSERVICE: / Seats Estimated water Osage (gallons per day)
7. Type of water supply: ly/County/City 0 Well 0 Coamunity
e. Do you anticipate additions or expansions of the facility this system is intended to serve! 01(es 0 No
U yes, what type.' sL O`C�c�.�c ��c.,� \elc.��.c�� -���c �� : r N'0
***IMP0RTAN7*** CLIENTS 1llUST CODIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Eltber a PLAT or SITE PLAN MUST BESUBIIIITTED by the client with THIS APPLICATION.
Property Dimensions: WRIT B DIRECTIONS (from MockrAlie) to PROPERTY:
Tax Office PIN: # S i 4R as -
Property Address: Road Name L-ak (,
City/Zip moc���.\\�_ Q'"7C1S
If in a Subdivision provide information, as follows:
Name:
Section: _ Block: C _ Lot: C
ncA Co-�t 1:r Cir
Date Property Flagged: /A - ' -
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 cbanged. I, also, andestand 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 determine the site suitability.
DATE — ii ' SIGNATURE �—'�-
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).
Account No. 'T .r1-
Revised DCHD (07/98) Invoice No. 6/7
r
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM
Davie County Health Department'al, ;�1
IB Environmental Health Section
J P. O. Box 665 J01. j 11,q C!}
Mocksville, NC 27028
1. Application/Permit Requested By J e C P oS
Mailing Address RXU r4 NCe C, D.-` nri L
Home Phone
//IA�U
Business Phone `7 ((b a-/
00
2. Name on Permit if Different than Above
3. Application/Permit for:
General Evaluation
[I Septic Tank Installation
/
4. System to Serve: � House
❑ Mobile Home
❑ Place of Public Assembly
❑ Business ❑ Industry
❑ Other
❑ Unknown
5. If house, mobile home: Subdivision "2
Section
T 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: C"Public
❑ Private
❑ Community
3/y
8. Property Dimensions QLICl _0
Sewage Disposal Contractor
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:
This is to certify that the information provided is correct to
incurred from this a plication.
19 C�
DATE
best of my knowledge.�and I understand I am responsible for all charges
SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. L9 -Z. 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 Count ,Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine s 'd site's s ' for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME ® CJ SDATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY / LOCATION OF SITE
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS
1
2
3
4
Landscape position
Sloe 2
G
HORIZON I DEPTH
e
Texture groupC
�C
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Al,2"
"
1P
Texture group
Consistence
i
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
SITE CLASSIFICATION: /--' EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: Is 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-Very 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
5C -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
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116.90
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' (Davie County Nealt`r (De artment
and .dome Jfealtlr� Myency
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634.5985
July 20, 1994
Wendy Fielding Combs
c/o Lifestyle Realty
12 Bermuda Quay
Advance, NC 27008
Re: Site Evaluation
Hickory Hill I—Lot 8
Dear Ms. Combs:
As requested, a representative from this office visited the aforementioned
site on July 18, 1994. Based upon the information provided on the application
for a site evaluation and after the evaluation was completed, the site was
found to be provisionally suitable for the installation of an on—site sewage
disposal system.
If you have any questions, please feel free to contact this office.
Sincerely, 7
Robert B. Hall, Jr., R. S.
Environmental Health Section
RH/wd
Enclosure