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146 Lakeview Road Section 2 Lot 7Davie County, NC Tax Parcel Report Tuesday, January 17, 2017 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: MOCKSVILLE WAK1V11VG: 'l'HIS IS NUI A JUKV hY Parcel Information 16140A0043 Township: Shady Grove 5758730866 Municipality: 8300631 Census Tract: 37059-804 GROFF KEVIN Voting Precinct: WEST SHADY GROVE 146 LAKEVIEW ROAD Planning Jurisdiction: Davie County Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: LOT 7 HICKORY HILL SECTION 2 Fire Response District: CORNATZER - DULIN Assessed Acreage: 0.93 Elementary School Zone: CORNATZER Deed Date: 1/2012 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 008810011 Soil Types: GnC2,GaD,WATER Plat Book: 0005 Flood Zone: Plat Page: 026 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: 91,�v �� All data is provided as Is without warranty or guarantee of any Idnd 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 Counttrs GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ag daims or causes of acdon due to r'pU N�4 Nl./-+ or arising out of the use or Inability to use the GIS data provided by this website. AUTHORIZATION NO. 1175 DAVIE COUNTY HEALTH DEPARTMENT Lake 4 ✓ , Environmental Health Section PROPERTY INFORMATION Permittee'sf,- r' "� i P.O. Box 848 f i . •,% aTL"52 tMocksville,NC 27028Name:'Subdivision Name:�•:'�riri Phone #: 704-634-8760` Directions to property: ^%i"� j'' .' .� Section: r Lot: AUTHORIZATION FORS.. _ WASTEWATER .e�'N�r• - s Tax Office PIN:. SYSTEM CO �UCTION Road Na e **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 � DAVIE COUNTY HEALTH DEPARTMENT "t IMPROVEMENT AND OPERATION PERMITS N am— Subdivision Name: ✓' f c. : "� ! a -Ir. Section: f� Lot: &-qke,''V1r(J GjX� PROPERTY INFORMATION Y I Directions to property: E%IPROVEMENT PERMIT GIl Tax Office PIN:.}_ Road N e•i � i1L .1 (:- **NOTE** : **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*** TILS PERMIT IS SUBJECT TO REVOCATION IF SITE A! , x , E ./ . , ?,f/ E �' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER l . ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE /;� # BEDROOMS,—_? # BATHS= # OCCUPANTS 4 GARBAGE 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) -%L) NEW SITE-4,,"'� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEZ/�L!} GAL. PUMP TANK ��PhAL. TRENCH WIDTH TC �'ROCK DEPTH -Z,L LINEAR FT. �D OTHER C ^ REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT **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. ..r OPERATION PERMIT 1 SYSTEM INSTALLED BY: �� �►`'-Sai� fly ' `rA AJ W- �'TT PT J� 1-7 0 �4 HooSc` -JO A -r i— % _ ) AUTHORIZATION NO. ' (� � OPERATION PERMIT BY: � DATE: o /Y� **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 EVALUATION/IMPROVEMENT PERMIT & AT n Davie County Health Department Q �J - D ._ Environmental Health Section P.O. Box 848 ,lAN 6 I�Z;J Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED L7IQLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Neff Li iz dd// Contact Person J�% e JG�t Mailing Address 2,2-45- Gil L°�o L �ee e`i2P Home Phone 13 "ZZ3 '4 [` 3 City/State/Zip &%i f✓� < vil? Sta f f)f?,t,271h � Business Phone 'IsZ� 2. Name on Permit/ATC if Different than Above 7Z J; SZ d ' Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation Improvement Permit & ATC 4. System to Serve: jjcr House [ ] Mobile Home !! [ ] Business [ ] Industry [ ] Other 5. If Residence: # People Z # Bedrooms # Bathrooms p Z..5r CiC] Dishwasher M Garbage Disposal [M Washing Machine [k] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes [ ] Both # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [x] County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes D4 No If yes, what type? r -LMP -K A rLAI UK J1 PROPERTY INFORMATION REQUIRED: *** IMPORTANT **1I3' OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: / -7TH' .64 117<Y. x 17 WRITE DIRE1CTIO>NS (from M1ocksville) TO/ PROPERTY: Tax Office PIN: #�,51 - _1- D $ 6� /�� �0.c 7 Yo ��� �/' /alt 4.c/ Property Address: Road fame Aad City/Zip If in Subdivision provide information, as follows: Name:%��c�_'/%c Section: Z Lot #: 7 ; 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 determine the site suitability. DATE SIGNATURE_,;%�&w Revised DCHD (06-96) THIS AIZEA MAY 13E USEb F01? bRAIVINC YOUR SITE PLAN: Zo 1A 01W W 1L1 W W w UA i 000 of ON IN _ ; .. C4 ! NNN ..-. _.. .. '1 j-" I SSG APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section P. O. Box 665 Q� Mocksville, NC 27028 Application/Permit Requested By :TasOn rowbrlC= 4 Marla A. Mafr1SCIno Mailing Address 4155 CountN Gab Rd 1 41 I�3T .{ Home Phone6M765-N24 W 1nStio - S L I -M , N C Z7104- Business Phone 1792 2. Name on Permit if Different than Above pvvo 3. Application for: General Evaluation Tank Installation Permit 4. System to Serve: / House ❑ Mobile'fl`bme ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision hobN 1 5 . � n kb'lm (int"b Section Z Lot # 7 No. of People 2 - No. No. of Bedrooms . 5 No. of Bathrooms 2 - Dwelling Dimensions 000 •1 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: ❑ Public No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private ❑ Basement/Plumbing ❑ Basement/No Plumbing JZ( Washing Machine Dishwasher gGarbage Disposal 8. Property Dimensions •`13 QCrfl_S Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If 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: Roup 158 West i wardS Mocl suint; , I fft atito Bat,-hrnort, Rd- T0,Kf- io -end, Tak, onto Corner Rd. @ 3-5 milts to Itfj ►nfio k-ticKory tiill Subdiv&OI-) -Thir�1 property oh r�gh�-C��ooded) 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. DATE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. X2. 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: I hereby give consent to the authorized representative of the Day ieCount�H alth Department to enter upon above described property located in Davie County and owned by EI�(),)(�}`j � Shxml Rr) f n S to conduct all testing procedures as necessary to determine said site'6 suitability for a ground absorption sewage treatment and disposal system. � 1 31nP_ 211 105 6 DATE SIGNATURE DCHD (1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME n'71� (10, ADDRESS PROPOSED FACIILTY DATE EVALUATED PROPERTY SIZE LOCATION OF SITEIV Water Supply: On -Site Well Community Public L--' Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position LIL.L Slope % d - HORIZON I DEPTH Texture group GL C Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC C Consistence Structure i 51zle S4/11 Mineralogy A. ' 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: A EVALUATED BY: //"/,Z 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 Ti-_xture 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--ry 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 a f Davie County Nealb De artment X and .�vme ealt§yen ey 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 July 6, 1995 Jason Trowbridae & Maria Matriscino 4755 Country Club Rd. Apt. 113 I Winston-Salem, N.C. 27104 Re: Site Evaluation Hickory Hill II Lot 7 Dear Mr. Trowbridge and Ms. Matriscino As requested, a representative from this office visited the aforementioned site on July 5, 1995. Based upon the information provided on the application for a site evaluation and after an evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. The area that is classified provisionally suitable is along the front portion of the lot. A pump may need to be used in order to keep the lines at an acceptable depth. When the house placement is determined, contact this office and at that time a permit can be issued. Please advise should have any questions. Robert B. Hall, Jr., R.S. Environmental Health Section Enclosure(s) 1. Permit Ri 2. Address 3. Property Address 4. Permit Ti b) Privy Conventional her Type Ground Absorption c) Sub-Divisio Zcv,_t, Sec. Lot No. _ 5. System used to serve what type fac lity: House Mobile Home ' Business Industry Other b) Number of people -5 'APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT `2 $ Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of "ter -using fixtures: commodes of!- urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public_ Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions .93 C, b) Land area designated to building site c) Sewage Disposal Contractor _ 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is corre the b y knowledge. -:77 �Z Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) L E/, • • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 p SOIL/SITE EVALUATION % Name_ B `f Date Address Lot Size 'P FACTORS APPA 1 APPA 9 ARFA A AQGA A 1) Topography/ Landscape Position S S S S PS U 2) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) P CP fps S PS U U 3) Soil Structure (12-36 in.) Soils (PS) jT PS SClayey U U 1) Soil Depth (inches) S S PS i) Soil Drainage: Internal p `rtf PS S S PS U ExternalS � P U S PS U i) Restrictive Horizons Available Space S S C S S PS U U o) Other (Specify) S PS S PS RS S PS U(� U U U 1) Site Classification .S' P -f U—UNSUITABLE Recommendations/ Comments: S—SUITABLE PS—Provisionally Suitable Described by �%� Title SITE DIAGRAM r DCHD (6-82) Date • • % fe pavie (aunty Pealth Department anb PC= 'Veult4'1.gentv1 P. O. BOX 665 f ocksuille, Yort4 Carolina 27028 CONNIE L. STAFFORD, SA, MPH August 3, 1988 TELEPHONE Health Director (704) 634.5985 (704) 834.5881 Roy Potts Potts Realty P. 0. Box 11 Advance, NC 27006 Re: Site Evaluation Hickory Hill/Sec. 2 -Lot 7 Dear Mr. Potts: On August 2, 1988, this office evaluated Lot 7, Section 2 of Hickory Hill. The lot is classified provisionally suitable along the front portion; however, a pump may need to be used in order to keep the lines at an acceptable depth. When house placement is determined, contact this office and at that time a permit can be issued. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health RH/wd Enclosure STATEMENT DAVE COUNTY HEALTH DEPARTIVWENT r ' ENVIRONMENTAL HEALTH SECTION 210 HOSPITAL STREET P.O. BOX 848 MOCKSVILLE, NORTH CAROLINA 27028 (704) 634-8760 Payment Due Upon Receipt of this Bill. Detach and Mail a Copy of Bill with your Check. Your cancelled check is your receipt. January 21, 1998 5.cvpMin FruciIt 2L15 Chcrol;ee Ln. Winp nston—salo , Iv a 2/10-; 01-2-1-98 jR::rmit/',iC ;117::/fAicl;cry Hill 'Al—Lot 7 ( t5 .4'67 M.