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202 Lakeview Road Section 2 Lot 12 (2)Davie County, NC ITax Parcel Report Tuesday, January 17, 2017 WARNING: THIS 1S NOT A SURVEY Parcel Information Parcel Number: 16140A0039 Township: Shady Grove NCPIN Number: 5758735470 Municipality: Fire Response District: CORNATZER - DULIN Account Number: 82532026 Census Tract: 37059-804 Listed Owner 1: DEQUENNE DAMON CHRISTOPHER Voting Precinct: WEST SHADY GROVE Mailing Address 1: 202 LAKEVIEW ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-12-S,R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 11 HICKORY HILL SECTION 2 Fire Response District: CORNATZER - DULIN Assessed Acreage: 1.31 Elementary School Zone: CORNATZER Deed Date: 4/2014 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 009550553 Soil Types: GnC2,GaD,WATER Plat Book: 0005 Flood Zone: Plat Page: 026 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: All dataIs 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 Countys GIS website shall hold harmlesstheCounty of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to Fa7 NC or arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT • IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c fSewage `Treatment and Disposal Rules (10 NCAC 10A .1934-.19 8) Permit Number Name r(�j�-d SAV/ 9f3 &Y, ` �_ Date �. 2, N2 w Location tAx Subdivision Name `:: ✓ '' Lot No. - `- Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths __ No. in Family Garbage Disposal YES p NO Specifications for System: Auto Dish Washer YES , NO ❑ Auto Wash Machine YES []. NO C] Type Water Supply ' _— hX3X/. *This permit Void if sewage system described below is not installed within 36 months from date of issue. 1 1 y r rj. F r,n *�z bytf Df a•�� Improvements permit by __ +4-I D *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 V ,44 e`e 5z)l A.C../ � dX4 cfa Ao 75X3 X A2 :__ 7Sk3 kl y 000 Certificate of Completion 1�= Date. *The signing of th'i's 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. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 Account #: 990005499 Billed To: Allegacy Federal Credit Union Reference Dianne: Perry Crutchfield Proposed Facility: Residence ATC Number: 5087 OPERATION PERMIT Tax PIN/EH #: 5758-73-6390 Subdivision Info: Hickory Hill 11 Lot # 11&12 LocationiAddress: 202 Lakeview Drive -27028 Property Size: " **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type: T&O S.T. Manufacturer�C� Tank Date Tank Size_ Pump Tank Size Nlfi System Installed By: UVV E.H. Specialist: �� bate: DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005499 Tax PIN,EH #: 5758-73-6390 Milled To: Allegacy Federal Credit Union Subdivision Info: Hickory Hill II Lot # 11&12 Reference Name: Perry Crutchfield LocationiAddress: 202 Lakeview Drive -27028 Proposed Facility: Residence Property Size: ATC Number: 5087 Site Type: ❑New ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms L( # Bathrooms 3. S # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size G.C, Type of Water Supply: ❑ County/City ❑ Well ❑ Community Well System Specifications: Design Wastewater Flow (GPD)v Tank Size r SAL. Pump Tank GAL. Trench Width Ix Max. Trench Depth Rock Depth Linear Ft. C90 Site Modifications/Conditions/Other: Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. Environmental Health Specialist �k)Date: DCHD 11/06 (Revised) Davie County Environmental Health - P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005499 Tax PIN/EH #: 5758-73-6390 Billed To: Allegacy Federal Credit Union Subdivision Info: Hickory Hill II Lot# 11&12 Address: PO Box 26043 Location/Address: 202 Lakeview Drive -27028 City: Winston-Salem Property Size: Reference Name: Perry Crutchfield Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ❑New ❑Repair tZExpansion Permit Valid for: X5 Years ❑No Expiration Residential Specifications: # Bedrooms 14 # Bathrooms 3 b # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats ``''(( Square Footage(or Dimensions of Facility) Design Flow(GPD):�71j0 Type of Water Supply: 1_75,£ounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: Site Plan Systemm Type LTAR Initial . Repair a bktQ �,�a �--- � Nua c� 3')[100• „n12S - t Environmental Health Specialist i.p. 11-06 �7/z0, 04-29-10;10:35AM; ;3367740495 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Application For. ®'Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) O Both Type of Application: ONew System DRepau to Existing System 96pansion/Modification of Existing System or Facility •** IMPORTANT*** THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed en 6rb&1W eleVttt"ntact Person Billing Address O . T1_c Business Phone City/State/ZIP —� 4 srch-,.-*+4�r_.�s-- � Phone 33G 77!f Z ,(, yZ �--taa kas� YJ� CA*-h%T- L,,. � Name onPermit/ATCifDi erentthanAbove 20Z AY_eytr-s- 1 (L NMne.sLSy.0 eV Mailing Address Ci /State2i PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: O Site Plan OPlat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name Au.c 6-&e.a„ il,sst Oxb rt- Llys f,_, Phone Number_ 3 3 G 7 7 Lf2 t-tL Owner's Address VO 07[ 4G0*f'% City/Statetzip i./ -S n/ C 7711 yr Property Address 7- LEVr 7'WL. City nnL r s.• • s Lot Size Tax PIM :'7!!- 7 - 4 p Subdivision Name(if applicable) tad_ _ 1 ( Section/Lot# Directions To Site: G 4 5 i o C0Il..!�t_1R. t ei� Lar o -Tse LMLmA w Jt If the answer to any of the following questions is `yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Byes ONo Does the site contain jurisdictional wetlands? ? OYes ONo Are there any easements or right-of-ways on the site? Bites ONo Is the site subject to approval by another public agency? Oyes RN -0 Will wastewater other than domestic sewage be generated? OYes 8No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms —&/— # Bathrooms 3. r Garden Tub/Whirlpool oyes ❑No Basement: GYes ONo Basement Plumbing: 19 -Yes DNo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: BCS ventional OAccepted OInnovative OAlternative OOther Water Supply Type: 8<ounty/City Water O New Well OExisting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? O Yes 0-90 If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pennit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property limes and corners and locatinin or 1 house/facility location, proposed well location and the location of any other amenities. Property own 's ora s egal resentative signature Site Revisit Charge i 10 Ulu #A(j V (� IClient NotificationDate: Date D u U i -+C EHS: Sign given OYes APR 3 0 211Q 01 Account # Revised 11/06Invoice # ENVIRONMENT AL HEALTH P4,��,-Io DAVIECOUNTY 41156 V 2/ 2 Z92.5- F- vi.& E 0- 12-qLT 20 1— DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990005499 Billed To: Allegacy Federal Credit Union Reference Name: Perry Crutchfield Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5758-73-6390 Subdivision Info: Hickory Hill II Lot# 11&12 Location/Address: 202 Lakeview Drive -27028 Date Evaluated: ��ZLO Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 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: f"J LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND OTHER(S) PRESENT: 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 clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm y -d NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic j Mineralogy 1:1, 2:1, Mixed MCA 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) TTAR - T.nnv-term arrentanre rata - an]/r1nv/ft7 TnT1r ncinc 1" _.JN DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.19618) Permit Number Name Date NO Location Subdivision Name z7� Lot No. sec. or Block No. Lot Size House Mobile Home Business .-- Speculation No. Bedrooms p No. Baths No. in Family Garbage Disposal YES -C] NO E] Specifications for System: Auto Dish Washer YES [D NO 0 Auto Wash Machine YES rF1 NO C] Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. V /j Improvements permit by *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 *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.