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
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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.
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Improvements permit by __
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*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
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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
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Environmental Health Specialist
i.p. 11-06
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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
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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
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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.