193 Lakeview Road Section 2 Lot 46Davie County, NC, # Tax Parcel Report Tuesday, January 17, 2017
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City: MOCKSVILLE
State:
WARMING: THIS 1S NUT A SURVEY
Parcel Information
1614OA0004 Township: Shady Grove
5758736782 Municipality:
11411000 Census Tract: 37059-804
BULLINS JOHN Voting Precinct: WEST SHADY GROVE
193 LAKEVIEW ROAD Planning Jurisdiction: Davie County
Zoning Class: DAVIE COUNTY R-20
NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag. District:
Legal Description: LOT 46 HICKORY HILL SECTION 2 Fire Response District:
Assessed Acreage: 0.79 Elementary School Zone:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
6/1996 Middle School Zone:
001960544 Soil Types:
0005 Flood Zone:
026 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
No
CORNATZER - DULIN
CORNATZER
WILLIAM ELLIS
GnB2,GnC2
DAVIE COUNTY
W
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a DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
S nniitarry Sewage Systems .,� Permit Number
Name _ J' / f�%✓�;: t — Date -J' / //—i ND
� _ / 7586
Location * c :-" J% l - f • . %• i'' —
Subdivision Name Lot No. %' Sec. or Block No. V
Lot Size House Mobile Home _ Business _— Industry
No. Bedrooms —.No. Baths a�2 _ No. in Family — Public Assembly Other
Garbage Disposal YES ❑ NO [-jam
Specifications for System:
Auto Dish Washer YES NO❑ d t.%
Auto Wash Ma;hine YES [� NO E]�� 0 J ��
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
ON
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System installed by U M* 4IS4 QLi
qs sti"w,
Certificate of Completion \ ��� Date r
*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. __
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME ��/i?r' DATE EVALUATED
ADDRESS
PROPOSED FACIILTY
PROPERTY SIZE
LOCATION OF SITE
Water Supply: Supply: On -Site Well Community Public f--"
Evaluation By: Auger Boring Pit LI Cut
FACTORS
1
2
3
4
Landscape position
L,
A-
�-
Slo a Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH`
Texture group
C
Consistence
i
Structure
/iC
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: �ZZ
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-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
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
1 Environmental Health Section fG
1 P. O. Box 665
%� Mocksville, NC 27028
/ /"
1. Application/Permit Requested By/
Mailing Address Home Phone
2. Name on Permit if Different than Above
3. Application for: ❑ General Evaluation
4. System to Serve: 01House
Business Phone
U Septic Tank Installation Permit
❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision %flGxvRr/ IlaL Section f— Lot #
sement/Plumbing
No. of People `lam �� M-ga—s—ement/No Plumbing
No. of Bedrooms N'Washing Machine
No. of Bathrooms •Z- ishwasher
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes _
No. of Lavatories _
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Garbage Disposal
7. Type of water supply: ❑ Public ❑ Private ❑ Community
8. Property Dimensions Sewage Disposal Contractor Z'*eEyd
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
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: !�
e� Mop,
This is to certify that the information provided is correct to the best of my knowledge,
incurred from this application.
DATE
I understand I am responsible for all charges
TURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 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 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 said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE
DCHD (1193)
SIGNATURE