282 Lakeview Road Section 2 Lot 22Davie Countv. NC
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T.qy Pnrnel Rennrt
Tuesday. January 17. 2017
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Parcel Infonnation
Parcel Number: 1614OA0028 Township: Shady Grove
NCPIN Number: 5758834877 Municipality:
Account Number: 46883000 Census Tract: 37059-804
Listed Owner 1: MALLORY PAUL J SR Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 282 LAKEVIEW ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27028-7313 Voluntary Ag. District:
Legal Description: LOT 22 HICKORY HILL SECTION 2 Fire Response District:
Assessed Ac ane: 0.65 Elementa School Zone:
Deed Date:
Deed Book I Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
4/1992 Middle School Zone:
001630218 Soil Types:
0005 Flood Zone:
027 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
CORNATZER - DULIN
CORNATZER
WILLIAM ELLIS
GnC2,GaD
DAVIE COUNTY
Mel
F07All data Is provided as Is without warranty or guarantee of any IdInd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular um All users of Davie County's GIS website shall hold harmless the
County of Davie, No th Carolina, its agents� consultants, contractors or employees from any and all claims or causes of action due to
NC or arising out of theruse or inability to use the GIS data provided by this website.
'PAVIE COUNTY HEALTH DEPARTMENT
.4y
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
in Compliance With Article 11 of G.S. Chapter 130a
AAita7,S Permit r
agM stems - il
7-7
Nam Date
0
00 ,7 -;04;76
Location
7
r
;�,
Subdivision Name Lot No. Sec. or Block No.
Lot Size - House Mobile Home Business Speculation
No.,Bedr,00ms No. Baths-. No. in Family
d I
Garbage -Disposal YES NO L]
Auto Dish Washer j!
YES NO
YES NO
Auto Wash Ma-.hine�
Type Water Supply,
*This permit Void ifs6wage systern described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans orth6 intended use change.
t
Improvements permit bi
*Contact a representative of the'Daivie County Health Department for final i I rispection of this system between 8:30-
9:30 A.M'. or 1:00-1:30 P.M. on ..day,,O'f completion. Telephone Number 704-634-5985.
Final Installation Diagram: System Installe'd by
P_V_
EP
70
1z
ion
Certificate ot,dompleti Dat
The signing of this certificate 'shall indicate 'that the system� described above has been installed with
compliance
the standards set forth injhe above regulation, but shall in NO way be taken as a guarante6th t th system will function
satisfactorily for any given period of tim6. F1
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665 VZ
Mockpville, NC 27028 OC 1 1993
1. Application/Permit Requested By. uo(—.
Mailing Address T Home Phonq �'7;f .7 J/01
or- c �i -7o Business Phone 0
2. Name on Permit if Different than Above 14 I'l C--�'
3. Application for: 0 General Evaluation erls-�eptic Tank Installation Permit
4. System to Serve: 16"'House 0 Mobile Home 0 Place of Public Assembly
0 Business 0 Industry 0 Other 0 Unknown
5. If house, mobile home: Subdivision A1-14i�OIC41 Section 7!4' Lot #
/ e.-gasement/Plumbing
No. of People
:3
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions 00
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Sinks
No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: ublic E-1 Private
8. Property Dimensions 4�26 X -13 7 Sewage Disposal Contractor
C1 Basement/No Plumbing
b"'Washing Machine
Er/Di shwasher
n -'Garbage Disposal
9. Do you anticipate additionslexpansion of the facility this sytem is intended to serve? 0 Yes b -ho
If yes, what type?
0 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:
This is to certify that the information provided Is correct to the best k ledge, and I understand lam responsible for all charges
incurred from this application.
L4�� — ,
DATE SIGNATURE
CONSENT FOR SITE EVALUATION !Q BE DONE Ql� ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 0��1. I OWN the property. 0 2. 1 DO NOT OWN the property.
N
C H E K 7NE. -' E'
C 0 -
x #2 , th
ent to tj
erty e Davie ,
G t g pr C
MUS
If you chocked Box #2, the rest of this form MUS 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.
D T
ATE SIGNATURE
DCHD (1/93)
NAME
ADDRESS -
PROPOSED FACIILTY
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Water Supply: On -Site Well Community Public
Evaluation By: AugerBoring Pit Cut
FACTORS 1 2 3 4 6
Landscape position
Slope Z
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:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
Landscat)c Position
EVALUATED BY: -
OTHER(S) PRESENT:
LEGEND
R -Ridge S7Shoulder 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
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
Mineraloizy
1:1, 2:i, 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 watef 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
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
SOWSITE EVALUATION
Name D L Date
Address 'L P"L, - a, ? Lot Size 'z lr�x so
A
1:Ar.Tr)QQ APPA 1 APFA 9 ARFAR ARPA A
Topography/ Landscape Position
im>
S
S
PS
PS
einE::)
ET��
U
U
U
U
Soil Texture (12-36 in.) Sandy,
d S
Le /,,I
S
S
Loamy, Clayey, (note 2:1 Clay)
/01-- 3�
C2:E�->
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
3,-
S
S
Clayey Soils
dn::>
C!J�
4:�q�
U
U
U
U
Soil Depth (inches)
4:��
4f
<::��
PS
PS
PS
PS
U
U
U
U
Soil Drainage: Internal
S
4:��
S
S
<2E5::�
S
cfe�
U
U
U
U
External
<��
Z�
<!�
PS
PS
PS
PS
U
U
U
U
Restrictive Horizons
,,014. X-
e,6� ,/ 3
Available Space
PS
S
<1a=:1
S
<In:>
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Site Classification
V
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations /Comments:
W1--- S'014'- C.— 6—
Described by Title Date
SITE DIAGRAM
DCHD (6-82)
( +� Zz-1 ) 0
["4�0 4,T4 vv�
-1 2- 3 D
APPUCATION FOR SITE EWkLUAr ION/ IMPROVEMENTS PERMIt
Davie County Health D,?pajjmejjt
Environmental I-lealih Sec -tion
P 0. [kox 665
MOCI(Sville, N.C. 27028'
CONSTRUCTION SHALL NOTBEGIN UNTIL IKIPRoVEMEN7S PERMIT HAS KFN 166UG11
149me Nono
I. POrmill Requested By& )0-6-Af _.____PusIness Phone 9 2
2. A rags eA P077A ge-44 -
Ale Aa, Cd E N -C 26 *7 tf A (a
Prop" Owner If Dirowent than Above
Address
4. Permill To: a) Install. Repair -
b) Privy— Corwentional_?�f6ther Type_
Ground Absorption
c) Sub-Divislony;te"� P ;. — S:e�c,_.�I____ Lot No. dl d",
5. System used to serve what tyt Housej-_ Mobile Home— Elusine$&_
Indust -y__ Othc:r--.
b) Number of people 44" _.
a) If b0L86 or mobile home, state size of home and number of rooms.
House Dimensions �iv y
Bad Rooms -3 Bath Rooms..AZA-_ Dan w/Closet-__..
b) If Suesinoss, Industry or Othar, State: Number of persons seried
What type busirms,
Estimate amount -of waste daily (24 hours) --.---.--
7. Number anq type of wator-using fixtures:
cosnmAes 3 garbage disposal
lav3tor,y showers washing rnwhine—
dishwasber inks_-/
"""s
S. a) Type water supply* Public_1._::__�F'rivaje_...____ Community—.—
b) Has the water supply system been approved? Yes No_
9. a) Property Dimensions Q_ 3 0 /
b) Land area designated to building sit:i _Lf!
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of ttie facility tl�is sewa!je systern is Intended to serve?
What type?
This Is to cortity that the informatio�nis corre,t to th, Ole of my knowledge.
"e
O�ner
Date Owner SignattIfe
OWNER I'll SOLELY RESPON!318LE FOR C OM;:'LIAN:,E INITH ALL STATIF AND LOCAL LAWS
Allow !,.tays for processing
Directions to property:
yc- A�
L 0 7
14 Ifi
'P I
XPISS 't,
'Z_ A K
/ .3-3-
- '( -r r 4 -t -T-,
cc"D 0-32)
e4
yc- A�
L 0 7
14 Ifi
'P I
XPISS 't,
'Z_ A K
/ .3-3-
- '( -r r 4 -t -T-,
cc"D 0-32)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME—
ADDRESS
PROPOSED FACIILTY I
DATE EVALUATED
I A 0 ? � f
3 4 6 7
PROPERTY SIZE /A-r7x
Z_
LOCATION OF SITE
164A11 -
Water Supply: On -Site Well Community Public
Evaluation By: AugerBoring Pit Cut
FACTORS 1
2
3 4 6 7
Landscape position
Z_
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON 11 DEPTH
ell
Texture group
Consistence
Structure
5-ke,
rl�i'411
Mineralogy
'47
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
;71)
LONG-TERM ACCEPTANCE RATE
5/
SITE CLASSIFICATION: EVALUATED BY: 2y��I_Z
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape Position
R -Ridge S7Shoulder L -Linear slope FS-Footslope 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
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
SC -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