846 Ben Anderson Rd Davie County, NC Tax Parcel Report 1 U Friday, September 23, 201 f
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: C20000000303 Township: Clarksville
NCPIN Number: 5803510647 Municipality:
Account Number: •- 82526902 Census Tract: 37059-801
Listed Owner 1: POOLE JONETTE W Voting Precinct: CLARKSVILLE
Mailing Address 1: 880 BEN ANDERSON ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-5643 Voluntary Ag.District: No
Legal Description: 1.000 AC BEN ANDERSON RD LT 1 SMITH CL Fire Response District: SHEFFIELD-CALAHALN
Assessed Acreage: 0.90 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 8/2006 Middle School Zone: NORTH DAVIE
Deed Book/Page: 006750549 Soil Types: MnB2
Plat Book: 0008 Flood Zone:
Plat Page: 0381 Watershed Overlay: DAVIE COUNTY
Building Value: 173400.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 13540.00 Total Market Value: 186940.00
Total Assessed Value: 186940.00
All data is provided as Is without warranty or guarantee of any kind 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 County's GIS website shall hold harmless the
County of Davis,North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to
�CUN�� NC or arising out of the use or inability to use the GIS data provided by this website.
DAME COUNTY HEALTH DEPARTMENT 1 s'
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990004043 Tax PIN/EH#: 5803-51-5353
Billed To: Jonette Poole Subdivision Info:
Reference Name: Location/Address: Ben Anderson Road-27028
Proposed Facilily: Residence Property Size, 1 acre
ATC Number: 4470
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CONSTRU TION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: (7 C3
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 of S.Cha ter 130A,Section.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY a em will function satisfactorily for any
given period of time.
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Septic System Installed By:
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Environmental Health Specialist's Signature: Date: /d 10- 110,
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
• Io_ Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028 f 1/
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 990004043 Tax PINI H#. 5803-51-5353
Billed To: Jonette Poole Subdivision Info:
Reference Name: Location/Address: Ben Anderson Road-27028
Proposed Facility: Residence Property Size: 1 acre
**NO TE*This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INN-S�T^ALLING SYSTEM.
Residential Specification: Building Type #People #Bedrooms ,/ #Bathx2
Dishwasher: 00" Garbage Disposal: ❑ Washing Machine:Jr Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #P/eople #People/Shift #Seats Industrial Waste: ❑
Lot Size Ci Type Water Supply Design Wastewater Flow(GPD) _ Site: New Repair. ❑
System Specifications: Tank Size,��GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft IW
Other:
J As stated in 15A NCAC 18A.1969(S
Required Site Modifications/Conditions: ���/� accepted Systems may also be used
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of in tallation. Telephone#is(336)751-8760.****
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Environmental Health S e ialist's Signature: /� / Date:
P !�
DCHD 05/99(Revised)
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.,P]OL R SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
21 2006 Environmental Health Section
P.O. Box 848/210 Hospital Street
R���^E101 JA A = Mocksville,NC 27028
E fpT0 (336)751-8760/Fax(336)751-8786
Application For:IKSite Evaluation/Improvement Permit ❑•Authorization To Construct(ATC) XBoth
***IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed ?Or1dt�t. Role. Contact Person Tyiefte,P001c,
Billing Address $8'0 &nsews d Home Phone 33(o—'-192- 7515
City/State/ZIP Aoc_ksV t 11g, _ NC. ID-70Q% Business Phone 33(0—761-59 0 5
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION
NOTE: A survey'plat or site plan must accompany this application.
(Permit is valid for 60 months with site plan,no expiration with complete plat.) 5�f0z S l 53Y.3
Street Address City Tax PIN#
Subdivision Name Section/Lot# Lot Size l Ac-re—
Directions
creDirections To Site: (o0I /� , Lef+ oc> U bed2A Ch: (Zc# , {={- or, 8ea.r t=reek. Ch. Rcl,
%ZZ4V1 on Be.n Andersoc\ t26 , Cross -tfie c.reex o__ovsi- second house.
"r line, runs + ee cco n
Date House/Facili Corners Flagged �7 l 2ooto
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? Dyes P<o
Does the site contain jurisdictional wetlands? Dyes PNO
Are there any easements or right-of-ways on the site? Dyes Colo
Is the site subject to approval by another public agency? Dyes �
Will wastewater-other than domestic sewage be generated? Dyes 20
IF RESIDENCE FILL OUT THE BOX BELOW .
#People15 #Bedrooms 00 #Bathrooms sK—? Garden Tub/Whirlpool VIVes ON
Basement: Yres ❑No Basement Plumbing: Dyes Pilo
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: /ConventionalAccepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: ❑ County/City Water C�iew Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? R-*Yes ❑ No c C kc>r I
If yes,what type? 2 addi+iona.l Wr'ooms and one baAAroorvm }firs I.• W
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand thavol—
any permit(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 understand that I am responsible for all charges incurred
from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to
conduct necessary inspection determine complia ce with applicable laws and rules on the above described property located in
Davie County and owned by
r Site Revisit Charge
Prop#ty owner's or owner's legal representative signature
Date(s):
7 (()(p Client Notification Date:
Date` 3 EHS:
Sign given Ves ❑No Account# /_/7�3
Revised 2/06 Invoice#
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990004043 Tax PIN/EH#: 5803-51-5353
Billed To: Jonette Poole Subdivision Info:
Reference Name: Location/Address: Ben Anderson Road-27028
Proposed Facility: Residence Property Size: 1 acre Date Evaluated: tat
Water Supply: On-Site Well P'- Community Public
Evaluation By: Auger Boring ( - Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH Y pJ
Texture group
Consistence ,r
Structure
Mineralogy '
HORIZON H DEPTH i
Texture group
Consistence
Structure r
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: EVALUATION BY-
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 clay loam SIL-Silty loam CL-Clay loam SCL-'Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay f
CONSISTENCE
NluisY
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
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
Nola
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 05105(Revised)
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Davie County Health Department
Environmental Health Section
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760/Fax(336)751-8786
Improvement Permit
August 2,2006
Ms.Jonette Poole
880 Ben Anderson Road
Mocksville,NC 27082
Re: Ben Anderson Road
Tax PIN#5803515353
Dear Ms. Poole,
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 or the intended use change.
System To Server Wastewater Design Flow(GPD): Valid: Years ❑No Expiration
System Type: 816onventional XAccepted ❑Innovative ❑Alternative ❑Other
As stated in 15A NCAC 18A.1969(5)
Site Modifications/Permit Conditions: Li<eepted SVctpm-; may also be used
Site Plan
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Environmental Health Specialist Date
Lp.letter 7/06