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846 Ben Anderson Rd Davie County, NC Tax Parcel Report 1 U Friday, September 23, 201 f 1 , - 846 *%1P r �l- +1/ l�1 l� Y 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. i �dl Septic System Installed By: 7r 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.**** G� eu 9�*i Environmental Health S e ialist's Signature: /� / Date: P !� DCHD 05/99(Revised) tt .,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# �_ ' a '„ —- . ,_ �_ \, '�q�• J `; y' I i r . , ,�r � . � N L', . �� ; �� 3. �"'y „f , — ' \i . �;� � 1 ^ .r” ,.� T B d 7 by J/ `+ Y _ K • Y iii . a �Y w '� n+R�'•�o � , �.� x � gip.*: a •I� ;a ?O 4083 ANO Z 5 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) ■■■■■■■■■ale■■■■■■■■■■■■■■■■■■ee■ ■■■■■e■■■■■■■els■e■■■■■■e■■■■■■■■ ■■■■■■■■ell■■■■■t■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■n■■■■■■■■■■■■■■■■■ ■■■■■■■■■Ise■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/I■■■■■■■■■e■■■■■e■ ■■■■■■■■Milo Non ONE■■■■■■■■e■■■■■■■■■■■■■■■■e■ w■MEMO■■■■ ■■■►�■►ettillisl■■■■■■■■■■NON■■■■■■MEMO WEE ■■■■■■■■■■■■/I■lliii■■■■■■■■■■■■ ■■■■■Illl`1r/li■■■■■■e■■■■■ei■■■ee■■■■e■■eie■■e■■■■■�I■■■■■■■■■■■■■■■■■ ■■■iC�■i■e/lee■■■■■■■■■■■■■■e■■■■■■■e■■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■ NON■e■■■■■ ■■NEE■■■/:■■■e=== .......!JMEN CI?vN■■■III■■■le■■■■■■■■■■■■■■■■ iiiiieNi::::::W iMENNEN wu■liMENNEN ■■■■■■■■■■■■OEM■■■■■■■L'-- -==== �i�■■■■■■■■■■■e■■le■■■■■■e■■■■e■■■■ ■■■iee■■■■11■■■■e■■■■■■■■l■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■ ■■■■■■e■■eie■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ie■■e■■■■ee■ ■■■■■■■■■■■■e■■■■■■■■■■■e■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■e■■■■e■■■■■■■■■■■e■■e■iw■■i■■nee■■■■■e■■mono ■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■e■ew■■■ee■■e■■■e■■■■ 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 �-� �1�1Z) Environmental Health Specialist Date Lp.letter 7/06