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234 Broadway RdDavie County, NC , � Tax Parcel Report Wednesday, October 12, 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: N500000023 Township: NCPIN Number: 5745339791 Municipality: Jerusalem Account Number: 8302274 Census Tract: 37059-807 Listed Owner 1: BROADWAY KENNETH DALE Voting Precinct: COOLEEMEE Mailing Address 1: 222 BROADWAY ROAD Planning Jurisdiction: Davie Counry City: MOCKSVILLE 2oning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27028 Votuntary Ag. District: Legal Description: 50.758AC BROADWAY RD Fire Response District: Assessed Acreage: 0.93 Elementary School Zone: Deed Date: 4/2013 Middle School Zone: Deed Book / Page: 2013E0426 Soil Types: Plat Book: 11 Flood Zone: Plat Page: 134 Watershed Overlay: Building Value: Land Value: Total Assessed Value: �°" w'�' Davie County, �o- U`� NC 45970.00 Outbuilding 8� Extra Freatures Value: 15850.00 Total Market Value: 66320.00 No COOLEEMEE COOLEEMEE SOUTH DAVIE Gn62 DAVIE COUNTY 4500.00 66320.00 . ., . .. _._ . . . ,.: , . ;; , ....:: , •:: � _:. . _ . ,_.,,,�..�-• t 1/j�p � �;, �A°'r7THOR�ZATION NO: �� DAVIE COUNTY HEALTH DEPARTMENT ' ' ' Env�ronmental Health Section PROPERTY INFORMATION � ,, + ��rmittee's ,,fy+ P.O. Box 848 Name: �i �,�� ;:�� ;�:��-g Mocksville, NC 27028 Subdivision Name: � / .-> Phone #: 704-634-8760 ' Directions to property: ��•;>�..� �,�� Section: Lot: AUTHORIZATTON FOR WASTEWATER R .A!:r^"' :; � "-„ � �-'c�'.�` SYSTEM CONSTRUCTTON Tax Offce PIN: ,� =+ - ._- �°;�+ - _,+� r�` � �� ' Road Name: 'l.�.r.?•'� f/c� ~'�ip. � �� '. �� **NOTE** This Authorization for Wastewater System ConstrucUon MUST BE ISSLTED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Forn�/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATTON FOR WASTEWATER CONSTRUCTION r"'� +. '� ~:~ Ff��f..�� ;� �`%�• r�� -//�': �d IS VALID FOR A PERIOD OF FIVE YEARS. .r�-+, ,c�..�.v�',i'. ENVIRONMENTAL HEALTI-�SPECIALIST DATE ISSUED r , , ., - �„ V'°�,, G , .y.r r-=-� . r� �� DAVIE COUNTY HEALTH DEPARTMENT : �; , . � � �-. �' �-` , "" IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION r�xr a .'' � ' . � . � . . . . . . . ,: - Per�rttee �s :. ,�9: , • fi � r"i'` �.,� Name: �/;�{� rr,r ;•;.>° ��T; �`�'��'`: '" Subdivision Name: �i , _ Directions to property: ,�'" �:,. ,.� r; : Section: � Lot: ;. ». ,.., IlVIPROVEMENT PERMIT TaxOfficePIN:#�� ~^:�,' - � �,`. r;' Road Name �> "��.� �7: �� 1: u�c'� r f.'�Z p��%� �"_�p=:?� �_' **NOTE** This Improvement Pernut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An AU'I'HORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained from this Department prior to the ._._,,,, construction/installation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) � , %�� ***NOTICE*** TEIIS PERNIIT IS SUBJECT TO REVOCATION IF SITE < 5 �`� , � r �. if"'�, ,�` �, '� �,,,�; i PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTI-I SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE . INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �"�=fg # BEDROOMS .,��_ # BATHS � # OCCUPANTS � GARBAGE DISPOSAL: Yes or No �� . COMMERCIAL SPECIFICATION: FACILITY T'YPE # PEOPLE # PEOPLF/SHIFT # SEATS INDUSTRIAL WAS1'E: Yes or No C LOT SIZE �t7 ` TYPE WATER SUPPLY /% DESIGN WASTEWATER FLOW (GPD)`—S �� NEW SITE� REPAIR SITE / �, 7 �i ,�' /' SYSTEM SPECIFICATIONS: TANK SIZE �✓:j GAL. PUMP TANK GAL. TRENCH WIDTH �.-�� > ROCK DEPTH,,�-� LINEAR FI'. _S� REQUIRED SITE **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH 1 BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF OPERATION PERMIT � �� : � l� � � SYSTEM RTMENT FOR FINAL INSPECTION OF THIS SYSTEM 'tjLLATjON. TELEPHONE # IS (704) 634-8760. AUTHORIZATION NO. �� OPERATION PERMIT BY: �--�' DATE: v� � **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD OS/96 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC '-� t ' Davie County Health Department (� � " ' ' �c��o�� Environmental Health Section D P.O. Box 848 Mocksville, NC 27028 OCT I Q 1997 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSI�B-� THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Bi11ed,�1,/Q�N �; . X�I C!'}'�'Z Contact Person �t�1'U i3f�?nra.,� __�.1 Mailing Address I i"1.51 n l�X� � f�� ,�� Home Phone a g`� —� 3� L� City/State/Zi� _iY' �0.1J�i. iJ� �7(�� Business Phone i t-i v-� v R� C 2. Name on PermidATC if Different than Above Mailing Address City/State/Zip 3. Application For: [�ite Evaluation [�provement Permit & ATC [�th 4. System to Serve: [�use [] Mobile Home [] Business [] Industry [] Other 5. If Residence: # People�_ # Bedrooms ? # Bathrooms�_ [►�]/ishwasher [] Garbage Disposal [�hing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: �County/City [] Well [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [rj'�10 If yes, what type? � EITHER tt PLtIT OR SITE PLtIN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **�T OF THE PROPERTY MUST BE � SUBMITTED H THIS APPLICATION. Property Dimensions: � WRIT�IREC NS (from Mocksville) TO PROPERTY: Tax Office PIN: # .S% `�S� - �3 _ 9 � 9l ; �G� i � � � / �innr� � Property Address: Road �ame �r'a�/��Y 1� � �0' �"'► � City/Zip f'i'IoG,C�Jv%/�t `1G Z?o2` � ,,� � � � If in Subdivision provide information, as follows: �� 1�0- ��• � 1y ��Q Name: � n"r �� Section: Lot #: ' � This is to certify that the information provided is correct to the best of my knowledge. I understand that any pertnit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incuned from this application. 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 • '�Z`ll�l►7i � ..,_ l�� • � � • Revised DCHD (06-96) to conduct all THZS AREtI MAJ $E USEb �OR blltttUlNC JOUR SZTE 7'LAN: to determine the site suitability. � INDEXED ON 5745.14 4 i�� \ ; � , �. � �- a,�,_� i��_ - .� � �� The Davie County Tax Administrator's Office assumes no liability for any in�ormation contained on this map. Public information sources should be consulted for verification of information. � i , ; � October 09,1997 8:59 AM � � I Parcel Identification Number 5745-33-9791 ' „ . + � • � ' DAVIE COUNTY HEALTH DEPARTMENT �, . ' • Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME �'�/(,c ! `�• DATE EVALUATED �G7 ��"'/"/ PROPOSED FACILITY � PROPERTY SIZE �� SUBDNISION ROAD NAME Water Supply: Evaluation By: FACTORS HORIZON I DEPTH Texture group Consistence Structure HORIZON II DEPTH Texture erouv Structure On-Site Well Community Auger Boring � Pi[ 1 L •r HORIZON III DEPTH Texture group Consistence Structure HORIZON IV DEPTH Texture group Consistence RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE i SITE CLASSIFICATION: � LONG-TERM ACCEPTANCE RATE: � ; REMARKS: DCHD (01-90) 2 Public �/ Cut 3 4 5 6 7 EVALUATION BY: OTHER(S) PRESENT: LEGEND Landscape Position R- Ridge S- Shoulder L- Lineaz slope FS - Foot slope N- Nose slope CC - Concave slope CV - Convex slope T- Tenace 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 Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky 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 Mineralogv 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 - gaUday/ft2 ■■�■��■■��■�■■■■��■■■ ■■■■�■■■�■■�■�\�■■■■■■■■■■��■ ■■■■��■■��■��■■■��■ ■�■■ ■��■��■�■■��■��■■■■ ■��■ ■■��■��■��■��■■■■■■�■ ■��■�■■��■■�■��■ ■��■■��■��■■�■■��■■��■■ ■��■��■■��■■�■■■■■■■■■■■ ■�■�■■��■■■■■■��■��■ ■■■�■��■■■�■��■��■��■■■■ ■��■■■��I■��■�■■��■�■��tl�■■■■■■■��■■ ■��■�■��'■■��■■��'L�■■■�■l1�11��■��■■�■��■ ■��■�■��■■��■�■■r,�■■��■��;��■■��■■�■■�■ ■��■�■��■■��■��■��■��_==:�r��■�■■��■■�■ ■��■�■��.��= �:;:��■�■■��■r�■■��■�■■■■ ■■■■■�■��=:��u��■■■■■■�■■■■■��■ ■��■■:t■�■■■�■��■��■��■��■�■■��■ ■■■�■��■■��r�•■�■■�■■�■■■��■�■�■ ■�■■■■■■ ■■■�■�■■�nA�rr■��■■��■■t�■�■■■■■■■��■��■ ■�■��■■.�11�.��■��■■��■■■■■■■■■��■�■■■■■�■ ■■■�■�■■I�L•■■■■��■�■■��0■■■■■■��!�■ ■■■��■■1��■■■■�■■��■�■��l=� :��:iii��1�■ ■■��■■�11■■■■■�■��■■��I■��■■��■■■■■11■ ■��11■■�■��■��■■��■�■I■■�■■■■■��■��■�11■ ��1�� ■■�■■■■■11■■�■�■■��■�I�■■■��!�n��i^::! ■��■■■��11■��■■■■■■�■��L'i��■��■ ■■■■�■��i■��■■�■■��■�■■��■��n��■�■�■■■ ■�■■■■�■�i■�■■■■��■■■■■�■■�■��:��■��■ ■■■ ■■■ ■■■ ■■■ ii ■■ ■��■■■■■ ■�i■■��■ ■�i■■�■�■ ■ri■■�■�■ ■�i■��■�■ ■�i■��■ ■�i■��■ ■�i��■�■■ ■��■■■■■ ■�i��■��■ ■■ ■��■■ ■��■■ ■■�■ ■��■ ■■�■ ■��■ ■�■�■ ■■■■■ ■ ■■■■ ■��■ ■�■��■■■�0■ ■�■�■■��■■■■ ■�■��■�■�■■ ■��■■��■�■■ ■■■■��■■■�■■ ■�■��■�■■ ■■■��■■■��■■ ■�■�■■��■ ■■�■��■■�■■■ ■■■■■��■■�■ ■��■��■ ■�■■■��■■�■■ ■■■��■■■■�■■ ■��■■■■��■■ ■■��■��■��■ ■■��■■■■��■■ ■�■�■■■��■�■ ■■■�■■�■■■�■ ■��■■\�■■■■ ■■�■■■��■�■ ■■■■■■■�■■�■ ■��■�■��■■■ ■��■■■��■ ■■■■■■��■■ ■��■■■■��■■ ■■�■��■■■ ■�■■■■■�■■■ ■■��■■■■■■ ■■■��■■■■ ■�■�■■■■��■ ■��■■■■■■■ ■■■■■��■ ■�■■■■��■■ ■■■ ■�■ ■■