133 Brook Rose Ln Davie County, NC Tax Parcel Report Monday, September 26, 16
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WARNING:
THIS IS NOTA SURVEY
.Parcel lrifbftnation .
Parcel Number: J700000077 Township: Fulton
WCMNNumbeo 5767895444 Municipality:
Account Number: 82524910 Census Tract: 37059-804
Listed Owner 1: BISHOP BRIAN ALAN Voting Precinct: FULTON
Mailing Address 1: 173HICKORY TREE ROAD Planning Jurisdiction: Davie County
City: K0OCKSV|LLE Zoning Class: D/YNECOUNTY R+\R' O
State: NC Zoning Overlay:
Zip Code: 27020'0000 Voluntary Ag.District: No
Legal Description: 10.821ACHVVY64 Fire Response District: FORK
Aoonmsod Acreage: 10.50 Elementary School Zone: CORNAlZER
Deed Date: 7/2005 Middle School Zone: WILLIAM ELL|S
Deed Book/Page: 006160783 Soil Types: PcB2.PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: D/YV|ECOUNTY
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Building Value: 8830.00 F�~^otureo :o±ra 0.00
Land Value: 91740.00 Total Market Value: 100370.00
Total Assessed Value: 100370.00
DAVIE COUNTY HEALTH DEPARTMENT /C�c/
Environmental Health Section
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT �2 RD
/ 7
Account #: 990000960 Tax PIN/EH#: 5767-69-5444
Billed To: David Lee Childress Subdivision Info:
Reference Name: David Childress Location/Address: Hwy. 64 East-27028
Proposed Facility: Residence Property Size: 13.3 Acres
**NOTE*'N iIsgmprov3m6ent/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 INSTALLING SYSTEM.
Residential Specification: Building Type i �n�•WO/Ylr. #People _Z #Bedrooms Z #Baths ;?—
Dishwasher:
Dishwasher: e Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size IS30 kw— Type Water Supply&rJW Design Wastewater Flow(GPD) } Site: New M`__Repair❑
System Specifications: Tank Size IUD aGAL. Pump Tank GAL. Trench Width11
moo, Rock Depth 7-4 Linear Ft.ISO'
Other: —_"DISC tt�.3 zcic . I,SS�t.I, U•J-�S <::?a.G. M1,3.
Required Site Modifications/Conditions: O� GU"IA 'P IL
Orr, �-�- S�a
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 installation. Telephone#is(336)751-8760.****
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Environmental Health pecialist's Signature: Date: Z Zl m
DCHD 05/99(Revised)
r
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990000960 Tax PIN/EH#: 5767-89-5444
Billed To: David Lee Childress Subdivision Info:
Reference Name: David Childress Location/Address: Hwy. 64 East-27028
Proposed Facility: Residence Property Size: 13.3 Acres
ATC Number. 2326
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 WASTE WA S S V FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: _.. ate: 2 V 100
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 G.S.Chapter 130A,Section.1900"Sewage Treatment and
TI-4 Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By: " A ��-
Environmental Health Specialist's Signatur . Date: -44 )v-,
DCHD 05/99(Revised)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT �5' �2, ow I
Davie County Health Department D
Environmenta/Hea/th Section 2000
P.O. Boa 848/210 Hospital Street JAN 2 7
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CAMOT BE PROCESSED UNLESS ALL'-THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed 1�� � h p 2 �� 1 A2�e:srC,ontact Person
Mailing Address 'ee'S ,Aui;e t' Home Phone- 7-s-
i y �
City/state/ZIP Ile- &C Business Phone
2. Name on Permit/ATC it Different than Above
Mailing Address City/state/Zip
3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC EYBoth
4. system to service: ❑ House RAMgbile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms �_ # Bathrooms
Dishwasher ❑ Garbage Disposal Gashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/other: specify type # People # sinks
# Commodes # showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of Water supply: xl.C'unty/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑No
If yes,what type?
***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
3d
Property Dimensions: I s p-,/f�-C�,� �j WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PIN: # �, � O/- Yy/ �f c �' fG,,�,.: ',� i3,���,0-4�C
Property Address: Road Name 2 rl ? �� d � d
City/Zip
If in a Subdivision provide information,as follows:
Name:
Section: Block: " Lot: Date Property Flagged:
This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(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 1,also,understand that I am responsible for all charges incurred 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 by
to conduct all testing procedures as necessary to determine the site suitability.
DATE 0d SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR PLAN(Include all of the following: Existing and proposed
property-lines B ions structures, setbacks, and se tic locations).
Site Revisit Charge
--�— Date(s):
a Client Notification Date:
`1
EHS•
Account No.
Revised DC HD(07/99) Invoice No. ��
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This ma is for PERC TEST
s 8 14 and BUILDING PERMIT purposes
only. The Davie County
Tax Administrator's Office
assumes no liability for any
information contained on this map.
241
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COUNTY-ID:J700000077
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` /539 :cB2 January 28,200010:34 AM
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!3081 /2021 (205)
- /390/ Parcel Identification Number
/7171 5767-89-5444
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» -'► DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000960 Tax PIN/EH#: 5767-89-5444
Billed To: David Lee Childress Subdivision Info:
Reference Name: David Childress Location/Address: Hwy. 64 East-27028
Proposed Facility: Residence Property Size: 13.3 Acres Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position t__ L
Slope% 5
HORIZON I DEPTH
Texture groupSL�--
Consistence
Structure G!�
Mineralogy1
HORIZON II DEPTH CP - teg , -77'1'
Texture group
Consistence 'F'
Structure 611
Mineralogyt
HORIZON III DEPTH Z�{
Texture group q
Consistence 55_
Structure r I
Q_
Mineralogy
HORIZON IV DEPTH ,a
Texture group.
Consistence -r
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
0'C
SITE CLASSIFICATION: ro EVALUATION BY: +-`�►� t.W
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
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 05/99(Revised)
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