709 Country LnDavie County, NC Tax Parcel Report All � l Tuesday, September 27, 2016
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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, NCimplied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold
harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
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a
Parcel,nformatiorq
Parcel Number: I'
H40000004001
Township:
Mocksville
NCPIN Number.
5739634514
Municipality:
Account Number:
53833300
Census Tract:
37059-806
Listed Owner 1:
NEWBERRY VINCENT KURT
Voting Precinct:
NORTH MOCKSVILLE COUNTY
Mailing Address 1:
709 COUNTRY LANE
Planning Jurisdiction:
MOCKSVILLE
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY,MOCKSVILLE R-A,FP,OSR
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
9.878 AC COUNTRY LANE
Fire Response District:
MOCKSVILLE
Assessed Acreage:
9.89
Elementary School Zone:
MOCKSVILLE
Deed Date:
1/2009
Middle School Zone:
SOUTH DAVIE
Deed Book f Page:
007790469
Soil Types:
GnB2,MsC,ChA,MsD
Plat Book:
Flood Zone:
AE,X
Plat Page:
Watershed Overlay:
-
Building Value:
164170.00
Outbuilding & Extra
3460.00
Freatures Value:
Land Value:
60620.00
Total Market Value:
228250.00
Total Assessed Value:
228250.00
101
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, NCimplied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold
harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001129 Tax PIN/EH #: 5739-63-1496
Billed To: Janice Sushereba Subdivision Info:
Reference Name: Janice or Richard Sushereba Location/Address: Country Lane -27028
Proposed Facility: Residence Property Size: 9.878 Acres 700
ATC Number: 2411
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 W R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature:�-Ile Date: Z
(oo m pew -1
CERTIFICATE OF CO
**NOTE** The issuance of this Certificate of Completion shall indicate the
has been installed in compliance with Article 11 of G.S. Chapter
Disposal Systems," but shall in NO WAY be taken as a guaran
given period of time.
.01
Septic System Installed By:
Environmental Health Specialist's Signature :
DCHD 05/99 (Revised)
edibed on Improvement/Operation Permit
ction .1900 "Sewage Treatment and
system will function satisfactorily for any
f -,5-d xl� /)� /,"/o (
Date: '511 'lam
LN.
1 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001129
Billed To: Janice Sushereba
Reference Name: Janice or Richard Sushereba
Proposed Facility: Residence
Tax PIN/EH #: 5739-63-1496
Subdivision Info:
Location/Address: Country Lane -27028
Property Size: 9.878 Acres
ATC Nffb r: 2411
**NOTE** 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 INSTALLING SYSTEM.
Residential Specification: Building Type I #People �2 #Bedrooms �Z #Baths 3
Dishwasher: Garbage Disposal: 0 Washing Machine: B'O"* Basement w/Plumbing: [a'�' Basement/No Plumbing:
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:
Lot Size Type Water Supply W tLL Design Wastewater Flow (GPD)o,2&& Site: New Repair
System Specifications: Tank SizelePd GAL. Pump Tank GAL. Trench Width—. Rock Depth 1-2 Linear Ft�
Other:
Required Site Modifications/Conditioins:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K BELOW
FINISHED GRADE. ****NOTICE: Contact a representa ive 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 . . on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: �- /, Date:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848810 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001129
Billed To: Janice Sushereba
Reference Name: Janice or Richard Susheneba
Proposed Facility: Residence
ATC Number. 2411
Tax PIN/EH #: 5739-63-1496
Subdivision Info:
Location/Address: Country Lane -27028
Property Size: 9.878 Acres
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 ONSSTRRUCnOON,IIS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Ala f/ ,G /1• Date: 457'�— S
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 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.
Septic System Installed By:
Environmental Health Specialist's Signature:
• DCHD 05/99 (Revised)
Date:
Account #:990001129
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Tax PIN/EH M 5739-63-1496
Billed To: Janice Sushereba Subdivision Info:
Reference Name: Janice or Richard Sushereba Location/Address: Country Lane -27028
Proposed Facility: Residence 700 Property Size: 9.878 Acres
**NES* 'Tlii bfmprove"
OTt/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.
11
Residential Specification: Building Type n #People #Bedrooms #Baths
Dishwasher: 00' Garbage Disposal: ❑ Washing Machine: 0000' Basement w/Plumbing: a Basement /No Plumbing:
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:
Lot Size Type Water Supply //Design Wastewater Flow (GPD) .Lv Site: New;?' Repair In
System Specifications: Tank Size GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. ,Trench Width Rock Depth _4�L Linear Ft'/
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 µ BELOW
FINISHED GRADE. ****NOTICE: Contact a rf presentative 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.n4jo 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: 4Date:
DCHD 05/99 (Revised)
s
• DAVIE COUNTY HEALTH DEPARTMENT 12-0e I /j
Environmental Health Section
P. O. Boz 848/210 Hospital Street
• Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001129 Tax PIN/EH #: 5739-63-1496
Billed To: Janice Sushereba Subdivision Info:
Reference Name: Janice or Richard Sushereba Location/Address: Country Lane -27028
Proposed Facility: Residence Property Size: 9.878 Acres
**NOTE** Tlii bimprer ovement/Operation Permit DOES NOT altthorize 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.
U
Residential Specification: Building Type j/ #People c2 #Bedrooms _� #Baths 43 i
Dishwasher:'e Garbage Disposal: ❑ Washing Machine: 0 Basement w/Plumbing: a Basement/No Plumbing: 0
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:
Lot Size Type Water Supply //Design Wastewater Flow (GPD) Site: New;?' Repair
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width ?,er Rock Depth 1c Linear F�
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 •• BELOW
FINISHED GRADE. ****NOTICE: Contact a rEvresentative 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. 0 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
1�
Environmental Health Specialist's Signature: 'Date:.��Zj�
DCHD 05/99 (Revised)
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001129
Billed To: Janice Sushereba
Reference Name: Janice or Richard Sushereba
Proposed Facility: Residence
ATC Number: 2411
Tax PIN/EH #: 5739-63-1496
Subdivision Info:
Location/Address: Country Lane -27028
Property Size: 9.878 Acres
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 ONSTRUCTITIO/N,IIS VALID FOR A PERIOD OF FIVE YEARS.
4WEnvironmental Health Specialist's Signature: {/ !'!�� Date: f ��
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
Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:
APPL1CA710N H!R 6ffE EVAWATIONj1AlPROVEN1tM PERM do ATC
Davie County Health Department
EnWonmedtyalHeslthSbWon APR } 9 2000
• P.O. Box 866/210 Hospital street
Mocksville, NO 27028
1336) 751-8760 EN 1 v FE o NT�Y LjH
***XW0RTA1M** THIS AMICATIm ClI1iI= = PROMS= MMISS AU TIM PXQUIM
Ilil'OFMION i8 PROVIDID. Rotor to the IN1'ORtdil2M smas IN for instructions.
1. Mouse to be abllad 'Jll►1 i Ce- contadt person \JQDuC C, 670- 10"C eW-4e
Mailbag address P• /i- 6by, /aL%Z some rams 767 -27q;?
city/state/sop Moe -k-< v, '//e-,. 9 6, -;-70aF susirmse vhane
a. Meme on ssrmbt/ora i! Di!lsrent than !,bore
Mailbag Address city/state/aip
S. Application tort O Site Rvaluation
s. system to ssreioet ,*House 0 Mobile Hones
a. It Residence: i people A_
IrDiebwasher 0 Gasbags pieposal
0 Improvement wermit/ATC ,w Both
O Business 0 Industry 0 muter
i Bedrooms / i Bathrooms
Rllrasbing Maottbns WS"emant/plumbing 0 31"ement/No plwbiag
S. It awbneas/Znduetsr/0dmwt apeoii'r typo
I commodes
I people i stink.
I showers i urinals i water coolers
It 1=81mca t # Beats )estimated water Usage toalons z" Irl
7. Type of Mater supply: 0 county/city
Jewell
a. Do you anticipate additions or expansions of the hellity this system Is Intended to serve?
If yes, what type?
0 community
U Ya ONo
I* * *IMPOR TA NT* * 0 CLIENTS MMT COMPLE?BTHE REQUIRED PROPERTY INFORMATION REQUESTED l
BELOW. Eltber a PWT or SITE PLAN UMBESUBMITTED by the diest witb THIS APPLICATION.
Property Dimensions: 7 g
Tax Office PIN: 0 ;F -* ,9 : [O Xz
Property Address: Road Name catwk4 lam
77
citynip M cksuf lk lie - ,;-7 W
If In a Subdivision provide Information, as follows:
Nam:
Section: Bloch Lot:
WRITE DIRECTIONS (from Moelav111e) to PROPERTY:
%� 7 Court c� 1.a i a- Wss Rod
la x t�ra,o {�SlQooaoo yo
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 ase change, or if the Information
submitted to this application is falsided or changed 1, also, understand that I an responsible for all charges Incurred frost
this appUcados. ; hereby, give consent to the Authorized Representative of the County Health Department
to enter upon above described property located In Davie County and owned by u4SkPfa4a_
to conduct ail testing procedures as necessary to determine the site suitability.
DATE / 9 SIGNATURE IC7144 1
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the follc-+xt Zsdeol .g and proposed
property !louse sod dimenalous, strictures, setbacks, and septic locations).
Site Revislt Charge
I Date(s):
I Client Nodfiadon Dates
IEHS-.
Revised DCHD (07/99)
Account No. jl
Invoice No. __.`
O ,$36 46' DAVIE COUNTY TAX OFFICE
123 South Main St
Mocksville, N. C. 27028 Mary Nell Richie
Tax Administrator
0 0 ly'� Telephone: 336-751-3416
Fax: 336-751-0154
DATE T /%— 2 0 0 e
Applications for certification that a property owner owes no delinquent taxes for the purposes of
obtaining a building permit.
1. PROPERTY OWNER:
ACCOUNT #:
2. PROPERTY OWNER ADDRESS: o
3. MAP NUMBER: '�-y J -i -- Yr
4. PIN NUMBER:
5. DESCRIPTION OF IMPROVEMENT,(newdwelling, addition to existing dwelling, garage,
shop, farm building, etc.)
6. DIRECTIONS TO SITE _ a� ac _= �7 O 1111
APPLICATION FOR CERTIFICATION APPROVED:
The office of the Davie County Tax Administrator certifies that the above named property owner
owes no delinquent taxes as of the date above. n
TITLE: � c. /fi&—L
APPLICATION FOR CERTIFICATION DENIED:
The office of the Davie County Tax Administrator denies certification. The reason being that the
property owner named above owes $ in delinquent taxes as of the date above.
TITLE:
7. APPLICANT:
DATE:
APPLICATION FOR CERTIFICATION APPROVED:
The office of the Davie County Tax Administrator certifies that the above named property owner
owes no delinquent taxes as of the date above. n
TITLE: � c. /fi&—L
APPLICATION FOR CERTIFICATION DENIED:
The office of the Davie County Tax Administrator denies certification. The reason being that the
property owner named above owes $ in delinquent taxes as of the date above.
TITLE:
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59.81
RICHARD SUSHEREBA
D.B. 81 Pg. 319
D.B. 83 Pg. 511
D.B. 170 Pg. 520
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APPLICANT INFORMATION
DAVIE COUNTY HEALTH DEPARTMENT
ENT
Environmental Health Section
Soil/Site Evaluation
Account #: 990001129
Billed To: Janice Sushereba
Reference Name: Janice or Richard Sushereba
Proposed Facility: Residence Property Size:
PROPERTY INFORMATION
Tax PIN/EH #: 5739-63-1496
Subdivision Info: .
Location/Address: Country Lane -27028
9.878 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 G
Slope %
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:
EVALUATION BY: �h
OTHER(S) PRESENT:
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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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*1NOTEAssued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems
Name + t POSS' Date
Location
Permit Numlier
N2 6309.
11
Subdivision Name Lot No. Sec. or Block No.
Lot Size Y w House Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES Ed NO F] Specifications for System:
Auto Dish Washer YES [g/,.I`NO E] 0 0 U Z-)
Auto Wash Maohine YES M-, NO E]
Type Water Supply S_
*This.permit Void if sewage system described below isnot installed within 5 years from date of issue.
I I
This,'permit is subject to revocation if site plans or the intended use change.
i3
Improvements permit by
*Contact a representative of the Davie County Health Department for final• inspection of this system between 8:30-
9:30 A.M. or 1-.00-1-.30 P.M. on day of completion. Telephone -Number 704-634-5985.
Final Installation Diagram: System Installed by \A3 371
....... ..... ...... - ---------
A N
0
Certificate of Completion Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system4ill function
satisfactorily for any given period oftime.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
�» Davie County Health Department
Environmental Health Section 9�
3 P. 0. Box 665 �^
Mock+aville, NC 27028
1. Application/Permit Requested By FeED W V040W W Y-eiP
Mailing Address 79 L�- V\) L6 R) A/UA C % )70 /SL /49,4P9 8'3%0
Home Phone rP05' --3)3 Ra % % Business Phone 393 % y
2. Name on Permit if Different than Above 5APit
3. Property Owner if Different than Above 3A nnF
4. Application/Permit For: 9-15-eneral Evaluation a -&-/Tank Installation
S. System to Serve:
G—fiouse
Mobile Home
0 Business
0 Industryu
Other
0 Unknown
6. If house, mobile
home: Subdivision
)VOOvc
Sec. Lotus
No. of People
3
Dwelling
Dimensions
_r? c 0 O
No. of Bedrooms
Basement/Plumbing
No. of Bathrooms
Basement/No
Plumbing
Washing Machine
_�_
yDishwasher
&-Garbage Disposal
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
8. Type of water supply: V Public Private ANr)/rA @-community
9. Property Dimensions ( •� 4�t�>rS
10. Sewage Disposal Contractor -FI41S T1 �
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 Yes B—No
If yes, what type?
*NOTES 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.
This is to certify that the informatiork provided is correct to tyle
best of my knowledge, and I understand I am responsible for all
charges incurred from this app cation.
3- i -or/�'�) \ r"�JL'�
Date 8ignature
Directions to Property:
C�� i ii ► gym -A AKC-Yz r�
p Tduw
e
l
d ro-ve
bao-/< 1var
Wil 1k a
DCHD (10-89)
62
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bit
f:48
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37.01
4.45 Ac Sot i^
es# � to 3� d SA . 4 � �': �' �' r 7•�
j 39 Ac. ,t &4
d G ._ C� rtJ t •A F 5 *t�•• ►•:s t �l'' a ? d4
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12•9
4.75 Ac
130 g
559,3taa
131
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
\ _ ` Soil/Site Evaluation
NAME F� W DATE EVALUATED - -
ADDRESS 5 Q` �PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On -Site Well Community Public l/
Evaluation By:�_'�L^ Auger Boring l/ Pit Cut
FACTORS
1
2
3
4
Landscape position
S
S
._S'
Sloe R
o -8G
0 q
O-Ro
O-'%�
HORIZON I DEPTH
Texture groupL
L
L
C
Consistence
- L
-'�
F`!r=-I
Structure
C
C
C
Mineralogy
HORIZON II DEPTH
S
-S
Texture group
Consistence
-
Structure
-
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS -
s Is
S s
SS
RESTRICTIVE HORIZON
--
—
—
--
SAPROLITE—
CLASSIFICATION
S
S
LONG-TERM ACCEPTANCE RATE
,3 S yo
? ' _Ll v
SITE CLASSIFICATION: J EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: °3s - l�U OTHER(S) PRESENT: End W ZXl
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
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 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
DCHD(01-901
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