1179 Eatons Church Rd �avie County, NC Tax Parcel Report ✓� � �tj Friday, September 30, 201E
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' . . . � . WARNING: THIS IS NOT A SURVEY
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Parcel�Iriforniation y ; � ;
Parcel Number: . � ,D30000005601 Township: Clarksville
NCPIN Number: 5822421450 Municipality:
Account Number: � 82518220 Census Tract: 37059-801
Listed Owner 1: HURSH SAMUEL R Voting Precinct: CLARKSVILLE
Mailing Address 1: 5008 PEPPERTREE ROAD Pianning Jurisdiction: Davie County
City: CLEMMONS ° - " • Zoning Class: DAVIE COUNTY R-20
' State: NC Zoning Overlay:
Zip Code: 27012-0000 Voluntary Ag. District: No
Legal Description: 1.002 AC EATONS CHURCH RD Fire Response District: WILLIAM R. DAVIE
Assessed Acreage: , 1.00 . Elementary School Zone: WILLIAM R DAVIE
Deed Date: 9/2003 Middle School Zone: NORTH DAVIE
Deed Book/Page: ° 005140660 Soil Types: MnC2,Mn62
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 54400.00 Outbuilding &Extra 0.00
Freatures Value:
Land Value: 12610.00 Total Market Value: 67010.00
Totai Assessed Value: ° 67010.00
,9[��1�, All data is provided as is without warrenty or guarantee of any kind either expressed or implied including but not Iimited to the
Davie County� Implied warranties of inerchantability or fltness for a particular use.Ali 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
��UN`�� NC or arising ou!of the use or inability to use the GIS data provided by this website.
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� ,` �� � DAVIE COUNTY HEALTH DEPARTMENT �
'� IMPROVEMENTS PERMIT AN�D CERTIFICATE OF COMPLETION„ �
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
nit ry Sewage Systems , , Permit Number
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Name '� _ � Date NO 7�6 0
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Location ��" —
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Subdivision Name Lot No. Sec. or Block No.
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Lot Size � House � Mobile Home ��_ Business _— Speculation
No. Bedrooms � --.No. Baths _�— No. in Family _
Garbage Disposal YES ❑ NO 4.
, � Specificatio.n�for,;eS�stem: �.-� ,_ ;,
Auto Dish Washer YES �f�0 � -��� U';,,,;;�'
Auto Wash Ma^hine YES : NO ❑ �-�-�. ��r , "
,� ��>t:,,,,.,�.r l�
Type Water Supply _ � ___—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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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�T�l�phone Number 704-634-5985.
�Q� ,�t� � ----- � `
Final Installation Diagram: � S�'"ys,tem Installed by _ ��'� � � ' ' F� �`� �r"
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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 system will function
� satisfactorily for any given period of time.
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� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER �
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�p� ���� Davie Counry Health Department � � � � `� � i
C�r � Environmental Health Section D
'�� � P. O. Box 665 � �'j�'� �,4 '�F''�
�� Mocksville, NC 27028 ` ;
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1. Application/Permit Requested By /'� ��� ! � ��--I
/2� � `/.,���.�� ,�5v,���� /U� �-���-� �
Mailing Address �
Home Phone �l��_�% /J —r.�/(�� Business Phone Ii
2. Name on Permit if Different than Above �I
3. Application/Permit for: ❑ General Evaluation �Septic Tank Installation I
4. System to Serve: ;� ❑ House `�Mobile Home ❑ Piace of Public Assembly `
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❑ Business ❑ Industry ❑ Other ❑ Unknown I
5. If house, mobile home: Subdivision Section Lot # �
' ❑ BasemenUPlumbing
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No. of People � ❑ BasemenUNo Plumbing
No. of Bedrooms � , �Washing Machine I
No. of Bathrooms � ❑ Dishwasher � I
Dwelling Dimensions ❑ Garbage Disposal �
6. If business, industry, place of public assembly, other: Specify type I
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No. of People Served ° , No. of Sinks �
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: ❑ Public � Private ❑ Community
8. Property Dimensions � a�� Sewage Disposal Contractor r" �^�
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes, what type?
*NOTE: Improvements Permits shali 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.
Directions to Property: �O � �^ _�i� /� ('�/� � � n�SZ�� �i,))�� 1/J �a���
�w�( l /')T l �� J // K�
���� > �� 1.��l� ,�i S�cond lu�c� �� �� °' � d n ��l P�
/����� �� �a /n;l e s, 'fl�i� � C� a-�o� � /��'lP� at1 ���
w,�r � �. y������ �u� .
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C;Fd� -� �.� ��i� �,,.� . h�.k �- b� .
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This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
s��93 9
DATE SIG AT RE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: � 1. I OWN the property. ❑ 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 said site's suitability for a ground absorption sewage treatment
and disposal system. � '��'�l
—� DATE SIG URE
DCHD(12-90)
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• :�,� . . `'� ' " DAVIE COUNTY HEALTH DEPARTMENT ,
Environmental Health Section
Soil/Site Evaluation
NAME �✓ DATE EVALUATED `� J� ��
ADDRESS PROPERTY SIZE ���C
PROPOSED FACIILTY ,�Z,� LOCATION OF SITE .��4�✓���+'
Water Supply: On-Site Well r� Community Public
Evaluation By: Auger Boring � Pit Cut
FACTORS 1 2 3 4
Landsca e osition y- L �— L-
Slo e z �— — — �
HORIZON I DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH ��- -7 �' ,��t �
Texture rou � `
Consistence � �
Structure �
Mineralo /.`% ,�/
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLaSSIFICATION
LONG-TERM ACCEPTANCE RATE , C
SITE CLASSIFICATION: !I EVALUATED BY: ,/`Y!C��
LDNG-TERM ACCEPTANCE RATE: . I 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-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
CONSISTENCE
Moist
VFR-Very friable FR-Friable FI-Finn 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--SYngle grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralo�r
1:1, 2:1, Mixed
Notes
H orizon depth - In inches
Depth of fill - 1n inches
Restrictive horiZon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free wate�' 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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