120 Fairfield RdDavie County, NC
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Tax Parcel Report
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WARNING: TII1S IS NOT A SURV�Y
Parcel Inforination
Parcel Number: L5070A0021 Township: Jerusalem
NCPIN Number: 5746164054 Municipality:
Account Number: 8300525 Census Tract: 37059-807
Listed Owner 1: POOLE MARY FRYE Voting Precinct: JERUSALEM
Mailing Address 1: 9025 HIGHWAY 601 SOUTH Planning Jurisdiction: Davie County
City: SALISBURY Zoning Class: DAVIE COUNTY R-20,H-B
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 28147 Voluntary Ag. District: No
Legal Description: 2.52 AC FAIRFIELD RD Fire Response District: JERUSALEM
Assessed Acreage: 2.26 Elementary School Zone: COOLEEMEE
Deed Date: 3/2011 Middle School Zone: SOUTH DAVIE
Deed Book / Page: 2011 E0063 Soil Types: PcC2,Ce62
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 123060.00 Total Market Value: 123060.00
Total Assessed Value:
9��°'F Davie County,
�o�;N�i NC
123060.00
411 data Is provided as is without warranty or guarantee of any klnd either expressed or implied including but not limited to the
mp�ied warrantios oF merchantability or fitness for a particular use. All users of Davfe Countys GIS webslte shall hold harmless the
�ounty of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all clalms or eauses of actlon due tc
�r arising out of the use or Inability to use tho GIS data provided by this website.
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AUTHORIZATION NO. O� 4% DAVIE COUNTY HEALTH DEPARTMENT
..w- �. '- �`, Environmental Health Section PROPERTY INFORMATION dy p�-�]�
Permittee's P.O. Box 848 J��,. 1��
Name: ���j ' 00 �� Mocksville, NC 27028 Subdivision Name: W
�"" � ' , ' Phone #: 704-634-8760 � ,
Directions to property: .,. �. � j� 'r ��'� :�� Section: Lot: �
AUTHORIZATION FOR ��E
WASTEWATER ���- �— - � � �
SYSTEM CONSTRUCTION Tax OffiG� P�N:# •� � C% �
+ � ��'� al��P•��
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Road Name:_ I� 1 f�.. �.. i i%r �
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts. '
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
� , `�� �� � r ` �_� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
LS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH PECIALIST DATE ISSUED
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� DAVIE COUNTY HEALTH DEPARTMENT
�.:k:': °,.�=' � IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ����J'I
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Perii�itte�e's ' '
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Name: ,��,��i�l�” �Cs,� /'<�
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Directions to property: .%` � x' ,
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IlNPROVEMENT
PERMIT
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Subdivision Name: �
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Section: Lot: � j���
Tax Office PIN:# ��r% � i�� f_ �^ _°',t-F; i j�-��
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� Road Name f : � r -' �."� �' � �Lip ,,, i F,�'�% �
'**NOTE** This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
ALITHORIZATION 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)
�: "' - ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
,� ` . � . : .�:t '�" J i . ; t j ,k`r=; , ' '✓ `" •_. r , _ PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING T'YPE %T�%�. # BEDROOMS %�, # BATHS �# OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No
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LOT SIZE :r l/�� TYPE WATER SUPPLY !`�� DESIGN WASTEWATER FLOW (GPD) -_ /` � NEW SITE� REPAIR SITE
,: �� '`
SYSTEM SPECIFICATIONS: TANK SIZE �r"' GAL. PUMP TANK GAL. TRENCH WIDTH �l ROCK DEPTH {' LINEAR FT��� ��%
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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**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 THE DAY OF INSTALLATION. T'ELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION N0. �� OPERATION PERMIT BY: ��J � DATE: S�v!
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OS/96 (Revised)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
.� = "� Davie County Health Department
' \ � � � � � Environmental Health Section
�� �� ka J � P o. BoX g4s
� � I Mocksville, NC 27028
Q� � (704) 634-8760
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****IMPORTANT****
THIS APPLICATION CANNOT BE PRO
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed *��'��CC:I P
Mailing Address �l� �� � r.v c� p�i�
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City/State/Zip � C�..� + S� ta V` G 1V ,�'� � J 7
2. Name on PermidATC if Different than Above
Mailing Address
Contact Person
Home Phone 7o y- ky' �%��.
Business Phone
City/State/Zip
3. Application For: [] Site Evaluation [] Improvement Permit & ATC �] Both
4. System to Serve: [] House �{v] Mobile Home [] Business [] Industry [] Other
5. If Residence: # People # Bedrooms �# Bathrooms_L [] Dishwasher [] Garbage Disposal
�] Washing 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 �] No
If yes, what type?
EZTHER A PLt1T OR SZTE PLAN
�
i PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** �t'AOF THE PROPERTY MUST BE
SUBMITTED WITH T� APPLICATION.
Property Dimensions: �.,Z r� /� C' . � WRITE DIRECTIONS (from ocksville) TO PROPERTY:
Tax Office PIN: #�� -r� - � ��� �o � f�i f�/'�; .�-� h'I i � '%v ��� 5 � �flf
PropertyAddress: Road Name I �D % "' ��t�i�r� � %Gl�(Q, �e� � /�co��j��— �a.i.�-,�..e��v%��
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City/Zip /�%a G%I�SC/� l�� �.if/_ C ;� o� r� i'1 � orh ,� t7" D t l Ul y� .Y� % i�, �N /.�
If in Subdivision provide information, as follows: �
Name: �
�
�
Section: Lot #: ;
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. I, also, understand that I am responsible for all chazges 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 �� r�- AiL�v to conduct all testing pro edures as necessary to determine the site suitability.
DATE S� " � % � SIGNATURE �;� ' 1 �"" "" 1 ���
Revised DCHD (06-96)
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* r r� DAVIE COUNTY HEALTH DEPARTMENT
." Environmental Health Section SECTION LOT
4� SoiUSite Evaluation
APPLICANT'S NAME 1/ �� �� DATE EVALUATED �
� �
PROPOSED FACILITY /%� /6� PROPERTY SIZE Y� /�'G
SUBDIVISION
Water Supply:
Evaluation By:
Slope %
rt�r�i��w� r rr.rmrr
acn�uic �i�i
HORIZON IV DEPTH
SITE CLASSIFICATION:
On-Site Well
Community
Auger Boring _ � Pit
ROAD NAME
EVALUATION BY:
Public �
Cut
LONG-TERM ACCEPTANCE RATE: i OTHER(S) PRESENT:
REMARKS:
DCHD (01-90)
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
Wet
NS - Non sticky
NP - Non plastic
FR - Friable FI - Firm VFI - Very firm EFI - Extremely frm
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
Mineralo�v
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