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334 Yadkin Valley Rd Lot C Davie County,NC Tax Parcel Report Thursday,December 29, 2016 128.15 120 z } 374 ^i a LiJ ------,----- rr, NAYWO OD �- ', ' < � D1Z�< 113 i rr- 346 341 >' �~'4 ,,4 334 ,�----r- -----w 325 Q > 332 Y � 293 Q --- LL ' X304 vn.y ' -- 169 '� r 161 .z 11 151- 1010 91119; WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: C80000000111 Township: Farmington NCPIN Number: 5872385403 Municipality: Account Number: 82514097 Census Tract: 37059-802 Listed Owner 1: FALLS B KEITH Voting Precinct: HILLSDALE Mailing Address 1: 4540 COUNTRY CLUB ROAD Planning Jurisdiction: BERMUDA RUN City: WINSTON SALEM Zoning Class: BERMUDA RUN RM State: NC Zoning Overlay: Zip Code: 27104-3518 Voluntary Ag.District: No Legal Description: 6.00 AC YADKIN VALLEY RD Fire Response District: SMITH GROVE Assessed Acreage: 5.79 Elementary School Zone: PINEBROOK Deed Date: 9/1999 Middle School Zone: NORTH DAVIE Deed Book/Page: 003140316 Soil Types: PaD,PcB2,PcC2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: BERMUDA RUN Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 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, Implied 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 rod p S� NC or arising out of the use or Inability to use the GIS data provided by this webshe. �0i t4^•' t l4i•./Y "1'41+v^'a*l roHa .9•�.Yi ,,�a'a q..a. , y.,i _.woes. .+: .o.w.i .Fla^,1 -+rLi+w' Y:-a 1 �' ^.tr..`�T..a3R`'k AufHORI NO: .1DAVIE C LINTY HEALTH DEPART NT - environmental Health Section PROPERTY INFORMATION Permittee's P.O.Box$48 Name: �' �J.-''��+' Mocksville,NC 27028 Subdivision Name: �� �. Phone# 336-751-8760 Directions to property �AV Section:' Lot: AUTHORIZATION FOR _ WASTEWATER �jY��1> .� SYSTEM CONSTRUCTION Tax Office PIN:# :0—W- -; Road Name: **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior. to issuance of an Y Building Permits.This Form/Authorization Number should be presented to the Davie CountyBuilding Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S.'Chapter 130A,Wastewater Systems,'Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL'HEALTH SP tIALIST . .':DATE ISSUED • A 7DAVIE. OUNTY HEALTH DEPARTMENT IMPROYEMENT AND OPERATION PERMITS PROPERTY INFORMATION fermittee�5 , ^+ _,..... Narde: �d' t�'€�' r�. 1��..' `44 Subdivision Name: " Directions to property: Sr%'��� d'� �' 1� Section: /� Lot: %IMPROVEMENT w �� i PERMIT Tax Office PIN:# Road Name: **NOTE**This Improlement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the constructionrnstallation of a system or the issuance of a building permit. (In compliance with Article I I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE S" , "ir F "r ;{:• � J ii' �> , PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING.THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS#BATHS 3 #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE_GAL. PUMP TANK C) GAL. TRENCH WIDTH: G ROCK DEPTH �'LINEAR FT.—s7-e/ OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT vA 'ul **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.TELEPHONE#IS (336)751-8760. OPERATION PERMIT SY TEM INSTALLED Y: -,��, � � r�-�- F AUTHORIZATION NO. OPERATION PERMIT BY: DATE: IV **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE` WITH ARTICLE 1 I 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 05/96(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC /l Davie County Health Department Environmental Health Seaton bV �% P.O. Box 848/210 Hospital street Mocksville, NC 27028 U L (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT HE PROCESSED UNLESS ALL THE REQUIRED INFORMATION Is PROVIDED.. Refer to the(INF�O/R�MATION BULLETIN for instructions. Name to be Billed srL' �+ ��J �IYf Contact Person Nailing Address �UfC^ Rome Phone City/state/ZIP 4✓rY/J/rBusiness Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0 Site Evaluation ❑ Improvement Permit/ATC Both 4. system to service: Aouse 0 Mobile Home 0 Business 0 Industry 0 Other If Residence: # People # Bedrooms # Bathrooms 0 Dishwasher 0 Garbage Disposal 0 Washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. if Business/Industry/Other: Specify type # People # sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: T seats Estimated Water Usage (gallons per day) 7. Type of water supply: O—County/City 0 Well 0 Community S. Do you anticipate additions or expansions of the facility this systeym is intended to serve? 0 Yes 0 No If yes,what type? S ?�` �6 �7te ***IMPORTANT•**CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: , /Y WRITE DIRECTIONS(from Mocksvllle)to PROPERTY: Tax Office PIN: # 6-7?7- 2fk/A// //. A'qr-1 Property Address: Road Name City/Zip If in a Subdivision provide information,as follows: Name: S Section: _L 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. I,also,understand that I am reaponsiblefor 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 neces ary to determine the site suitahi'tom DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. 65 Revised DCHD(07/98) Invoice No. � ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI Q ,�� Davie County Health Department n 1�p� Environmental Health Section 19 C'ajJ #1 L�P P. O. Box 665 01 Mocksville, NC 27028 d le 1. Application/Permit Requeste By Q:k Mailing Address Z °? Home Phone- " fig a A1-7J fid Z7 Pd b~ Z 14/44 Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation U Septic Tank Installation Permit 4. System to Serve: Q /House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Y Section -� Lot # 2-19asement/Plu mbi ng No. of People ❑ Basement/No Plumbing No. of Bedrooms MAWWashing Machine No. of Bathrooms 5a-1 ishwasher Dwelling Dimensions 'Vw tNh" [Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type 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 :! or Cq;5 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes,what type? 'NOTE: 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. Directions to Property: 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 fromVrg pplic tion. DATE SIG ATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 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. Ip" �- DATE SIGNATURE DCHD(1193) t r r ntr 0 ,. / IOM 1 f ri y` f �t.•� � � ti 0 � 1Ilk 5 Py` 1 1/ z l Y•4G�i •. � ti jfl� CCi rj� . DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation NAME /' DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY 10!K LOCATION OF SITE Water Supply: On-Site Well Community Publicy Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position 1-• L Slope Z G HORIZON I DEPTH Texture groupS.L SCG SY G Consistence Structure MineralogX HORIZON II DEPTH r� Texture group '."7 �- Consistence i Structure Mineralogy "/ 1, •% - /-` 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 p / SITE CLASSIFICATION: D EVALUATED BY: �YL� 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 ..;lay 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(01-901 'iiiiiiiiiiiiiiiiii�iiiiiiiiiiiiiiiiiiiiiiiiiiiiii�■iiiiiiiiiiiiii ■■■e■■■■■■■■■■■■■■■■■.■■■■■■■■■■ ■■■■■■■■■■■■■/■■■■.M■.M■■■OEM■■■ ■.■■■tttMttt■■oM■■■■M■t...■■.■.■■■■■tM■Ette■t.�t.ttEEEtt�t.tE■tt■■■ ■■.■■■■■■■■teM■■■O■■■■O■■.■■■■■■■.■..■■.■ ■Mt■ tttttt■t ■Oe.tt ■■ ■.■■t.■■■Et■■t■■tttt■■■t■■tte■MM■E■Ettett�ttt.■E■■t■■tttt■Ett■■ on ■■M■■■■■■t■■■■■tE.■■■.■■/■■■■tt■■■■w■M■M■EteM.tM..■tttt■ttt■t■tt■t ■■■■E■e■sN.MM■.■.■■■e.M■tM.Mtttt�■vie.■tMEtte..E■MMtttt■■.ttttttt■ ■tt■teMM■te■tMM■■■■.■.■■■■.■.■. ■►iw■■■MMM■Mtt■t.Mt.ttE■tttttE■E■ ■■■t■■■■■■■MMM.■■■■■.■M■■■.■�,■■■■■vacs■.Me.MMMMte■■.■■■.ttMMMtt■M■ ■■tt■M■■■■■■■M■■■M..■■■■■.■■oiw■�rei�trt.t.■ttt■■t.t=..ttt..tttt■tt■ ■■■■■■■■■.■■.■■■■■.■.■MN.■N■r� ��;.�N■■.■.../M■.■■.■ ■■■■■M■■■■■■Ee ■■■■.t■■■.M■.■■■■■■E.M■.M..■ut■M■■=M.t..teM■tt■uiMttettt■tMEt■.t. 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