334 Yadkin Valley Rd Lot C Davie County,NC Tax Parcel Report Thursday,December 29, 2016
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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.
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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)
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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
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