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119 Janice Ln (2)Davie County, NC Tax Parcel Report 6`51 Thursday, September 29, 201( �v I� WARNING: THIS IS NOT A SURVEY All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Implled warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the .. ����II�Y Parcel Information �� �_ ' Parcel Number: L5100B001705 Township: Jerusalem NCPIN Number: 5746330809 Municipality: Account Number: 82523388 Census Tract: 37059-807 Listed Owner 1:. BLALOCK JEFFREY L . Voting Precinct: JERUSALEM Mailing Address 1: PO BOX 773 Planning Jurisdiction: Davie County City: COOLEEMEE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27014-0773 Voluntary Ag. District: No Legal Description: 1.258 AC HWY 601 Fire Response District: JERUSALEM Assessed Acreage: 1.25 Elementary School Zone: COOLEEMEE Deed Date: 9/2004 Middle School Zone: SOUTH DAVIE Deed Book / Page: 005740072 Soil Types: PcC2,CeB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 74150.00 Outbuilding 8r Extra Freatures Value: 9460.00 Land Value: 27500.00 Total Market Value: 111110.00 Total Assessed Value: 111110.00 �v I� Davie County, All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Implled 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 NC or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT 9� IMPROVEMENT PERMIT and OPERATION PERMIT IBA IMPROVEMENT PERMIT 0 � **NOTE** This improvement 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 .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) NAME PROPERTY ADDRESS .Tangy c_t La..t2 712 r DATE "� • G LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLDG( NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE M # BEDROOMS # BATHS a # OCCUPANTS (I GARBAGE DISPOSAL: Ye No COMMERCIAL SPECIFICATION: �fA(JLITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: YeAllNo LOT SIZE cs css TYPE -,WATER SUPPLY l; DESIGN'WASTEWATER FLOW (GPD) p ..NEW SI /(lam' REPAIR,,,SITE SYSTEM SPECIFICATIONS: TANK SIZE, 00 D GAL. Ptd TANK GAL. TRENCH WIDTH 3� ROCK DEPTH LINEAR FT'. x OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECTJO REVOCATION IF SITE PL.ANSQOR THE INTENDED USE R WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE; SYSTEM. a . k. a a IV 11 IMPROVEMENT PERMIT BY **CONTACT A REPREPTATIVE`OF`THE DAV19-CMkTTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.,,OR 1:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT . ` SYSTEM INSTALLED BY ' AUTHORIZATION NO. OPERATION PERMIT BY DATE **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 WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 Davie County Health Department�`I'�� ENVIRONMENTAL HEALTH SECTION P.O. Box 665 ti J Mocksville, N.C. 27028 1 0U. ®Q .w AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater`.System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie Couf►ty,Building Inspections Off' wh 1• f B 'ld' P t *** VC, ic99 \en OFF �y.�ng or uiQing ern s. q { NAME x„10 xp Q ' \ V 4 �' t� DATE � " 6' I b NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION y c cz �+AN Q COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM NAUTHORIZATI NUP%R t ,.' **WICE*ff THIS AUTHORIZA N FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. --9� ENVIN ENTAL HEALTH SPECIALIST . DATE DCHD,10/95 .', _..._ _ . ...,. ... .'1.-.. ¢ .. ..,. .. .., s ..,•d �.,.z`7 APPLICATION FOR SITE EVALUATIONAMPROVEMENT, ' Davie County Health Department Q �% Environmental Health Section D P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT****. THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed er 0W Contact Person 0 �� D r Pi A/ Mailing Address 2 33 Home Phone *27 / 2 2 / ig City/State/Zip rn,c—ffSV,0Z.t� AJC, 170 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ Site Evaluation bolimprovement Permit & ATC [Both 4. System to Serve: [ ] House [ *10"Obile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: #PeopleZ # Bedrooms # Bathrooms 2 [AlDishwasher[ ]Garbage Disposal W-'ashing 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? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: MC4-e— WRITE DIRECTIONS (from Mocksville) TO P/ROPI Tax Office PIN: # -7 yL - 33 - D -3 6ol -5. F A Property Address: Road Name 'tce,L /`` • O O f) A !� t� city/zip M o C6y ; I (e , /y<- 2 76 22 L A/. 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 charges incurred from this application. I, hereby, give consent to the Authorized Represe of the Da {County Health Department to enter upon above described property located in Davie County and owned by,TiZe, �3 i ' O W Ifto coVyct aptest ng procedures as neqdgto determine the site suitability. DATE Revised DCHD (06-96) a •ery.. �. sr 4 Am ool H12A0N >'tr: A L rd'• 4 [ ys�S ^W ` a Rp 7 �r R v s. r• zn # NI r a + �- •� ! � �ti. .� s• rri '91 1. n i.'• '9. yat ox OO i 91, \ tr o i Y• r G o IV y 6 s� a t `,` � " �,i ,Q f * 'd'' �ii� .� �'' • Ft"},,,'�\ . ",4 '`, . v rii' . / � { 3,�i r .. v . DAVIE COUNTY HEALTH DEPARTMENT • ' Environmental Health Section R- Soil/Site Evaluation NAME ° `�� `� , �o W DATE EVALUATED ADDRESS M f PROPERTY SIZE 1 PROPOSED FACIILTY . o (`cro LOCATION OF SITE0 Water Supply: On -Site Well _ Community Publicy Evaluation By: Auger Boring —� Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture groupL I� Consistence Structure Mineralogy HORIZON II DEPTH `' v Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5S RESTRICTIVE HORIZON — —' SAPROLITE — -- CLASSIFICATION ,S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ��' EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: N R REMARKS: —e 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- V? --.-y 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 3C --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 MEMO ■■.■......■■■■..■■.■■...■■■.■■.N■ENON.M.■■.■ ■....■...■.■...■.OMEN ■■■NN■■■■■■■■■■OOONM.■■■■EEE■■.■■■/■■..■/■■■■■■■■.■■■■E■■EEM■■.■■■ ■s.eEE.E■■■■.EEE■■EE■■EEE■■.E■E■■■■■■■■■■■■/■E■EE■■■.■■■■■■E■■■■■■ ■■■...■■■■■■.E■■■M■■■M■■■■■■E.NEEEE■E.EEO■EEE.■.EE■ ■.■..■...■..■ ■■MN.NNNEE■■■E.N■■NM■■M■■NMENEN■ NEVE■NEOEOEE.EO■ ..■.EEE■EEEEE■ ■■■EOEEE000.■■■■■■■■■■■EOEO■■■■■ e■■■■ME■■E■■■O■■■■E■■E■■E■EE■.■■ ■■■■EOE■■■OOO■■■■■E■■■■■■EO�.E■.EE■........■.■■�■■■■�.■■.■■.■■■■■■ ■..■■..■..■■■■■EEO■■E.EEEE■ ■OEO..E.EEE.EE■...■ ■■■■ ■■.■EEE.E■■M■ ■■■■■■■■■■■■■■■■■■■■■■■.■O�■E.■■■■■■■N■.E■.■■■ ■■■■■■H ■.■ ■■■mom ■■■■■■■■■EEE■■■■OOE.EE..EI.�!!JI,.���'�.■■■■■�■■■��MIN�■NNE ■■■ONEI�N■ ■■■■■■■■■■■■■■■■■■■(!!�■■■■rel■rE■■(LJ�N■■..■■E■■■■■.00.■■■.■■■■■■MEMO ■■■■ ■.■■■■.■.■■EEE■■■■ .■E■s��r1■ !!O■ .......N.■O.■e....O.O■.■.■■■■■■ ■■..■ ■■■ ■■■■..■ENEE.EMEEE.EIIMEt_vr',f:� _ .� ...rrNlironMEMENSIMMEMMOMIlki OEM Oslo moons E■ ■■■MEMO■ ■■■NNE..■MM■rIO■atlv■■■i1E.Nta■.EII.M■..(1��N]..■...■...■■MMEM..G�\`le..... ■■■OWNEMEN ■■N.NN.E■EEOI .....■.EE.EE■OE■I�O.�r�iN CHNC�_ ENO NNa..u.V1 WN0O■e..0M ■■N■■■■■E.MM'/r..■M■.NH.M■■NMS/rN�i NNC/OII.■■OO....wft illi\1►\■i\MEN.... ■.■.■EEON■iii■■■■■■■LEEN■■i:�■...;■..�i...■■....■. 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