286 Legion Hut Rd Davie County,NC , Tax Parcel Report (� � �j Tuesday, October 4,2016
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WARNING: TffiS IS NOT A SURVEY
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� Parcel Infvrmation
Parcel Number: M50000000102 Township: Jerusalem
NCPIN Number: 5736818099 Municipality:
Account Number. 82531332 Census Tract: 37059-807
Listed Owner L• SMOOT SHARON DENISE Voting Precinct: COOLEEMEE
Mailing Address 1: P O BOX 814 Pianning Jurisdiction: Davie County
City: COOLEEMEE Zoning Class: DAVIE GOUNTY R-A
State: NC 2oning Overiay: DAVIE COUNTY CZOD
Zip Code: 270140000 Volurrtary Ag.District No
Legal Description: 1.00 AC LEGION HUT RD Fire Response District: COOLEEMEE
Assessed Acreage: 0.97 Elementary School Zone: COOLEEMEE
Deed Date: 12/2009 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 008130499 Soil Types: GnB2,GaD
Plat Book: 0007 Flood 2one:
Plat Page: 022 Watershed Ove�lay: DAVIE COUNTY
Building Value: _ 54800.00 Outhuilding 8�E�ra 0.00
Freatures Value:
Land Value: 11060.00 Total Market Value: 65860.00
Total Assessed Value: 65860.00
9�,���, All data is provided as Is wlthout warnMy or guara�tee of any Idnd etther exprcssed o►implied Induding but not Ilmited to the
Davie County� tmplied wammles of inerchuMabNky or fltness tor a particular usa Ail uaers ot Davle County's GIS websRe shall hold harmlesa the
NC ��°t Dawe,North Grolina,its�geMs,conwttaMa,co�actors or employees hom any end a0 dalma or causes ot actlon due to
�p�N�� or arlsing out oT the use or Inabllity to use the GIS data provided by thfs websRa
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AU'�xo�lz�T�oN NO: e� DAVIE COUNTY HEALTH DEPARTMENT 3��fl
' '� t � � ! � � �• Environmental Health Section ' `PROPERTY INFORMATION
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,. .. , . . -.,. .
Pe7miffee's , .. P.O.Box 848"
' Name: �- L"t�l�`3n� '��Yl�d� Mocksville,NC 27028 Subdivision Name:
C ��,Phone#:704-634-8760
Directions to property: f�L'�5 '��` �.Al�.���` : Section: Lot:
AUTHORIZATTON FOR
''", � • L�L ,— i was�wn�R .
1l,(� �'^7 �r.� Tax 0ffice PIN:# - -
SYSTEM CONSTRUCTTON ' }
. o�ame• ��:G�Ic�r�1 11�f!"Zip; 2-�v2-�
**NOTE**This Authorizadon for Wastewater System Constiuction 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 fhe Davie County Building Inspecdons
Office when applying for Building Permits.
(In comphance with Article 11 of .S.Chapter130A,Wastewater Systems,Section:1900 Sewage Treatment and Disposal Systems). �
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7; /,� .•-�--.,, [� ***NOTICE***THIS AUTHORIZATION�OR WASTEWATER CONSTRUCTION �
�,....--^,;1! t ����, � `` � IS VALID FOR A PERIOD OF FIVE YEARS."
ENVI 0 MNR ENT'�AL HEALTH SP CIA�'f DATE I SUED
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�' � � � � �-�--�, �,� ��� � DAVIE COUNTY HE�I:TH DEPAR�3'1T ,,. '. 3: �� ;
�� `�'"" ' � � „ IMPROVEMENT AND OPERATION'�ERMI'Y'`S PROPERTY INFORMAfiION �-
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l��me:=.�-.� � -� Subdivision Name:
.:� C '�'�' ``�,'�.
Directipns to property. ��"f-��� ��� ����-�t���i-��, Section: Lot:
.,,� n�RovE�rrr
� ` �1::''.� L�-� i t�.`�"I �'�: r�� PERMIT Tax O fice PIN:#
. � o�ame: �-�+�!r"n1 f�t� i:;�''' 2.w�t�:a�.'�s
Zip:
**NOTE**This Improvement Pernut DOES NOT authorize the construction or installation of a septic tanlc system or any wastewater system.An
ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/'msfallation of a system or the issuance of a building pernrit.
(In compliance with Article 11 o�G:S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
F �„ .
`� ' � I ***NOTICE�**THIS PERMIT LS�SUBJECT TO REVOCAT�ON IF SITE
� ;� �� f� r�..---�--�.
.�'�� -:1-.��. -�—i�---,, �.,�i' "I PLANS OR Tf�INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENfAL HEALTH SPECIA�L.ST DATE I SUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
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RESIDENTIAL SPECIFICATION:BUILDING TYPE M�'� #BEDROOMS c3 #BATHS Z� #OCCUPANTS_�GARBAGE DISPOSAL:Yes or�Io ,.,
COMMERCIAL SPECIFICAT'ION: FACILITY TYPE #PEOPLE #PEOPLFJSHIFf #SEATS INDUSTRIAL WASTE:Yes or No
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LOT SIZE��JTYPE WATER SUPPLY COJN7'� DESIGN WASTEWATER FLOW(GPD) �� NEW SITE �REPAIR STTE
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SYSTEM SPECIFICATIONS: TANK SIZE_�GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH �Z LINEAR Ff. 'Z✓�
OTHER � ��iT�-Ir71)��^' ��C
REQUIRED SITE MODIFICATIONS/CONDITIONS:__I/u STALL On� C�ZOI�Q
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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 1:00-130 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. ��
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OPERATION PERMIT � �
SYSTEM INSTALLED BY:_ r�� c��C�T�g
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� AUTHORIZATION NO. 1�� OPERATION PERMIT BY: A�: � � �
**TF�ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WIT'H ARTICLE 11 OF G.S.CHAPTER 130A,SECI'ION.1900"SEWAGE TREAT'MENT 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 TIlvfE.
DCHD OS/96(Revised)
2�� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE �
•�;.;�� �r�' , 5 '� ('� Davie County Health Department ► � �' �'� '���� . `�
� � , �,=� � €:��;, � �
"" f .. �1 �p��r� Environmental Health Section : �
� t� ,� �j� �`�L L P.O. Box 848 '
�� J �� Mocksville,NC 27028 � � 8 �
c�� �,d �� ��,
� G�� �\'�j (704) 634-8760 E►�VIRONMENTAL NEq�i}t
�' . DAVIE COUNTY
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION I5 PROVIDED.
1. Name to be Billed L � S ro 3 �'Y'0 O Contact Person � SGL �1'Y1
Mailing Address , � / Home Phone � b "�
City/State/Zip O� �� Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [ ] Site Evaluation [ ]Improvement Permit&ATC [�/jBoth
4. System to Serve: [ ]House [�Mobile Home [ ]Business [ ]Industry [ ] ther �
5. If Residence: #People� #Bedrooms� #Bathrooms�,� f�]Dishwasher[ ]Garbage Disposal
[V�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?
•{„` - EITHER A PL�1T OR SZTE PLtiN
PROPERTY INFORMATION REQUIRED:***IMPORTANT**'��f.�i'�OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions• � 1 � l /` � •�� �WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
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Tax Office PIN: # r� - � ' - � 1��I_�j� �/� �j - �� /�"',
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Property Address: Road I�ame�L�.� t)i � r ' � �
City/Zip l�� !j Q.�-k'Y�� . �� ;
If in Subdivision provide information,as follows: � �Z/Y� liti—.• '
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Name: �
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Section: � Lot#• �
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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
Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned
by �7h2_ ��%�►�`�1�_J_�.u-�o conduct all testi procedures as necessary to determine the site suitability.
DATE �'�g�j � SIGNATURE
Revised DCHD(06-96)
THIS AREA A1AJ $E USEb �OR blttltiVlNC �OUR SZTE PLAN:
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• �f�� . • � DAVIE COUNTY HEALTH DEPARTMENT
� '--� , � ' � Environmental Health Section SECTION LOT
� SoiUSite Evaluation
APPLICANT'S NAME /�N'nS�Y �OC 7' DATE EVALUATED 1 �
PROPOSED FACILITY �, . I-�O M� PROPERTY SIZE_I Q�
SUBDIVISION ROAD NAME • ��fr l�� �J� �
Water Supply: On-Site Well Community Public �
Evaluation By: Auger Boring ✓ Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition L L
Slo e% �
HORIZON I DEPTH - D- -�/
Texture rou G�- Cl..
Consistence F 5
Structure
Mineralo l:� ��
HORIZON II DEPTH ��/ F . �
Texture rou ";°
Consistence : S F'
Structure
Mineralo � : � ('[
HORIZON III DEPTH —
Texture rou
Consistence F S P
Structure �$k
Mineralo '
HORIZON IV DEPTH
Texture rou
Consistence -
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION S
LONG-TERM ACCEPTANCE RATE �• p,
SITE CLASSIFICATION: } ✓ EVALUATION BY: � �c�c.��
LONG-TERM ACCEPTANCE RATE: �•� OTHER(S)PRESENT: _C�r^�� A J
REMARKS: �T+�'� IJ�tr� �%D Cti � �
LE END
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 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
tructure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angulaz blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineraloav
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
DCHD(01-90) � .�� �
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