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127-129 M & D Ln Davie County,NC Tax Parcel Report Friday,December 30, 2016 130 EDGE 108 _4 ray 104 i ;152 129 156,E 126 17'1357 138 127 151 ~ r 129 ,+ 210 119 266 � 176�i 246 228222216 206 192 i` 284270 25$; 1 256 1, i 342 ,334326 310 298 i 276 GLADSTONE WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: L50000001305 Township: Jerusalem NCPIN Number: 5736958632 Municipality: Account Number: 66064370 Census Tract: 37059-807 Listed Owner 1: SHREWSBURY ROBERT Voting Precinct: COOLEEMEE Mailing Address 1: PO BOX 64 Planning Jurisdiction: Davie County City: MAYBERRY Zoning Class: DAVIE COUNTY R-A State: WV Zoning Overlay: DAME COUNTY CZOD Zip Code: 24861-0000 Voluntary Ag.District: No Legal Description: 2.780 AC OFF GLADSTONE RD Fire Response District: JERUSALEM Assessed Acreage: 2.74 Elementary School Zone: COOLEEMEE Deed Date: 6/1994 Middle School Zone: SOUTH DAVIE Deed Book/Page: 001740873 Soil Types: Ce132 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY 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 Idnd 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 webalte shall hold harmless the County of Davie,North Carolina,its agents,consultants,contractors or employees from any and ag daims or causes of action due to r'p�Nq'L NC or arising out of the use or Inability to use the GIS data provided by this websfte. Davie County Health Department ` ENVIRONMENTAL HEALTH SECTION P.O. Box 665 1 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. .Chapter 13OA, 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 County Building Inspections_..,. Office when applying for Building Permits.*** AUTHORIZATION NUPAR NAME rdA/3'D 4&1<- DATE _ �"J�'�� N° 0 4 2 2 MRME ON IMPROVEMENT PERMIT (If `different than above) SITE LOCATION //I COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE#ff THIS AUTHORIZATION FO ASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL WEALTH SPECIALIST — DATE DCHD 10/95 yo DAVIE COUNTY HEALTH DEPARTMENT 10 IMPROVEMENT PERMIT and OPERATION PERMIT a17 ,,. AM,& IMPROVEMENT PERMIT **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) PROPERTY ADDRESS ?_ 7E)Z d°" DATE —9 LOCATION (��!/l�S7G.✓r �� SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE —�� i r # BEDROOMS 3 # BATHS # OCCUPANTS ,,,? GARBAGE DISPOSAL: Yes/No COMMERCIALSPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/ND LOT SIZE TYPE WATER SUPPLY ��. DESIGN WASTEWATER FLOW (GPD) ,,?&/d_ FEW SITE Af!:"- REPAIR SITE 14 SYSTEM SPECIFICATIONS: TANK SIZE/V GAL. PUMP TANK GAL. TRENCH WIDTHROCK DEPTH LINEAR FT. 6 / OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. 1- IMPROVEMENT PERMIT BY **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 (704) 634-8760. OPERATION PERMIT SYSTEM INST E Y X14 I� AUTHORIZATION NO. D 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 z X0 DAVIE COUNTY HEALTH DEPARTMENT l0 IMPROVEMENT PERMIT and OPERATION PERMIT A)B� r. IMPROVEMENT PERMIT ' 1 . .**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater dystem. 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 6.S. Chapter;136A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r!'t ,7��" l /��!l PROPERTY ADDRESS �I'a ����` �� � ?�Z� DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS .—:? # BATHS # OCCUPANTS%1E_ GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY �_ DESI6N WASTEWATER FLOW (6PD) �.-f� NEW SITE J:t� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE/,,2,0 GAL. PUMP TANK GAL. TRENCH WIDTH �� • ROCK DEPTH /� , LINEAR FT. OTHER ' REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT''BEFORE INSTALLING THE SYSTEM. fi• Y�•4, N. ' f IMPROVEMENT PERMIT BY / **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 (704) 634-8760. OPERATION PERMIT SYSTEM INST E Y .ne 1x4 �Ch , AUTHORIZATION NO. U OPERATION PERMIT BY OY��.j 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 136A, SECTION .1900 -SEWAGE TREATMENT AND DISPOSAL SYSTEMS-, BUT SHALL IN NO WAV BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNrCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE r Davie County Health Department D 0 Environmental Health Section P.O. Box 848 JUL — 1 1996 Mocksville,NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Contact Person M/RJWZW Mailing Address 22Z ads oArc I Home Phone 2 9y-g82y City/State/Zip UL k'S y/ /1-e-- .:C. .-Z�d.Z� Business Phone 2. Name on Permit/ATC if Different than Above ''\L_' n.,-C As L Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation [ ]Improvement Permit&ATC Both 4. System to Serve: [ ]House [Mobile Home [ ]Business [ ]Industry [ ]Other L,1 ' u.b 1'e- L.A),c�-2. 5. If Residence: #People :3 #Bedrooms 3 #Bathrooms 2- XDishwasher[ ]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: Aol ounty/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [�j�No If yes,what type? Yes / PROPERTY INFORMATION REQUIRED:***IMPORTANT***A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: o'��'� G.(`J1�-U WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # '3 ;Z :t,,61 S 5�bNl�c) Mass '�rn2hC'��Rt;� "��, Property Address: Road Name . QNc� a Obu. St�¢- L-S,//3-0,17-Zo�City/Zip --Mo4a l 9g, :Mt. 2,-,DK Arne duRchAlke If in Subdivision provide information,as follows: (?-i Vi-.u)iAts 1 S (2-.tq} J GLC Z6S5 Rom Name: 4iU 5i K_"RiUt.eWq rt.t Section: Lot#: + Wil Hau.s�L o1J Jqft r-N cd S g d_e_ L>E qL&4s*r,)e r t ,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 esentative of the Davie County Health Department to enter upon above described property located in Davie County and owned by b19 RA 2e WS L- . P-14 to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE Q� Revised DCHD(06-96) r � , I 197 8 1g7 I 41 73B 0 i, t a H 1 Z p x m F 0 ; Z 01 -4 a 2.78A rn N 2.77 A N i (5.55A) � 8.�63.�.d9631 � to 4598 4 b i r r - i f t 1 137 273 75 120 180 i 300 200 1 S00 100 S00 i 4 4 f tD 2153 N (1.40A) 6184al A) 8105 m 0;12 i 5102 9104 to Soo (301) SR 1121 o GLADSTONE ROAD 300 j �. DAVIE COUNTY HEALTH DEPARTMENT =' Environmental Health Section a , Soil/Site Evaluation '• NAME /� 1!`S DATE EVALUATED 1 ADDRESS PROPERTY SIZE 1 PROPOSED FACIILTY j LOCATION OF SITE ] �,0�✓ Water Supply: On-Site Well _ Community Public, -i Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .4— Slope LSlo e 7. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence r Structure Mineralogy / l HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group j Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: 6 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-Floodplain 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-Nonplastic 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 ■■■■■■■■■SSSS.■■■O■■■■EE■■■■■.■■■.■■■■■■ ■■.■.E■O■EEE■S■i MS�Bi".fE■ ■■■■■■.■■■■■_■■■■■.■■■u■■■■■■■■■■■■..■■ ■SEEM■■.■..■■■■■■■■■■■■■■ ■■■■■■■../■■.■■.■■.■■■..../..■■■�M■.■O■�� ■■MMEO■■.■■■■■O■IM■■ ■■■■.■■■■■■■■■■■.■■■■■■■..■■.■■■■■■..■■■ ■/ M■■■M■■■M■E■■M ■■■ ■■■■■N.■■■■■■■.■■■■.■■■■■■■■■■■■E■■aE■■■E■ ■■■■■■.IMMEMMEM HIM ■■■■■■.■■■■■■■■.■■■■■■■■■■■..■■■ u■■■■E■■EE■■■■U E■■■■ME■M■■■■ ■■■■■■.■■.■..■.■■..■■■■N■S■■■■E M■■■M■EMM■■Ni■�■�■■O■■.MN■MME■ MEEEMME M ■ ................■■.■■■■■■■E�■■■■■■■■■■E .�.■�MEN..... ........................... 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