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152 M & D LnDavi County. NC Tax Parcel Report 10 0— Friday. Sentember 30, 2016 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1 City: State: Zip Code: Legal Description Assessed Acreag Deed Date: Deed Book/Page Plat Book: Plat Page: Building Value: WAK1V11V1i: bila 1N 1VU1 A NUKVLY Parcel Information L50000001309A Township: Jerusalem 5736959631 Municipality: 24074500 Census Tract: 37059-807 ELLIS FRED O JR Voting Precinct: COOLEEMEE 145 Riverdale Road Planning Jurisdiction: Davie County Mocksville Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: DAVIE COUNTY CZOD 27028-0000 Voluntary Ag. District: 2.770 AC OFF GLADSTONE RD Fire Response District: e: 2.71 Elementary School Zone 3/2008 Middle School Zone: 007500515 Soil Types: Flood Zone: Watershed Overlay: 44340.00 Outbuilding & Extra Freatures Value: Land Value: 18900.00 Total Market Value: Total Assessed Value: 64910.00 No JERUSALEM COOLEEMEE SOUTH DAVIE CeB2 DAVIE COUNTY 1670.00 64910.00 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 Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the 101 1�Tl'+ 1 \ C County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ail claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website. f , Com' r'` ; ,�' 1 tip; -, �SZ 1\44V LtJ 1062 11 . av x I.,. V. NO: DAVIE COUNTY HEALTH DEPARTMENT i I Environmental Health Section PROPERTY INFORMATION Permittee's~..�� -�-- /// P.O. Box 848 Name: j'zq /,�4a iii 19 Mocksville, NC 27028 Subdivision Name: _ Phone #: 704-634-8760 Directions to property: /, ii'r`/")�.= c Section: Lot: AUTHORIZATION FOR WASTEWATER Office SYSTEM CONSTRUCTION Tax PIN:,{ Road Name: `L'Zi ' **NOTE** 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. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �. r. IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALT SPECIALIST DATE ISSUED DAVIE COUNTY HEALTH DEPAT�TMENT '' =r' IMPROVEMENT AND OPERATION PERMITS _,. , Permittee's, f e Name:' Directions to property: �n.Gr iz('O 11%,00 PROPERTY INFORMATION Subdivision Name: Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:#..:f Road Name:'' 1 .:...#i. p **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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 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 AW # BEDROOMS -7 # BATHS ':P, # OCCUPANTS—'? GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE A C TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) `���' � NEW SITE 1/� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1�4 GAL. PUMP TANK GAL. TRENCH WIDTH r (� ROCK DEPTH ,l-? "'LINEAR FT ?e U OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: **CONTACT A REPRESENTATIVE OF THE PATI BETWEEN 8:30 - 9:30 A.M. OR 1!0C 1:30 OPERATION PERMIT Fad 1110 Dy.H H- )EPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. �0 iM INSTALLED BY: UkN N. 14G 1y\ %z. AUTHORIZATION NO. �2' 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 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC • � Davie County Health Department , Environmental Health Section" " P.O. Box 848 7 1997 j Mocksville NC 27028 SEP (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS19W THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed FSJC�.iCfJ c h S d Mailing Address £' V11 City/State/Zip l r 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [ ] Site Evaluation Contact Person� I'll M- r` d� Home Phone 2 1 1 ' Business Phone City/State/Zip improvement Permit & ATC [ ] Both [ ] Other [i4Dishwasher [ ] Garbage Disposal v� 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 [i4W"'ell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [✓] No 4. System to Serve: [ ] House [Mobile Home [ ] Business [ ] Industry 5. If Residence: # People # Bedrooms # Bathrooms [Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **#QPFMT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: I ; WRITE DIRECTIONS (from Mocksville) TO PROPERTY: ,f Tax Office PIN: # 5 7 3 - r� - Kyr' S.0/0}� Property Address: Road )�ame G'14 Si'Vy 7Z7 r �� 1° cG h City/Zip O,7 � �� e r JP_ '�J 1 !✓!° E' 1 If in Subdivision provide information, as follows: 1 �9 h : e� 4 �!s �(/'GC TO Ille a lP P V 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 Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned •!' l e-rN i i by J e- SS,- r • I bhh to conduct DATE 91/ % A SIGNATURE Revised DCHD (06-96) THIS AREA MA II $E 11SEb FOR DRAWING 1101121 SITE PLAN: as necessary to determine the site suitability. S�U'APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P T Davie County Health Department 14 �'(/ G/ Environmental Health Section P. O. Box 665 23 10 J„(e Mocksville, NC 27028 1. Application/Permit Requested By `� C�� nb`� Y� j� /��r CI 5 r / r % Mailing Address if b�jc�- Gj Q '- A �0 n e Home Phone `1 ` (0`l b 2 (-igd ce me r- 18C C' % i Business Phone (o -7 -/- 2. Name on Permit if Different than Above 3. Application for: General Evaluation. 49LptIc Tank Installation Permit 4. System to Serve: ❑ House 060bile Home ❑ Business ❑ Industry ❑ Other 5. If house, mobile home: Subdivision No. of People No, of Bedrooms No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures . 7. Type of water supply: ❑ Public �iC1 Private 8. Property Dimensions %D t ae Z-7� Sewage Disposal Contractor ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing P'Vrashing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? �ommuni Qd�� �1 '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: Lo Q - (L S 2 -hO L 5 e C" �q Pr� SN 1 n+C Pe.,\Q E 5 o -�a c�- 4t -o ft.`. t L -c ff) A � k 5 1 A v-\cl A v\cA A- 1 ray v\cA 1), , -1 Z v4) c Le S . A, r 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 from this appli ion. 2 �A ��t'k ru DATE SIGNATURE CONSENT FOR SITE EVALVATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: V11. 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 t e e e s 'd site's suitability to ground absorption sewage treatment and disposal system. DATE SIG T RE DCHD (1/93) r T DAVIE COUNTY HEALTH DEPARTMENT i Environmental Health Section Soil/Site Evaluation NAMElr ADDRESS PROPOSED FACIILTY ,, ��'D e Water Supply: On -Site Well _ Evaluation By: Auger Boring /I / DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Community Pit Public L--*" Cut FACTORS 1 2 3 4 Landscape position L L— 4- Z_ Slope Z — "— HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence Y7 i Structure S /'(1 - Mineralogy 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 RATEl I I, SITE CLASSIFICATION: EVALUATED BY: 1_ Y _& 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- 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 ■�������������������������������������/����■����� �������� �����■ ■■��������������������N�■���������n�������/���� ���■■�■�■■�����■ ■■���������� �������■����/�������������r� �����������■���������■■ ................................ ........�._.................�... .......................................... . ................. ... ..................................■.........■..■■■..■.■..■..■....■ .................................................................. ...........................................� ....... ............. .......................................... ....■...�............. ................................................... ............. ................................�........_........s.............. ::::::::::::�:::C::C::::C:�C:::..:CC::=::.::::�::C==::::=C:::C::C ........... ....... .... .■■. ........ ■��������������■������������������■����������� ������N �� ������ ■�����������■����■��■����������■_������■i�iii=�i��=ii��iiiiin�iii iiiiiiiiisiiiiiiiiiiiiiiii=iiiii�iiiiiii�■���������■�_��_■�������� ■■����■���������������■■�����■����■��■����■����������� ■����■�■■ ■������■����■�■��■��������■�■�■ �������N����������������������■ ■�����■��\������■��■�������������■■������■�N���������■�N������� ■���������������■�■���������������■������������ _ ���/���������� ■���������������������■■��■���■■����p����� ��■��� ■���� ■ ��■■�� �����������■���������\H������������C:��������������������������� �������n��������������ri���������������v����u����������� � ■�■■�■������■���■■�������������o����������� N������■��������� ■��������������������N����/�������N�������� �� ������������� � ............................................... . ...�......� ■�������N����■��������■���■����������������H� ■ ����� ������ � ■����������■�a������������■�������������■�������� ���u������ �����H���������������������������������u�u���\�� ������ ■�H���������������������������������H������ �N� �� ������� ■:::�:::'��iiiiiii■ni�iiiiiiiiiiiiiiii�i�'iiiiiii��Cn■��C ������� �����������■��■����������■�����u� ■ ���� ■ ����iiiiii= ■�����■�������■����■�������■����� _� i��■�i�� ���� =iiii� ■t������������■�� ���� n���■■ �������� ■�������■��_������■�������■�������� �� Hu�i �i �� ������ _ �iiiiii�i�iiiii�iiiiii �iii�i�i�iii i ■ �u����■���i ■���������N�����������■����\�■������ � ��� ������ ■����������������■������N�������■ ��� �N�� �������� ■��■�����■��N�������������������� u �� �■������ iiiiiiiii�iii nr�iii�iiiiii�i�u�=i �i � =i i�i�i�i' iiiiii�i�ii��ai�iiiiiii��niiuiu� ■ �Q =iiiii�� ■�■������G����n���������■�����■� ���■■���iii ■���cr������,�!�^�����■�iiii=iii �� ���i i■i���� ■����r�■�� .� r� �u�■�� ■s���r����: � ������au� ■u ■ a■ �� ■ ������ iiiiii���:�iii=iiiiiiiiiii=i�i��=��� N �� n��■�� �I����I,v�����N��������� ������ �� �u�u� �I����lu��������n����������� �� uN������ ��::_':: �':C�::::::��u.�.=::�:.:. _ : "".�'.�..a: �.........�......................�. . . ... ..... ■��������N������������������l�■�� �■��� ■������������������������� �■�������� ■ ■ �■�N��u��� ■���v■������������������������ ■����������������■��■���������� �� ������■��■ ■■ ��������� ��■���������������■�I�� u����N���� :s::::��.a.:�:::::::::�::::::: .. . ,.:::��::�:� ..... ....�:::�:�:::::::::::: .: ..: :. :::::�.::::::: ■�iiii ii�ii■������������������ �■ ��r.�n�� ������n����u��� ■�����u��������■���■��������■����_�������■ui■���������������� iiiii�iiii=i�iiw%�iii�iiiiiiiiiiiii�ii�■iiiiiiiiiiiiiiiiiiiiiiiiii ■���������►.�■�.��������������■���������■��■��■�����������������■�� ■��■�/��I���/���■���������������■���■��N�������■���/�������■/����� ■������r���.�■��������������_������������_����■�_��������■��������� ii�■i=ii�iiiaiiiiiiiiiiiiii�i�■i��iiii=■ii�iiiiiiiiiiiiiiiiuii=i ��������i����������������������� ■��������_���������■�■�������■�■ ������ i��::::�����������...��■��.......��,�=====c�:��==���������■ , � ,� � ' � 4 " Davie Coan�v NealtFr Department and .dome NeallFr qenq 210 HoSPITAI STREET I P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634.5985 March 30, 1995 Brian & Robin Nichols P. 0. Box 993 Cooleemee, HC 27014 Re: Site Evaluation/Closest to Gladstone Road Dear Mr. & Mrs. Nichols: As requested, a representative from this office visited the aforementioned site on March 29, 1995. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site Was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosures