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205 Mr Henry RdDavie County, NC Tax Parcel Report A-� 8 5 Friday, September 30, 2016 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 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 I or arising out of the use or Inability to use the GIS data provided by this website. Parcel Information Parcel Number: K300000002 Township: Calahaln NCPIN Number: 5717732467 Municipality: Account Number: 8303475 Census Tract: 37059-801 Listed Owner 1: LACHAPELLE RUSSELL JOSEPH JR Voting Precinct: SOUTH CALAHALN Mailing Address 1: 205 MR HENRY RD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: 33 AC OFF MR HENRY RD Fire Response District: COUNTY LINE,CENTER,SCOTCH - IRISH Assessed Acreage: 37.95 Elementary School Zone: COOLEEMEE Deed Date: 5/2014 Middle School Zone: SOUTH DAVIE Deed Book / Page: 009570674 Soil Types: AaA,PaD,PcB2,PcC2,RvA,ChA,WATER,MaB,MsD Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 67830.00 Outbuilding & Extra Freatures Value: 1760.00 Land Value: 133770.00 Total Market Value: 203360.00 Total Assessed Value: 203360.00 Davie County, /-� NC 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 County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to I or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department 36 Environmental Health Section . ,, M Y• V;y�a P.O. Box 848 210 Hospital Street !�' D Courier #: 09-40-06 1 U Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: " !(/ �� G� �11 Phone Number �344 (Home) Mailing Address:�.� f!'Ir-/7' C Ni� - ' (Work) �1 /7a�1-'47 11ble Ailf- Z Zd og . Email Address: Detailed Directions To Site: Z0 Property Address: Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Type Of Facility: Date System Installed (Month/Date/Year): 2062- Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: !a _rNumber Of Bedrooms: Number of People. Pool Size: arage Size: 0ther: Requested By: Date Requested: Z D (Signa e) For Environmental Health Office Use Only pproved Disapproved Comments: 71-z 1ki 5 r yY) rYl irY v w o . -' seP4�C, O rQa- Environmental Health Specialist Date: 1.1Z I .I) q *The signing of this form by the Environmental FUalth Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order # Amount:$ Paid By: Received By:l Account #: a Invoice #: Date: zotcl; e�, ybqrk �4s�k All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the Implied r, 4W Y 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 or arising out Pri nted: J u 121, 2014 5 of the use or Inability to use the GIS data provided by this website. Account #: 990002495 Billed To: Ted Guye Reference Name: ATC Number: 3314 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5717-73-2467 Subdivision Info: f06"- Location/Address: 4WMr. Henry Rd -27028 Size: see AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS,,,/ AUTHORIZATION FOR WASTEWA CO TIO IS VALID FOR A PERIOD OF FIVE YID . Environmental Health Specialist's Signatu e: Date: 1 !✓0a n4s CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. /1b1— ---- �` Fin1l t,-�t Ncxr,a i Ari k A -r -DA-rC 9 -6 -02 - Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) 6\ 1 6007- l �r I ao x Stp'. -t= M It Lt � /o, - -yGCX a, N- ILP )0-), L-- DAVIE COUNTY HEALTH DEPARTMENT fX 12,1: / • Environmental Health Section 1 ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002495 Tax PIN/EH #: 5717-73-2467 Billed To: Ted Guye Subdivision Info: Reference Name: Location/Address: 0 Mr. Henry Rd -27028 Proposed Facility: Residence Property Size: see map ATC Number: 3314 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type#People _- #Bedrooms #Baths Z Dishwasher: G2`� Garbage Disposal: ❑ Washing Machine: I2�' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type � #People #People/Shift-�#Seaeats IndustrEl 1ial Waste: Lot Size 5-7M -1� � Type Water Supply OZLt— Design Wastewater Flow (GPD) Site: New u Repair ❑ System Specifications: Tank SizeI� GAL. Pump Tank GAL. Trench Width�Rock Depth OF Z Linear Ft. Other: J Pl %i/ rl O!j 6-,,0 Required Site Modifications/Conditions: 1p� A(,(� CA i (` �� !� ►,�} -� S' 4 IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6 "BELOW FINISIIED GRADE. ****NOTICE: Contact a representati of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.r4.. he dW of installation. Telephone # is (336)751-8760.**** aja po� N •v/OD' %b Lj NX Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: hh% u— APPLICATION FOR SITE EVALUATION/IMPROVEMENT PEI Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 WIN L***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PPROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ii oo�cc� V C Contact Person�7�`� Mailing Address �J�(J \ Home Phone City/State/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. system to Service: ❑ House )� Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher IJ Garbage Disposal L�)(Washing Machine U Basement/Plumbing I:1 Basement/No Plumbing 6. If Business/Industry/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 e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17YED by the client with THIS APPLICATION. Property Dimensions: .5-- e t%-k-'°?� Tax Office PIN: # ti � I " S 3" � �- 0 Property Address: Road Name aFP // �, n 4 City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1t '-'j. c) ,- 6f,r4- GC rld�F— Date Property Flagged: t5 2 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 1 ain 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 to conduct all testing procedures as necessary to determine the site s itu/ :` DATE Id �30 -2-- SIGNATURE Imo^ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and ISroposcd property lines and dimensions, structures, setbacks, and septic locations). :57 -e- Revised DCHD (07/99) 4.� EHS: Account No. C / / Invoice No. APPLICANT INFORMATION Account #: 990002495 Billed To: Ted Guye Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5717-73-2467 Subdivision Info: Location/Address: Off Mr. Henry Rd -27 28 Property Size: see map Date Evaluated: t/ Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L L Sloe % HORIZON I DEPTH Texture group J -` Consistence Structure Mineralogy I 1 HORIZON II DEPTH NO Texture group C Consistence -; Structure Mineralogyl I HORIZON III DEPTH p Texture group 5.40 Consistence Structure �c MineralogyI HORIZON IV DEPTH '30 Texture group Consistence Structure Mineralogy'. SOIL WETNESS Z RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION v LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: " �'� ft7'� "fill��►� LONG-TERM ACCEPTANCE RATE: 0 REMARKS: H+Vf EVALUATION BYr—� OTHER(S) PRESENT: 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 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 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 05/99 (Revised) ■ ■ ■ bq-q■■■ ■NER NEED DOES moss soon ■■NE■ ■ENE■ MOONS ■■O■■ ■■■E■ ■O■■■ ■■NE■ ■■■■■ ■ ■ ■ ■ ■■ MASON MERENONEEDEDMEN ■■■■■■■■CC■■======'L■d[!A■■■■ L'�'JG!rii:iliti%lis■■■■■■ ■ ■ ■EN■■ ■O■■■ MEMOS MOONS NEEDS ■■■mmOmmm■mll ■■mm■■m■■■■m ■■■m■■■■■mm■ ■M■■mmmm■■m■ ■ ■ ■ ^'- tQAC1 rii r .. �' �I y7333+�<<,m, 1151 292 } 23 AD 171 18 _ '� o2s5 os ayx,m C_ r 5869 �6 23.83A L a 1615 zes 63 OA 4407 tz�1 A.,qx 4t 33 x 1,7,9 Ij 6920 r J,' i (36.84A) oya 2467 3410 sa8 r' (Is6) 461 g c (111.03A) n 1883 {8 Boa} 0720 x 193- (8.96A) C or 3469 s z r gra Z 3410 - 217 T s,.r � SR IJ442.1 2 MA 888$ aan (4.11A) 1628 1.4661 LDERNESS . 8525 I