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118 Mt Zion Church RdDavie Countv. NC Tax Parcel Report ) L . "1 Friday. September 30. 2016 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: WAWN11NG: THIS 1S IN U1' A SU.K VLY Parcel Information H900000033 A Township: Shady Grove 5789802717 Municipality: 82530861 Census Tract: 37059-804 PEEBLES MARY ALICE HEIRS Voting Precinct: EAST SHADY GROVE 127 MT ZION CHURCH ROAD Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006-0000 Voluntary Ag. District: 0.844AC MT ZION CHURCH RD Fire Response District: 0.78 Elementary School Zone: 9/1993 Middle School Zone: 1994E0101 Soil Types: 0007 Flood Zone: 116 Watershed Overlay: 0.00 Outbuilding & Extra Freatures Value: 21120.00 Total Market Value: 25620.00 ADVANCE SHADY GROVE WILLIAM ELLIS PcB2 DAVIE COUNTY 4500.00 25620.00 FD1 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 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. :55;xo AU H(yRI4ATION NO: � 1659 DAVIE ClJUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee'L-`f jam/ P.O. Box 848 Name:t�4+�s�;' Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# 'S� 'z' SYSTEM CONSTRUCTION ,r',+ Road Name: -.•Lip [1 �IC�fc� **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 Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) s' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED x , , '16 5 , DAVIE CPUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION �RM}T� PROPERTY INFORMATION Name:Subdivision Name: Directions to property: ,Z - Section: Lot: IMPROVEMENT f PERMIT Tax Office PIN:# N ,.�,,t, Road Name:/.�`' �t�%"��• Zip: **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 l I 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 /X fid # BEDROOMS # BATHS # OCCUPANTS �_ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE- # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE, � TYPE WATER SUPPLY e r DESIGN WASTEWATER FLOW (GPD) G NEW SITE t--' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZED_GAL. PUMP TANK GAL. TRENCH WIDTH J ROCK DEPTH J; LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT **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 (336)751-8760. OPERATION PERMIT P1,NS/ALD BY: 0 l� AUTHORIZATION NO. t! S4 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 EVALUATION/IMPROVEMENT PERMIT & D �' Davie County Health Deparinent EnvironmeNaiHeaiti Section P.O. Box 848/210 Hospital Street W 17 Mocksville, NC 27028 (336)751-8760 . `^�` YF0fOulaf11liH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL QUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed U Contact Person Mailing Address Rome Phone City/State/ZIP ' n IV Business Phone 3 -le 2. Name on Permit/ATC if Different than Above Hailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. Sys+:em to Service: ❑ House 9 Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: #People_ #Bedrooms # Bathrooms o� ❑ Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers IF FOODSERVICE: # Seats # Urinals # water Coolers Estimated Water Usage (gallons per day) 7. Type of water supply: County/City Well ❑ Community 8. Do you anticipate additions or expansions of the fac' ity this s stem is intended to serve? WYes ❑ No -"IMPORTAN " CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: C' /Z. ITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # � ' $V 'Z % / % 1, 1J00,� Property Address: Road Name D0� 7��'o/mss Cry e% City/Zip - If in a Subdivision -provide information, as follows: Name: / Section: Block: 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 ounty HealtftDeparlm to enter upon above described property located in Davie County and owned by 2, to conduct all testing procedures as necessary to determine the site suitability. p n DATE— SIGNATURE [�Cf� AREA MAY BE USED FOR DRAWING I DCHD (07/98) qP U) J�' ,PJiu), 0, J vuSSj a - c?-9e9L- No. 0 5 Invoice No. A xVy sa 40 e b5 3Lo�atD �99 c 0.01 N 8 w 47.82 A-1 �i v nc79 cQ A, � g2 372.05 aco 2 5. 01 a r , �.;� 25.03 a j% % r. ` 1.01 Ac �O 5 0 21 I v v,� 730,12 4 2 1 275 I9. � 25- 0 4 , al E 4.75 Ac.� y 2.31 AC. --F A� F r-. � 5 2 873.5 _ ' 4. 25 Ac o, 2� I�7� O' 1 554 4 3'�6 Y a 01 off' n 9.9 Ar c. z 2� 8 9; , 2i7 200 7�0.2 .. Q t 4 x'73 24.31J . � V 270 �01N � 27 � '� `. oM� �o! ► �"� 20 ��g. 0 2g 2y., 20.72 Ac 0 17© 545. .Z 2g — 155 7 t7 99�� 267 L21. t r 9 AME E. 12 s . �'�, ZION 29 42.03 32"`r< C �6.8 AcU H. A c .,- , r zr_ 17.13 AC. � 2.5 Ac,� . � .. 1386 86 896 94 oU - � 3 2085(�, OD � 34 A-5�,,�. 35 3 �� A 596 ,_5'8 N i . 5 A C . 42.04 36 H-7 35.03 AC � a 45.45 AC. a _ 220 37 - 1A 8 245tk. 3 56 O �.2 S.Q� v 290 +�; ; i i3 PIC 956.27 b !p DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community, Evaluation By: Auger Boring ✓ Pit DATE EVALUATED PROPERTY SIZE >2—/4 C ROAD NAME /l'I /- 0,� Public (/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position SIC - Silty clay C - Clay Sloe % CONSISTENCE HORIZON I DEPTH Texture group FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Consistence Structure SS - Slightly sticky S - Sticky VS - Very Sticky Mineralogy SP - Slightly plastic P - Plastic VP - Very plastic HORIZON II DEPTH ¢ 3 r - Texture group M - Massive CR - Crumb GR - Granular ABK - Angular blocky Consistence r Structure S Mineralogy ! 117 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 RATE t SITE CLASSIFICATION: EVALUATION BY: 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 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 (01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■SSSS■/■■■■■■■■■■■■■■■/■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■E■M■■N■s■EEE■■■■■■■■■■■■■■ESE■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■H■/■//■/■■///■/■/■■■////!a��w�..�CC:��a_��/SSSS/■■■■■■■■■■■■■■■ ■iMENNENMOMMEMMEMOMMIEMEMON MENNENMEMNONMEMNONMORMON ■■■■/■■■■■/■■■■/■■■//■■/■/■■■■■///■■///SSSS//SSSS■/SSSS//■■■/■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■/SSSS ■■■■■■■■■■/■■■■■■■■■/■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■EMs■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/SSSS//■■■ ■■■ ■E■ ■E■ ■E■ ■E■ ■E■ ■E■ ■■M■N■■E■E■■E■ ■■■■■M■■■MM■M■ ■MOMME■EMME■E■■ ■E■EME■MEMEMEM■ ■EMEN■■MEMEME■■ ■M■■M■MMM■■M■M■ ■■■■MSM■■M■■EM■ ■M■■■■■M■■■■■■■ SEEM ■■E■ ■EM■ ■E■■ NONE MEMO NONE SEEN MORE ■■■M■MME■ ■E■■MEN■■ MEMEMEMEN MEMMEMEME ■■M■■MME■ ■■■MME■E■ ■■■ME■■■■ MEMOMMEMN ■EMM■■MM■ ■■■ME■■M■ EMEMEMEME ■■■■■ON■■