159 Red Fern Ln �avie County, NC , Tax Parcel Report '�l,3� Monday, October 3, 201 t
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-�_ -� - WARNING: THIS IS NOT A SURVEY
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Parcel Number.. __ . K60000003306 Township: Jerusalem
NCPIN Number: 5757509543 Municipality:
Account Number: _ _ - 82522286 Census Tract: 37059-807
Listed Owner 1: BECK SUSAN V Voting Precinct: JERUSALEM
Mailing Address 1: 159 RED FERN LANE Planning Jurisdiction: Davie County
City: _ MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,H-B
State: NC Zoning Overlay:
Zip Code: 27028-5491 Voluntary Ag.District: No
Legal Description:. 5.000 AC OFF DEADMON RD Fire Response District: JERUSALEM
Assessed Acreage: , 4.85 Elementary School Zone: CORNATZER
Deed Date: 3/2004 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 005380001 Soil Types: PaD,Pc62,PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 125150.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 34830.00 Total Market Value: 159980.00
Total Assessed Value: 159980.00
9�v��, All data Is provided as Is without warranty or guarantee o(any klnd either expressed or Implied Including but not Iimited to tha
Davie County� Implied wartantfes of inerchantability or fltness for a particular use.All users of Davie County's GIS website shall hold harmless the
County of Davte,NoAh Carolina,its agents,eonsukants,eontractors or employees from any and all claims or causes of action due to
�'pUN�'� NC or arising out of the use or Inabllity to use the GIS data provided by this website.
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• DAVIE COUNTY HEALTH DEPARTMENT
� . �• Environmental Health Section
, ' P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(33G)751-8'7G0
Account #: 990001600 � Tax PIN/EH#: 5757-50-9543
Billed To: David Beck Subdivision Info: �/9_,
Reference Name: Location/Address: Red Fern Lane-27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3636
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 Tr tment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER C CT N IS ALID FOR A PERIOD OF FI YEARS.
Environmental Health SpecialisYs Signature Date: (�
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 guazantee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By: ` �I�,s �'� �
Environmental Health Specialist's Signature: ate: �
DCHD OS/99(Revised)
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' . DAVIE COUNTY HEALTH DEPARTMENT
' ' Environmental Health Section
' , P.O.Boa 848/210 Hospital Street _Q � �� �
• � ` ' ' Mocksville,NC 27028 ���`�
` (336)7S]-8760 �D
IMPROVEMENT/OPERATION PERMIT
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Account #: 990001600 Tax PIN/EH#: 5757-50-9543
Billed Ta David Beck Subdivision Infa .�/��
� Reference Name: Location/Address: Red Fern Lane-27028
Proposed Facility: Residence Property Size: see map
. **NO�''�*��pro���nt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An ALJTHORIZATION 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 STTE PLANS OR TFIE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type M• �1���- #People � #Bedrooms 3 #Baths�_
Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: � BasementlNo Plumbing: ❑
Commercial Specification: Facility Type � #People #People/Shift #Seats Industrial Waste: �
Lot Size �'��A��'Type Water Supply W�� Design Wastewater Flow(GPD)�� Site: New� Repair❑
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System Specifications: Tank Size���GAL. Pump Tank GAL. Trench Width� Rock Depth �2 Linear Ft.�
• Other: _� 4�1 ��'�JV�(� �X�`�
Required Site Modifications/Conditions: �+� A,l.l� ��'t�� ��� � � �fl C��
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IM11PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6��BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.****
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Environmental Health SpecialisYs Signature: ��. Date: 2 �D� � ��
DCHD OS/99(Revised)
' DAVIE COUNTY HEALTH DEPARTMENT
• ' Environmental Health Section
� . ' P.O.Boa 848/210 Hospital Street
• '' Mocksville,NC 27028
• � (336)751-87C►0
IMPROVEMENT/OPERATION PERMIT
Account #: 990001600 Tax PIN/EH#: 5757-50-9543
Billed To: David Beck Subdivision Info:
Reference Name: Location/Address: Red Fern Lane-27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3636
**NOTE**This Improvement/Operation PeTmit DOES NOT authorize the construction ofa septic tank system or any wastewater
system. An AiTfHORIZATION 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 STTE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMTT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type �,��^-�� #People � #Bedrooms � #Baths�_
Dishwasher: U� Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size .��� �'ype Water Supply\�� Design Wastewater Flow(GPD)�.� Site: New " Repair❑
S stem S ecifications: Tank Size �� �� `
y p �AL. Pump Tank GAL. Trench Width� Rock Depth�Z. Linear Ft.�
o�n�: ������� ���.�
Required Site Modifications/Conditions:�_1��� � C�6�.� '�J p� 4-�Y ,y���r- �,�eF�Q�•l.�s�
I1�'[PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection of this
system between 830 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.****
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Environmental Health SpecialisYs Signature: � ate:
DCHD OS/99(Revised)
' � DAVIE COUNTY HEALTH DEPAR'I'MENT GQ�
Environmental Health Section
' ' P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990001600 Tax PIN/EH#: 5757-50-9543
Billed To: David Beck Subdivision Info:
Reference Name: Location/Address: Red Fern Lane-27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3636
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MLJST 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 I 1 of
G.S. Chapter 130A,Wastewater Systems,Section.1900 Sewage Tre�tment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER C �UCT N IS ALID FOR A PERIOD OF FI YEARS.
Environmental Health SpecialisYs Signature Date: b
CERTIFICATE OF COMPLETION
**NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemendOperation 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. �
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Environmental Health SpecialisYs Signature: Date: �
DC�ID OS/99(Revised) --
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D - AP ION FOR SITE EVALUATION/IMPROVEM11ENT PERMIT&ATC ' ' `
� t J�3 D�vie County Heaith Department ,
� D�`� l b Envi�onmenta/Hea/th Section C�
P.O. Box 848/210 Hospital Street ,
EIIVIR�N��A���� Mocksville, NC 27028 �
pAJtEC��f:'�1y (336)751-8760
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***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED IINLESS ALL THE REQIIIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BIILLETIN for instructions.
1. Name to be Silled ,/ )�,�(�,� Contact Person�qv,�� ,(���
Mailing Addresa _�// /'i�G �.�/se /Q�/ Home Phone 133G)'.Z�7is7� �
, City/State/ZIP ����/,�� /y,�. ��d�d Busineas Phone �33(�)^ 7�7� 7��� X�7�
2. Name on Parmit/ATC if Different than Above
Mailing Address City/State/Zip
�✓ �(�u,. L tco 0
3. Application For: I� Site Evaluation �mprovefnent Perm't/ATC ❑ Both
4. system to service: �_ House L� Mobile Home ❑ Business ❑ Industry ;❑ Other
5. Type aystem requasted: f�J Conventional ❑ conventioaal modified ❑ innovative ; . .
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6. If Reaidence: # People 3 # Bedrooms � # Bathrooms ' 2
,
ODishwasher ❑Ciarbage Disposal �Vashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: varify type # �eople # Sink�
# Coa�odes # Showers # Urinals '� # Water Coolera -
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• IF FOODSERVICE:: # Seats Estimated Water Usage (gallona per day) "
s. Type of water supp y: O�County/City ❑ Well` ❑ �.Community '
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9. no you aaticipate �aaitions or expansions of the facility this system is iutended to serve? �Yes • �No
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If yes,what type? ) ;:
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***IMPORTANTi'`**CLIENTS MUST COMPLETE TIiE RLQUIRED PROP�ttTY INrOI2MATION RCQUGSI'GD
BELOW. Eitl�er a�PLAT or SITE PLAN MUSTI3ESUI3MITTED by the clicnt witl�THIS APPLICAT[ON.,
W, � � •A� J � :. .
Property Dimcnsions: /� "X �G�D `� "U-1 �� WRITE DIRGCTIONS(from Mocicsvillc)to PROP[:RTY:
� Tax Officc PIN: # �757�"o!S�/3 Go/ Sa�� to 7�4.�,on R� .so
�• PropertyAddress: RoadName%�t�/�t�h �4na � Af,'/es �a/�e.lfs�.r �s.re od /et�'l�
, City/Zip aC.�CS✓.'��G .Z 7l,.ZY �e e✓..^f;e.�fi�n�•�r �a Gvoe ,1 s�
V
�If in a Subdivision provide information,as follows: L/e�i� �ie�e�fy or1 �G tc7� �h+� �ouS�
Namc: [�i��6e/et.h./es� 7`'�[e- 3"'�i�e.
Section: Block: Lot: Date liome corners flagged:_�� —�'�3
�This is to certify th�t the information provided is correct to the best of my knowledge. I w�derstand tliat any permit(s) .
issued hereafter are subject to suspension or revocation,if the site plans or intended use cl�angc,or if tlie information
submitted in this application is falsiFed or changed. I,also,understaiid t/1at I aui responsiGle for all charges i�rcirrred fi•oni
tlris application. I,hereby,give consent to tl�c Authorized Rcpresentative of thc Davie County Hcaltli Department " �
to enter upon above descriUed property located in Davie County and owned by SaS.n ✓ aeeK
to conduct all testing procedures as necessary to determine tlie site suitability.
DATE /�—/O.O� - SIGNAT � �L�,��
THIS AREA MAY BE USED FOR DRAWING YOiJR SITE PLAN(Include all of tlic follo�ving: Existing alid proposed
property lines and dimensions, structures, setbacks, and septic locations).
'. � Site Revisit Cl�arbc
� Datc(s):
�-- Clicnt NotiC►cation Datc:
� 6�. �C � EHS• '
, � �
Sign given �� Accouut No. �l
Revised DC (OS/03 Invoice No. ��. �/
. P;3n)
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` ' ' � DAVIE COUNTY HEALTH DEPARTMENT
' � ' Environmental Health Section
' '' . : _ � Soil/Site Evaluation ,
APPLICANT INFORMATION � � PROPERTY INFORMATION
Account #: 990001600 � T<�x PIN/EH#: 5757-50-9543
. Billed To: David Beck :�uudivision Info: - � �
Reference Name: , � Location/Address: Red Fern Lane-2702$
Proposed Facility: Residence � Property Size: see map Date Evaluated: - �� = j � ( �� .
� , . . . . - _ - r j. . ..
Water Supply: On-Site Well Community Public _� �t`
Evaluation By: � Auger Boring Pit Cut r'
FACTORS ` 1 2 3 4 ` 5 - 6 7 �
Landsca sition L
Slo % ��'�
HORIZON I DEPTH � O O--
Texture rou ; ,$�L i� _
Consistence - i .
Structure .
Mineralo 1 • 1 ti•
HORIZON II DEPTH ..1� -2 , � � � .
Texture rou
'Consistence " : ° �
SWcture � •`�
Mineralo � i: �
� ;HORIZON III DEPTH •. • ,Zp� n� - •.
Textwe rou � -� ='^r
_, Consistence • -i55 • �:Y•' .
Structure 'S C l�.
Mineralo � i�• i:" i% 1 • •
HORIZON IV•DEPTH � °�� :��: -
Texture rou �;:r�<. '
Consistence 'r':.
Structure +
Mineralo •
SOIL WETNESS �
RESTRICTIVE HORIZON �
SAPROLITE ►,:. „�
CLASSIFICATION "'
LONG-TERM ACCEPTANCE RATE �
SITE CLASSIFICATION: EVALUATION BY: �"�'�'
LONG-TERM ACCEPTANCE RATE: �� 1 OTHER(S)PRESENT: � U(Q �-��-G�.-
REMARKS:
LEGEND � . .
Landscape Position : -' ` ' "°4� '
R-Ridge S-Shoulder L-Lineaz 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 day loam
` SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Mois
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-Granulaz ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogv
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
DC�-ID OS/99(Revised)
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