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198 Rock House RdDavie Countv. NC Tax Parcel Report 41.1111) Thursdav, October 6, 2016 WAKN1iNU: 1'H1N 1S IVU'1' A SURVEY Parcel Information Parcel Number: G50000006205 Township: Mocksville NCPIN Number: 5840835036 Municipality: Account Number: 82530203 Census Tract: 37059-803 Listed Owner 1: SHREWSBURY TIFFANY A Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 152 STATION LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 3.45 AC OFF FOSTER DAIRY Fire Response District: SMITH GROVE Assessed Acreage: 3.50 Elementary School Zone: PINEBROOK Deed Date: 10/2008 Middle School Zone: NORTH DAVIE Deed Book / Page: 007730999 Soil Types: SeB,EnB,MsC,MsD Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY .Building Value: 6910.00 Outbuilding & Extra Freatures Value: 13360.00 Land Value: 28370.00 Total Market Value: 48640.00 Total Assessed Value: 48640.00 All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the 9"' F Davie County, 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. APPLI N FSR SITE EVALUATION/IMPROVEMENT PERMIT & ATC�(�I+' VN Davie County Environmental Health �01>, P.O. Box 848/210 Hospital Street PPR 2 Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 Aion For: f7Site Evalu tion/Improvement Permit ❑ Authorization To Construct (ATC)B� oth Type of Application: l\lew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPT ICANETT T1vTPC)I?A/fATTfl1xT Name ffr&v Contact Person Address 7VV 6 Home Phone l SS 3 City/State/Z1P C V `UBusiness Phone Name on Pennit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) wner's Name - , _ Ir civ Vt/S rc Phone Number j owner's Address City/State/Zip Property Address /bit It. q US ffil/ d/ .f Y! l CitYl'% pC&St/ 11 Lot Size 2-z C Tax PIN# s' ` Q Oso Subdivision Natne(ff applicable) Section/Lot# _�R I DirectioTts-To Site: 1�� --t-_ 4-O` GC�C�,CY ,�P, k0 P�hCu'-Se I eku If the ai v e to any of the following questions is `-`Yes",supp Are th re any existing wastewater systems on the site? Does the site contain jurisdictional wetlands? Are there any easements or right-of-ways on the site? Is the site subject to approval by another public agency? Will wastewater other than domestic sewage be generated'. Yes No _Yes ,ZNo Nes N _Yes10 Yes No must be attached: IF RESIDENCE FILL OUT THE BOX J3ELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool es ❑No Basement: 0 es o Basement Plumbing: ❑Yeslo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: ❑ County/City County/CityWater New Well 0 Existing Well ❑ CommunityWell "xa . Do you anticipate additions or expansions of the facility this system is intended to serve? U Yes If yes, what type? 40 This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the'intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and loc, a =ra ing the otise/facility location, proposed well location and the location of any other amenities. M CA -40 Pro erty o is or o per's ega repre ntative signature Site Revisit Charge Date(s): Client Notification Date: ate EHS: Sign given LJYes ❑No Revised 11/06 i Account #�p 7� Invoice # _"06 Map Frame Davie County, NC - GIS/Mapping System Click Here To Start Over , p U Active Laye. c . Q Use aP Tips 0 O�' ® PARCELS (Map Tips Available) 70 .20�AC H 158 f— — ooi57lt ROCK 11OL'SE RD r Ii Page 1 of 1 Quid, Search: (County ID or Owner Ni Na Addre http://maps.co. davie.nc.usIGoMapslmaplmapframe.cfm?CFID=4129&CFTOKEN=61640881 5/2/2011 __---� �0� I � � � � � , � �� ��2 ��� ������ � � � �� � �il ^ ���, J � � ����� . J � �' \` , • . ' . ,������/��� � . , J APPLICANT INFORMATION Account #: Billed To: Reference Name: Proposed Facility: Water Supply: Evaluation By DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation 990005675 Tiffany Hendrix Residence PROPERTY INFORMATION Tax PIN/EH #: 5840-83-5036 Subdivision Info: Location/Address: Rock House Road -27028 / Property Size: . 3.45 Acres Date Evaluated: On -Site Well _ / Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Al 5 Slope % & HORIZON I DEPTH `t A 0 — 3 G O> CZ O—$ a— Texture group S G 5 C 5 C .5 e- (r G L G Consistence "r r 'r v SsP s5 lT5V Structure 1�y -) K Q f tQ C Mineralogy 'F k t0 — o HORIZON II DEPTH — /-7 Texture groupL Consistence tl5 v Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION U- Lk LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND --ic-1 6,.,dl EVALUATION BY: 0 JV OTHER(S) PRESENT: 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 VFR - Very friable FR - Friable FI Firm VFI - Very firm EFI - Extremely firm YYrt 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 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■�������������������������������������������r�������/�����������■ ■�������������■����������/�����■ ■��■���������������������������■ ■������■�������/�����������������■■���������������������������/��■ ����������������������������������������/�����v����������/����/��■ June 3, 2011 Memorandum To: Joe Mando, Environmental Health Supervisor Davie County Health Department From: Kevin Neal, Regional Soil Scientist On -Site Water Protection Section Subject: Soil / Site Evaluation of PIN 5840-83-5036 Rock House Road Tiffany Hendrix — Applicant and Owner Property Size — 3.45 Acres On May 27, 2011 Rob Nations, Andrew Daywalt and I did a soil / site evaluation of the aforementioned property to determine its suitability for the installation of a sub -surface sewage treatment and disposal system for a four-bedroom residence. Water must be obtained from an on-site well. The soils on the site have 0 - 6 inches of a sandy loam surface layer. A BC horizon was encountered from 6 — 10 inches. Saprolite and rock were found at 10 inches. The clay mineralogy was found to be expansive due to very firm moist soil consistence and a very plastic wet soil consistence. The saprolite was found to be very firm. Soil wetness conditions were encountered at 6 inches of soil colors of chroma 2 or less This site is unsuitable for a sub -surface sewage treatment and disposal system because of shallow depth to unsuitable soil characteristics (.1941), soil wetness (.1942), soil depth (.1943), and unsuitable saprolite (.1956(6)). 1642 Mail Service Center I Raleigh, North Carolina 27699-1642 Phone (919) 733-2895 / Fax (919) 715-3227 hftp://www.deh.enr.state.nc.us/osww—new/newl//index.htm An Equal Opportunity / Affirmative Action Employer Nne orthCarolina Naturally . Ilkt tvorth Carolina Division of Environmental Health State of North Carolina r Beverly Eaves Perdue, Governor Terry L. Pierce, Director � Department of Environment and f� On-site Water Protection Section Natural Resources Division of Dee Freeman, Secretary Environmental Health Ted Lyon, Chief June 3, 2011 Memorandum To: Joe Mando, Environmental Health Supervisor Davie County Health Department From: Kevin Neal, Regional Soil Scientist On -Site Water Protection Section Subject: Soil / Site Evaluation of PIN 5840-83-5036 Rock House Road Tiffany Hendrix — Applicant and Owner Property Size — 3.45 Acres On May 27, 2011 Rob Nations, Andrew Daywalt and I did a soil / site evaluation of the aforementioned property to determine its suitability for the installation of a sub -surface sewage treatment and disposal system for a four-bedroom residence. Water must be obtained from an on-site well. The soils on the site have 0 - 6 inches of a sandy loam surface layer. A BC horizon was encountered from 6 — 10 inches. Saprolite and rock were found at 10 inches. The clay mineralogy was found to be expansive due to very firm moist soil consistence and a very plastic wet soil consistence. The saprolite was found to be very firm. Soil wetness conditions were encountered at 6 inches of soil colors of chroma 2 or less This site is unsuitable for a sub -surface sewage treatment and disposal system because of shallow depth to unsuitable soil characteristics (.1941), soil wetness (.1942), soil depth (.1943), and unsuitable saprolite (.1956(6)). 1642 Mail Service Center I Raleigh, North Carolina 27699-1642 Phone (919) 733-2895 / Fax (919) 715-3227 hftp://www.deh.enr.state.nc.us/osww—new/newl//index.htm An Equal Opportunity / Affirmative Action Employer Nne orthCarolina Naturally Korih Carolina Division of Environmental Health Terry L. Pierce, Director On-site Water Protection Section Division of Environmental Health Ted Lyon, Chief RECOMMENDATIONS The owner has the following options that might allow the property to be used as desired: State of North Carolina Beverly Eaves Perdue, Governor Department of Environment and Natural Resources Dee Freeman, Secretary 1. The applicant may purchase Provisionally Suitable property to place the wastewater system. 2. The applicant may obtain an easement on a Provisionally Suitable property to place the wastewater system. 3. A wastewater system can be pursued under Rule .1948 (d). Written documentation must be submitted to your office showing that the proposed wastewater system can be expected to function properly. The data must contain the following: A. The effluent must be non-pathogenic, non-infectious, non-toxic, and non- hazardous. B. The effluent must not contaminate the ground water and surface water. C. The effluent must not be exposed to the ground surface or discharge to surface waters where it could come in contact with people, animals or vectors. 4. Hire a licensed soil scientist to evaluate the remainder of the property. If you have any further questions, please feel free to call me. 1642 Mail Service Center I Raleigh, North Carolina 27699-1642 Phone (919) 733-2895 / Fax (919) 715-3227 http://Www.deh.enr.state.nc.us/osww—new/newl//index.htm An Equal Opportunity / Affirmative Action Employer NorthCarolina Naturally DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 0! P.O. Box 848/210 Hospital Street Courier 909-40-06 Mocksville, NC 27028 Phone#:(336)751-8760 Fax#: (336) 751-8786 June 2, 2011 Tiffany Hendrix 1969 US Hwy 601 South Mocksville, NC 27028 Re: Site Evaluation 198 Rockhouse Road Mocksville, NC 27028 Tax PIN: 5840-83-5036 Dear Mrs. Hendrix: As requested, Robert M. Nations, REHS; Registered Environmental Health Specialist with this office on May 6, 2011 evaluated the above -referenced property at the site designated on the plat/site plan that accompanied your improvement permit application. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1900 and related rules. Based on the criteria set out in 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system. Therefore, your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: Rule .1941 Soil Characteristics Rule .1942 Soil Wetness Rule .1943 Soil Depth These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, in surface waters, directly into ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. However, this office has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above, the property is currently classified UNSUITABLE, and an improvement permit shall not be issued for this site in accordance with Rule .1948(c). However, the site classified as UNSUITABLE may be reclassified as PROVIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule .1948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal review of this decision. You may request an informal review by the environmental health supervisor with this office. You may also request an informal review by the N.C. Department of Environment and Natural Resources regional soil specialist. A request for informal review must be made in writing to the Davie County Health Department, Environmental Health Section. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Center, Raleigh, N.C. 27699-6714. To get a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 733-0926 or from the OAH web site at www.ncoah.com/fonns.shtml. The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150-B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is June 2, 2011. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 15013-23) to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. Send the copy to: Office of General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-1601. Do NOT send the copy of the petition to Davie County Health Department. Sending a copy of your petition to Davie County Health Department will NOT satisfy the legal requirements in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel, NCDENR. Please call or write this office if you have any questions or need any additional assistance, as follows: Telephone number: (336) 751-8760 Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 Sincerely, Robert M. Nations, REHS Environmental Health Specialist /df Enclosure(s): Soil -Site Report Rule .1948 Invoice LAWS AND RULES FOR SEWAGE TREATMENT AND DISPOSAL SYSTEMS 15A NCAC 18A.1900 Rule .1948 .1948 SITE CLASSIFICATION (a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper design and installation. (b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning, design, and installation in order for a ground absorption sewage treatment and disposal system to function satisfactorily. (c) Sites classified UNSUITABLE have severe limitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement permit shall not be issued for a site which is classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules .1956 or .1957 or this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955, .1956 or .1957 of this Section or a system approved under Rule .1969 if written documentation, including engineering, hydrogeologic, geologic or soil studies, indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious, non-toxic, and non -hazardous; (2) the effluent will not contaminate groundwater or surface water; and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people, animals, or vectors. The State shall review the substantiating data if requested by the local health department. History Note: Authority G.S. 130A -335(e); Eff. July 1 1982 Amended Eff. April 1, 1993; January 1, 1990.