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
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http://maps.co. davie.nc.usIGoMapslmaplmapframe.cfm?CFID=4129&CFTOKEN=61640881 5/2/2011
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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 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)
ITAR - T.nna-term nrrr ntnnrr rntr _ and/rinv/ft7 Tll1TT7\ nclnc m-_-c--.JN
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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.