214 Sugar Creek Rd Davie County,NC Tax Parcel Report � �� � Tuesday, October 4, 2016
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WA1tNING: THIS IS NOT A SURVEY
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; ParcelInformation , :
Parcel Number: E50000003202 Township: Farmington
NCPIN Number: 5851181515 Municipality:
Account Number: 82530226 Census Tract: 37059-802
Listed Owner 1: HORNER WILLIAM PAUL Voting Precinct: FARMINGTON
Mailing Address 1: P O BOX 1871 Planning Jurisdiction: Davie County
City: CLEMMONS Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27012-0000 Voluntary Ag.District: No
Legal Description: 21.40 AC OFF GILBERT RD Fire Response District: FARMINGTON
Assessed Acreage: 21.54 Elementary School Zone: PINEBROOK
Deed Date: 10/2008 Middle School Zone: NORTH DAVIE
Deed Book/Page: 007740489 Soil Types: ArA,Mr62,En6
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 148660.00 Outbuilding&Extra 5030.00
Freatures Value:
Land Value: 112780.00 Total Market Value: 266470.00
Total Assessed Value: 266470.00
9�,v��, Atl data Is provided ae Ia without warrenty or guarantae of any kind either expressed or fmplied Including but not Iimfted to the
Davie County� implied warranties ot merchantability orfttness for a particular use.All usen of Davle County'a GIS webslte ahall hold harmless the
County of Davla,North Carolina,Its agenta,consulWnts,contractors or employees from any and all claims or causes of action due to
�o�tlN,�i NC or arlsing out of the use or Inability to uee the GIS daW provided by this website. �
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, �AU�' lJRIZATION NO: ° �. DAVIE COUNTY HEALTH DEPARTMENT. ��
� � ,�':�� ��.� �; �� Environmental Health Section PROPERTY INFORMATION
� Permi�tee.sJ y;��l r"� ' P.O:Box 848 , .
Nafne: ���r� ��'���'"� Mocksville,NC 27028, Subdivision Name: '
-�' � � �f, � � Phone#:704-634-8760
'Directions to property: _� '� '` '`l� Section: r!c��'Gaty
AUTHORIZATTON FOR �r,� �'f
WASTEWATER Tax f6ce PIN:#'`-�"�.� �i� �"�,"���
: SYSTEM CONSTRUCTION '
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**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
: to issuance of any Building Pernuts.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts.
(In compliance with Article 11 of G.S:Chapter 130A;Wastewater Systems,Section:1900 Sewage Treatment and Disposal Sysfems)
� ;��'�'^ /,+� ' �,/ 1� ***NOTICE***THIS AUTRORIZATTON FOR WASTEWATER CONSTRUCTION
�r�'�J��".. oG�`Lf`,�'1�/� .+` G��r���� ` IS VALm FOR A PERIOD OF FIVE YEARS: .
ENVIRONMENTAL HEALTH SPECIALIST. : DATE ISSUED ' `
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� ��i;��,��, A� DAVIE COUNTY HEALTH DEPA�T NT` ; , , � :
,.-�,�� �'��.�--�.Y , TMPROVEMENT AND OPERATION PE�I�1'S PROPERTY INFORMATION °
�.��'Peri��e�'� �,,�;;�^ ,;
.l�ame.'�% ��.�t�.���r'",rd�lf'�'' : Subdivision Name: ,
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"� Directions to property:�...1,��',��-a�.�'�>•��,t a�'':>" Section: Lot•
. IlVIPROVEMENT ��;'".��""�,�}. ""' .���
, PERMIT Tax Office PIN:�+��'' � {
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**NOTE**This Improvement Pernut DOFS NOT authorize the construction or ins la6on of a septic tank system or any wastewater system.An
' AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained fram this Department prior to the
construction/'mstalladon of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
Y���` �,,! ` ,,�r f c� r**NOTTCE***TI�S PERNIIT IS SUBJECT TO REVOCATION IF STTE
d' .� t,s �,�;i.� !;�<::t���;���., !�>.�,��y.. ,'°-,�;'�' :{ PLANS OR Tf�INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST ATET1 ISSUED SYSTEM CONTRACTOR MUST SEE THLS PERMIT BEFORE '
INSTALLING TI�SYSTEM. , ,
RESIDENTIAL SPECIFICAT'ION:BUILDING TYPE� #BEDROOMS �'l� #BATHS�#OCCUPANTS � GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE �f AC TypE WATER SUPPLY �r�/DESIGN WASTEWATER FLOW(GPD)� NEW SITE //'� REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE .�pO1 GAL. PUMP TANK GAL. TRENCH WIDTH� ROCK DEPTH_,,1,7 ��LINEAR FT. ��
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OTHER wGll/ Y [� � �` +CJ'A G'X�l� .
REQUIRED SITE MODIFICATIONS/CONDTTIONS:
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IMPROVEMENT PERMIT LAYOUT
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**CONTACT A REPRESENTATI COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
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BETWEEN 8:30-9:30 A.M.OR 1:00-�Y: P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760.
OPERATION PERMIT �, _ / . � �
SYSTEM INSTALLED BY: � ,� �_
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AUTHORIZATION NO. v ' OPERATION PERMTT BY: . . '""'f /� �"
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**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TEIE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
ARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
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S/96(Revised) _ ... _ ; __
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" � ` APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
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, , --� Davie County Health Department
, � � Environmental Health Section ��` �� �P�
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Mocksville,NC 27028 � i�1/ ._
(704) 634-8760 (�;� �
�`***IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
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1. Name to be Billed � � ((1.4; �`d �1��/� Contact Person �a.�� ��'( G t�/�� �
MailingAddress ����� (' 1�nG� s�� HomePhon � ���a��
`City/State/Zip�u(�A� Na/�� /UC �7��� Business Phon /� 7� ���d �rt a`t�
2. Name on PermidATC if Different than Above .'�trne
MailingAddress,s��"'`� City/State/Zip
3. Application For: [tJrSite Evaluation [ ]Improvement Permit&ATC [ ]Both
4. System to Serve: [�House [ ]Mobile Home [ ]Business [ ]Industry [ J Other
5. If Residence: #People� #Bedrooms #Bathrooms [�ishwasher[Jj Gazbage Disposal
[v�Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing ,
6. If Business/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 [v�Well [ ]Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No '
If yes,what type?
� ,' ' E I THER �t PL.tLT OR S I TE PLAN
. PROPERTY INFORMATION REQUIItED:***IMPORTANT**'�1�`�OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: �I A C31St1� �WRITE DIRECTIONS(from Mocksville)TO PROPERTY:
E 5"eo� a�o 3 2o Z, ; s�c ,r,.�r e�a...- ...
Tax Office PIN: # - - ,
Property Address: Road N�me S� ��'lS�Su �C)V�Xi
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City/Zip �otKs�i`GF �'; 4 ZI.�f°-q� �IJ' SR l4�_S"
If in Subdivision provide information,as follows: � 5����'19/S/� J,�G-z�
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Name: �
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Section: Lot#• �
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This is to certify that the information provided is conect to the best of my knowledge. I understand that any permit(s) issued hereafter aze
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 chazges incurred from this application. I, hereby, give consent to the Authorized
Representative of the Davie Count Health Department to enter upon above described property located in Davie County and owned
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by �Gt.�) ��3��� rn�Y to co ct all testing procedures as necessary to determine the site suitability.
DATE /"'I I—�T� SIGNATURE
Revised DCHD(06-96)
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` � � DAVIE COUNTY HEALTH DEPARTMENT
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1 � Environmental Health Section sECTioN LOT
SoiUSite Evaluation
APPLICANT'S NAME /70/'l�� DATE EVALUATED �(�'—�"'�
PROPOSED FACILITY PROPERTY SIZE ����
SUBDIVISION ROAD NAME �G�.�'Q����✓�
Water Supply: On-Site Well f Community Public
Evaluation By: Auger Boring (,� Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition
Slo e%
HORIZON I DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH DZ �- ''
Texture rou ' C
Consistence
Structure /c
Mineralo ,'/
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE �
SITE CLASSIFICATION: ���L!� 7`O'/YCi EVALUATION BY:
LONG-TERM ACCEPTANCE RATE:�� OTHER(S)PRESENT:
REMARKS:
LEGEND
Landsca�e 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
Mineraloav
1:1,2:1,Mixed
otes
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-gaUdayift2
DCHD(OI-90) . �
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