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1436 Underpass RdDavie Countv, NC . � T� Parcel Report Wednesday, October 12, 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: WA1tN1N(T: "1'H151� 1VU"1' A SUKVr:Y Parcel Information E80000001709 Township: Shady Grove 5881137317 Municipality: 48352000 Census Tract: 37059-803 MCCALLISTER JOHN S JR Voting Precinct: EAST SHADY GROVE 1436 UNDERPASS ROAD Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R-A NC Zoning Overlay: 27006-7533 Voluntary Ag. District: No 11.068 AC UNDERPASS RD Fire Response District: ADVANCE 10.91 Etementary School Zone: SHADY GROVE Land Value: Total Assessed Value: 9 �%'�' Davie County, ��„�� NC 6/1997 Middle School Zone: WILLIAM ELLIS 001950293 Soil Types: ApB,GnB2,GnC2,GaD,RvA,ChA,WATER Flood Zone: Watershed Overlay: DAVIE COUNTY 330010.00 Outbuiiding 8� Extra 33400.00 Freatures Value: 178020.00 Total Market Value: 541430.00 541430.00 ; � �; , . . .: . . . ..:.: . -�;.,,: , ; :, - - � , r . , > - - , .: ,. . .. _ ,,.. . �, s , . . _. , _: ,, . . .-. r. . , � K•.�t�'.KORizaTiorr 1vo: O 9 O 3� D�VIE COUNTY HEALTH DEPARTMENT ��' �• ° d . � � ; � � . Environmental Health Section PROPERTY INFORMATION PermitteE' � �. . •.� . ;. . , P.O. Box 848 .,_,__ Name: -� c��ti r:� •``��`" ` �•',,� �_`i�:'�1,, !�'�- ocksville, �, � fVI NC 27028 Subdivision Name: ✓ ( � r << 1,_; �� Phone #: 704-634-8760 _____. __.,, Directions to property: ---� f�= �'1�� Section: Lot: ^� `� AUTHORIZATION FOR �;� .G.�,,,,� L.�: �`�',. e,. � .�s��. \ �i. ` y� C.:'�.�aD WAST'EWATER Tax Office PIN:# � t � � _ �_ _ "�`.,`� � SYSTEM CONSTRUCTION �� ''�� . � h ��;�..,�;c�-. �r:,:��.� ��M(:,�, RoadNameV'�t::,�c�..,�.,1 ��i Zip: .t�. :`�' ' „ � **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 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 Systems) �' (,..� �� r r.. ***NOTICE*** THLS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,, ��1�,,-.;�.��•s,�,� ��.,,_.:,�.�..`;.�, �� V' � IS VALID FOR A PERIOD OF F'IVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED i,..�.r,�.��: ''�.,�w�_ :r.,.��'1_e j ::�':•ci 1.'� �:-i'��- 1.....� ��"�� l ..:. . � ! ' - � ' � . r � , ..� ... . . r,. . ' -. -' ' a.}". � .. . . . . . �, .. �. . . . . . � . , _ .. -,... .., - . , . , ,. -, . �, ...� 1...::- . ...� .. .. . .. ...-.. �: . � .. ' . . _. . , �- -, a . `�-��y �� y� �� o• - D.A�VIE COUNTY HEALTH DEPARTMENT __. � *� �� .. y �" - IMPROVEMENT AND OPERATION PERMITS � � Pe�tt�e.s;�'-",- � Name'`-�� . -! - 1�, ' � � , � � `D i�ctioris to property: S � � " � �. ` ' - - 1. l `� . .. p. . ..}" ;:a» � �_� ^�-t- . � ... _ ._ : r� :-- � � . x,��.. J r.�.-;, � � PROPERTY INFOXtMATION i -�-- Subdivision Name: Section: �� Lot: � IMPROVEMENT PERI�IIT Tax Office PIN:#_ �. t � � _ �_ _ : -`� �_� t, �, r t Road Name � , �� `,. ZIP: + ; ,�r" **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 pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERNIIT IS SUBJECT TO REVOCATION IF SITE � �`' , �,�;:�.`�. �� t.i ",�� PLANS OR TIIE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �� %# BEDROOMS �'�" # BATHS -� # OCCUPANTS � GARBAGE DISPOSAL: Yes No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIF"I' # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE � n�-`� TYPE WATER SUPPLY C�s DESIGN WASTEWATER FLOW (GPD) �' f,O NEW SITE "` REPAIR SITE h �� ' SYSTEM SPECIFICATIONS: TANK SIZE �VO GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH �-2 LINEAR FT�� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT [J -. � � � ��J��'�� \ \ 1�� v 1 �`�i G� ).a;. .'�1'� """'''��' `}� SC�--u.ra�— **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEAL DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE D�AY�F INSTALLAT'ION. T'ELEPHONE # IS (704) 634-8760. OPERATION PERMTT �� ♦, ►� AUTHORIZATION NO. og� OPERATION PERMTT BY: �� DATE: z G **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 WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) ' '� . APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC .. • � , ` Davie County Health Department � � � � C� � � Environmental Health Seclion p U P.O. Box 848 JU�� - Mocksville, NC 27028 I1 4 �g�7 (704) 634-8760 Ll r !I ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. � ' �i�v1n S. I � ICI,Q ��iS�(^ 1. Name to be Billed D il S. I' l C, �G2 `� I S'�P f_�C. Contact Person Mailing Address �� S � S'E' Rehe2 �� Home Phone I_I c� —(f� � I$ City/State/Zip �r�v0.nc�,� _ N�, 2��s�_ Business Phone I� �-- 2'79 - 3� �5 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: �te Evaluation [] Improvement Permit & ATC �th 4. System to Serve: [�.]'�-Iouse [] Mobile Home [] Business [] Industry [] Other 5. If Residence: # People� # Bedrooms� # Bathrooms 3 [�ishwasher [] Garbage Disposal �ashing Machine asementlPlumbing [ ] 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 [] Well [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [ No If yes, what type? tt PLfIT Olt SZTE PLttN PROPERTY INFORMATION REQUIRED: '�** IMPORTANT *��AT OF THE PROPERTY MUST BE SUBMITTED WITH TI�IS APPLICATION. Property Dimensions: � � r�� i� 3 �� WRITE DIRECTIONS (fro� Mocksville) TO PROPERTI': Tax Office PIN: # 5�� -_ l3 -�2 ; r�f0 EQ57� 1�0 ��T S r,�7��i AN �a / fo Property Address: Road Name (//)(��r 11QS5 ,<i3� � .�i�C'�Q�/JraS �'�; �e-�f' !_�N �.,�l3('.,�C�l',Qa�� City/ZiP /�GLCI�?��'. �,2.7�0� ; .�c{�� Lca��eP �� ac�o�s s��ec� ��sm- If in Subdivision provide information, as follows: ��r�r.�,.'�'r1,r S��G? NOSS -�RnM. -��r 9� Name: � a �(��l�G� nCQ � COGlrv //` �, C'� � i2 ) � v � � � Section: 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 County Health Department to enter upon above described property located in Davie County and owned by fi/R/`T/1�lanJ 1..��tll>,l C.� DATE SIG Revised DCHD (06-96) as necessary to determine the site suitability. THZS fl1zEA MrIJ $E USEb �'OR btttlWZNC JOUIt SZZE YLftN: , P(�ase eci (� so .� c�a �u �6� �i� es e� t�.s�I`"e e uA /c�.�p �ioN - �'��Nks /- . �%d%N �GL'All/S�r aC� � R��' "'�'°T � _ _�` putc�PJ�N I � S lTC � � l /r 1 , C' �� v _ . Z � Z O '? 0 � l� _ . � , � , � � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT SoiUSite Evaluation APPLICANT'S NAME `, �� j �v W�.�� PROPOSED FACILITY � a " � � SUBDIVISION - Water Supply: On-Site Well Community Evaluation By� �,L Auger Boring � Pit FACTORS Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence , Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure SOIL WETNESS „�,S S-= RESTRICTIVE HORIZON — SAPROLITE � CLASSIFICATION .$ LONG-TERM ACCEPTANCE RATE � � � SITECLASSIFICATION:_� �, LONG-TERM ACCEPTANCE RATE: . � REMARKS: DCHD (01-90) _ � �:� � LEG DATE EVALUATED _ b '� b '� PROPERTY SIZE �� D' �� d d� ROAD NAME v � Public Cut 4 I 5 I 6 I 7 EVALUATION BY: �S� ��-�� OTHER(S) PRESENT: �� \s\� � N� � �►-�, 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 Mineralo�v 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fll - 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 ■t■■�■�a�■��■■■■■■■�■■■■■��■■ ■■��■■■■■■■�■■■��■�■��■��■ ■�■��■��■�■�■■■■■�■ ■�■�■��■��■■ ■■■■�■■■■■■ ■�■■��■■■■■��■��■■�■■■�■■■ ■��■■�■■■■�■■■■��■■■ ■■■■�■■■■■■■��■��■�■■��■ ■��■■�■��■��■■��■■��■�■■ ■■■■■��■■■■■■�■■■��■��■��■ ■■■�■■■■■��■��■��■■■�■�■■�■■ ■■�■■■�■■��■��■■��■■�■■■��■ ■��■■■■��■■��■ ■■��■�■■�■■ ■��■■�■�■■■■■■��■■�■■��■�■ ■■■��■■■■■■■■��■��■■�■��■ ■��■�■■��■■■■■■�■■■■■■�■ ■��■■��■��■■��■■��■��■■ ■��■�■��■►�•�■■■■��■�■ ■��■■■��■��..��■■■ ■��■■v■: Ci�■�Ci"'�"'J��■�■ ��\��■��■■��■�■■�.�,..�� ■��■C��■�■��o�iii��■�■ ■��■�■��■■��■■■■r��t�*A■■ ■■■■■■■■�■��■��■■f'►\I�YI��ifi►��■ ■��■�■■[�L�lI�!/i�`]�■ ■��■■��■■■■!!�\■■■�C!�J■■■■■■ ■�■�■■�■■■��■'!��■■■■■�■�■��■ ■�■�■��■■��■l��r�■�■■�■■■■�■ ��i�� ■��■�■■�■■��n�■��i��■ ■��■�■��■i��r�an�■��■��■■■�■ ■��uu■■�■■■■■■■■w�■■■■ ■��■�■�1■�■■■■■�■■■��■��1��■ ■�■■�■�1�■■■�■■��sa:�: �E"ii,:�l��■ ■�■■�■I�� :i�i��■��■■t.■■I��1��■ ■�■■�■■■■■■■■■!:!■��■■�■l�IN��■ ■�■■■■■�■■■■■■{�■��li��■ ■�■■��■��■��I��C�i:Z�■■ ■■ ■■ ■■ ■■ ■■ ■■■■��■ ■■�■��■ ■��■�� ■��■■ ■��■��■ ■�■■�■■ ■�■■��■ ■�■�■■■ ■■■■■■■ ■■■�■�■ ■■■�■N ■■■■■■ ■�■■■■ ■��■ ■��■ !►7[S��■ ■ir11/1■ ■��J■ �■■�■■ ■■��o� ■■■■■■ ■��■�■ ■��■�■ ■■■■■■ ■��■�■ ■■■■■■■■■■■■■■■■■■■■�■�■�iri■��■■��■��■��■ ■��■��■��■■�■■■■■■■��■ ■■■ ■��■■ ■��■■