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167 Underpass RdDavie Countv. NC � , Tax ParrPl R Pnnrt Wednesdav. 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: WAK1VllVli: '1'tI1.S' 1�.1' 1VU'1' A .�'UKVI+'.Y Parcel Information G8050A0013 Township: 5880216301 Municipality: 36928000 Census Tract: HOOTS WANDA GAYE Voting Precinct: 173 UNDERPASS ROAD Planning Jurisdiction: ADVANCE Zoning Class: NC Zoning Overlay: 27006-0513 Voluntary Ag. District: .424 AC UNDERPASS RD Fire Response District: Land Value: Total Assessed Value: 9 �u'�' Davie County, °o�„��' NC 0.40 Elementary School Zone: 10/2005 Middle School Zone: 006310344 Soil Types: Flood Zone: Watershed Overlay: 116630.00 Outbuilding 8� Extra Freatures Value: 15490.00 Total Market Value: 132920.00 Shady Grove 37059-804 EAST SHADY GROVE Davie County DAVIE COUNTY R-20 ADVANCE SHADY GROVE WILLIAM ELLIS PcB2 DAVIE COUNTY 800.00 132920.00 No � -� � � , t� {� % � ��"�`�S �- � ��'' `'r�.-' -�r � t' w�'' ;; ,:: � �• - ` DAVIE COUNTY HEALTH D '� � � .r� _ , _ �� _ .: ... IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION �` -� �;,;` ' NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a � Sanitary Sewage Systems � ;'�� ,.; , • 1 ; . :, 1 Name � �r,>��,, �:; , ,,;:,, .; � � f, � � Date ��% � �, ',/- � ---- �-, ( �' ,/ �, f''' ' p _ _� Location . �� `- � � �i� ��/,. � Permit Number��,� N ° �, - f ,,. l.;_ �"��"�� -. / `'� - y :� ; — — -- Subdivision Name Lot No. Sec. or Block No. Lot Size � �' � �� ' �= ' �"�� % � House '�'"�� Mobile Home _ Business __ Speculation No. Bedrooms �� .No. Baths ��--7 No. in Family �_ Garbage Disposal YES ❑ NO p' Specifications for System: • Auto Dish Washer YES ��NO ❑ ��,,,, Auto Wash Ma :hine YES ❑ NO L]-"' ,' c�C '- "� :��. .,; __� � _ . Type Water Supply --- , �:'�.-�..:; �; "�.,: *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. '� �` -' /� Improvements permit by --,�� r'%'-�,ff 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone NumbPr 704-634-5985. Final Installation Diagram: (� System Installed by � '�'� ! ;% �-..__:�_ l, " %� - —� , ; � r i; ; � �; I_.;'L,; , Certificate of Completion � ��''+%' Date �/�� ` "The signing of this certificate shall indicate that the system described �above has been installed in rcompliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. --- - APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksvilie, NC 27028 � � � 1 �9lle� Ca v% �,�� x� 1. Application/Permit Requested By N r�A e Mailing Address �� '�j� lD�� UY�r�('P� �,C� s2%o l� Home Phone �� 0 ` 9 J� D B�siness Phone S��%P 2. Name on Permit if Different than Above 3. Appiication/Permit for: 4. System to Serve: �ouse p Business ❑ Industry 5. If house, mobile home: Subdivision No. of People � No. of Bedrooms 3 No. of Bathrooms �. Dwelling Dimensions _ a� t i�� Q� ❑ General Evaluation ❑ Mobile Home ❑ Other 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures �Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ BasemenUPlumbing ❑ BasemenUNo Plumbing ❑ Washing Machine � Dishwasher ❑ Garbage Disposal 7. Type of water supply: j� Public ❑ Private ❑ Community 8. Pro ert Dimensions _ �5-I � wt ck � � � a �� ' � ' X1 /i1l,�.A/pl� � p y � � �'7 �� ge Disposal Contractor 9. Do you anticipate additions/expansion of the facility t15isUs�yte�s intended to serve? ❑ Yes � No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: ,��,, Ar/Ce, f,1�e� �U� -''J �l�L� SiA��Or-( �� . .., j ��c �. ��-' ► �-�- �' �,,�T � 5-t- h0�:�s � Or� � � � This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges incurred from this application. t. � �' yoZ ✓ �— -�C Ca�) DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: � 1. I OWN the property. ❑ 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. �- c� / - 9� �1��2.8� af.u�aa� �`(li�� DAT� . --' SIGNATURE DCHD (12-90) ��% i j ► �, � , � � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME _��('7;�✓%i�� DATE EVALUATED '� �y"�2 ADDRESS PROPERTY SIZE ✓ �I.�� PROPOSED FACIILTY ��lf.� � LOCATION OF SITE Water Supply: On-Site Well Community Public �� Evaluation By: AugerBoring Pit Cut FACTORS 1 2 3 4 Landsca e osition �L 1— <-- ci.,,,e 2 �- ,_ . — HORIZON I DEPTH 8" Texture rou .r'.� .t" Consistence Structure Mineralo HORIZON II DEPTH , �' G " �C � Texture rou Consistence � � r-- Structure ,� � Mineralo / / , / l�"/ HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineraloev CTIVE HOR ITE FICATION 0 � � SITE CLASSIFICATION: vJS EVALUATED BY: ,�/� �� LDNG-TERM ACCEPTANCE RATE: � OTHER(S) PRESENT: REMARKS• LEGEND 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-SYngle grain M-Massive CR-Crumb GR•-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�► 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 watet 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 - gal/day/ft2 DCHD (01-901 '�' ■��■■■�\��■■��■��■��f��■��■��■ ��■��■ ■��■■��■��■■��■��■��/��■��■��■��■■ ■■��■��■■�■�■��■ ■��■��■��■■��■��■��■ ■■��■��■��■��■��■��■��■�■��■�■ ■■■��■■��■��■��■�■��■��■ ■��■�i■��■��■��■�■��■�■�■��■■■ ■■��■■��■��■��■■■■��■■■��■��■ ■��■�■■��■�■�■��■��■■�■��■■■■ ■�■■■■■■��■■■��■■��■��■��■��■��■�■■■��■ ■�■��■��■��■■■■��■��■■��■��■■��■■■ ■��■��■��■��■��■��■■ ■�■��■��■��■ ■��■��■��■��■�■ ..................r........�...................................... ........................... ...................................... .................................................................. ..............................................■.■.■....■......�... .........................................■........■............... .................................................................. ................................ ................................ .........................■......�................................ .................................................................. ■��■��■■��■■��■��a��■��■��■��■■��■ �■��■�� ■��■��■�■�■��■��■��■�■�_■�■�� ■��■■��■��■�■�■��■�n�■■■��■ ■��■��■■�■�■■�� ■��■■■■��■s��■�■��_�■��■ ■��■�e!��■■�i�■■��_��■ ■��n��■�� ■■��■■��■�■��■■■� ��■ ■��■■■■��■■��o��■■��■��■�� ■��■■�■■�■�■�■��■■■��■��■��u��■N��■��n��■ ■��■��■�■■��■��■��■��■��■�� ■ ■■��■��■��■��■■■��■�� ■ ■■��■��■��■�� ■��■��_��■��■ ■�ss��■�■��■��■■nn��■■�� ■■�■��■��■�■��■■�■�■ ■��■��■��w��■�■ii� ��■��■��■ ■■��■��■■■��■��t■■■■■u��■ ■■■��■��■�■■�■��■��■��■�■■�■��■ .........................................................�........ ......................................................... ........ ■��■��■��wi��ii■e��■��■■■■�■��■ iiiiiiiiiiiiiiiiiiiiiiiii■�iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii �iiiiii�iii�ii�iiiiiii�iiiiiii�iiiiii�iiiiiii�iiiiiii�iiiiii� ■��■■■■■��■��t��■■��■�■��■■�■�■ ■■�■��■■�■�■■��■��■��i�■��■�■��■�■��■ ■■■�■■�■ ■�■■��■��i�.�■■.......�� n��■■■��■ ■�■■■�■■■��■�■��■■iiiiiiiiiei��■��■�� ■��■■■■■��■�■��■■��■��■■�■■�� ■ ��■�■�■��■ ■��■��■��■■ ��■■��,�■��■�■�■��■u� �t �� ■��■� ■w��■ �� w� ��C■��■�� ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■.�■■■■■■■■■■■■■■■■■■■■■■ ■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■i■■■■ ::::::::::::::::::::CC::::::::::::::::::::::::�::_::::::C......�: ...... ■�■■��■■��■■��■��a�■��■��n■�� ■ ::::::::::::::::::::::::::::::::::::::::::::::�_::::�::�::::::::_ ................................ .............. .... ............ ■��■��■��■�■■��■��■■�n��■��■��■�� ■�■�■��■��■�■��■�■��■■■��■��_��■��■��■ ::::::::�:::C:::::::.::::::::::::::::::::::::::'.::'�:::::::_::�:: .■......................................... ......C.... .......... ...........................................C...........C....._... ................................ ........................... .... ................................�i................................ .................................................................. .................................................................. ......................................... ............... ........ ■��N��■�■�■■■■■��■��H��■��■�� ■■��■��■■■��■��■��■��■��■��■ ■��■■��■■��■■ ■��■��■��■��■■��■ ....................C...........�................................ ................................ ................................ ............................................■..■■.■.............■■ .................................................................. .................................................................. ......................................■■...■■...■■...■..■...■■■■■■ ..■............................................................... ........................................■■......■..■........■■..■. ................................ ................................ ................................�................................ ■��■��u��i��■■��■��■�■■