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136 Moll Hodgson Rd Lot 5Davie County, NC I Tax Parcel Report Tuesday, November 8, 2016 WARNING: '1'1i151S NOTA SURVEY Parcel Information Parcel Number: H10000000805 Township: Calahaln NCPIN Number: 4799863719 Municipality: Account Number: 8305446 Census Tract: 37059-801 Listed Owner 1: WHITE ROBIN LYNN BRACKEN Voting Precinct: NORTH CALAHALN Mailing Address 1: 332 PLEASANT HILL DRIVE Planning Jurisdiction: Davie County City: ELKIN Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 28621 Voluntary Ag. District: No Legal Description: LOT 5 BRACKEN DOWNS Fire Response District: SHEFFIELD - CALAHALN Assessed Acreage: 0.74 Elementary School Zone: WILLIAM R DAVIE Deed Date: 6/2013 Middle School Zone: NORTH DAVIE Deed Book / Page: 2013EO612 Soil Types: GnB2,PcC2,CeB2 Plat Book: 0008 Flood Zone: Plat Page: 152 Watershed Overlay: DAVIE COUNTY Building Value: 59290.00 Outbuilding & Extra Freatures Value: 0.00 Land Value: 16070.00 Total Market Value: 75360.00 Total Assessed Value: 75360.00 9 Ate: AAll data is provided as is without warranty or guarantee of any Idnd either expressed or implied Including but not limited to the Davie County, Implied warranties or merchantability or fitness for a particular use. Ag users of Davie Countys 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 r'p N•t NC or arising out of the use or Inability to use the GIS data provided by this website. Account #: 990003389 Billed To: John Bracken Reference Name: Proposed Facility: Residence ATC Number: 4694 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Tax PIN/EH M 4799-86-9137.05 Subdivision Info: Bracken Est Lot # 05 Location/Address: County Line Road -28634 Property Size: see map **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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 will function satisfactorily for any, given period of time. System Type:_ S.T. Manufacturer c'��Tank Date' ( Tank Si e� Pump Tank Size System Installed By: %DC41.1. Spec' ' t DCHD 11/06 (Revised) . ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 . AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990003389 Billed To: John Bracken Reference Name: Proposed Facility: Residence ATC Number: 4694 Tax PIN/EH #: 4799-86-9137.05 Subdivision Info: Bracken Est, Lot # 05 Location/Address: County Line Road -28634 Property Size: see map Site Type: ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use chance. Residential Specifications: # Bedrooms '5 # Bathrooms Z # People 2— Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) 2 Lot Size Type of Water Supply:Xounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) '3G�, Tank Size I CW GAL. Pump Tank GAL. Trench Width fit' Max. Trench Depth2_q _ Rock Depth 441 Linear Ft. Site Modifications/Conditions/Other: Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. r,71 45k Environmental Health DCHD 11106 (Revised) Date: '711A ') SITE EVALUATION/IMPROVEMENT PERMIT &ATC Davie County Environmental Health ,uN _ 1 2001 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 A�N�LiN (336)751-8760/ Fax (336)751-8786 E�V1R4N�'1 -V n For D� va uation/Improvement Permit Authorization To Construct(ATC) ❑ Both kation: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION 'R Name to be Billed %Cp".1 Contact Person Billing Address— eF Home Phone 7q- Z Oq City/State/ZIP Business Phone Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION City/State/Zip *Date House/Facility Corners 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.) Owner's Name Apme— Phone Number Owner's Address City/State/Zip Property Address City Lot Size Tax PIN# - 1 % Subdivision Name(if applicable). _ _ _ Section/Lot# o Site: rM If the answer lb any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes Ql5o Does the site contain jurisdictional wetlands? ❑Yes PN -o Are there any easements or right-of-ways on the site? ❑Yes DXo Is the site subject to approval by another public agency? ❑Yes 15�To Will wastewater other than domestic sewage be generated? ❑Yes ❑No IF RESIDENCE FILL OUT THE BOX BELOW # People _9 # Bedrooms �_q— # Bathrooms c2 Garden Tub/Whirlpool ❑Yes ❑N3i5'- Basement: ❑Yes J Basement Plumbing: ❑Yes �S 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; I. iventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Typ ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes D -Na___ If yes, what type? 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 locating and flagging or,,staing t house/facility location, roposed well location and the location of any other amenities. Site Revisit Charge Broperty owner's or owner's legal representative signature -/'UT Date Sign giv n ❑Yes ❑No Revised 11/06 Date(s): Client Notification Date: EHS: Account # 339q Invoice # LTIxE 712 pG DISTANCE ,4- w 52.46 w 74.76 4" w 81.12 6" w 4400 6" w 33.62 4" w 74.71 7" w 17.00 7" w 52.66 9" w 107.12 B" w 99.38 I' w 20.00 IW 130.00 " w 14910 f" w 98.09 i" w 129.40 i" E 73.73 i" E 104.48 I" E 149.08 E 101.23 ` E 76.17 I` E 65.01 " E 132.27 � Sze 1 S>8 1 6199 l or9� r_._.'-_ 60' / R;'W LIGATION FOR SITE EVALUATION/IAIPROVEh1FM PERMIT & ATC Davie County Health Department EnvironlnentaiHea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 U� { (336) 751-8760 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED RMATION IS PROVIDED. Refer to the INFORMATION BULLETIN.for instructions. 1. Name to' be Billed �,Iono R. I' ilit.KL Contact Person JOI�I�i �I�l^i�laK�/y Mailing Address IO2 51095 7R. Homo Phone M z!9-2..�0 1 C. City/State/ZIP %CKWF-LL 11.C. Q ZBI3A Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Evaluation E3 Improvement Permit/ATC E3 Both 4. aar l/ System to Service: fU' House ❑ Mobile Rome ❑ Business ❑ Industry ❑ Other S. Type system requested: (Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms _1_ # Bathrooms �4 13Dishwasher 00'arbage 04ashing ❑Basement/Plumbing ❑Basement/No Disposal Machine Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) 8. Type of water supply: [County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes MIN If yes, what type? ***IMPORTANAT' CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TI ITS APPLICATION. 1 � Property Dimensions: , w x � ��� Tax Office PIN: i! 4?998 9137 r b Property Address: Road Name _C00W LTNF- Zn.' cityizip ktroyYM . C • Z 34 - If in a Subdivision provide information, as follows: Name: 7BRACK FN E5T. Section: j Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: A& G4- uwr_g j o N.C. MI I Nov Lal 2o . I INTM5EGRO0 or lntro IntroIAODGON k Date home corners flagged: ) ! -5 A 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 tlue site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I aut responsible for all charges incurred front this application. I, Hereby, give consent to the Autliorized 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 the site su' ability DATE �Z — 7 2 _ b SIGNATURE / THIS AREA MAY BE USED FOR DRANVI.NG.YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). i Sign given Revised DCIID (05103 Site Revisit Cliarge Datc(s): Client Notification Date: EHS: Account No. �'% Invoice No. f� APPLICANT INFORMATION Account #: 990003389 Billed To: John Bracken Reference Name: Proposed Facility: Residence Water Supply: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation PROPERTY INFORMATION Tax PIN/EH #: 4799-86-9137.05 Subdivision Info: Bracken Est Lot # 05 Location/Address: County Line Road -28634 Property Size: see map Date Evaluated: 1 t� Community Public Evaluation By: Auger Boring Pit ✓ Cut II.w. n. FACTORS 1 2 5 6 7 Landscape position l_ V l_ L Sloe % HORIZON I DEPTH p -13 C-1=1 p- -17- 0 -17 - Texture Texture rou St -L- C, t4_ Consistence 1rrSS P. G PCMW Structure Cel k Mineralogy 5.Iq y ' HORIZON II DEPTH 11,5-61 tow - Texture group Consistence F,S F; S S Structure k Mineralogy HORIZON III DEPTH at - L41 2 Texture group IAIe S'C�t Consistence Fr 1 Structure k fir Mineralogy 5. - HORIZON IV DEPTH 41 (cel Texture group WrUgly l Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I Ps LONG-TERM ACCEPTANCE RATE 1 0.5 SITE CLASSIFICATION: 5 t� EVALUATION BY: LONG-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 - 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) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) 429 (330) oLt O Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990003389 Tax PIN/EH #: 4799-86-9137.05 Billed To: John Bracken Subdivision Info: Bracken Est Lot # 05 Address: 1002 Sides Street Location/Address: County Line Road -28634 City: Rockwell Property Size: see map Reference Name: Proposed Facility: Residence **NOTE* *This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Z Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):3( fo Type of Water Supply: .0eounty/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions: Site Plan Environmental Health Specialist i.p.l 1-06 /-'L � -__ Date 7/1 IE % I 6 � * A TOTAL= 338. 19 Q, 278.19 N 55*10"37' W IJ ter. �: ,4 .a � , 012 9 7 S Q FT, --- LOT 5 TOTAL= 271.29 0 P(DIH�` 15, i-1 %IN N 55*,'SY,'10" W J WIN co \\,*\t i. N 55*10"37' W IJ ter. �: ,4 .a � , 012 9 7 S Q FT, --- LOT 5 TOTAL= 271.29 0 P(DIH�` 15, i-1 %IN N 55*,'SY,'10" W J WIN co \\,*\t