County Line Road Lot 1Davie County. NC t
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Tuesday. November 8. 2016
WAKNING: '1Mh 1b 14U'1' A IUKVLY
Parcel Information
Parcel Number:
H10000000801
Township:
Calahain
NCPIN Number:
4799876381
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:
DAME COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
28621
Voluntary Ag. District:
No
Legal Description:
LOT 1 BRACKEN DOWNS
Fire Response District:
SHEFFIELD - CALAHALN
Assessed Acreage:
0.80
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
6/2013
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
2013E0612
Soil Types:
PcC2,CeB2
Plat Book:
0008
Flood Zone:
Plat Page:
152
Watershed Overlay:
DAVIE COUNTY
Building Value:
0.00
Outbuilding S Extra
Freatures Value:
0.00
Land Value:
16700.00
Total Market Value:
16700.00
Total Assessed Value:
16700.00
9Ail 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 of merchantability or Illness for a particular use. All users of Davie County's GIS webste 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
�� U N NC or arising out of the use or Inability to use the GIS data provided by this website.
CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC / -4-
Davie County Health Department
Environmental Health Section
(. P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
X
***IM ** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
�,
1. Name to be Billed otia R. 7BwaN Contact Person JOIjd R. _817* 5#
Mailing Address 1002 SIDES ST Home Phone 704 Z (9`250
City/State/ZIP ROCKWF-LL A.C. 2813 Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: Site Evaluation 13Improvement Permit/ATC E3Both
//
4. System to Service: M house ❑ Mobile home ❑ Business ❑ Industry ❑ Other
S. Type system requested: Conventional ❑ conventional modified ❑ innovative
6. Iffnesidence:# People 4 # Bedrooms 1-3 Bathrooms 1Z_
11Dishwasher 0,5a�rbage Disposal 04ashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
7.
If Business/Industry /Other: verify type,
# Commodes
# Showers # Urinals
# People
# Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: E County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes [DINO
If yes, what type?
***IMPORTANT'"'** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: , 1 X 1100 1
Tax Office PIN: # 4799% 9 137 01
;;77
Property Address: Road Name CDyof bine ZA -
city/zip N/IQmwY . N.C. 2604 -
If in a Subdivision provide information, as follows:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
4& G4- wcsT TO N. C. �a
7n CwTY 1-,#P 2A . T�INTMSECTID OF MOLL 00bG
Name: _3R4CK VW 1�5T. n
Section: l Block: Lot: Date home corners flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
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, urulerstaird thral l aur 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
to conduct all testing procedures as necessary to determine the site slL abilit�A
DATE T — „Z 7 — d Cc SIGNATURE
THIS AREA MAY BE USED FOR DRA«'ING.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 Charge
I Datc(s):
Client Notification Date:
EHS:
Account No. , I
Invoice No. `T
APPLICANT INFORMATION
Account #: 990003389
Billed To: John Bracken
Reference Name:
Proposed Facility: Resiodence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 4799-86-9137,o(
Subdivision Info: Bracken Est Lot # 01
Location/Address: County Line Road -2863
Property Size: 300'x 1100' Date Evaluated: �� J
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
N
Public V
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
C
Consistence
r S
Structure
L
Mineralogy
HORIZON III DEPTH
1
Texture group
Consistence
rSS
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
Q.
SITE CLASSIFICATION: P 22
LONG-TERM ACCEPTANCE RATE: �' J
REMARKS:
LEGEND
Landscape Position
EVALUATION BY:y tJ
OTHER(S) PRESENT:
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)