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County Line Road Lot 2Davie Countv. NC Tav Parr�r 1 Rs�r�nrt Tuesdav, November 8. 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: WAI NIAki: -1n1b lb INU1 A JUKVL' Y Parcel Information H 10000000802 Township: Calahain 4799876211 Municipality: 8305446 Census Tract: 37059-801 WHITE ROBIN LYNN BRACKEN Voting Precinct: NORTH CALAHALN 332 PLEASANT HILL DRIVE Planning Jurisdiction: Davie County ELKIN Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 28621 Voluntary Ag. District: No LOT 2 BRACKEN DOWNS Fire Response District: SHEFFIELD - CALAHALN 0.79 Elementary School Zone: WILLIAM R DAVIE 6/2013 Middle School Zone: NORTH DAVIE 2013E0612 Soil Types: GnB2,PcC2,CeB2 0007 Flood Zone: 152 Watershed Overlay: DAVIE COUNTY Building Value: 0.00 Outbuilding & Extra Freatures Value: Land Value: 16460.00 Total Market Value: 16460.00 Total Assessed Value: 16460.00 AM 161 Alt 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 fitness for a particular use. All users of Davie County's GIS website shall hold harmless the �T County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to l� C or arising out of the use or inability to use the GIS data provided by this website. N' y LICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnvironlnentaiHeaith Section �j 15 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 { (336) 751-8760 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to' , be Billed onm R. 7RAcKaj Contact Person J011ni R. -511AL-KISA/ Mailing Address ICOZ 5N1DES5-r. Home Home Phone 704 Z79 Z5 City/state/ZIP ROCKW9(L ,C, Zg39 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: MSSite Evaluation 13Improvement Permit/ATC 13Both 4. System to service: M iIouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: conventional ❑ conventional modified ❑ innovative 6. IfResidence: ,� # People 4 # Bedrooms 3_ # Bathrooms 1_ 2DishwasherfRM'a�rbage Disposal Washing Machine ❑Basement/Plumbing ❑Basement/No 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 [DINO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE TILE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client wilil THIS APPLICATION. Property Dimensions: . 1 X 1100 t Tax Office PIN: it 479.98 9137 Property Address: Road Name C011of Lwe- EA. city/zip kevy 11 u. C. Z604 - If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Awy- CA- Vie -5T 1 o N, C. / o INr sec aoa ©ic MoLL l oomy Rio Name: 70IznC.K FN 95? C) L Section: l Block: Lot: Date home corners Ragged: 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 tliis apl;lication is falsified or changed. I, also, understand that I ain responsible for all charges incurred frau this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth 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 sit ' ability DATE f — ,� 2 _ CI SIGNATUIt1; THIS AREA MAY BE USED FOR DRAWING.YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). t Sign given Revised DCIiD (05/03 Site Revisit Cliarge Datc(s): Client Notification Date: EHS• Account No. Invoice No. - APPLICANT INFORMATION Account #: 990003389 Billed To: John Bracken Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 4799-86-9137.02 Subdivision Info: Bracken Estate Lot # 02 Location/Address: County Line Road -28634 Property Size: 300' x 1100' Date Evaluated: Community / Auger Boring ` Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH 0 —10 Texture group C Consistence Structure S Mineralogy HORIZON II DEPTH ©-2Z I tI-- -Z'S Texture group; C_ -.15L Consistence 5 S Structure Mineralogy HORIZON III DEPTH 02— 2S — Texture group+� Consistence Q -st if Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ti LONG-TERM ACCEPTANCE RATE 3. SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA REMARKS: Landscane Position h U. 3 LEGEND EVALUATION BY: �.,_ 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)