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106 Childrens Home Road Site 1Davie County, NC 4 Tax Parcel Report Wednesday, November 2, 2016 WARNIN T: '11t11S 1S NOTA SURVEY Parcel Information Parcel Number: B30000000614 Township: Clarksville NCPIN Number: 5813894141 Municipality: Account Number: 2074000 Census Tract: 37059-801 Listed Owner 1: ANDREWS TIMOTHY M Voting Precinct: CLARKSVILLE Mailing Address 1: 194 JONES DRIVE Planning Jurisdiction: Davie County City: WINSTON SALEM Zoning Class: DAME COUNTY R-A,R-20 State: NC Zoning Overlay: Zip Code: 27107-8838 Voluntary Ag. District: No Legal Description: 2.00 AC CHILDRENS HOME RD Fire Response District: COURTNEY Assessed Acreage: 1.96 Elementary School Zone: WILLIAM R DAVIE Deed Date: 4/1998 Middle School Zone: NORTH DAVIE Deed Book / Page: 002010598 Soil Types: Mn132,MdC Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 52900.00 Outbuilding & Extra Freatures Value: 0.00 Land Value: 16000.00 Total Market Value: 68900.00 Total Assessed Value: 68900.00 1:01 All data Is provided as Is without warranty or guarantee of any kind either a:pressed 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 County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. t s� ¢' AUTHORIZATION No: 18.8',DAVIE COUNTY HEALTH DEPARTMENT /ed a I - Environmental Health Section PROPgRTY INFORMATIONL Permittee's P.O. Box 848 ' ACIP0 rn Name: � ?-mm,-57 Mocksville, NC 27028 Stibdivisio Name: Phone #: 704-634-8760LG" Directions to property: e'/%�/.^ {`��.�.��.*r Section: Lot: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:#92 R Road Name: ' " ip; , 9- **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 Permits: (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION f IS VALID FOR A PERIOD OF FIVE YEARS.. ENVIRONMENTAL HEALT SPECIALIST DATE ISSU ,.r � 'nom � . ., y � .T rt,�y....»w..t .r ••.�`s'w..rw�.- rwr-. -v• -..�a. - .... ., ,.... . .. , .. .v. - t DAVIE COUNTY HEALTH DEPARTMENT, / „.� c, IMPROVEMENT AND OPERATION PERMITS ROPER INF6RMATIO Permittees r .'�3 i'14 � f) t'.• " " "` ': x Name:, t See sion Name: Directions to property: .✓ `�. f'' �. ,xy `' Section: L'ot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name• �,Fip: ) **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 permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE J PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTW SPECIALIST DATE ISSU D SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 17 # BATHS A- # OCCUPANTS �� GARBAGE DISPOSAL: Yes or No COMMERCIIA�L SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No' LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �-,& 10_ NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE S00 �yOy GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTHS LINEAR FT. OTHER REOUIRED SITE MODIFICATIONS/CONDITIONS: "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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: A. -Vin It)- �117 AUTHORIZATION NO, y�z� OPERATION PERMIT BY: /!/ DATE: "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 WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) w APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE ' Davie County Health Department Environmental Health Section 0 �� 7 P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS A THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed iI rn 6Y.x� Contact Person '' II Cl a amoc—=) Mailing Address 5-1 Home Phone N' 01!0 City/State/ZipCJ i Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation [ mprovement Permit & ATC [ ] Both 4. System to Serve: [ ] House [VIIM*'obile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms # Bathrooms [hwasher [ ] Garbage Disposal [Washing Machine [ ] Basement/Plumbing [ ] 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 [1�}<ell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ' ] No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***-VnWAY' OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: (10 ff f7) WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #5!R.1a - - Property Address: Road 14ame CEI vv� City/Zip �l S me If in Subdivision provide information, as follows: Name: _L. �s Section: .. Lot #: � 6 I Tom— 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 De County Health Department to enter upon above described property located in Davie County and owned by . J a ' to conduct all estin procedures as necessary to determine the site suitability. DATE SIGNATURE Revised DCHD (06-96) THIS AREA MAY 13E USED FOR DRAWING YOUR SITE PLAN: V V .00 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC It Davie County Health Department Y ^ ' Environmental Health Section f 1 eP/'V P.O. Box 848 t Mocksville, NC 27028OGT i 7 1997 (704) 634-8760 1 ! PN I -/ ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSIEW THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed B o � e v Pe -Al jS JA Contact Persona) 16e, 56 T e ,— Mailing Address aIJ/8 14ujN 191' Home Phone ' 9g- 77.-3 City/State/Zip Q J V A (J C f A]• Q• -2 % b O t!o Business Phone 9 ! ls'— r� S3 t -A 2. Name on Permit/ATC if Different than Above �"TA M . Mailing Address cS%1 /'\t City/State/Zip c5'/4 M -e- 3. Application For: QdSite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: 3 # People_ # Bedrooms .O— # Bathrooms Dishwasher [ ] Garbage Disposal pd"Washing Machine [ ] Basement/Plumbing [ ] 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 W Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes 0 No If yes, what type? rt!'J EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***�C.F'.Y. T OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �� r e T✓/1C�S cC` 3f1C'�s % WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #,S-913 _ - Z? - 3((g 4 ! ; % o) 140 ✓i� k Ap N i ] J r ey r r Property Address: Road Dame o h i v e ms b4 o m,-- % A 1-1 a o_ /J / e g TVIV city/zip O OC KS l/i 11 If in Subdivision provide information, as follows: Name: Section: 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 13—a h /T�/;Za5 to cqfflduct all testingocedures as necessary to determine the site suitability. DATE f' U "' %� `i f SIGNATURE _ D d ' ak/-c. Revised DCHD (06-96) THIS AREA MAY BE USED FOR bRAWINC7 JOUR SITE PLAN: io 71*�1� DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME r PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community, DATE EVALUATED /D '02��% PROPERTY SIZE ROAD NAME Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position .✓ Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH I- r Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P9 LONG-TERM ACCEPTANCE RATE 13 1-3 SITE CLASSIFICATION: EVALUATION BY: �v 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 (01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■/■■■■■■■■■■■■//NOON/■■■/■■/■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■//■■■■■■■■/NOON/■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NOON/■■■■■■■■■■■■■■■■■�■■■■■■■■ NOON/■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■■■■■■■■■■■■/NOON■■■/NOON■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ MEMNONMOMMEMMEMMEM 'I�iMEMNONWOMEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NOON■■■■■■■n■■■■■■■�\■■■■\M■■■■■eN�■■E■■■M■■■■■ ■■■■NOON■■■11■l■■■■■11■■■■If■■■■■■► >GLi■■■■■■■■■■■ ■■■■■■■■■■■■.Ire■■■■■■■�■■■■I■■■■■■M�a■■■■■■■■■■■■■ ■/■■■/■■■/■I■/■■■/■ME11■/�1i■■//■■ ■//NOON■■/■■■ ■■■■■■■■■■■I■■■■■■■■■■Iri \■!■■■■■■�■■■■■■■■■■■■■ NOON/■E■■■■■■■MNN■■■■■■■Elle■■■■■/■■■■■■■����■■ ■NOME■■■ ■MEMEME■ ■■■■E■■■ ■■■N■■■■ ■EM■■ME■ ■E■NEM■■ ■MEMMEM■ ■MEM■EE■ Davie County Heafth Department andHome Health Agency Environmenta(Health Section P.O. BOX 848 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 October 30, 1997 Boger Real Estate 5248 Hwy. 158 Advance, NC 27006 Re: 3 Site Evaluations Childrens Home Rd. Tax PIN: #5813-89-3844 Dear Client (s) : As requested, a representative from this office visited the aforementioned sites on October, 29, 1997. Based upon the information provided on the application(s) for site evaluation(s),..and after the evaluations were completed, the sites were found to be provisionally suitable for the installation mf an on—site sewage disposal system on each site. Before any permit(s) can be issued the appropriate application(s) must be filled out and the house/mobile home 'location(s) staked off. If you have any questions, please feel free to contact this office. RH/wd Enclosure(s) cc: Zoning Office Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist CO 10 - co - co CO 0 05 a - Tax Lot 6 Tax Map B-3 R.S. Pratt Estate This map or drawing and arq' accompanying documents are furnished to the persons) named thereon and no atterations or use by others is permitted unless authorized by Allied Land Surveying. PA Map not for recordation. Precision 1:10.000+ NOTE: ri ht—of—w This property is subject to ail easements, g M, streets and assessments, if any, as the some may appear of record in the office of the Register of Deeds. Clerk of Court. Town or County Tax Office or which may have been acquired by prescriptive use.Ts ull and accuurate is iect to any title search. NOTacts umished at may be disclosed by af as of this date. Tax Lot 6.06 Tax Map B-3 Derek P. Scherer a/w Virginia L Scherer DB 187 0 PG 430 NOTu DB 187 0 PG 433 The property lines and property comers are the same. Bearing basis for the McIntosh tract is Deed Book 128 O Page 384. Bearing basis for the Scherer tract is Deed Book 120 0 Page 167. 1 /2"EIR 76.88' S 8181 8'35"W 3 IRS Te Line r 0 �, NM e M ac N 0 Z N 81038'35"E 673.00' Part of Tax Lot 6 Tax Map B-3 2.00 Acres +/— 1 /2"EIR �0 Ny G C5n m Tie Line 33.72'% . N 8800620"E -------------------------•-- ----�R X820 "PRIVATE" IRS Centerline of Proposed 50' R\W 6 493; 96 • S 84027'50"W 465.00' IRS N 8pe� Tax Lot 6 Tax Map B-3 R.S. Pratt Estate D8400PG612 t LEGEND aa Center Uns i R/W — Right—of—Way C — Center Line { Elp — Existing Iron Pipe EP — Edge of Pavement 1 oR _ Existing Iron Rebar FC — Face of Curb — Poo e i P _ C�onerete PP Po?'e Monument —le O Joh ,Q/ C-) row/ 1/2"EIR d ` 1 /2"EIR ,s��{fNlllrr,, .�``t CAROB :... D / w `0 ClzarlerL� �n�z part of Tax Lot E Tax MOP B-3 Deed Book 40 0 Page