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170 Robert Austin Trail Lot 3f Davie County, NC Tasr Pnrrr-1 RPnnrt Wednesday. November 2. 2016 WARNIN T: THIN IS NUT A,UKV.LY Parcel Information Parcel Number: F60000005308 Township: Farmington NCPIN Number: 5851816781 Municipality: Account Number: 82530018 Census Tract: 37059-803 Listed Owner 1: DEWITT JOHN A Voting Precinct: SMITH GROVE Mailing Address 1: 170 ROBERT AUSTIN TRAIL Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 6.535 AC OFF HWY 158 LOT 3 BIG OAK Fire Response District: SMITH GROVE Assessed Acreage: 6.48 Elementary School Zone: PINEBROOK Deed Date: 8/2008 Middle School Zone: NORTH DAVIE Deed Book / Page: 007680843 Soil Types: SeB,EnB,MsC Plat Book: 0007 Flood Zone: Plat Page: 051 Watershed Overlay: DAVIE COUNTY Building Value: 190220.00 Outbuilding & Extra Freatures Value: 55430.00 Land Value: 54660.00 Total Market Value: 300310.00 Total Assessed Value: 300310.00 101 7�T All data Is provided as Is without warranty or guarantee of any ldnd either expressed or implied Including but not limited to themDavie County, Implied warranties of merchantability or I ess 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 1� C or arising out of the use or Inability to use the GIS data provided by this website. r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000836 Tax PIN/EH #: 5851-81-6781 Billed To: Brian & Lisa Burley Subdivision Info: Big Oak Estates Lot # 3 Reference Name: Brian & Lisa Burley Location/Address: Robert Austin Trail -27028 Proposed Facility: Residence Property Size: 6.53 Acres ATC Number: 2233 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATERLQUjTRUCTJQN IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. I1 K n 3 Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT /0 o�/ . ' Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000836 Tax PIN/EH #: 5851-81-6781 Billed To: Brian & Lisa Burley Subdivision Info: Big Oak Estates Lot 3 Reference Name: Brian 8 Lisa Burley Location/Address: Robert Austin Trail -27028 Proposed Facility: Residence Property Size: 6.53 Acres ATC Number: 2233 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms �� #Baths 44 Dishwasher: �� Garbage Disposal: 12'�- Washing Machine: ❑"-- Basement w/Plumbing: GBasement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size (p5-5bM"5 Type Water Supply WELL- Design Wastewater Flow (GPD) Site: New 8 Repair ❑ System Specifications: Tank Size GAL. Pump Tank � Other: Ll �xC. GAL. Trench Width '�Lo Rock Depth J7 Linear Ft.� JS,-MLL, Ute: S 910. c , 1 Required Site Modifications/Conditions: P `qMj,- 0A GZ-4TOtV-, y-� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p:mon the dam yy oinstallation. Telephone # is (336)751-8760.**** 3 8BQ ,. 140• �,��15 '� p S � I _ ISO w3(o� X-Iz'' Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: /5/ APPUfr'.1TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC I5 1!1 l5 Davie County Health Department D Entlmnmental Hea/fri Secdon B.O. Box 848/210 Hospital Street OCT 2 5 1999 Mocksville, NC 27028 (336) 751-8760 - ENVIRONMENTAL HEALTH DAVIE COUNTY ***XBPCRTANT*** THIS APPLICATION CANNOT BZ PROCEBSBD UNLESS ALL THE REQUIRED INFORMATION 18 P ROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to b. allied \�2 P�^ �l L� a► sA QuR le►� Contact Parson $Spr BuQ1eu or_ Mailing AddV-0, ress { . 0 , &A Som Phone 91IG -q (,IS-- os 'T "�L- City/state/ZIP bCrV�Mo(-Ji PC- DLI 0\-4- - kTQA susiaess shone 33Ca -F1(, -t1Q %9 2. Name on Pezmit/ATC if Different than Above SAOL Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip -- // 0 Improvement Permit/ATC ff Both 4. system to service: Ga' House ❑ Mobile Home ❑ Business ❑ Indus Industry 3. If Residence: # People 3 # Bedrooms 3 a Dishwasher M/ Garbage Disposal !washing Machine 8/sasement/Plusbing S. It Susiness/Industry/Other: specify type # People # Commodea # showers # urinals ❑ Other # Bathrooms C! Basement/No Plumbing # sinks # Nater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallon per day) 7. Type of water supply: 0 County/City O'Nell 0 Community S. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑ Yes ErNo If yes, what type? ***IMPORTANT"** CLIENTS MAST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST B SUBMITTED by tke cUent with THIS APPLICATION. 5JI; -,4 s Property Dimensions: '770 x Nan x $ 7-7 is is WRIT DIRECTIONS (from MockavWe) to PROPERTY: O O O og /" A Tax Office PIN: # (7� ooS3 Property Address: Road Name RAy as��' T2. city/zip {V\oC'k-sU i\\3- a 10'X3 If in a Subdivision provide InIb ation, as follows: Name: Section: Block: Lot: �a 15'i ca -s �- 4,. Q; y otry- i 2 dA, A11�S�,w T�af t e"& Gam\ so- L Date Property Flagged: -- R 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 we change, or if the information submitted In this application is falsified or changed I, also, understand that I am responslble for all charges Incurred from this application. I, hereby, give consent to the Authorized Representative of thevie County Health Department to enter upon above described property located in Davie County and owned by �RZaJ d LISA Q...rLe.� to conduct all testing procedures as necessary to determine the site suitability. DATE tn- SIGNATURE - 12 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). C�/o�1TG `L0t) Revised DCHD (07/99) Date(s): Client Notification Date: I EHS: Account No. d Invoke No. �cJ .2—xo _v I r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990000836 Billed To: Brian & Lisa Burley Reference Name: Brian & Lisa Burley Proposed Facility: Residence Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5851-81-6781 Subdivision Info: Location/Address: Robert Austin Trail -27P28 Property Size: 6.53 Acres Date Evaluated: On -Site Well v Community Auger Boring Pit Public Cut FACTORS 12 3 4 5 6 7 Landscapeposition !, L L L Slope% S / E to HORIZON I DEPTH Texture grouplG Sc- 6C- GConsistence Consistence r ; 5 Pi Structure 5 Sg G C,Q Mineralo Ati i HORIZON II DEPTH • yg — 3142 Texture groucZ4 Consistence 5 Structure Z 4!:1Z Mineralogy nN, HORIZON III DEPTH - D Texture group Consistence Structure Mineralogy M HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION -s LONG-TERM ACCEPTANCE RATE p. Z O. 2 175— 1 SITE CLASSIFICATION: - P_' LONG-TERM ACCEPTANCE RATE: D • 2 - EVALUATION BY: OTHER(S) PRESENT: REMARKS: `I-Lxry& fi)nta 4OC-11� ' t"La7" `61}ALLoo i�oT JPpi✓T)q &cco 5f2 l> 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) ■ ■ ■■■MEMS ■■■SSS■ SOMEONE ■■■MEMS SOMEONE SOMEONE ■ I■■■M■M■E■E■ ■■E■■■M■ ■■■■■■■■■■■■■■■■■■■■■ ON ■■N■ ONES moon NONE 1111?%■ W;%M■ ROME 2■■■ ■■■■■E■■NIHOMM■ MENEM CMENNEN� mm■■EN.EMEMM■■ ■■■■■■■■■■■■■■ ■■■■■M■■E■■M■■ ■M■MMM■MMMMM■■ ■■■MMMMMM■MM■■ MEMEM■ME■■M■■■ ■OCEEMME■ EREM■ ■■■M■■■E■NAM■■ ■E■■■ ■E■■■ ■E■E■ ■■N■■ MESON SEEMS moon ■■N■ ■E■■■■ ■E■■M■ ■MMON■ ■E■■■■ ■■■■■■ ■M■■N■ ■■■■E■ ■■■■E■ ■■■NE■ ■M■ON■ ■E■■O■ ■EMNO■ ■■■■■■ ■■■M■■ ■■m■■■ uN■■■ MEMO ■NEEM■ ■■NN■■ ■M■■E■ ■■n■m■ ■E■■■■ ■E■■■■ ME MEN ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■MEM■■m■■■■■■■■■■■■E■mM■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ME ME ME am APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT=J1R a rn Davie County Health Department LS V Environmental Health Section P. O. Box 848 WR 2 4 Mocksville, NC 27028 IgI (704) 634-8760 ENVIRONM VUt HEALTH DAVIEM ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Contact Person Y -L s m t -i t Mailing Address Home Phone q 1 d ` Li 9 1' c -M AGV�� Lk C' 0"'st-1 City/State/Zip Sv1��e _ tV L '.)..7 O )A Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address _ 3. Application For: 4. System to Serve: 5. If Residence: ❑ Dishwasher 6. If Business/Other: # Commodes If Foodservice: O"'Site Evaluation CB'House ❑ Mobile Home # People City/State/Zip ❑ Improvement Permit & ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms 3 # Bathrooms Q '❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 7. Type of water supply: Specify type # Showers _ # Seats ❑ County/City # People # Sinks # Urinals Estimated Water Usage (gallons per day) ❑ Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes ❑ No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: f /J �%'�' 1 WRITE DIRECTIONS (from 5 (6!� t Tax Office PIN: # `� '`-fir -� - 1 Ln r% 1 Mocksville) TO PROPERTY: (S 7�1-6T Property Address: Road Name 1 city/zip Mer \es.,.\\e a. :J o a z� 1 < If in Subdivision provide information, as follows: 1 Name: 1 Section: Lot #: 1 1 1 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 consdsnt to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by k ov i Se- S to conduct all testing procedures as necessary to determine the site suitability. DATE ? cZ3 - S k SIGNATURE Revised DCHD (06-96) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT 3 Soil/Site Evaluation ArrLICANT'S NAME lP/ DATE EVALUATED 7� PROPOSED FACILITY PROPERTY SIZE S��e SUBDIVISION �/�� vc6r Water Supply: Evaluation By: On -Site Well .'� Community Auger Boring V Pit ROAD NAME Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH J777— 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 9(&Z A we LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) Landscape Position EVALUATION BY: 4 OT R(S) PRESENT: —�/9XIe LEGEND 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