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126 Springdale Court Lot 9R Davie County_ NC Tax Pnrr-.fl R Pnnrt Thursday. October 20. 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: Building Value: WARNIAG: THIS 1S NOTA SURVEY Parcel Information G8060A0009 Township: Shady Grove 5880003933 Municipality: 45082340 Census Tract: 37059-804 LE BLEU CORPORATION Voting Precinct: EAST SHADY GROVE PO BOX 2093 Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY 1-1,R-20 Land Value: Total Assessed Value: NC Zoning Overlay: All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the 27006-0000 Voluntary Ag. District: No LOT 9 BENTBROOK Fire Response District: ADVANCE 1.59 Elementary School Zone: SHADY GROVE 10/1998 Middle School Zone: WILLIAM ELLIS 002060568 Soil Types: WeC,WeB 0006 Flood Zone: 112 Watershed Overlay: DAVIE COUNTY 0.00 Outbuilding & Extra 0.00 Freatures Value: 40000.00 Total Market Value: 40000.00 40000.00 Davie County, All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the F -& NC County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this website. 1. T :.PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 Mailing Address 2. Name on Permit if Different than Above 3. Application for. General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: f Houses O Mobile Home O Place of Public Assembly ❑ Business ❑ Aqustry ❑ Other O Unknown 5. If house, mobile home: Subdivision - ,o/,T�roO� Section ' / Lot'# No. of People No. of Bedrooms No. of Bathrooms O Basement/Plumbing O Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher Dwelling Dimensions O Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: ❑' Public No. of Sinks No. of Urinals ,No. of Water Coolers Water Usage Figures O Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? ❑ Community 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges Incurred from this application. 4-a---2-29-�-Z- DATE •M •; •Za Lei --I =spielg 14019 ;:• : 1:1 =1 9111=191' ti MUST CHECK ONE: ❑ 1. 1 OWN the property. O 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUSZ be completed by the owner or a person authorized by the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. . DATE SIGNATURE WHO (11P DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED Z/ ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On -Site Well Evaluation By: Auger Boring Community Pit A Public Z--' Cut FACTORS 1 2 3 4 Landscape position L L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence i 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: EVALUATED BY: I /`ya LONG-TERM ACCEPTANCE RA REMARKS: S ,- cella OTHER(S) PRESENT: 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 Mi neraloey 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface jo 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(01-901