128 Springdale Court Lot 8Davic County, NC i Tax Parcel Rcport TIMI -Slay, Octobcr 20, 2016
Parcel Plumber:
NCPIN Number:
Account Numb -or:
Listed 0,64mer 1:
r0ailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Va!ue:
NVAHNENU: IS NOT A. SURVEY
1 1.. .... ... t tl'.� .....+
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G806OA0003 Township: Shady Grove
58800027 18 N'lunicipality:
16670500 Census Tract: 37059-804
CONNOR FRED E Voting Precinct: EAST SHADY GROVE
128 SPRINGDALE COURT Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY 1-1,R-20
Land Value:
Total Assessed Value:
NC
Zoning Overlay:
27006-7319
Voluntary ^g. District:
LOT 8 BENTBROOK
Fire Response District:
1.72
Elementary School Zone
2/2002
Piddle School Zonc:
004070007
Soil Types:
0006
Flood Zone:
112
Watershed Overlay:
232010.00
Outbuilding & Extra
Freatures Value:
40000.00
Total Market Value:
279680.00
ADVANCE
SHADY GROVE
WILLIAM ELLIS
WeC,WeB
DAVIE COUNTY
7670.00
279680.00
No
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iivie Count �r� ? implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
i- -I I County of Davie, North Carolina, its agents, con su;tatits, contractors or employees from any and all claims or causes of action due to
NCnUN� � I or arising out of the use or inauiiiiy to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
r Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002135 Tax PIN/EH #: 5880-00-7630.08
Billed To: Fred Connor Subdivision Info: Bentbrook Lot # 8
Reference Name: Location/Address: 128 Spring Dale Court 27006
Proposed Facility: Residence Property Size: 1.7 acres
ATC Number: 3056
**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 1 l 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 /jam #People_ #Bedrooms F_ #Baths
Dishwasher: Garbage Disposal: ❑ Washing Machine:/ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size % Type Water Supply_ Design Wastewater Flow (GPD) � Site: New,,21'o' Repair ❑
System Specifications: Tank Size ✓Opti GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width .� Rock Depth /02 " ' Linear Ft.
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.m. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
Account #: 990002135
Billed To: Fred Connor
Reference Name:
ATC Number: 3056
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5880-00-7630.08
Subdivision Info: Bentbrook Lot # 8
Location/Address: 128 Spring Dale Court -27006
Size: i.t acres
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 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWANSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
'x
4AEnvironmental 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.
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date: o'er
JAN2� O
IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed v LI �i7 Al i1/ J �— Contact Person �%�/,/ /ri/; L l /��/- �'ti�✓e/110�
Mailing Address �� ��� �. /� Home Phone /// �X�—�/ d' 3
City/state/ZIP /i )/ R- n! r2< Business Phone / T 2S U 3 5
2. Name on Permit/ATC if Different than Above
( Mailing Address �G /it�2 ��P i2 r /state/Zip
bl
Improvement
3. Application For:
Evaluation
Permit AT
❑ Both
4. System to Service:
House ❑ Mobile Home
❑ Business s ry ❑ Other
5. If Residence:
# People
# Bedrooms r _ # Bathrooms
P-15ishwasher ❑ Garbage Disposal V4ashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type
# Commodes
# Showers
# Urinals
# People # Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: ❑ County/City ❑ Well ❑ Community /
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes d
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: #�' �� o `�A " � I? a .
Property Address: Road Name :-� S v'✓?� a� Psz
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
City/Zip
If in a Subdivision' provide, information, as follows:
Name: 4�v'c//1�--a-- �- -< ,l.Uz
Section: Block: Lot:
t
Date Property Flagged: / — ;- r --e 2 --
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 ount health Dcpartmc t
to enter upon above described property located in Davie County and owned by d`
to conduct all testing procedures as necessary to determine the site suitability.
DATE o�-�--y 7f- SIGNATURE
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).
L
n 6 &. 7� . ,
EHS:
Account No.
Invoice No.
1
APPLICATION 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
Business Phone
3. Application for. XGeneral Evaluation O Septic Tank Installation Permit
4. System to Serve: J Houses ❑ Mobile Home ❑ Place of Public Assembly
❑ Business Odustry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision 5,?hT��"o0� Section Lot #
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions
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: 0 Public
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Private
8. Property Dimensions Sewage Disposal Contractor
O Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
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.
-:9 -� 2 -
DATE
CONSENT FS29 BM EVALUATION IQ BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form jy1UST 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
DCHD (11R
,i Ir ..S
'DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME " T e" _
ADDRESS
PROPOSED FACIILTY l yele�ysK
Water Supply: On -Site Well
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Community
Public a---
Evaluation By: Auger Boring Pit d---- Cut
FACTORS
1 2 3 4
Landscape position
L
Slope 7.
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC'
Consistence
.,
Structure
,lam
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 RATEE
HE�,
SITE CLASSIFICATION: �_ EVALUATED BY: 19?Z ZZ
LONG-TERM ACCEPTANCE R/TE:
REMARKS: SPI /NA.(' t ,- i
DCHD(01-901
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
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
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Acco u rll 9: 990002135
Biiied To.- Fred Connor
oell'G -once 111-la—me:
1\GIGi Gi1GG
Proposed Facility: Residence
Property Size:
PROPERTY INFORMATION
Tax PINIEH 9: 5880-00-7630.08
Subdivision info: Bentbrook Lot # 8
128 Spring Dale Court -27006
;%tIQ LIJi 1!llUUi GJJ.
1.7 acres Date Evaluated:
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Public
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
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:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
Landscape Position
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
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)