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216 Essex Farm Road Lot 51Davie County, NC ' Tax Parcel Report Tuesday, December 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: Land Value: Total Assessed Value: WARNING: THIS IS NOT A SURVEY Parcel Information F8030A0051 Township: Shady Grove 5870643673 Municipality: 8305451 Census Tract: 37059-803 CLINE DAVID V Voting Precinct: EAST SHADY GROVE 216 ESSEX FARM ROAD Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006 Voluntary Ag. District: LOT 51 ESSEX FARM PHASE 1 Fire Response District: 0.73 Elementary School Zone: 9/2015 Middle School Zone: 009990523 Soil Types: 0009 Flood Zone: 290 Watershed Overlay: Outbuilding 8r Extra Freatures Value: Total Market Value: 7M. ADVANCE SHADY GROVE WILLIAM ELLIS GnB2,EnC DAVIE COUNTY Davie County, Ail 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 101 NC County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to data by this or arising out of the use or inability to use the GIS provided website. - 'OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone #: (336) 978-7120 I1 or vmce useynty "CDP File,Number 191920 -1 County IDrNumber, Evaluated For: NEIN Township: rroperty owner. RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive Cly: Greensboro State/Zip: NC 27409 14Phone #: (336) 978-7120 Property Location & Site Inform s Address/Road #: Subdivision: Essex Farm Rd Essex Farm Road Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC "IP Issued by. 2140 -Nations, Robert *CA issued by: 2140- Nations, Robert Design Flow: 4 8 0 Soil Application Rate: 0 - a a 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Phase: Lot: 51 Directions Hwy 64 East, Left on Comatzer Rd, on left past Beauchamp Rd *System Classification/Description: TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) SeproliteSystem? OYes @No *Distribution Type: GRAVITY -SERIAL Pump Required? QYes ONo *Pre Treatment: 1 7 4 5 Sq. ft. 4 4 4 0 ft. Inches O.C. (M)Feet O.C. 3 Olnches Q+f Feet inches Minimum Trench Depth: a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth:.3 6 Inches Maximum Soil Cover: 2 4 Inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Frank transou Certification #: *EH S: 2140 -Nations. Robert Date: 0 7/ 1 6/ 2 0 1 5 CDP File Number 191920 " I County ID Number: Pump Tank Manufacturer PT: septic Tante . Manufacturer. shoal Date: Lat. Gal Certification #: 760 RiserSealed ❑ Yes Long: STB: RiserHeight: ❑ Yes ❑ No (Min.6 in.) Gallons: 1000 ❑ No Installer: frank Transou Date: 0 3/ 2 4 / 2 0 1 5 Certification It: Valves Accessible ❑ Yes ❑ No *EH S: 2140 - Nations, Robert *Filter Brand: POLYLOK PL -122 With Pipe Adapter ❑ Yes ST Marker: ❑ Yes 59 NO Date: 0 7/ 1 fi/ a 0 1 5 nforced Tank: ❑Yes R No r+uvai statuses APProval Ststusr va h ElYes ❑ No © Approved'❑Dlsaproe� a O Approved ❑ ©tsapprayet ❑ Yes 1 Piece Tank: ElYes [] No h�. ', ., F, :, a F x r, , _ Pump Tank Manufacturer PT: Gallons: Dosing Volume: Date: Gal Certification #: RiserSealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ NO lnstaaer. Certification #: THS: Date: supply )Line Pie Size: inch diameter Installer: Pipe Length: feet Certification #: *Schedule: *EH S: Pressure Rated ❑ Yes ❑ No Date: ►pproved fittings ❑ Yes ❑ No Pump Type: Installer. Dosing Volume: — Gal Certification #: Draw Down: Inches THS: *Chau: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ No r+uvai statuses PVC Unions ElYes ❑ No © Approved'❑Dlsaproe� Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ No CDP File Number .191920 -1 County ID Number: Electric Equli)ment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ Na Certification #: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Alarm Audible ❑ Yes ❑ No Alarm Visible ❑ Yes ❑ No 2140 - Nations, Robert *Operation Permit completed by Authorized State Agenh, Date of Issue: 0 7/ 1 6/ a g 1 5 Owner/Applicant Signature: _ This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A"NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by.a TYPE It A. sewage Septic system. Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: WA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator. NIA Rule .1,961 requires that a Type IV and V septic systems designed fora hometbusiness owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operatorforthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator for the lire of the septic system. Rule, 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity priorto the issuance of an Operation Permit for system required to be maintained bya public or private management entity, unless the system owner and certified operator are the some. The contract shall require specific requirements for maintenance and operation,, `responsibilities of the owner and systems operator, provisions that the contract shall be in effect fores long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the bperation Permit that subsequentowners of the systems execute such a contract. @tHand Drawing Olmport Drawing **Site Plan/Drawing attached,** ` OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27428 Drawing Drawing Type: Operation Permit CDP File Number: 191920•-1 County File Number: Date: / ! Q Inch Scale: OBlock r-- 0 N/A II � -j-L] 7 � I i I i `- • CONSTRUCTION AUTHOR1ZA1I0N Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 0 3/ 1 7/ a 0 a 0 Applicant: RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive City. Greensboro State2ip: NC 27409 Phone #. (336) 978-7120 Address/Road M Essex Farm Road Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC r roperty Owner: RS Parker Homes/Joy Springer ddress: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone #: (336) 978-7120 on & Site information Subdivision: Essex Farm Rd Phase: Lot: 51 Directions Hwy 64 East, Left on Cornatzer Rd, on left past Beauchamp Rd Dana i rnf Q Minimum Trench Depth: a 4 Inches Site Classification: Provisionally Suitable Saprolite System? OYes @No Minimum Soil Cover 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a 7 5 Maximum Soil Cover. a 4 inches "System Classification/Description: 'Distribution Type: GRAVITY -SERIAL TYPE It A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons 'Proposed System: 25°/n REDUCTION 1 -Piece: OYes Q No Pump Required: OYes @No OMay Be Required Nitrification Field 1 7 4 5 Sq. ft. Pump Tank: Gallons No. Drain tines 4 1 -Piece: QYes ONo Total Trench Length;, 4 3 6 ft. GPM -vs— ft. TDH Trench Spacing: — 9 Inches O.C. 8Feet O.C. Dosing Volume: _ Gallons Trench Width: 3 Inches 2Feet _ . Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -11 Septic Tank Installer Grade, Required: 01011 0I11 01V Dana i rnf Q COP Fite Number 191920-1 County ID Number, [:] Open Pump System Sheet Repair System Required: @Yes ONO ONO, but has Available Space evair System Trench Spacing: ( Inches O. 9 t *Site Classification: Provisionally Suitable Inches O.C. Trench Width: 0 Inches rDesign Flow: 4 8 0 @ Feet Soil Application Rate:0 2 7 5 Aggregate Depth: inches Minimum Trench Depth: 2 4 Inches *System Classification/Description: TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. 1 2 Inches *Proposed System: 25% REDUCTION Maximum Trench Depth: 3 6 Inches Nitrification Field 1 7 4 5 Sq. ft. Maximum Soil Cover: .1 4 Inches No. Drain Lines 4 *Distribution Type: GRAVITY - SERIAL TotalTrench Length: 4 3 6 Pump Required: Oyes @No OMay Be Required Pre -Treatment: ONSF OTS -1 OTS -11 *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. "Permit Conditions The issuance of this permit by the Health Department in noway guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall bevalld for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be Issued at the same time the Improvement Permit Issued (NCGS 1130A-336(b)j If the Installation has not been completed during the period of validity of the Constvctlon Permit the Information submitted in theapplication fora permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installirtion, operation, maintenaric% monitoring, reporting and rquir Applicant/Legal Reps. Signature Required? Oyes ONO ApplicanVLegal Reps. Signature: Date: - / - / *Issued By: 7140 -Nations, Robert Date of Issue: 0 3 / 1 7 / 2 0 1 5 Authorized State Agent: Malfunction Log Oyes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 191920 -1 County File Number: Date: 03/17/2015 Q Inch Scale: QBlock ON/A 17 �TI t"kiI APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERn Davie County Environmental Health D P.O. Box 848/210 Hospital StreetDUN� , Mocksville, NC 27028 (336)753-6780/ Fax (336) 753-1680 Application For: Site Evaluation/Improvement Permit Authorization To Construct(ATC) ❑ Both Type of Application: kew System ❑Repair to Existing System ❑ Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed S ?0jituoom-e-s Contact Person J OLA Sp r i Billing Address 0 Home Phone J336 • TIE , % GCP City/State/ZIP C Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip FKUFLKIY INt'UKMAIIUN 'Date NOTE: A survey plat or site plan must accompany this application. Included:5 (Permit is lidfo 60 months with site plan, no expiration with complete Owner's Name KS 0n r KP r "Nnn—Os Owner's Address 6 j PropertyAddress LO Lot Size (5 Tax Subdivision Name(ifa plicable) Directions To Site: 1 S o corners r iaggea e Plan ❑Plat(to scale) t If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yesgo Does the site contain jurisdictional wetlands? ❑YesAre there any easements or right-of-ways on the site? ❑Yes Is the site subject to approval by another public agency? ❑Yes Will wastewater other than domestic sewage be generated? ❑Yes IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # B�at!lrooms Garden Tub/Whirlpool es ❑No Basement: ❑Yes o Basement Plumbing: ❑Yes�S,No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: N onventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type:xcounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? O Yes If yes, what type? ANO This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and 194ing angagging or staking the house/facility location, proposed well location and the location of any other amenities. I� 1 Site Revisit Charge ptoe own 's or owner legAl representative signature Client): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 I q 1 qw Account # Invoice # /W X003 G0u'°� R -I (,`•�,''K� jli/��;%1d��I�`%it�l�(�%!1, I j. r (1 s iii � � i \... / � C� FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Q r Davie County Environmental Health P.O. Box 848/210 Hospital Street 2 3 2001 Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 � Q4;F& ite Evaluatio mprovement Permit ❑ Authorization To Construct(ATC) ❑ Both E4 t ,ppllCa�ion: ystem ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility * * *IMPORTANT* * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT Name to be Billed ASC T 5a%, Contact Person %cRRY ,&r7-cc;Z Billing Address A.o . s"K 310 Home Phone City/State/ZIP _&'2g=a&d' -Ic- Z7oZ 8 Business Phone 7S/ - 7300 Name on Permit/ATC if Different than Mailing Address rKVrhK1 T ll I VIUVIA11VN 'Late House/racnity Uomers ria ea NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan lat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name ADSc d0,ne GoAffJ �i cif i�G Phone Number 7S/ - 7.3--10 Owner Address 40,4X City/State/Zip /t/oc[ c �icc.r /�G 17oZt3 Property Addr s City Lot Size Tax PIN# -ZZ S Subdivision Name(if annlicable) . Ess Fk --*A r _ Sectioo/Lot# iogg must be attkhed. If the answer to any of the following (uestionstis "yes", supporting documenta21 Are there any existing wastewater systems on the site? ❑Yes ❑1V� po Does the site contain jurisdictional wetlands? Dyes ❑ Are there any easements or right-of-ways on the site? Dies 0 N Is the site subject to approval by another public agency? Dyes 0� �4 Will wastewater other than domestic sewage be generated? Dyes C3'1`l0 IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms -6 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) . FOODSERVICE ONLY: # Seats Type system requested:, 6 -Conventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: O'County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? ❑ No This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pennit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating an ging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Prope rt -or o er's legal representa re Date(s): 7 Client Notification Date: Date EHS: Sign given Dyes ❑No Account # Revised 11/06 Invoice # -W3 DAVIE COUNTY HEALTH DEPARTMENT c Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004425 Tax PIN/EH #: 5870=b-ZZb0.*'r Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 51 Reference Name: Brad Coe Location/Address: Cornatzer Rd -27006 Proposed Facility:. Residence Property Size: 0.735 Ac. Date Evaluated: 9 — tS' ^cl' 7' Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit_ Cut FACTORS a 0 1 J 4 5 6 7 Landscape position 4— L• Slope % HORIZON I DEPTH O —q 14 D -- Ze 7 Cb— Texture group Consistence . P r P 'r i t Structure 5 8 Mineralogy 3 9- V HORIZON H DEPTH Texture group Consistence Structure Mineralogy HORIZONMI DEPTH Texture group Consistence C Structure _ Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 4. Lte LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: d` 7 REMARKS: EVALUATION BY: Qr\(', l i I t d Kf> 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 1►�fii�3i VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm M'a 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 votes 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 DC14D 05/05 (Revised) ti Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account #: 990004425 IMPROVEMENT PERTI`2OIN/EH #: 5870-64-2265.51 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 51 Address: PO Box 340 Location/Address: Cornatzer Rd -27006 City: Mocksville Property Size: 0.735 acre Reference Name: Brad Coe Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: gNew ❑Repair. ❑Expansion Permit Valid for: Q5 Years ❑No Expiration Residential Specifications: # Bedrooms_ # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): " y ou Type of Water Supply: VCounty/City ❑Well ❑CommunityWell AG stated in 15A NCAC 18A.19139(ei) Site Modifications/Permit Conditions: &=pted Slrstemc may n1 --,o he usi LTAR I Initial I I I Site Plan Let- L 05 c Environmental Health r� DLOo �1.Oa•3 Date 16 — «—,0 1