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125 Fernhaven Lane Lot 3Davie County, NC I Tax Parcel Report Wednesday, December 28, 2016 WARNING: TIMS 1S NOT A SURVEY Parcel Information Parcel Number: E60000002403 Township: Farmington NCPIN Number: 5851824803 Municipality: Account Number: 82527693 Census Tract: 37059-803 Listed Owner 1: KHAN YAHSSAIN Voting Precinct: SMITH GROVE Mailing Address 1: 125 FERNHAVEN LANE Planning Jurisdiction: Davie County City: MOCKSVILLE 2/2007 Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 3 RICHARD SHORT PROP Fire Response District: SMITH GROVE Assessed Acreage: 0.84 Elementary School Zone: PINEBROOK Deed Date: 2/2007 Middle School Zone: NORTH DAVIE Deed Book / Page: 007020036 Soil Types: MrB2,MsC Plat Book: 0008 Flood Zone: Plat Page: 058 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. Ali 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 dalms or causes of action due to wpb p S, NC or arising out of the use or Inability to use the GIS data provided by this website. 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 ***IM$ii THIS ICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFOR 24-.11 ROVIDED///. CRefer to the INFORMATION BULLETIN for 'instructions. 1. Name to be Billed �` t C. -. ccs rtS /1 n r'�11 Contact Person Mailing Address i�.5 rarm,t/ dzn) V Home Phone City/State/ZIP Mbr_)68Idl� /UL Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: DA`ite Evaluation ❑ Improvement Permit/ATC ❑ Both P1061(0— OZAN4f 4. System to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry U-6ther eel dr 5. If Residence: # People # Bedrooms_ # Bathrooms 1761shwasher ❑ Garbage Disposal Washing Machine 11 Basement/Plumbing II 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 s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Clio If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 11 A3 (AL WRITE DIRECTIONS (from Mocksville) to PROPER'T'Y: l Tax Office PIN: #S`d ' 1 $ �- (p7 �8' b 3 I n ca ill I (r) e, S �- Property Address: Road Name MU)LI b k V ) �l { f City/Zip 0rt, O-er- 1_ GAJ If in a Subdivision provide information, as follows: 1.34 h re'l I e'�.- T(f S Name: Fb,+e jr Section: Block: Lot: Date Property Flagged: cjP-a -ed (rA, ' per Me? This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) 0 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. 1, also, understand that I ani responsible for all charges incurred front this application. 1, hereby, give consent to the Authorized Representative of the Qavie County Flealt rDepartnuut to enter upon above described property located in Davie County and owned by ,ice lues•}' Fbet- _ to conduct all testing procedures as necessary to determine the site s -it . DATESIGNATURE �. 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). ;NC,I L,dd S ' map I N C- WQaC, Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. 10& 1 ( Y Ix� x 108. 16' 108. 16 .41 11 QZ s h y 90 .� So oCO � °h °h 03 R-3 R-4 w N. 63 085' , l4 yy 46 16-58 Q h ,LICANT INFORMATION Account #: 990001288 4,1, Billed To: Richard Short Reference Name: i� Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5851-82-6728.03 Subdivision Info: Location/Address: Highway 158-27028 Property Size: see map Date Evaluated: �? !� O Water Supply: On -Site Well • Community Evaluation By: Auger Boring Pit Public y4� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH - - Texture groupL - Consistence Structure G Mineralogy HORIZON II DEPTH Texture group Consistence 7, Structure Mineralogy1 HORIZON III DEPTH - Texture group Consistence Structure t. Mineralogy HORIZON IV DEPTH Texture group7 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: �• REMARKS: EVALUATION BY: A '- OTHER(S) OTHERS) 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 oiA VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm We 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) - DAVIE COUNTY HEALTH DEPARTMENT Y Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900057 Tax PIN/EH #: 5851-82-4803.03 Billed To: Randy Grubb Subdivision Info: Richard Short Divis. Lot # 3 Reference Name: Location/Address: Fernhaven Dr -27028 Proposed Facility Residence Property Size: 1 ac. ATC Number: 4498 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 WASTEWATER CON TRU TION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: o CER FICA'PI& OMPLETION **NOTE** The issuance of this Certificate of ompleti al* i e he system described on I provement/Operation Permit has been installed in compliance 'th Article G. h 130A, Section .1900 ` Sewage Treatment and Disposal Systems," but shall ij N ' WAY be tak a that the system will ction satisfactorily for any given period of time. �J Jj ? J � cv '• 1 3 1 Septic System Installed By: �t) I •a !n Environmental Health Specialist's Signature: ate: I DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 f IMPROVEMENT/OPERATION PERMIT Account #: 989900057 Tax PIN/EH #: 5851-82-4803.03 Billed To: Randy Grubb Subdivision Info: Richard Short Divis. Lot # 3 Reference Name: Location/Address: Fernhaven Dr -27028 Proposed Facility Residence Property Size: 1 ac. ATC Number: 4498 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 L- #Baths Dishwasher: Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine:;a Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size3�pe Water Supply Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size IadbGAL. Pump Tank GAL. Trench Width ITI? 'Rock Depth Linear Ft. Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PE MIT LAYOU' FINISHED GRADE. ****NOTICE: 1contact a reprc system between 8:30 a.m. to 9:30 a.m. 1:00 P.M. to 1 F Systems may also be ROVED EFFLUENT FI TER RISER(S) IF 6 " BELOW of the Davie County Heal h Department for final inspection of this on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: �G Date: DCHD 05/99 (Revised) DIE F SEP 1 3 2006 I ENVIRONMENTAL HEALTH DAVIE COUNTY 01,3 4(0L EVALUATION/IMPROVEMENT PERMIT & ATC avie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax 336)751-8786 Application For: ❑ Site Evaluation/Improvement Permit Authorization To Construct(ATC) ❑ Both ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed —✓,/wb Contact Person Billing Address Home Phone City/State/ZIP /o' 7- V Business Phone — !R'9191 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey'plat or site plan must accompany this application. (Permit is valid for_60 mouths with site plan, no expiration with Ampl�t_e play) Street Address 7 f-rrhy h i q� 17rxs , e- Tax PIN# Subdivision Name&e ,e x ion/Lot# 3 Lot Size l c r 1 Directigps/To Site: ; �w ��Oyt �fr`j c ✓%�/ , (-C-/— cr,-r1,-104- Date f Date House/Facility Corners,,Flagged — / —(, 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? ❑Yes BNo Does the site contain jurisdictional wetlands? ❑Yes fff�o Are there any easements or right-of-ways on the site? Dyes e< Is the site subject to approval by another public agency? Dyes CdNo Will wastewater other than domestic sewage be generated? Dyes C to IF RESIDENCE FILL OUT THE BOX BELOW # People# Bedrooms 3_ # Bathrooms 3 Garden Tub/Whirlpool es ❑No Basement: es ❑No Basement Plumbing: ❑Yes oflo 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: ❑Conventional ❑Accepted ❑Innovative ❑Alternative /'Other Syt Water Supply Type: WCounty/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? M 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 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 understand that I am responsible for all charges incurred from this application. 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 on the above described property located in Davie Cou ty and owned by Site Revisit Charge rope owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given Dyes ❑No Account # 40 , CM00 7 Revised 2/06 Invoice # — ' APPLICATION FOR SITE EVALUATION/ IMPROVEMENT PERMI Davie County Health Department Environmental Health Section SEP 2 9 2005 P.O. Box 848/210 Hospital Stroot Mocksvilla, NC 27028 (336) 751-8760 ENVIRONMENTAL W" DAVIE COUNTY ***XIJPORTANT*** TIIIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORi•IATION IS PROVIDED. Refer to the INFOR11ATION BULLETIN for inatructiona. 1. Name to be Dilled Mailing Address l City/S tato/ZIP�� Ji / 1�(a 7 -707 -9 - Contact %0Za 2. Name on Permit/ATC if Different than Above Contact Person Itome Phone LY R 7C- < // Business Phone ac - O %( Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATCl'J Doth A. System to service: YJ I2,nvontional El Mobile Home ❑ Business 11 Indus try' 13 Other S. Typo system requested: ❑ convontional modified ❑ innovative MacCepted 6. ,IfResidence: it People It Bedrooms 3 0Bathrooms 21 -Dishwasher ❑Garbago Disposal Mashing Machine [basement/Plumbing dDasement/Iio Plumbing 7. If Dusineen/Industry /Other: verify type 0 People tt Sinks N Commodes 0 Showers tt urinals tt Water Coolers IF FOODSERVICE: It Seats G. Typo of wator supply: l�County/City Estimated Water Usage (gallons par day) ❑ Well ❑ Community 9. Do you anticipate additions or expansions of tlhe facility this systen, is intended to serve? ❑ Yes 0 No If yes, what type? ***Il1fPOR7' 1N7-** CLILNTS AIUST COAlPLETE THE REQUIRED PROPERTY INFORMATION ItEQUEST ED nELOR'. Either n PLAT or SITE PLAN AtU.ST RESUBMITTED by the client with TI ITS APPLICATION. t t Property Dimensions: _100 �l 3n0 Tax Office PIN: ii ,��/ �C,2 �4 Flf�o� )16 Property Address: Road Name Fcrh h -fle.7 �rl. City/Zip ac&A-C od WRITE DIRECTIONS ((fyfroit Mockwille) to PROPERTY: S If in a Subdivision provide information, as follows: Name: Section: cratalock: Lot:_ Date ]Ionic corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernhit(s) Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if lie infornhalion submitted iu (his application is falsified or changed. I, also, understand that I ani responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth Deparhnent to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 9` 2� t75 SIGNATURE 5e..�i,� TIIIS AREA MAY BE USED FOR DRAINVING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and.dimensions, structures, setbacks, and septic locations). Sign given Itevised DCIID (05/03 Site Revisit Charge Date(s): Client Notification Date: MIS: ,Account No. Invoice No. - DAVIE COUNTY HEALTH DEPARTMENT • - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001288 Billed To: Richard Short Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5851-82-6728.03 Subdivision Info: Location/Address: Highway 158-27028 Property Size: see map Date Evaluated: '1 // O Water Supply: Evaluation By: On -Site Well Auger Boring Community Pit Public � Cut Sloe % FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture groupL< Consistence SS Structure Mineralogy HORIZON II DEPTH '60 Pf Texture group Consistence GF Structure Mineralogy1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Z Texture group Consistence64 Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE -0.' 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 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 tructure 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)