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133 Fernhaven Lane Lot 4V Davie County, NC Tax Parcel Report Wednesday. December 28. 2016 WA"1LN T: TMS 1S 1VUT A SURVEY Parcel Information Parcel Number: E60000002404 Township: Farmington NCPIN Number: 5851824871 Municipality: Account Number: 82530131 Census Tract: 37059-803 Listed Owner 1: MACKIE RUSSELL KEITH Voting Precinct: SMITH GROVE Mailing Address 1: 133 FERNHAVEN LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 4 RICHARD SHORT PROP Fire Response District: SMITH GROVE Assessed Acreage: 0.91 Elementary School Zone: PINEBROOK Deed Date: 9/2008 Middle School Zone: NORTH DAVIE Deed Book I Page: 007710473 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, Implled wanan es of merchantability or fitness for a particular use. All users of Davie County's GIS webstte 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 NC or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT ,f Environmental Health Section Soil/Site Evaluation Account #: 990001288 ' Billed To: Richard Short Reference Name: ' Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5851-82-67?8.04 Subdivision Info: Location/Address: Highway 158-27028 Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % 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: V✓ LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: LEGEND Landscape Position R - Ridge S 7 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 ow VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremel firm DAVTE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900057 Tax PIN/EH #: 5851-82-4871 Billed To: Randy Grubb Subdivision Info: Fam.Div R. Short Lot # 04 Reference Name: Location/Address: Fernhaven Dr -27028 Proposed Facility Residence Property Size: see map ATC Number: 4033 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 CO N IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa Date: J 1i CERTIFICATE OF COMPLETION lq .% *I OTE** 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. 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as arggtan at the system will function satisfactorily for any given period of time. \\ Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) a IA;J D Y nn t t_ L k-2 Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT 989900057 Tax PIN/EH M 5851-82-4871 Randy Grubb Subdivision Info: Fam.Div R. Short Lot # 04 Location/Address: Fernhaven Dr -27028 Residence Property Size: see map ATC Number: 4033 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of aseptic 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 OOZE #People #Bedrooms #Baths Dishwasher: [Z'— Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ��}�i eType Water Supplyo'L*4 I T� Design Wastewater Flow (GPD) Site: New 0"' Repair ❑ p r System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width 3(� Rock Depth t2 Linear Ft. 4 CO . Other: S �tSTelf? i l�`)►J `7K�^ Required Site Modifications/Conditions: 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 DCHD 05/99 (Revised) Date: d� ; • LSU V APPLICATION FOR SITE EVALUATION/Ih1PROVEh1ENT PERMIT Davie County Health Department Environmenta/Health Section 2 3 2005 rENVIRONMENTAL P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 H ETM ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1 i 1. Name to be Billed -?7—i/I/✓J Contact Person m rl t Mailing Address Home Phone � `s City/State/ZIP /.' U ?3 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 11S' a Evaluation I3 Improvement Permit/ATC [3 Both 4. System to Service: L-7 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: Lr Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms_ # Bathrooms lJDishwasher ❑Garbage Disposal ER/Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. I£ Business/Industry /other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: 0/county/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended taserve? ❑ Yes M No , If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS (from Moclisville) to PROPERTY: Tax Office PIN: # � �' [� ZqS71 X/C 14 Property Address: Road Name Ee-- vtd�h �n m d /e 95City/Zip dr 'S /lr �I 7G�1 %Y I c� i'n r/tri' f" 2117 If in a Subdivision provide information, as follows: Name: ��l� .-��s�t el- / % -ry►,' �/ b ��f ✓iS i �� Section: Block: Lot: q Date home corners flagged: 3 = 0-N 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 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,the site suit PIPY. DATE �" �� `�� S SIGNATURE TI11S AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclua all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge . Datc(s): Sign given Revised DCHD (05/03 Client Notification Date: EIIS: Account No. C A'9 % ,pa o�7 Invoice No. YNo �� .. • ' � ' ��,/ \ �{ � � ; Y 1 is - .. . 1011 SITE-EVALUATION/lh1PJiUV1111PNI 1,L- 1i111T Si ll'I•C bavie County Health Department a ' 'g 2004 Enyironuienta%/ea/1YiSection 1?. Dox 898,/210 Hospital Streetc, I•iock3ville, NC 27028 nnWWAtH�� r (336) 751-81760 � pAVIECA�� ; * * *.* S ALL TIIE REQUIRED INFO RMATION rIt PROVIDiEDP�In4'kbrrNtoALho�INF6hhi4ATIOiT BULLEA; for inStruct;ionB 3 1. Hama to be Dinedo, Contact P6. Mon Hailing Addrea / 0 L% / �+'�' 110111Cltlibnc Ouainass PlslaCity/State/ZIP 33 / q/0 SWI 6/L 2. llama on Parmit/ATC if DiffaranL thaA Above Hailing Address -: Ci tyISCaCa/Zip Grp J. Application Fort 11Site EValuat:ion '0 /Ymprovement 02. iii ❑ I)oL11 4 system to Servicer (House ❑ 24oi�ile Home ❑ DUsinebs ❑..industry ❑ Other 5. Type system requaated: Convantiorih1 ❑ canvantional modified El innovative lid G. If Residence. It People 8 Bcdro6m6 It Dathroolu.; `"' 3�5iahwasher • Cldarbage Disposal L7Flaahing Michihc ❑Basement/I'lwii' Ing ❑Dazemcnt/No Plumbing 7 If Duaiaeas/Industry Verify typo /Other: tl Paopla fI'Sinka Commodaa tE ShdWera1E Urin" Q.1Vatcr Coolers IF FOODSERVICE 6,• t)_SSeat:s hhtinlzit6C1 Water Uaag(~ .(gallons per day) s. Type of water auppiy: Fk Count$!/C Ej, Well ❑ Colmnunity S. Do you anticipate. hdditions or ekpallSioas or the rheility this S sttllli is il1te11ilc.ii tU serve: ❑ Yes a, u irycs, what type? ***LIIP0RTWN', ***CLIENTSkUST.tomjLLY'L A-iL- /t13QUh6 DPRO1'LIt1YINFORMATION REQl11,STE'0 ^I BELOW. Elthel ,a PLAT orSlTE I'Lr11Y� VUSTIICSUhNITTL:D liy the tlicnt iutli THIS APPLICATION. J Property Dimeilsiolls7 'DIM (Cron] 1lludsv llc) to l'1tU!'lilt'1'1': Tax 0Mice PIN: fE -� Ife • �:�' =(��_ Property Address: 110 id Nalnc� 4 CItyIZip j Irin a Subdivision provld,e information, hs follolvs: h1a111c' 1 0 Section; Blocic: Lot! _ Date 1lbnlc corrlcls !]rigged: - Y This is to certify that tile. 1hrohnation provided is correct to the Gest of illy ici1611•Icdge I it iderstalld that any llerillit(s) ' issued Ilcrcaftcr are subject to suspcllsioDor rcvbcatioll, if tilc`sitc plans or.iutended usd eii:ulge, or it ti,e iurol•ivation S in this applicatloit is Lllsilicd or chaN6Cd. I, alio, rrirderstdhil ]Iia! 1 uln re lioRS�IOIL' jur rill clrrub'c's iacru rrr/ %ruin !Iris uppllcariurr. I, hereby, give consent to tie Aelthorized Rcptreseu'talivc of the ll:n'ic Cltiiiily IIealth 1)cp:u tulcut to enter 811)011 above desc-lOdd property lo'hicd Iii Davie Comily and ii lviicd bj' _ to Conduct all testing proidcdili'es as IIecess:0Y to determine ti1C Sill` suitabili( ' ~ DATE SIGhIATUItL -1' THIS AREA MAY 1311; USED rOR DRAW G FOUR SITI•; PLAN"(Tliclildc all of the dyin g: Lxistitig aiid proposed property lines and dimensioiis, structures, sctbacics, and septic locations). Site Revisit Cllarl;c Datc(s)1 Client Notification Date: lis -z-;-, SiSn given Ac,countNo. Rcrisrd Tirvin mr-IA-z AUG � 2001 t TAl HEA�� IS PROVIDED. IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department ,o Environmenta/Health Section t Y tD P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 211111 cSA L f+1 n Contact Person Mailing Address /,-3,(ra r%- J.'Jci1"L') fU / Home Phone 9 / � 7Q •�- r \) City/State/ZIP _ b JCA6)We- A)CJ 11-2 hl)- Business Phone W3-2g1k 2 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: DA/Ite Evaluation ❑ Improvemfent Permit/ATC fl Both �� 4. System to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry U, ther 5. If Residence: # People # Bedrooms -- # Bathrooms lybishwasher ❑ Garbage Disposal Washing Machine I:.I Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well L.I Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes VIKO If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 11 A3 to G Tax Office PIN: # -sc�'E i "'S �L ` •0 1 Property Address: Road Name MWU lS City/Zip lqu -J V) /,�, If in a Subdivision provide information, as follows: Name: Section: Block: Lot: y WRITE DIRECTIONS (from Mocksvillc) to PROPERTY: l c► Iax 3�� v►� I0 rs'-�- �� ae b ria k T)6 `) v •e Or6o-er4 4 1S bM 'fizz t'51��- �.� rer 1 es -4r,4 -c s �5 ),) rbs+e r Date Property Flagged: e-1r-a(P44 FI <-�-izC �L� Ivice 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 Q.1vie County 1-Iealt i Department to enter upon above described property located in Davie County and owned by e hat's'{- Fe' f er to conduct all testing procedures as necessary to determine the site s it . DATE &6 -6 / SIGNATURE C� 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). /q ap ►N c.l N dJ SSII MOP INS 1J10J Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No.. /,;)L.8 d 1 Invoice No. SzW� APPLICANT INFORMATION Account #: 990001288 Billed To: Richard Short Reference Name: Proposed Facility: Residence Water Supply: On -Site Well DAVIE COUN'T'Y HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5851-82-6728.04 Subdivision Info: Location/Address: Highway 158-27028 Property Size: see map Date Evaluated: 103 Community Evaluation By: Auger Boring Pit cri 'AAL 6'4 � _.. Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L t. Sloe % 2c HORIZON I DEPTH p � � Texture groupCom, Consistence Structure MineralogyMG HORIZON II DEPTH !� Texture groupL' . Consistence Structure AEk Mineralogy IVB HORIZON III DEPTH Texture group Consistence Structure Mineralogyhit HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: VS f � At P4T_>f 4t EVALUATION BY: J% jJ t.,T LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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) =BAR SET REBAR SET .a 01. ! J J` REBAR SET Co _1 _R -20 R -A 5,18* REBAR SET rn WA 058,113 "W 382.34' 324.70' (,�,p Qt 518" REBAR SET S 31 058'1 3 "W 413.98' 330.53' "W" �o Q� 5i8" REBAR SET 'm t � S 31.058'13 "W 445.63' 365.63' gib" REBAR S S 31