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339 IJames Church Road Lot 13I Davie County, NC Tax Parcel Rennrt Wednesday, December 28, 2016 WARNUN T: TMS IS Nt)'1' A SURVEY Parcel Information Parcel Number: G3060B0013 Township: Mocksville NCPIN Number: 5820216228 Municipality: Account Number: 82512961 Census Tract: 37059-806 Listed Owner 1: MAXIE MICHAEL Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 339 IJAMES CHURCH ROAD Planning Jurisdiction: Davie County City• MOCKSVILLE Zoning Class: DAVIE COUNTY R -A CENTER WILLIAM R DAVIE NORTH DAVIE PcC2,CeB2 DAVIE COUNTY Is E01All 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. All 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 ail 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. State: NC Zoning Overlay: Zip Code: 270284823 Voluntary Ag. District: Legal Description: LOT 13 FOREST BROOK Fire Response District: Assessed Acreage: 0.80 Elementary School Zone: Deed Date: 8/1999 Middle School Zone: Deed Book / Page: 003100647 Soil Types: Plat Book: 0006 Flood Zone: Plat Page: 137 Watershed Overlay: Outbuilding 8r Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: CENTER WILLIAM R DAVIE NORTH DAVIE PcC2,CeB2 DAVIE COUNTY Is E01All 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. All 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 ail 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. 59 1A AUTHORIZATION NO: DAVIE COUNTY HEALTH DEPARTMENT (^ ��� Environmental Health'Section PROPER 4NFORMgTION' Permittee's P.O. Box 848 Name: Mocksville, NC 27028 Subdivision Name: 12S' Phone # 336-751-8760 DNretions o ropertt �V . AUTHORIZATION FOR Section: ... ,, . WASTEWATER SYSTEM CONSTRUCTION Tax PI111- t, Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by Davie County Environmental Health Section prior to issuance of any Building-Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections' Office when apply' g for Building Permits: (In comp fan apply* 1 of G.S. Chapter 130 W tewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ,. ENVIRON NTAL HEALTH SP IST DATE ISSUED 60 A DAVIE COUNTY HEALTH DEPARTMENT k - IMPROV ENT AND OPERATION PERMITS PROPERTY INFORMATION �Permittee`s� � �� � • hh1 lame: { 1'�` .t U�.l. Y 1 Subdivision Name Directions to property: (I� rj - Section: Lot: IMPROVEMENT PERMIT �i " .G L , f / •^ 1'T (�.4 rL t_:L(� :� Tax Office PIN:#` Road Name:—b, vUZip **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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 110 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) `,.-• y;' '°"""'--;� .***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE raw 1 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER . ki ENVIRON ENTAL EALTH SPECIALIST DATIOSSAD SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE t-Lj�t # BEDROOMS_ # BATHS,< # OCCUPANTS GARBAGE DISPOSAL: Yes o(5-to-\' COMMERCIIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No FI LOT SIZE A� �' kPE WATER SUPPLY'dk>'' / y DESIGNYWASTEWATER FLOW (GPD) NEW SITE REPAIR SITE /t �1 t SYSTEM SPECIFICATIONS: TANK SIZE 1�AL. PUMP TANK GAL. TRENCH WIDTH >�_ ROCK DEPTH 2 LINEAR FT.5 OTHER�TQr.Ii0TiOr- REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 `V LL ON ) 6 red, L"Ns, �+Y IMPROVEMENT PFUrrLAYOUT *AppROVED EFFLUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE* 4 ► -3 �/ yam' 41 Ste' '7ov5gO1 10 ` Nj ( /� 11 tA CIS' zo' **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (%4 X0* MX (336)751-8760 OPERATION PERMIT SYSTEM INSTALLED BY: 14 3f TL -j 1.-9 gel:" & codec AUTHORIZATION NO. t � OPERATION PERMIT BY: DATE: t0 "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT HE S M DESCR BE�VESBEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900"SEWAGE TREATME AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) ,APPUCAMON FOR SITE EHAUJAMON/IMPROVEMENT PERMIT I A1101 r Davie County Health Depatfinent O CAU- , Environmentallfealtfl SeWon P.O. Box 848/210 Hospital Street uA Mockaville, HC 27028 MAY 2 0 1999 (336) 751-8760 ***ZHFORTANr*** THIS APPLICATION CZM'tOr BE PROCESSED UNLESS XI,L THE tannin- 1 INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Same to be Billed fi)1c14&-Ly' CsrWW-f�1RAy�Contaet Person (,&z,--; n o,-,- Nailing 2 LnyprV� Nailing Address 9CC .rS0 7 - /�J 1D* ,6; N%CD Name Phone 4: o 9 /�-6 ! l S City/State/ZIP c� 1 H' ✓-Z G ' �AL�'. Zg snusiness Phone �O! - W a6 -O s /7 �%S Z. Name on Permit/ATC if Different than Above Nailing Address S. Application For: Ws"ite Evaluation City/State/Lip Improvement Permit/ATC moth a. system to service: W House 0 Mobile Home ❑ Business 0 Industry ❑ Other S. If Residence: # People 0 # Bedrooms # Bathrooms I/a2 Dishwasher O garbage Disposal 8/washing Machine O Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sinks # Commodes # Shovers # Urinals # Water Coolers IF rOODSERVICE: li Seats Estimated Water Usage (gallons per day) 7. Type of water supply: iy County/City 0 Well ❑ Commaunity e. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes Clio If yes, what type' *"IMPORTANT•" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: , .q_��. 60029,0015 .WRITEDIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 5 0 dQ -- C — " &0/ N Property Address: Road Name 3 3 9es Cd 1'c- la' ra / e 77 b n I J'Qme-S City/Zipmac 5VWE 27�8 CaU01-tic E0 0d If in a Subdivision provide information, as follows: Name: f�nR -P—e,+ A rook Section: Block: Lot: Date Property Flagged: �) / 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 irrarrred 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 suitabi ity. C, e DATE S ZD r SIGNATURE THIS AREA MAY BE USED FOR DRAWERG YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. Invoice No. ��2 ennett, et al ) PG 792 LEGEND Pipe ae �ipe ary 1 r, Center Line — Center Line EP— Edge of Pavement FC — Face of Curb PP — Power Pole ht Pole H n Hole — Radius U— Chord Distance 0 — Part of — Sight Easement DB — Deed Book PB — Plat Book CB — Catch Basin FP — �ence Post 14 FOREST BROOK 12 FOREST BROOK PB 6 PG 137 P: Point in Cl +/- of SR 1307 Tie Line N 09018'00"E 25.07' Ijames Church SR 1307 Road � o Vicinity Map (Not to Scale) Survey for: Michael L. Maxie and Xife Linda J. Maxie Lot 13 FOREST BROOK Plat Book 6 0 Page 137 0.861 Acres +/- by coordinate computation SCALE TOWNSHIP er Lie I declare that on , 19 � DATE BoC -�ack o� Curb � - 1 � COUNTY STATE we surveyed the property shown on 1" = 60' Colahaln Davie North Carolina 5-11-99 so 120 iso this plate SUR,,, Stone Land Surveying Company ,toe No. MT.BL _ G S6799 George Robert Stone, PLS L 3162 MAPPED: 113 Drum Lane Phone (336) 998-4733 MAP N0. FEETMAPPED: Mocksville, N.C. 27028 56799 I am .. r � ^. �M;l� �� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS lPt-���i �'�" • Davie County Health Department > ' Environmental Health Section P. O. Box 665 ! I 10 i 7 101), � J �, Mocksville, NO 27028 1. Application/Permit Requested B�yr ) e tt�n Mailing Address L� C�! I Y t (� c"a ( I ► C) C" �.� U 1 C Home Phone . D �'� Business Phone �. 2. Name on Permit if Different than Above _. 3. Application/Permit for: General Evaluation i 4. System to Serve:] House ❑ Mobile Home ❑ Business '❑\ Industry r01- e ❑ Oth r 5. If house, mobile home: Subdivision. * O 4 Lfttl�� COU1dTY �tL;,;_,r...'.11rry?•I !�:." t ❑ Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown ) 3 Section _ lot # / Basement/Plumbin ❑ g. i No. of People __ ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine f No. of Bathrooms ❑ Dishwasher j Dwelling Dimensions ❑ Garbage Disposal 6 If business indust lace of ublic assembl other: S ecif t pe rY. P P y. P y y No. of People.Served No. of Sinks _ No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private 8. Property Dimensions _ 'Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes It Una whit Iona? ❑ No '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 Pr�o%perty: `� V 01 U (jC C. --116 �- ( (: e-�— U This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges , I n urred from this application. DATE l SIGNATURE i CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE f!ESCRIBEP P O� PERTY MUST CHECK ONE: ❑ 1. I OWN the property. ff 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST 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 byt_pr 1 .. ^ Y'. _ L t_. to conduct all testing procedures as necessary to determine said site'. suitability for a ground absorption sewage treatment and disposal system. Dc1#ID t12 -90t ,TORE ❑ No '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 Pr�o%perty: `� V 01 U (jC C. --116 �- ( (: e-�— U This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges , I n urred from this application. DATE l SIGNATURE i CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE f!ESCRIBEP P O� PERTY MUST CHECK ONE: ❑ 1. I OWN the property. ff 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST 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 byt_pr 1 .. ^ Y'. _ L t_. to conduct all testing procedures as necessary to determine said site'. suitability for a ground absorption sewage treatment and disposal system. Dc1#ID t12 -90t ,TORE DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �Ufi Soil/Site Evaluation , V S NAME \, . �. ���\} DATE EVALUATED - /'4Q ADDRESS PROPERTY SIZE �D ' )Q5 751' PROPOSED FACIILTY d9-- LOCATION `OF SITE Water Supply: On -Site Well _ Comm uni Public Evaluation By:Okj1 Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z S HORIZON I DEPTH 1�y Texture group1. Consistence Structure Mineralogy��► HORIZON II DEPTH Texture groupC Consistence Structure Mineralogy 4 HORIZON III DEPTH Texture grou2 Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON --• SAPROLITE --- �. CLASSIFICATION , LONG-TERM ACCEPTANCE RATE 6 SITE CLASSIFICATION: - .ISEVALUATED BY: LONG-TERM ACCEPTANCE RATE:: "LA OTHER(S) PRESENT: (Fs� REMARKS: �al`�. �t ,\ %,,&& I' LEGEND - Landscape Position R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace 'EFP-Flood plain H -Head slope _Texture S -Sand LS -Loamy sand SL-Sandy,loam .r •L -Loam SI -Silt SICL-Silty -;lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V=:. -y 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 .3C --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(01-901 w ■■■■.■■■■■■E■■..■.■■......■■■■■■■■■..■..■■.....■■�■..■■■■■ ■■■MM.■ ■.■.....■■■.■......■.■..�\�■_■��■ ■■MEMEMM.MME■■...■■■■.■.■.■■■■■■ MEN M MIEN ■■■...■....■.■.■■.■...........■■■.■...■■■■■■■■■■■ MM■M■MMMMM■■MMM■ ■.■■■.■■■■■...■■■■.■■.■■■■■■■.. ■MM■MMM■..■■.■..■.■.■■■■.■■■.■.■ ■■........■/...■....■....■.■.■■ SOME■■MN■■■..■■■■■■■■■.■■■■.■.■ ■■■■...■..■.........■■......■.■■■■■■■■■■■■■■.■■ ME_ ■■.■■■■■■■■■■■ .............■.................... ...■...■BMNMMM■.�..... 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