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431 IJames Church Road Lot 19Davie Countv. NC Tax Parcel Rennrt Wednesday, December 28, 2016 WARNING: '1711515 NUT A SURVEY Parcel Information Parcel Number: G3060B0019 Township: Mocksville NCPIN Number: 5820114451 Municipality: Account Number: 8303794 Census Tract: 37059-806 Listed Owner 1: SHEPHERD SANDRA S Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: PO BOX 353 Planning Jurisdiction: Davie County City: CLEMMONS Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27012 Voluntary Ag. District: No Legal Description: LOT 19 FOREST BROOK Fire Response District: CENTER Assessed Acreage: 0.72 Elementary School Zone: WILLIAM R DAVIE Deed Date: 712014 Middle School Zone: NORTH DAVIE Deed Book / Page: 009630036 Soil Types: CeB2 Plat Book: 0006 Flood Zone: Plat Page: 138 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: QED All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to theDavie 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 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. k i+ a- +f iN{'� C RAS; '',,f. 'r '� N A b.., r=,..•�ah'�r... ';n oaf 4;.., •r•^w{v:. +tS •S•t'x� . .,,fit ,p• . , ''� 'j� O +., .AUTHdRIZATION NO: 0997 DAVIE COUNTY HEALTH DEPARTMENT "• b: Environmental Health Section PROPERTY INFORMATION Perm}t[_e�e's ,.►�' � P.O. Box 848 Name: �, ' 1 4� + Mocksville, NC 27028 Subdivision Name: Phone #: 704-634-8760 Directions to property: %'t a' Section: Lot: AUTHORIZATION FOR - WASTEWATER Tax Office PIN:# F� SYSTEM CONSTRUCTION Road Name:. 4.. ! C� Y?1 E'er `. '1 Zip: �"� 0 **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the 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 applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �4�,y,..�`NM¢yr.+-.-.•f•' � :H.ti+.w * ,..-r's• '�ty.ea'=5: W s.i -�.'n S' n..: .( ,, r(^*.. . _ , ». , a + .-.. _ . .. .. ... .. ,Y, �.s a ;.w.i K wa P rry 1 k' 1.., rr•`!+ t. 00, DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION -Perm's- -_Name: Subdivision Name: Direciionrto property: ' . r " i Section: Lot: ' IMPROVEMENT PERMIT Tax Office PIN:#Q � - Road Name: e.5 (� 3 Zip: **NOTE** This Improvement Permit DOES NOT authorize the constriction 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. M compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ✓ ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ''X r' % PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS _ # OCCUPANTS r GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY �Q_ DESIGN WASTEWATER FLOW (GPD) NEW SITE—j!!:`_ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 4,L94,GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fr. -'?liU OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: **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 (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: - w AUTHORIZATION NO. 7 OPERATION PERMIT BY: ,�e� DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. ✓l. Name to be Billed & rdaSo2 N'- ", JeL- Mailing Address t,"W y�f v City/State/Zip i' lyc-690/ 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [ ] Site Evaluation -O'Contact Person r/ Home Phone Business // City/State/Zip [fi]'Improvement Permit & ATC [ ] Both - 4. System to Serve: House [KMobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People --.1— # Bedroom!K # Bathrooms V ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ J Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: LA"C"ounty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AXMVCOF THE PROPERTY MUST BE �i SUBMITTED WITH T APPLICATION. Property Dimensions: ��' ��� WRITE DIRECTIONS (from Tr TO PROPERTY: Tax Office PIN: # -- �� - =�' rCAl c'=;� Property Address: Road Name :Zqi 'dr Gil City/Zip ; If in Subdivision provide information, as follows: Name: Section: Lot #• I� 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 DATE SIGNATURE Revised DCHD (06-96) THIS AI?EA MAY 13E USED F011 DRAWINC7 JOU1t SITE PLAN: procedures as necessary to determine the site suitability. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PEIHIf� •c,•-� Davie County Health Department ! Environmental Health Section P. O. Box 665i NW 1 7 1 5 Mocksville, NC 27028 J 1. Application/Permit Requested By �> Y -, Q. 1 �� Mailing Address C! 0. I 5 U I Home Phone `t . a " �'� Business Phone 2. Name on Permit it Different than Above DAVIE COUNTY rii.i:i.?.1 [l� 3. Application/Permit for: General Evaluation 4. System to Serve: House ❑Mobile Home ❑ Business ❑ Industry, �oRe ❑ Oth r 5. It house, mobile home: Subdivision 0,(3 r No. of People _ No. of Bedrooms No. of Bathrooms _ Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of Peopie.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: IB' Public ❑ Private 8. Property Dimensions _ -Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If vac what Iona? ❑ Septic Tank Installation I 1; ❑ Place of Public Assembly 44 i` ❑ Uhknown Section _ Lot # ❑ Basement/Plumbing. gg ❑ Basement/No Plumbing ❑ Washing Machine { ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ 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 Property: cit C >act 0!thCC 11 6t 1 V)e_.eAy.0 �ecI -lei L 1 �►✓ /r/cvurr,�iJ��rr - .l�2-oce, G�Izc�' I w This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for an charges intjurred from this application. DATE �SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBEP P Off, PERTY Laond ECK ONE: ❑ 1. 1 OWN the property. 22. I DO NOT OWN the property. cked Box #2, the rest of this form Q5_1 be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Qavie County Health Department to enter upon above described cated in Davie County and owned by �� • > f�, �` ^ r _.� t all testing procedures as necessary to etermine said site'A suitability for a ground absorption sewage treatment al system. �—DATE—`E DCII0(12.90) DAVIE COUNTY HEALTH DEPARTMENT j Environmental Health Section �(st r Soil/Site Evaluation c� NAME �• _ Sy$e`r\ DATE EVALUATED I I� a��- h� ADDRESS IN `Cn s. PROPERTY SIZE PROPOSED FACIILTY'9 LOCATION OF SITE Water Supply: On -Site Well _ Community Public V Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 Landscape position :57 - Slope R 'Ib HORIZON I DEPTH Texture groupL Consistence I Structure C Mineralogy HORIZON II DEPTH Texture group Consistence t - Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE — CLASSIFICATION,g- E7�..E LONG-TERM ACCEPTANCE RATE .14 1 1 SITE CLASSIFICATION: '-�>' EVALUATED BY: LDNG-TER�AC�C,EPTANCE RATE: '� OTHER(S) PRESENT: N REMARKS: \m7� '�'\ a.� �s9► 1=�. d LEGEND Landscave 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 :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 c ■.■■■■■■■■.■■■II\161■�J■1\■■G!]■■■.■■. ■■■■■■.■■■�■■■■■■■■■■■■■■■■■■■■■ ■!■.■!■■■■■■■■■.■�/■■■■■■■..!■■.■■■■■■■■■■. .MEMO■■■ ■■■■■.■...■■■ ■.■■■.■■■/■■■■■■■■■■■■■■■.■/■■■.■■■■■■■■ ■E■ 10.1 ■■■■■■■.■■■■■■■■■/■■.■■■■■■■■■Hm■■■EE■...■■..............■■■..■■ MEMMEMMEMMEMOM EMS MEEMMUMMIN MEiiiiiiiiiaiiiiiiiiiiiiiiiiiiiiiiii=i'■� MMOMMEN iEiii'i=iii■ii'i'i�=iWiii'ii ..............................................■...CMC■.......� .._ ■■■■■■■N■■■■■■.■■.■■.■N.■.■■■M�■■■■■NN�■■■NEH■■■■■Ee■■■�MEN ■■■■■■■■N■■■■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■■H■�� MES= MEMNON EM■ON ■■..■.■■■■.■■.■.■.■...■...■.!■!..■■■.■■.■■..■.■ ■ ■N■■..e■I ......................................... 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