147 Pudding Ridge RoadDavie Countv. NC
Tax Parrs :l R Pnnrt
Thursday. December 29. 2016
WAKNING: THIS 1S NOT A SURVEY
Parcel Information
Parcel Number:
E50000001409
Township:
Farmington
NCPIN Number:
5841583226
Municipality:
Account Number:
75129250
Census Tract:
37059-802
Listed Owner 1:
VERNON DONALD G
Voting Precinct:
FARMINGTON
Mailing Address 1:
147 PUDDING RIDGE ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
7.579 AC PUDDING RIDGE RD
Fire Response District:
FARMINGTON
Assessed Acreage:
7.56
Elementary. School Zone:
PINEBROOK
Deed Date:
9/1996
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
001890911
Soil Types:
EnB
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
& Extra
Building Value:
FO eatulres Va ue:
Land Value:
Total Market Value:
Total Assessed Value:
101
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. All users of Davie Countys 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
NCor arlsing out of the use or Inability to use the GIS data provided by this webslte.
Davie County Healdi Department
9t1336rtc Environmental Healdi Section
P.O. Box 848
t?,�
Q210 Hospital Street ��
O U �� Courier k : 09-40-06 1011
Mocks%Ue, NC 27028
Phone: 13361 - 753-6780 Fac: (336) - 758-1680
ON ER CERTIFICATION
(Check ne).lReplacement etnodeling Reconnection
Name: / 0 N Phone Number
(Home)
- Mailing Address: `
L (Work)
1 7
Detailed Directions To Site:
Property Address:
Please Fill In The Following Information About The E)UST17V Facl-1}(ry� �% )
c1 WCL f. 5 "GiGt Facility:
Name System Installed Under: _Typety:
Date System Installed (Month/Date1Year): Number Of Bedrooms: Number Of People: o�
Is The Facility Currently Vacant? Yes No If Yes, For How Long?
Any Known Problems? Yes 6 / If Yes, Explain:
Please Fill In Th Following Information About The NEWFacUlty:
Type Of Facility: �PgiMOa e Number Of Bedrooms:--J�_Number of People
Pool Size: Garage Size: 30Other. ,,
Requested By:_)w � g A -0'K_ Date Requested:_{ 21
(Signature) 0
For Environmental Health Office Use Only
(Approved)Disapproved
� 07000AC
of I
Environmental Health Specialist Date: Z
The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order N Amount:$ Date:
Paid By: Received By:
Account N: Invoice N:
73,
94
60 a
rJ
h 7
-1' DAVIE COUNTY HEALTH DEPARTMENT
yam.--�
!. IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION 1
Permit - PU9 e 116-� 77�T
„=dame: Subdivision Name:
"'Directions.to property: Section: Lot:
v IMPROVEMENT v� f /
PERMIT Tax Office PIN:t) 7 l
Road Name: 6t 3 r •1 ` Zip: --� .
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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)
r . ` ***NOTICE*** THLS PERMIT LS SUBJECT TO REVOCATION IF SITE
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 ",7 # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE i # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY / /U DESIGN WASTEWATER FLOW (GPD) NEW SITE —L," REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE &M—GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �— LINEAR Fr. Q�
OTHER �3 ��� Z".4
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 J
I n0}% //� L SYSTEM INSTALLED BY:
(51
'rgc7B� �S�p f $
1i+l c%r;d61
D
/;Vrs 4,4 sexlol
11
axe/
AUTHORIZATION NO. l��---F--- OPERATION PERMIT BY: _J��/! DATE: 1/y) -y 7
"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)
s.
fi '(.. N'�Y tiY-�;•Auf .YT. i�-.�'jt Yy i�h-TI"i.J.Y^S (y j^,,=�;{Y ih ZV � ;..f - - .. .., ,
AUTHORIZ,�TION N0: Q 6,14 DAVIE COUNTY HEALTH,DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Permitte"e's P.O' Box 848 Zl� C� //ES �S774T
Name: Mocksville, NC 2702E Subdivision Name:
,� / Phone #: 704-63478760
Directions to property: ,,rJ �i/, Section: Lot:
L/ AUTHORIZATION FOR �/ r i req
WASTEWATER Tax Office PIN:#-,' Ie/
SYSTEM CONSTRUCTION
Road Name:A1 ci J t )t r, / 1 4ip: —
**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 l I 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 '
a� , roi'APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
' A Davie County Health Department -
�o�p`U r t>7 Q Environmental Health Section
P.O. Box 848 Q
j� Mocksville, NC 27028 " 31996 1,
t
6JQ� (704) 634-8760
L .-
8MRONMF.IIT L
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS
/THE REQUIRED INFORMATION IS PROVIDED. I
1. Name to be Billed o,-4 Uliz f`Nr c a Contact Person ton 1\1 V V tl
Mailing Address
03 e% o T e 1 tRK kd Home Phone ( jq
City/State/Zip I e V- C- Z l07 Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: [VSlta Evaluation [ ] Improvement Permit & ATC [ ] Both
4. System to Serve: [ Iouse [ ] Mobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People # Bedrooms # Bathrooms [ ishwasher
ashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
] Garbage Disposal
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: [t ] County/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes kJ/No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
r/p SUBMITTED WITH THIS APPLICATION.
Property. Dimensions. q, � / / - O`cRao WRITE DIRECTIONS (from Mocksville) TO PROPERTY -
Tax Office PIN: #
Property Address: Road Namey� �t —F F_/�r� P✓
City/ZipF1" _ter �5u�/���`r X'�tf�$ ;
If in Subdivision provide information, as follows:
Name:
Section: Lot #:
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 c duct all tes ' g proc u s as necessary to determine the site suitability.
DATE – SIGNATURE
Revised CHD - 66)
DAVIE COUNTY HEALTH DEPARTMENT
' . Environmental Health Section
• Soil/Site Evaluation
NAME /�lj�J��9�% DATE EVALUATED
ADDRESS PROPERTY SIZE D Ci
PROPOSED F'ACIILTY LOCATION OF SITE
Water Supply: On -Site Well _ Community Public l/
Evaluation By: Auger Boring c/ Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupL' L
Consistence
Structure i /t /
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: ,/lCO �? EVALUATED BY: ,"
LONG-TERM ACCEPTANCE RATE: OTHERS) PRESENT:
REMARKS: �3fJPl�ZP�!
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
Mi neraloey
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
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