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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 ■■.■.■■■■■■■■■■■■.■■■■■■..■■■■■■ ■■■..■■■■■■■■■■■■.■■■.■■■■■ ■■■ ■■..■■..■..■...■..■....■...■■■.. .......��.�...■■.■..■■■■.■.■■■EN ■■■■■■■.■...■■■.■■■■■■■■■..■■■■■■..■.■■■. ■ ■MMEM■EM■.■■.■■■.■.■■ ■■■■■.■■....■■....■..■■■....■■..■..■■■.■■■■■■■■■■.■■■■■■■■■■■■.■■■ ■■.■■■.■■■■■..■...■■■.■■■..■■.■■...■■.■....■■.■■..■■■■■..■■■■■■■/■ .......................................... ........�...■....■■NEM .................................................... 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