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111 Brier Creek Road Lot 1f Davie County, NC Tax Parcel Report Friday, December 30, 2016 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: WARNING: T111S 1S NOTA SURVEY Parcel Information H70000006406 Township: Shady Grove j 5779077361 Municipality: 60109340 Census Tract: 37059-804 REED SCOTT DAVID Voting Precinct: WEST SHADY GROVE 111 BRIER CREEK ROAD Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC Zoning Overlay: 27006-0000 Voluntary Ag. District: No 1.013 AC FORK BIXBY RD LOT 1 Fire Response District: ADVANCE 0.94 Elementary School Zone: SHADY GROVE 3/1996 Middle School Zone: WILLIAM ELLIS 001860056 Soil Types: GnB2 0006 Flood Zone: 119 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: All data Is provided as Is without warranty or guarantee of any kind 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& GIS webs@e 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 r'pUN.t� NC or arising out of the use or Inability to use the GIS data provided by this website. i �.doa �+ DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT -IMPROVEMENT PERMIT **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 11 of 6.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) / Avo& NAPE y �n �� // PROPERTY ADDRESS A,191 R P_ C-6 f` DATE LOCATION / r� k a / - � / // "al ^./ SUBDIVISION NAME LOT NUMBER SEC. /BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS s_ # BATHS _.2_ # OCCUPANTS �? GARBAGE DISPOSAL: Yes ( o COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE /% TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) .__� NEW SITE 1 / REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ZfI2 GAL. PUMP TAW GAL. TRENCH WIDTH ?/ ' ROCK DEPTH / "` LINEAR FT. _Fr. o OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST, SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **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 " TEMM_4N D BY 7S /� Ho Q's Q, AUTHORIZATION NO. 0 13 L0 OPERATION PERMIT BY DATE I 0 ` !S — � **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 136A, 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 10/95 Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of _G.S. Chapter 1 A; Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davjp„County-Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number s ou1Ti` d p esented to the Davie County Building Inspections Office when applying for Building Permits.*** - AUTHORIZATION NUMBER NAME `� (!J J�t" e/% DATEe; 1 +0 n ?;4 1 � —, C � a NAGE ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ***NOTICE*** THIS AUTHORIZATION FOR WA5 WATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. /_ ENVIRONMENTAL HEALTH`SPECIALIST DATE DCHD 10/95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 D DEC 2 9 1995 1. Application/Permit Requested By F��iG �� i�r 2c� Home Phone q10 -76q - S Mailing Address 16 l/P.dY►, �ry5 AUC- 2W/2 Business Phone Q 10-?qq-D/S7 2. Name on Permit if Different than Above 3. Application for: O General Evaluation Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision G 12 EE/U 5 Pc Zf R ,AG2ef5 Section Lot # No. of People No. of Bedrooms No. of Bathrooms a Dwelling Dimensions oZg X Li S 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Sinks _ 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 C2 X06-' X /73' Sewage Disposal Contractoi 09. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ BasemenUPlumbing ❑ Basement/No Plumbing N Washing Machine 1�1 Dishwasher ❑ Garbage Disposal ❑ Yes 9 No ❑ Community I '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: FRUm mcL-,f-s uZccE 7 �1hE /S8 E -,,Lo �O 1 Soc A ,. T U R N R s G l4T ON c0 R N A'NT Z ER T1=� -CLkR`N LEFT Oty F02k 131X61( Rd. -rtAQNQ 1Z2:6. NT 0t3 5ZIER GREED ed. LoT of 13RzEg C2FEh d�lv p 1=U Qk 13ZX 13 Y 1ZcQ, YKUPEMA INEW-IM UU14 KLquiKSU: Tax Office PIE # Road Name J3RIE2 LP -667A Box # (if available) City 51V\Ng� &ROUE TowA)601F This is to certify that the information provided is correct to the best of my knowledge, and, I'unndderstand 1 am responsible for all charges incurred from this application. nG��`�'�f ays -CJS DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 OWN the property. ❑ 2. 1 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 by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1/93) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE �j 0 U R \ Davie County Health Department P. 1 Environmental Health Section sville, NC 27028 il. Box 665 APR 2 4 1995 Moc J` ENVIRONMENTAL HEALTH �� • �_ , L OAVIE COUNTY 1. Application/Permit Requested By II��wl Mailing Address 15,Fs �U� N7 6y �� Home Phone Act //A/Lp Business Phone &3 fes- �o� SGU 2. Name on Permit if Different than Above 3. Application for: �<General Evaluation *Septic Tank Installation Permit A064. System to Serve: Mouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Ot e Z ❑ Unknown 5. If house, mobile home: Subdivision �3 r�n� I" r PJ" IS Section Lot # 0'r� ❑ Basement/Plumbing No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public • 47 � ❑ Private 8. Property Dimension 7 ewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ No ❑ Community '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: � p � p (0�— '' This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. 2Kg9f6:e fs DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: M. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this fofm UST 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 by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment If disposal system. DATE SIGNATURE DCHD (1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME //9110e !/ ADDRESS PROPOSED FACIILTY DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well _ Community Publicy Evaluation By: Auger Boring i/ -o Pit Cut FACTORS 1 2 3 4 Landscape position d- L 4 Slope HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH t 3 F Texture groupC 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 ZEE] SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 Landscane Position EVALUATED BY: 4& OTHER(S) PRESENT: LEGEND 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 ■■■■..■■■..■■...■.■■....■■.■■■.■■..■..■■■..■ NOON .......■ ■..0.0■ ■■■.■.■■.■.._......■■■H■■■..S■■■■■nN■E■NN.�■■■■ ■N■■■■N■■■■■■■■■ .......................................... ... .... 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BOX 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 ON-SITE WASTEWATER C TFIC N FOR DWELLING (Check One) Replacement Q Remodeling Reconnection Fax: (336) - 7.53-1680 Name: 1 I Phone Number V (Home) Mailing Address: (Work) Detailed Directions To Site: L 1-0 C.LJ°ki Lely— -F Ejly"by S) Oji Property Address: "I U CQ Cti_-1;)L yL..l'� . k-N&I.1CZ i' I AI � 177 9�7- 73 Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: —Type Type Of Facility: Date System Installed (Month/Date/Year): 1 I i51P Number Of Bedrooms: 3 Number Of People: 3 Is The Facility Currently Vacant? Yes ( If Yes, For How Long? Any Known Problems? Yes If Yes, Explain: Please Fill In The Following Inf /r]m tion About The NEW Facility: Type Of Facility: t Oc c rl ��ZI�/� Number Of Bedrooms: 3 Number of People Pool Size: tj N arage e• N A Other: /2 > � 1� X17 � " 1 Requested By: Date Requested:/ 7&> (Signature) For Environmental Health Office Use Only loinEDisapprovedments. Environmental Health Speciali Date: *The signing of this form by the Environmental Health Sta f 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: C Paid By:, Account #: Check Money Order # f. c'cue�ilCt�vi. p 5(t, a mount:$ t00 If-) a Received By: Invoice Date: I Z-47-0