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289 River Road P/O Lot 4Davie County, NC It Tax Parcel Report 1E Thursday, January 5, 2017 Shady Grove 37059-803 EAST SHADY GROVE Davie County DAVIE COUNTY R-20 ADVANCE SHADY GROVE WILLIAM ELLIS GnB2,GnC2 DAME COUNTY No Land Value: Total Market Value: Total Assessed Value: 9D1�, 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 webake 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 arWng out of the use or Inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: E8110B001701 Township: NCPIN Number: 5881141788 Municipality: Account Number: 28746000 Census Tract: Listed Owner 1: GALLIMORE ROBERT D Voting Precinct: Mailing Address 1: 289 RIVER ROAD Planning Jurisdiction: City: ADVANCE Zoning Class: State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: Legal Description: P/O 4 GREENWOOD LAKE Fire Response District: Assessed Acreage: 1.26 Elementary School Zone'. Deed Date: 11/1992 Middle School Zone: Deed Book / Page: 001660260 Soil Types: Plat Book: 0003 Flood Zone: Plat Page: 053 Watershed Overlay: Building Value: Outbuilding 8r Extra Freatures Value: Shady Grove 37059-803 EAST SHADY GROVE Davie County DAVIE COUNTY R-20 ADVANCE SHADY GROVE WILLIAM ELLIS GnB2,GnC2 DAME COUNTY No Land Value: Total Market Value: Total Assessed Value: 9D1�, 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 webake 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 arWng out of the use or Inability to use the GIS data provided by this website. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Requested By 2. Address -3S60 0,- 3. 'Y 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair. b) Privy Conventional Other Type Ground Absorption Home Phone 76- 4 - b c? 7.3 Business Phone _7411- 1 E 4 3- c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business Industry Other b) Number., of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms �� Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes • urinals lavatory showers dishwasher I sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions garbage disposal / washing machine_ b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. JP6� ll')i'd' 9g.-Q�,.�ti Date Owner Sig ture Cl OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) Name— Address FAr;TnRS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION ARFA 1 ARFA Date �//? � _ Lot Size AREA 3 ARFA A Topography/ Landscape Position pSJ 4) S PS S PS U U U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S PS S PS S PS "CT U U U 1) Soil Structure (12-36 in.) Clayey Soils S S � S PS S PS U U )Soil Depth (inches) Ste. S PS U S PS U ) Soil Drainage: Internal pS PS S PS U S PS U External S c 7P) � S PS U S PS U 1) Restrictive Horizons Available Space pS S S S PS S PS U U U 1) Other (Specify) S PS S PS S PS S PS U U U U 1) Site Classification U—UNSUITABLE S—SUITABLE � S—Provisionaliy Suitable Recommendations/ Comments: _ Described by SITE DIAGRAM DCHD (6.82) Title �'!v Date `gh,,l� DAVIE COUNTY HEALTH DEPARTMENT /,M— Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ver I Account #: 990001316 Tax PIN/EH #: 5881-05-8582 Billed To: Craig Carter Builders, Inc. Subdivision Info: Greenwood Lakes Lot # 4 A Reference Name: Location/Address: River Road -27006 Proposed Facility Residence Property Size: see map ATC Number: 3970 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTI N IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. 0)4a 40r 5 Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001316 Billed To: Craig Carter Builders, Inc. Reference Name: Proposed Facility Residence Tax PIN/EH #: 5881-05-8582 Subdivision Info: Greenwood Lakes Lot # 4 A Location/Address: River Road -27006 Property Size: see map ATC Number: 3970 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths_ Dishwasher:/e Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) 15�� b Site: New Repair ❑ System Specifications: Tank SizeGAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width Rock Depth/ �Linear Ft IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** p t / h e�"A�11C�1C AAj��46-f c ly� )LTJ 5✓ '`� c� i vs -e � Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IAIPROVFAIENT PE Davie County Health Department Environmental Health Section J - a rr 5 2005 P.O. Box 848/210 Hospital Stree Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEWN DAME COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer /jto the INFOORMATION BULLETIN for instructions. 1. Name to be Billed C„o,.� �� 11v� /44/ t2�L Contact Person O_�/-�� Mailing Address .�.� w/ .� Home Phone 3.7G—%y0—w73y/ City/State/ZIP %la✓✓Oit�G NG e7��7��d0C Business Phone 2. Name on Permit/ATC if Different than Above !t/� /aye A, oe, �oa�r�f ✓�/ Mailing Address City/state/zip-- 3. ity/State/Zip-3. Application For: ❑ Site Evaluation Improvement Permit/ATC C:Both 4. System to Service: AHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: X Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People ;;z_ # Bedrooms 3 # Bathrooms ^ishwasher ❑Garbage Disposal )K(ashing Machine ❑Basement/Plumbing Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: #i Seats Estimated Water Usage (gallons per day) 8. Type of water supply:,�<County/City ❑ Well ❑ Community 9. Do you anticipate additions or CXpallSiollS of the facility this system is intended to serve? ❑ YCs <No If yes, wllat type? ***IMPORTANT*** CLIENTS hfUST COMPLETE TILE REQUIRED PROPERTY INFORMATION REQUESTED BELONV. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the dictit with THIS APPLICATION. Property Dimensions: _91G 4?68 of ! 4 Tax Office PIN: Property Address: Road Namc Kl.tt r oad City/Zip If in a Subdivision provide information, as follows: Name: latGn /Vo,N 4e "elG Section: _Z_ Block: Lot: WRITE DIRECTIONS (frons 11locksyll1e) to PROPERTY: dol afvos.SS �a�• ��r� o-• Date home corners flagged: This is to certify tIlat the information provided is correct to the best of Illy lnlowledge. I understand that any permit(s) issued hereafter arc 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 1 aul responsible for all charges incurred frons this appliciltiou. I, liercby, give consent to the Autliorized Representative of the Davie County IIcaltll Department to enter upon above described property located in Davie County and owned by - :�z to conduct all testing procedures as necessary to determine the site suitzw DATE SIGNATURE//�� i4 � TRIS AREA MAY BE USED F OR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lilies and dimensions, structures, setbacks, and septic locations). Sign given Revised DCIID (05103 ,, ` ! C fy�' % g Site Revisit Charge Datc(s): Client Notification Date: EIIS: Account No. ( —14 Invoice No. 6 .91" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001316 Billed To: Craig Carter Builders, Inc. Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5881-05-8582 Subdivision Info: Greenwood Lakes Lot # 4 A Location/Address: River Road -27006 see map Date Evaluated: On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH A '/ Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 1 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 C SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: , OTHER(S) PRESENT: LEGEND Landscape 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 clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very 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 SC - 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 05/99 (Revised) i ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■eee■■■■■■■■■■■■■■■■■■■ Mee■■ecce■■■■■■■■■■Mee■■�■e■ ■■■■■■■■■■■■■■■■■■■■■■■■ ONE ■eee■■■e■■■eee■eee■■■■■■■■■■■ ■■■■■■■■■■■■■■Mee■■■■■Mee■■e■ ■■■■■■■Mee■■■e■■■E■■■■■■■■■■■ ■■■■eMee■■■e■e■■■■■■■■eeeMee■ ■■■■■Mee■■■Mee■eee■■■eeeMee■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ecce■■■eee■■■eee■■eMee■ ■■■ ■■■■■■e■■Mee■■■■■■■e■■■■ ■■■ Mee■eMee■M■ee■e■e■■■■■■E■■■■■ ■■■■■■■■■M■■■■■■■■■ecce■ecce■ ■eeee■ee■■■Mee■■■■EeeM■■ecce■ Mee■eMee■■■Mee■Mee■■■■■■�■■■ ■eeee■Me■■■■■■■■eeeee■■■ ■■■ ■ecce■■e■■eMee■■■■■■eeeeee■■■ ■■■eee■■■■■eee■■E■■ecce■ecce■ ■eeeeeeee■■■■■■Mee■ecce■■Mee■ ■■■■■e■E■■M■■e■■eee■■■M■■eee■ ■■ecce■■■Mee■■eMee■■■■E■■eee■ ■■eMee■■■■e■■eeeeeeee■E■■eee■ ■eeeeeMee■■■■■■Mee■■eee■�e■■ ■Mee■■■■■■■■Mee■■■Mee■■■ ■■■ ■Mee■■■■■■■eee■eeeMee■■■ecce■ ■■eee■■e��e■■■■■eee■e■eeee■■■ ■■eeeeee■■■■eee■■��■eeeee■■ ■eeeeeee■■■■■eee■■■eee■■-:�•�. ■■■■■■■■■■■■■■■eeeeee■■■ecce■ ■■ecce■e■■eee■��■■■■■■■■■eee■■ MEMNON mom ■■Mee■e■■■■■eery■eMee■eeeeeee■ ■■e■■Mee■■■■■■�■M■eeeee■e■■■■ ■■eee■■■eeee■■Mee■■■■■■eeeee■ ■eeeeeeeee■■■■■■■■■■■■ ■■■■■■■■■eee■■I\eMee■■■ ■eeee■eMee■■■■11��'==:== ■eMee■eeee■e■eM■■■■■■n ■■■■■■eee■■eeee■■Mee■►= ■ee■eeeee■■!�ee■e■e■■`■ ■■■■eeeee■ene■■eMee■e■ Me■■■■■ee■Mer�■■■■eeee■ MEMO ■■M■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■s■■■eee■■e■ee■e■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■ace■■e■■■eeee■e■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 1p ,r / Iv Cf�S. `gyp 0 Z�0n, building 9y yf' LOT 2 36.65 / - ARE C� LOT 6 S RTIFY THAT UNDER SION, THIS MAP FIFi.n CUP.VEY r r.. ffUMp P 0 z f- ci PLAT OF SURVEY FOR, WILLIAM B. KING sr,At, 1 50, APPRM13 rn. GLT MAVN sY. SPH aim OCT. 04 1996 BEING LOTS 3.4 h 5. BLOCK 4 OF THE GREENWOOD LAKE SUBDIVISION. SECTION 1 RECORDED IN PLAT BOOK 3 Pg. 53. LYING IN THE 'SHADY GROVE TOWNSHIP. COUNTY OF DAVIE. NORTH CAROLINA. BRAYING mums R 22796-3 PLAT OF SURVEY FOR- T r-• ff__9 Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 January 11, 2005 Craig Carter Builders, Inc. 118 Highway 801 South Advance, NC 27006 Re: Site Evaluation/ River Road Tax Office PIN: #5881-05-8582 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, January 10,2005. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RBH/dlf Enclosure(s) I- 10" J. !�N L0,-A%Kl JAAF-- c s S, PEAL SITE PLAN ONLY THIS WAS MAPPED FROM A DEED CR RECORD PLAT AND NOT FROM A SURVE7Y BY N.E. GRkP"r- SCALE — FEET W.Ap CRAIG CARTER BUILDER M" of I 4 pis 3 PC 17 cWqlcDWmo"W LAa swmylmV WM. tient . HOW&RD SUPnYwC -*9 NO. JOHN RkXwD "'"RD Fs 05011 P.O. WX 776 AVON' E. N.C. (330 698-5356 LF 7ff4