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420 Merrells Lake Road Lot 1Davie County, NC Tax Parcel Report Wednesday, January 11, 2017 WA CN11Nti: '1'Hlh lh 1VU'1' A SUKVEY Parcel Information Parcel Number: J700000059 Township: Fulton NCPIN Number: 5768621630 Municipality: Elementary School Zone: CORNATZER Account Number: 82523191 Census Tract: 37059-804 Listed Owner 1: BRAHIM EDRES Voting Precinct: FULTON Mailing Address 1: 159 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A R-20 State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC Zoning Overlay: 27028-7164 Voluntary Ag. District: No LOT 1 HAYES HILLS Fire Response District: FORK 5.71 Elementary School Zone: CORNATZER 8/2009 Middle School Zone: WILLIAM ELLIS 008020917 Soil Types: GnB2,GnC2,MsC 0009 Flood Zone: 020 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 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 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 �� UN NC or arising out of the use or Inability to use the GIs data provided by this website. DAVIE COUNTY ENVIRONMENTAL HEALTH �t P.O. Box 848/210 Hospital Street 3�0� • Mocksville, NC 27028 I (336)751-8760 Fax #(336)751-8786 Iw r M, ATC Number: 4622 Site Type: �w ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms IL# Bathrooms 3 # People 3 Basement❑ Basement plumbing2l" Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size S / �CS Type of Water Supply: Xounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) GJTank SizelX0 GAL. Pump Tank GAL. n � Trench Width ' 'r Max. Trench Depth . Rock Depth 1 Z!' Linear Ft. �33 Site Modifications/Conditions/Other: /n)g"I u— (>j 6&Aoa,2 . Q iSTC-iho-a R0,� Contact the Davie County Environmental Health Section for final inspection of this system between ., n 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. 1 Environmental Health DCHD 11/06 (Revised) As stater! in 15A NCAC 88.1969(5' accepted Systems may alsc be used R)Tolz Ek7reo)0 4G ., Date:__ F>) z4fl% 1I AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account .#: 990004273 Tax PIN/EH #: 5768-62-1630.01 Billed To: Mike Bumgarner Subdivision Info: Hayes Hills Lot # 1 Reference Name: Jeff Hayes Location/Address: Merrells Lake Road -27028 Proposed Facility: Residence Property Size: 5.75 acres Iw r M, ATC Number: 4622 Site Type: �w ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms IL# Bathrooms 3 # People 3 Basement❑ Basement plumbing2l" Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size S / �CS Type of Water Supply: Xounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) GJTank SizelX0 GAL. Pump Tank GAL. n � Trench Width ' 'r Max. Trench Depth . Rock Depth 1 Z!' Linear Ft. �33 Site Modifications/Conditions/Other: /n)g"I u— (>j 6&Aoa,2 . Q iSTC-iho-a R0,� Contact the Davie County Environmental Health Section for final inspection of this system between ., n 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. 1 Environmental Health DCHD 11/06 (Revised) As stater! in 15A NCAC 88.1969(5' accepted Systems may alsc be used R)Tolz Ek7reo)0 4G ., Date:__ F>) z4fl% 1I Account #: 990004273 Billed To: Mike Bumgarner Reference Name: Jeff Hayes Proposed Facility: Residence ATC Number: 4622 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5768-62-1630.01 Subdivision Info: Hayes Hills Lot # 1 Location/Address: Merrells Lake Road -27028 Property Size: 5.75 acres **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type: S.T. Manufacturer Tank Date Tank Size Pump Tank Size System Installed By: E.H. Specialist: Date: DCHD 11/06 (Revised) q0A +0 ovr�� SITE EVALUATION/IMPROVEMENT PERMIT & ATC DDavie County Environmental Health P.O. Box 848/210 Hospital Street FEAR .1 2 2007 Mocksville, NC 27028 (336)751-8760/ Fax (33 751-8786 A plica iong6E9ifh9dIHation/Im ovement Permit Authorization To Construct(ATC) ❑Both T e of Applicdi' i JC, ii`Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTAN7*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed //l�/ Jo�,�r1^ - , r,= Contact Person f4 d,4& IJ Vi`Y- "sVit! Billing Address f(�!„�j,,r t n � L-AuLJuE Home Phone City/State/ZIP e�:,U+1,1,-)A/ i✓ r'?� i �-- Business Phone -f qQ r) ; Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name �, r.,, �;-. ,,,,,/ Phone Number 1SC--7y�-Ili _ Owner's Address ` 9 ; ,,,. vE City/State/Zip O! Property Address ���Z /�'!�,�� 11 (c City Lot Size 1-.7 CA- .S TaxPIN# Subdivision Name(if applicable) Section/Lot# / Directions To Site: lotl C.6 Mei rlclls b4 -/Lc: Ory 1--e 4l • � � and e- ON 124-A7' . If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes [XO Does the site contain jurisdictional wetlands? ❑Yes C14Ky Are there any easements or right-of-ways on the site? ❑Yes 5 Is the site subject to approval by another public agency? ❑Yes BZQ Will wastewater other than domestic sewave be venerated? []Yes VO IF RESIDENCE FILL OUT THE BOX BELOW 01" fie # People # Bedrooms Bathrooms Garden Tub/Whirlpool es []No Basement: es ❑No Basement Plumbing: es ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested; v onventional ❑Accepted ❑Innovative ❑Alternative ❑Other, Water Supply Type: R County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? �\ • This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's oro r s legal representative signature Date Date(sy Client Notification Date: EHS: Sign given ❑Yes ❑No Account # Z�,s Revised 11/06 Invoice # E"T-1 fps, PPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Bolt 848/210 Hospital Street tlylAl NE1 Mocitsville, NC 27028 ERO�N C01f1 (336)751-87601 Fax (336)751-8786 pAVIE Application For: itc Evaluatioramprovement Permit huthorization To Construct(ATC) 0 Both IMPORTANT''•" THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRM INFORMATION IS PROVIDED. Raft to the INFORMATION RULLEM for instructions. Name to be Billed 4&y Q q Contact Person TZ R LiVV •27 Billing Address w vatS. Home Phone City/State/ZIP v Business Phone -O O Name on Permit/ATC if Different than Above Mailing Address City/State/Zip NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 nths with site pla no expiration with comp plat.) Street Address Mry,elk%.City Tax PIN# . 16 jl'% L / (a 3 0 Subdivision Name Sectiot✓Lot# Lot Size S— S rte a_ 7_ - l as t , DircctionsTo Site: 1* g. 1., Q �. arc l Date Hou$e/Facility Comers Flagged Z ^J o "cK- if the answer to any of the following questions is "yes", supporting documentatio est be attached. Are there any existing wastewater systems on the site? OYes Does the site contain jurisdictional wetlands? Oyes Are there any casements or right-of-ways on the site? Oyes 7p. Is the site subject to approval by another public agency? Oyes t�?I�tl Will wastcwatcrothtme r dun domestic sewage be generated? ayes Brio IF RESIDENCE FILL OUT THE BOX # People # Bedrooms # $athrooms _ Garden Tub/Whirlpool f� ONo Basement: es ONo Basemen P G'fees ONo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building !1 People # Sinks # Commodes # Showers # Urinals^j Estimated Water Usage (gallons per day) (Attach docu mentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: GConventional OAccepted 0-1movative ❑Alternative 00ther Water Supply Type:ounty/City Water 0 New Well OExisting Well 0 Community Well Do you anticipate additions or expansions of rhe facility this system is intended to serve? 0 Yes FYPo If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I understand that I am responsible forall charges incurred from this application. I hereby grant tight of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to Jetermine compliance wt applica le laws and rules on the above described property located in Davie County and owned by 1 P v \ r l 6i ens �'l cz Property i s'or o tier's legs presentative signature Date Sign given UYes ONo Revised 2106 Site Revisit Charge Date(s): Client Notification Date: EHS: Account #? Invoice # ZOO/IOOt d0d VNI10M 21dIEM H80 866 9E£ IYd WIT GA 900Z/ MO {.' S U N NOM Ga Olin Click on the Map toi IS Zoomin 0. ZoomOut cwder�rle�.� r Zoom Factor 4 Radius Search trees o ............ .r,,... ats •rw r k cra a y�A }II •fY! R raakrt. !re 1 vav arr►ok. raa !ti i ana Fina_AeioiologYands. j • Courtly 10rJ700000059 • ACCOuntNumber�00011956000 • PIN; 5768621630 • Legal 1:14 AC MERRELLS LAXP RD • Owner Name: BYERLY GLEN HEIRS i • OwnerlAddress f: BYERLY GLEN HEIRS • Owner/Address 2: • OwnerlAddress 3. % BETTY HOCTOR • City.State Zip: WALDICK ,NJ 07483 - 0038 • Land Value: $86,950.00 o Building Value: $0.00 I z00/goQ w i Map Li ' graw..L Draw seioet [j Census Tra City Bound County Zor Multi Syl 0 E411 Fire C Flood Pane (] Flood Zone a Parcels School 0161 Multi Syl [] Solis Q Town Zonlr Townships Multi SYI voting Pre( Infrastructu 13 Driveways 0 Rail Unes ❑ Street Cent Q L13lNC H191 Multi Syk U .� N ❑ Aerial Phot dOd YKI10M HHIXHHd WO 866 9££ XYd £6:11 ah 900Z/ WO rnrawar • Land Unk /Typo: :IAC Crocks and 9 Dead Book/Paga 00042/0495 E911 Addre • Deed Date: 1944/0101 [] Fire Depart • Safes Price: $0.00 k © schools • Property Address: ..;.. ;Dl raw • County Zoning: R-20 j • Census Code: MAP CQ.1 City Code: • Fire Distrid. FORK This map is prep: • ROOd Zone: ZONE X :memory of real 1 within this jurisdit Rood Community: 370308 compiles from re>, • ROOd Panel.• 0100 C plats, and other F and data. Users r • Rood Map Date: 12-17-1993 hereby nollffad Ili dOd YKI10M HHIXHHd WO 866 9££ XYd £6:11 ah 900Z/ WO -I ■ v m ■ S 66'00'001 E s 86'00'00' -0' E 8 54 00 0, Or So 336AD 159.00 loo Iv1-70} LOT 1 5.46 ACRES +\ ro 14 N 88*17107' W i 843,75 — --------- LA AC. -g--Ito LOT 2 ry 5.46 ACRES w Ln < C) 7C N 87'28'59- W UD CD w 813.70 ro LOT 3 ro 5.46 ACRES 1 736 JI LOT 4 5.46 ACRES co ZLO 86,00,00, W ti &o , 1&0 CA ca -4 ro CD LOT 5 ya pa 5,46 ACRES 336.00 188.00 301.00 0 ,T3 N 86-Doloo, N 86#00,00, V '20 10 'o It- 70 10, �16:mlll 2.04 S + -o 4 ' 336.00 MELVrN C. 86 00 00, W N 86'00100,' W -D.R. f f 6, • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990004007 Billed To: Rodney Bailey Reference Name: Jeff Hayes Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5768-62-1630,81 Subdivision Info: /-01#1 Location/Address: Merrells Lake Roa 27 28 Property Size: 5 acres Date Evaluated: CAO Water Supply: On -Site Well Community / Evaluation By: Auger Boring Pit Public Cut SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: © • 2% REMARKS: in LEGEND EVALUATION BY: �GIy" &)0&Q(244A--P OTHER(S) PRESENT: O.A q 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 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 Mineralog 1:1, 2:1, Mixed NAM 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 05105 (Revised) Landscapeposition ����0---- Texture group 1� ConsistenceVCtWmIM4L00Ei'�t' ►1����� r 'M OMMW&OMMineralogy ��■�� W to HORIZON II DEPTH Texture group Consistence WFUR EM ►_ 00 a12_ TextqTql,rouR___- Consistence r4 Wim.' WITERM HORIZON IV DEPTH Texture group Consistence ------� SOILWETNESS ------- CLASSIFICATION offGAM SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: © • 2% REMARKS: in LEGEND EVALUATION BY: �GIy" &)0&Q(244A--P OTHER(S) PRESENT: O.A q 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 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 Mineralog 1:1, 2:1, Mixed NAM 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 05105 (Revised) Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Improvement Permit Jeff Hayes 228 NC HWY 801S Advance, NC 27006 Re: !3 -Acre Tract / Merrells Lake Road Lot # I Tax PIN# 5768621630 Dear Client(s): This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve:(2412SICM,) Wastewater Design Flow(GPD): LIP0 Valid: 05—Years ❑No Expiration System Type: Z56onventional ❑Accepted Site Modifications/Permit Conditions: ❑ Innovative ❑ Alternative ❑ Other i.p.letter 7/06