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128 Sumter Road Lot 4Davie County, NC I Tax Parcel Report Tuesday, November 15, 2016 WAMN11N%x: IMb Ino PIV11 A bURVL' Y Parcel Information Parcel Number. F301OA0004 Township: NCPIN Number: 5811722116 Municipality: Clarksville Account Number: 82517433 Census Tract: 37059-801 Listed Owner 1: DODD RICHARD W Voting Precinct: CLARKSVILLE Mailing Address 1: 128 SUMTER ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-4980 Voluntary Ag. District: No Legal Description: LOT 4 CHARLESTOWNE GRANT Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.83 Elementary School Zone: WILLIAM R DAVIE Deed Date: 8/2001 Middle School Zone: NORTH DAVIE Deed Book / Page: 003850531 Soil Types: Mn62 Plat Book: 0007 Flood Zone: Plat Page: 102 Watershed Overlay: DAVIE COUNTY Building Value: 200260.00 Outbuilding & Extra Freatures Value: 1920.00 Land Value: 28000.00 Total Market Value: 230180.00 Total Assessed Value: 230180.00 101 Davie County, �T l� All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or nbuss for a particular use. All users of Davie County's GIS websiteshall hold harmless the County of Davie, North Carolina, Its agenda, consultants, contractors or employees from any and A claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section P. O. Boa 848/210 Hospital Street C)>al– I C� —S' O l Mockwille, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001888 Tax PIN/EH M 5811-72-2116 Billed To: Richard Dodd Subdivision Info: Charleston Grant Lot # 4 Reference Name: Location/Address: Sumter Road -27028 Proposed Facility: Residence Property Size: see map **NOTEC*%mbler: 2956 is mprovement/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 3 #Bedrooms 3 #Baths 2 Dishwasher: CJ Garbage Disposal: iii Washing Machine: ga Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial 13all Waste: Lot Size Ali =C% Type Water Supply C� Design Wastewater Flow (GPD) — Site: New 12" Repair ❑ ,r � System Specifications: Tank Size IWO GAL. Pump Tank GAL. Trench Width,Rock Depth 12 Linear Ft.�� Other: Z lD i ST,t 6071 orJ 80X —S r 1 11 Required Site Modifications/Conditions: 1,3ST&Ll– UAW L-W6 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** l bats 10 ci - - NJ Environmental Health Specialist's Signature: • / -- DCHD 05/ 9(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001888 Tax PIN/EH #: 5811-72-2116 Billed To: Richard Dodd Subdivision Info: Charleston Grant Lot # 4 Reference Name: Location/Address: Sumter Road -27028 Proposed Facility: Residence Property Size: see map ATC Number: 2956 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 WASTEWA NST TIO VALI OR A PERIOD OF FFIIVQE YEARS. Environmental Health Specialist's Signa e: !� O 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. I-�-kT� It -3 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) LtrJ�c rs C I /31 /pz • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Hea/dt Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 A� 2 2 2001 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. . _ ,. 1. Name to be Billed Contact Person K (lam Mailing Address t4,2- W 71 (i% /� 1 y Home Phone 33� fJ 1 City/state/ZIP Mbe�d5\)JL E r NC �,t70A Business Phone 3JIp+ � � �� J `� 2. Name on Permit/ATC if Different than Above Jr1 m� hgi�1f"i'� e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XN 0 If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. 115X 377x asoxo�39I/x OSx io Property Dimensions: J / WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 59 11-7a � I tD o/ A' PropertyAddress: Road Name 5U mlie r R o G d 1.e40-1- o n Ll b e rt, C h u rch Rd . city/zip Mno- ksyi I Ie. 01 9, lie If in a Subdivision provide information, as follows: ' ` I q ) C u r k-5-kwne- Am ntSU lAd . Name: aarles-kwne. Arant Section: Block: Lot: Date Property Flagged: C� 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 conduct all testing procedures as necessary to determine the site suitability. /� JDATE SIGNATURE I/V i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septi: locatio �1 alk S ti Revised DCHD (07/99) e7f -7 Account No. r U Invoice No. �`- 7 ` f L---- Mailing Address City/State/Zip 3. Application For: Site Evaluation 1' Improvement Permit/ATC ❑ Both 4. system to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 3 # Bathrooms Dishwasher Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type N # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: 6i County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XN 0 If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. 115X 377x asoxo�39I/x OSx io Property Dimensions: J / WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 59 11-7a � I tD o/ A' PropertyAddress: Road Name 5U mlie r R o G d 1.e40-1- o n Ll b e rt, C h u rch Rd . city/zip Mno- ksyi I Ie. 01 9, lie If in a Subdivision provide information, as follows: ' ` I q ) C u r k-5-kwne- Am ntSU lAd . Name: aarles-kwne. Arant Section: Block: Lot: Date Property Flagged: C� 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 conduct all testing procedures as necessary to determine the site suitability. /� JDATE SIGNATURE I/V i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septi: locatio �1 alk S ti Revised DCHD (07/99) e7f -7 Account No. r U Invoice No. �`- 7 ` f L---- 0 1i ' P lj°`� � �► a v� w O -1 i • APPUCATION FOR SITE EVALUATION/IMPROVEMENi PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***ZHPCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1 . Name to be Billed Y#,-/ �E �EGe— Contact Person ��/fp�hl 60IQ2 EG -C. Mailing Address X13 Z / TLE D6E ea Home Phone `-�f , Z --546o City/State/ZIP MOGkSf//GG.L�, /y C— 2-70 �i� Business Phone 1'"%Z -S¢g a 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: X Site Evaluation 0 Improvement Permit/ATC 0 Both 4. System to Service: A House U Mobile Home 0 Business U Industry 0 Other 5., If Residence: # People # Bedrooms # Bathrooms 1.1 Dishwasher 1.1 Garbage Disposal IJ Washing Machine I] Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated water Usage (gallons per day) 7. Type of water supply: County/City 0 well U Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 'KNO If yes, what type? ***IMPORTANT*** CLIENTS AIUST COWLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either s PLAT or SITE PLAN AfUST BESUBMITTED by the client with THIS APPLICATION. i Property Dimensions: ry// - �� _ n� z�/aO�W I� ��ey TE DIRECTIONS (from Mocksville) to PROPERTY: TaxTOffice PIN: # �f I/ J (, WA J o I 40 L/gcgr Property Address: Road Name WACwcp— 26A Z> 11 ►/ g, LP? F -r o � Li BEeT N 6o I A11 � Citylzip c.r Vit-c.E 2-7v Z If in a Subdivision provide information, as follows: Name:%}�1•A��'T Section: Block: 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 1 am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the D-jA�vie Count Health Department to enter upon above described property located in Davie County and owned by ff6c.�t,Cti �• to conduct all testing procedures as necessary to determine the site suitability. DATE Jr— �.-. ' / d SIGNATURE230i� • �'', 'DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT __q_ Soil/Site Evaluation APPLICANT'S NAME�-1� �1.'LCi DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE 49x /7.5 7X3. -'-20o--37b, ttm SUBDIVISION _��? J .�E.� ROAD NAME V)2461j . 09 �Z Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position V Slope % Zo HORIZON I DEPTH Texture group Consistence F/ SSS' Structure ASK Mineralogy • 1 1, HORIZON II DEPTH Texture group -1-7,9 C Consistence Structure Mineralogy) : j HORIZON III DEPTH ; 2 - Texture group Consistence r 5 Structure Mineralogy; HORIZON IV DEPTH v - vii Texture group42 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 66 LONG-TERM ACCEPTANCE RATE p, SITE CLASSIFICATION: P, LONG-TERM ACCEPTANCE RATE: Q. zc REMARKS: DCHD (O1-90) 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(provisignally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■MM■MM■■■ENMMM■■MMM■■■ ■■ENMEM■■ME■■MME■N■E■ ■■■■■■■■ESII■■■■■■■■■■■■■■■■iii■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■EM■■■ ■■NNE■ ■EMEM■ ■ ■ ■E■■■■ ■■■EM■E■ ■■■■NEEM ■ME■■M■■ ■EMM■MMEMM■ ■MEN■EM■■E■ ■■■MEM■■M■■ ■■M■■MME■M■ ■EM■■MME■■■ ■EMMEMEMEM■ ■EMEMEMEME■ ■■MM■■■ME■■ ■ ■ ■ ■■M■E■ ■M■EM■ ■E■N■■ ■MEMS■ ■M■■M■ ■MMEM■ ■ENN■■