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195 West Knoll Brook Drive Lot 33Davie Countv, NC' Tax Parcel Report Wednesday, January 18, 2017 WAK1V11V1i: lrilb lb NkJ1 A JUKVEY Parcel Information Parcel Number: H516OA0033 Township: Mocksville NCPIN Number: 5749336553 Municipality: Account Number: 82531438 Census Tract: 37059-805 Listed Owner 1: LIM ZEMBOWER MELINDA M Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 195 W KNOLL BROOK DR Planning Jurisdiction: MOCKSVILLE City: MOCKSVILLE Zoning Class: MOCKSVILLE FP,OSR State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 33 MEADOW RIDGE SECTION THREE Fire Response District: MOCKSVILLE Assessed Acreage: 2.54 Elementary School Zone: MOCKSVILLE Deed Date: 11/2008 Middle School Zone: SOUTH DAVIE Deed Book / Page: 007750876 Soil Types: WeC,WeB,ChA Plat Book: 0007 Flood Zone: Plat Page: 226 Watershed Overlay: MOCKSVILLE Outbuilding & Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: [61 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'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 NC or arising out of the use or inability to use the GIS data provided by this website. Davie County Health Department r. 4�; f Environmental Health Section P.O. Box 848_ .f 210 Hospital Street }= Courier # : 09-40-06 - , X11 -1-1 _ Mocksville, NC 27028 Phone: (336) - 753 - 6780 Far (336) - 753-1630 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling "C' Reconnection Zewu%Name: �/Yt�� l�C.cJ Phone Number �b0 1 ` ` (Home) Mailing Address: ( W Ktobl o l ootc- t� (Work) -1'1�C��C ULAG�G IUC.. Z76Zei Detailed Directions To Site: Property Address:� Jr �lN�! Z016 . 2, 0 Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: '(ll M&A 11%y Type Of Facility: &L/ Se Date System Installed (IVlonth/Date/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes Any Known Problems? Yes (9 %No J If Yes, For How Long? If Yes, Explain: Please Fill In The Follotiving Information About The NEIYFacility: Type Of Facility: Number Of Bedrooms: Number of People For Environmental Health Office Use Only Approve rDisapproved ' `� _ 1 � /� Comments: G'�k`� -O � — &, � o VY'�P,��g c6-4 'S� Y Environmental Health Specialist. *The signing of this form by the Date: 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 P Amount:$ Date: Paid By: Received By:_ Account #: Invoice #: GoMaps 4.0 Page 1 of 1 http://maps2.roktech.net/davieNC_gm4/ 10/18/2016 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (334)751-8760 /45 k1 1'(A1011 baa k 6t - Account #: 989900158 Tax PIN/EH #: 5749-33-2338RH Billed To: Richard Hendricks Subdivision Info: Meadow Ridge Lot # 33 Reference Name: Location/Address: Meadow Ridge -27028 ATC Number: 3165 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED bythe 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 Trea t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER-GO)k$TRUC14G9 ;IS V ID FQRA PERIOD OF,FIV4YEARS. Environmental Health Specialist's CERTIFICATE OF COMPLETION Date: **NOTE** The issuance of this Certificate of Completion shall indicate the system described o Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .190 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the syst�m wil function satisfactorily for any given period of time. 1 1 -[-tv,� 1Dw, 11.23 Septic System Installed By: Environmental Health Specialist's Signatures° DCHD 05/99 (Revised) Ami Kj Date: qI zqIQ 3 f DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900158 Billed To: Richard Hendricks Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5749-33-2338RH Subdivision Info: Meadow Ridge Lot # 33 Location/Address: Meadow Ridge -27028 Property Size: see map 40 **NO41T&14YM�gflprbVegent/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 1 I 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 �o u #People #Bedrooms 3 #Baths 2— Dishwasher: Dishwasher: 0'." Garbage Disposal: Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 2 * 5S nCa'�SType Water Supply OWt"-yDesign Wastewater Flow (GPD) � Site: New Repair ❑ System Specifications: Tank Size Ib0QiAL�{Pump Tank GAL. Trench Width 3( Rock Depth 10- Linear Ft. -C -V Other: Required Site Modifications/Conditions: tw 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.**** ®2 Environmental Health Specialist's q0 DCHD 05/99 (Revised) - lu/ N Date: l®�� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & CS Davie County Health Department Eft vironmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 �< / (336) 751-8760�/Ro AAee ` ***1MPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQS b,E�N INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Wela/ ftlE� Contact Person ,(. ,)y//o Mailing Address /dall-lyt'n 1/y Home Phone, 33C- 9P- "sw, City/state/ZIP �GLc�S,. </�� ,�/�, 70 F� Business Phone 33 G 7 s / - / 7S/ 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation improvement Permit/ATC ❑ Both 4. System to Service: W/House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms 3 # Bathrooms G'Dfishwasher V Garbage Disposal '.Y/Washing Machine U Basement/Plumbing H 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 ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes P-�- If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: #% 7 7-` 3 _ -;k- 3-1J Property Address: Road Name ( J . ff")° ll Y/R• City/Zip If in a Subdivision/provide information, as follows: Name: P_ !l Section: Block: Lot: '33 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Jo SA,,, &..,(. /la n,; /fs on R" 4L oA Date Property Flagged: S-30- o-1 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 sitesuit i DATE S 30 - 0 2 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations)I i I 6, Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. �9 ` Oa /S8 Invoice No. o 0 f APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department DI— All(�EnWvnmenta/Hea/thSer�nn E U E P.O. Box 848/210 Hospital Street ' .Mocksville, NC 27028 ❑ MAY 9 2001 (336) 751-8760 * * * IMPORTANT* * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T REQUINM�nCEALTIINFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i AIU 1. Name to be BilledppNt�tnTnH L•�rFO�TEQ Contact Person Kem t-o'sTr-M.. Mailing Address 18(. �'1APLrE `QEE Looc Home Phone x44- iia' -1-189 city/state/ZIP Kocy.s-'RE 14(-. Business Phone 3--A4 CR - 2. 2. Name on Permit/ATC if Different than Above -- Hailing Address City/state/Zip 3. Application For: I(Site Evaluation ❑ Improvement Permit/ATC ❑ BoLh 4. System to service: id House ❑ Mobile Home O.Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms 4 # Bathrooms 4 1- D / iaheaeher H Garbage Disposal W'Wazhing Nacbine FS Easement/Plutabing I:1 Baaem.-%nt%110 Plumbing 6. If Business/Industry/Other: Specify type # People # Urk% _ # Commodes # Showers # Urinals # Water Coo1Fs.-ti IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day � 7. Type of water supply: d County/City ❑ Well C 'Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MVSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED _ BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 88 )4 483)(5-15 D( 367 5749 33 2338 Tax Office PIN: # Property Address: Road Name City/Zip Itin a Subdivision provide information, as follows: Name: WAoow RIDGE ( PR poSeD) Section. TWO Block: Lot: 33 WRITE DIRECTIONS (from Mocksville) to Us 159 1�14wriA. RkGIAT O&J iso R o , fZ t G kE r P.T ,� N�gs►wt ce'- it v ME'4c-ow 21r c,F-0 AV De p -D R1Gl4T _Ge -M EJJD OF ST'R: r;:'T Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any pe rMit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the inferiv-21"On submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges inc: rr ed front this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Dei irtmeat to enter upon above described property located in Davie County and owned by tRabaRT G• �cCR.�r: t>�o�,k;__ to conduct all testing procedures as necessary to determine the site suitability. DATE Mn Y 'r, ZGe/ SIGNATURE _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and Proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Ch_rge Datc(s): Client Notification Date: _ Imo° Account No. Revised DCHD (07/99) Invoice No. APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Account #: 989900654 Billed To: Kenneth Foster Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: On -Site Well Property Size PROPERTY INFORMATION Tax PIN/EH #: 5749-33-2338.33 Subdivision Info: 4adowridge Section two Lot # 33 Location/Address: see map Date Evaluated: Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA 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) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOTS Soil/Site Evaluation APPLICANT'S NAME CCaP DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION _��) /1 ROAD NAME G�ls7G 1I/I f��/ Y%p Water Supply: On -Site Well Community Publicy Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position 21 L Slope % 2 HORIZON I DEPTH Wet Texture groupIre SS - Slightly sticky S - Sticky VS - Very Sticky L Consistence Structure Structure M - Massive CR - Crumb GR - Granular ABK - Angular blocky Mineralogy HORIZON II DEPTH Texture group C Consistence Structure !C 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: LONG-TERM ACCEPTANCE RATE: / REMARKS: DCHD (01-90) EVALUATION BY:/ O OTHER(S) PRESENT: 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