137 South Hemingway Court Lot 36Davie County, NC
Tax Parnf-1 R Pnnrt
Tuesday, November 29, 2016
WAKNhNG: '11ii51S f40T A SURVEY
Parcel Information
Parcel Number:
H8060A0036
Township: Shady Grove
NCPIN Number:
5789145394
Municipality:
Account Number:
82519164
Census Tract: 37059-804
Listed Owner 1:
SOUTHERN CLYDE WARD JR
Voting Precinct: EAST SHADY GROVE
Mailing Address 1:
137 SOUTH HEMINGWAY COURT
Planning Jurisdiction: Davie County
City:
ADVANCE
Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-7049
Voluntary Ag. District: No
Legal Description:
LOT 36 COVINGTON CREEK PHASE TWO
Fire Response District: ADVANCE
Assessed Acreage:
0.73
Elementary School Zone: SHADY GROVE
Deed Date:
7/2002
Middle School Zone: WILLIAM ELLIS
Deed Book / Page:
004280095
Soil Types: PaD,PcB2,PcC2
Plat Book:
0007
Flood Zone:
Plat Page:
139
Watershed Overlay: DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
1:01
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, Impliedwaan es of merchantability or fitness for a particular use. Ali users of Davie County's GIS website shall hold harmless the
�TCounty of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
1� C 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. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900317
Billed To: Glory Home Builders
Reference Name:
Proposed Facility: Residence
Tax PIN/EH M 5789-14-5394
Subdivision Info: Covington Ck Lot # 36
Location/Address: HEMINGWAY COURT -27006
Property Size: see map
**NOTE* iiIsgmprovement/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 5
Dishwasher: Or*" 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) Site: NeWO-IRepair ❑
System Specifications: Tank Size.%GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Widtho Rock Depth Linear Ft.�
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.****
6w f 6--p
r'
Environmental Health Specialist's Signature. Date:
DCHD 05/99 (Revised)
'
' DAME COUNTY HC7EALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 989900317 Tax PIN/EH #: 5789-14-5394
Billed To: Glory Home Builders Subdivision Info: Covington Ck Lot # 36
Reference Name: Location/Address: HEMINGWAY COURT -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3168
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, S ion .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWA STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: a 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. �� t , S d
w
F
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
u
J00 Yolyr
Date:
JO
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department
En vifonmentaiffeaith Section J
P.O. Box 848/210 Hospital Street (�
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE
INFORMATION IS PROVIDED. /R`nefer% to the INFORMATION BULLETIN for ins
1. Name to be Billed (3'�br'� ,f j li ;(�P�S Contact Person
Mailing Address �'7 _`� (, �/� �/ CY/y✓� ��if , Home Phone
REQUIRE'I )y\,
.ruction .
h�
City/State/ZIP Cleml,7ot2f IVC—. Business Phone
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: ` 0 -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms _ # Bathrooms 2, 5—
b'trishwasher garbage Disposal Wishing Machine [e'sasement/Plumbing n 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: 42'County/City ❑ Well ❑ Community"
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes H -Ko`
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: //P X .Z'Wt�
Tax Office PIN: #_�7 c� / I / -5U9 /
Property Address: Road Name
City/Zip
If in a Subdivision provide information, as follows:
Name: ��� V i J'� q '�D C r e P K
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
r
Date Property Flagged: O', //- d 2—
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 fran
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.
DATE v" " D 3 - 4'-12-- SIGNATURE ZA/.���lu�,�, A/I
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).
IN
Revised DCHD (07/99)
Site Revisit Charge
Date(s):
Client Notification Date:
EHS'
Account No. 16 7 ?o66 3
Invoice No. 7�3 0 ; S
A► -..
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI
Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REgUIRED INFORMATION IS PROVIDED.
1. Name to be Billed Q E C Contact Person / of e- k rwr
Mailing Address PA ,IA d X � ,3 I) Home Phone
City/State/Zip ,lam/[ U'liJ Ce NC J2 760 Business Phone 91k -Y77:2- 1813-2Nik C 4,L1
If
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: M4fie Evaluation [ ] Improvement Permit & ATC [ ] Both
4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ ] Other %O+ Sq& 1yiS'O•J
5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal
[ ] Washing Machine [ ] Basement/Plumbing [ 1 Basement/No Plumbing
6. If Business/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
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [�j1Vo
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***`A FLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: A>ar+ 04 66 &C. lucc.e WRITE DIRECTIONS (from Mocksville) TO PROPEP7Y:
Tax Office PIN: # 781 - �& c1'2; ?6 1 ?� Ir-} K 0:C 0J V 4 Pu C.f
Property Address: Road Dame j D r 1( / m 'I — t. aS 4 t'Icar .4
Cit rzi A Z?oo b �e I f IUI u� rS
Y P
If in Subdivision provide information, as follows:
Name: [ b1 in %a+y C�ree.k J�RODQAced
r
Section: Lot #: 3
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter ar
subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified o
changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorize
ve of the Davie County Health Department to enter upon above described property located in Davie County and owne
.
Revised DCHD (06-96)
all testing proc oWs as necessary to determine the site suitability.
1111,5 :II;T•1 .11 111 LIF 11"T.1) J"UR LWAIPIN(i lint .` i II: PIAN:
r - DAPI iE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION_Z LOT
Soil/Site Evaluation
APPLICANT'S NAME �� DATE EVALUATED . a
PROPOSED FACILITY PROPERTYSIZE
SUBDIVISION _Lj /1 �ll i✓ f� C �� ROAD NAME6
Water Supply:
On -Site Well Community.
Evaluation By: Auger Boring Pit
t.�
Public 1�
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
k '�
Texture groupG
C
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:(1;12: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: ' / OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscane 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
Mineralo
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of 611- 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 (01-90)