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312 Covington Creek Lot 20Davie Countv, NC Tax Parcel Report Tuesday, November 29, 2016 WAKNnG: TMh IS NUT A SURVEY Parcel Information Parcel Number: NCPIN Number: Account Number. Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: H8060A0020 Township: Shady Grove 5789145914 Municipality: 82523988 Census Tract: 37059-804 KULIS MATTHEW R Voting Precinct: EAST SHADY GROVE 312 COVINGTON DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006-7892 Voluntary Ag. District: No LOT 20 COVINGTON CREEK PHASE TWO Fire Response District: ADVANCE 0.75 Elementary School Zone: SHADY GROVE 2/2005 Middle School Zone: WILLIAM ELLIS 005930864 Soil Types: Pc62 0007 Flood Zone: 139 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 9 :�AAll data Is provided as is without wamnty or guarantee of any Idnd either expressed or implied Including but not limited to the Davie County, Implied warral. es of merchantabitity or fitness fora particular use. M users of Davie County& GIS website shall hold harmless the �r County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to �7 �O C NSC 1\ C or arising out of the use or Inability to use the GIS daft 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 #: 990001299 Tax PIN/EH #: 5789-14-5914 Billed To: Con Shelton Subdivision Info: Covington Ck Lot # 20 Reference Name: Location/Address: Covington Creek Drive -27028 Proposed Facility: Residence Property Size: .755 acres ATC Number: 2608 **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 1,f #Baths �-*04-S Dishwasher: Z` Garbage Disposal: e Washing Machine: 00" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size o k�-`f Ci Type Water Supply rl Design Wastewater Flow (GPD) w Site: New 91' Repair ❑ System Specifications: Tank Sizqla&Q_ GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Widthd;�' Rock Depth /.2 Linear Ft.Mr 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. nth day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialists Signature: Aa Date: DCHD 05/99 (Revised) Account #: 990001299 Billed To: Con Shelton Reference Name: Proposed Facility: Residence ATC Number: 2608 L A— DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5789-14-5914 Subdivision Info: Covington Ck Lot # 20 Location/Address: Covington Creek Drive -27028 Property Size: .755 acres 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 WASTEWAT R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 64V—Vz��r Date: /jQ & 'bb 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 arantee that the system will function satisfactorily for any given period of time. 1 if t Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department • Enwimmenta/ Health Swdon P.O. Box 648/210 Hospital Street Mocksville, NC 27028 (396) 781-8760 ***nW0RTMV** THIS IIPPLICKTION CR MOT BE PROCESSED UMLESS ALL THE REQUIRED tNrOR WXON IS PROV IDED . Refer to lthe IMt1"O MTION BULLETIN for instructions. j 1. Nar to be Billed Contact Verson /�'Q - ^e To �— Ma ring Address ., /2 S 7 lJ S (,q shun* ! -! 9 - 2 C> Z k citylab's/::p i%%n s 11 /J - G. Z-70 ZR ausinese whone, t 3 � �� 3 �i S - 2 0 0 (o Z. Nar an Rerait/ATC it DLEfesent than above Mailing Address city/stab/zip e. Applioatioa For: 4 Per= -'103 O Batik a. system to services �e O Mobile Some O Business Other S. it Residence: s People 3 a Bedrooms _ a Bathrooms 2 J shwashsr fil- a�rba Disposal Offing lfaahina O aasa�ant/Dlm�bing 0 sasdant/1:o pluobing 6. It susinsss/Industry/oth"t specify typa I people ! sinks I commodes # showers I urinals t# water Coolers IF S'OODSERVICR: # Seats Zatimated Water 'Usage 'gallon per day) 7. Type of water supply: r&unq/Cite O Kell' O Community a. Do you anticipate additions or expansions of the facWty this system Is Intended to serve? O Yes axe— -- If yes, what type? ` f ***IMPORTANT*** CWENTS MIST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPWCATION. Property Dimensions: 1 /fc S WRITE DIRECTIONS (from Mocbvilie) to PROPERTY: Tai Office PIN: # / y - S--,/ 20 Property Address:' Road Nama�0 s City/Zip Te�f/l✓� _ < < Z7yo6 If in a Subdivision provide information, as follows: Names section: 1E + Block: IAt: Z � Date Property Flagged: 9/0S-/00 This is to certify that the lutbrmation provided Is correct to the bat of my knowledge. 'I andershnd that any permit(s) Issued here&fler are subject to suspension or revocation, if the site plans or intended no chsuge, or If the information submitted in this application Is falsified or changed I, also, understand that I am nsponsOk for all charges Incurred front this application. 1, hereby, give consent to the Authorized Representative of the Daviq ty Health Departme t to enter upon above described property located In Davie County and owned by Sf c -'/A_ _ C. to conduct all testing procedures as necessary to determine the site eaitablity. DATE+,, • f V /7 y J 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). y 1 r Site Revisit Charge `i U. �e Revised DCHD (07/99) 'S 12' l Date(s): Client Noti6adon Date: EHS: M i Account No. / Invoice Na }' 3 �^ ✓ APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department D C@ n Environmental Health Section U P.O. Box 848 JAN J o Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE UIRED INFORMATION IS PROVIDED. us46 r" 1. Name to be Billed r+A e Contact Person / el —A A g Mailing Address �� 1I91_1 >! � d Home Phone City/State/Zip .q/i�aia CC- A2( 706() Business Phone 77.Z Z8/3-,391k(�"�+bl�) 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For:ite Evaluation [) Improvement Permit & ATC [ ] Both , l 4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ ] Other c2 -*t 10+ SLS i I y/S /n�1 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ ] 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 If yes, what type? EIIIIEh A PLAT cit? SI IE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***-A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: r+ 6� 66 ct.0 . PAt-Le I WRITE DIRECTIONS (from Mocksville) TO PROPERTY - Tax Office PIN: # 78`3 �_ - '� ; Tkl a ST 1x +CS Property Address: Road Dame g� 1 D r �( / m l — [ y �5 -� C We 14 City/zip ^,B�IJ . 270 0 4, c ar [j =CAM l iN e rs If in Subdivision provide information, as follows: Name: �bl)/�'4'-AJ 0-1-ee-lC ��roraoted i Section 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 I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized ve of the Davie County Health Department to enter upon above described property located in Davie County and owned u v I Revised DCHD (06-96) SIGNA all testing procS�Iures as neyessary to determine the site suitability. I-11IS Al?EA MAI/ 13E 11SEb fOk blMIVINC 110111? SITE PLAN: ' DAVIE COUNTY HEALTH DEPARTMENT 1 - Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME �i�$ 6' DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit L ROAD NAME 21t Z Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH r f Texture group Consistence r Structure Mifieralogy A, / 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: OTHER(S) PRESENT: END 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 Mineraloav 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