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400 Hobson Drive Lot 21, Section ADavie County, NC , I Tax Parcel Report Tuesday. January 31. 2017 WARNING: THIS IS NOTA SURVEY Parcel Information Parcel Number: M5110B0021 Township: Jerusalem NCPIN Number: 5745560566 Municipality: Account Number: 82527111 Census Tract: 37059-807 Listed Owner 1: SPILLMAN CALVIN D JR Voting Precinct: COOLEEMEE Mailing Address 1: 366 HOBSON DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE State: Zoning Class: DAVIE COUNTY R-20 NC Zoning Overlav: DAVIE COUNTY CZOD Zip Code: 27028-0000 Voluntary Ag. District: Legal Description: LOT 21 HOLIDAY ACRES SECTION 2 Fire Response District: Assessed Acreage: 1.24 Elementary School Zone: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 512006 Middle School Zone: 2006E0184 Soil Types: 0003 Flood Zone: 111 Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: No COOLEEMEE,JERUSALEM COOLEEMEE SOUTH DAVIE GnB2,GnC2,ChA DAVIE COUNTY 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 webslte 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 �pUN� NC or arising out of the use or Inability to use the GIS data provided by this website. �►V j 5= Q e County Health Department 1836 ,Enronmental Health Section P.O. Box 848 j,{'; 210 H 'tai S 1. -1 111 ospi treet Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Fax: (336) - 753-1680 Name:�a'L jn b p1 I ( fYvIYI Phone Number 2) 3 L `oq " Q �Y4(Home) Mailing Address p L Hob 7 nRAIx (' 3��j G - J 5 p 1- _I 9 (D 6, (Work) yC. 5U1I1' AX a�6)D Email Address: Detailed Directions To Site: b r\ 1A0b56n -bf , &,bc 1 e home C #61;b4 -em . 416 lice.— d c)—ozi Property Address:_ q6t) abbsbr (-. 1,\org-sm11 U e-, Please Fill In The Following Information About The EXISTING Facility: r Name System Installed Under: t_(i loo 5 p 1 f I ro a Type Of Facility: No6l f e �) ni C Date System Installed (Month/Date/Year): ICON Number Of Bedrooms: Number Of People:_ Is The Facility Currently Vacant?Yes No If Yes, For How Long? ►'Yl(Ztn`}� 5 Any Known Problems? Yes (5 If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: b6fn e Number Of Bedrooms: 3 Number of People_ Pool Requested By: (Signature) Garage Size: Other: _Date Requested: �/� ! /.Z Q / 3 For Environmental Health Office Use Only C;ppro�ved . Disapproved � omments: 1(f)4 3 h (A 140t440 A `rAA- ��` 416 W1 < P 0 h L 16 V1 tiM-t /7 / Environmental Health Speciali Date: *The signing of this form by the Environmental Health 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. Check Money Order /,-) . 'i I Paid By:_ Account #: Amount:$ Received By: Date: /• 15" 0 RLYZHO'WZATION NO: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's '/�!' ' Mocksville, NC 27�2i P.O. Box 848 Name: a :r ./X�// •may / . N '" Subdivision Name: �•J � Ir Phone # 336-751-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#p •7 Cl �o SYSTEM CONSTRUCTION - - Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building -Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In ✓ liance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �C•-% C<�JJ ;�! ' `f..' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED DAVIE OUNTY HEALTH DEPARTMENT 7 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION 'Name:.? / �� _ " • Subdivision Name.rC�I-C--- Directions to property: :. r" Section: Lot: IMPROVEMENT PERMIT' Tax Office PIN:# Road Name j /.., y Zip: —NUIlCL""" THlb YEH,NllT 1J SUIfJEUl-l'U REVOCA11UN 1P• s1TE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS_ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE/ TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) - (�� NEW SITE L/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE��GAL. PUMP TANK GAL. TRENCH WIDTH .�_ ROCK DEPTH LINEAR FT. OR/ OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: f IMPROVEMENT PERMIT LAYOUT "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: i j Cls S�&W-8� �' —1A,•1 �� I�T� IAQ M. laor►ht, � ° ti F _ AUTHORIZATION NO. 1 OPERATION PERMIT BY: DATE: 11t "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY M DESCRIBED ABO AS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 05196 (Revised) 1 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 QXVX)CX (336)751-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED CRP ROWE JUN 19 1998 EtIV11202!'.',EtlT/.! it�!,a"j D "VIE C011;1TY UNLESS �l % ^ ALL TCHEE REQUIRED INFORMATION IS PROVIDED. Name to be Billed I Q, / � 1,`n "� �/ - .J`� 1 VJ 01-"Y , if � Contact Person _ Mailing Address il+'� - 0 �� o 7 Home Phone City/State/Zip ��/ �'��^ f'/� �/Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address �A yYL e Q6 O � Q City/State/zip 3. Application For: 4. System to Serve: 5. If Residence: ❑ Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: W" Site Evaluatio ❑ House Mobile Home # People ❑ Garbage Disposal Specify type _ # Showers 7. Type of water supply: ❑ Improvement Permit & ATC ❑ Business ❑ Industry # Bedrooms ❑ Both ❑ Other # Bathrooms 2— Q ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # Seats County/City # People # Sinks # Urinals Estimated Water Usage (gallons per day) ❑ Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? REQUIRED: *** IMPORTANT ❑ Community ❑ Yes ❑�No WITH THIS APPLICATION. Property Dimensions: C 1 WRITE DIRECTIONS (from -� ✓ . ^ I cksville) TO PROPERTY: Tax Office PIN: # /� (JQ 1 Property Address: Road Name 1 40 bran Cityrzip � `� i � � e to c_ DLO 19 - 3 l on (-16,11t. 1 If in Subdivision provide information, as follows: 1 T Name: 1 Section: Lot #: 1 1 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 , G I L) (� 1) e_, C,n O n 1 `lrrl GYl _to conduct all testing procedures as necessary to ea the site suitability. DATE e1117' � SIGNATURE Revised DCHD (06-96) YOU MAY USE THE 13ACK OF THIS FORM FOR DRAWING YOUR SITE PLAN. �� " V,0// • , „ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME EVALUATED PROPOSED FACILITY// PROPERTY SIZE l%t //PSUBDIVISION ' �^ fwC ROAD NAME ��d�t 1-,4 Water Supply: On -Site Well Community Public &--*" Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH >< o Texture groupC 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_L__, L J SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) EVALUATION BY:� /!.� (z 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 O■ ■M■■■■ ■M■M■■ ■■M■O■ ■■N■■■ ■■■■■■ ■EMNO■ ■■■N■■ ■■■■N■ ■■M■■■ ■MMO■■ ■■MMM■ ■■N■■■ ■■■N■■ ■■■N■■ ■■MN■■ ■MM■■■ ■MMON■ ■■■■N■ ■MMO■■ ■■M■■■ ■■S■■ ■■N■M� ■■■M■■ ■■MON■ NONE ■■m■ ■■M■ ■■MNO■ ■■NN■■ ■■■■■■ MONS■■ ■■■■■■ ■■M■O■ ■M■■M■ ■■M■■■ ■O■■■■ ■M■■■■ ■MMM■■ ■NM■■■ ■■M■O■ ■NM■■■ ■ENN■■ ■■■■■■ ■M■MM■ ■M■■■■ ■M■MM■ ■O■■M■ ■OM■■M ■■■■M■M■■ ■■■MM■■■■ ■■■■■M■■■ ■■MMM■■M■ ■■■■MMM■■ ■■M■■■M■■ ■MM■■MSN■ ■■■■M■M■■ ■■■mom■■■ ■M■M■■MM■ ■M■■M■■■■ ■■MMOM■■■ ■■MO■■■M■■■NM■MM L■■N■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■M■M■■■M■■M■ ■■MM■■ ■M■M■■MO■■■■MM■M�■■MN■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■MM■■■■■ ■■M■■M■■ ■■MM■■O■ ■■M■M■M■ ■■O■■M■■ ■■Moo■■■ ■OM■■M■■ ■ ■ ■■M■■M■■ ■■M■M■■■ ■■M■■■■■ ■■■■MM■■ ■■■o■■o■ ■■M■M■M■ ■M■■■■■■ ■■M■■■■■ ■■■■M■■■ ■■M■■M■■ ■M■MM■■■ moss■■■■ ■■M■■M■■ ■N■■M■M■ ■O■■ ■