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406 Lakeview Road Section 2 Lot 29Davie County, NC Tax Parcel Report Tuesday, January 17, 2017 WA KING: TH1515 NUT A SURVEY Parcel Information Parcel Number: 1614OA0021 Township: Shady Grove NCPIN Number: 5758839928 Municipality: 027 Watershed Overlay: DAVIE COUNTY Account Number: 8304152 Census Tract: 37059-804 Listed Owner 1: BRIDGEWATER LARRY A Voting Precinct: WEST SHADY GROVE Mailing Address 1: 414 LAKEVIEW ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: LOT 29 HICKORY HILL SECTION 2 Fire Response District: CORNATZER - DULIN Assessed Acreage: 0.98 Elementary School Zone: CORNATZER Deed Date: 9/2014 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 009690603 Soil Types: MsC,MsD,WATER Plat Book: 0005 Flood Zone: Plat Page: 027 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: Davie County, All data is provided as is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the [—a]-- NC County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all 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 210 Hospital Street p M Y t= P.O. Box 848 �r Mocksville, NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 North Carolina Public Health 07/17/2014 David L. Roach 4522 IvY Run Lane t" Denver, NC 28037 *RE: Application for improvement permit fo• Tax Lot: 29 Tax Block: Property Site: 406 Lakeview Rd, Mocksvil , 27028 Health Department File No.: 139509 - I Dear David L. Roach; The Davie County Health Department, Environmental Health Division on e 7 / 1 6 / 2 o 1 4 evaluated the above -referenced property at the site designated on the plat/site plan that accompanied your improvement permit application. According to your application the site is to serve a SINGLE FAMILY with a design wastewater flow of 4 s o gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 including related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule. 1900 and related rules. Based on the criteria set out in Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system. Therefore, your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: 0 Unsuitable soil topography and/or landscape position (Rule .1940) 0 Unsuitable soil characteristics (structure or clay mineralogy) (Rule .1941) M Unsuitable soil wetness condition (Rule .1942) Unsuitable soil depth (Rule .1943) Presence of restrictive horizon (Rule .1944) ❑ Insufficient space for septic system and repair area (Rule .1945) ❑ Unsuitable for meeting required setbacks (Rule .1950) ❑ Other (Rule .1946) These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, into surface waters, directly to ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. However, the Health Department has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. 15A NCAC 18A .1948 SITE CLASSIFICATION (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955, .1956, or .1957 of this section or a system approved under Rule .1969 if %vritten documentation, including engineering, hydro -geologic, geologic or soil studies, indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non infectious, non-toxic, and, non -hazardous; (2) the effluent will not contaminate ground water or surface water, and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people, animals, or vectors. The State shall review the substantiating data if requested by the local health department. History Note: Authority G.S. 130A -335(e); Eff. July 1, 1982; Amended Eff. April 1, 1993; January 1, 1990. APPLI CATI�OR SITE EVALUATION/IMPROVEMENT PERMIT & ATC RE Davie County Environmental Health P.O. Boz 848/210 Hospital Street Ree plVQd Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 Applicationor: 1 S' Evaluation/Improvement Permit F1 Authorization To Construct (ATC) ❑ Both Type of Application: ❑New System []Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name 0/4y 10 L Contact Person J/ AV, /J ©R PA-Roi Address 'f Sot-_7—VV RU A/ 1 -A -e Home Phone 704,2- City/State/ZIP Zt-7il/✓E2.. AJ- L' • --� S o 3 7 Business Phone 33& - ,:3v9 - 33cf Email OT6G Gu o,4 ►" it/ A- Co en eE� Name on Permit/ATC if Di erent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) ' ' (Permit is valid for 60 months with site plan, no expiration th complete plat.)p 4-7 Owner's Name �, 1� H S • Phone Number 3 3(, -1309 - 3(. 3 Owner's Address 415-,-2d- 2 v P u A) e ity/State/Zip ,1),FX/ Vc iC, Al d, ,Z91)37 PropertyAddress 4/40Q MII;euJ City/V1oC14SU :2a -2o AT Lot Size .. q 4 qe-P Tax PIN# --11- Subdivision Name(if applicable) {¢teao2 //i // _su�S g S�,, .Sectio D Directions To Site: Fhoy 641E aar of D-1ccg Auitt , A.i e- /-z Cy -,"?P -A) /47 zE 2 fz6 k %_u 2ti1 J- i /�!�.,n �-_ A-aDw . ✓ 7 m i /P n di?-1ZnAt/ W/// ,o-Dni 7-mA/CR i. ecify Problem Occurring: e 4FaU LS T iti y' PE/LK rE-5T DN DoT- .30 IF RESIDENCE FILL OUT THE BOX B LOW # People <J # Bedrooms # Bathrooms Garden Tub/Whirlpool kles ❑No Basement: [�� ❑No Basement Plumbing: EAkl�s`- ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats 6// Type system requested:onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: PC County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No i s, what type? 7�6 This is to certify at the information provided on this application is true and correct to the best of my known e. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this annlication is falsified or changed_ I herebv Brant right of entry to the Authorized Renresentative LAV-E:ViF-w leo 1 • ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION i i Account #: 63g6M Billed To: / n �Q DI N Reference Name: Proposed Facility: 4use Property Size: PROPERTY INFORMATION Tax PIN/EH #: �/ l! L Subdivision Info: >�6etor� Location/Address: T V & �q�w-ae. Date Evaluated: -I / /_ _l 1 L I - 1R A 0, Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public i i Cut ` SITE CLASSIFICATION: \�' 15 LONG-TERM ACCEPTANCE RATE: EVALUATION BY: f1LY1 iU`�l ibVl� OTHER(��P*&' �Q(64(U4 e4 44 REMARKS: 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 j Texture S - Sand LS i Loamy sand SL - Sandy loam L - Loam SI .7 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 EF! - Extremely firm 3Yet 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 lYQte� - Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface i 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 accentance rate - val/dav/ft2 noun nvhs ID—A—AN Landscapeposition HORIZON I DEPTH Texture group • Ism, Mineralogy_ HORIZON II DEPTH Texture Consistence HORIZON III DEPTH Texture group i Consistence HORIZON IV DEPTH Texture group Consistence Mineralogy • ���■�s��a������ RESTRICTIVE HORIZON CLASSIFICATION SITE CLASSIFICATION: \�' 15 LONG-TERM ACCEPTANCE RATE: EVALUATION BY: f1LY1 iU`�l ibVl� OTHER(��P*&' �Q(64(U4 e4 44 REMARKS: 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 j Texture S - Sand LS i Loamy sand SL - Sandy loam L - Loam SI .7 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 EF! - Extremely firm 3Yet 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 lYQte� - Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface i 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 accentance rate - val/dav/ft2 noun nvhs ID—A—AN DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c , Sewage Treatment and Disposal Rules (10 NCAC 10A 1934-.1968) Permit Number Name•'date ;�,"`-�/� Np Location _ *This permit Void if sewage system described below is not installed within 28' monfhs from date of issue. 36 avIds Improvements permit by *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: El System Installed by i ,c- Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. -r NIJ M gf'aV 41 Subdivision Name ,fir-�� /� =�� Lot No. �i Sec. or Block No. Lot Size 'Yr House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ { r . �l l Auto.Wash Machine YES NO ❑ '/`��� ) Type Water Supply *This permit Void if sewage system described below is not installed within 28' monfhs from date of issue. 36 avIds Improvements permit by *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: El System Installed by i ,c- Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS. PERMIT J Davie County Health Department b1 Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 76 o - G Z'7 1. Permit Req,uu�eJsted ByU G,OUla 1 Business Phone 2. Address ,�,�7~ T3 n _ r: , zo 6,6- 3. E3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorptio c) Sub- Divisioo/2 L' 4L Sec Lot No.� 5. System used to serve what type facility: House, -X— Mobile Home Business Industry Other b) Number of people Z 6. aj If house or mobile home, state size of home and number of rooms. House Dimensions 7 to X 3 `O Bed Rooms_ Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes ,2- urinals garbage disposal lavatory Z showers Z washing machine Z dishwasher sinks 2 8. a) Type water supply: Public— Private Community b) Has the water supply system been approved? YesX No 9. a) Property Dimensions 12- C h 24 O b) Land area designated to building site c) Sewage Disposal Contractor —5 -EA- d� 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? 4/0 What type? This is to certify that the information is correct to the bes my k edg . Date O e SignatDJOCAL OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE LAWS Allow 5 days for processing Directions to property: DCHD (6.82) Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size fi9C FACTORS AREA 1 AREA 2 AREA 3 AREA A 1) Topography/ Landscape Position 9) C_ U SS (<'__F –U (raj �{� S P U 2) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay)PS S S S PS U 3) Soil Structure (12-36 in.) Clayey Soils S S S PS U 1) Soil Depth (inches) pg - PS S PS U i) Soil Drainage: Internal S U S - S S PS U External PS S i) Restrictive Horizons Available Space U S'U U S 1) Other (Specify) S PS U S PS U S PS U S U Site Classification ✓ � - r U—UNSUITABLE Recommendations/ Comments: S—SUITABLE P_' ionaliy Suitable Described by Title SITE DIAGRAM k f-�'e -e DCMD )6-82) Date d