169 Blue Grass Trail Davie County,NC Tax Parcel Report Friday, September 23, 201 f
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:- K20000006801 Township: Calahaln
NCPIN Number: 5717046784 Municipality:
Account Number: ` 8300235 Census Tract: 37059-801
Listed Owner 1: SWEET MARC D Voting Precinct: SOUTH CALAHALN
Mailing Address 1: 169 BLUEGRASS TRAIL Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 28.764 AC DAVIE ACADEMY Fire Response District: COUNTY LINE
Assessed Acreage: 28.67 Elementary School Zone: COOLEEMEE
Deed Date: 3/2011 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 008560070 Soil Types: ApB,EnB,MsC,CeB2,MsB,WATER
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 152990.00 Outbuilding S Extra 33000.00
Freatures Value:
Land Value: 186760.00 Total Market Value: 372750.00
Total Assessed Value: 372750.00
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
�OfJN'�Y NC or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT DO 3:yep
Environmental Health Section
P.O.Boz 848/210 Hospital Street
MockrAlle,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000972 Tax PIN/EH M 5717-04-6784
Billed To: Vicki Athan-Berkeley Subdivision Info: /641 Z/W d05, rl wil
Reference Name: Vicki Athan-Berkeley Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: 28.67 Acres
**NdPFI pr�ve?nent/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 M.V-0NAC #People #Bedrooms Z #Baths I
Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: EK Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Z$. - 51'ype Water SupplyQEIJ-�- Design Wastewater Flow(GPD) Site: New B- Repair❑
System Specifications: Tank Size )COO GAL. Pump Tank GAL. Trench Width� Rock Depth I Z' Linear Ft.
Other: 2— v=g�(>,-3
Required Site Modifications/Conditions: �,-'s-STQU- Or-3 C a-31W1-A L� 10t ocr- kop LI'JI�
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6 u 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 insta latio.Telephone#is(336)751-8760.****
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Environmental Health Specialist's Signature: Date: 2 27i t?O
DCHD 05/99(Revised)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990000972 Tax PIN/EH#: 5717-04-6784
Billed To: Vicki Athan-Berkeley Subdivision Info:
Reference Name: Vicki Athan-Berkeley Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: 28.67 Acres
ATC Number: 2331
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 T tment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE C TR rJON VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: 2
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 N 'WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time. ly
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Septic System Installed By: .J t L'Ltrlz-
Environmental Health Specialist's Signature: e: 2 2Z
IM
DCHD 05/99(Revised)
APPUCAT10N FOR SITE EV D
AWATION/IMPROVEMENT PERMIT&AT D
Davie County Health Department
En3 2000
Environmental Health Suction
P.O. Boa 848/210 Hospital Street '
Mocksville, NC 27028
(336)751-8760 `
***II�ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed Aro Contact Person - �j
Mailing Address 3 3 Home Phone ��JJ
City/state/ZIP i/7i"�C��/l/l� l � 7i9c�F Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: 40tite Evaluation ❑ Improvement Permit/ATC 940th
4. system to service: ❑ House 'Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms # Bathrooms
❑ Dishwasher ❑ Garbage Disposal "asking Machine ❑ Basement/Plumbing ❑ 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 nater supply: ❑ County/City I4Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes 9499
If yes,what type?
***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: bid �j(e� ,q�� Y uSID#VX0o WRITE.DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PIN: #
Property Address: Road Name (, � E�hk. �t'O 11,4f/1� y LIG%z
City/Zip 1'YVD N l� ,� a Zt��i •. 02 � �l�� 61,
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If in a Subdivision provide information,as follows:
Name:
Section: Block: Lot: Date Property Flagged:
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 Coun alth Depart e
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 19 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 Charge
5 Fes'' Date(s):
IL .
Client Notification Date:
c A7
EHS:
30
Account No.
Revised DCHD(07/99) 1 Invoice No.
-Li0
4 112 (57.22A) N (z.szn)
(3.96A)
4137 3270
1491 �� 2156 SR 1�5A (4.31A)
408 (385) 087 0079
111
y
G�0 49
3A)698 (11.0 4i1 yea
(1.94A) ''� 0955 03A) 94 3A
6879 2867
INDEXED y69 ` (4.aaA)
9428
ON 1747
5717
970
(3.65A)
4620
(23.93A)
(2.23A) (1.6A)
2326 9345 , 0364 8346 ` 2387
209
(219)
$ (1.01A)
0
5172 R
209 �J z9
295 2.14A) .
8909 (27.42 A)
5979 �a o 5966
(12.08A)
7345
(n
w
,p
1313 � Nw 9q z
(8.03A) • GIMP�� cif°
3600CA
,
� eJ
1106 v (8.99A) (15.22 A)
a
� + 7369 9440
11 3 Q(�
(60.75 A)
7108
1067.44 �q3 -
0043 95
234
(20.37A)
�1e1 (1124)
2922
(28.67 A)
S
6784 (25.85 A)
9501 a a^
79 q
337
y1\
O
W
i (5.34A)
2237
(569
569 I (2.04A)
$� 263 0142
INDEXED ON 5717 (261)
3 6L
(203) -
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000972 Tax PIN/EH#: 5717-04-6784
Billed To: Vicki Athan-Berkeley Subdivision Info:
Reference Name: Vicki Athan-Berkeley Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: 28.67 Acres Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L L
Slope%
HORIZON I DEPTH O b
Texture group C L Cts
Consistence S S
Structure
Mineralogyl:
HORIZON 1I DEPTH —1 to Z
Texture group
Consistence 5
Structure
Mineralogy ;
HORIZON III DEPTH
Texture group SG PG
Consistence
Structure
le-
Mineralogy1` `
HORIZON IV DEPTH -( 11Z ro+
Texture groupS� Sa
Consistence S
Structure I
e-
Mineralogy1 1
SOIL WETNESS 3 Z
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE / 012,
K
SITE CLASSIFICATION: 7 EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: NOL-Sr:%S DOGS
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
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)
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