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133 Brook Rose Ln Davie County, NC Tax Parcel Report Monday, September 26, 16 LIJ LL OZI WARNING: THIS IS NOTA SURVEY .Parcel lrifbftnation . Parcel Number: J700000077 Township: Fulton WCMNNumbeo 5767895444 Municipality: Account Number: 82524910 Census Tract: 37059-804 Listed Owner 1: BISHOP BRIAN ALAN Voting Precinct: FULTON Mailing Address 1: 173HICKORY TREE ROAD Planning Jurisdiction: Davie County City: K0OCKSV|LLE Zoning Class: D/YNECOUNTY R+\R' O State: NC Zoning Overlay: Zip Code: 27020'0000 Voluntary Ag.District: No Legal Description: 10.821ACHVVY64 Fire Response District: FORK Aoonmsod Acreage: 10.50 Elementary School Zone: CORNAlZER Deed Date: 7/2005 Middle School Zone: WILLIAM ELL|S Deed Book/Page: 006160783 Soil Types: PcB2.PcC2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: D/YV|ECOUNTY dzui|�in�~~�� Building Value: 8830.00 F�~^otureo :o±ra 0.00 Land Value: 91740.00 Total Market Value: 100370.00 Total Assessed Value: 100370.00 DAVIE COUNTY HEALTH DEPARTMENT /C�c/ Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT �2 RD / 7 Account #: 990000960 Tax PIN/EH#: 5767-69-5444 Billed To: David Lee Childress Subdivision Info: Reference Name: David Childress Location/Address: Hwy. 64 East-27028 Proposed Facility: Residence Property Size: 13.3 Acres **NOTE*'N iIsgmprov3m6ent/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 i �n�•WO/Ylr. #People _Z #Bedrooms Z #Baths ;?— Dishwasher: Dishwasher: e Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size IS30 kw— Type Water Supply&rJW Design Wastewater Flow(GPD) } Site: New M`__Repair❑ System Specifications: Tank Size IUD aGAL. Pump Tank GAL. Trench Width11 moo, Rock Depth 7-4 Linear Ft.ISO' Other: —_"DISC tt�.3 zcic . I,SS�t.I, U•J-�S <::?a.G. M1,3. Required Site Modifications/Conditions: O� GU"IA 'P IL Orr, �-�- S�a 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.on the day of installation. Telephone#is(336)751-8760.**** L4 :5b� i -ISO* t�•�ao+� �, i I 9-00 ' 3 r ` 1 'p 71 1 (— Environmental Health pecialist's Signature: Date: Z Zl m DCHD 05/99(Revised) r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000960 Tax PIN/EH#: 5767-89-5444 Billed To: David Lee Childress Subdivision Info: Reference Name: David Childress Location/Address: Hwy. 64 East-27028 Proposed Facility: Residence Property Size: 13.3 Acres ATC Number. 2326 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 WASTE WA S S V FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: _.. ate: 2 V 100 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 TI-4 Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. /!7 ti ST- moi t o Septic System Installed By: " A ��- Environmental Health Specialist's Signatur . Date: -44 )v-, DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT �5' �2, ow I Davie County Health Department D Environmenta/Hea/th Section 2000 P.O. Boa 848/210 Hospital Street JAN 2 7 Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CAMOT BE PROCESSED UNLESS ALL'-THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 1�� � h p 2 �� 1 A2�e:srC,ontact Person Mailing Address 'ee'S ,Aui;e t' Home Phone- 7-s- i y � City/state/ZIP Ile- &C Business Phone 2. Name on Permit/ATC it Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC EYBoth 4. system to service: ❑ House RAMgbile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms �_ # Bathrooms Dishwasher ❑ Garbage Disposal Gashing 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 Water supply: xl.C'unty/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑No 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. 3d Property Dimensions: I s p-,/f�-C�,� �j WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # �, � O/- Yy/ �f c �' fG,,�,.: ',� i3,���,0-4�C Property Address: Road Name 2 rl ? �� d � d City/Zip 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 1,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 to conduct all testing procedures as necessary to determine the site suitability. DATE 0d SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR PLAN(Include all of the following: Existing and proposed property-lines B ions structures, setbacks, and se tic locations). Site Revisit Charge --�— Date(s): a Client Notification Date: `1 EHS• Account No. Revised DC HD(07/99) Invoice No. �� IIZ46AI P C2 2413 7N /N ]6 �6f�' PcC2 L-- ';,,4j �® U � PaD ChA V5767 INDEXED ON 5787 INDEXED ON INDEXED ON INDEXED ON E 5767 5767 5767 ChA PaD � N 0 O V \ v � (13 38 A) This ma is for PERC TEST s 8 14 and BUILDING PERMIT purposes only. The Davie County Tax Administrator's Office assumes no liability for any information contained on this map. 241 8 21 2337 v A • a COUNTY-ID:J700000077 /254/ ` /539 :cB2 January 28,200010:34 AM /20 Ir !3081 /2021 (205) - /390/ Parcel Identification Number /7171 5767-89-5444 (2sa � 1 �O �y xQL � 1 » -'► DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000960 Tax PIN/EH#: 5767-89-5444 Billed To: David Lee Childress Subdivision Info: Reference Name: David Childress Location/Address: Hwy. 64 East-27028 Proposed Facility: Residence Property Size: 13.3 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 t__ L Slope% 5 HORIZON I DEPTH Texture groupSL�-- Consistence Structure G!� Mineralogy1 HORIZON II DEPTH CP - teg , -77'1' Texture group Consistence 'F' Structure 611 Mineralogyt HORIZON III DEPTH Z�{ Texture group q Consistence 55_ Structure r I Q_ Mineralogy HORIZON IV DEPTH ,a Texture group. Consistence -r Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0'C SITE CLASSIFICATION: ro EVALUATION BY: +-`�►� t.W LONG-TERM ACCEPTANCE RATE: _ OTHER(S)PRESENT: 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■/■■■/■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■E■■E■■■■E■■■EEE■X11■■■E■■E■■■■■■■■■E■■M■MM■E■■■■■■■■■■■■■■■■■■■■■ ■■ore■n■E■■■■■■■■■■i�■■■■��■■■ri■■■1�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■e■■■■■e■■■■■_�_-.'■■E■e■■■►�■■■■■■■■■■■��■e■■■■■i.a■■■■Mee■■■■■■■■■ ■■■■e■e■ee■■■■■■■■■■■■■■■■�■■■EE■ �■■Eri■■EEE■■�•9■t,�ee■,■■■■■e■ee■■■■ ■■efil'/I■I.i■■■■■■■■■■■■■■■■■Ilea■■■e■�I■■■■■cell■■■■■I�/i!�ia7Rif1.^,i�■■■e■■ ■■EI.■I■■■■■■■■poi:\■■■■■■IIE■OE■■I,■■■■■■■■11■■■Uii\■■■`1lliGiii■■■■■■■■■ ■!ER��iO■■■■�i�■■M■\\■■■■■11■■■■■■1/■■■■■■■■11■■■■■It■t■■■t'!1!It1aF■■■■■■■■ ■�liE:e%■■■■■►■■■■■e■■■\■■e■11■■■■■eie■e■■■■■it■■■■■11■■■■■ilillil■Ir■■■■■■■■ ■■■/■■■■■I.■■■■■■■■■■\■■■■11■■■■■IJ■■■■■■■■■11■■■■■Il■■�■Mil■■■■■■■■■■■■ %��■■■� ■ENNEN MM■U■■ IMMERSE MMMR2M ME■■EN limm11u■ ■ENNE■ ■■r�■■■■r�E■■■EE■■■■■E■■EE■■��.1■e■s■�eeEEEE■■■■■■■■eu■elles■■■■■ace■■ ■11■■■■■i�■■■■■■■■■M■■■EE►�■■■■■Ec■i ■■■■■■■■■e■■■eEEi■■■�i■■■EEE■■■■c■ ■■■■■■■E■■EE\�\■■■■■EEEE■■EE■■■■■■■■■■■■■■■■■■■�■i►�l�►`711■■■■■■■■■■■ ■■■■■■■E■■■■E■■���■■■■■■■■■■■���/■■ice\■■■■■■■■■■■■\1■rill■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■IiC�_!!sir■■■■■■■■■�\■■■■■■■■■■■I■■■\1■■■■■■/■■■■ ■■■■E■■cc■■a■■■■■■■E■■■■■■■■■■■■■■■■■■■■gin■■c■■cEE■i■�.c■i■e■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■E■■M■■■■■■■■■■■■■■■■■■■■■■Ifl�ii■■■■■■■■MEMO ■■■■M■■■■■■■■EEE■■■■■■■■■■■■■■■■�■■■■■■■■EEE■EEE■E!J■EEM■■■■■■OM■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■//��■■■■■■■■■■E■■ ■■■■■■■eEEE■■e■EEE■■■■■■■■c■■■■■■■■EE■■■c■■■■c■■■■■■ISE■■■E■■■■MEM■