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237 Clark RdState: NC WARNING: THIS IS NOT A SURVEY 27028-0000 Legal Description: .712 AC OFF CLARK RD arceftn-Tion, 0.72 Parcel Number: M4120A001301 Township: Jerusalem NCPIN Number: 5735575021 Municipality: WS -IV -P Account Number: 12676250 Census Tract: 37059-807 Listed Owner 1: CAMPBELL NANCY Voting Precinct: COOLEEMEE Mailing Address 1: 237 CLARK RD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zip Code: 27028-0000 Legal Description: .712 AC OFF CLARK RD Assessed Acreage: 0.72 Deed Date: 7/1997 Deed Book/Page: 001960028 Plat Book: X Plat Page: WS -IV -P Building Value: 55290.00 Outbuilding & Extra 940.00 Freatures Value: Land Value: 12600.00 Total Market Value: 68830.00 Total Assessed Value: 68830.00 Zoning Overlay: DAVIE COUNTY CZOD Voluntary Ag. District: No Fire Response District: COOLEEMEE Elementary School Zone: COOLEEMEE Middle School Zone: SOUTH DAVIE Soil Types: GnC2,RnD,ChA Flood Zone: X Watershed Overlay: WS -IV -P [#I 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, NCimplied 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 or arising out of the use or inability to use the GIS data provided by this website. AUTHORMATION NO: 0889 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section rmitfee`r/%�/�fi�'' r �'Jir�� P.O. Box 848 Pe 3.`30 ✓Ko PROPERTY INFORMATION Name:' Mocksville, NC 27028 Subdivision Name: ' Phone #: 704-634-8760 Directions to property: Section` ltfIlotl—L. AUTHORIZATION FOR all WASTEWATER Tax Office Pint t 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 in fiance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage. Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED. ,�. .1r;v ({Zc rd"�'`�M'Y .>. +'Y'" :'"" ♦r !'ti.i^ra }r.,': ,..,r ,� '. } �r-r `,r . ... � Y.r t"' .yv.cY1is h<£.+� .r4i �• may,.»t .l.Sls T'^ ):., :j;Ori 1-``� iy�a� , `/ DAVIE COUNTY HEALTH DEPA,,�T FNT S IMPROVEMENT AND OPERATION PE�Ri�IPROPERTY INFORMATION PerrrutteF..s iName i f < �' �.: - / •r i% Subdivision Name: `puections to property �` y1,>; Section: Lot: +. DAFROVEMENT ff E PERMIT Tax Office PIN:# % !�' 4 Road Name id / -- Zip: ,.ler) **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ;r"iir�: �• �. • F, R:c ,': r r% i ,rr 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 „y.� #BATHS r f # OCCUPANTS �,1 GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPES # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY %;, DESIGN WASTEWATER FLOW (GPD) NEW SITE L_--' REPAIR SITE it ^ i.. _ r SYSTEM SPECIFICATIONS: TANK SIZE.,2C7U GAL. PUMP TANK GAL. TRENCH WIDTHS ROCK DEPTH LINEAR FT. z, OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: 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 (704) 634-8760. OPERATION PERMIT y� SYSTEM INSTALLED BY:�N 70 70 • v, Go i � g AUTHORIZATION NO. '� { OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DE RIBED ABOVE 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 GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) :. DAVIE COUNTY HEALTH DEPARTMENT Ej IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION " "Pernutie,& Directions to property: " ._. IMPROVEMENT PERMIT Subdivision Name: Section: Lot: Tax Office PIN:# r1 hc Road Name:+ t� tlh�:- .'�_,. Zip: .-i **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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) J� ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 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 'fit_ # BEDROOMS } # BATHS - ` # OCCUPANTS :� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No �' •F TYPE WATER SUPPLY ~ ` f DESIGN WASTEWATER FLOW (GPD) '11'P,',`,,`-' LOT SIZE � � NEW SITE lam--'` REPA82 SITE SYSTEM SPECIFICATIONS: TANK SIZE�r,OP GAL. PUMP TANK GAL. TRENCH WIDTH 'S ROCK DEPTH J LINEAR FT.,. ' r OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT JLC'%� � �;�'.�; l.,�',✓;�.%r` "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 (704) 6348760. OPERATION PERMIT SYSTEM INSTALLED BY: Jj N d 1/ ► 11 �/l 701 7v ' V, _0 AUTHORIZATION NO: Q 9 OPERATION PERMIT BY: --- (�fi'►' t %- i�d DATE: "THE ISSUANCE OF THIS OPERATION PERMrr. SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 M (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. N 29C C C amp 1 i� qn c C. cavnv be, 1 1. Name to be Billed U1 � e 1 Contact Person �l U Mailing Address f• ti • 6 X 3 a 31 Home Phone 1 0 9 3 -1 p 3 6 I City/State/Zip So l ls6-x rUA NC 09) L46 Business Phone 2. Name on Permit/ATC if Different than Above `ST A'N Q RN C 0.MP b e'l I Mailing Address F -0-6y, 3 31 City/State/Zip Sags bvkrh C' a? ILA5 1-0 3. Application For: P'rSite Evaluation [►Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] Houses L4-Klobile Home [ ] Business [ ] Industry [ ] Other ' 5. If Residence: # People 1 # Bedrooms # Bathrooms teMishwasher [ ] Garbage Disposal PI -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: Pj2ounty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [PI"No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE SUBMITTED WITHS APPLICATION. Property Dimensions: ' i C WRITE DIRECTIONS (from ocksville) TO PROPERTY: Tax Office PIN: # 5`?3 5 - _ - l� -I O iD U l -k-6 Property Address: Road Name ClO, T -Y1- S��-V k'x y-' O r 'Ir0 �L4� cS�O Yle F.00� City/Zip C 00 -C M.'e a10 l q '�'4 k,'e & �0. d 5A UU n e. V -p 0.O If in Subdivision provide information, as follows: SVA 0aeA- -�-o CAarY,, S- - rre e+ Name: C)n �OVI.r 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 Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by 1AS,1 S � �� to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE rnG�� C Revised DCHD (06-96) THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAY: 1% a 1�� f'b 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME f PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community, Evaluation By: I Auger Boring [i- Pit SECTION LOT. DATE EVALUATED 4 3 `147 PROPERTY SIZE Z ROAD NAME ioel Public Cut - FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTHt— Texture groupG° Consistence Structure J7 /L 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 i SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) LEGEND Landscape Position EVALUATION BY:�� OTHER(S) PRESENT: 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 AMA 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 EE■E■■■■O■ ■■EOEO■EE■ ■■E■E■■NN■ ■OOONEMEME ■E■E■EN■■■ ■E■■■EE■O■ ■■■E■EN■E■ E■E■E■ENE■ ■■EEE■■E■■ ■EEEE■ON■■ MEMO■■EE■■ ■■■■■EENE■ ■EE■ ■EO■ ■■■N ■■E■ ■■NNE■ ■■NNE■ ■NEON■ ■NEEM■ ■EMNON ■NN■E■ ■MEMO■ ■N■■E■ ■ENNE■ ■ENNEN ■■O■■■ ■■E■■■ ■ENNE■ ■■O■■■ ■ONSON ■NEE■■ ■EN■E■ NONE ■■E■ ■■E■ ■EO■■ ■ENEM ■■■E■ ■■EN■ ■ENEM ■E■■■ ■ENEM ■■NE■ ■■EN■ ■■■ONNNNN■■■ ■■■■■EEE■NE■ ■■■■ENNE■EME ■E■■EENENN■■ ■O■ENNNNNO■■ ■E■E■■EEEOE■ ■E■ONENEE■■■ ■■■■■EEE■■E■ ■■■■ONO■■■E■ ■NN■■E■■NN■■ ■ONNEE■■■NE■ ■EEENNEN■■N■ ■■■EN■EOENME ■■■OO■EE■■N■ ■■N■■NOON■O■ ■■■■NEEEMEME ■E■ ■EEN■■ ■■■NEN ■■■EN■ ■■NEE■ NOENO■ ■EMNON ■ENE■ ■ENE■ ■N■■■ ■OE■■ :• Referents Survey : Sur-,. fcr Charlie Bamhor by Tutterow Surveying Co. Grady L Tutterow, R.L.S. Dated : 11/07/83 OWG Line Bearing Distance L/ N 68' J4' 58'-E-_. 51.11' L2 N 6' 32' 09' W 47.26' L3 N 63' J4' 58' E 51.74' L4 S 6' 32' 09' E 43.72' L5 S 2' JS' 40' W ,774' L6 S 2' J5' 40' W !00.00' L7 N 68' J4' 58' E 44.41"' L8 N 2' 22' 43' E 39.46' L9 N 6' 32' 09' W 15.43' VO S 1' J5' 40' W 5Q 00' L11 N 68' J4'58' E 44.26' L12 N 2' 22' 43' E 49.92' L13 S 6' 32' 09' E 32.25' L14 S 88'51' 04' E 9.88' L15 S 1' J5' 40' W 100.00' L16 N 68'J4' 58-E 4.785' L17 N 2' 22' 43' E 98.13' L18 S 2' 22' 43' W 16.20' L19 N 69' 45-68- E 5Q 16' L20 S 87' 48' 59' E 16.42' L°l N T 08' 46' W, 107.0J' L22 S 15' 30' 36' E 103.84' L2J S 7 08' 46' E 14,891 L24 S 67' 51' 12' W 1,752' L25 N 15' 30' 36' W 66.28' L26 N 67' 51' 12' E 19.62' L27 S 31' 48' 37' E 18.89' L73 S 9'20' 42' E 18.72' L29 S 40' 27' 56' E 99. a'7' LX N 77' 09' 18' E 2Q 49' L31 S 62' 50' 39' W 95.73' LZ N 4.24' 29' W 2.k26' LJJ N 80' 59 54' E J222' U4 N 75' 24' J8' E 54.40' John M. Cobb 78 - 155 Mop M-4-12. 146 - 852 Elk A. P17 Moo M-4-14 1 g9 t 6:k A. P19 - P. .�GETAIL 12 0 �/ t �w� o4N N vQ�I 1 ��o i^ Alma Woodruff Sylvia W. Duniop 129 - 694 Mcp M-4-12. B:k A. P16.01 dt" t jet (L-2527) . lats.�-2 . Sylvia A. White 185 - 779 'Mao M -A--12, m t4Elk A, P15 t s:: Ref. L_�' ohn F. Cuthber:son191 - B7t ✓// Map W-4-12 1 Blk A. Pio Rodney P. Tenor 172 - 115 Moa u-4-12. Elk A. P1201 1 1 l' CETA1L }2 /NOT TO SCAL tw 1 ., RIGriT-CF-WAY A=ISITION `h C r CLARKS ROAD Tax Mop 4-12 parcel t Area of Acquisition 1 16.01 0.054 Ac. / 2,360 Sq. Ft. e 15 0.097 Ac. / 4,204 Sq. FL e 14 0.047 Ac. /2,025 Sq. Ft. it 19 0.049 Ac / 2.114 Sq. Ft. 13 0.092. Ac / 4,024 Sq. FL: 12 0.1.3,8 Ac / 6,032 Sq. Ft. 22 (Area #11 0.020 Ac / 872 Sq. Ft_ ' 22 (Areal) 0.171 Ac / 7,447 Sq. Ft. t 8k A. Pit r Tax Mop 4-13 I Area of. Acquisition parcel # I. -Mitzi M; at]tter--, -that Mei G. lhcn 30 0.053 Ac. / 2.294 Sq. Ft. 33 0.086 Ac. / 3,753 Sq. Ft. Will White, Jr. -+r 1 1 1 Grady L u stow, ._ . Dated : 8/07/81 DWG # 11681-2 64 - 474 15.01 0.417 Ac. / 18,177 Sq. Ft. Mcp M-4-12, M Blk A. P13 L16 y48J' atone �� J Charles T. Tenor 1 t 160 - 822 Mop M-4-12. ` t t 8k A. Pit noir by r rir,o' 1 `r :;c _ j,; •s Referenca' �grvey�;'`'"'� ; r �_ 'Sure. for Moses David Stevenson ^ I. -Mitzi M; at]tter--, -that Mei G. lhcn 141' Sg• cnd Albert Woodruff" me this day and 2y � �■ Ref. by Tutterow Surveying Co. Witness my hand ., t I T tt R t S (L-2527) e.t.p2 44 Will White, Jr. -+r 1 1 1 Grady L u stow, ._ . Dated : 8/07/81 DWG # 11681-2 64 - 474 Lff Pt. on Mcp M-4-12, M Blk A. P13 L16 y48J' atone �� J Charles T. Tenor 1 t 160 - 822 Mop M-4-12. ` t t 8k A. Pit noir by C ✓ t i► �• E _ aLp.. 3/4' 141' Sg• � Lig N a�. e.t.p2 44 t,'y o9. y Q Comeiiw Horgrovec �p ` a► ; a'S J__ a•� 63 - 322 C" Mop M-4-12, Elk A. PI t C+ ai.x. 1' by � � scone • / A.R. Haile man . t Mitzi . Tu teroN My Commission State of North C the foregoing ca tp be correct. 1 in Mcp Book Register of Deed: C* mi.p. - New firer s.:.p. - Existing :xist:ng cp """ ' ComF