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784 Daniel Rd�avie Counry, IVC Tax Parcel Report Wednesdav, October 12. 201E WARNING: THIS IS NOT A SURVEY �..�� , ,��.�,��„�� ..�,�,....�aa.� �� .a._�� _ _ .�, �.r..�,, �_, �.�:._��,�,�a�.�.��.��,�.� � � Parcel Information ..�.�� ...�_._�.� Parcel Number: L40000003503 Township: Jerusalem NCPIN Number: 5736442623 Municipality: Account Number: 69980000 Census Tract: 37059-807 Listed Owner 1: SPIILMAN ROGER P Voting Precinct: COOLEEMEE Mailing Address 1: PO BOX 738 Planning Jurisdiction: Davie County City: COOLEEMEE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27014-0738 Voluntary Ag. District: No Legal Description: 1.137 AC DANIEL RD Fire Response District: JERUSALEM Assessed Acreage: 1.03 Elementary School Zone: COOLEEMEE Deed Date: 3/2006 Middie Schooi Zone: SOUTH DAVIE Deed Book / Page: 006530184 Soil Types: Gn62,MsC Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 37630.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 14370.00 Tota) Market Value: 52000.00 Total Assessed Value: 52000.00 °A �'F Davie County, `'oUN�� NC �,r . . . ` - . . . . , � �s: _r�i - . , . �.'��L-:...`'OI�'��,C`Y'�t�� }1,� ,, -�.� . -•, � � ,.. . . , . _ . :.. .. :. ' n�.i.r, .. i' i` 4� J �1}, S ,�, a F� • � �* , .. .: . . ., . �.. . . . AUTHoxIz�,;riON NO: O$ 5 � DAVIE COUNTY HEALTH DEPARTMENT " � Environmental Health Section PROPERTY INFORMATION �� - ti� Permittee's �� P.O. Box 848 1� ��;f'�� Name: Mocksville, NC 27028 • Subdivision Name: ��,( i-� , �* �l2 Directions to ro ert � i„� /� ,,y�� Phone #: 704-634-8760 r7�as g�% P P y� �� ' AUTHORIZATION FOR Sec[ion: Lot: i,18� WASTEWATER Tax Office PIN:# �/�i� - � �! - �� SYSTEM CONSTRUCTION Road Name: ��I�1L,t. ��'�. ZiP; c� j�D,�,� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �! , � / ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,�` ;.�`�/}�„fi'��!`✓.�.%� �`f �� `�"��'7 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HE� SPECIALIST . DATE ISSUED ' 1 n � ', ,.,` '�� } � _ . . _ - :' �S� L'fi; " � � � . �.� � . . _,t � t o.��.,. t � �.��,s�C � � ��v �e . �� .�� 3� . , - . - � , -�'°� �' » : � ' �� `_� _ DAVIE �OUNTY HEALTH DEPARTMENT v -; ; : a.�. ,.� ; + ,, , . � y . , .� -� � , IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION �- �� : ._ Pernuif�e's'+.�'� -`, /�' ,,.. � �• f � Name:� � "�,.� ��.F/.� �,..r>��'.i°,/ ,� . ' Directions to property: _� ��"� - �� ;%" ��r` IlbIPROVEMENT PERNIIT �- - � t ,= Subdivision Name: ... t * 'r'; � �+�"�.' �3� r � Section: Lot: � 1�,;�� t.�,�. , � / ^ 1 f ! ,;f ...._� .. Tax Office PIN:#� `�` " 1' " - =1=` �� ^� � Road Name: 1,r3,d..%1:�/ �, t��. ZIP: G� r L�.'? �i ,. **NOTE** This Improvement Pemut DOFS NOT authorize the constcuction 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 pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Secdon .1900 Sewage Treatment and Disposal Systems) '/ ,: r' ***NOTICE*** TfIIS PERNIIT IS SUBJECT TO REVOCATION IF S1TE . ,', . `, , ;',' , , ,�.',: � �,' ,r>n� '�' PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER �' ENVIRONMENTAL HEAL'I'H SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING Tf� SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �# BEDROOMS c� # BAT'HS `� # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFTCAT'ION: FACII.ITY TYPE # PEOPLE # PEOPLF/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE ��I! � TYPE WATER SUPPLY �� DESIGN WASTEWATER FLOW (GPD) � �� NEW SITE� REPAIR SITE / ' r, � / SYSTEM SPECIFICATIONS: TANK SIZE �� GAL. PUMP TANK GAL. TRENCH WIDTH ---�1 ROCK DEPTH �=+ LINEAR FT. ��6 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT f� **CONTACT A REPRESENTATIVE OF THE DAVIE COUN'fY 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 �TEL.FPHONE # IS (704) 634-8760. OPERATION PERMIT ,_.. ....s- SYSTEM INSTALLED BY: t..—a ��C� x�� r }-�%►L�� _ �.�.-�-..� � .��.,,._,.-��,. k � r,,� ��.> � � � AUTHORIZATION NO. �" OPERATION PERMIT BY: / v '�/� �}/�� DATE: 1/� S% �� I , � **THE ISSUANCE OF THIS OPERATION PERMIT 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 OSN6 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 � (704) 634-8760 Is��..�� h�AY 2 2 19�7 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed�G'�Y�\f � �y'i Contact Person �'��( 1�� C�� 2 Yl MailingAddress � �i � QQY1i L'` �,Cl Home Phone ��'�/' � �03� �-��0`�3 �' City/State/Zip �l(�C.��I�J l �� @ n,�C o��ag��$ Business Phone � ��i - �� % -s'��j4,� � 2. Name on PermidATC if Different than Above Mailing Address 3. Application For: [] Site Evaluation City/State/Zip ' [�] Improvement Permit & ATC [ ] Both 4. System to Serve: [] House �] Mobile Home [] Business [] Industry [] Other 5. If Residence: # People�o _# Bedrooms_� # Bathrooms (. � Dishwasher [] Garbage Disposal (� 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: [] County/City [)(J Well [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [�] No If yes, what type? EZTHEn A 1'LtIT OR SZTE PLtiN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** ��mOF THE PROPERTY MUST BE y`j� c�k4 �.CI 1� 3� SUBMITTED WITH APPLICATION. 1 Property Dimensions: 1. �� Li' C f��'" ; WRITE DIRECTIONS (from ocksville) TO PROPERTI': Tax Office PIN: #_�� -�I_ -��_ ;� n U � ��ut r� � d�1 �� C �� Q�'1 �C`I Property Address: Road Name 7�_��1 Yl i e � �C 1 � 1 F�s2�'1 � S�t �r� �� QQ1�lt e, �C` City/Zip I��(�f�SUc �(�P rU� a�ea 8; s� (�r �-� 1'�'�� e S pY1 �.G�l� If in Subdivision provide information, as follows: ��.-C7� �l_t.�i (�i�iS� �--f.`nilC ��C� o�Y�C� Name: ; �-�O� C� r� �,G�� —�5 \ C� �C��I�J eC' �l Section: Lot #: � oC � C� tK 1�►c� us e�`' lFCit�Pi �1G� � kX1k �� This is to certify that the mformarion 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 1,�,L „(� _/Yl to conduct all testing procedures as necessary to determine the site suitability. DATE 5- a a-�� SIGNATURE l.�-J ,�i�Yl Revised DCHD (06-96) THZS �InEA �1tt� $E USEb �OIZ bt�itVZNG JOUR SZTE 1'LAN: APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE �� n�— Davie County Health Department D L� Environmental Health Section P. O. Box 848 FEB - 41997 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCE ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ,�� /�i%%��Gi G,� — L„1�% � Contact Person ��i�'1 —�� Mailing Address �� U �,��( _ � �'�1'l�! Home Phone b/ L� City/State/Zip � � .�� , - � �� 11..�� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: � Site Evaluation ❑ Improvement Permit & ATC ❑ Both 4. System to Serve: � House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms � # Bathrooms ��, '0"Dishwasher ❑ Garbage Disposal � Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: # Commodes If Foodservice: 7. 'I�pe of water supply: Specify type # Showers _ # Seats 0 �it�- # People # Sinks # Urinals Estimated Water Usage (gallons per day) ,�' Well # Water Coolers ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes ❑ No If yes, what type? PROPERTY REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �� r%�> � WRITE DIRECTIONS (from � Mocksville) TO PROPERTY: Tax Office PIN: #�',� c_ y� - �/ 2� � . , �70/ S,T�M�� Property Address: Road Name _�/YI O . � . ��0�1 �� ,%��%d�� ' �d �� rs-t' �-�'o i c�cyiz�P �� , nli�� I-- If in Subdivision provide information, as follows: ; �th �/� �S� jD� / ! Name: � �h �l6 use Section: Lot #: � r ' , .� �A n� �� rar►� 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 as necessary to determine the site suitability. DATE �C L��— % � SIGNATURE Revised DCHD (06-96) . cond'uct all testing procedures : �..�� .-, � _ + L ��,:. , ;g.t�. : � '�'; � � � �o�� bZc Z I 175 C� K._ , . �s - '. � , �- �s ,,, a. . . ;� , O _ rv c,� I� i �' - � ; '_ . QI .�i . d W 2 -� - o�i , � W � W N 2 ._ t� 'A " p w. _ _ . > _, � �"`.: ,. _ � ,., „�'� -rK :., , � , � (3j _ �w� �� ti 08 5 Q � �� — y � a v� ,. � _ _ , , �„,... `j' D: ,��. : V _ F �.� �" �..= ��c �.� n D c., � �'� -� �0 0 � j cs" " N� a, , � o' II � ' 1 ��::z� r �.:��+�;,_ � i�� 2QQ. �c'09E r �✓• : _. �- ', 392 27 .' 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' DAVIE COUNTY HEALTH DEPARTMENT " ' Environmental Health Section SECTION LOT � SoiUSite Evaluation APPLICANT'S NAME ��/'i �� DATE EVALUATED �l /�/�� PROPOSED FACILITY � PROPERTY SIZE �� SUBDIVISION ROAD NAME � � /�� C � Water Supply: Evaluation By FACTORS Slope % HORIZON I DEPTH Texture group Consistence Structure HORIZON II DEPTH Consistence Structure HORIZON III DEPTH Texture group Consistence Structure HORIZON IV DEPTH Texture group Consistence On-Site Well Community Auger Boring f Pit 1 I 2 Public !� Cut 3 4 5 6 7 �, _s D " 3b" G �i tr'i SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION � LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: � LONG-TERM ACCEPTANCE RATE: � � REMARKS: DCHD (01-90) ., EVALUATION BY: ��/� 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 Mineralo�v 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 - gaUday/ft2 ■■ ■��■��■ ■�■�■��■ ■�■�■��■ ■�■�■�■■ ■■��■ ■■■■■■■■ ■■��■ ■■�■■■■■ ■■■■■■■■ ■��■��■ ■��■��■ ■��■�■■ ■�■��■■ ■■■■��■ ■■�■ ■ ■■■�■�■■�■ ■��■�■��■ ■��■■■■�■ ■��■■■■■�■ ■��■■ ■��■ ■�■��■�■■■ ■■■■�■�■■■ ■■■��■�■■■ ■■��■■■■■■ ■��■■��■ ■�■■■�■■�■ ■��■�■■�■■ ■�■ ■■ ■■■■■ ■ ■ ■ ■��■�■■��■■■ ■i!�il■■■��■�■ ■■��■■■■■�■ ■■��■■■��■�■ ■��■ ■■■■�■ ■■�■ ■�■■■■ ■■■■■�■��■ ■�■■��■■■�■■ ■��■■■■■■ ■�■��■■�■■■■ ■■��■■■�■■■■ ■■�■■��■■ ■■�■��■■��■ ■■■■ ■�■�■■ ■■■■��■■■�■■ ■■ ■■ ■■ ■■ ■■ ■� ■■ ■ ■ ■��■��■ ■■��■��■ ■■��■ ■��■■��■ ■��■■�■ ■■��■ ■�■��■■ ■■■■■■■■ ■��■��■■ ■��■��■ ■��■■■�■ ■■■■�■■■■■■■�■■ ■��■■��■■ ■��■��■■■ ■■■��■■�■��■■■ ■��■ ■■■■��■�■■■ ■��■■��■■■�■��■ ■��■■■■■■��■ ■��■■■��■��■ ■��■��■��■ ■■■■■��■�■■ ■��■■■■■■■�■■ ■■■�■■��■��■■ ■��■�■■■��■ ■■��■■��■■�■�■ ■■�■��■��■�■ ■■■e■ ■��■ ■■■■■ ■��■■�� ■��■■■■��■ ■��■■■■■■■■■■ r' � ` �avie County .�-CeaCth �epart�nent ` ancl �-Come .�eaCth ��ency �nvironmental.�Cealth Section P.O. Box 848 / 210 HosPrra,� STaEer }' COUR�ER ii09-4O-06 I MocKsviue, N.C. 27028 PHONE: (704) 634-8760 Donald W. McBride 146 McBride Ln. Mocksville, HC 27028 February 14, 1997 Re: Site Evaluaiion Daniel Road Ta.s PIN: #5736-44-2623 Dear Mr. McBride: As requested, a representative from this office visited�the aforementianed site on February 12, 1997. Based upon the information provided on the application for a site evaluation and after the evaluation was campleted, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sEWage disposal system. If you have any questions, please ieel free to contact this office. � Sincerely. 1 �� . ��:��. �� Robert B. Hall, Jr. , R. S. Environmental Health Section RH/Wd Enclosure(s)