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175 Doby Rd (2) Davie County, NC Tax Parcel Report 3� Monday, September 26, 2016 DOBY RD 175 ; 55 5S 195 i _ -.•.••• WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H10000000302 Township: Calahaln NCPIN Number: 4799657513 Municipality: Account Number: 82518802 Census Tract: 37059-801 Listed Owner 1: CAMPBELL MICHAEL TODD Voting Precinct: NORTH CALAHALN Mailing Address 1: 175 DOBY ROAD Planning Jurisdiction: Davie County City: HARMONY Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 28634-8911 Voluntary Ag.District: No Legal Description: 2.787AC TRACT 1 DOBY RD Fire Response District: COUNTY LINE Assessed Acreage: 2.30 Elementary School Zone: WILLIAM R DAVIE Deed Date: 7/2009 Middle School Zone: NORTH DAVIE Deed Book/Page: 008020086 Soil Types: PcC2,CeB2 Plat Book: 0010 Flood Zone: Plat Page: 101 Watershed Overlay: DAVIE COUNTY Building Value: 89330.00 Outbuilding&Extra 4650.00 Freatures Value: Land Value: 25460.00 Total Market Value: 119440.00 Total Assessed Value: 119440.00 l,v 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 webs@e shall hold harmless the County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to r'p U N•t; NC or arising out of the use or Inablllty to use the GIS data provided by this website. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital.Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004267 Tax PIN/EH#: 4799-65-8071 Billed To: William Jerry Campbell Subdivision Info: Reference Name: Location/Address: 175 Doby-28634 Proposed Facility: Residence Property Size: 12.75 ATC Number: 4634 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. C �6G tQ System Type: S.T.Manufacturer ✓ �c� Tank Date 0,1b Tank Size�� Pump Tank Size System Installed By: E.H. Specialist: Date: i. b a w� •' i ' dun✓ � ( . -u— y- ? sT °PC o car►ce•eie d-rdp bo y *d F z ,.c -C DCHD 11106(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004267 Tax PIN/EH M 4799-65-8071 Billed To: William Jerry Campbell Subdivision Info: Reference Name: Location/Address: 175 Doby-28634 Proposed Facility: Residence Property Size: 12.75 ATC Number: 4634 Site Type: ❑New ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms —#Bathrooms 7— #People q Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: ❑County/CityfTWell ❑Community Well System Specifications: Design Wastewater Flow(GPD)2� 0 Tank Size GAL.Pump Tank&GAL. Trench Width 3G!` Max.Trench Depths Rock Depth /A Linear Ft. 310 (S Site Modifications/Conditions/Other: As stated in 15A NCAC 18A.i969 _____-�ysterns may also be-us� Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751:8760. TLC ads r7/'..c u � r oti y' 'dUJAlH ✓vim `"—' ' , k- V.2 Y/-{✓tC Gt 6 O d7 `Ac.f.r Environmental Health Specialist Date: .1 l o ' CAST SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 r✓o� _ (336)751-8760/Fax(336)751-8786 App 'cation F Q Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) o Type plication: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing�Ith stem 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 to be Billed r C Contact Person S, L 1 _ Billing Address J - Home Phone Dr)V S-�4 Cc City/State/ZIP i1d�l�tZa /V C_ K-63�/ Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 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 with complete plat.) Owner's Name_1 ;11t1A,- _ P_ 00,' Cf�9h't -Ee71 Phone Number 70V SY61 .363 S Owner's Address /SS J-Do6c,, tc-VW City/State/Zip _e!Lt� SCJ 6- Property Property Address /-7— City Lot Size Tax PIN# p $- Subdivision Name(if applicable) Section/Lot# Directions To Site: &(/ W - 70/A) F',) L`6L- Tia Liv t / 3/y .1111/e � /)QAy R4 3 i4 i7'r If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes Olo Does the site contain jurisdictional wetlands? ❑Yes JdNo Are there any easements or right-of-ways on the site? ❑Yes W,;o Is the site subject to approval by another public agency? ❑Yes P'No Will wastewater o1hei than domestic sewage be generated? ❑Yes DOo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms � #Bathrooms Garden Tub/Whirlpool ❑Yes O Basement: ❑Yes o Basement Plumbing: ❑Yes o IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers I #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested; ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑New Well X�X: isting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �Io If yes,what type? / This is to certify that the information provided on this application is true and correct to the best of my knowledge. 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 application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging ors king the house/facility 1 cation ropo ed well location and the location of any other amenities. Site Revisit Charge Prope owner' oro er's idial representative signature Date(s): - /- Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# 426,7 Revised 11/06 Invoice# //j't'4 �i •7 VI ?top, nn I' - � ` l c T2 { Y r �I•' 1 Yr i 12 71 t VY F) r ` ti oc` 9££L 2iS �,t °a • `- a a:i , `.- - - . •-, -_:�_�'`��. n nil SR 1336 '30 77 273 ' .$S 170 105A b� ) pas) Foal I 4658 Ce+l Ln I (4.60A) / ao (1.38A) �m 9670 (21aa> 9597 Ln a� 1.7596 7513 U 348 Ln DO 12 101 .po CeB2 14.8 A 0507 12.75A U y 8071 W b iii M1' O a G Y7 DAVIE COUNTY HEALTH DEPARTMENT - - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004267 Tax PIN/EH#: 4799-65-8071 Billed To: William Jerry Campbell Subdivision Info: Reference Name: Location/Address: 175 Doby-28634 Proposed Facility: Residence Property Size: 12.75 Date Evaluated: Water Supply: On-Site Well C// Community Public Evaluation By: Auger Boring v Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position ^� Slope% HORIZON I DEPTH Texture group G Consistence { Structure MineralogyY HORIZON H DEPTH Texture group Consistence Structure Mineralogy HORIZON Ill DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE Q SITE CLASSIFICATION: a �f.D EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: i 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 - SC_L-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay, CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm i EFI-Extremely firm 3Y'et 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 Mine—ralov 1:1,2:1,Mixed �.tes 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 05105(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■s■ss■■■■■■■■■■■■s■■■■■s■■■■■■■■■■■■■■■■■■■■■s■■■■■■■tees■■■■ ■■■A■■I■■■■■■_■■■■■■■■_t•�_�_�_r.�_�_�_��_u:��r��_��t.r•�r•t•t.��■■■■■■e■■■■■■■■■■■■■■■■■■■■ee■■■■■ ■■■■�ii�C��:nii■■■��■e■■■■■t1■CI■■■■■■■■■■■■■e■It■■■■■■■■■■■■■■■■■e■■■■■■■■ee■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■■■■■■■■■■fess■■■■■■■■■■■■■n■1►■■■■■■■■■■■s■■■■■■■■■■■■■■■■■■■■sss■■■■ ■ci•■i�u■ii■�■e�■es■■■■■■s■■�■■v■■�■■■■■■c�:�■■■■�■■■■■■s■■■■s■■■■■■s■■ses■■■■■■es■■■■■■■ ■■■■�■■■■SIF_!1■■■■■■■■■■■■■■■■r■■e■■■■■■■■■■■�!CI■■■■■■■■■■■■■■■■■ee■■■■■■■■■■■■■■■■■■ ■■■®■ale■■■■■■■■■E=■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ee■■■■■■e■■■■■■■■■■■■ ■■■■■■■■s■■■■■■■■■■■■�■�n■■■■■■■■■■■■■■■■■■■■says■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■si:.e�■■■■■■■■■■■■■■■■r�cr■■■■■■■�►�■■■■ i■■■■Ips■■■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■��■s■■e■■■■■■■■■■■►i■■■■e■e■■■■■■■■■■■■■■■■■■■sss■■■■■■■■ Davie County Environmental Health P.O.Box 848/210 Ilospital Street 1Vlocksvil1e,NC 27,028 (336)751'-8760/Fax(336)751=8786 IMPROVEMENT PERMIT Account #: 990004267 Tax PIN/EH#: 4799-65-8071 Billed To: William Jerry Campbell Subdivision Info: Address: 155 Doby Road Location/Address: 175 Doby-28634 City: Harmony Property Size: 12.75 Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: 0'l l�ew ❑Repair ❑Expansion Permit Valid for: .❑5 Years ❑No Expiration Residential Specifications: #Bedrooms �L #Bathrooms )Z. #PeopleBasement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ❑County/City ❑Well ❑CommunityWell As, stated in 15A NCAC 1EA.1969(5) Site Modifications/Permit Conditions: accepted Systems may also be used System Type LTAR Initial CC G- r Re airell Site Plan K t-✓IfIINCe.t h --y k' Environmental Health Specialist _ Date i.p.11-06