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2195 Farmington Rdn—ao r.,... h, nit' Tax Part -PI Ppnnrt I 1� q 9 VdPdnPcriav Rantpmhpr 9A 9n1R All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold Davie County, NC iharmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or j °r causes of action due to or arising out of the use or inability to use the GIS data provided by this website. Parcel Information Parcel Number: 050000005301 Township: Farmington NCPIN Number: 5843713790 Municipality: Account Number: 10236000 Census Tract: 37059-802 Listed Owner 1: BROCK RICHARD J Voting Precinct: FARMINGTON Mailing Address 1: 2199 FARMINGTON ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 270284655 Voluntary Ag. District: No Legal Description: 1 AC FARMINGTON RD Fire Response District: FARMINGTON Assessed Acreage: 0.82 Elementary School Zone: PINEBROOK Deed Date: 7/1980 Middle School Zone: NORTH DAVIE Deed Book / Page: 001110419 Soil Types: MrB2 Plat Book: Flood Zone: X Plat Page: Watershed Overlay: - ,WS -IV -P Building Value: 39580.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 21910,00 Total Market Value: 61490.00 Total Assessed Value: 61490.00 All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold Davie County, NC iharmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or j °r causes of action due to or arising out of the use or inability to use the GIS data provided by this website. 13 9 AUTHMIZATION NO: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Permittee's P.O. Box 848 PROPERTY INFORMATION Name: XfOC Mocksville, NC 27028 Subdivision Name: /� � > r j Mone #: 704-634-8760 Directions to property: c' _%: '.',%.'. % �. Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#�f SYSTEM CONSTRUCTION Road Name:Fca-Y' Yl; 71 ct%iP `f **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 compliance 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 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS) PROPERTY INFORMATION Permittee ' ;� •�� . ,% t,�/ :• if Name: Directions to property: C Subdivision Name: Section: Lot: IMPROVEMENT rM PERMIT Tax Office PIN:#=" +'" - 711-4 RoadName:1'��i'y����)ZIp'�'.' **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 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TILS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �! # BEDROOMS .2 # BATHS ,7 # OCCUPANTS � _ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZES c TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) Shy NEW SITE J/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEP%fr GAL. PUMP TANK GAL. TRENCH WIDTH. -F,-"' ROCK DEPTH -LINEAR Fr., r' OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT F pe U j_10dy "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 AUTHORIZATION NO. —/W OPERATION SYSTEM INSTALLED BY: BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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) APPLI ATION FOR SITE EVALUATIONAMPROVEMENT PE Davie County Health Department V //�j Environmental Health Section '"1 P. O. Box 848 v � � � a a Mocksville, NC 27028 (36)751-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS D ALL THE REQUIRED INFORMATION IS PROVIDED. n 1. Name to be Billed �1 10 J,06icice GY Contact Person IG �A�� /.S IP0 Mailing Address ? i 9�5� / ;Q L', 1 N �l O N A Home Phone-` 1 T% City/State/Zip M DG'eswl �Li � C c 2 / d �� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 4. System to Serve 5. If Residence: Dishwasher 6. If Business/Other: 19 Site Evaluation ❑ House 0 Mobile Home # People _3 ❑ Garbage Disposal Specify type City/State/Zip ❑ Improvement Permit & ATC 0 Both ❑ Business ❑ Industry ❑ Other # Bedrooms 3 # Bathrooms �Z— Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Commodes # Showers # Urinals # Water Coolers C If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: &L County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 14 No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLATM THE PROPERTY MUST BE Q SUBMITTED WITH THIS APPLICATION. Property Dimensions: J l ACA e 1 WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY. Tax Office PIN: # .�� el 3— - -S�o' 1 Property Address: Road Name I =A 2 /%1 r City/Zip M,6C o;L-Lt= AC + •Z%D z� 1 1 Ne /En4 `To 2 qs l If in Subdivision provide information, as follows: L T 1 Name: ; W V05 %-D T/etC'-- Section: Lot #: 1 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 1A 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 Count' Health Department to enter upon above described property located in Davie County and owned by as necessary to determine the site suitability. DATE i -W SIGNATURE Revised DCHD (06-96) conduct all testing procedures 1YOU MA1�J. USE THE BACK OF THIS FORM FOR PRAWING YOUR SITE PLAN. 2/--V- k . 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SivuY Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence S[ructure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION:� LONG-TERM ACCEPTANCE RATE: � OTHER(S) PRESENT: REMARKS: ����� �L! ��%%'I/�i/.%y� /r'/� -���i�L- ZEGEND 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 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 Mineraloev 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) ;;�...,TAR - Long-term acceptance rate - gaUday/ft2 DCHD (01-90)