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134 Ford Trail Davie County,NC . ' Tax Parcel Report Tuesday, October 4, 2016 " " --.6 68 ,', � �.'` 662 : n� 12b 661�f �e�'lQG� � , , �d� � � 6 49 rr ' 7'� �,�641 r �-----`'� ��t�'�'� 6 37 l 6 29 142 ,�� I FO�D 50 <qG�F�N 1�� 'SRL 16a� ; 134 � _r' ti 115+ ~-�----- � � 125' 172 0.��. ,``��oF°� . , , � _� WARNING: THIS IS NOT A SURVEY ; �. .� _ ..,..., . .._.. .....,.w .. . �_ . _.. _.. ._. _ � Pazcel Informa-, . ,. .. , _ ._ ._ _. ,_ . _. _ :__-_ tion _ ` Parcel Number. N5110A0015 Township: Jerusalem NCPIN Number: 5744495512 Municipality: Account Number: 36200000 Census Tract: 37059-807 Listed Owner 1: HOFFMAN MILDRED Voting Precinct JERUSALEM Mailing Address 1: 134 FORD TRAIL Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27028-0000 Voluntary Ag.District: No Legal Desc�ipUon: 6.786 AC OFF LAGLE LN Fire Response District: COOLEEMEE,JERUSALEM Assessed Acreage: 6.78 Elementary School Zone: COOLEEMEE Deed Date: 11/1996 Middle School Zone: 50UTH DAVIE Deed Book/Page: 001900914 Soil Types: EnB,EnC,ChA,WATER Plat Book: Flood 2one: Plat Page: Watershed Overlay: DAVIE COUNTY Buitding Value: 56750.00 Outbuilding 8�Extra 5060.00 Freatures Value: Land Value: 32890.00 Total Market Value: 94700.00 Total Assessed Value: 94700.00 9���, Atl d�ta b provldM as ia without warraMy or yuaranteo of any Idnd ekher expreued or Impiled including but not tlmited to the Davie County� Impped warrantles of muchaMabllity or fltness fw�partleular usa Alt users of DaWe Courrt�s GIS website ahall hold harmiess the ComRy of Davle,North Carollna,its agmts,wnwMa�rts,coMractors or employees hom a�ry and aN dalms or uuxs of actlon due to �O��y�S NC or arlsing out of the use or Inabtlky to use the GIS dah provlded by tlda websita . ,, �' Ar .p ��',` ,.m'�_d _i 4.-.'�4, ^.4'�y ,���� � �.,.:", ' ..-3 ...�.., `a �� .� ' . ,._^ , i i , ... ;` :.' 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A�t1THO�zATtoN No., � ��?J DAVIE COUNTY HEALTH DEPARTMENT . �� � �, .,:� • Environmental Health Section � PROPERTY INFORMATION Perii�ittee'"s���p� ��i ,�� P.O.Box 848 Name: �//l�"�dI' �D,�pj��9- Mocksville,NC 27028 Subdivision Name: Phone#:.704-634-8760 ,Directions to property:��,.�,=��i?., j _ Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#��_ �-9 - �a/'o1" SYSTEM CONSTRUCTION Road Name: L.:� • Zip: 'rJO� **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pernrits.This Form/Authorization Number should be presented to the Davie Counry Building Inspections O�ce 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 :, ,�.=�.� ` -�" -_ . �'- : �1,� IS.VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH P�`CIALIST;; DATE ISSUED _ ,� �, � ..�'• � .�y�rt�.�,.� ,i' kp "jt J''I' ' � ,...�Y i„�,-.- ��-' ��' �� �r . . ,'"c r1�� . ��'�.�' 3 �--� .�w',: ,. �°''e �� � �� ' DAVIE COUNTY HEALTH DEPARTMENT . � .... � �,' . �W _, , t��.+%�'�'r � . TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Per�►itfee s�,� � ' . j . Name:_� .�.r�/��l�y��,�w�lTA'J7 Subdivision Name: , .r / � ��;': 1 .. Directions to property: .�'����.::`,'!d_ ,+ �` c, Section: ..Y.ot�� ' • ..'. . "=v ;� Il1�IIPROVEMENT • : � PERMIT Tax Office PIN:#���_ ' ,t� _ S"�`U,.,�' Road Name:����• Zip: `l�d� , , **NOTE**This Improvement Pernut DOFS NOT authorize the constniction or installation of a sepdc tank system or any wastewater system.An '. �. : AU'THORIZATION FOR WASTEWATER SYSTEM CONSTRUC"TION must be obtained fram this Department prior to the � y'' ,.w construction/'u►stallation of a system or the issuance of a building perrrut. ' ' (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ; f ... _ �,,�.,.�� �t'' � , ,, ����,^{ t �..4 �.. ***NOTTCE***THI.S PERNIIT IS SUBJECT TO REVOCATTON IF SITE,' ,,� :� �`".... r r_:+�. r"�+r.t � �'" �.�. � PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH P�CIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING THE SYSTEM. , ' • RESIDENTIAL SPECIFICATION:BUILDING 1'YPE�� #BEDROOMS�#BATHS�_#OCCUPANTS�_GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFTCATION: FACILiTY TYPE #PEOPLE #PEOPLFJSHIFT ' #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE�i–�A� TYPE WATER SUPPLY � lJ DESIGN WASTEWATER FLOW(GPD) v�� NEW SITE �/ REPAIR SITE r' `� . ' SYSTEM SPECIFICATIONS: TANK SIZE ` �� GAL. PUMP TANK GAL. TRENCH WIDTH��.ROCK DEPTH� LINEAR Ff.� OTHER �!U[.t�/,G%�, '!/l--+�iC' ��`�" �G%'�'<.'' _ REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT ,,,,.--..._ — . _ � ., .-�-- � � � /� .- /Y� Q �r� , o! ,�,w�s d P : � � �,s�, r1 sT !��'�'t''� � . ���,r � .� � r,�c�,,, . ; { � **CONTACT A REPRESENTATIVE OF THE bAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM '.BETWEEN 8:30-9:30 A.M.OR 1:00-1 s30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760, OPERATION PERMTT. ; � SYSTEM INSTALLED BY: , , _ 1._J � . �-�'p �(� X/� �` t°i4C�( ; . ,. � , AUTHORIZATION NO.�OPERATION PERMIT BY: ������� DATE: �'— **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRTBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE '' WIT'H 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 WII..L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96(Revised) � � . �� �� - � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT � � � �k� ' �'1� Davie County Health Department Environmental Health Section � ' � �mp P.O.Box 848 ��vv Mocksville NC 27028 xx ( 3 6���876� ���io`:OI�t;,_t7dT�'iL 1�;'l.�To� "t�G'+��U:� ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ��/����� �F�+�A� Contact Person /�"/���£/� Mailing Address �(/ �, oS �� Home Phone ��4���L�(� City/State/Zip C,dl���� ��, �� ����Y' Business Phone 2. Name on PermidATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site�Eyaluation ❑ Improvement Permit&ATC � Both 4. System to Serve: ❑ House � Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People � # 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 ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes,what type? E Z THER A PL�4T OR S Z TE PLrtN PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A Pk�R'THE PROPERTY MUST BE SUBMITTED WITH TffiS APPLICATION. � o1 Property Dimensions: � oS a�'- � Q�,J� ' ��a"e' � WRITE DIRECTIONS(from �/�c� � Mocksville)TO PROPERTY: Tax Office PIN: # 57y� - � - SS � � / � / ; �Yt e �c� � " Property Address: Road Name /�-��1 � f 7�( . � � 1 � n. City/Zip p� �D� !1 � 1 1 If in Subdivision provide information,as follows: � 1 Name: � 1 Section• Lot #• � 1 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 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���L���� ,��''��r ���� to conduct all testing procedures as necessary to determine the site suitability. DATE ��II[_+'% � SIGNATURE . Revised DCHD(06-96) � 1�OU M,4y USE THE $ACK O� THIS �OIZM �OR DI�IWING 1�OUR SITE PLAN. A�i `�a �NV,�3g , � . � � � i� _ � 1� � ��` '� I v4. �o�� • .? . \ _ _ _ ,�, � � _ � � _ _ __! 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L•2527 ����.�-._. . - _ 3y��.��.�'t` :}.+�-,¢r=•�"I � ;^-�, �..�.• .. . - . .. - . � - . � ' � � � . ~�n•:-' .�.1C�� ';1-SIF-r.:c C . �9A�� ;; ,c = _� '` "�'�`��`a s��'� .:=' �'�'`h'`��'`�'� � - �-. �� I .C.• SUR`l� - • . .. ,.r� � :. . � , . 2. :, .. .:r,. ,< ,� ' .. ...�r.�� � .,� ..:.._. :.I k��'C,�re'fi�'',.,.7- � a-"„, ..a -��-.:� .'-=�^r�'....,. ....._... . . . - . • � . . . .. . . .. .. ... .. ;x��s�-�'�x ."',5,; - y'4'0�� ��i t" G � ... . � ,`_ . , . _ . . ,. -:: � .�, . .,.w-..«x: a..F . � , r. .�,. . • �,. ` � DAVIE COUNTY HEALTH DEPARTMENT '. Environmental Health Section SECTION LOT SoiUSite Evaluation APPLICANT'S NAME rblT��/Ja • DATE EVALUATED ���D��� PROPOSED FACILITY �.�/ PROPERTY SIZE �� 'S�'�- SUBDIVISION ROAD NAME ��� Water Supply: On-Site Well (/ Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition ,L Slo e% HORIZON I DEPTH �� t� i, Texture rou Consistence Structure Mineralo HORIZON II DEPTH Texture rou Consistence Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Swcture Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � ` SITE CLASSIFICATION:��/0(�� �o � EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: REMARKS: Dv`'� r2Gl�' �jZOl�i Q's`�(Y 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angulaz 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) LTAR-Long-term acceptance rate-gaUday/ft2 DCHD(O1-90) ■■■�■�■■■��■�■■�■■��■■�����■■■�■■■��■■■■■��■■���■��■■■������■■■w■■ ■■■�■�■■■�■�■�����������■■�����■■��■�������e�������■■�■■��■■■■■��■ 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