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378 Foster Dairy RdDavie Countv. NC Tax P�rr.Pl RPnnrt Wednesdav. October 12. 2016 WAK1V11V(J: '1'ti15 l� 1V11'1' A �UKVLY _ Parcel Information Parcel Number: G500000056 Township: NCPIN Number: 5840918579 Municipality: Mocksville Account Number: 82523548 Census Tract: 37059-803 Listed Owner 1: WARD MARTHA JO Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 378 FOSTER DAIRY ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: Legal Description: 1.59 AC FOSTER DAIRY RD Fire Response District: Assessed Acreage: 1.39 Elementary School Zone: Deed Date: 1/2002 Middle School Zone: Deed Book / Page: 020010577 Soil Types: Plat Book: 0004 Flood Zone: Plat Page: 053 Watershed Overlay: Building Value: Land Value: Total Assessed Value: °"�°'�' Davie County, �o�;N�j NC 65040.00 Outbuilding & Extra Freatures Value: 28630.00 Total Market Value: 98170.00 SMITH GROVE PINEBROOK NORTH DAVIE WeC,We6 DAVIE COUNTY 4500.00 98170.00 No 411 data Is provlded as Is without warranty or guarantee of any kind elther oxpressed or Implied Including but not limited to the �mplied warranties of inerchantability or fitness for a paRicular use. All users of Davie County's GIS website shall hold harmless the �ounty of Davie, North Carolina, its agents, consultants, contractors or employees from any and a�l claims or causes of actlon due tc �r arising out of the uso or Inability to use the GIS data provlded by thls webslte. 5 . ;.._ �,� _ :, . ._+:. p"s� ^.,^r b.�. ';t�� . <y. : t- .. �t -` ;, ...4 . , .. ... ..:, , �.��;. - � � . -,, lo: 3� AVTHOR17ATioN No: ��j �'� DAVIE OUNTY HEALTH DEPARTMENT . ,.�: �� . ! Environmental Health Section PROPERTY INFORMATION Per�it� ti�' — `'1 f#- P.O. Box 848 Name: __��9�j�� f„(��,� Mocksville, NC 27028 Subdivision Name: �' , ; Phone # 336-751-8760 Directions to property: ��'' ��;� -t f"'�' Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#��- �� - ��.� SYSTF.M CONSTRUCTION . r Road Name'. �, �ip: �_� **NOT'E** T'his Authorization for Wastewater System Conswction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented ro the Davie County Building Inspections Office when applying for Building Permits. (ln compliance with Articie I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NTAL HEALTH SPECItCLI� �'-,:'%'_�'' DATEISSUED ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ., .. . . ,. , : _ ��r,. � _ - ., : '�' � ._. .. , ., . Y . �y3 -� . � . h . 9 ., . � � . . . � � . . „ o, w.'. �� DAVIE OUNTY HEALTH DEPARTMENT � `" ., a;;; t j�, �.: IMPR VEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perniitt�'ef �` . �, ' �iame: � �a , � 1 � Subdivision Name: - a. . Directions to property: �` `�� f rj �: �' �' Section: Lot: � # Il1�PROVEMENT \ %: , , . PERMTI' Tax Office PIN:#�� - �, - a�`� , ��+ � � �: > � Road Name: C�t�-r..� �. ipc.�+ t��i� **NOTE** Tl�is Improvement Pemut DOES NOT authorize the construction or installation of a septic tank system or any was[ewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construcdo�nstallation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) , ,�.;. ***NOTICE*** THIS PERMIT LS SUBJECT TO REVOCATTON IF STI'E �� ' - ,;%'_, x-;;.,r PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPE AL'IST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TEIIS PERMIT BEFORE INSTALLING T'HE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �� # BEllROOMS �# BATHS �.c _# OCCUPANTS -2 GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFI' # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE �t '� TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW (GPD) NEW SITE " REPAIR SITE f � SYSTEM SPECIFICATIONS: TANK SIZE �ai� GAL. PUMP TANK GAL. TRENCH WIDTH ._,�� ROCK DEPTH �;� LINEAR Ff. �1�� OTHER L-r`� -. uii�l � �/ � ��/� REQUIRED SITE MODIFICATIONS/CONDITIONS: I IMPROVEMENT PERMIT LAYOUT .��y� /D� a �� . l ;-� - st��'�!o� � �� S G�� // 1=^ '*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR I:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATIONPERMIT � �� SYSTEM INSTAL[.ED BY: � �� 1H-N � �� Y� Iv�.. ��My � � ��, /.,:_ , � �` �.�"X ii ' � � \ � AUTHORIZATION N0. I��) OPERATION PERMTT BY: DATE: "�THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH SY M DESCRIBED A OVE HAS BEEN INSTALLED COM LIANCE WITH ARTICLE 11 OF G.S. CHAP'TER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPUSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNGTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) �l �� APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Heaith Departrnent Envirrvnmenta/ Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Q � � .�..[� fi� � ,-�� ;. J�� Q �� EI�YiRO�ti, ,-. yEAl.tll f1Alllt . . �.�..� ***Il�ORTANT*** THIS APPLICATION CANNOT BE PROC',ESSED UNLESS ALL TE� REQUIRED INFORMATION IS PROVIDED. Refer to the INFORI�ITION BULLETIN for instructions. 1. Name to be Billed +�` ��/-��-Z�'_�.� /_ �� Contact Person `�µ""�c1• «�C�✓�"'�-t-� Mailing Address 3/ Si /�.S%�� -��i'"i�✓� Home Phone �t� f�— �� c7 City/3tate/ZIP //t� �' C�� (J � CL-C /��C Business Fhone 2. Name on Permit/ATC if Different than Abave !lailing Address City/State/2ip 3. Application For: ❑ Sl'te Evaluation �Improvement Permit/ATC ❑ Both 4. system to service: ❑ House �Mobile Hoaus ❑ Business ❑ Industry ❑ Other 5. if xesidence: # People a # Bedrooms � # Bathrooms � I] Dishwasher � Garbage Disposal QYElashinq Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: S�ecify type � Pevple A S1nks 11 Co�ocles # Showers 1� Urinals # Water Coolers IF FOODSERVICE: � Seats Estimated Water Usage (gallons per aay) 7. rype of srater supply: ❑ County/City ��Tell ❑ Coaacninity e. no you anticipate additions or eapansions of the facility this systero is intended to serve? � Yes F�'No **"IMPORTANT't*'� CLIENTS DtUST C0�1lPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN �IiUST BE SUB�IiITTED by the client wit6 THIS APPLICATION. Propert� Dimensions: WRITE DIRECTIO S(from Mocksville) to PROPERTY: Taa Office PIN: # Property Adc".-ess: Road Namc � Cit�•/Zip 1 If in a Subdi��sion provide information, as follows: Name: Section: Block: 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 submittcd in this application is talsificd or changcd. I, also, u»derstand that I am responsible jor all charges incurred jrom this application. I, hereby, gi�-c consent to the Authorized Representati��e of t6e Davie County Health Department to enter upon abo�•e described property located in Da��e Count� and owned b�- �� / C,t r _ to conduct all testing procedures as necessary to determine the site suitability. DATE �J� 3' c� � SIGNATURE /�,/ ,%d,��' � /G�� TNIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN: �/ �'�'�• / � �� NO. (O Invoice No. 0 / Re�-ised DCHD (07/98) � � � ? .� y �,�.,.� .. --'� `� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT '' �J Davie County Health Department � � 6 �� Environmental Health Section � � / P. O. Box 848 EtJy1&Oi�".tEPiTAL HEAITH .��..�0 � � Mocksville, NC 27028 DAVIE COUNTY ,� � � ��J I�� %��1,� � (336 )751-8760 cc:�' ' �G� > ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ��"' -/� V ALL THE REQUIRED INFORMATION IS rROVIDED. � —_ 1. Name to be Billed .4/Z A�� %��S Contact Person �/`-+��'� Mailing Address ,_ � 7 r� f�17 S/`� r" </J �;1-%�� Home Phone 1 l�"� 1%� City/State/Zip �Q(� �K S �� a �(, � 1�1 � G- o� 70 Z� B usiness Phone �5 �-�3 5 ln 2. Name on PermidATC if Different than Above Mailing Address 3. Application For: �LJ' Site Evaluation 4. System to Serve: ❑ House L�" Mobile Home 5. If Residence: ❑ Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: # People � ❑ Gazbage Disposal Specify type _ _ # Showers # Seats City/State/Zip ❑ Improvement Permit & ATC ❑ Business ❑ Industry ❑ Other ❑ Both # Bedrooms �. # Bathrooms � l� Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals Estimated Water Usage (gallons per day) # Water Coolers 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? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A�}�� THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: ��°� rn �� WRITE DIRECTIONS (from $"d o 9/ �'S7�j � Mocksville) TO PROPERTY: Tax Office PIN: # - �-/ � S�� Q 0 Q.� (� � � I 5 S��s-� -�- o-� o Property Address: Road Name 3%� �� 5'�"e �� q; r., �� 1 1 /�,4 � � `� �Ci o v,, � : City/Zip .�11� �s v� I l� 0�. G• a 7 o Z� � � r � � i� rnn�.� .� h a us �e If in Subdivision provide information, as follows: � T ��I I OY� ��I�,�', 1U�U'STa,^ Name: � t� � 4)r�c.� hou5�� 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 aze 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 �i� /� - �( �i SIGNATURE Revised DCHD (06-96) V vC��Z//�v l� JOU Mtl i� f USE THE $tICK O� ZH I S�OIZM �OR b1ZflW I NC� l�'OUIZ S I TE PLttN . conduct all testing procedures ��,�, �.,,...•...,..•..� � .� � � �.. ,.� , ,:� �;�` � ";� �;� X �` ��; . .. ..�,... t...�.. �...� y �� r .. t' �u«� t t . II �. .. . ' ,. �. ��5�l��. , : , � ,.� �, N Y' t. -. 1. `: I� 11 �i � � 5��. /J(� D S�}G �� r � - �+ 1 �. � � � � Q C� �� , � N � t ti _ � _ Q , ,��; - -. -- --� �, v � � : :. _. : ��... .._... . �. - _ _ ----.�., - ' : �" � � �r� _ 4 . : r�i� �RM a� . � .. . .. I „� �.»+,..x { ,� .�t -, ' . . +y�i i �. f� . f � Z r�� k � . . � . .. � . . . "� �' � '�x . � ta„p : . . . . ni ; 2 � ' �, . . �. � � � � S� '� k x 4> . . . . � 3 .1" � ,y z• . . .. . . ... .� y .,• y� g t �, ��, r Ea ` a �.. G � � „� i�" �.s: as r {� .. . .. . _ �1 � t €�� r ,. ':' e . � a.�rn .'��`"� ,Hs,.� .s � � � ��" .;,.'s+✓ OLti ' _- : _ � _ , . ,. .. � /. �— � . _ C� :- ' _ ; I;; ; � ;. ' i: 3?D _ _ _ _,. � � _ a ` � - : 1 � '__ _ .'� , ,, i ' �r �� , ; U .� �� ; `;� �, � O _� J � � 'h�r` _ :.. � � \�� U . . . . ' " � . :� .•._. , � . _ .... . . = ` . .:i� :�� . . � . � � .�. . .. . �. tq �• �� 1 ' .. .. ' _... . 1 : . � � �� . �� Il ... .._ . . . _ . .. .. ; . �� .� . �.� : . � .. . :....� . _. : �`._.---�"'' : �� _ _ _ - ;. _. . . W . _. _ : - Ul: - '- C� � n • . '• DAVIE COUNTY HEALTH DEPARTMENT �' � Environmental Health Section SECTION i..oT � Soil/Site Evaluation APPLICANT'S NAME ��/�!'i%� DATE EVALUATED �`�6 `�� PROPOSED FACILITY PROPERTY SIZE l��' SUBDIVISION ROAD NAME �5�� /R�� Water Supply: On-Site Well t� Community, Evaluation By: Auger Boring L� Pit Slope % L7llnT7llAT T TTT1TTi 1v111IC1 QIU�' y unnr�r�wT r�� r�cn-ru SOIL WETNESS Public Cut SITE CLASSIFICATION: �1 EVALUATION BY: ��C LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: ` � REMARKS: ____ 611f'�'� 2� ��/1 %� � DCHD (01-90) 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 Wet NS - Non sticky NP - Noa plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky 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) LTAR - Long-term acceptance rate - gaUday/ft2 ' ■■ ■■ ■■ ■■ ■■ ■■ ■■��■ ■�■�■■ ■��■■ ■�■�■■ ■��■ ■�■��■ ■�■��■ ■■■■■■ ■�■��■ ■�■�■■ ■��■■ ■�■�■■ �� ■■ �� ■�� ■�� ■�■�■■ ■��■ ■��■■ ■�■��■ ■�■��■ ■�■■�■ ■�■�■■ ■�■��■ ■■�■■■■ ■■�■■■■ ■��■■ ■�■��■■ ■��■ ■�■■�■■ �a■��■ ��■ ■��■��■ ■��■��■ I�■�■■■■ ■■■■■■■ ■■��■■■ ■■��■■■ ■■■■■�■ ■■��■■■ ■■��■■■ ■■�■■■■ ■■�■■■■ ��!�� ■��■■■■■ ■��■��■■ ■��■ ■��■��■ ■��■ ■��■��■ ■��■ ■■�■��■ ■■�■��■ ■■��■ ■�■■■�■■ ■■��s ■��■■��■ ■■■■��■ i��■■■■ �1��■■■■ �I�■■■■■ 11■��■ �� :� N a I � € a ��0 � NIP. 2 0 : N � KEL Y N. WARD u 8.14�i�PG. Il2 � � � �� ; E oM-��.. E �" ' N je 2g � , . 79 � 0.75" EIP i I I KELLY N. Wq RD D.B. /46 PG_ //2 I �•. - r . �'i :�n• � - . - • �� r ti• ~ i •r : r.,+u..� v...,s.r► �o �.�, �.,�, KELLY N. WARD D.B. l46 PG. 112 N A7• 29' 2B" E 2H4.5 259.57 � � P/K NAIL 3.4' N!P ON L1NE � �T � �' � �. 25.00 � I U � o�g� AREA = 0.500 ACRE N � � pNCLUDES SR /639 R/K'1 F � � � I 0.75" EIP f46.63 t�POIM IN OR — --5 B8• 12' 28.. W--_. 1VEAR �c � RD. --- —, .. •N ' � 176.J1 TOTAL 10' GRAVEL ORNE 96 B9 3 -- - -- - _-- --- -- - -- - --'--- �' 68. t6� � _ � -�� 5 r_ � � ��cs�- � :. MARTHA PH/PPS � ( D.B. /46 G. /l8 � � � 1 � � L f� � I l �y�' ��,�� I z I ��_ � � � I �G`�.> , I I . �yo p \�/ � �zS�T � � �b To ��r � �--3� I _ . ' � — . .. -.. I � � EiP 5 A2• 37' 00" w I �� 0.75" EIP 227.07 � 1 N 0 v < m 0 � fJ0 SCALE V!C/MTY MAP SfT� �> a '�� r`''� C A R 0"•. ♦ � ;� ,`� .��..�� : ' Q: �,�\STfyE+.:2 •: �� e` 0;�� I, GRADY L. TUTTEROW , CERTIFT THAT UNDER Z: S E A L •. � MT UIRECTION AND SUPERYISION , THIS MAP L,L5•z7 ' = WAS ORAWN FROM AN ACTUAL FIELD SURVEY '��9 �Q� MAOE� YT TER SUR�EY�NGCOMPANY. ' NO su� • a' ' ',,c'9��r �� T�;`.�QO,,`, REGISTERED} AND SU VEYOR 1-2527 .� .� �/ I SURVEY FOR : � MARTHA W. PHIPPS � SCAIE: I" = 5O' APPROVEO BY DRAWN BV D�7E: 06/09/9B GLT MEC BEING 0.500 ACRE TAKEN FROM THE KELLY N. WARO PROPERTY - (D.B. 146 PG. 112) LYING IN THE MOCKSVILLE TOWNSHIP . DAVIE COUN'TY, NORTH CAROLINA DRAWINp NVMBER TAX MAP REF : G-5, a portion of PARCEL 56.01 i329e-2