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P231002-1 Boger Rd Davie County,NC Tax Parcel Report Tuesday, December 20, 2016 204 r 191 f 190 W 154-- ~ (D m . 160 '103 �4 1! x154 r' ~` 108 104 1 ................................................. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: E60000000702 Township: Farmington NCPIN Number: 5851518795 Municipality: Account Number: __... :::8305727 Census Tract: 37059-802 Listed Owner 1: NEELY JOSEPH F' Voting Precinct: SMITH GROVE Mailing Address 1:- 2705 BARTRAM ROAD Planning Jurisdiction: Davie County City: WINSTON SALEM Zoning Class: DAVIE COUNTY R-20 State: = NC Zoning Overlay: DAVIE COUNTY OD ..Zip Code: 27106 Voluntary Ag.District: No Legal Description: 1 AC BOGER RD Fire Response District: SMITH GROVE - -Assessed Acreage: 0.96 Elementary School Zone: PINEBROOK Deed Date:_ _ 4/2014 Middle School Zone: NORTH DAVIE Deed Book/Pager 2014EO416 Soil Types: GnB2,EnB Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 161 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 website shall hold harmless the /� County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. IMPROVEMENT PERMIT Far office Use only *CDP File Number 231002--1 d•�`^'r� Davie County Health Department �- 210 Hospital Street County ID N umber:5851518795 . ... P.O. Box 848 Evaluated For. NEW Mocksville NC 27028 Township: Phone: 336-753-6780 Fax:336-753-1680 - PERMIT VALID UNTIL: 10/21/2021 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Joseph Neely Propertyowner. Nina Harden Address: 2705 Bertran Place Address: COY: Winston-Salem 'City: State/Zip: NC 27106 `State/Zip. Phone#: (336)650-6147 Phone#: PropertyE[gperty Location & Site Information Address/Road#: Subdivision: Phase: Lot: Boger Road Mocksville NC 27028 Directions - Structure: SINGLE FAMILY.- Hwy158, left on Boger Rd. 1st lot on left past 9 of Bedrooms: 3 Rayl-en Vineyard Exit #of People: *Water Supply: NIA - System Specifications nitial System *.Site GlaSSllication: Provisionally Suitable - Minimum Trench Depth: 3 6 Inches Saprolite System_ 7 Oyes QNo. Maximum Trench Depth: 3 6 p Inches Design Flow: 3 . 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate`. 0 a 7. 5 1-Piece: OYes QNo Pump Required: @Yes ON OMay Be Required *System Classification/Description: TYPE III G.OTHER NON-CONY.TRENCH SYSTEMS Pump Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: OYes G)No Repair System Required:OYes ONO ONo, but has Available Space Repair System *Site Classification: PS Shallow Placement Minimum Trench Depth: 2 4 Inches Soil Application Rate: 0 a 5 Maximum Trench Depth: 2 8 Inches u *System Classification/Description: Pump Required: (E)Yes O No O Maybe Required TYPE III G.OTHER NON-CONY.TRENCH SYSTEMS *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 231002 - 1 County ID Number: 5851518795 ► *Site Modifications p Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; The Improvement Permit shall be valld for 6 years from date of Issue with a site plan(means a drawing not necessarily drawn to Site Plan scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surfacewaters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drawn to a scale of one Inch equals no morethan 60 feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit is subject to revocation if the site plan,plat or intended use changes(NCGS 130A-335(j).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring, reporting,and repair(.1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps.Signature; Date: I Issued By: 2140-Nations,Robert Date of Issue: 1 0 l 2 1 / a 0 1 6 Authorized State Agent. OValid without Expiration? 0Create CA. 01-land Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department CDP File Number: 231002 - 1 210 Hospital Street 5851518795 P.O.sox 848 County File Number: Mocksville NC 27028 Date: Q inch Drawing Drawing Type: Improvement Permit Scale: Qs/A _ ft IL l O s L4 J-1------ J _ `� _ IMPROVEMENT PERMIT a Davie County Health Department 210 Hospital Street CDP File Number: 231002 - 1 P.O.Box 84$ 5851518795 Mocksville NC 27028 County File Number: Date; 1 0 / x 1 / 2 0 1 6 �• Click below to import an image from an external location:Drawing Type: Improvement Permit NCD ENR Division of Environmental Health On-Site Wastewater Section "Date: 1 e / 1 a e 1 s Soil/Site Evaluation `File#: a 3 1 e e :1 For 0 n•Site Wastewater System PIN #: 5851518795 "Owner Nina Harden Proposed Facility SINGLE FAMILY - Proposed Design Flow(:1949) Location of Site Boger Road Property Size 1 Water Supply N/A Evaluation Method n1a Horizon SOIL MORPHOLOGY Profile# Lan1d cape Depth .1941 Other Profile POS (�N) Mineralogy Matrix Mottle Factors Slope% -- TextureStructure Consistence Color Color ir. L 0-4 SL 1-Wea' cr fr ns np 1942 Wet. 2 % '4-19 SC 1-Wea' abk fi s P .1943 Depth GPS Saprolite:(in) 1948 C 1•Wea' m vfi vs vp .1944.Rest. Horizon EHS .1947 Class U Profile Nations,Robe LTAR 0-2 SL 1-Wea: cr fr ns np 1942 Wet. % 2-48 C 3-Sing sbk fi s P .1943 Depth GPS Saprolitcon) 1944 Rest. - - - - Horton -... 1947 Class Ps _._.EHS___. Cop rofile Pro 4e 6 . 2 7 5 LTA 3 L 0-48 C 3-Stng„sbk fi s P .1942 Wet. 2 , °'o .1943 Depth GPS Saprolite:pnj` .1944 Rest. _ Horizon raEHS 1947 Class Ps Copy rofile Nations,Robe Profile © 2 7 5 LTAR - 0-3 SC 2-Mod. gr vfr ns np .1942 Wet. o/o 3-40 C 2-Mod. sbk fi Is P .1943 Depth GPS Saprolite:gn) 4048 SC 1-Wea' abk fi vs vp .1944 Rest. Horton ENS 1947 Class PS Copy Profile LTAR 0 5 .1942 Wet. % .1943 Depth GPS Saprolite:(m) .1944 Rest. Horizon 1947 Class EHS Copy ofile Profile LTAR,_, Available Space (.1945) PS OtherFactors(.1946) Site Classification (.1948)PS Initial LTAR: o . a 7 5 Repair LTAR: e 5 Others Present: Comments: Evaluated By. Nations,Robert NCDENR Division of Environmental Health On-Site Wastewater Section Date: © / a 1 .70� 6 Soil/Site Evaluation Fie#: a 3 1 0 0 2 For On-Site Wastewater System PIN #: 5 8 5 1 5 1 8 7 9 5 14940 Horizon SOIL MORPHOLOGY Prl;file# Lan scape Depth 1941 Other Profile Slope°/a SIN) Mineralogy Matrix Mottle Factors Texture Structure Consistence Color Color .1942 Wet. % .1943 Depth GPS Saproldcon) .1944 Resta Horizon EHS .1947 Class CopyArotile Profile LTAR. .1942 Wet. ---- ._ oo .1943 Depth GPS Saprolite:(in) .1944 Rest. Horizon EHS .1947 Class Capy�tOfil Profile LTAR r 1942 Wet. % .1943 Depth GPS Saprobe:on) .1944 Rest. Horizon _ - 3 .1947 Class CO rofil Profile LTAR .1942 Wet. Q'o .1943 Depth GPS Saprolite:(in) .1944 Rest. Horizon EHS .1947 Class Copy Frofil Profile LTAR .1942 Wet. % .1943 Depth GPS Saprolde:(n) .1944,Rest. Honzon raEHS 1947 Class Cop LlIrofil Profile u LTAR Comments: ; • Attach Image w� The "Open Drawing Form"button, opens the the drawing form. 3 The "Import"button, attaches the drawing, or other image Into the space below. ' Open Drawing Form 1A J1� Profile: 1 X y Z Profile: 2 X y Z Profile: 3 X Y Z Profile: 2 X Y Z Profile: X Y Z`____r Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z ,w ,`iz APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC 4 Davie County Environmental Health P.O.Boz 848/210 Hospital Street , Mocksville,NC.27028 Date: �Q 3 (336)753-6780/Fax(336)753-1680 gece p kation For. W ite Evaluation/Improvement Permit ❑Authorization To Construct(ATC) ❑Both Type of Application: WKew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility "•"IMPORTANT"O THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed To 3;01, N:e,\.q Contact Person 33`" (a,�0 — �o y 7 Billing Address ?^1 o S r-}rQ,n 1. Home Phone City/State/ZIP UN;0 Ah A fil et,.. W e- 7-13 OL Business Phone Name on Permit/ATC if Different than Above Mailing Address City/StateOp PROPERTY INFORMATION "Date House/Facili Comers Flagged /0-44P. 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\/;in EJ.!d er-% Phone Number Owner's Address City/State/Zip Property Address or City Lot Size l Arc.. Tax PIN# S 1r S I S 1 Y'1_ 9 yt Subdivision Name(if applicable) Section/Lot# Directions To Site:1}u� 1 s'I -lti I 'R .,.. o au A. — {i ti t tot- 0, a If the answer to any of the following questions i3"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes ONo Does the site contain jurisdictional wetlands? oyes Wa Are these any easements or right-of-ways on the site? ❑Yes A0 Is the site subject to approval by another public agency? ❑Yes 01 o Will wastewater other than domestic sewage begenerated? ❑Yes&Ro IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms _ 3 #Bathrooms 2—3 Garden Tub/Whirlpool OYes ❑No Basement:❑Yes CWo Basement Plumbing- ❑Yes @Woo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY- ##Seats Type system requested: BConventional ❑Accepted Dlnnovative DAltemative ❑Other Water Supply Type:4ty/City Water YNew well ❑Existing Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes 6'No 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 s. I understand that I am responsible for the proper identification and labeling of property lines and comers and locatir naggin akin ho e/facility location,proposed well location and the location of any other amcnities. Proppq o ' or owner's 1 Site Revisit Charge gal reps sentative signature Date(s): Client Notification Date: D EHS: Sign given ❑Yes❑No Account# ,2 3/04 L Revised 11/06 Invoice# .t,, 1 ax Parcel Keport Friday,February 26,201E --A13 y zi 9964 I w 9833 W` f Co 8795 20 a ; 2194 , A-60 50 zoo a 5�a WARNING:THIS IS NOT A SURVEY . .. - .., z >Parcel intortnatron'•: . ... _ .. _ .- Parcel Number. E60000000702 Township: Farmington NCPIN Number. 5851518795 Municipality: Account Number. 8305372 Census Tract: 37059-802 Listed Owner 1: HARDEN NINO D Voting Precinct: SMITH GROVE Mailing Address 1: 191 BOGER ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028 Voluntary Ag.District: No Legal Description: 1 AC BOGER RD Fire Response District: SMITH GROVE Assessed Acreage: 0.96 Elementary School Zone: PINEBROOK Deed Date: 4/2014 Middle School Zone: NORTH DAVIE Deed Book/Page: 2014EO416 Soil Types: GnB2,EnB Plat Book: Flood Zone: X Plat Page: Watershed Overlay: - Building Value: 0.00 Outbuilding&Extra 0.00 Freatures Value: Land Value: 24660.00 Total Market Value: 24660.00 Total Assessed Value: 24660.00 oPv�F f 1 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,NC i implied warranties of merchantability or fitness for a particular use.Ail users of Davie County's GIS website shalt hold �0f harmless the County of Davie,North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website. z N 5 of P,'r i y y wr t SP C� SG C el 00 4r-Cl U5 p 5 P s s o;�5 o, --25 _ l