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194 Deacon Way Lot 5 Davie County,NC Tax Parcel Report Monday,December 19, 2016 383 351 r i 365 5 262 256 ` 246 41G 2651 'r r ' r r � 2.26 259 Y QEq r' 206 _� r Chi ,�_, f ��''✓,qr 309 '.3 2 2391 �� 194 217 '� 178 LL! U 1193 f 162 r 276 -_–. _- -- ----— ------------------ —'1.61 ��_��_ --- ------------ -- � ---.1--��- - ---.._----- ---' WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: K5030A0005 Township: Mocksville NCPIN Number: 5747664291 Municipality: Account Number: 82531957 Census Tract: 37059-805 Listed Owner 1: KOLBASH RONALD L Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 194 DEACON WAY Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag.District: No Legal Description: LOT 5 DEACONS RIDGE Fire Response District: JERUSALEM Assessed Acreage: 4.68 Elementary School Zone: CORNATZER Deed Date: 5/2010 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 008260768 Soil Types: PaD,PcC2,CeB2 Plat Book: 0006 Flood Zone: Plat Page: 060 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 161 Ail data is provided as Is without warranty or guarantee of any idnd 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 /'rCounty 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. • DAVIE COUNTY HEALTH DEPARTMENT f Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003776 Tax PIN/EH#: 5747-66-4291.05 Billed To: Ray&Sue Ballestero Subdivision Info: Deacons Ridge Lot#05 Reference Name: Location/Address: Deacons Way-27028 Proposed Facility: Residence Property Size: see map ATC Number: 4520 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON UC N IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: / ' Date: 1 rf 3i CERTIFICATE OF COMPLETION - **NOTE** The issuance of this Certificate of Com�on�shan�the system described on Improvement/Operation Permit has been installed in compliance with Article 11 0 wage Treatment and Disposal S ," AY n as`a�guar ee that the system will function satisfactorily for any given period of time. � LOV'13'(L l.�.it ��7 � 1�`-►y2S.�-t�tf}.) Gj. to Septic System Installed By: �1x� Environmental Health Specialist's Signature: e: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �i P.O.Boz 848/210 Hospital Street ��� '. Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003776 Tax PIN/EH#: 5747-66-4291.05 Billed To: Ray&Sue Ballestero Subdivision Info: Deacons Ridge Lot#05 Reference Name: Location/Addressl:gteacons Way-27028 Proposed Facility: Residence Property Size: see map ATC Number: 4520 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People o� #Bedrooms �Ir #Baths.—Z _ Dishwasher: Garbage Disposal: ❑ Washing Machine: 2� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ ��rfiAe Lot Size V Type Water Supply Design Wastewater Flow(GPD) ti Site: New 2" Repair❑ System Specifications: Tank Size 6VO GAL. Pump Tank GAL. Trench Width �Z-Rock Depth X2 Linear Ft.(�G Other: As stated in 15A NCAC 18A.198%5) Required Site Modifications/Conditions: accepted SystPrnc may --iso bb used IMPROVEMENT/OPERATION PERMIT LAYOT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Conta a re tative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m. or 1:00 p. .t 1: p.m.on the day of installation. Telephone#is(336)751-8760.**** I.f6 Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) n • , 1 APPLICATION FO ITE EVALUATION/IMPROVEMENT PERMIT & ATC avie County Health Department nvironmental Health Section d5 Hospital Street D P.O. Box 848/210 Hos /P Mocksville,NC 27028 36)751-8760/F�AuOr (33 751-8786 Applic tion r: ��iTk i ement Permit thization To Construct(ATC) ❑ Both ***I AN7***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 F '� Contact Person Billing Address Home Phone 7 -3—196D City/State/ZIP iNT , 2-7bZf3 Business Phone D Name on Permit/ATC if Different than Above 733— R� l Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Permit is valid formonths with site plan,no expiration wi complete plat.) Street Address � % City. Y-�J 1// Tax PIN# Subdivision Name ► Section/Lot# 5 L t Size D' do To Site: 0 -S• �5 % 100 O paa t e ali / 1 5 Date House/Facility Corners Flagged — U,_i 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 IRNo Does the site contain jurisdictional wetlands? ❑Yes RNo Are there any easements or right-of-ways on the site? ❑Yes ©No Is the site subject to approval by another public agency? ❑Yes ®No Will wastewater othet than domestic sewage be generated? ❑Yes BNo IF RESIDENCE FILL OUT THE BOX BELOW #People ,2 #Bedrooms -3 #Bathrooms o2 Garden Tub/Whirlpool O'Yes ❑No Basement: ❑Yes RNo Basement Plumbing: ❑Yes ®No 1F 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: EConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:lir County/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0'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 understand that I am responsible for all charges incurred from this application. 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 on the above described property located in Davie County and owned by r Site Revisit Charge iP lol a owner's or owner's le al re resentative signature p g pDate(s): Client Notification Date: Date l EHS: Sign given ❑Yes 01CO Account# 7� Revised 2/06 Invoice# . o �V N IP N• �Lrs O BLANCHE f X110 D.S. 61 , W .e Iron oS.4 R c.. 7 O 4.5 Ac. 4.5 Ac N 3 3 Rc .ifaT9 S 51. 42' Iron 71,09 ���,,� X, Q 268.E 1 z l A� 16 /.1 c 14 >s /19y+ ,a 3./ Ac. 3. 2.7 AG. z Rc. �/Qt S 37. 46'17" W "bis 557 99.54 N 50. 27 17 CREOLAf S38' '.art,y Iron 0•B 72 .69 3.0 AC, 04' 47" W 99.93 SOBBYY 28 WD•B. Ila "'sling Iron S 50' sLnnp 29' .3e;-- Iron 9' 36'•ron 788.14-- N 52;—F-7' 'p 0�2 O ��� � O p5- �� - (p� O _ Ztn '0 O N G C)uA�� G _'nA NCprc Z APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT& L5 Q \'fir q pDavie County Health Department t U �O� Environmental Health Section 0�'l JAN — 7 P.O.Box 848 1 C Mocksville,NC 27028 V� 704 634-8760 . ✓U" ****IMPORTANT**** THIS APPLICATION CANNOT BE PR CESSED UNLESS, ALL THE REQUIRED INFORMATION IS PROVIDED. t �� 1. Name to be Billed = i� C6o _��XContact Person" Q �G Mailing Address g V4 1'-eH Po� Home Phone City/State/Zip � S 0,. ,w [ ` 7)GV Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 'IQ-11te Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: �ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other ^� 5. If Residence: # People —3— # Bedrooms # Bathrooms 4' ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes 4c— # 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 If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: cee S 1 WRITE DIRECTIONS(from 1 Mocksville)TO PROPERTY: Tax Office PIN: # Property Address: Road Name a fV +7 ; City/Zip Ile r- , 1 c J If in Subdivision provide information,as follows: �T 1 / /,eS i'Ile Name: 2ND l uJE 01,J 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 � `�' �" ' /C62)A a to conduct all testing procedures as necessary to determine the site suitability. DATE /— �' SIGNATURE ` Revised DCHD(06-96) • DAVIE COUNTY HEALTH DEPARTMENT O� ` • ' Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE 2 Water Supply: On-Site Well Community Public C.J Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 4,1yt Texture group Consistence Structure Mineralogy /. HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: — EVALUATED BY: LONG-TERM ACCEPTANCE RATE: // OTHER(S) PRESENT: REMARKS: EGEND 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 Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 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 - gal/day/ft2 DCHD(01-901 ■■■■.■■■■■■.■■■■■■■■■■■■■.■■■■■.■■■■■■■■■.Mee■■.■■■■■■■■...■■■■■■■ ■■■.■.■..■■.MeeeeEe■■■e■■M■■M■e■■Me■.eeEM■■Me■E■.■e■ee■eEEEee■■MM■ .................................................. ............... ................................................■................. ................................ ................................ ................uMME■e■■ee■■■■■■ee■■■N■eE■■eNNe■ueeeEEMe.ee■eM■ ......................°............................. .... ....... ........................................ ■■■E■Nue.■.■e..e■■■■M■e■ ■■■■e.M■ee■e.e■e.■eM■Mee■■M.ecce■Me■■eM.eeEEE■MMEEeeeeE■MMEM■e■E.M■ ��■iiii�iiiiii�� ii°■iii�i°.ii°i■i�iiiiii�iiiiii■�iiiiii� ■■■■Me.E■■Me■eeeee■■■■..eeM■■ee■M■■■■.■■MEN■■eeM■.MNe■■■■Mee■MM■e■ ■■■■■■■.■■■E■■eeeee■.ee■ee■■Mee■■M■M■■HE ■■M■■■■ H■■e■■ee■■■■MMM ...................................... ..�■■■■■■. ■�M■MMEM■E■EMOM■ ■■■■■.■■■■■..■...■.■■■■.■■...■..■.■e■■ M■■■■■ ■ ■■■■■■■■■■■■.■ ...................................... .SE■:C°°C� EMINIMMI■■■.■■■I ■.....■O..N.■..■■■■..■ ........ .... MEMO H ■■ ■MEMMEM ■■■M■.■■■e■■■■eM..■..■S.■■..■■■Mee■e■■��■�■MMM�� ■■■EE.M■EEM�Me■■ ...■■■■M■eee■■e.■e.■■■NE■MMee■MMee ■MMOMEM 0 mommommi ■■■Me■■■■■■■eEMMM■e■eEEMeM■■MM■■■.S■EE ESE ■ S■ ■ ■ ONE ■MEMMMME ..................................=...5.�.�.... O■M■■■■E H . ■■■■■.Mee■Mee■MM■.■■■■Mee■■..Ne■� eMM HHM ■�■�MMMMMM■MMM■. ■■.■■■■■■■■M.■.O■■■■.■■■■■..■■■■ ■■■■.N■■.. MMMMM■M■MMMM■MMM ■■■■■NEEM■eMM.Meee■■■■■E■■■eEEEEEE■ ■eEE ■ ..■■■■..■E■■.■N■.■.■N.■..E■.■■e..■■■°e..■.■..■..■■.■e...■eMe..■■..■MMM..■e..■M.Me..M■..■M■...Me..■S■..■■■...■■■...M■.M■...Me..■...E.Ee..■.e.■■.■.■.■..■.■e..He.�e.■■.■■�.e.��.N.:■■■ ■O■O..■.N.■�.ME....■.EMEMEMMMMMEEeE.MN.MM■EN■MM■■ ■■ HMEMNNHNUN ■°SEEN■■ iiii ■ ■i AN i ■e ■MM■EM■° .H ■■. ME■■M■Eu ■MME■=MME■ ■■ ONENNNN■■■■■■■e■ M■ MOMMMEMMUM MEN EMMEMMOM MEMORIMMI■■■■■■EM■■■ee■■■■■■.C........... ....■■.......................... ........■...■....N.e■■.■■.■■Nee■....■..■■.■■..■.■.■■■■■uee■■.■■ .................................................................. .................................................................. .................................................................. .■■■=.■■■Mees■E■■E■■.■.M■■e■■■■■■■■............................... .... ...........................�.■............■E■e■.e■Mee■u■■.■ ............................. ... ................................ °°■■■■°■■°.■°■■■■■°.■■°■■■■■...H■e■■■■e■...■.....■..■............ i R i APPLICATION FOR SITE EVALUATION/IMPROVEAIENT PERNI1 Davie County Health Department OCT 19 2005 Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 fNv11 MENTA1.HWH (336)751-8760 DAVIECOUW ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �C Contact Person O Mailing Address Home Phone Co — -2--1 2.— 60n 5 `. City/State/ZIP Business Phone �� — 20 — 0�-.�(D 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. System to service: V House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: 9 Conventional ❑ conventional modified ❑ innovative 11-2- 6. 6. If Residence: # People 2— # Bedrooms 3 # Bathrooms 2 ! Z IJDishwasher ❑Garbage Disposal .Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply: -Z County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes N rNo If yes,what type? ***IMPORTANT***CLIENTS AIUST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESU61177ED by the client witl►THIS APPLICATION. Q 1, �ov5•a2 Property Dimensions: I ��X 1 a �� ,Xp�,�t�J�X WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 3�/ �! 7 1 1 ��D - 1 Property Address: Road Name V3e^eo'n -A 0-L CityaipMot,�(CS. t 1 (rc 1J y rll� 2R e NtkwRe. . L.r-Y1 If in a Subdivision provide information,as follows: W rt o P A CPQ S C -,,)A�, Name: ��' N C'c>"-)S V,—,() C 1.2, CD Section: Block: Lot: Date home corners flagged: )o' This is to certify that the information provided is correct to the best of my knowledge. I understand that any pern►it(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 front this application. I,hereby,give consent to the Authorized Representative of the Dav}iCounty IIealth Department to enter upon above described properly located in Davie County and owned by N Ss y-p R_ to conduct alltestingprocedures as necessary to determine the site suitability. DATE �` C1 . Lo J� SIGNATURE \D111 1.6d � THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS: Sign given Account No. 31 -76 Invoice No. o% © S Revised DCHD(05/03 � �'7��� �e"�-rte .r✓���-� ;ayµ; DEACON' S RIDGE # Filed at 11 : 15 A.M. on November 19, 1993 - F08AL SU$OWWON PLAT APPROVAL y..........MK .P...BALL....... ._ and recorded in Plat Book 6 page 60. -ow mysupevionfivima,„Mw Tbie is to ow**W this pW nests&*recording r~~if*of dw Subdiw reoord&d in Hook_........................151 1 of 2 pages sioa RAWAabond fa Davie count'W%.4.Q appkcaas,that a Chet the boundaries not wirveYbd ys cerebrate of aeu,,ovei raa bean isuied by the D'iviaiat of FGjt- ays pursuant to Bonk ...................... .._ AfW*7.Cr.;Wwr 136 of ft Genera!Statutes,State of North Carolina ........... ••. AP4iFiOVFQ..._._ • cakufagtd u 1:2%.Q.99...... ___. _. 47 30 as amen Witness m D/STHiCT ENGRaEEti This,tte..._..4tM yy of ....._.. N�MM>i?ItL............ ..... 9 ..83 . Y my DATE........_...__.... �.. ..� . ._. ._ �/ J .I NORTH CAPCLk%A_ Da4ViE c ry f?IRECT) OF (Seal or Stam a aatf sill U ;- =,. � r•Y.,wz t 1 e1 -t2r30 ��jll�',}3WSiy L � - S , J�3 d w f B I I V s II ARE4,=4.601 ACRES t �t3, Y. .i' �9. j in AREA= 3.518 ACRES . � f I I 00 ,9 s AREA= 2.C59 ACRES v I ✓r � I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003776 Tax PIN/EH#: 5747-66-4291.05 Billed To: Ray&Sue Ballestero Subdivision Info: Deacons Ridge Lot#05 Reference Name: Location/Address: Deacons Way-27028 j Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring__ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence �- Structure �r Mineralogy HORIZON II DEPTH Texture group Consistence Structure J/ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE n SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: _ OTHER(S)PRESENT: REMARKS: Landscape Position LEGEND 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 33�' t 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 Mineralogy 1:1,2:1,Mixed rlQies 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■MMM■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 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Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 )754-8760 s 'F y9�f �„� ya 5s�pr cs�r ,✓ a' ' October 25, 2005 Ray& Sue Ballestero 34207 N. Peaceful Valley Road Palmdale, Ca 93551 Re: Site Evaluation/ Deacons Ridge, Lot# 5 Tax Office PIN: #5747-66-4291 Dear Client(s): As requested, a representative from our office visited the aforementioned site on October 24,2005. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, it was found to be provisionally suitable for the installation of an on-site sewage system. Before and Improvement/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, Robert B. Hall,Jr.,R.S. Environmental Health Specialist RBH/dlf E i A IAavie County,NC Tax Parcel Report Wednesday, February 8, 2017 r � 383 i I 351 ti r I 365 1 �•� #� 262256/ 41 216 f 2654`;. 226 259 -�'t�'� t 206 — L 247- ��r ilk gf'' � 309f-312 239 ,/ F,�r '?r. r.�19 Uj , Z 17 / ' 'titi _ Q- 178 U 1. LU x193 -� S 162 U •276 .............................................................._.........................................................................."�....a.........1..6.1................... ....,..... .................................... L............................................ WARNING: THIS IS NOT A SURVEY —7 77-77777 Parcel Information Parcel Number: K503OA0005 Township: Mocksville NCPIN Number: 5747664291 Municipality: Account Number: 82531957 Census Tract: 37059-805 Listed Owner 1: KOLBASH RONALD L Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 194 DEACON WAY Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag.District: No Legal Description: LOT 5 DEACONS RIDGE Fire Response District: JERUSALEM Assessed Acreage: 4.68 Elementary School Zone: CORNATZER Deed Date: 5/2010 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 008260768 Soil Types: PaD,PcC2,CeB2 Plat Book: 0006 Flood Zone: Plat Page: 060 Watershed Overlay: DAVIE COUNTY Building Value: 263290.00 Outbuilding 8r Extra 20830.00 Freatures Value: Land Value: 33480.00 Total Market Value: 317600.00 Total Assessed Value: 317600.00 tIE 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 Davis,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. Davie County Health Department 4 1836 f Environmental Health Section ,. . UCEIVED,- r.o.Bo.suis 210 Hospital Street ;�� Courier# : 09-40-06 " 1911 U Q s �a� Mocksville,NC 27028 Phone:(336)-753-6780 Fax:(336)-753-1680 ON-SITEWASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: ? ALI� �� �� Phone Number �Z /(O/Q(Home) Mailing Address:_19e/ dyal aW kI� (Work) lVae%s✓f /% Detailed Directions To Site: #W y k491_5' (J 2G1�1�4ZDYi �• rUl relc/ll'A/e- iN D Ueao Ns 64e Property Address: /q C�ClCON Please Fill In The Following InformationA,bout. e EXISTING Facility: Name System Installed Under: `�S(�� La 21-a Type Of Facility: use Date System Installed(Month/Date/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes Flo )If Yes,Explain: Please Fill In he Following Inform'on About The VFaciliX: Type Of Facility: G/Vl/tlG 01 norm 0.SI 4& Number Of Bedrooms: Number of People Pool Size: Gar ge ize: Other: Requested By: Date Requested: !� Signature) For Environmental Health Office Use Only A approved Comments: •� ! 5 It -14, 'c rC Environmental Health Specialist Date: = *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function prop ly for any given period of time. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: Account#: Invoice#: e County Health Department t 0 ronmental Health Section ! P.O. Box 848 4 210 Hospital Street u,•; Courier # . 09-40-06 s MockS\rille, NC 27028 • ., Phone: (336)-7 3-678 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: [ 1'�1Qr 6n}t,,�i,s s ht� Phone Number 33& 3L 6 636-p (Home) Mailing Address: �jHl ct ­ Creex /lc (Work) 1'tyo4so;l4- Nr- e)v7� Detailed Directions To Site:&DI ro d e"I men Rdaet Turn ! pv� Lrrejiyu Ad ao 6 1.)caun s Qc-j.,, on 44 Property Address: Please Fill In The Following Information About The EXISTING Facility: r/ Name System Installed Under:A214 Esus- bcdlfs�ryy Type Of Facility: $1txk 44,,' ,Li V ty�luce, Date System Installed(Month/Date/Year): 3-2-Z-0-1 Number Of Bedrooms: 3 Number.OfPeople: 2. Is The Facility Currently Vacant? Yes / o If Yes,For How Long? Any Known Problems? Yes - If Yes,Explain: 100 Please Fill In The Following Information About The NEW Facility: Type Of Facility: e7ara+& Number Of Bedrooms: 0 Number of People Pool Size: Garage Size: 26 -V z(e Other: Requested By:--� Date Requested:I-/,?- D (' gnature) For Enyironmental Health Office Use Only Approves`(Disapproved .....EorrimentS: Environmental Health Specialist A CLU r '? Date: 6 ?CJ % *The signing of this form by the Environmental Health Staf is in no way intended,nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check M/oney Order # Amount:$ "n Date: Paid By: CY/�'�' Received By: (Gf Account#: � Invoice#: 7' __