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440 John Crotts Rd �avie County,NC � Tax Parcel Report ' �`�1 Monday, October 3, 201 t � � . ''� �`�`, .f'�'r�15�E� -�`;:�, '\ �F I',:'. � r`� ��'�,�.�..`l�$.~;��� ,.� ' ��. , � �3 5�•� �� �,:� ��. ,.,i��`;, ,� i � �"y,'ti:�;i'�;`ti, 7 '"� J�HN GR(�TTS �D�.. ,r, `�r�,.1�0'� ;'� —,'— �— __�"_�—.�—�—�—_��`f,f f f;` .� � ;--,----- 4 ..,j. i.,`�,-,:, __.=�:`, � � 4?s :�40 \ ��,•��:r"'"-4�i -f r: i , ','�. �.. {: i �1i'S�16� �� � .-r,'�., ,,." 33� 161x��.�'�,�',� ���' ,'� f _;�,,� 15 4,:-'' ,,`�'1�{'��'� �, \i j �I ,i�� I% �'� r '_*��;14� rr •,cS-� _,.,_--.-- E - ��. �.�_�" � 1�9 �,�� r , r� - � 13� -' �'Q_'-" � �,; 'l�,``��.-,;f r���, � ,; 135r;�.�1��1 �,'�4' SJ� _.�- ^1 f r� tf 4^.. 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WARNING: THIS IS NOT A SURVEY _ �..__._ �_ �_s__.�.., ��_.� _____ ��. �_�..� _�_� �._______a�_ _. �.m,__ _ ___ _ ___ . � _� _ew______ �___�.__ . �._H ���,_:,.__ _e�,._�_. � �� � �� Parcel Information �e �� Parcel Number: J500000011 Township: Mocksville NCPIN Number: 5748937457 Municipality: Account Number: 8303512 Census Tract: 37059-805 Listed Owner 1: MILITZER RICHARD T Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 440 JOHN CROTTS ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag.District: No Legal Description: 3.958 AC JOHN CROTTS RD Fire Response District: MOCKSVILLE Assessed Acreage: 3.96 Elementary School Zone: CORNATZER Deed Date: 5/2014 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 009580454 Soil Types: GnB2,PcC2 Plat Book: 0005 Flood Zone: Plat Page: 099 Watershed Overlay: DAVIE COUNTY Building Value: 218450.00 Outbuilding&Extra 6100.00 Freatures Value: Land Value: 32970.00 Total Market Value: 257520.00 Total Assessed Value: 257520.00 �,v� All data Is provided as Is without warrenty or guarantee of any kind either expressed or impl(ed Including but not Iimited to the 9'p�6�' Davie County� Implfed warranties of inerchantability or fitness for a particular use.All users ot Davle County's GIS website shall hold harmless the 1�7�r County of Davie,North Carolina,Its agents,consultants,contractors or empioyees from any and all claims or causes of action due to �oUr�� 1�l.. or arising out of the use or Inability to use the GIS data provided by this website. �{ yF F " �Ae+�Tx�'�. � � �v #-^ `� , ' � �* , 'i= . a¢fsc a�5. 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' , '. . .. . .. _ ., . . ___ . . . �. • .� ' , , . �./ , , ' • DAVIE COUNTY HEALTH DEPARTMENT � , Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001869 Tax PIN/EH#: 5748-93-7210 Billed To: Joe&Dorothy Hemrick Subdivision Info:�V Reference Name: Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2947 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSLJED 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 d Disposal Systems). THIS AUTHORIZATION FOR WAST ER N VALI OR P D OF FIVE YE S. g � I Environmental Health Specialist's Signatur • ate: ' � J CERTIFICATE OF COMPLETION **NOTE** T'he issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with 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 will function satisfactorily for any �� given period of time. �� ^_�D `�� � � LlJ r5 FL� t�1 (92Q 'o <� '� �- � � �� � � � � � � "rq..�� NO�'5.�1.�-� Septic System Installed By: ��Z ' Environmental Health Specialist's Signature: e: � � DCHD OS/99(Revised) •. • ,DAVIE COUNTY HEALTH DEPARTMENT . • ' ' Environmental Health Section ( , . ' ' P.O.Boz 848/210 Hospital Street �� � �' Mocksville,NC 27028 � /� + (336)751-8760 � IMPROVEMENT/OPERATION PERMIT Account #: 990001869 Tax PIN/EH#: 574&93-7210 Billed To: Joe 8�Dorothy Hemrick Subdivision Info: Reference Name: Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map **NO"I'�**'I1iib�mprove�inendOperation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An AiJTHORIZATION 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 H�S� #People 2 #Bedrooms 3 #Baths �- Dishwasher: d Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size 3 �S Type Water Supply��� Design Wastewater Flow(GPD)t�� Site: New� Repair❑ , ,, System Specifications: Tank Size���GAL. Pump Tank GAL. Trench Width3_(� Rock Depth �2- Linear Ft.��� �� • Other: 2 'il S�� �'�.-t�' i lo� �� _�� �eJ STi�,� L.,e�"S q �.C. �,►S. Required Site Modifications/Conditions: ��15'�/�,� o,, G.O<�TZ6��, 14�� �� t��f- }�p��. �--�� L� DC� . ��.J� I1�IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(336)751-87G0.**** /� _ Sq . —c� U C.� -n T — - � � a 8 8- � � � e,Q�a�... �zo' �� N. �2' `--a`o•e. n��r� . � Environmental Health Specialist's Signa e: Date: � �s �J �6v C�. o�l . l...t�5 c DCHD OS/99(Revised) , 1. r �. � �i � ' 3, �,, �� �, ���-'''��{ APPI�CATION FOR SITE EVALUATION/IMPROVEMENT REfiMIT&ATC ,� �0�\ Davie County Health Department � �G , Environmenta/Hea/th Section p` �.�����N P.O. Box 848/210 Hospital Street �.�^��j�P�-sy Mocksville, NC 27028 'J<�"'{'w C�UN �t�y\�P�;�F� (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALI, THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORI�TION BULLETIN for instructions. � 1. Name to be Billed �O E. �" � p f� l�t vYl I^�C �� Contact Person �O C U• ��n'1►^1 Gk Mailing Address �L a g �oh n PU t{S �IOQCl, Home Phone `cJ 6' 'l 3� �'I City/State/ZIP ` `O�.�S V� I �C, I V+C . �?0�0 Business Phone F 5�`a S�3 C�O ro�hY Gt o� � 2. Name on Permit/ATC if Different than Above SAmC G�S G bpV'�� Mailinq Address City/State/Zip O r�P,(_ �� � 3. Application For: Site Evaluation ❑ Improvement Perm9.t/ATC �Both � 4. system to service: �House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People �_ # Bedrooms 3 # Bathrooms o3_ GYbish�rasher ❑ Garbage Disposal �Washing Machine ❑ Basement/Plumbing CI Basement/No Plumbing 6. I£ Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Esti.mated Water Usage �gaiions per day) 7. Type oP water supply: �County/City ❑ Well ❑ Community e. Do you anticipate additions or e�pansions of the facility t6is system is iatended to serve? ❑ Yes 0�0 If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTGD BELOW. Either a PLAT or SITE PI.AN MUST BESUBMITTED by the client with THIS APPLICATION. �- 3 4C2eS ` Property Dimensions: �'�'' �VRITE DIItCCTIONS(from Mocksville)to PROPERI'Y: Tax Office PIN: # ���0 " /.3 —� �-/ 'D ?a�� , �o� �4 5� 1"o c7oh r� �r0'�}S �c� _ Property Address: Road Name c� oh n Cro-(�s IRd _ Ttirn �e�'f O n dD�n ��ro �S �o�� , c;ty�z�p (�'10�ks v; I1 c� �7oa� Te�a�v�.l app►-ox . a rr, � . �an� l s If in a Subdivision provide information,as follows: � n �h e- r'q�"� �1 U�- bc t�O�d o�r Prese�-� how►e � La n�l enc losr�. �o)/ Name: . �CnCG "' urSC p4S�'��/ I ' Section: Block: Lot: Date Property Flagged: � � i � 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 chunge,or if the information submitted in t6is application is falsified or changed. I,also,understand tltat I am res onsible or all rarges iirc rred from this application. I, hereby,give consent to the Authorized Representative of the e Co ty e th Depart nt to entcr upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. � DATE �/ a �6 � SIGNATURE L��-c..�7��. � ,�j(�,,,�„��J 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). 5ite I�evisit Charge Date(s):_ Client Notification Date: i/���✓ EHS: ��— � �"� c C� ' � Account 1Vo. ; Revised DCHD(07/99) Invoicc l,to. �� `�� sa��z JOHN CROTTS ROAD ' �' �B a? � IM _���� :'I � i�� ' ! � �� ' _- � x � _ - ; _ ,:�`j� _-_ _ I � _ _ � � 1: � � �., : � _ _ ; '_. .�'�.�..� c,l ///��� � (1.9i4J �� �' �{ � O� ; V �I` 7457 �T� _ _ C,i L I � —�-•..-� ...._. _ I 'F J� _ /� i I = I t �� ' _ Y j � _ INDEXED ` t ON = ' �- "574816 -- . _ - \t:- .. ' ' _ L� Y �� _ _ - la - - - - t - - .: -. _ .-; '- _ - - ,._ , . . . _ , u,�s,r;':, „ � - ' - -�- _ ' " � _ � . �,_ _. ' - _.:': rno :'. l�(i I 0 _ `- t�•� I � _ - : �f�': 9141 � /� � � ` _ ' - _ _ N �`� �'� �`'' � � �`' - =� ,:� � _ -�+� �. = - - " i r - . l:: - - _ _ _ -� _ : : , - _ .. > ~ - :- . _, . • ' - �� ' = J500000012 � �- � _ _ - - - �- - _ _ ,� • ¢_- - - _ _ � � �_ - _- _ �: � : - � _- =, = _ _ = - ;- : - : - - - _ . � - -_ - - wo�ceooNs�aa.is � • - } _ • . - -- � .. . � • . � ��� � ' � DAVIE COUNTY HEALTH DEPARTMENT , ,� Y . . ' ', • ' Environmental Heaith Section ' � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001869 ' � Tax PIN/EH#: 5748-93-7210 Billed To: Joe&Dorothy Hemrick Subdivision Info: Reference Name: Location/Address: John Crotts Road-270 Proposed Facility: Residence Property Size: see map Date Evaluated: g �� 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 Q - D -l� �-�S Texture rou ' C C. Consistence -f'SS Structure c Mineralo HORIZON II DEPTH $, � Texture rou Consistence ; Structure � c� c Mineralo ` ` : 1 HORIZON III DEPTH 7- •-y� �L Texture rou C� C�-� Consistence r S Structure c S Mineralo � 1 �:1 ", 1 HORIZON IV DEPTH �- Texture rou L Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION �S PS LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: � � LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:' � ��k��"�`�� �I� REMARKS: 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 day 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 ' 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 OS/99(Revised) ■���������0■���■��■��■���■�����■�■■�■�������������■�■■�■�0■�����■ ■�������■����■��■����������■����■������■�■���■■��■���■■������■��■i ■������■������������������■����■�■�■�■�■��■����������■�������■��■ ■���■\��■���������������■�\����■ ■������������■��5����������■��■■ ■����������������������������������������������������������������■ ■���������■�■�����������������������■��e����������■����������■�■�■ 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