310 Lat Whitaker Rd Davie County,NC , T�Parcel Report Tuesday, October 4, 2016
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WARNING: TffiS IS NOT A SURVEY
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� Parcel Information
Parcei Numbe�: C200000015 Township: Clarksville
NCPIN Number: 5803618702 Municipality:
Account Number: 82533022 Census Tract: 37059-801
Listed Owner �T WHITAKER ROAD ASSO LLC Voting Precinct: CLARKSVILLE
1:
Mailing Address 1700 SOUTH HAWTHORNE p�anntng Jurisdiction: Davie County
1: STREET
City: WINSTON SALEM Zoning Class: DAVIE COUNTY R-A
State: NC 2oning Overlay:
2ip Code: 27103-0000 Voluntary Ag.District: No
Legal Description: 175.22 ac Lat Whitaker Rd Fire Response LONE HICKORY,WILLIAM R. DAVIE,SHEFFIELD-
District: CALAHALN
Assessed Acreage: 175.22 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 1/2012 Mlddle School Zone: NORTH DAVIE
Deed Book/Page: 008810107 Soil Types: MnC2,MnB2,MdB,MdD,ChA,MdC,RwA,WATER
Plat Book: 11 Flood Zone:
Plat Page: 14 Watershed Overlay: DAVIE COUNTY
Building Value: 43760.00 Outbuilding&Extra 101250.00
Freatures Value:
Land Value: 548140.00 Total Market Value: 693150.00
Total Assessed Value: 211770.00
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` AUTHO�tIZATION NO., , � � 1 .��DAVIE COUNTY�HEALTH DEPARTMENT. Q
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`�' c�� � � . :Environmental Health Section ' PROPERTY INFORMATION '
� ,Permittee�s `'- �. : � � P.O:.Box 848 �
-Name:'' 1 4��(.��'�� " �.���`° �yY} Mocksville,NC 27028. ' Subdivision Name:
' '�" :�` i Phone# 336-751-8760
Directions to property: .��1 � �b � Section: Lot:
- �" AUTHORIZATION FOR
��"��� �) ��;�""�����,,,.� . WASTEWATER Tax Office PIN:# - -
_ � . SYSTEM CONSTRUGTION' ��, �
�� �j�"T �F�i!'1!�["� i U�� Road Name:��� Ulll��'14��Zip: � l7 G✓�
**NOTE**This Autti�rization for Wastewater System Construction MUST BE ISSUED by the Davie Gounty Environmental Health Section prior '
`to issuance'of any Building Petnuts:This Forni/Authorization Number should be presented to the Davie County Building Inspections', '
' ::Office when applyin orBuilding Permits.': -
(In compliance t ith?uticle 11 f G S..:Chapter 130A,WasteWater Systems,Section.1900 Sewage Treatment and Disposal Systems), `
�***NOTICE***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION :
, � � ' . IS VALID FOR A PERIOD OF FIVE YEARS.; , ' <
IR� NT�jL ECIA DATE SU D . �
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, ��:. <- ���� TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION �
; ,`Per�ittee�s" �.° ', y �
- -Name:` � t. o�����a .. f�,r:t.�'�". :. Subdivision Name:
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r , '.,�D�rections to property;�.;'�:�� � ���`` Section: Lot:
� IMPROVEMENT
�.m;._�s;�.�.:...'��� L'��� �+; 4.�t} r.7��/ . PERNIIT. Tax Office PIN:#
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**NOTE**This Improvement Pernut DOES NOT authorize the construction or installation of a septic tanlc system or any wastewater system.An
5.ALJTI-IORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
' construction/installation of a system or the issuance of a building pemut. '
(In compliance�with Article l l;�f G.S:Chapter 130A;Wastewater Systems,Section:1900 Sewage Treatment and Disposal Systems) ;
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� ' t,� ,r;^�, + ` �""'`> *** E'**TfIIS PERNIIT IS SUBJECT TO REVOCATION IF SITE
'� NOTIC
. / �,,x � ` �,,?.� :j.'`�""''� ,,.,.''"`'�^'� f " PLANS OR Tf�INTENDED USE CHANGE.YOUR WASTEWATER '
....,�':.•-ENVIRON�IENTA���HE' TH SPECI � DATE SU D . SYSTEM GONTRACTOR MUST SEE THIS PERMIT BEFORE
� . i'-�-...� „ � INSTALLING THE SYSTEM. ; . .
RESIDENTIAL SPECIFICATION:BUILDING TYPE�" ��BEDROOM �� �
( S '3 #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
� . �MO� .
� COMMERCIAL SPECIFICATION: FACILTI'Y T'YPE #PEOPLE #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or No
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LOT SIZE������"'TYPE WATER SUPPLY ���^' DESIGN WASTEWATER FLOW(GPD)� NEW SITE� REPAIR SITE �
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SYSTEM SPECIFICATIONS: TANK SIZE 1 l�(.(J GAL. PUMP TANK GAL. TRENCH WIDTH�, ROCK DEP'TH �� LINEAR FT.�=-'�^•'
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� o�R , � i o� �T A�..t.� l�-t►� �� � O.C. !K�r.1.. � .
REQUIRED SITE MODIFICATIONS/C• ITIONS: Q� �^J �UR -l..L=Ar.1`L�.?('� -
IMPROVEMENT PERMIT LAYOUT APp 'R` '� : ' ` .
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**CONTACT REPRESENTATIVE OF THE DAVIE COUNTY ALTH DEPARTMENT FOR FINAL INSPECTION OFjtT�j$�$�y�7�,�
BE EN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE AY OF INSTALLAT'fON.TELEPHONE#IS(704k6�9�'�16�r.J1_�7�.
OPERATION PERMIT _ ,, rj �� � �
SYSTEM INSTALLED BY: y�A�V
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AUTHORIZATION NO. ; "OPERATION PERMITBY: A'I'E�� -
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**THE ISSUANCE OF THIS RATION P T THE SYSTEM D RIBED ABOVE HAS BE STALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAP'fER 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.
DCHD OS/96(Revised)
' ' � '� APPUCATION FOR SITE EVALUATION/IMPROVEMFM PERMIT&AT � � � a��
Davie County Health Department D
Envimnmenla/Hea/ifi Secrion
P.O. Box 848/210 Hospital Street �EC, — a 2n��
. Mocksnille, NC 27028
(336)751-8760
***�ORTANT�'** THIS APPI,ICATION CANNOT BE PROGESSED UNLESS ALL T REQUIRED
INFOFtN�,TION IS PROVIDED. Refer to the INFORMATION BULI,ETIN for instructions.
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1. Name to be Hilled � '� Contact Person �
` ^� f� ^�L 1 �f
Mailinq Adctresa ��"�i�A� `V�C.\�. Home Phone ��� / V [ �0
City/State/ZIP ` �r y " `3��v�usinesa Phone t 1
2: Nama on Permit/ATC if Different than Above ��-+M \ '
Mailinq Addresa City/State/Zip
3. Application�For: •(rYSite Evaluation ❑ Improvement Permit/ATC ❑ Both
a, syet� to se=..s�e: [�YHouse ❑ Mobile Home ❑ Business ❑ Industry � Other��� v 1
s. �f Residence: 11 People �_ � Bedrooms # Bathrooms
❑ Dishxaaher ❑ Garbage Disposal O Washi Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Husinesa/Induatry/Other: Specify type �li� �]7 � A People �^ � Sinka l
� Co�odea l / Shoxera �_ # Uri a � � Water Coolers �_
IF EOODSERVICE: # Seats Estimated Water Usage (gallona �r a$y�
�. Type of water supply: ❑ County/City Well ❑ Community
e. Do you anticipate additions or eapansions of the facility this system is intended to serve? �Yes ❑No
If yes,what type? p L�[]
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***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMi1TION REQUESTGD .
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
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Property Dimensions: �� '�-�� WRITE DIRECTIONS(trom Mceksville)to PROPERTY:
Tax Omce PIN: # ���- � �-8 70 � _., o ( ��� �I,�� �1,�
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Property Address: Road Name � A-� Ut�.!N�\`�"''�� �j +�.�'� � ``� ��
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City/Zip � C r�J � C� � (�O t''t
If in a Subdivision provide information,as follows:
Name: "
� �� a
Section: Block: I.ots Date Property Flagged: 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 revceation,if the site plans or intended use change,or if t6e information
submitted in this application is falsified or changed I,also,understand that I am responsible for a/l charges incurred J�om
thls application. I,hereby,give consent to the Authorized Representative of t6e Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessaty to determine the site
DATE I�/ � I ��� SIGNATURE �
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include ull of the following: Eaisting and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
q�5'�
Account No. � /
Revised DCHD(07/99) Invoice No. � � g ,
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, . • � DAVIE COUNTY HEALTH DEPARTMENT
- . � � � • ' Environmental Health Section
' " � .� Soi]/Site EvaluaHon
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900017 Tax PIN/EH#: 5803-61-87U2
_ Billed To: Thomas Handy Subdivision Info: :
Reference Name: Location/Address: Lat Whitaker Road-27028
Proposed Facility: Farm Bidg Property Size: 150 acres Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition
. Slo %
HORIZON I DEPTH _
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
Structure _
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON �
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: , EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:
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 clay SIC-Silty clay C-Clay
� CONSISTENCE
Mois
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
DC�ID OS/99(Revised)