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135 Old Farm LnDavie County, NC . I Tax Parcel Renort ) 6CA 1� Wednesdav, October 5. 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: N600000026 Township: Jerusalem NCPIN Number: 5744998962 Municipality: Account Number: 8303478 Census Tract: 37059-807 Listed Owner 1: SHOUGH MARGARET REBECCA Voting Precinct: JERUSALEM Mailing Address 1: 135 OLD FARM LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAME COUNTY CZOD Zip Code: 27028 Voluntary Ag. District: Legal Description: LOTS 38-41 OFF PINE RIDGE Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 0.34 Elementary School Zone: 5/2014 Middle School Zone: 009570742 Soil Types: 0002 Flood Zone: 022 Watershed Overlay: 50520.00 Outbuilding & Extra Freatures Value: 6920.00 Total Market Value: 57440.00 001 JERUSALEM COOLEEMEE SOUTH DAVIE PaD,PcB2 DAVIE COUNTY [1110l] 57440.00 F-a County, NCor All data is provided as Is without warranty or guarantee of any Mnd either expressed or Implied Including but not limited to theDavie Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS websRe shall hold harmlessthe County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to arising out of the use or Inability to use the GIS data provided by this website. AUTHORIZATION NO:9 7ADAVIE COUNTY HEALTH DEPARTMENT a����2 • Environmental Health Section PROPERTY INFORMATION Permittee's c� P.O. Box 848 Name: Mocksville, NC 27028 Subdivision Name: .92 Phone # 336-751-8760 Directions to property:_ AUTHORIZATION FOR 7 / WASTEWATER SYSTEM CONSTRUCTION Section: Lot: Tax Office PIN: Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. DATEI SUED I DAVIE COUNTY HEALTH DEPART� IMPROVEMENT AND OPERATION PERMIT PROPERTY INFORMATION "Permittee 's, 4•' Name: / > Subdivision Name: Directions to property: _ -"' ,' Section: Lot: IMPROVEMENT PERMIT Tax Office PIN: % Road Name:Zip: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HFA' LTH'SPECIALIST DATE ISSUED ,/ SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. I/� n RESIDENTIAL SPECIFICATION: BUILDING TYPE .� # BEDROOMS J # BATHS C:�k' # OCCUPANTS C-7�( GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No 17 LOT SIZFIM J✓ TYPE WATER SUPPLY�D 'DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE CYT GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. 345 REQUIRED SITE MODIFICA1 IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLU01T FILTER* *RISER(S) IF 6" BELOJ FRIISHED GRAVE-* S-fA o ' q-�;; 01- �o a "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (70)04;U t yE OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: .<7 ✓ "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYN E DgCGiCBED ABOVE 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. DCHD 05/96 (Revised) APPLICAl10N FOR SHE EVALUA11UN/IMPROVEMENT PERMIT & ATC r �Davie County Health Depatfinent 0 Environmental Health Saftji P.O. Box 848/210 Hospital Street MAY i Mo�aville, NC 27028 11999 (3361751-8760 ENVIROMIFNTAI WCAITL j ***IliPORTANT*** THIS AP2LICAT=iH CIRWM BE PROCESSED UNLRS3 ALL TI�QVIIfED � �J INFORMATION IS PROVIDED. Refer: to the INFORMATION BULLETIN for instructions. I 1. Dame to be Billed �_�[ ����Q_ _ i'�.•_ � ' _{ 1_( �n r Contact Person -��kGY C 0� Nailing Address �. /�� 1-7 -1 `¢ r -gnaoa phone 3 3 (11 — ir, CIt City/state/ZIP .1 1(�[I�S�� 1 X11 �� ( Business Phone 33k(1--�j �7L` �0 Z. Name on Permit/ATC if Different than Above 7 /Q 33 'R"L��D� Nailing Address City/state/Zip 3. Application For: )<Site Evaluation 0 Improvement Permit/ATC ff Both 4. system to service: 0 House X Mobile Home 0 Business 0 Industry 0 Other 8. If Residence: # People A _ # Bedrooms —5 # Bathrooms �— )'Dishwasher U Garbage Disposal Washing machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/industry/Other: specify type # People # sinks # Co®odes # showers # Urinals # Water Coolers IF FOODSERVICE: I Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 'X County/City 0 Well e. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type.? 0 Community 0 Yes A(No ***IMFDRTAN7%**CLIENTS AIUSTCVAfPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: #_ 15 J ' � q 9 S� C1 Properly Address: Road Name &-1-1 City/Zip 07W$ If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from MockrAlle) to PROPERTY: (D G 1 90-,AAk o oy� i-•�Q-f� Date Property Flagged: 5' (1 - ri 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. 1, hereby, give consent to the Authorized Representative or the Davi my Health De artmeuit to enter upon above described property located in Davie County and owned b. to conduct all testing procedures as necessary to determine the site suitability. DATE -"�' I'D - -7q SIGNATURE Lltl &� 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). Ze.+t.�ed ;CHD (07/98) Account No. 1 F�f 7��Invoice No. W- 125 9` '0 - Ftwt 30' 5j e, 131 ka( 30 S4E guA Mo�tt (O -r -s oble- We- N1.E�. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME 01" `t DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE nn� C It t5D SUBDIVISION ROAD NAME (311-D Water Supply: On -Site Well Community NoPublic � Evaluation By: Auger Boring �� Pit Cut • • o���o©tea Landscape position Uoll Texture .. , Mineralogy HORIZON 11 DEPTH Texture group W�� INVOW.47J, Consistence Mineralogy HORIZON III DEPTH Texture group Consistence ISM M, 92 Mineralogy HORIZON IV DEPTH Texture grqup_ Consistence i� / a I�7�+u•`.�' i�----. Mineralogy SOIL WETNESS CLASSIFICATION SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA' REMARKS: DCHD (0]-90) EVALUATION BY: l OTHER(S) PRESENT: CJ. 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 ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■C:�CGii■■iiii::��C����C: �_'��■!SAA ■■■I,■■■■■■■■■■■■■■ ■■■n■■■■■■■■■■■■■■ ■■wM■■■■■■■■■■■■■■ ■■►i■■■■■■■■■■■■■■■ ■n,!■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■ ■■■ ■■■ ■■■■ ■■ ■■ ■■ ■■ ■ ■■■■■■ ■■■■■■ ■■■ ■ ■■ ■ ■ ■■ ■ ■■ ■■■■ ■■ ■■■ ■ ■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■sig_,►i■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■N■■i■■■■■■■■■■■ ■■tt■ ■■ur■ ■■cu■ ■■ii■ ■KtII■ ■■ FJA ■■■ ■■■■■■■■■■■■■ ■■■■■■■■■M■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ut■■■,■■■■■■■■■■■■■■■■■■■■■■ ■■■ ■■��■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■��■■■■■■■■■■■■tri■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■