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148 Old Farm LnDavie County, NC I Tax Parcel Report Wt b Wednesday. October 5. 2016 Zip Code: 27028-6745 Voluntary Ag. District: Legal Description: LOTS 106-117 BROADWAY Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 1.78 WA"ING: TH1S 15 NOT A SURVEY Middle School Zone: 005990468 Parcel Information 0002 Parcel Number: N60000002805 Township: Jerusalem NCPIN Number: 5744996708 Municipality: 19040.00 Account Number: 31342000 Census Tract: 37059-807 Listed Owner 1: GUESSFORD KAREN CARTER Voting Precinct: JERUSALEM Mailing Address 1: 148 OLD FARM LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAME COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27028-6745 Voluntary Ag. District: Legal Description: LOTS 106-117 BROADWAY Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 1.78 Elementary School Zone 3/2005 Middle School Zone: 005990468 Soil Types: 0002 Flood Zone: 022 Watershed Overlay: 175870.00 Outbuilding 8r Extra Freatures Value: 19040.00 Total Market Value: 235680.00 JERUSALEM COOLEEMEE SOUTH DAVIE WeC, PcB2, RnD DAVIE COUNTY 40770.00 235680.00 O wt� Davie County, All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the hnplied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the 7�7 1\ C 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. Phone: (336) - 753 - 6780 Davie County Health Department Environmental Health Sec6CR5CEIV P.O. Box 818 210 Hospital Street MAR 0 8 gnp Courier # : 09-40-06 DC HEALTHMocksville, NC 27028 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement emodeling Reconnection 1 rm: (336) - 751 - 8786 Name: L' l�,e a Amp 1 14RJA) W&VC4- Phone Number 7y� ?` e" 3Z6(Home) Mailing Address: /q &� OLA ;4�. "114- (Work) MQCMS Nr- 27II2X Email /Ig5jG6Ls02 aOXd'knvlQ .Kr. (its^ - Detailed Directions To Site: „ S'�- /J AC -Q Property Address: l V [( CLIO M9,01L—� aele� kjVe N 76 2-9' Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: 1 l'USE ,�Cx tf#4<kJ ./44,Wj d`'- Type Of Facility: Date System Installed (Month/Date/Year): S !G - �'E Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes ON If Yes, For How Long? Any Known Problems? Yes N If Yes, Explain: Please Fill In The Followin Information About The NEW Facility: Type Of Facility: N^ rot( Number Of Bedrooms: � 4 Number of People Requested By: 9. - Mod rk - AAIMie, &l. V,41 Date Requested: A Sa-VV AS- (Signature)- 7,q- 7/1.- 77-3, N. e _ L,�u./ i��ci47� 614fl4' For Environmental Health Office Use Only pprove Disapproved Comments: Environmental Health Specialist Date: *The signing of this form by the Environmental Health StatVis 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 CheckMoney Order # Amount:$ Date:/ 51%-3 117— Paid By: /L� �I f > +G , i r�ft'�. je»`�'i Received By: -461-3E2-- i� �Lt f j 0' (- Account #: sxr 37" Invoice #: :!�l} 3 g --'' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a nitary Snewag,lpiSystem j_%)L Permit Number Name L�F�`"<�_-- Date t �_- N2 8018 Location -' — — t , Subdivision Name —_ _ Lot No. - Sec. or Block No. Lot Size13OG — House Mobile Home —__— Business --- Industry No. Bedrooms —.Z— No. Baths —/"— No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO S ecificat ons fo System: Auto Dish Washer YES �KI0 ❑ � U` iOY , D—�OA Auto Wash Ma^hine YES �fn,NOO�❑ /vn� 2 y, Type Water Supply This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation it site plans or the Intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. I t 1 i LJ i Improvements permit by -Contact a representative of the Davie County Health Department for final Inspection of this system between 8:30.9:30 A.M., 1:00-1:30 P.M. or 4:30.5:00 P.M. on day of completion. Telephone Number: 704.634.5985. Final installation Diagram System Installed by -1 RDS x 0-tr 'ion VC] 04d Certificate of Completion _ —_ Date _ 'The signing of this certificate shall indicate that the system described above has been installed in compliance with DAVIE COUNTY HEALTH DEPARTMENT I IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systes Permit Number M Name_ `>. V3 tt� �� ' _� — Date �1 ! _ N2 8018 Location �L + _L r ; , — :; Subdivision Name �b Lot No. Sec. or Block No. Lot Size +_��'_' — House — Mobile Home --_ — Business _— Industry No. Bedrooms No. Baths --M\-- No. in Family t�'- — Public Assembly Other Garbage Disposal YES ❑ NO [q1 Specifications for System: Auto Dish Washer YES p� NO ❑ % L:'�� t . - _ �`'•, !',. Auto Wash Ma^hine YES [j' NO ❑ �,' ; � Type Water Supply 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. Improvements permit by 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by CZdysx1g- // Certificate of Completion — Date _ 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Vtt i Davie County Health Department Environmental Health Section PWi — 9 P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address S _P_ d i Y\If- Home Phone ')Di (03n G (o S GJ01 1 S V r C, Li � 1Business PhoneQ) '1 2. Name on Permit if Different than Above � oQ1✓� A � (XQW A Q Alz2 T �RA 60 Q zAt 3. Application for: ❑ General Evaluation 19 Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People 0), ❑ Basement/No Plumbing No. of Bedrooms jff Washing Machine No. of Bathrooms ,f Dishwasher Dwelling Dimensions X )% ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: Public ❑ Private 8. Property Dimensions �r t 'X 3 o ` Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes V No If yes, what type? ❑ Community 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: (ouD l -P NE , Mce-ksUi I le up,.aril This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. C*cam 6 A a � DATE SI NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: [Id i. I OWN the property. ❑ 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the vie County Health Department to enter pon above descriaed property located in Davie County and owned by C?/1 P�r� .d . ��/L��1a�.. —7ta�rnQ; l to conduct all testing procedures as necessary to determine said site's suitability fora ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1/93) 'DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY X\ Z� DATE EVALUATED PROPERTY SIZE 2--,ust X 3o0' LOCATION OF SITE 0A_ Water Supply: On -Site Well _ Community Public V Evaluation Byz�:'� Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position ,s Slope �- �,' 15� �•l6" �d '�5 HORIZON I DEPTH Texture group1-- Consistence Z _T_ -L Structure - Mineralo L l Il L HORIZON II DEPTH `' ` 4au 3." Texture group Consistence -Z F" - Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 55 fs S cS RESTRICTIVE HORIZON — — -- SAPROLITE CLASSIFICATION _ ,S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 1? EVALUATED BY: LONG-TERM ACCEPTANCE _ RATE: OTHER(S) PRESENT: CIN REMARKS: ,_ �re6� J st�% .�ZS_ " gTas a.-�Na. DCHD(01-901 LEGEND Landscaoe 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 ;lay loam• SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V, ---y 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 3C -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 ■��■��■��\��■ ��■ ■��■��N��nr�� ■��■ ■�■��■�� ■��■��r��■ ��■��■■ ■��■��■��/� ��■��■ ■■��■��■��■�■ ■��■��■��■■��■■ ■��\��\��■��■ ■��■�■��■��■��■�■��■��■ ■��H��■��■��\�� ■�� ■��■■ ■■��■��■��i��■��■■■■��■ ■��■■��■��■��■��■�� ■�■��■ ■��N��■�� ■��■ ■�� ■ �� ■ �� ■�■�■��■��■��■��■��■■■��■�� ■��■�■■��■ ��■ ■�� ■�� \ ■�■�■��■ ■■��■��■��■��■r�■ �� H �� ■ ■�■■�■��■��_��■��■��_��_��=iii�?iiiiin�i�■ ■�� _�� ■ � �� ■■��■��■��■■��■��■ ■��■�� ■��■��■ ■��■��■��■��■��■��u■�■�� ■��■��■ ��■�N��■�■��■�■�■��■ ■��■��■��■��■��N��=�_��iiiiiiiii ■■�■��■��■�■��■��■��■��■��■ �� ■��a��■�� ■�■��t��■��■■�■ ■�i��_� ■u��■_■ ��■■ � ..............■........■.........._..■.......C.■■==■�....._.■=..C= ................................................. . ........ _.. ■��n��n��H�/� �N�u�� ■��■��■�� ■■ ■ ��■�� ■��N��■��/��N�� \��■��\�� ■��■S■��■��h��H�� ......................�........................ . ....C...... .......................��.��...�................__ �iC..�.........0 ........................•��...........�...... .... .......... ��C��!.�w�■�■�..====�ii■i■ii:�:��-��i::��--�_►7r.-=='��7�� ..� w��/��C�� t� =-��■�� ■�■��r��r�� u��s—�— ■�N�v��N�n��\��i��C�� ■��■��r� ,r�■��■■■■ �� ■�� ■��■��7�■��u ",-�►7�� ■ ��■�� ■��■��r�%��\■�h�� ■ �� ■�■��■\��Y�IAl��I��■�� !�!"�.�I �� ■■■��■�� \u\�1��\��■�N. 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