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249 Persimmon Grove Ln (2) .. ._ •.- ' DAVIE COUNTY HEALTH DEPARTMENT : Environmental Health Section �� P.O.Boz 848/Z10 Hospital Street Mceksville,NC 27028 (33G)751-8760 Account #: 990003399 Tax PIN/EH#: 5727-59-7580 Billed To: Jeff Joyner Subdivision Info: 2c(q�G>/'Sirn✓�o�l G�JG2�'I Reference Name: Location/Address: 6reerrHi4 Proposed Facility Residence Property Size: 50.53 acres ATC Number: 4026 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his 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 WASTEW ON N IS V LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu : ,�.t.� Date: c-�Zq�t�J� � � CERTII ICATE OF COMPLETION **NQTE** The issuance ofthis Certificate of Completion shall indicate the system described on Improvement/Operation Permit l,P�� has been installed in compliance with Article 11 of G.S.Chapter 130A, Section.1900"Sewage Treatment and �� U Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any �� given period of time. U I�� ���� , 'o J�=� r-i �/' ��`� � , �� , , x� - �rlL,., /c�p� � O� � �2 � ��,-���.i�: 4--�'-, � . ��� � Septic System Installeri By: Environmental Health Specialist's Signature: Date: � /� c DCHD OS/99(Revised) , `�'�� ,• DAVIE COUNTY HEALTH DEPARTMENT , ' Environmental Health Section > ' ' � P.O.Boa 848/210 Hospital Street ,►�GL ` ��'O S ' Mocksville,NC 27028 � (33G)75]-87(0 IMPROVEMENT/OPERATION PERMIT Account #: 990003399 Tax PIN/EH#: 5727-59-7580 Billed To: Jeff Joyner Subdivision Info: ��c�'� Reference Name: Location/Address: Gre ill Road-27028 Proposed Facility Residence Property Size: 50.53 acres ATC Number: 4026 **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 Artide 11 of G.S. Chapter 130A,Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF STI'E PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �](`,)t�SL, #People � #Bedrooms 3 #Baths � Dishwasher: � Garbage Disposal: � Washing Machine: � Basement w/Plumbing: � BasementlNo Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size ��A�GS Type Water Supply ��-t— Design Wastewater Flow(GPD) 3(�t,7 Site: New� Repair� System Specifications: Tank Size�(�"��OGAL. Pump Tank GAL. Trench Width �� Rock Depth 1 Z'� Linear Ft. �, ' Other: �� I�1STQtQ',�,�Jiiv.J �6x�S Required Site Modifications/Conditions: ��S�"�� c�.J CE�.1ia�. �� �� ��%n-... 1�.� �"� 1 d0� F��- v��-7U— 11�1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G "BELOW FINISHED GRADE. ****NOT[CE: 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(33C)751-87G0.**** .�►�- r���� �D�c.,z10� 41 ?1� � �-rQ� �� �.}�, �..� � �r=�:�Lt�.1c� ia �2� � � �-1 1 � ,'f�y,� �5' 100 x_3to � s r I t� f�. ��� r- Environmental Health Specialist's Signature: !�� Date: C� Zq oJ DCHD OS/99(Revised) a .. � , ,� . � �=�`� . t ; � � • � � a TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC ' � ' �, Davie County Health Department DEnvironmenfa/Hea/th Section d $ 200� P.O. Box 648/210 Hospital Street l��� � QC,� 2 Mocksville, NC 27028 /� � � ,�n A1.tiF��N (336)751-8760 ***IM �1� .* THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INF ON IS PROVIDED. Refer to the INF'ORMATION BULLETIN for instructions. /1 � , / 7 / 1. Name to be Silled �l�fr ��(%/V,!' /� Contact Person � '� ' .`�1� �'' L . .� Mailing Address ��� ' )i'Gl.l/�= �C'� Home Phone ���� h :� �— � �� City/State/ZIP �;r��S %/� �/� � ' l- � ����J Busine8s Phone ,`�,�1 l� �� ������ ` /� � ' —c--- 2. Name on Permit/ATC if Different than Above Mailing Addreas City/State/Zip 3- 2�t-�s' ���� _� 3. Application For: C�Site Evaluation ❑ Improvement ermit/ATC � 1Both � -- 4. Syatem to service: CT House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type syatem requeateds � Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People � # Bedrooms �.S # Bathrooms �� LidDiahwasher L�Garbage Diaposal �Rashing Machine OHasement/Plumbing ❑Basement/No Pltunbing 7. If Buainess/Industry /Other: verify type # People # Sinka # Coa�odea # Showera # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (qallons per day) 8. z'ype of water aupply: ❑ County/City I�Well ❑ Community 9. no You anticipate additions or expansions of the facility this system is intended to serve? ❑Yes C�No If yes,what type? ***IMPORTAN7�**CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED IiELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TNIS APPLICATION. Property Dimensions: J U - s � d-'�:-.✓` WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Of�ce PIN: # ���� .1�_�C���L��(J . .. - Property Address: Road Name �iz�.Y J1� /�/, �/l�r� �- `�-�- �� City/Zip If in a Subdivision provide information,as follows: Name: /� �° � Section: Block: Lot: Date home corners flagged: � This is to certify that the information provided is correct to the best of my kno�vledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if tlie information submitted in this application is falsiCed or changed. I,also,understmid t/1at I am responsible for all clrarges incirrred fro»: t/�is 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 to conduct all testing procedures as necessary to determine the site suitability. DATE ;� . G� �/ SIGNATURE r --'s'�J" �' � THIS AREA MAY BE USED FOR DRAWING YOUIt SITE PLAN(In ude all of tlie following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locatio�s). '� \ Site Revisit Charge Y Date(s): �� Client Notification Date: ` � EHS: ; �� Sign given --C ) . Account No. � ! / �.�-.�'� Revised DCH OS/03 ;, �� ��'G`� f`� � Invoice No. �� �o ��,C—� .e..✓�- ,�-� � °�`�� �- � �a 3 Zs � rvv � , � ��.a.. L r�g� � � �.� � . . . � �. � ;_ n ��� � .. , (7.F,�OA) . . . � . � .�� .., •a"351 ` az8 , . . .,� � rr�} . .; . : 5g89 .. �4 (4.46A) (4.b7A} /�// � /� 1807 . J '1804 ��0 ��./ � / . .�� �� � .�c� y 809 � C �77�5 f �� . �e9 .- . . 5746 � d`"^,8736 � � t9a �t5� _y � � f ��ava � " � 57'i2 0 �. - (1.75R} , �,�.oi _ .. � � ��66n ,�^A6 � '.�'ce�'�a�c� '�.." � � ,..__.--�—``�°i .,-� „s� ^`'° M "�. . M isr — d � � -. COGNFYMOMEitOAD�"^""�� — � � � f , (B.OBAJ x �/��r /"� 2543 � `J 1► C �� �`''1 a I �fa:5oay 3asz ; '� � � 23 „� � � �� �� L � ����2��>��,�.�_������� � � q 1�UI�AIVG4U*3 � � ��' ���'� n��ri�c a,a, , 9� �� � ��•___ � �� � ��3b91 -� . A � 5as: �� �7 3 �: ,�;�. /�� d � i � � � � S � . �� �,� ���� � � {�� t,��, a 8558 w �s (50.53A) � �`�� �; ��^ 7580 , i . ,f67aJ. � �' ; � '� i�i�'�!� �� j � (4 62Ae), ? � i i � ia j ��� �ii Ii������V� 'M�i� ���)���Iill�) � �Pm�lk� ( �i�i , ��N��;� �.� �!,2�ii��� �i�.@ lu(�mit�'N��oa a��, ,��§,.�4 � � � �u a�q � �p�� � %�I�9Afl(�� ��s'����k4�, i� ' „� <.�il�s N �����"��A flpi�9 • �i��I�� � �i� ��o �'' � ��'�^�� ,an � ,ON jJ � � � � � � ,'�� `Q925 � #it.78Ay RA7z � , y ; � � � � ��i (�}� .: p N 4�� 301 '1307 � '�.164 ��.i I I� P i�� �'��e i ��Ni ��� . � s a E � : a h"c.,li° Ita i+ li'������i�liki�� �: i ,) 4�; �, � � ti����i��Pi i 911�i1i��i��� ta�� Xr y��� �}���e�J��� �°� ^�, �` �������� � � �: �{ s�i��i�° dP�°��i�, {1.48� �.� a'� ' .,,,i � �� q�a � ii �� r ' ��l �' � � ������ 1 �� ����4�t`'�b � s �., (,y�7�� � I Iq I)��!�p;�ma���i� dh I, � ��uP� ��t���E i I \./�� �II � h ' R, �i , � �{ �d iv �� �r t�oi,� �r`'° �asi � � d.�.� � i� �� � I. � zis j g { V � 7 � � � `�' �r #� #�2_stA) a ' 6466 1 ' „r� . N. f �a �;r i�t ;` 5 , � " � � '� �ii a �� . . iu��� �! . ����' � . .. . . . . � � i, ti i � i. o.i � ��� � p P.. i ' � �������I���^ �) ii P iiliiPii ^a i` ' ' ,. �-. ;�. . ' �� '-- : . � " �� i��. �' M .. ,. '.Y��.��� , 6 �3��� . � . .._ S. .. . . . . .. . f�F 3'iAS�.. .Qa.«, �.. �_ � I ' �� �. • � � , , DAVIE.COUNTY HEALTH DEPART'MENT •� ` ' , Environmental Health Section � � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003399 Tax PIN/EH#: 5727-59-7580 Biiled To: Jeff Joyner Subdivision Info: Reference Name: Location/Address: Green Hill Road-27028 Propased Facility: Residence Property Size: 50.53 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 L Slo e% �� (.r?.c HORIZON I DEPTH �- ' p� b ���I Texture rou S�:-t..- C;� ' Consistence SS �55 � 1 Structure C d1 M Mineralo S:. � �1c. HORIZON II DEPTH - 1 -2 1 �- Texture rou C.,. "52 C�S Consistence —,5 A ' S SS S Structure '� 1� � Mineralo i i.-'1L. HORIZON III DEPTH I 1 - 4 � --4 'L�S Texture rou (S� (s� � ,�c Consistence ��- S - �S Structure U2. Mineralo HORIZON IV DEPTH Texture rou � ^c:,iL. ConsisteRce Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ' '-US LONG-TERM ACCEPTANCE RATE �p. �`•3 SITE CLASSIFICATION: EVALUATION BY: R�-���'�4`� LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: ����^3� REMARKS: �'"'Z' ��"y �-'� 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 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 Mineraloav 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) ■����������■■■������■��■��■�������■�■■���������■■����■■��������r�■ ■������■■�������������������■■!�■���������■����������������/�����■ ■�����������■�■���■����������■������������■/��������������������■ ■����■��■�����■�\��■����■■����■■ ■■■���■������■■�����■�����■����■ ■��\������������������■��■����■����������������������■��■��������■ ■��■��������■■■■��■�■��■����■����■■����■��■��■��■��■��■�■■��■����■ ■��������������������������������������������/���������/���������■ ■�������■■��■■■������■��■\��■■�����■■■�\■�����■■��■�■������������■ ■■����■■���■�■■��■�■��■��■■������■�■■���■■������■�■���■�����■■��■■ 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■����■�■■��■■■����������������■■�����������■■i���e5���r��■�■����r,�■�■�■ ■��■�■��■■���■�����������■����■��■L��J���fi��■I�■■■■�r�`�■�■■���%��■■�■ ����������������������������������Ca���`���������r�'1�������/������■ ■�������■■���■■�����■�����■■���■ \►I�■�■��■��■���%\!r�����/,���!,■��■ ■����������������������■�������■ i:�������■������i�\������l��I//d0��■ ■�������������■�■■■�■�■■■■�■■�■■��[w^�■��■■�������■�■■■■�■I/�■'i�i��r�1� �► � . , ' ; DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 November 12, 2004 Jeff Joyner 222 Shuler Road � Mocksville,NC 27028 Re: Site Evaluation- 50.53 Acre Tract/Greenhill Road Tax PIN#: 5727-59-7580 Dear Client(s): As requested, a representative from this office visited the above site November 10, 2004 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this office will revisit the site to issue an Improvement PermitlAuthorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked � off. If you have any questions, feel free to contact this office at 751-8760. . � Sincerely, Jeff G. Beauchamp,R.S. Environmental Health Section Enc(s) � � � �. "� '' ��r �,sw ��,�� � �''�'�-��,.,�,� �a ,� , �r.��,� �:°,�+ � �.����� �,. � �� � � �� ,,�� � , � _� �;. k" .. .. '�y� R ,�- g; m,»_. � '� ,�' ,�-3���g ��, � `g �'`� y &� ��:,g�s }� t `�� _ �g¢ -o , �� ''v . � °' ,. •5'�p'�y '� ,�.�c �� , . �. �'� `-. a .'�s €�i �. : ,�a��_�` i g �+�,Y � � '�`�,�- y ° � : �. n . � c : . .��' * =i.� ,s�. 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"�_'� a.�.. ., ..,.. . f�'���. .. .,.Vi/ �, �,.r.* �. �� ����:.F" �� . . :# _ . r � z°�...:� a ;,. ` ' `� _ , '.. x,....- " .. � � `�� ,' " .. �� � Appraisal Card 'i Page l of 1 , � � l j � • • I� �i DAVIE COUNTV NC � 1 24 2013 2:42:56 PM � OYNER JEFFREV DEAN Return/Appeal Notes: )3-000-00-023 49 PERSIMMON GROVE LN j UNIQ ID 17864 , 1944000 NN:08-DNISION OF REAL ESTATE � D65-P4 ID NO:5727597580 �'� COUNTY TAX(100),FIRE TAX(100) j CARD N0.1 of 1 i _ eval Year.2013 Tax Year.2013 23.68 AC GREENHILI RD � 23.680 AC 23.680 AC SRC=Owner . - raised b 19 on 09/26/2011 06005]ERICHO TW-06 C- EX- AT- LAST ACTION 20110712 � CONSTRUCTION DETAIL MARKET VAWE: DEPRECIATION CORRELATION OF VAWE � - Foundation-3 EH. BASE S[andard 0.2000 ' _ ontinuous Footin 5.0 US MO Area UA RATE RCN EYB AYB REDENCE TO MARKET '�� ! ub floor System-4 01 01 1 586 301 70.70 11213 199 199 %GOOD 80.0 DEPR.BUILDING VALUE-CARD 89 70 , .. I wood 8.0 ' _. x[erior Walls-10 TYPE:Single Family Residentlal Single Family Residential DEPR.OB/XF VALUE-CARD 23,01 _ MARKET LAND VALUE-CARD 158,54 luminum/Vin 1 Sldin 29.0 STORIES:1-1.0 Story OTAL MARKET VALUE-CARD 271,25 ' oofing Structure-03 I '� able 8A , oofing Cover-03 OTAL APPRAISED VALUE-CARD 271,25 s hal[or Com si[ion Shin le 3.0 . OTAL APPRAISED VALUE-PARCEL 271,25 nterior Wall Construdion-S ��� wall/Sheetrock 20.0 '� nterior Floor Cover-08 ' OTAL PRESENT USE VALUE-PARCEL ' heet Vin I/lamina[e 6.0 OTAL VALUE DEFERRED-PARCEL nterior Fioor Cover-14 � OTAL TAXABLE VALUE-PARCEL 271,25 � aret 0.0 +-----20-----+ eating Fuel-04 I F S P ' I PRIOR �. fectric 1.0 I � I BUILDING VALUE 91,93 I I BXF VALUE 26,74 eating Type-10 I ', I ND VALUE 158,54 eat Pum 4.0 I I PRESENT USE VALUE ir Conditioning Type-03 � � 4 DEFERRED VALUE entral 4.0 OTAL VALUE 277 21 Bedrooms/Bathrooms/Half-Bathrooms I � I 3/2/0 12.00 I I I I drooms I I � AS-3FU5-OLL-O I � I '� a[hrooms +-6-+-----20-----+--8--+---14---+ � PERMIT �� � AS-2 FUS-0 LL-0 I B A S � � I CODE DATE NOTE NUMBER AMOUNT ��� OTAL POINT VAWE 300.00 I � �I I BUILDING AD)USTMENTS I . 1 ROUT:WTRSHD: � uati 3 AVG 1.000 I , 6 SALES DATA i ' ha e/Desl 3 FACTOR 3 1.000 Z ', I FF. INDICATE i Ize 3 Size 1.010 '� RECORD DATE DEED SALES , 8 + BOOK�AGE M R TYPE / / VRICE OTAL ADlUSTMENT FACTOR 1.01 I '�� I � � OTAL QUALITYINDEX 101 I �� I 0599 501 3 005 WD E I Z5700 � _ I � 1 0078 333 11196 WD X I � I 2 ' I I I I , +---""'Zg""'---+-'10--+ +4+ � �.. I F O P +-6-+ I HEATED AREA 1,356 ' 6 6 � '. +""'Zp'""'"+ NOTES ! ' plit Der plat 2011P1CKED UP STG BLDG � 'OS 24X36 FDG ' REVISED HOUSE DRAWING � SUBAREA UNIT ORIG% ANN DEP k OB/XF DEPR. . GS ODEDESCRIPTIONLTH THUNIT PRICE COND BLDG#LBAYBEVB RATE OV COND VALU TYPE AREA %RPL CS 24 HED 1' 24 288 10.00 0 _ L 00 2005 55 60 172 AS 1 35 10 9566 1 TORAGE 20 30 600 15.00 0 _ L 00 006 53 79 711 OP 10 3 268 2 ARAGE 2 3 86 20.0 L 00 200 S 8 1417 . FSP 48 4 1357 OTAL OB/XF VALUE � 23 00 ` FIREPLACE 1-None j I UBAREA 1,94 112,13 OTALS � � UILDING DIMENSIONS BA5=W14W8 FSP=N24W20524E20S WZ652 8E28FOV=56E20N6W452W6N2W10$E1052E6N2E4N12 N36E� i LANDINFORMATION I I HIGHEST THERADJUSTMENTS LAND TOTAL , ND BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES ROA UNIT LAND UNT TOTAL AD7USTED LAND LAND � SE COOE 20NING TAGE DEPTM SIZE MOD FAR RF AC LC TO OT TYPE PRICE UNITS TYP AD]5T UNIT PRSCE VALUE NOTES ! RURAL AC 0120 44 0 1.0000 4 1.0300 12+20+00-OS+00 PW 6,500.0 23.68 AC 1.03 6,695.0 15853 � I OTAL MARKET LAND DATA 23.68 158,54 OTAL GRESENT USE DATA � I � � http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parce1=J300000023 1/24/2013