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145 Petes LnDavi Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: MOCKSVILLE State: WARNING: THIS IS NOT A SURVEY Parcel Information 060000000501 Township: Jerusalem 5744949803 Municipality: 56771100 Census Tract: 37059-807 PHILLIPS ERIC P Voting Precinct: JERUSALEM 145 PETE'S LANE Planning Jurisdiction: Davie County Zoning Class: DAVIE COUNTY R-20 NC Zoning Overlay: Zip Code: 27028-6763 Voluntary Ag. District: Legal Description: 8.390 AC RIVERDALE RD Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 8.39 Elementary School Zone: 2/2013 Middle School Zone: 009170403 Soil Types: 10 Flood Zone: 254 Watershed Overlay: 275060.00 Outbuilding & Extra Freatures Value: 48440.00 Total Market Value: 353170.00 JERUSALEM COOLEEMEE SOUTH DAVIE PaD,PcB2,PcC2 DAVIE COUNTY K.*W6attI1] 91-11KIIIIII 122 2016 9 MIS 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 Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS websHe shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. AUTHPRIZATION 1y0: Q 923, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Permittee'sP.O. Box 848 PROPERTY INFORMATION Name: `� VN \ \ V a �•A C.. Mocksville, NC 27028 Subdivision Name: >� Phone #: 704-634-8760 Directions to property: �U � � � G� Section: Lot: -'� AUTHORIZATION FOR WASTEWATERS SYSTEM CONSTRUCTION Ta ice PIN:# load Namel.q& C. 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 11 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. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED F., 49 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION?ERMITSI PROPERTY INFORMATION _,Perimttee�-s. Name: %, x'��' .� (` v-, Directions to property: r Subdivision Name: Section: _.., Lot: IMPROVEMENT PERMITs ' S Tax office PIN:#, koad Name� � 1� S • 11 Ij C?_ zip:."i E **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 HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS �'�) # BATHS. k. # OCCUPANTS_ GARBAGE DISPOSAL: Yes o -No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ,O NEWS REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE W GAL. PUMP TANK GAL. TRENCH WIDTH 1 ROCK DEPTH / LINEAR FT.-, REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r { Nous 10Q "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 01T INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM 1/0 eAM- BY: AUTHORIZATION NO. !� OPERATION PERMIT BY: ,!'L� DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED 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) APPLICATION FOR SITE EVALUATION/IMPROVEMENT . ~ Davie County Health Department � rp Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed M Y. a nd M r -s . tri G P P Ave-� 1 p Contact Person e ►tel a hi Mailing Address � J f �►�'�nn ff Y _ �/ Home Phone C, d �3 `+ " 0 5 IV City/State/Zip M oG S1/� C �-702 Business Phone (T-0 ) 723 — 1 000 2. Name on Permit/ATC if Different than Above Mailing Address d ' ' ` City/State/Zip 3. Application For: Site Evaluation Improvement Permit & ATC [ ] Both 4. System to Serve: House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other l 5. If Residence: # People—,5 Bedrooms # Bathrooms 2 L XDishwasher [ ] Garbage Disposal Washing Machine [ ] Basement/Plumbing XBasement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City X] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes X No If yes, what type? Ll LtmK A PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A NA OF THE PROPERTY MUST BE SUBMITTED WITH APPLICATION. y 1 SSE Property Dimensions: t7RAw,v„�G S.P7o cksville) TO PROPERTY: WRITE DIRECTIONS (fromrS Tax Office PIN: #'Y? (001 80ui-6 , PCIS} 601 Property Address: Road Name , �S ��)1� y - Ct, b 1� V D X m t R V�"d a 1,�, A n City/Zip Iv t S�ii I IVC t dead i --rid t� J If in Subdivision provide information, as follows: A-702-8� Peirs l�hr- nex+ C.'l I r+ Name: 'd rive to ; Section: Lot #: ; 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. 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 (Ar. Qnd hlrs - &yi G P Phi Ulf to conduct all testing procedures as necessary dete me the ' e suitability. DATES ' _ Q 7 SIGNATUREc ��L�� f' /�/, Revised DCHD (06-96) THIS AREA AtAy $E USEb t fi DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY Tiay' SUBDIVISION Water Supply: Evaluation By: t• _L On -Site Well Community Auger Boring ✓ Pit DATE EVALUATED L- :5-T PROPERTY SIZE ':�-J`s'A ROAD NAME R fes` Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position 1.9 Slope % HORIZON I DEPTH " Texture group t L_ C L, ConsistenceF Structure Mineralogy'.1 \► HORIZON II DEPTH (o'' Texture groupC Consistence _T _F S K S Mineralogy V. I' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS SS RESTRICTIVE HORIZON-- SAPROLITE — -- CLASSIFICATION . $ LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: §K S , LONG-TERM ACCEPTANCE RATE. REMARKS: 1w— DCHD (01-90) EVALUATION BY: OTHER(S) PRESENT: cvsk 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 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 ■■NEM ■E■■■ ■■EE■ ■EEE■ ■■■■■ ■EMEE ■■■■■ ■■ME■ ■EM■■ ■EME■ EMLIM■ ■■MMES ■■■M■■ :EEE■■ ■E■E■■ MENNE■ ■E■E■■ ■E■EM■ ■E■ME■ MEEEE■ ■E■■■■ ■E■■E■ ■■■■E■ ■EEEE■ ■E■EE■ ■E■EE■ ■■■■E■ ■■ ■■MEMS■■ ■■E■MOMM ME■■■EME ■■■■■EE■ ■RE■EEE■ MEMO "AN ■■■■MEZU ■■■■M■■■ ■E■■ME■■ ■MMMMMM■ ■E■■ME■■ ■■■■E■■■ ■■■MU■■ ONES ■■ ■■■■E■■■ ■■■■E■■■ ■■ME■■■ ■ ■■■MEM■■EM■ ■■■E■■M■■■■ ■MMEME■MEM■ ■■MMEM■■EM■ ■E■■■■EM■E■ ■E■■■MEM■■■ ■■■E■EME■■■ ■EMEME■E■E■ ■■■MEM■■ME■ ■■■■■MM■■■■ ■■■EM■■EME■ ■■■EME■■■■■ ■■■EM■■UMEM ■E■MEM■MME■ ■■M■ME■■M■■ ■EMEME■■■E■ ■■MEM■■■ME■ ■■■■■■MMME■ ■MMMEM■■■M■ ■■■■■■■EME■ ■EMEME■■■E■ ■■■■■ME■■E■ ■ME■EM■■■■■ ■■■M■MEMME■ ■MEHME■■■■■ ■■■EMEMMEM■ ■MEMEM■■■■■ ■EMEEE■E■SE ■■■■M■MEM■■ ■■E■NESS■■■ ■■■■[1M■■■■■ ■■■■EMEMME■ ■MMEWI■■■■■ ■UMMERI■E■■■ ■mmMMKlMMMMM ■nA■■RIMMEME ■WAMERI■■■■■ ■EE■EEEEMME ■■■■EEE■■■■ ■■E■EEMOMME ■■■■■MEMEME ■EM■EMEM■■■ ■■■■■■RE■■■ ■EMEMEME■■■ ■EM■EMIRE■■■ ■EM■EMINEMM■ ■■■■■■HEMEM ■■■■■ERI■ME■ ■■■E■EWEEM■ ■MM■MERI■■E■ ■■■E■ENOMM■ ■■MEMEEM■M■ ■KIMM■ Davie County Heafth (Department and Home Heafth Agency Environmenta(Health Section P.O. BOX 848 / 210 HOSPITAL STREET COURIER 1109-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 June 4, 1997 Mr. & Mrs.' Eric P. Phillips 435 Sanford Avenue Mocksville, KC 27028 Re: Site Evaluation/Pete's Lane Tax PIN: 45744-94-6316 Dear Client(s): As requested, a representative from this office visited the aforementioned site on June 3, 1997.; ,Based upon 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. If you have any questions, please feel free to contact this office. Sincerely, Charles E. Little, R.S.. Environmental Health Section CL/wd Enclosure(s) Davie Bounty Health Department 9N1 t�` Environmental Health Section P.O. Box 848 • C� ~ 210 Hospital Street Courier # : 09-40-06 1911 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) — 753-1680 (Check One) Replacement Remodeling Reconnection r Name: ,) T E�0 UY' l- 1.21 /l& S (('Y 'F j (f l y P one Number t, ./ ` i u - y � r ( (Home) Mailing Address: U! 19wsP Cf- 91e`i- g7og (Work) E- e yf,-r I-CAJ.(. 2 %2qa Email Address: �1✓ 1 x,� 1 U,1 �i n�;S CX�� y9l1CG. CCS �1 Detailed Directions To Site: ,�C, ( ,C7I;,!J -.�� r Property Address: No l alyo- 06' 6000006 jo( 5, Please Fill In The Following Information About The EXISTING Facility: �lI1 Au�e Name System Installed Under: Date System Installed (Month/Date/Year): S i Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes ' C No If Yes, For How Long? Any Known Problems? Yes No f Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Nupber Of Bedrooms: Number of People Pool Size: Garage Size: 2-7j/ X -5 1 Other:.. Requested By:ibate Requested: 1 U / T— (Signature) ; (Signature) ` r t For Environmental Health Office Use Only Appy' ro—ivec,Disapproved Comments: Environmental Health Specialist { ; Get % Date: *The signing of this form by the Environmental Health Staff is 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 Check Money Order # Amount:$ Date: Paid By 1�'/. i ,t}'.1 a? ! l f 1' x� 4> / t:._ ,..i Received By: Account #:)� )' ` Invoice #: CbP 91 037 , I 1I - - r --- ' r I r -- -- - I I I I 1 ! 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