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217 Red Bud Ln } _ f Davie County,NC Tax Parcel Report Tuesday, December 20, 2016 195 r 130 128, FOX HORN CT r 217 r' t +r I 129f 1 'r S 1 I I 1 t 5 t _ . WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H50000005307 Township: Mocksville NCPIN Number: 5749736682 Municipality: Account Number: _ -- 72792250 Census Tract: 37059-805 -Misted Owner 1: TAYLOR RICHARD K Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 195 RED BUD LANE Planning Jurisdiction: Davie County -City:_ MOCKSVILLE - Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code:. 27028-0000 Voluntary Ag.District: No Legal Description: 5.098 AC OFF SAIN RD Fire Response District: MOCKSVILLE Assessed Acreage:. 5.10 Elementary School Zone: MOCKSVILLE Deed Date: 5/2002 Middle School Zone: SOUTH DAVIE Deed Book/Page: 004200472 Soil Types: PaD,GnB2,GnC2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 101 All data Is provided as is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website 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. Y - , OPERATION PERMIT or fice use UnIV s„ Davie County Health Department *CDP File Number 200112-1 f T 210 Hospital Street H50-000-053-07 P.O. Box 848 County ID Number. Mocksville NC 27028 Evaluated For. NEW .... _ Phone:336-753-6780 Fax:336-753-1680 Township: Applicant:_ Richard Taylor/Marti.Carter. r erty owner: Richard Taylor/Marti Carter Address: 195 red Bud Lane ress: 195 red Bud Lane City: Mocksville City: Mocksville ~.. StatefZip: NC: 27028- State/Zip: NC 27028 Phone#:` (336):940-2341: Phone#: (336)940-2341 Pro a Location & Site information FAddress/Road #: Subdivision: Phase: Lot: ud Lane ville NC 27028 Directions Structure SINGLtFAMILY = " H '158 East turn right on Sain Rd, right n Red Bud lot on the left #of Bedrooms: 4 #of People: *Water Supply: NEWWELL *IP Issued by. 2140=Nations,Robert *System Classification/Description: - -_ : . !TYPE III G.OTHER NON-CONY.TRENCH SYSTEMS *CA issued by: 2140-Nations,Robert Saprolite System? 0Yes (E)No Design Flow: ._,4. 8 0 *DisfributionType: GRAVrTY•SERIAL Pump Required? QYes (DNo Soil Application Rate: 0 a 7 5 *Pre Treatment: Drain field Ni trificationld 1 ,7 ; 4 _ 5 ; Sq. g. *System Type: INFILTRATOR QUICK 4 STANDARD N 5 Installer: Marty Cater Total Trench Length: 4 4 a ft. Certification#: 3027 Trench Spacing: 9 Inches O.C. Feet O.C. EH S: 2140-Nations.Robert Trench Width: _ 3inches gFeet Date: 1 1 a 8 1 a 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Approval status Maximum Trench Depth: 3 6 Approvetl© Dlsapprovetl Inches Maximum Soil Cover: 2 4 Inches CDP File Number 200112 - 1 Septic Tank County ID Number: y'O-'O0.053-07 Manufacturer. Shoat Lat. STB. 760 Long: , . .. - - - - - - Gallons: 1000 Installer. Martin Carter Date: 0 8 / 2 7 / 2 0 1 6 Certification *EHS: 2140-Nations.Robert *Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter Date: ST Marker. ❑ Yes No Reinforced Tank: ❑ YeS n NO Approval Status 1 Piece T _ -_ _ __ � ® Approved❑ Dlsapproved ank: ❑ `Yes` - ® No - A 6 - Pump Tank Manufacturer. Installer: PT: Certification#: Gallons: *EHS: Date: I I Date: / RiserSealed ❑ Yes ❑ No RiserHeght: ❑ =Yes ❑ No (Min.6 in.) atus Approval St < Reinforced Tank: ❑_ Yes 0 Nop Approvetl❑ L}tsapprovec ��l Piece Tank: a NO Y s Supply Line Pipe Size: inch diameter Installer, Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated- El Yes ❑ No Date: / -- - - - Approved fittings (] Yes ❑ NO Apprartal Status © An"D ❑ Disapproved' u equiFein—int ��PumpType: Installer. Dosing Volume: — Gal Certification 4: Draw Down: Inches 'EH S: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ N o Check-valve ❑ Yes ❑ No Approval, tatus PVC Unions El Yes El No D Approved❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole El Yes 0 NO . CDP File Number 200112'- 1 County ID Number: H50.000-"3.07 - Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer; Box 12 inches Above Grade ❑ Yes ❑ No ' Certification-9: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'ENS: Pump Manually Operable ❑ Yes ❑ NO "Activation Method: Date: Approval Status Alarm Audible ❑ Yes ❑.NO -Approved❑ Disapproved. ` - Alarm Visible ❑ Yes :__.. • ❑ NO i' 2140-Nations,Robert "Operation Permit completed by: �..,.Authorized State Agent: - Date of Issue: 1 1 a 8 a 0 1 6 Owner/Applicant Signature: This:system has*been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules1 for 'Sewage Treatment and Disposal,-15A NCAC 18A.1900 et. Seq.,and all conditions of the Improvement Permit and; -= Construction Authorization.-This property is served by a TYPE III G. sewage septic system. -Rule:1961:requires that a Type . TYPE III G. septic system meet the following criteria: Minimum System-Review_ByThe Local Health Department: WA .-----,.--.-,Management,Entity: OWNER - Minimum System InspectionlMaintenance Frequency ByCertified Operator: WA Reporting Frequency By Certified Operator:NIA Rule .1961_requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract— wh a public management entity with a certified operator or a private certified operator forthe life of the septic system. -Rule .1961 requires that Type VI septic systems designed fora homelbusiness owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. _ Rule. 1961 (2)(e)requires a contract shall be executed between the system ownerand a management entity prior to the issuance of an Operation Permit fora system required to be maintained by a public or private management entity, unless the system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the ownerand systems operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. d Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department CDP File Number: 200112 - 1 ' 210 Hospital Street H50-000-053.07 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 1 Olnch Scale: . O131ock Drawing Drawing Type: Operation Permit ____. ON/A -r - - CONSTRUCTION For office use only AUTHORIZATION 'CDP File Number- 200112-1 Dalie County Health Department County ID Number.NSa000-053-07 210 Hospital StreetEvaluated For: NEW .� �. P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 3 / 1 8 / a 0 a 1 Applicant: Richard Taylor/Marti Carter Property Owner: Richard Taylor/Marti Carter Address: 195 red Bud Lane Address: 195 red Bud Lane City: Mocksville City: Mocksville StatefLip: NC 27028 StatelZip: NC 27028 Phone#: (336)940-2341 Phone#: (336)940-2341 Property Location & Site Information rRe ress/Road #: Subdivision: Phase: Lot: d BudLane ocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 158 East turn right on Sain Rd, right n Red Bud lot on the left #of Bedrooms: 4 #of People: ter Supply: NEW WELL System Specifications Minimum Trench Depth: a 4 rDesign ssification: Provisionally Suitable Inches Minimum Soil Cover. System? QYes (}No a Inches ow: 4 8 0 MaximumTrench Depth: 3 6 Inches SoilMaximum Soil Cover: Application Rate: 0 a 7 5 a 4 Inches "System Classification/Description: 'Distribution Type: GRAVITY-SERIAL TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons "Proposed System: 25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes QNo QMay Be Required Nitrification Field 1 7 4 5 Sq. ft. Pump Tank; Gallons No. Drain Lines 4 1-Piece: QYes QNo Total Trench Length: 4 3 6 GPM—vs-- ft. TDH Trench Spacing: Inches O. — 9 @Feet O.C.C. Dosing Volume: Gallons Trench Width: — 3 Q Inches Feet Grease Trap: Gallons TS-11 Depth: inches Pre-Treatment: ONSF OTS-1 O Septic Tank Installer Grade Levet Required; OIOII OIII OV Donn 1 of Q CDP File Number 200112 - 1 County ID Number. H50-000-053-07 ' Q Open Pump System Sheet Repair System Required:E)Yes ONo ONo, but has Available Space rrDesign System Trench Spacing: 9 O Inches O.C. ification: Provisionally Suitable Feet O.C. Trench Width: Inches w: 4 8 0 — 3__. Feet Soil Application Rate: $ a ? 5 Aggregate Depth: inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover 1 a Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 1 7 4 5 Inches Sq.ft. ' No. Drain Lines 4 *Distribution Type: GRAVITY-SERIAL Total Trench Length: 4 3 6 ft Pump Required: Oyes ONo ( May Be Required ' Pre Treatment: ONSF OTS-1 OTS-11 *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and maybe Issued at the same time the Improvement Permit issued(NCGS 130A-336(b)�If the installation has not been completed during the period of validity of the Construction Permit,the Information submitted in the application for a permit or Construction Authorization is found to have been Incorrect;falsified or changed,or the site is altered,the permit or Construction Authorization shall become Invalid,and maybe suspended or revoked(.1937(g)).The person awning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature* Date:, *Issued By: 2140-Nations,Robert Date of Issue: 0 3 1 8 0 0 1 6 - - - - - - - Authorized State Agent: Malfunction Log OYeS F @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 ' CONSTRUCTION AUTHORIZATION 200112 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: HsaoOooss-a� Mocksvilie NC 27028 Date: 03 / 1 8 / a 0 1 6 Q Inch Dra'rving Drawing Type: Construction Authorization Scale: , QBlock QN/A �i I -7 FT deo : ?r CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 200112- 1 P.O.Box 848 HS0-0 00.053-07 Nlocksville NC 27028 County File Number: Date: .0 3 / 1 8 / 2 0 1 6 C Ck below to import an image from an external location: Drawing Type:Construction Authorization 1 ^�U� 1. 0/1 r, IMPROVEMENT PERMIT For office useonry *CDP File Number- 200112-1 Davie County Health Department 210 Hospital Street County ID Number:1-150-000-053-07 Evaluated For. NEW P.O.Box 848 Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL: 3/18/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Richard Taylor/Marti Carter Property owner. Richard Taylor/Marti Carter Address: 195 red Bud Lane Address: 195 red Bud Lane Cty: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)940-2341 Phone#: (336)940-2341 Progerty Location & Site Information Fddress/Road#: Subdivision: Phase: Lot: Lane lle NC 27028 Directions Structure: SINGLE FAMILY Hwy 158 East turn right on Sain Rd, right n Red Bud #of Bedrooms: 4 lot on the left #of People: *Water Supply: NEW WELL System Specifications nidal S stem *Site Class1 ica ion: Provisionally Suitable Minimum Trench Depth: 2 4 Inches Saprolite System? OYes i�)No Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 . 2 7 5 1-Piece: OYes &No Pump Required: OYes QNo OMay Be Required "'System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 25%REDUCTION 1-Piece: OYes O N o Repair System Required.0 Yes ONo ONO, but has Available Space Repair System *Site Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inches Soil Application Rate: 0 a 7 5 Maximum Trench Depth: 3 6 Inches u *System Classification/Description: Pump Required: OYes (j)No, O Maybe Required TYPE If A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) "Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 200112 - 1 County ID Number. HSa000-053-07 *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance ofthis permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; Site Plan The Improvement Permit shall be valid for 5 years from date of Issue with a site plan(means a drawing not necessarily drawn to O scale that shows the existing and proposed property lines with dimenslons,the location of the facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valld without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drawn to a scale of one inch equals no more than 60 feet,that includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that Is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit is subject to revocation If the site plan,plat,or Intended use changes(NCOS 130A335(1)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance;monitoring, reporting,and repair(.1938(b)} Applicant/Legal Reps.Signature Required? OYes ONO Applicant/Legal Reps.Signature; Date: 'Issued By: 2140-Nations,Robert Date of Issue: 0 3 1 8 .2 0 1 6 Authorized State Agent: OValid without Expiration? Q Create CA? @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 200112 - 1 Davie County Health Department CDP File Number: 210 Hospital Street H50.000-053-07 P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch DrawinDrawing Type:, Improvement Permit Scale: QBlock ONia el C. 41::i0oot 80 'ILFi I cc f �r r L—1 -i I I I I I � IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street CDP File-Number: 200112 - 1 P.O. Box 84$ H50.000-053.07 Mocksville NC 2702$ County File Number: Date: 0 3 / 1 8 / 2 0 1 6 Click below to import an Image from an extemal location:Drawing Type: Improvement Permit APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health i P.O.'Box 848/210 Hospital Street -Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: 7 Site Evaluation/Improvement Permit C Authorization To Construct(ATC) Jboth Type of Application: ANew System ❑Repair to Existing System :]Expansion/Modification of Existing System or Facility IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION A ff Name Contact Person W,9, rn C O J Address nG. Home Phone Jr6_,0d0 r,?3/r/ City/Sta tAf✓r &4 Business Phone — f<S..7O 7 . Email Email: A7Co��r/_��✓ Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged -21071,R01 NOTE: A survey plat or site plan must accompany this application. Included:, 4Site Plan UPlat(to scale) (Permit is valid 0 ont w iie,Pwn,no piration with complete plat.) Owner's Name /'l� / d Phone Number.�C-�.S:30_517 Owner's Address City/State/Zip .4/e We !9710,4? Property Address n� S, .c City o c v Lot Size Tax PIN#//,.r DS'909 Subdivision Name(if applicable) je&Z/_On Section/Lot# Directions To Site:J<'9 If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes &0 Does the site contain jurisdictional wetlands? _Yes ZCNo Are there any easements or right-of ways on the site? _Yes)CNo Is the site subject to approval by another public agency? _Yes Z(No Will wastewater other than domestic sewage be generated? Yes No IF RESIDENCE FILL OUT THE BOX OW #People #Bedrooms 7 Bathroomsp2 Garden Tub/Whirlpooes INo Basement: :]Yes Basement Plumbing: 7Yes>_4lo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: Conventional ❑Accepted []Innovative ❑Altemative ❑Other , Water Supply Type:E County/City Water /,New Well ❑Existing Well 7 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?E Yes XNo If yes,what type? This is to certify that the info tion prod is application is true and correct to the best of my knowledge. I understand that Ainformation permit(s)or ATC s Iect to suspension or revocation if the site is altered,the intended use changes,or if n su ti is falsified or changed. I hereby grant right of entry to the Authorized Representative e o conduct necessary inspections to determine compliance with applicable laws and rules. espo i the proper identification and labeling of property lines and comers and locating and flagging s facil' to ion,proposed well location and the location of any other amenities. is owner's legal representative signature Site Revisit Charge p Date(s): ,7 p ��. Client Notification Date: �Q Date EHS: given I Yes❑No Account# I I 1 oed 11/06 Invoice# I Davie C4ounty,NC Tax Parcel Report Monday,February 8,201E 161 - 148 1W 178 12G i ► - (�,. 117►IIt1G6 1*4 ►143 124 122 ■ -_- ■160 1J0 159 /. 13G�� 137' 136 13] 123 .>16, 6131 150 140 138► 6137.► 117 1'/107 / /�'\ 1]9 1301 116 127 114 `109y 100 113 ■ /► 107 a� 149 1, \fir 127' 1gg 6131 X117 741J/ {110 8 120 110 7. 1 a I ,21■►115 124e` 7/ 71 k �f 26 734 6147 _ 6 146 104 1261 �: .� 201 10711041110 132►i rv' LI35 146 � 1543 164 ■1 707/129, i--3011 I ■ 140 153 6 149 L]10 , ryy 801 ► 39 163 ■ 1 X130 s >'� I �\724� 1539 ]W i. ■ 149 170 1466>.30►122 -{r .l 165 1T7\y124 75 L r 823 138 t.t: 1581 1 ,I 1 123 9GG 811• L 195 171 157 1 129 ♦ /170 1L167 5 •. ]94- :T�_ 'i • 6785 ►138 ■ ► � • ■ 159x15 d(T r 121 ! \ 195�1 6135 774 • 18W 822 I-*852 ...n.c �� 124r 1129 11 226 \9 �i39/L7G2 `�l '�2l 148 1281 129 I11 117 I 22G■ :7/ Y 613321 196,143 _ \.. 2.4 16 ■1626 ►173 797-20f '201 L235 274 1'262 L235 ■ L _.ao7 2 ss _2 209 `28r275, 1201%6 ►1451. - 12861` 1G22� , 296 / 1425i s s L240 ; \\ 6300 F 1'123 `J11 1297.. _ 1159 1 4/409 ■11 140 ,r►119' ■ ■ \ / /�� 159 f206 X147■136%6 to �,] al 368% �iaz1 nor 2,B Lz98 J1p 4,,. / L138►162 20 5,1; 1�2,L 77 ►3U11, i f1 t V 22 1LLY '6 1Y9 149 'y76187 274 ■157 x1.41 ''s I�127 pea ►157 r Its 10/ 111 128 / 1334 YL _... \ \A� ot5 74r- ,, 4r- 7 L►�.r{ ;1Y P-,' IIP ]'� { � _.1 64 If I ii r�t ►tt 4122 WARNING:THIS IS NOT A SURVEY Parcel Information Parcel Number: H50000005307 Township: Mocksville NCPIN Number: 5749738882 Municipality: Account Number: 72792250 Census Tract: 37059-805 Listed Owner 1: TAYLOR RICHARD K Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 195 REDBUD LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag.District: No _ Legal Description: 5.098 AC OFF SAIN RD Fire Response District: MOCKSVILLE Assessed Acreage: 5.10 Elementary School Zone: MOCKSVILLE Deed Date: 52002 Middle School Zone: SOUTH DAVIE Deed Book/Page: 004200472 Soil Types: GnB2,GnC2,PaD Plat Book: Flood Zone: x Plat Page: Watershed Overlay: Building Value: 0.00 Outbuilding 8 Elam 0 00 Freatures Value: Land Value: 46470.00 Total Market Value: 46470.00 Total Assessed Value: 46470.00 Fh_.ml� vided as is without wananty,or guarantee of any kind either expressed or implied including but not limited to the Davie County,NC nties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold "o County of Davie,North Carolina,its agents,consultants,contractors or employees from any and all claims or on due to or adsing out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION d 14� Ad gid lane, Ae, 33 5K-3o,57 Water.Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 12 3 4 5 6 7 Landscape position 1__ Slope % t- 4 HORIZON I DEPTH ._ (j " Texture group Consistence r� Structure Mineralogyt,( � C, — HORIZON H DEPTH (-. Texture group :rDll Consistence l� Structure = v Mineralogy HORIZON III DEPTH Texture group . Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS - RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE • 02 SITE CLASSIFICATION: EVALUATION BY: �y ry LONG-TERM ACCEPTANCE RATE: V� -Z 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 )ZZ41Sli VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wel 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 LYQteS 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-Loniz-term acceptance rate-eal/dav/ft2 21812016: „ Appraisal Card D1rR COUKN SIC t.DRie 1�):l]RSI wttSWD0. Lr1pl Dlwerw RNnVIRpr woleS: R RD ��Mi:/IIMIQD.nw DwRRr.T)IYWR WC-K iwul:KS-DO "53-07 2)7aI50 D MIX 5)N)Y6ea caum rwvtim),I3RETIwtim)� [rDxo.frf ' cer.misru r.r.mle xNs)c on xw RD � xlmK xlmK sec-u.om. i)m0 D tSmS02 ..ODw RD6E� CL iw-]a ICilOw ml.laM sTewrlow Drtu wDKerwewn mewcero .c)wusrnEwr *c000 enY ruaDDlD roue-buD ' w0.wm3lDflt rYae:vawe aw.a/�Drwue-cwro eae slrlE: w�uw-uuD ru�mvwue-rwwD �� nurwsm use vuue-R.RCR. roue Daelwm-r.Rcn - rwxuuruue-Rura YIG YNLE �VNYE ®a!YSe Vw11E e5 FE0.0.ED ewlIF CDDE pSTE IIOIE�w w+Wxr eRln DRTR ♦n nwscwn eRas ' dace rurwn wrt olaww or/Keo nnA=w o ueRRue eu n:iwewn swo wD rorwx RDI-A—" D owme rlls a K lc lD Rw¢e nrRltt vM ous uMDsoe wo . . e,mxa xl K wo S,lla. httpJ/maps.daviecounW.gov//ITSNeVAppraisalCard.aspx?parcel=H50000005307 �/1 APPLICATION FOR PRIVATE WELL PERMIT Date. Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name Contact Person May--�-i n l _(.Lr4eR Address _ Home Phone l 3�) Ctt-( City/State/ZIP Business Phone ( z1 q 5_365 1 Email�}r��Ot V to p, U arl:te,(+ne V Name on Permit if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or siteplan must accompany this application. Included: & to Plan ❑Plat(to scale) Owner's Name i 6)ctr, Phone Number( (_,)J—I6 Owner's Address 1 City/State/Zip_MX f ,SV► I YAC 70 Property Address enl Tax PIN# 3� �'u�y 1 I�'—r Lot Size , Subdivision Name(if applicable) U e Section/Lot# Directions To Site: iC) f) t erl h t3o I 2 DEVELOPMENT INFORMATION Permit Type: New Well Well Repair Well Abandonment Other(specify) Facility Type: Residential Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO ' V Do You Intend To Install A New Septic System On This Site? YES NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed propertylines with dimensions;the specific location of the facility and any existing or futureappurtenances,the location of any existing septic system,sewer lines,water lines,any existing water supplies and any surface waters. The applicant is responsible for idenifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application,the applicant signifies that they understand the terms and conditions and that they give permision for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. Signed Date 7/30/09 Account# Invoice#