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142 Son Shine WayDavie Countv, NC Tax Parcel Report b b � Mondav, October 3, 201 E Plat Book: 0009 Flood Zone: Plat Page: 258 Watershed Overlay: DAVIE COUNTY Building Value: 47390.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 23570.00 Total Market Value: 70960.00 Total Assessed Value: 70960.00 I v� 9 inrs F �oUN'� WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: G50000004801 Township: Mocksville NCPIN Number: 5840427966 Municipality: Account Number: 8304219 Census Tract: 37059-806 Listed Owner 1: SHORT RICHARD C Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 142 SON SHINE WAY Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028 Voluntary Ag. District: No Legal Description: TRACT 1 2.556AC SMITH S/D Fire Response District: SMITH GROVE, MOCKSVILLE Assessed Acreage: 2.54 Elementary School Zone: MOCKSVILLE Deed Date: 10/2014 Middle School Zone: SOUTH DAVIE Deed Book / Page: 009700783 Soil Types: WeC,RnD,ChA,WATER Plat Book: 0009 Flood Zone: Plat Page: 258 Watershed Overlay: DAVIE COUNTY Building Value: 47390.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 23570.00 Total Market Value: 70960.00 Total Assessed Value: 70960.00 I v� 9 inrs F �oUN'� Davie County, `J � �7 1\ C All data is provided as Is without warranty or guarantee of any kind either expressed or implied Including but not limited to the Im lied warranties of merchantability or fitness for articular use. All users of Davie County's p ty p 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 or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department 7 Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: �i?—, L-0 -S4 a r --f-- Phone Number T D� b Tod --q (Home) Mailing Address: 144,�- S6),) SS, ^jz &)a (Work) tTJC-5t 1 V e N L- J- %bya- Email Address: �S'%a - /b 14 60G/M Detailed Directions To Site: 46 Sam If. CJG N -01 Property Address:�49 9 b a v t Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: /C , c,.ktj < r Sk t C -t'- Type Of Facility: t" -P 14 a M Date System Installed (Month/Date/Year): 144511"Number Of Bedrooms:^3 Number Of People: Is The Facility Currently Vacant? Yes & Any Known Problems? Yes 0 If Yes, If Yes, For How Long? Please Fill In The Following Information About The NEW Facility: Number Of Bedrooms: O Number of People Type Of Facility: ^�-6 «. �-�, Pool Size:Gara a Size:, [���(� D Other: Requested By: _ Date Requested: ( ignature For Environmental Health Office Use Only ApprovedJ Disapproved i) \ / A „ i i / -EP i Environmental Health Specialist *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 Paid By:_ Account #: Amount:$ Received By:_ Invoice #: WV+ --.. (E ppU�� s Printed:Oct 14, 2015 All data is provided as is without warranty or guarantee of any kind 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 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 or arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT v//Yrr IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improyement 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) NAME PROPERTY ADDRESS (� 7d� DATE I :� -1-55 LOCATION 1 s) y E SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE o v S # BEDROOMS _::� # BATHS D� # OCCUPANTS GARBAGE DISPOSAL: Yes No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No_ LOT SIZEa TYPE WATER SUPPLY ` 'DESIGN FLOW (GPD) ��� NEW SITE. REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE QV GAL. PUMP TAME{ SAL. TRENCH`WIDTH �} ROCK DEPTH �LINEAR FT.� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS 'OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. F 14 00s'2 "\ Go' da a` IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPAR OR FINAL INSPECTION THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-87E8. OPERATION PERMIT . SYSTEM INSTALLED BY � d Al. h 0 �e F AUTHORIZATION NO. OO $r> OPERATION PERMIT BY C. a-zna. DATE a`1� 9 b **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 10/95 Davie County Health Department ENVIRONMENTAL HEALTH SECTION r„ P.D. Box 665 Mocksville, N.C. 27L AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION _ (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) r b, ***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.*** }� AUTHORIZATION NUMBER NAME A \'.1� S rn. ` h DATE NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION i S 2 ) COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM a t " ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE DCHD 10/95" �e�~ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE ��IEIN nAV 1 Davie County Health Department Environmental Health Section I� P. O. Box 665 NOV Mocksville, NC 27028 yj 1. Applicatetmit Requested By Mailing Address u 2S I +Wt Home Phone�/ - # YN a Ck/S 0 r// C-, A C, -`Z,i Business Phone3 O 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business 0 General Evaluation Aseptic Tank Installation Permit House ❑ Mobile Home ❑ Place of Public Assembly ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions ❑ Other 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 / `7. 73 cuSewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ No PROPERTY INFOFI-IATION REQUIRED: ❑ Community Directions to Property: Tax Of f ice PIAT ;k5g-Lin —1 G 6 �oe<r - Road Name L10j'Y /je �� Box #(if available) a �� City 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: I- I OWN the property. El2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this f m MUST be completed by the owner or a person authorized by.the owner: I hereby give consent to the authorized representa ' of the av' County ealth Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to de said site's suitability for a ground absorption sewage treatment and dis poral ystem. // Lea— bATE SIGNATURE DCHD (1/93) _ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation p{� NAME \ " ' �l `� (E`M� DATE EVALUATED ADDRESS _ �A �� PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITES p Water Supply: On -Site Well _ Communit Public Evaluation By: Auger Boring V Pit V Cut FACTORS 1 1 2 3 4 Landscape position r Sloe R 15 - b - `d HORIZON I DEPTH ' is" '' u Texture group L C L L t. Consistence )L ' 1 Structure Z C Mineralogy HORIZON II DEPTH 5� b'' '6 Texture group C C. Consistence F1 Structure Mineralogy)� HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON — --- SAPROLITE Z CLASSIFICATION 1SLONG-TERM ACCEPTANCE RATEt SITE CLASSIFICATION: _ 1 EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:_ �UGN REMARKS: & \ •\ S C. � C_\Z-q%, �. 1�1 L GEN 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 ':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 DCHD(01-901 ■�����■■�\������������■���������������■���������■ ■������■ ������■ ■��������������\�������/����/������n/����������■ ���������������■ ■■■■��■����■ �������■����������■�������r�\����������������������■ ■����\���\�����������������������������������������■������������� ■��������\�������������������������������������������■�■���������■ ■�������■������������■����������������■����■�����0�\�������������■ ■�■��E■����■����■■��������������■■��������� ■�� ■��� ■�■���■���■�■ ■�����������■����������■�■������i����������������■���■���■������■ ■����������■���■�����������������������■��������■��� ■�����������■ ■��������\�������������\������■��N■�������������■ ������■�����■■ ■�������\�����/�����■��/�������� ������������� ��� �������������■ ■�■■������������������������������������������������ ������������� ■���������������_ ■������ ■■/���\��������■��l■�■■����■������������������� ����� H ��������■ _^- __ .� _� � _ .�� ■����.��..■..�.�wr�■■■������������■��■���■ ■�� ■ ■ ��� ■����� ■■ ■���.������������r���������_������������� ��� ■ � �� ������n�i�� ■�����■����w■__=•,������■��■ ■�������■����������■�� ���������������� ■/������.��'��!��VtI�'�►����■���������■�����■���5����������������■ 11.����\�■ii!6/:%����V\i/���■■��■ �������N������� � ��■���������■ Ii:�il�\'1ll��r������■■�tj:�Il�����������■����■����N�� ■ ■�■�H����N�� i����►:�r������i.��■��r���������������■�����������■ _ ������■�■�■■�� ■��.������������t�������������������� ��� ������ ���t� ■ ������ �----�� •.-. ■������������f.��������J�f��������■�■ ■ ���■■� ���� ��■�■� ■ ����� � iiiiiiiiiiiiiiiii�iiiii�:,�iw�iiiiii=iiiii��iiii�i�i=ii�iiiii�ii�=�i=�i ■�■■��������i����������r�■����������������■�����u������i��c=��� ■���������■�������������r��.�r������� �������� ■ ����ti��������i��i �� ■��■�����������r.■���wa►��.�ar�������N���■������i��r��=■�•a������i � ■���������►ir.���������ir��n►���►��������■��H��■��� �r�� ■■�C�����■� ■�■�■�■��a�i�u�i-.��■i�:a��:�����■������������a �� , ���� ������ ............��...�...�..................... .... �_ .._.........0 ............�...�.�..�.....................�..... .�.. .._■...... ■����H�����91���i����l��\�������Q�������u� ����� ■ �� ���� ������� ■�����������/�\�����I�u�����������0������N���������� ������� ■�N�■�����/������1��■���������� �������/■I/��.......J��■��■���������������N�����■�����5�����■� ■��■ ������������������������■�������� ��������� ■ �� ���■�� ���������/�■���%\���■��■������� '���� ■ ■ ■�����■■��� ������■���%%11�I:il��l����h�������� �: \�� � ��� ���i�� ���■ ���a= ■■■���■�����lul��������■��������� ■�� ���1 �� ■ �e��■■� ������� lii/IG►\ic�� ����� ������-����� tu7u i u� ■����� . ■�\��■�i%���!������ ���������l� ► ��u����■�� ����������H�������/�� ■ /���������� ■ ��� ����� ■�����������������������H����■�\� �� ' \N �� ■���■■�■ :::::::::::::::::::�::::::':::_: � � ' �': :::C�: ................... .......�"� _ :::::::C:::::::::::::��::..::' �C =.....�� ����e ■�������������������u�������■�� �����u�i■�■iii ■■����������■Yiiuii�iii�iiii=iii �� ��ii iu��� ■ ■�■��■��� �� ����������������u����������� H ,��� h������ ■�����������■���■■���■���� ■��� ■ ■ \ ������� ■����■■����■�N������������������ �� �G�v�v� ■�■���v�/����H�����������■■�� ■ ■������u���■���n���������� uN����'I�N� �����u■ ��■� :::C:� C::' ::::::�=::C=:.': . .' ..:: '��: ....... .C�..............■.....0 .■ ..�..�. .........=C........................ . _ . ..�. .��.. ....■...■■.■...■.■■.■..■■■■■ ■■.■■■. _ .r.C. �... ............................�... .-. ��... ..�...C�... ................................�.=C= . . .:..•.��....... ................................ .. � ...�....... .■_....■.■..:C:::::�:::::::::::?::::' . - 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