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209 South Angell Road Lot 2Dav ?016 9R�.lC °oh a WARNING: THIS IS NOT A SURVEY All data la provided as is wltwamm houty or guarantee of any kind eltberexpressed orlmphed lncluding bm not llmlted to the Implletlunuranesofmerchantability orfltnesfor apartlwlaruse. All users ofWvleCounty's GIs vuebskeshall hold bemuses the County of Davie, Norm Carolina, as agents, consultants, contractors or employees from any and all dalms or causes a action due to or arising out 0the use orinebilkyto use the GIS data provided bythis webstre. Information____ _Parcel Parcel Number.. G50000000903 Township: Mocksville NCPIN Number: 5840104427 Municipality - Account Number: 8300772 Census Tract: 37059-806 Listed Owner 1: SIMMONS DONNIE RAY Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 1121 BEAUCHAMP ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006 Voluntary Ag. District: No Legal Description: LOT 2 BROWNSTONE VALLEY Fire Response District: MOCKSVILLE Assessed Acreage: 1.17 Elementary School Zone: MOCKSVILLE Deed Date: 3/2012 Middle School Zone: SOUTH DAME Deed Book / Page: 008850345 Soil Types: PaD,RnD,CeB2 Plat Book: 0007 Flood Zone:. Plat Page: 031 Watershed Overlay: DAVIE COUNTY Building Value: 94190.00 Outbuilding 8r Extra ' 0.00 Freatures Value: Land Value: 24480.00 Total Market Value: 118670.00 Total Assessed Value: 118670.00 9R�.lC °oh a Davie County, 1. NC All data la provided as is wltwamm houty or guarantee of any kind eltberexpressed orlmphed lncluding bm not llmlted to the Implletlunuranesofmerchantability orfltnesfor apartlwlaruse. All users ofWvleCounty's GIs vuebskeshall hold bemuses the County of Davie, Norm Carolina, as agents, consultants, contractors or employees from any and all dalms or causes a action due to or arising out 0the use orinebilkyto use the GIS data provided bythis webstre. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001285 Tax PIN/EH #: 5840-10-4427.02 Billed To: Sheryls Land Home Subdivision Info: Brownstone Valley 1 Lot # 2 Reference Name: Sheryls Land Home Location/Address: South Angell Road -27028 Proposed Facility: Residence Property Size: 1.142 Acre T*ioeBe**Niss in rvmnt/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 Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYS T EM Residential Specification: Building Type ////7 #People _ #Bedrooms #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD)(:?61Y Site: New Repair ❑ System Specifications: Tank Size GAL. Pump Tank,�l ( GAL. Trench Width yRock Depth f� Linear Fto200/ Other: -/- 0 Required Site Modifications/Conditions: IMPROVEMENT/OPERATION Pl�t�f( LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NO �i mact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m, WPM "" Por 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # 's 60.**** DCHD 05/99 (Revised) Q —/� Date: 7('-ZVD DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990001285 Billed To: Sheryls Land Home Reference Name: Sheryls Land Home P. O. Boa 848/210 Hospital Street Mockwille, NC 27028 (336)751-8760 Tax PIN/EH #: 5840-10-4427.02 Subdivision Info: Brownstone Valley 1 Lot # 2 Location/Address: South Angell Road -27028 P - Proposed Facility: Residence Property Size: 1.142 Acre ATC Number: 2488 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This 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 WASTEWATE O STRUCTION IS VALIDD FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ¢�� O�e e% Date: (q -do 'CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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.U fl .,._ Septic System Installed By: �0�67 C Environmental Health Specialist's Signature: Zz Date: DCHD 05/99 (Revised) APPLICATION FOR SITE AI.UATION/IMPROVEMENT PERMIT & Davie County Health Department Ebyirlvnmenfal Hea/tHt SectFOlr JUL 1 3 2000 P.O. Box 848/210 Hospital Street ,,Mocksville, NC 27028 (336) 751-8760. ENVIRO N E COUNiY�L� ***IMPORTANT►**- r•• THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION,IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed •( Contact Person on. SP�&f' I 7 Hailing Address E �/ �� , _ Nome Phone City/state/Zip Business Phone 2. Name on Permit/ATC if Different than Above Hailing Address City/state/Zip 3. Application For: ❑ Site Evaluation improvement Permit/ATC U Both *. system to esrvioa: ❑ House bile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: t People Y Bedrooms Bathrooms Dishwasher Il Garbage Disposal ti Hashing Machine C1 Basement/Plumbing 1.1 Basement/No Plumbing_ 6. If Business/Industry/Other: specify type Y People Y 91nka - Y Commodes Y showers Y Urinals Y Hater Coolers IF FOODSERVICE: # Seats Estimated Water Usage g (gallon. per day) - 7. -Type of water supply: ❑ County/city Well. KKK ❑ Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes q�N _ \o If yes, what type? ***IMPORTANT*** CLIENTS htUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTE3D by the client with THIS APPLICATION Property Dimensions: /� /�7/j �� Z r WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: #_(�� Z � Property Address: Road Name .'3om J/. Y) itQ At ® f) City/Zip If in a Subdivision provide information, as follows: Name: Section:_ Black - Lot: 12 Date Property Flagged: � � �el--a 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 responsiblefor 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 pre,: a ;• le .ted is ^s Caanty end atii;cti 6y to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN property lines and dimensions, structures, setbacks, and septic loc. Revised DCHD (07/99) all of the following: Existing and proposed EHS: Site Revisit Charge Notification Date: Account No. /Z O 0 Invoice No. A(o//U d' s' APPLICATION FOP. SITE EVALUATION/IMPRO.VEMENT PERMIT &ATC Davie County Health Department r�7 Environmentgiwealth SectionU v ` 0, P.O. Box 848 Mo cksyilie;' NC 27028 DEC 3 1 199T IJ (704) 634-8760 ****IMPORTANT**** THIS APPLICATION.CANNOTBEPROCESS T REQUIRED INFORMATION IS PROVIDED. 1. Name` o be Billed " Contact Person i }I u Ma.!g Address es l e� .. - Home Phone fµ .; .. � ,? ' '?W` City/StateJZip%� d v� �L e: 2 Zia Business'Phone 2 Name on; PermiUATC if Different than Above t MailQAddress City/State/7ip 31z Application For:.' P,113ite Evaluation ^ [ ] Improvement Permit & ATC [ ] Both ,,tr 4i Systosm to Serve:]Mobile Home . [ ] Business [ '] Industry [ ]Other 5' If Residence: # People1•_- *Bedrooms ms _ # BathroolA] Dishwasher [Garbage Disposal �5,1[ aslung Machine '! [ ] Basement/Plumbing [ ] Basement&N Plumbing y 6If Businbss/Other Specify type #People #Sinks # Commodes #-Showers # Urinals " # Water Coolers If Foodservice # Seats-- Estimated Water Usage (gallons pet day) 7 Type of water supplyCounty/City [ ]Well [ ] Community`, )' 8 Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [No' If yes; what type? EITHER A PLAT OR SIZE PLAN -� PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***AkJWAA' OF THE PROPERTY MUST B: SUBMITTED WITH THIS APPLICATION. Property Dimensions: 3 IRActS •• IOD' 40D ; WRITE DIRECTIONS (from Mocksville) TO P.T•.OP,ERRTY ;Tax Office PIN.. # . 840 10 45U 1.� P lSds T r'o Yh r} /h' Propci;jAddress::. ; Road JameSpipi &rkL IZOA() 90 wt;be TO sa 4 4 r. City2ip _Ai7(`Y.SVII �' ,' IU; C • .27DZj} �icrn �� Iii./ ��i/ %" of If in Subdivision provide information, as follows: '�-/`�/' �%g ! s Name: i`7t�9�f�°T �ItiD?U7LS �7m2 VV'+';' r IN Section Lot 0: r This ii 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 ° to conduc testi rocedu s ner sto dete ine the site suitability. SIGNATURE - 7D(06-96) EAf as kAJ,'SEgUSEb ]=0R DRAWING�'YOUR SITE PLAN: A+ ), ! r,l r i � y41 - 'f.'A r d DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME Z/.I"W2..94 PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By: On -Site Well Community Auger Boring ✓ Pit SECTION_ LOT DATE EVALUATED PROPERTY SIZE ROAD AD NAME S/�X/GPG Public FACTORS 1. 2 3 4 5' 6 7 Landscape position 1 Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure C S 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 i SITE CLASSIFICATION:_ LONG-TERM ACCEPTANCE RATE:_ REMARKS:' DCHD(01-90) EVALUATION BY: OTHER(S) PRESENT: 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 Wet NS - Non sticky, NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S - Sticky VS - Very Sticky 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Room ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■o■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■