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160 Montclair Drive Lot 10Davie Countv, NC f 1W Tax Parcel Report Wednesdav, October 19. 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: F712OA0010 Township: Shady Grove NCPIN Number: 5860859355 Municipality: Flood Zone: Account Number: 43107270 Census Tract: 37059-803 Listed Owner 1: KITTLE GERALD E Voting Precinct: WEST SHADY GROVE Mailing Address 1: 160 MONTCLAIR DRIVE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC Zoning Overlay: 27006-0000 Voluntary Ag. District: No LOT 10 BALTIMORE HEIGHTS Fire Response District: ADVANCE 1.01 Elementary School Zone: SHADY GROVE 4/1997 Middle School Zone: WILLIAM ELLIS 001940284 Soil Types: SeB,MrB2,EnB 0006 Flood Zone: 076 Watershed Overlay: DAVIE COUNTY 178160.00 Outbuilding & Extra 17100.00 Freatures Value: 36000.00 Total Market Value: 231260.00 231260.00 9 uYi,�tt` 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 �� N� NC or arising out of the use or Inability to use the GIS data provided by this website. Permittee //� DAVIE COUNTY HEALTH DEPARTMENT le Name:e���G,<<e Environmental Health Section PROPERTY INFORMATION �n P.O. Box 848 'Directions to property: ,14�/1id�i� /J- Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 'f r:/ , Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - 2 "'* Cba F AUTHORIZATION NO: () A Road Name: 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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 3, l''! t ,l ,% a '" f '' IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE b'4 # BEDROOMS _C # BATHS _2 # OCCUPANTS.,, GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY e.116' DESIGN WASTEWATER FLOW (GPD) �1r NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK -GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. "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 OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: '" /f' / � ►'Z 0 � � Y�JU Ilt� hYA � l� Of iK 6v AUTHORIZATION NO.. D?a" OPERATION PERMIT BY: otic DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 07!02 (Revised) DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT • IMPROVEMENT PERMIT --�- ✓X6 **NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic lank 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) j NAME LOCATION PROPERTY ADDRESS D ti DATE SUBDIVISION NAME LOT NUMBER ,%�, SEC. /BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE �go)D N{BEDROOKS # BATHS # OCCUPANTS -% GARBAGE DISPOSAL: Yes ,No 0 �.. COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE &0 > TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE 1---' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE Adel) GAL. PUMP TANK AP GAL. TRENCH WIDTHROCK DEPTH ./+�i �f LINEAR FT. i OTHER RED SITE MODIFICATIONS/CONDITIDNS: ,] ***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. 1� i� IMPROVEMENT PERMIT BY�Q fl **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 OF INSTALLATION. TELEPHONE # IS (704) 634-8760. i i OPERATION PERMIT `�q�'� dSYSTEM INSTA D BY Li � s ., . AUTHORIZATION NO. 03sq OPERATION PERMIT BY �/'� 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. " Permittee's -,. , D VIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION • ` z^ / ! P.O. Box 848 Directions to property: lr- {%' f.� � ~( tai ' Mocksville, NC 27028 Subdivision Name: / t Phone #: 336:751-8760 fr-� �`(r 1.�1 �� t1 f'' �' � Section: � Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - - CVCTVNI (YINRTRUCTION AUTHORIZATION NO: Z Z) V6 A Road Name: 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 bavie 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) f / ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE /9 # BEDROOMS r # BATHS C 2 %_# OCCUPANTS GARBAGE DISPOSAL: Yes or No 1 i COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)- Cl 6 NEW SITE REPAIR SITE / / !' rk SYSTEM SPECIFICATIONS: NK SIZE GAL. PUMP TANK . TRENCH WIDTH`--?�/ ROCK DEPTH LINEAR i REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT / � y'• ,�� �' ,>< � s vex 4-1 W **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 OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 1 I 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 02/02 (Revised) 7 41 499a;p, Perrr4ittee's . x } "�`�j.' DAVIE COUNTY HEALTH DEPARTMENT % 83ne:-- ®% - Environmental Health Section PROPERTY INFORMATION .- . • ~", w ' !""`�' l P.O: Box 848 D' ctions o ro a ij. ; ' r,' : i r ; T p P rty: Mocksville, NC 27028 Subdivision Name: t' Phone #: 336-751-8760 Section: l Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 'ED V A Road Name: 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 RESIDENTIAL SPECIFICATIONrBUILDING TYPE # BEDROOMS # BATHS � # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) -557t/ NEW SITE REPAIR SITE r ; SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK . TRENCH WIDTH ��' ROCK DEPTH LINEAR OTHER r REQUIRED SITE MODIFICATIONS/CONDITIONS: t IMPROVEMENT PERMIT LAYOUT "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 OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: 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. ��� n✓ �, pfd r ✓Ao DAVIE COUNTY HEALTH DEPARTMENT ;IMPROVEMENT PERMIT and OPERATION PERMIT`S f / tIMPROVEMENT PERMIT **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 frosAhis 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 .6Y z` _ _ ii��r�{ , I' PROPERTY ADDRESS a '�-� a-� r r• DATE' LOCATION f �✓e9.? SUBDIVISION NAME G i770� r" /Yf'%{, /+ �S LOT NUMBER �,i� SEC. /BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE . {BEDROOM '; i BATHS # OCCUPANTSGARBAGE DISPOSAL: Yes COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE t TYPE WATER SUPPLY �_ DESIGN WASTEWATER FLOW (GPD) NEW SITE //' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE IdOP GAL. PUMP TRMAZ 117h I 6 _NCH WIDTH ROCK DEPTH /Y -LINEAR FT.�--- OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USECHANGE. ' SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. >�el YOUR WASTERWATER SYSTEM CONTRACTOR MAST IMPROVEMENT PERMIT BY�g r� **CONTACT A REPRESENTATIVE OF THE DAVIE,COUJTY HEALTH DEPARTM0IT FOR FINAL INSPECTION OF 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=8760. OPERATION PERMIT OJ ;SYSTEM INST BY Jam/ VY el '5-e eq k3 I]. AUTHORIZATION NO. a3<9 OPERATION PERMIT BY 2!4//y DATE 7 `� **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—MALL jI-NO'I�IAY BE TAKa AAS AMI ! GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. f' I DCHD 10/95- " _e I � t i IMPROVEMENT PERMIT BY�g r� **CONTACT A REPRESENTATIVE OF THE DAVIE,COUJTY HEALTH DEPARTM0IT FOR FINAL INSPECTION OF 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=8760. OPERATION PERMIT OJ ;SYSTEM INST BY Jam/ VY el '5-e eq k3 I]. AUTHORIZATION NO. a3<9 OPERATION PERMIT BY 2!4//y DATE 7 `� **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—MALL jI-NO'I�IAY BE TAKa AAS AMI ! GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. f' I DCHD 10/95- " _e It,- * �� .� Davie County Health Departient ENVIRONMENTAL HEALTH SECTION -'A P.O. Box 665 k� Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 13OA, Wastewater Systems) ***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 I!Iwections Office when applying for Building Permits.*** �r AUTHORIZATION 1�J1BER NAME r r i ;�r DATE PR`', j / F`'� NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM *HNOTICE*1* THIS AUTHORIZATION FD WA5TEWATER SYSTEM MNST�RUCTION IS VALID FOR A PERIOD OF FIVE 5) YEARS. ENVIROMMENTAL HEAL SPECIALIST DATE DCHD 10/95 w... y APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERL2 D E Davie County Health Department 5 V W Environmental Health Section P. O. Box 665 1 MAR 2 1 1996 Mocksville, NC 27028 1. Application/Permit Requested By L �,/= S% %c r' Oy,vi i?4C70"e5 Itis Mailing Address % O 3am,, e % Home Phone 910 7,-',G 01 7f- CL Fir►mo:v5 ^/c a%U/P— Business Phone y/o 766 U-? 75- 2. 52. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation ASeptic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision 2.9L7%e»en& 1-)idf7S Section Lot # w ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms No. of Bathrooms Dwelling Dimensions J 0 X 39 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: X Public ❑ Private 8. Property Dimensions 2 O U X 2 ov Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? X Washing Machine f9 Dishwasher ❑ Garbage Disposal ❑ Yes y°j( No ❑ Community *NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: PROPERTY INFORMATION REQUIRED: Tax Office PIN: # .�Oli/�-�5' afi PROPERTY ADDRESS, as-tf Ilows: Road Name: %DeyTei-,41,� /</) City: SUBMIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. 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 SI NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: X 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 r61 �Ie CoX✓ I Rgaci OILS to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. , 3-ar-c(, DATE SIGNATURE DCHD (1/93) 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks _ No. of Urinals No. of Water Coolers No. of Showers / Water Usage Figures 7. Type of water supply: 9 Public ❑ Private 8. Property Dimensions d"i/C 4.( 12e':- Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes EHgo ❑ Community, 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: 4--A-;S- i- r7/14 4.�x '.��� U •� Gam' =r' .h�r�'�'o 3,'1 /Ges'> h G'c /�crss This is to certify that the information provided is correct to the-bf my knowledge, anc incurred from this application. est/ ;•� DATE J �= Ir TUBE 5 E I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE'5ONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ©"'2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative Af the Davie County Health Department to enter upon above described property located in Davie County and owned by Lz.. to conduct all testing procedures as necessary to a ermine "said, ite's suitability for d absorption sewage treatment and disposal syst m. % , -7 ATE---- tG ATURE DCHD (12-90) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By 1C lC%�� �!i�/G C, y Mailing Address c�l� �cl�L' C�/Ll � • %/.�a A/C- Z, 762 6 I Home Phone Business Phone _ C9 "'-2- l r� 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation ❑ Septic Tank Installation 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision 7-3— Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing f No. of Bedrooms ❑ Washing Machine d` No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks _ No. of Urinals No. of Water Coolers No. of Showers / Water Usage Figures 7. Type of water supply: 9 Public ❑ Private 8. Property Dimensions d"i/C 4.( 12e':- Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes EHgo ❑ Community, 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: 4--A-;S- i- r7/14 4.�x '.��� U •� Gam' =r' .h�r�'�'o 3,'1 /Ges'> h G'c /�crss This is to certify that the information provided is correct to the-bf my knowledge, anc incurred from this application. est/ ;•� DATE J �= Ir TUBE 5 E I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE'5ONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ©"'2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative Af the Davie County Health Department to enter upon above described property located in Davie County and owned by Lz.. to conduct all testing procedures as necessary to a ermine "said, ite's suitability for d absorption sewage treatment and disposal syst m. % , -7 ATE---- tG ATURE DCHD (12-90) ' DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME ��� 1 DATE EVALUATED ADDRESS PROPERTY SIZE�� PROPOSED FACIILTY, /� 1_XSe LOCATION OF SITE Water Supply: On -Site Well Community Publicy Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position /�=S G• Sloe % -- HORIZON I DEPTH Texture groupL Consistence Structure MineralogX HORIZON II DEPTH Texture group; Consistence Structure Mineralogy 11 ' J.= 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 , SITE CLASSIFICATION: AS EVALUATED BY: iii LONG-TERM ACCEPTANCE RATE: 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 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 DCHD(01-90) ■.........■..!l.l...■■.■..■.....■..MI■.....IY.l.■■...■.■■■.■.■.. ■O■ ■■■■■■....■■■■■■■■■■■■■■■■■■■■■■■■.■.■.■■MIDI ■■.■■■..■...■...■■!■.■ MMEMOOMMMMMEMOMMMMMOMMMMMEMEMOMMOMMEMMmmoolimomimm000kamommmEMEMMME ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■lN1■■■■■ ■.■■■■■■■.■■■M ON ■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■■■■■■■tl■■■■■E■E■E■■E■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■■MM■■■■■■■■S°■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■■■■■■■■■■■■■■■■■■■■E■■■■ ■■■■■■■■K■■■■■■■■■■■■■■■■■■iii.■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ni■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■.■.■■■■■■■■■!■■■■■■■■■■■■■■.■.■■■■■■■II■■■■■■.i■■■■■■■■MI■MI■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■!■■■■■■■■ll■■■■■.■ ■■■■■■■■■■■■■■M ■■■■■MI■■■■■■■■■.!■MI■■■■■■■E■■■■■■■ ■MI■■■■.ol■■■■u■■E■■■■■..■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■ .■■■■■■V1■■H■■■■■_■■.■■■■■. tl .■■■ ■■■.!■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■■■■■■■ ■■■■■■■■■ ■■■■MI■■■■ !■■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiMiiiiiiiii�=iiiiuiiiiiiiiii�=iii ■■■■■■■■■■■■■■■■■■■■■u■■■■■■■■■■■■N■■■■■I.l■■■■■■■■■■i■■■■E■E■■■■� ■■■..■■■■■■■■■■■■■■■■■H■■E■■■EMIMI!■■E■EE■■1N.■■■■■■.■■ ■■■.■■■.■■� ■■.■■■■■uEEH■■■■■■■■■■■■■MI■■■■■.■■■■■■■■Im■■■■■■MI H■■E■EE■E■MI■ ■ ■■■■■■■■■■■■■■■■■■■■■EE■■.E■E■EEEE■■■EE■■■■■.■.■■■ ■■■■■■■■■■■■■■■ ■■■■MI■■■■.■■■■■■■■■■■■■!■■■■■■iii■.■NEEM.■■■■E■■■■■■■■MI■■■i■.■■■■■ ■■!■■■■■■■■■■■■■■■■■■■■■■■!.■■■■■■■■■■■■■■E■■■■■■■■■■■■■■o ■■■■■■■ mmoommommmmmmmmommmmmmmmmommmmomummmmmmmommmmommmmmmmmmMMEMEME ■■■■■!■■■.■■.■■■HMI■■■■■■E■E■■■E■E■■■E■■E/■EE■ ommmmmmo ■■■■■■■■■ !■E■■■■■ ■!■■■■■■■■■.■■■■■■■■■■■■■!■■!■■■■■■■E■■■■.,■■■■■■■■■■■■■■■.lmmmmmmm MMOMMMEMMMMOSEMEMMMMMEMMMENEEN�■RMEMOMMISMMMMME�ON MMMM■u■■■■E■ ■■■■■■■■■■■■■!■■■■■■■■■■■■■E■■■■ ■■■.■■■ !J■■■■■H■■■■■■■■■■■■Mom■■ ■■■■■/■/!/■i■_■_■!■/■/■/■/./■■■■■■■■■■■■■■■■■■■■■■■■■ri■■■■■■!■■■■■■MI■.■■■■■■ ■■ u■MI■■■■m.■■■■■u■■■■■■n■■■■■■u■■■■■■ ■■■■■■m■■■■■nu■■■■■■n __ - =m !/:umm■■■■i ■ ■■■■ ■MIEMI■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.i!!■■■■■■■■■■■■■ ■■m■.■■■■■■■■■■■■ ■■■■■■.■■.■■■■■■■■E■■■■.!■■■■■■■!■.■.■E■■■■■■■■ ■■!■■■■■I■■■■■■■■ ■■■■.!■■■.■■■■■■EMI■MI■■■■■■■E■■EEMIE■■■■ ■■■!■■ ■E■■■ ■MI■MIMOM ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■�:::::' HdMMmM■M■■■■■■.■ ...............■...................... . : ■. ■■■■■■■■MI :: ::: �mmm ::: : C:::�MEM :: CC:C::C :MI:: : o : : : 0:: ■ :E : ■■■■■■■■.iii■■■■■■■■■■ii■MIMIMIMIMIi■�■■i HENEEHEMIiMIMIMIMIHMI.�MI.■■ ■.■■i■■■■■■■■■!■!■!■■■■■■..■.■■!■..■!! ■ ■ ■ E■ ■ MI■■■ ■■■ ONE MI ■ ■■■■ ■ ......................H........... ........ ■■! ■ ■C■■.■■■� ................................... .. ... .5.. . . .0 H.!■MEMISIMMERIMMEM■■. 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DAVIF_ COUNTY, NORTH CAROLINA --o-- N 89'.- 50-301 W 166.74 1f C. RAY T DRAWING NUMBER plaaped POT STREET Telephone 119 DE PARCEL 23 - HILARY C. WILSON— D.B. 152-706 119 DEI LLE N.C. 27028 704/634 - 3735 3195-9 MONTCLAIR DRIVE r S 890 - 50'- 2. E O -- z ---- iron fund f, 235.84 10' Wihiy cost. iron placed 397.5'to i BALTIMORE ROAD 1 S. R. 1630 chCd 1 -...__ v 1 I � ! � u Ol 3' a 3' = to - _� l _ 1.000 ACRE (by d . m. d) m - a 0 I O 19.T I�—� � 12.9 I u O c In c o 6 2, O brick and vinyl - — _ 3 M 1p] I• 69.1d � 1W a: Z 18.7• 21.55 ` 27. 7' r— — — — — —— N 89°- 50-25 W plac — — — — Ir^ Placed �- ed LOT 10 LOT 8 LOT 9�' c I -00 Oi M a g I cOv — O PLAT FOR _ - oRY LEWIS LOWDER and DENISE' S. S o SCALE: I = 40 AUG, 30, 1995 ( House) DRAWN BY of � DATE: 07 -17-951 REVISION OF LOT 9- BALTIMORE HEIGHTS- P. B. 6-76 soy iron found — —5' ne o"ive dnvewa Bose e-� SHADY GROVE TOWNSHIP. DAVIF_ COUNTY, NORTH CAROLINA --o-- N 89'.- 50-301 W 166.74 1f C. RAY T DRAWING NUMBER plaaped POT STREET Telephone 119 DE PARCEL 23 - HILARY C. WILSON— D.B. 152-706 119 DEI LLE N.C. 27028 704/634 - 3735 3195-9