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193 Essex Farm Road Lot 12f f Davie County, NC Tax Parcel Report Tuesday, December 20, 2016 p�V4 9h --`---204 ------- r Countyof MA, Nagy Carofl;tisagenda,000wkantaeordra aemployeesfmmanyandagdalmsoroausesofactiondueto I f F8030A0012 201 Shady Grove NCPIN Number: 5870640335 Municipality: Account Number. 82532216 Census Tract: 37059.803 i k - 193 W Mailing Address 1: 193 ESSEX FARM ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A W ------^--- - r --- r Zip Code: 187 Voluntary Ag. District: No Legal Description: p�V4 9h WARNING: TIHS IS NOT A SURVEY All dela Is proAded as owiThont ffardyorgueranlee of any kind etthereaprewed or Implied Induding but not linkedta the Impued..... s ofrnerehantabilgy orrdneasforapaNwlarum.Ag usesof DaNeCnurdt+a elSwebaheehall hold harmlewthe Parcel Information Countyof MA, Nagy Carofl;tisagenda,000wkantaeordra aemployeesfmmanyandagdalmsoroausesofactiondueto Parcel Number. F8030A0012 Township: Shady Grove NCPIN Number: 5870640335 Municipality: Account Number. 82532216 Census Tract: 37059.803 Listed Owner 1: DAMAZO JON J Voting Precinct: EAST SHADY GROVE Mailing Address 1: 193 ESSEX FARM ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: LOT 12 ESSEX FARM PHASE 1 Fire Response District: ADVANCE .Assessed Acreage: 0.69 Elementary School Zone: SHADY GROVE Deed Date: 9/2010 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 008360279 Soil Types: GnI32 Plat Book: 0009 Flood Zone: Plat Page: 290 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: p�V4 9h Davie County, All dela Is proAded as owiThont ffardyorgueranlee of any kind etthereaprewed or Implied Induding but not linkedta the Impued..... s ofrnerehantabilgy orrdneasforapaNwlarum.Ag usesof DaNeCnurdt+a elSwebaheehall hold harmlewthe Countyof MA, Nagy Carofl;tisagenda,000wkantaeordra aemployeesfmmanyandagdalmsoroausesofactiondueto „CA� wadsingautofNeuseorinabirdyfouwe eGlSdtapmNdedbythiswebslte DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 Account #: 990005029 Billed To: Dream Built Inc. Reference Name: Joseph Thurmond Proposed Facility: Residence ATC: Number: 4827 OPERATION PERMIT Tax PIN/EH #: 5870-64-2265.12 Subdivision Info: Es sex Farm Lot# 12 Location/Address:. lq5 Property Size: 100x301 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article I1 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 an given period of time. . -� System Type: S.T. ManufacturerTank Date Tank Size 00 0 �l Pump. Tank Si= � e -A q — 6z W41-4 () . 6. . System Installed By: -V—a6-L-C- E.H.Specialist I r� r'. DAVIT COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751=8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005029 Tax PIN/EH #: 5870-64-2265.12 Billed To: Dream Built Inc. Subdivision Info: Essex Farm Lot # 12 Reference Name: Joseph Thurmond Location/Address: Proposed Facility: Residence Property Size: 100x301 ATC Number: 4827 Site Type: L3New ORepair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental . Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms_ #Bathrooms # people _BasementO Basement plumbing❑ Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Lot Size O` I Cz&0 . Type of Water Supply: Reounty/City 0Well ❑CCoommunityWell System Specifications: Design Wastewater Flow (GPD) Jy &Tank Size—GAL. Pump Tank% GAL. n .. Trench Width 3G . Max. Trench DepthRock Depth 1J LinearFt.5 $;t- Site Modifications/Conditions/Other: As stated in 15A NCAC 18A.1969(5) accepted S s er!t, nom- ase be us -- Contact the Davie County Environmental Health Section for final inspection of this system between i 8:30 — 9:30a.m, on the day of installation. Telephone # (336)751-8760. —71 10` _ n a/�Vjfi .r C�) -75- 3't :,i -e-s - as= Feb 04 00 03:168 davie county envhealth 336 751 0706 F•2 APPLICATION FOR SITE EVALUATIONlIiMPROVEMENT LFEBI U Davie County Environmental Health , P.O. Box 8481210 Hosp3ta1;9treet Mocksville, NC 2701i (336)751.8760,' Fac (336)751-3786 EN111R014M1MAL HETH � DMIECOl1MY "Aaplication For: 10 Site Evaluation!Lnp-timmew Pern_lt lYAethorizaooil To Cur.SRRCt(ATC) Both Type of Application: 7New Systam z Repair to Exiting Sys' am -1Expawao.,1?vlodification oP Existing System or Facility "'IMPORTANT'" THIS APPLIC'A9'ION CUAWOTBEPROCESSED L'!ti1.ESS ALL OF THE REQUIRED INFORMATION 1S PROVIDED. HeLT to the INFORMATION BULLETIN for imtructions. APPLICANT INFORMATION Name tobe Billed _Contict Person PH%�e&vt+ A^ Billing Address f05 .5e1de fn /�n-e— Hc•me Pbonc jg � ,3$9-( Ciry/StaterZIP A,400 , nc e �, C-_� 7u�(s Busir.ess Phone Name on PermitlATC ifDifjerem '.harr Above Mailing Address _ _ _City/state/Zip ' PROPERTY INFORMATION _ . *14ate.14ouse fLoied Z-19 -Oe Q-A F61'E: A survey plat or site plan must a=mpany this application. Includo.l: O Site Plan OPlat(ro scale) (Permit is'Abd for 60 mnnibs wi :i site p'.tut, no expiration with contph!te plat.) Owner's Name tJRe- nt� Phone Nu:nbrr^--:5fe,s A (x,tx 1 Qwner's Address _ Cit} /StatejZip_ PioperyAddress _ Lot. Size J0L/X 30 i ` _;'ax PIN# SuhdivisionName(ifapp Iicabic)€SSEyc ,=A- rzrl' Secdc,(0,ot#—Zz__ IlirccnonsTOSite: /58 5T_ o.� l3I41r _ , .[.e£f or. /3ectieL.cw.P. -LL0+ L's i If th. answer to any of the followv>„e qutrh .ns is "yes", supporting do,.mnentaticn must be attached. Are there any existing wastewater systems on the site? Dyes O.No Does the site contain jutisdictiont 1 weUnds? -_,Yes 0 1 Ate there any easements or right-cj=ways on the site? CYes 030 - Is the site subject to approval by a,other public agency? Dyes ONO \ Will wastewater other than dortes+;c sewage be generated? . Dyes ONo IF RESIDENCE. FILL OUT THE E OX BELOW _ \• L#,People #Beisaoni - #Bathrooms 3�_ GardcnTtbM'hirlpool Yas DNo Basement: Eyes o Basemen':Plumbing:. f Yes No 1 — IF NON -RESIDENCE MLL OUT":'HE BOX BELOW Type of Facility/Business Total Square Footage of Building # People f1 Sinks # Commodes # Showers # Urinals _ Estimated Water Usage (gellons per da,-) __(Attach documentation cf similar facility water consumptimt) i'�OODSERVICE ONLY: # Seats 'Type system requested- onventiorial ❑ Accepted :;Innovative UAlte native OOlher -� Watc: Supply Typc: 0 Cotmty/Ciry WanT 0 New Well OExisting'A'ell O Conmtunity Well Do you anticipate additivas ur expansions o: the faciliy this system is intended is serve? ❑ Yes /,(No If yes, what type? _. This is to certify that the in`bTruatioa providrd on this appl:cation is true snd ootrsc: to Eve best of mylMowledge. I usdcrstatnd dwt any permit(s) er ATC(s) issued hereafter are sub,'cct to suspension or revocation ii the site is altered, the inOnded use changes, or if the informacor submitted in this application is falsified or changed I hereby grant.ight of entry to rite Authorized Representative nfthpDavie G,.nty rtnatti, t,,...,A,,.r ._�_...—.._._. _____._ _ •• - Flo,, _....n — 1--, .....0 aun vrumta mW wcawtg anu nagging or staking the house/facility locatio ro —,,d xnll location and the location of any her amenities. '% r'— /� • Site Revisit Charge y P riy ou/nsr's or jw:ter's legal representr:rvc si&�:urc - // � Q Date(s): '�./ �/y Client Notificatior.Dat.: Dat Sign given CYes ONo Account# 07 Revised 11106 Invoice 9 I� v '7ropose�( ( 5.5 Sax �55z-K �G.t-p-e (Zoc.a. uw Z- I°L-ted' - � ss�x FtzM _ZNZ /f 1 = 30 D G Z 3 APLI ATI N FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC .pV - Davie County Environmental Health P.O. Box 848/210 Hospital Street _ RONM ONC( - Mocksville, NC 27028 OpV\EGO (336)751-8760/Fax(336)751-8786 - - Application For: lit Site Evaluation/Improvenrent Permit - 0 Authorization To Construct(ATC) 0 Both Type of Application: ONew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or,Facility, •*'/MPORTANT't' THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed 05C A)crya"Pnd Billing Address - A-6- .x 3-,f0 City/State/LIP _4/ �- ,AC - Name on Permit/ATC if Different than Abr Home Phone isiness Phone 7S/ - 7300 NOTE: A survey plat or site plan must accompany this application Included: O Site Plan lot( to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat) Owner's Nzme�DSc iOeTVEloPNBNi ccx�iaG - Phone Number 7S/-73� Owner's Address fo B0 f0 City/State/Zip /AC 270LS Property A_ddr s - - City Lot Size , Tax PIN# - Subdivision Name(ifapil[cable) Es r . Sech_oQ�ot#- irectionsToSte: f(74 C(�5 PR "/ D C.�.�%Z/✓/fYZCiG L'[T� , —.—r Am there any existing wastewater systems on the site? DYes Does the site contain jurisdictional wetlands? Dyes Are there any easements or right-of-ways on the site? Dies Is the site subject to approval by another public agency? Dyes 73 -I#People #Bedrooms #Bathrooms Garden Tub/Whirlpool❑Yes ONo Basement: ❑Yes ONo Basement Plumbing: OYes ONo 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:6Conventional DAccepted Dbmovative OAltemafive DOther - Water Supply Type: D-C"ounty/City Water D New Well DExisting Well D Community Well - Do you anticipate additions or expansions of the facility this system is intended to serve? D Yes O No If yes, what type? - This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use - changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized - - . Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating an egging or waking thehousdfacili locatioq proposed well location and the location of any other amenities. .., Site Revisit Charge Prope r %er's legal represents re - Client Notification Date: Dat - - EHS: - Sign given ❑Yes ONo - Account Revised 11/06 Invoice #... h DAVIE COUNTY HEALTH DEPARTMENT - - Environmental Health Section 1 Soil/ Site Evaluation APPLICANT INFORMATIONROPERTY INFORMATION Account #: 990004425 Tax PIN/EH #: 58700 a> .�� Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 12 Reference Name: Brad Coe Location/Address: Cornatzer Rd -27006 Proposed. Facility, Residence Property Size: 0.691 Ac. Date Evaluated: %—oZ(% 'O 7 Water Supply: Evaluation By: On -Site Well Community Public Auger Boring Pit Cuter_ FACTORS 13 (p tj 4 5 6 7 Landscape position t. Slope % _ 1HORIZON I DEPTH 6Texture Njeq growConsistence Structure Mineralogy 5 HORIZON H DEPTH Texture group SG Consistence I! Structure Y, e Mineralogy HORIZON III DEPTH .:Texture group Consistence .'-Structure Mineralogy. HORIZON IV DEPTH , = - Texture group . Consistence. Structure . Mineralogy- - SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE , CLASSIFICATION ,. L de% LONG-TERM ACCEPTANCE RATE 7 1 SITE CLASSIFICATION:�� 1 t�o� EVALUATIONBY. 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 - Siltyloam CL- Clay loam SCL -, Sandy clay loam' SC - Sand claySIC - Silt clayC - Cla • CONSISTF.NCF. Y Y MoiSt V FR - Very friable . FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 33_et NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP -Very plastic" Struebire SC - Single grain M - Massive CR -Crumb GR - Granular ABK - Angular Blocky SBK - Subangular blocky PL - Platy PR - Prismatic 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 05/05 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 .(336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004425 Tax PIN/EH M 5870-64-2265.12 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex. Farm Lot # 12 Address: PO Box 340 Location/Address: Cornatzer Rd -27006 City: Mocksville Property Size: 0.691 acre Reference Name: Brad Coe Proposed Facility: Residence **NOTE* *This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. l Permit Type: Dew DRepair. DExpansion Permit Valid for: fly Years DNo Expiration Residential Specification: #Bedrooms 4 #Bathrooms_#People_BasementOBasement plumbingO Non -Residential Specifications: Facility Type - # People_ # Seats_ - Square Footage(or Dimensions of Facility) Design Flow(GPD): Lf 49 0 Type of Water Supply: �unty/City D Well ❑CommunityWell As stated in 15A NCAC 18A.1969(5) Site Modifications/PermitConditions: ,msSystems may alse be usedd System Te LTAR Initial cc e• o^f- 0 O. 5 - Repair QGr.o n11 •e e� G3. )`�6