234 Essex Farm Road Lot 25Davie County, NC Tax Parcel Report Tuesday, December 20, 2016
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Parcel Information
Parcel Number: F8030A0025 Township: Shady Grove
NCPIN Number: 5870644804 Municipality:
Account Number: 67021000 Census Tract: 37059-803
Listed Owner 1: SMITH DOUGLAS SCOTT Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 234 ESSEX FARM ROAD 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:
LOT 25 ESSEX FARM PHASE 1 Fire Response District:
0.71 Elementary School Zone:
3/2008 Middle School Zone:
007500306 Soil Types:
0009 Flood Zone:
290 Watershed Overlay:
Outbuilding 8r Extra
Freatures Value:
Total Market Value:
ADVANCE
SHADY GROVE
WILLIAM ELLIS
GnB2,EnC
DAVIE COUNTY
i!fa:
161
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County of Davie, North Carolina, its agents, consultants, contractors or employees from anyandalldalmsorcausesofactiondueto
NCor arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
a' • Mocksville, NC 27028
G► Q 1UOL (336)751-8760 Fax # (336)751-8786
OlN V�s�o� AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005047
Billed.To: Michael Hauser Construction
Reference Name:
Proposed Facility: Residence
14
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ATC Number: 4838
Tax PIN/EH #: 5870-64-2265.25
Subdivision Info: Essex Farm Lot # 25
Location/Address: Essex Farm Rd -27006
Property Size: .0711
Site Type: ew ❑Repair ❑Expansion
**NOTE** This Authorization to Constrict (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 # Bathro
Basement❑ Basement plumbing0
Non=Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Lot Size . 71I &cre, Type of Water Supply: 215—unty/City ❑ Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) Tank Size GAL. Pump Tankk GAL.
�' I
Trench Width Max. Trench Depth 36 Rock Depth • Linear Ft..� r3! 3W D �f
Site Modifications/Conditions/Other: Asstated in 15A hl=„ ,.
14 L -
accepted Systerns rna;! also bo: u:si;d
Contact the Davie County Environmental Health Section for final inspection of this system between
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Sheet
Mocksville, NC 27028
(336)751-8760 Fax #(336)751-8786
Account #: 990005047 OPERATION PERI PIN/EH #: 5870-64-2265.25
f
Billed To: Michael Hauser Construction Subdivision Info: Essex Farm Lot # 25
Reference Name: Location/Address: Essex Farm Rd -27006
Proposed Facility: Residence Property Size: .0711
ATC Number: 4838
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. � ��
System Type: S.T. Manufacturer Tank Date �[ Tank Size
Pump Tank S' e
Y
System Installed B : �/� a H. S ecialist: X ✓-1`Daa�
Y p
--e.
n/ TTT 11 /nC /Tl -. ____ J%
' DAVIE 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 #: 990005047
Billed.To: Michael Hauser Construction
Reference Name:
Proposed Facility: Residence -
ATC Number: 4?esid eel u-
Tax PIN/EH M 5870-64-2265.25
Subdivision Info: Essex Farm Lot # 25
Location/Address: Essex Farm Rd -27006
Property Size: .0711
Site Type: 41w ❑Repair ❑Expansion
**NOTE** This Authorization to Constrict (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 chance.
Residential Specifications: # Bedrooms—_L# Bathrooms I # People Basement❑ Basement plumbing❑
Non=Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Lot Size .7114,crr Type of Water Supply: Er6o'unty/City ❑ Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) 4180 Tank Size GAL. Pump Tank�GAL.
„ 3� o�
Trench Width 2 / 4 Max. Trench Depth 3G� Rock Depth Linear Ft.
Site Modifications/Conditions/Other: Ar. Mated in 9.5f. Nf AC 18A.1.9891S1 k5 Rett -J I
accepted Systems may also be use
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
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Date: i°1 U
P �A� SITE EVALUATfON/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751=8760/ F;Authorization
(33 751-8786
STH
FS �, ��1;ENTAIH�
A lication FoTlp1S ion/ Improvement Permit To Construct(ATC) ❑ Both
T e of on: ew 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
Name to be Billed ///►(' /1Ctr'/ �/�iG(��': — rt; 'icfa�l Contact Person 1q, 11tie/ e: tY�, f'
Billing Address ,v Home Phone 356. 4, 7 2 3`i*1
City/State/ZIPd•rev:%y S -S` Business Phone '3YC yL.Z
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION
*Date House/Facility Corners Fl
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale)
(Permit is valid fo 60 onthsKh site plan, no expiration with complete plat.)
Owner's Name r1 �, C 1Gtr'� u �,2!' (bnSAr"'l /-'A Phone Number
Owner's Address City/State/Zip
Property Address City
Lot Size 7 Tax PIN#
Subdivision Name(ifa plicable) Section/Lot#
Directiotls To Site: AR 6 U .,67, UCl 0,-J/5 _ dieNl4ze,i..M. 06 AVA'26K S
.0
of the answer to any of the following questions is "yes", supporting documentatio must be attached.
Are there any existing wastewater systems on the site? ❑Yes 9No
Does the site contain jurisdictional wetlands? ❑Yes o
Are there any easements or right-of-ways on the site? ❑Yes 3yo j
Is the site subject to approval by another public agency? ❑Yes o
Will wastewater other than domestic sewage be generated? ❑Yes &KO
W, -Z- e,55
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms # B41oomsGarden Tub/Whirlpooles ❑No
Basement:: OYes Basement Plumbing: []Yes❑No
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:. dConventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: County/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ 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 respoWble for the proper identification and labeling of property lines and corners and locating and flagging
or staking t e house/fa ili7� /cation, proposed well location and the location of any other amenities.
Site Revisit Charge
Property owners or owner's legal representative signature
C/ Date(s):
U Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account # q 7
Revised 11/06 Invoice #
VAPP CA ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
O Davie County Environmental Health
P�G P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
FN VSE kation For: MSite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both
Type of Application: ❑New 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.
-�� 73
Name to be Billed ASC /0c'V64opHr'NT eat_. /^x-- Contact Person 7aRRy d47a vX
Billing Address 'A.o - a_.;< 3f0 Home Phone
City/State/ZIP C►G Z los 6 Business Phone 7S/ . 7300
Name on Permit/ATC if Different than
Mailing Address
YKUFhK1Y 1NPUKMAHUN 'Date mouse/raclll L;omers Plaggea
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan lat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name A -Sc /��-yBcoPri�i�i cgt, ir�G Phone Number 7S/ - 73 -10
Owner's Address ,r°o doh j� City/State/Zip�/�Yr aic��r .yG 17"ia
Property Address City
Lot Size 0,111 Tax PIN# 0 - (gT Mr
.Subdivision Name(if avalicable) -ssJ x Amon Sectiou/Lot# `� ___ /►
1f the answer to any of the following (uestionstis "yes", supporting documentatio} must be atd hed.
2p1.
Are there any existing wastewater systems on the site?
❑ Yes
00
Does the site contain jurisdictional wetlands?
Dyes ❑
Are there any easements or right-of-ways on the site?
Bles ❑ o
Is the site subject to approval by another public agency?
Dyes CW
TN
wastewater other than domestic sewage be generated?
Dyes t3No
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms :fie. # Bathrooms Garden Tub/Whirlpool Dyes ❑No
Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No
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: K`onventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: County/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ 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
locatingan ging or staking the house/facility house/facilitylocation, proposed well location and the location of any other amenities.
Site Revisit Charge
Prope r s or o er's legal representa re
Date(s):
7 Client Notification Date:
Date
EHS:
Sign given ❑Yes❑No Account#
Revised 11/06 Invoice 4
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPFRT INFORMATION
Account : 99 Tax PIN/EH #: 587D=64=ZZ6 . b
Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 25
Reference Name: Brad Coe Location/Address: Cornatzer Rd -270
Proposed Facility: Residence Property Size: 0.689 ac. Date Evaluated: k s' - d
Water Supply: On -Site Well. Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS
ILA
30
31 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
,3cp
_ 3q
Texture groupC-
c
Consistence
f {
Structure
k-
Mineralogy>n
G
HORIZON H DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
a
Z'
LONG-TERM ACCEPTANCE RATE
0,) 7
7 5
4: a -73--
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE: a 7 5
REMARKS:
�c, AlG—t
EVALUATION BY: t Uyl S
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 FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3�t
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
MineraloU
1:1, 2:1, Mixed
1
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)
LIAR - 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
Account #: 990004425 IMPROVEMENT PER gfIPIN/EH#: 5870-64-2265.25
Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 25
Address: PO Box 340 Location/Address: Cornatzer Rd -27006
City: Mocksville Property Size: 0.711 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.
Permit Type: 94ew ❑Repair. ❑Expansion Permit Valid for: Years ❑No Expiration
Residential Specifications: # Bedrooms 4 # Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
DesignFlow(GPD): "l SO Type of Water Supply: EC;ounty/City ❑Well ❑CommunityWell
AS stated in 15A NCAC 18A.19S9(5�
Site Modifications/Permit Conditions: ancepted Systems ma;c
-alsa be u3
Site Plan
System Type LTAR
Initial OL C 1--e rJ 0.)--75—
Repair
.)--75—Re air a c , T --CA 0 .).75--
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Environmental Health Specialist //i/` Date
11`14,79
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Environmental Health Specialist //i/` Date
11`14,79