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201 Fox Run Drive Lot 16Davie Countv. NC Tax Parcel Renort Thursday. December 29. 2016 EO Ail data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Davie County, Impliedwanan es 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 NC or arising out of the use or Inability to use the GIS data provided by this website. WA"lAti: hill lb Pull A bURVL' Y Parcel Information Parcel Number: E6110A0016 Township: Farmington NCPIN Number: 5851731648 Municipality: Account Number: 62517120 Census Tract: 37059-802 Listed Owner 1: ROTHBERG KENNETH A Voting Precinct: SMITH GROVE Mailing Address 1: 201 FOX RUN DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 16 FOX RUN Fire Response District: SMITH GROVE Assessed Acreage: 0.44 Elementary School Zone: PINEBROOK Deed Date: 6/1999 Middle School Zone: NORTH DAVIE Deed Book I Page: 003060012 Soil Types: PcB2,EnB,EnC Plat Book: 0005 Flood Zone: Plat Page: 182 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Building Value: g Freatures Value: Land Value: Total Market Value: Total Assessed Value: EO Ail data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Davie County, Impliedwanan es 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 NC or 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 Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 Account #: 990005651 Billed To: Kenneth Rothberg Reference Name: REPAIR PERMIT Proposed Facility: Residential Repair REPAIR OPERATION PERMIT Tax PINfEH #: 5851-73-1648 Subdivision Info- Fox Run Lot # 16 LocationlAddrass: 201 Fox Run Drive -27028 Property Size:' ATQY":ThFs%ance 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: y '" S.T. Manufacturer)( Tank Date Tank Size Pump Tank Size System Installed By: E.H. Specialist ate: �8 GPS Coordinate: DCHD 11/06 (Revised) „ DAVIE COUNTY ENVIRONMENTAL HEALTH ' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR IMPROVEMENT PERMIT AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005651 Tax PIN/EH #: 5851-73-1648 Billed To: Kenneth Rothberg Subdivision Info:' Fox Run Lot # 16 Reference Name: REPAIR PERMIT Location/Andress` 201 Fox Run Drive -27028 Proposed Facility: Residential Repair Property Size; ' A"1'1✓i 51 5150Authorization 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 IP/ 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: # Bedrooms3 # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: *County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size(@LGk 1 AL. Pump Tanker GAL. Trench Width Max. Trench Depth_ Rock Depth Linear Ft. Site Modifications/Conditions/Other: 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)753-6780. Environmental Health S DCHD 11/06 (Revised) _jAuoie 7&2,9 APPLICATION FOR PRIVATE WELL PERMIT Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name Address City/State/ZIP Name on Permit if Different than Above Mailing Address PROPERTY INFORMATION Contact Person _ Home Phone Business Phone City/State/Zip *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan pPlat (to scale) Owner's Name Phone Number Owner's Address City/State/Zip Property Address City Lt.Siz Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: lAA7E1✓OPMENT INFORMATION Permit Type: New Well Well Repair Well Abandonment Other (specify) Facility Type: Residential Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO Do You Intend To Install A New Septic System On This Site? YES NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. Signed Date Site Revisit Charge Date(s): Client Notification Date: EHS: 7/30/09 Account # Invoice # �,m��.,L 4nW res •::,i' .. S.Ys fp air -{ - . !} ,, r._'' _ ,. �/ AUTHC' lZ. ATION NO: 3 DAVIE COUNTY HEALTH DEPARTMENTA Environmental Health Section PROPERTY INFORMATION Permi{tee's j /6/v P.O. Box 848 Name: �Q Mocksville, NC 27028 Subdivision Name: Phone #: 704-634-8760 Directions to property: Section: ` Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION 'A Road Name: �F /V Zip:i d **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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION Aler IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONME AL HEAL H SPECIALIST DATE ISSUED ti y w ,,. `92 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION --Petmitf�' 3� � _ Name:'�b°ri Q f Subdivision Name: Directions to property: Section: Lot: IMPROVEMENT PERMIT Tax Office PIN*A �r� � e `�� f f' y!' } t'� Zip. Road Name: **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 from this Department prior to the constructionlinstallation 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) ***NOTICE*** TILS PERMIT IS SUBJECT TO REVOCATION IF SITE d�j jam, ,'3, �F.. !'✓; y '"� ; : '�' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEAL H SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS -V # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE,/�M1 TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) lay NEW SITE REPAIR SITE A SYSTEM SPECIFICATIONS: TANK SIZEGAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH �? LINEAR FT.� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT /vaw /V(W **CONTACT A REPRESENTATIVE OF THE DAME COUNTY HEALTH DEP ,A{t,�vIENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF IN t LATION. TELEPHONE # IS (704) 634-8760. ^sir OPERATION PERMIT. CVCJLR LCT/7 TL%1. Affiv -71-P /fl ?p X- `� AUTHORIZATION NO. OPERATION PERMIT BY: 6 — / 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. DCHD 05/96 (Revised) N i[ DAVIE COUNTY HEALTH DEPARTMENT r IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perini �. Name: t 'i Q Q,v Subdivision Name: el" I/ Directions to property: r /X Section: Lot: BU OVEMENT . PERMIT Tax Office PIN:# Road Name: +' 71iIp: **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 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) •� ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE #BEDROOMS # BATHS —9 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No �d 'd LOT SIZES wD TYPE WATER SUPPLY �' DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE01 i SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH J�� ROCK DEPTH %514" LINEAR FT.� , OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: %F"t' fl 44'e/ . r "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPAPVMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF IN A%LATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT kety 701141 94X3.. � ,� 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. DCHD 05/96 (Revised) a..+y',.4. DAVIE COUNTY HEALTH DEPARTMENT �1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article li of G.S. Chapter 130a nita��yy Sew „ge. ystems rT r, ' �d�r� F -T /S .ras: •,,��� ✓l' Date . Name Location 4 Permit Number N°_ 7198 �n -T Subdivision -Name !� Lot No. Sec. or Block No. /Uli .� z�0�' ✓ Lot Size House— Mobile Home f Business _- Speculation No. Bedrooms .No. Baths No. in Family _ Garbage Disposal Auto Dish Washer Auto Wash Ma^hine Type Water Supply YES NO ❑ YES NO ❑ YESNO [Iv ifications for System: S 7pyevji6c *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. t Ival // Improvements permit by '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 day of completion. Telephone Number 13PA1 7,634-5985. Final Installation Diagram: d��f Ry �r 0e r 10 tit �1 It I pep" kp. dl n� l ` a vi 11 Ir , Tic y ►1� NO _];_C -P C )? % ru, �S /7 Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department 2 5 1993 ` Environmental Health Section lb- �y I P. O. Box 665 r (f� Mocksville, NC 27028 - -"'" ii, ) I " 1. Application/Permit Requested By /A / �G(2 / UiY S,o �O �jpDiQ Jp Y ! ��L� Mailing Address -/-E�E'SO-J �'� uR�' is �o q�, D, 13aX 8 Home Phone ___ / g �"' 3 Z Business Phone / '3 47 Z J 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 ) F-1Other El Unknown 5. If house, mobile home: Subdivision '14 0� le f" Section Lot # No. of People [(i✓%iryD �,�J No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions / % 3 l 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 93-1 asement/Plumbing ❑ Basement/No Plumbing 04 ashing Machine fB'Dishwasher Garbage Disposal No. of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community i 8. Property Dimensions X �-�©/ Sewage Disposal Contractor �� i `e �V-l2 �''r S 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes P�'1Qo If yes, what type? '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: 14 189 �rLe S % pr V t s�o� 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 CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBEDPROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 0 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 Davi County Health Departme to enter uporLa__ttove described property located in Davie County and owned by J ham �e� o��� pi2,o� .o.r/ to conduct all testing procedures as necessary to determine said site's suitability for a ground a orption sewage treatment and disposal system. DATE SIGNATURE DCHD (12-90) ` 1 DAVIE COUNTY HEALTH DEPARTMENT J Environmental Health Section Soil/Site Evaluation NAME 1l,—` C DATE EVALUATED���� ADDRESS PROPOSED FACIILTY PROPERTY SIZE `d©6 LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Il Pit Cut FACTORS I 2 3 4 Landscape position ,L G Sloe % ly HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence i Structure .J' 4- Mineralogy !'/ /, l•` HORIZON III DEPTH Texture groupf Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Cd, VV k"I' `EVALUATED BY: k1Z LONG-TERM ACCEPTANCE RATE: +► y OTHER(S) PRESENT: REMARKS: y f�S fa ZAI pIrl i%l9.`P 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 d Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) r� 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 ■■M■ ■■N■ ■■M■