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109 Fernhaven Lane Lot 1Davie County. NC T��r U�rra1 R Pr,..rt Wednesday, December 28, 2016 WAKNI-N T: THIS 1S NUT A SURVEY Parcel Information Parcel Number: E60000002401 Township: NCPIN Number: - 5851821970 Municipality: Farmington Account Number: 13818250 Census Tract: 37059-803 Listed Owner 1: CARTER TONY C Voting Precinct: SMITH GROVE Mailing Address 1: 109 FERNHAVEN LANE Planning Jurisdiction: Davie County City: MOCKSVILLE 6/2008 Zoning Class: ' DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-0000 Voluntary Ag. District: No Leal Description: LOT 1 RICHARD SHORT PROP Fire Response,District: SMITH GROVE Assessed Acreage: 0.76 Elementary School Zone: PINEBROOK Deed Date: 6/2008 Middle School Zone: NORTH DAVIE Deed Book / Page: 007630207 Soil Types: Mr62 Plat Book: 0008 Flood Zone: Plat Page: 058 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: All data Is provided as is without warranty or guarantee of any Idnd 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 ag claims or causes of action due to np p4� NC or arising out of the use or inability to use the GIS data provided by this website. Account #: Billed To: Reference Name: Proposed Facility DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 4 J 989900057 Tax PIN/EH #: 5851-82-1970 Randy Grubb Subdivision Info: Fam.Div R. Short Lot # 01 Location/Address:l%ernhaven Dr -27028 Residence Property Size: 100x 320 ATC Number: 4220 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 WASTEWATERCONSTRUC=N ISJGALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION Date: **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. QVIGc4 �bTbCu4)l �K Septic System Environmental Health Specialist's Signature: DCHD 05/99 (Revised) I �� )s DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900057 Tax PIN/EH M 5851-82-1970 Billed To: Randy Grubb Subdivision Info o9Fam.Div R. Short Lot # 01 Reference Name: Location/Address: Fernhaven Dr -27028 Proposed Facility Residence Property Size: 100x 320 ATC Number: 4220 **NOTE** This Improvement/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 l 1 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 SYSTEM. Residential Specification: Building Type HDL): -1, #People Ll #Bedrooms #Baths 2 Dishwasher: Er- Garbage Disposal: ❑ Washing Machine: 13,- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ElLot Size /e CR ok-;gype Water Supply- Design Wastewater Flow (GPD) '3(o© Site: New Repair ❑ � 1 System Specifications: Tank Size 10CD GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.- Other: ��ICTi�,l�t �.�rx�S Ali !n�i[o Required Site Modifications/Conditions �l Au. owl ( IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** G ' I atQ \bofikAo�-" -Y6WTV-X1-,r-hS Environmental Health Specialist's Signature: Date: SO a5 DCHD 05/99 (Revised) �V .�, R,1W 7X LINE S 31 003'06" W 87 37.04' ::0139.60' Sf8 * REBAR SET ._... 2,40' j 25.02' vp---� iib" REBAR SET 1 `8" REBAR SET 5�8 " REBAR SET 6 0' RIW (SEE CALL TABLE B NOTE) 'V S 3I °58'13"4t/ 3/9.05' RIW 285.02' S�8 " REBAR SET S 3 i 058'13 "W 350,70' 315.27' 5i8" REBAR CF) W� 0) W REBAR SET ..�, 5�8 " REBAR SET 6 0' RIW (SEE CALL TABLE B NOTE) 'V S 3I °58'13"4t/ 3/9.05' RIW 285.02' S�8 " REBAR SET S 3 i 058'13 "W 350,70' 315.27' 5i8" REBAR • APPLICATION FOR SITE EVALUATION/Ih1PROVOIENT PERMIT & {1Q Davie County Health Department II V� 15 Environmenta/Hea/t/y Section P.O. Box 848/210 Hospital Street SSP 2.9 Mocksville, NC 27028 2M (336) 751-8760 ten■pn 17MROtmArna * * *XIIPORTANT * * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL nC0I1WiY INFOR11ATION IS PROVIDED. Refer to thn INFOR11ATION BULLETIN for instructions. 1. Name Lo be Dilled &14elvContact � Person Mailing Address /3o 1sC•� f (�!. Nome Phone !ZLL— 76'9� CiLy/Stato/ZIP Wae S,,/ / IV, or Business Phone = �y — 0-,f, 71 2. Name on Permit/ATC if Different than Above Nailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC la"Doth 4. System to Sorvico: fj house ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Typo system requested: k_! Conventional ❑ convontional modified ❑ innovative QacCepted 6. If Residence: it People T ff Bedrooms ft Bathrooms 2 L"JDishwashor ❑Garbage Disposal E Washing Machine ❑basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type ft People tf Sinks _ N Commodes ft Showers ft Urinals It WaLor Coolers IF FOODSERVICE: It Seats 8. Typo of water supply: 01"County/City Estimated Water Usage (gallons per day) ❑ Well ❑ Community 9. Do you anticipate additions or expansions of tIle facility tills system is iI1tended to serve? ❑ Yes ❑ No If yes, n•ilat type? ***1j1IP0RV4N2-** CLIENTS MUST COMPLEM TIIE REQUIRED PROPERTY INFORMATION REQUESTED MELON. Either n PLAT or SITE PLAN AfUST BrSU11. f1TTED by the client with THIS APPLICATION. r Property DilUGlsions: l0 S )� 3 Zto Tax Office PIN: I! .996-/9'Z/470 loq Property Address: Road Raine rNh 4 C�I_tti Z -Ar City/'Lipzv--k _4 d WRITE DIRECTIONS (frons Modavillc) to PROPERTY:, "—C -C IL %2 %S eve If in a Subdivision provide %information, as ffollows�: f Nalnc:�f �� s��yt� 1i! `'✓i�l�� Section: '1�60000cjboclu Lot: _�_ Date Ironic corners flagged: Int. n / 'Phis is to certify that the information provided is correct to file best of lny knowledge. I understand that any permits) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the illfornlalion submitted ill Misapplication is falsilicd or changed. I, also, understand that I ant responsible for all charges incurred front this application. I, hereby, give consent to tl►c Authorized Representative of the Davic County I-Icaltl► Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suit.IJ*t43,. _ DAT!; <:?"-2- 9— 0 !�_ SIGNA'I'URL TIIIS AREA MAY BE USED FOR DRAIVING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCIID (05103 Site Revisit Charge Datc(s): Client Notification Date: EI -IS: ,Account No. 6'> 0- ! 763 65-7 Ln'oice No.�`P NEA�TM IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Heath Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***I1dP0E *C* THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. 1. Name to be Billed �R l4'1-1AShl�l+ Contact Person ,-72, lam.a'--cQ Mailing Address 1.1-3- rctf m 1aa,;A—) V Home Phone 9%1— 7�;7' City/State/ZIP /vldtk.SU) It /J(- Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: DA/ite Evaluation ❑ Improvement Permit/ATC ❑ Both . / ,le, ttome 4. System to Service: ❑ House 11 Mobile Home ❑ Business ❑ Industry U,16Lr 5. If Residence: # People # Bedrooms -_ # Bathrooms 31Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes D�PQo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 11 A3 A L WRITEDIRECTIONS(from Mocksville) to PROPERTY: Tax Office PIN: #SSS" ' �� `�� 0 1 �J b Q )�3��L M' I 04S V '�- Property Address: Road Name t,J 1 ?; /ue b rda k biy -e City/Zip Qrbo-eA'I S dM +�t� rl�j�T If in a Subdivision provide information, as follows: 1,34k red es -,6 4-c S l R 0 Name: Fje y --?ea I:61 Section: Block: Lot: J— Date Property Flagged: cjpAr a4kYer Map 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 responsible for all charges incurred front this application. I, hereby, give consent to the Authorized Representative of the Dave County leap Department to enter upon above described property located in Davie County and owned by .LJe IbeNS4r to conduct all to//sting procedures as necessary to determine the site s DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). M o f iNcl L,deo S d I I Mop 'I N c, I tAdLgej Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. ' -.�-> 7 a Revised DCHD (07/99) Invoice No. I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001288 Tax PIN/EH #: 5851-82-6728.01 Billed To: Richard Short Subdivision Info: Reference Name: Location/Address: Highway 158-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring Pit Cut SITE CLASSIFICATION: IJ EVALUATION BY: �htQW�7 LONG-TERM ACCEPTANCE RATE: O • 'V ✓-� OTHER(S), PRESENT: REMARKS: LEGEND Landscaae 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 05/99 (Revised) Landscape position HORIZON I DEPTH Texture group Consistence s.�r:•x�� EHORIZON Miner • _ V d'�----- II DEPTH group Consistence MineralogyTexture HORIZON III DEPTH group WAMOM Consistence MineralogyTexture Texture group Consistence Mineralogy SOIL WETNESSSAPROLITE CLASSIFICATION SITE CLASSIFICATION: IJ EVALUATION BY: �htQW�7 LONG-TERM ACCEPTANCE RATE: O • 'V ✓-� OTHER(S), PRESENT: REMARKS: LEGEND Landscaae 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 05/99 (Revised)