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119 Fernhaven Lane Lot 2Davie County, NC Tax Parcel Report Wednesday, December 28, 2016 Zip Code: WARNING: TRIS 1S NOT A SURVEY Voluntary Ag. District: No Parcel Information LOT 2 RICHARD SHORT PROP Parcel Number: E60000002402 Township: Farmington NCPIN Number: 5851822886 Municipality: PINEBROOK Account Number: 82524986 Census Tract: 37059-803 Listed Owner 1: ROMERO CESAR H Voting Precinct: SMITH GROVE Mailing Address 1: 119 FERN HAVEN LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-7862 Voluntary Ag. District: No Legal Description: LOT 2 RICHARD SHORT PROP Fire Response District: SMITH GROVE Assessed Acreage: 0.76 Elementary School Zone: PINEBROOK Deed Date: 8/2005 Middle School Zone: NORTH DAVIE Deed Book / Page: 006200475 Soil Types: Mr132,MsC Plat Book: 0008 Flood Zone: Plat Page: 058 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 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 webslte shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and aft claims or causes of action due to �p6N�4 NC or arising out of the use or Inability to use the GIS data provided by this websfte. N A ' NT INFORMATION Account #: 990001288 �' Billed To: Richard Short" eference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5851-82-6728.02 Subdivision Info: Location/Address: Highway 158-27028 Property Size: see map Date Evaluated: 411101 On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position J Slope % HORIZON I DEPTH Texture group Consistence Structure MineralogyI : I HORIZON II DEPTH -' O Texture group Consistence - Structure Mineralogy): HORIZON III DEPTH Texture group Consistence 'z Structure C� Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscaae Position EVALUATION BY: <" ' OTHER(S) PRESENT: 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 M.Mia 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) 2 DAVIE COUNTY HEALTH DEPARTMENT �-- Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001211 Tax PIN/EH #: 5851-82-6728.02 RG Billed To: Randy Grubb Subdivision Info: Fam.Div R. Short Lot # 02 Reference Name: Location/Address: Highway 158-27028 Proposed Facility Residence Property Size: see map ATC Number: 3912 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 1 O..S age Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE TER RUCTI N I V FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: % O CERTIFICATE OF COMPLETION **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. IFQAI� Pew--" 1 `l d V Septic System Installed By:� L 12 I Environmental Health Specialist's SignaturXe: t7 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT 30 . • Environmental Health Section • T P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 2-- IMPROVEMENT/OPERATION -IMPROVEMENT/OPERATION PERMIT Account #: 990001211 Tax PIN/EH #: 5851-82-6728.02 RG Billed To: Randy Grubb Subdivision Info: Fam.Div R. Short Lot # 02 Reference Name: Location/Address: Highway 158-27028 Proposed Facility Residence Property Size: see map ATC Number: 3912 **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 11 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 F6).. #People #Bedrooms —:s #Baths 2 - Dishwasher: 0Garbage Disposal: ❑ Washing Machine: 12" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0. -7LA AIOZType Water Supply �tol Design Wastewater Flow (GPD) Site: Newry Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width -5ko Rock Depth 12-" Linear Ft. qL-0 Other: �ST�-IJ�ie�1 Required Site Modifications/Conditions: L%- b t'3 0-2p, , ��Q &K ) L -P 10 cFf 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.**** 10 S0 7o �ro (sip Environmental Health Specialist's Signature: Date: %1 3 DCHD 05/99 (Revised) t WH�J t Olt sar. JVI*C Davie County H6aitfi depilitment BMromne1M71H&71t11 S!,0CM0h P B6X.848A,10 Itosp'ita'! Street: . 2dock vine, NC 27028 (33(;)751_87 60 WrCrT_AiMV4** vas APPLICATION cmao!r Ili P.Rdcrs,.qzD U14LlJ-_.SS ALL TIM REQUIRED IS PRO I' INFORMATION ' PROVIDED., R'for to the NroRmAT OIT BULLEV= for instructions. I' Hama to be Dill6d ContacL P81*?h'bn Mailing Addr6li '30 ev. 1101110 vh;na 9616 Duaineas 11 Wne City/State/ZIP 33 VV0 Y 2. llama on Permit/ATC if DiLf arcni thaw.Yi , 4Abova Mailing Address City/st'ato/zip 3 Application Foii ESite E�ra'1u a 3on iinVr' ement t�e'3.-iii t/ATC D Both El idoWUO ironit ❑ Blisin6ba 0 J:ndus L3. -y D Other 4i S�DLCM to service.' @/House dified ❑ innovative 5� Type systsystemrequested: I/Convbiiti fal 11 d" vantiona Mo I '00 Gi If Residence: It People 0 bedrodIlls 13<51hwaaher 6Ga'rbaqo Disposiir1a s h i In: M a d hi 'no' bBas`6menL/PlJ ing ElliaLemonL/Vo Ilumbing 7. If liusincaz/lndustry /Other: verily typo It P001316 IF Sinha N Commodes 0 SAW'ers It Urinals' 0 Water Coolaru Wager Usago '(Uallona per day) IF FOODSERVICE; 0 Seats i.;stimited J S. Typo of water adlpply: 0 unty/Clty E3 well' 0 Coiranuni ty 9. you anticipate additions or is hiteadeil t serve?, 13 Yes I)a aii, oils or (lie illc'illiy (Ills S3�slbili 0 ir)-cs, iyiiat typet?" *JA.1P OR TAIIV2'k C L I E N IrS Al UsT tdhfl'LL TL.- -r I I L4 ggQ &1IMD PI t 0 1 E ICl IN F0 I t M ik 110 N I t K Q I J ES I'l 1) BELOW. Eitliei'.IPLAT' orSITI�-OLANillUSTB—rS&i�il117-ft-Dbytii.�cliciiI ivitli'j�'l-IISAIII'l,IC,k'I'ION. Property Dimensions'. li'IZITL*DiltLCI'10c`Eg'(ii-(jlli Mucksville) W I'ROVE*1VIT: 6.7 ax Office PIN: T. � I , -1 . 4 Property Address. Mild Na Ille t�ity/Zip C If in a Subdivision PrAde hirorniationi :Is follows: to V Name: Section: Mock: k- L t: Date libbib corzicrs fllabged: t This is to certify that (Ila lllforinatioii prAded-li correct to ilib best of my I6i6iAcdgc. ffifid -s ally p L I el Land ilial issued licrcaf(er are sAbd to suspension lir rcv6catioii, irtlld:site pians 'or liliclided use @iange, oi- if Llic hifornia(ion sil ' billitted ill this ap'plica (16 ill is falsified of; "Olmiged. 1, alio, ujldeiitiMdshat !t'ijn respons-Vefor all charges incill-red.fi-oill [Ills application 1, licrel5y,"i'm conscat to 'ific Atitliorize'd Rdj)'t"csdilIatiye' of the Davie c6illity Ileal(ll De ).111111clil to enter upon above dcs6-1b6d property lot: dell ill Davi 'Coilfiiy and oiyjicd 6, to conduct all testing Procedures as necessary to iletermill,c 1116 site s'liltaliflit DATE 13 TRIS AREA MAY BE USED FOR DRAWING "`YOUR SIT.I•'PLAN (Include C, all of the Wag: Existing and proposed propdrty lines and dimefislons, structures, �ctbac'lcs, and septiclocations). -7 '7 Sign given Site Revisit clial Clicuf Nolification Date; EI -is: xecoulit No. 1-71 AUG 7 2001 �.,,,�onn1MFNTAI HEALTH FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section .O. Box 848/210 Hospital Street I Mocksville, NC 27028 (336)751-8760 P!�' a�"o I **IMPORTAQIIMkwl�!!`'rHI-S ItPPLMATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED ION IS PROVIDED. \^ReJfer to the INFORMATION BULLETIN for ^instructions. t 1. Name to be Billed �((, t [.'e ccs [s /'1 l+ Contact Person /pL I C�hp4 c� Mailing Address 1,13J rarM l.✓c�+',) f Home Phone q � / � 1v r' l City/State/ZIP 1"'bJeA,S 6) ffe NC c� 7�)f Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip -c,J- y Gr, -9,6 3 fu`I cots 3. Application For: Dzite Evaluation ❑ ImprovementPermit/ATC [l Both �� ';(e.. pzme 4. System to service: ❑ House ❑ Mobile Home ❑ Business L) Industry U -tither 5. If Residence: #People # Bedrooms -3 # Bathrooms _ lybishwasher U Garbage Disposal washing Machine CI Basement/Plumbing II 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: VCounty/City ❑ Well LI Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 11 Yes "_0 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 11,q3 tAG Tax Office PIN: # 1 " $ �t- - (a? o)-9 1, 0 2 Property Address: Road Name M WU 6- City/Zip �I6L / 4- Jj I ' If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to I'ROPERTY: ?IAje brmk br')Ue 1'4k real es -144(f fie' _s �5 >11) EES -I -e d- -?e-.-- Date ?ems Date Property Flagged: aree' C OLt I�a� 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. 1, also, understand that I am responsible for all charges incurred from this application. 1, hereby, give consent to the Authorized Representative of the Qavic County Flcalt i Department to enter upon above described property located in Davie County and owned by JXJ The (- 54e r to conduct all testing procedures as necessary to determine the sites i DATE 5�-A -4 % 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). IN(.( LA4AJ 5s1( rnQP �N�Ie� Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Yg " Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT ' ' { Environmental Health Section 41 Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001288 Tax PIN/EH #: 5851-82-6728.02 Billed To: Richard Short Subdivision Info: Reference Name: Location/Address: Highway 158-27028 //�� Proposed Facility: Residence Property Size: see map Date Evaluated: " C I f 0/ Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit Public J� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy: I HORIZON II DEPTH O Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure C� Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: CJt`a�"��`�fJ 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 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) i x U0.0. tJU3 oo� 065 --= 688 POINT h . )2 "E l 00.33' _--- __ p l Y 15811.' p ��i•4/, '--_.._'z--=— . Y— _- _- POINT �� X08.,6. 62.99 ` • �� 0P� y�� 8' 16, POINT hl� , h + ��2 �Q� .791 4 43 ojo t '► �� t� 011 tK tib, te 2 g a �b 5ti� .gam• � /ji 4 03 40P X58 p 0�