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141 Fernhaven Lane Lot 5Davie County, NC Tax Parcel Report Wednesday. December 28. 2016 WARNING: 1711515 NOT A SURVEY Parcel Information Parcel Number: E60000002405 Township: Farmington NCPIN Number: 5851825787 Municipality: Account Number: 82525028 Census Tract: 37059-803 Listed Owner 1: KENDALL JOANNE E Voting Precinct: SMITH GROVE Mailing Address 1: 141 FERNHAVEN LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -AR -20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-7862 Voluntary Ag. District: No Legal Description: LOT 5 RICHARD SHORT PROP Fire Response District: SMITH GROVE Assessed Acreage: 1.24 Elementary School Zone: PINEBROOK Deed Date: 8/2005 Middle School Zone: NORTH DAVIE Deed Book / Page: 006220227 Soil Types: MSC Plat Book: 0008 Flood Zone: Plat Page: 140 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: E01 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 orMness 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 oremployees from anyandagdaimsorcausesofactiondueto l� �T C or arising out of the use or Inability to use the GIS data provided by this websRa Account #: 990001211 Billed To: Randy Grubb Reference Name: ATC Number: 3944 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5851-82-6728.05 Subdivision Info: Fam.Div R. Short Lot # 5 Location/Address: Fernhaven Dr -27028 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Trea t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS UC ON IS V ID FOR PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa .Date: 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. Septic System Installed I Environmental Health Specialist's Signature : 1q6// Date: DCHD 05/99 (Revised) ,v' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001211 Tax PIN/EH #: 5851-82-6728.05 Billed To: Randy Grubb Subdivision Info: Fam.Div R. Short Lot # 5 Reference Name: Location/Address: Fernhaven Dr -27028 Proposed Facility Residence Property Size: see map ATC Number: 3944 **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 rFJI #People L4 #Bedrooms #Baths 2 5 Dishwasher: Garbage Disposal: ❑ Washing Machine: IV' Basement w/Plumbing: Basement/No Plumbing: 19"' Y46OAi-- AA.-I-Yi Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size 414 A, 2L Type Water Supply &ww Design Wastewater Flow (GPD) Z60 Site: New e Repair 0 System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width 2, Rock Depth tJ A Linear Ft. �� Other:.'S 17iST�1(�yTo� Y�� WNtVATIJ% % b,)ATTIM � 55U, Required Site Modifications/Conditions: 10STQiL O� lc' ow k& 13,36; pct �l'S� &F -r AOCL 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.**** In i —W 0-jTQAO02 c w lAcr f-th S c9laGlr-v PQ+o2 -Tz� �t..l..�t,.s� 1.�6Qs� "ka PAI� =1 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) I Id M►lr, l0' 1 � . rn1.4•tn Date: S '80 P6 '03 "E 108 16' 106. 16) • 8t 1066Cd y Cd 76 . % 00 1 �i 1 v f c / R-5 s' s 3 �: �' � / q.?•s � a34 ��� e� x�� 3� r��, � ice" '� z� � ;:+ ? Y rr' ➢F"4 3" rc i 1-�4 M 5+ M 1GE 5 F Al f `1R t REDAR SET M 4� 5/8' RE'8AR SFT N 84 °42'32 "W 431.171 k APPLICATION 17011 SITE- [VALUATION/Ih1PIi0VUIENT 1'L'I111111T & A' Davie County Health Department b7Yir0a11Jenta/11ea/tIl Section P.O. Box 848/210 Hospital Street: Nockaville, NC 27028 (336)751-8760 97) -3 P-Eca !�L C 20 c�.0� E10 NVIRONP,IPJT AL HEALTH OAVIE (;OUNTY I I ***X,%jPORTANT*** THIS APPLICATION CANNOT 131± PROCI;SSZD L114LESS ALL THE REQUIRED INFORMATION IS PROVIDED.Refer to the INFORMATION BULLETIN for inr,L•rucLionn. !I -17 i _ _ . n i .1. Name to be Dilled Contact Person I LMailing Address I �O /fit., { f -� C- home Phone �0 City/State/2IP //!l� �!?_S✓) //� ly.(C li7Q `�� Dusinc ss Phone � �' _ O ,1 .....—� ...._... 2. Name on Permit/ATC if Different than Above L?q6- b- l((J"� 2 i.`„e Mailing Address City/State/ziP _� __...._.._.._.._._ 3. Application For: 13Site Evaluation ❑ Improvement PenniL/ATC ❑ 1soLh 4. System to Service: 4ous e ❑ Molxile Home ❑ Businets ❑ Industry. ❑ Other 5. Type system requested: P(/Conventional ❑ conventional modified ❑ innovative G. If Residence: 11 People 11 Bedrooms 3 II BaL•llroaluS (Dishwasher ❑Garbage Disposal Washing Machine ❑Basement/Plumbing as'e(fienL/r�o I''lumbing 7. If Dusiness/Induptry /Other: verify type 11 People_ # sinks _ # Commodes` 11 Showers tl Urinals 11 Water' Cooleru IF FOODSERVICE:. #1 Seats Estimated Water Usage (gallons per day) 8. Type of. water supply: County/City ❑ Well ❑ Community .9. Do you anticipate additions or expansions Of the facility this systein i5 intended to serve? ❑ Yes ❑ No if yes, what type?. ***IMPORTANT* CLIENTS XUSTCOAl1'LGTZTHE 2GQUIRL••DPRO 1'LR'1'YINFORMATIONREQ 111.S'I'!s1) BELO1V. Either a PLAT orSITE PLAN t1fUSTBCSUBt11ITTZD by the client iyilli'1'111S APl'L1CA'1'ION. P.roperty Dinicasions: e'a rpp/ ' WRITE DIRECTIONS ([roto Mucksville) lu l'ltUl'l;lt'1'Y: 1'ax office PIN: #1 Property Address: Road Nalnc City/Zip If in a Subdivision provide. information, as follows: Nanic: ll�•� J (j , Section: Block: Lot: ^�_ Date lloluc corners flagged: � Z� This is to certify that Elie hiforniation provided is correct to the best of Iny knowledge. I understand that any pernih(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if the ilifornialiou subinilted in this application is falsified or changed. I, also, anderstaad that 1 ant responsible fur all ckages hicurreft. •hunt this application. I, hereby, give consent to the Authorized Representative of the Davie County Ilealtll Dep;11•t11iclll to enter upon above described property located in Davie. County and on•ned by to conduct all testing procedures as necessary to determine Elie site suitab' ' y. DATE — IGNATURE D TI11S AREA MAY BE US7ss W PLAN (Include all of Elie followhig: Existing and proposed property lines and dimensd ptic locations). 1P Site Revisit Charge Datc(s): . 6- Client Notilicalioll D, q0EIIS: Sign given Account No. Revised DC11D (05/03 Invoice No. I -�2 ig m N 00006'34"E `� Cb 0 -A 1:011 SIH L7WILUATION%141PHOVOIEW VOMIT& Nl*c' bavie County Health Department ; b7yirowinenta/Hea/i/i Section j . ' BOX.648/210 Iio,pital Street✓ r MockOvil :ae, k . 27028 (336) 151-67 GO ** TAiJT*** TIiIS APPtkAkON CANNdTr DL PROCI;S9ED UUL9S ALL TIIE REQUIRED t IIIFORMATIO14 IS, PROVIDED. Rei or to Lho'• 1NFdRMATION IIULL1;1jxN for in:,trucLiori:l: 1. Name to be Dilled ,' Contract P, Aon C 1!L 1 -failing Addredd 130 E ed: llomc 11liohel��f.. City/state/zlP Q, G O(%�D 9 Dunincaa Pkclixe � fJ - 7 �._ (•!, 2. flame on Permit/ATC if Different Shari Above a Hailing Address z_ Cty/State/Zip--.._......._._.._._ _ 3: Application Fof: ❑ Site Evhludtion 1�Iinpr6yement 116rinit/ATC . EJ I1ot11 4: Syetem to'serviceS.. VHouDe' U 12obile Home ❑ DusaileDD C) ndusLi-y ❑ Ol.lrcr 5 Type system requested: !!d Convcn tonal ❑ cohvahtional modified '❑ innovative r� Residence: I1 People �•,!__ II i3cdl.06mn �,;J .', II Isal:llroolu:.: l:7Disliwadher l�Gaibage DisposA , Kwashing Machirio LJBadament/P1uinliing ❑aa�emenl/llo Plumbing 7. it Dudiness/Indudtry /other: verify hype Il )'coplil 11 Sint, 1, Commode's' 0 shdkers UrinaliJ 11 WaL•cr Coolcry 1� FOODSERVICEIt Seats )rt3tihlated wAer USac 6 (gallono par day) 1 8 Type of water supply: lk County/CAY b Well ❑ Conniunitry S. Do' you anticipate additions or eba11S1011s of we facility (1115 si'sidiii i5 intended to serve? ❑��eJ QIK11111 1f yes, w 11at type? ***I11IPORTAiYY*"** CL1ENTshiuSTacohll'LL•'TE•rI.' It�iQUllfvb 1'l101'L111Y' 1Nl�O11114A'1'lON REQUE-S1'l,l) 13noly- L'ilhcha hLA'I' or SITE 11LAN �IIUSTBESUlIhIlTTCD by 'the tlicnt iulh.`l'I11S r1l'1'l,1Gl'1'ION. Ilropcl t}' lli111CriS10I1S: � ` will r1 17 1ZGL'Crloiy (Grua, (1•lucksville) to 1'1tON:1t•1'1': it.ts blticc PIN: !� = / • -Z ,_�o7�-g } �J >� K1111Il�r..-c_ ` s . Property Address: Rbatf Naine City/Zip Iflii a Subdivision provitlt: illfornlation, is follows: > 4 ; x Nanlo a s. Section: blocic: Lot: batt Ilolli,fc sorosis P:ibecd:� This is to certify that ilia ll&rnlation provided ii correct to tlh1c. best of lily lEllbtivlcdbe I tiiidcrs[atid tli:l[ ally pet lull(,) issucil 1lcrcafter are subjcct•to suspension oi'rcvocation, if the siteplalis or'fil Gilded use: (fillings, or if nic infornwaon subitiitteid ill this application is falsified or 6liauj iil. 4 also, itiid&straid djai l tan respell iGle jur all chaiges incill•red from 1liisulplicatiun. I, hcrcb}, 6llatiit Cg[1'I I1c:11111 Dep:u•tuiCai to enter upon above described property locillcd lin Davie Couniy`and owficil b), to cuilduct all testing proccilures as necessa `y to tleternline tlie: slte sultaliilit, DA I f✓, SIGNATU;ZE �'Lt THIS AREA MAYBE USLI) I+OR DRAWING YOUR SITE PLAI4 (Incl`udc nil of the 1� � ving: Existing and proposed property lines and dimensloiis, structures, s8(6ea lts, and septic locations). Site Revisit Ch:u gc 1. Date(s')E 3i Client Notification Date: E JS Sign given Account No. Revised 1�C:N1) (AVII tf ~ a " CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC DDavie County Health Department 2001 Environmental Health Section �uG P.O. Box 848/210 Hospital Street A Mocksville, NC 27028 (D ENVIRONMFNIA�N��TH (336) 751-8760 110 *** ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed /` t,d,-'J &6r+ Contact Person Mailing Address 135 Farm,✓_ �L'� Home Phone City/State/ZIP MtJe-8 ;)f(e NC. J-2h1l1/ Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ate Evaluation Improvement Permit/ATC [l Both 4. System to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry U-6ther P4L1*S. 5. If Residence: # People # Bedrooms —3 # Bathrooms (76ishwasher ' ❑ Garbage Disposal Washing Machine LI Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: aCounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes O 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 (Ac, Tax Office PIN: # 55" ' (a? �`� -E' S Property Address: Road Name / W is City/Zip / q "t � 4 V) P'Q- if in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksvillc) to PROPERTY: ?14e b raa It bi) %) -e 0 r b O -e wok red es4e,+e s )5 Ebs+e r --�-er- 14-4 Date Property Flagged: C.18a(-2 0-A L er /+yap This is to certify that the information provided is correct to the best of my knowledge. 1 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 Qavie Count -Ica! tJi Department to enter upon above described property located in Davie County and owned by N, -,Let to conduct all testing procedures as necessary to determine the site s it . DATE 3-6-61 SIGNATURE c - 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 r_l LA,&J SSt map INdt")d Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. os '- 1'_DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001288 Tax PIN/EH #: 5851-82-6728.05 Billed To: Richard Short Subdivision Info: Reference Name: Location/Address: Highwyay 158-27028 1 Proposed Facility: Residence Property Size: see map Date Evaluated: D Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring I Pit ✓ Cut MineralogyHORIZON .D III DEPTH Texture group Consistence •. Landscape position HORIZON I DEPTH Texture group Consistence OR Mal KAI =%!A FINWA117M w a2in1 i M �- Mineralogy wMEIMEM""iW����� : i►�:ll����i������ HORIZON 11 DEPTConsistence Texture group wr�►��r.���� MineralogyHORIZON III DEPTH Texture group Consistence �T=NMA- Mineralogy HORIZON IV DEPTH - • MineralogySOIL WETNESS SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA REMARKS: us EVALUATION BY: -�z,, g;(L 9L7A)e4jA'X-0 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)