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411 IJames Church Road Lot 17Davie County, NC I Tax Parcel Report Wednesday, December 28, 2016 WAKNING: TITS 1S NUT A SURVEY Parcel Information Parcel Number: G3060B0017 Township: Mocksville NCPIN Number: 5820116490 Municipality: Account Number: 8304564 Census Tract: 37059-806 Listed Owner 1: MOJICA GABRIELA Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 411 (JAMES CHURCH ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: LOT 17 FOREST BROOK Fire Response District: CENTER Assessed Acreage: 0.79 Elementary School Zone WILLIAM R DAVIE Deed Date: 12/2014 Middle School Zone: NORTH DAVIE Deed Book / Page: 009760284 Soil Types: PcC2,CeB2 Plat Book: 0006 Flood Zone: Plat Page: 138 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 101 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, consultands, contractors or employees from any and ail 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. d ..�"��"'ft`Y`'•• �rfi(G�Yr ;M'?rbG"n�t"'vi"i"itV'=`i K ALf RIZA,110 v NO: Q � 3 2 DAVIE COUNTY HEALTH DEPARTMENT / . �' 4G Environmental Health Section PROPERTY INFORMATION Perm`itte s� P.O. Box 848 Name:'e9..9 r.Nil Mocksville, NC 27028 Subdivision Name: Phone #:704-634-8760 Directions to property: �� `t1�• Section: 1 Lot: r T AUTHORIZATION FOR WASTEWATER Tax Office PIN:#„- I I— SYSTEM CONSTRUCTION Road Name: \ Zip: **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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED gi,rb ..� � r.�,�,,.<4u a�,�k �"� r �� y.,�e'Y`..}:yi; k. � 4., T •4 - � _ rf ir'y.�_._. � , lr'� l ., -. .,,i: .�. i.. ::1 :." �.J ''' o DAVIE COUNTY HEALTH DEPARTMENT' '`'� 'IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION rm s.-- Pe �fi r �. i eSubdivision Name: zs,<t z Directions to property: Section:. Lot: IMPROVEMENT PERMIT Tax Office PIN:#_ -_ Road Name:,—.-'" ° i 4.. ! Zip; **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/mstallation 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 •; *, �' i3 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 TYPES • i%# BEDROOMS ---� # BATHS �k. # OCCUPANTS _ GARBAGE DISPOSAL: Yes o COMMERCIAL SPECIFICATION: FACILITY TYPE(' # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE 15 TYPE WATER SUPPLY Jo DESIGN WASTEWATER FLOW (GPD) 30 NEWS REPAIR SITE 1 SYSTEM SPECIFICATIONS: TANK SIZl1 � GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 11 LINEAR Fr. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: S IMPROVEMENT PERMIT LAYOUT ` 4 y "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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLID1 AUTHORIZATION NO. OPERATION PERMIT BY: �,e�, DAT&' --� "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) APPLICATION FOR SITE EVALUATIONAMPROVEMENT P Davie County Health Department v i Environmental Health Section D P.O. Box 848 MAR 1 91997 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED—INFORMATION IS PROVIDED. 1. Name to be Billed �/`�/� / �!�`/i /Y`' Contact Person Mailing Address 'i�� /�� I % 7X' xtl e`5 Home Phone City/State/Zip �✓�sro'� .S /il A!C..PI'714 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Fite Evaluation 'A Improvement Permit & ATC 4. System to Serve: [ ] House Mobile Home / [ ] Business [ ] Industry [ ] Other 5. If Residence: # People_ # Bedrooms --'7 # Bathrooms .9- [`Dishwasher [ ] Garbage Disposal [ilVashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers .j*Both 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 K No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE SUBMITTED WITH S APPLICATION. Property Dimensions: �D(� Xd 1 WRITE DIRECTIO S (from VIoc le) TO PROPER Tax Office PIN: # Property Address: Road Name City/Zipoc&6,1AF— N.C• I If in Subdivision provide information, as follows: Name: foe—P-5+ o ; � ( Lot #: Section: ' 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 from this application. I, hereby, give consent to the Authorized Representative of the Davi Count Health Department to enter upon above described property located in Davie County and owned by ���(i►'t- ✓, to conduct all testtiin� proced as n cessary to determine the site suitability. DATE _ �'�9 % r% SIGNATURE � <1� k-` Revised DCHD (06-96) THIS AREA MAY BE USEJ) FOR I)RtAWINC� YOUR SITE PLAN: • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS �P Davie County Health Department ;! i Environmental Health Section P. i WV 17 O. Box 665 Mocksville, NC 27028 J Y� 1. Application/Permit Requested By - Mailing Address Nall O C.l C Home Phone `t f�.�, rl �-� Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: V1 General Evaluation 4. System to Serve: \,O House ❑ Mobile Home ❑ Business '❑Industry oR° ❑ Oth r 5. If house, mobile home: Subdivision go 4 ❑ Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section _. Lot # ❑ Basement/Plumbing t No. of People ___ ❑ Basement/No Plumbing No. of Commodes No. of Bedrooms ❑Washing Machine No. of Water Coolers No. of Bathrooms ❑ Dishwasher I. Dwelling Dimensions ❑ Garbage Disposal -Sewage Disposal Contractor 6. It business, industry, place of public assembly, other: Specify type No. of People.Served No. of Sinks _ No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ll� Public ❑ Private 8. Property Dimensions -Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If vae what IJna7 ❑ No '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: IV Of t C_\ \.k p e C1 0 c en 7- r Li�iiz G�YK2.d� w"wyv d�CcG( - Lt fYtlP�.ti This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible [or all charges I urred from this application. DATE lJ SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE D�ESC�RIBEI) E OPE TY MUST CHECK ONE: ❑ 1. 1 OWN the property. LSI 2. 1 DO NQT OWN the property. If you checked Box #2, the rest of this form MQ5-C be completed by the owner or a person authorized by the owner: 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site' suitability for a ground absorption sewage treatment and disposal system. DATE G'E � y DCI10 (12.90) r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �6t ' Soil/Site Evaluation NAME V). e DATE EVALUATED ADDRESS S\ PROPERTY SIZE , 'G 3 PROPOSED FACIILTY `� 9 LOCATION OF SITEn %a Water Supply: On -Site Well _ Comvty Public 'r Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S S Sloe R •1 -6 HORIZON I DEPTH Z1' r Texture groupRL L Consistence Structure C C Mineralogyi' HORIZON II DEPTH " b`' Texture groupe. C Consistence 771 Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS RESTRICTIVE HORIZON — -- SAPROLITE — -- CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM REMARKS: DCHD(01-901 NCE RA 0 EVALUATED BY: \ 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 ;lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Vl--ry 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 3C -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 ■...��111.■■■■...■.■....■.................... .......■........MENEM iii=�i'�'=MEN mommom No on IN M MEMEMEMEEMM MEN ■......■...■..■■............■... ■■■■...■ M MEN iiiiiiiiiiiiiiiiiiiii'.'■�iiiiiiiiiiiiii'iiiiiiii 'iNo MEi'iiiii'i'� ........N■MMD■■■M■M■■D..MOM.■....MMMDE■■MMMHE . 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