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453 IJames Church Road Lot 22Davie County. NC Tax Parcel Report Wednesday. December 28. 2016 WARNING: THIS 1S NOTA SURVEY Parcel Information Parcel Number: G3060B0022 Township: Mocksville NCPIN Number: 5820111473 Municipality: Account Number: 82526609 Census Tract: 37059-806 Listed Owner 1: BLUMQUIST BARRY Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 6845 VANCE ROAD Planning Jurisdiction: Davie County City: KERNERSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 272847340 Voluntary Ag. District: No Legal Description: LOT 22 FOREST BROOK Fire Response District: CENTER Assessed Acreage: 0.72 Elementary School Zone: WILLIAM R DAVIE Deed Date: 612006 Middle School Zone: NORTH DAVIE Deed Book / Page: 006670784 Soil Types: PcC2,CeB2 Plat Book: 0006 Flood Zone: Plat Page: 137 Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: 161 Davie County, NC All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless theCounty of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this webalte. rlyf 17 'a -'i AUTHORIZATION NO. 1067sDAVIE COUNTY HEALTH DEPARTMENT Environmental Environmental Health Section PROPERTY INFORMATION Pen tee's. P.O. Box 848 Name: 031 GMoeksville, NC 27028 Subdivision Name: obpeS [ y-ok Phone #: 704-634-8760 r 1 Directions to property: /aw N _ Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:a>b - SYSTEM CONSTRUCTION.. -� CT Road Name�'�r� '� ZipMD—)l **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 r.<e, a •+ _: v ?�" •Y�" -y .. Nw. i , p.o;A- ..,.. 0 6 7DAME COUNTY HEALTH DEPARTMENT � `e's�• .,�, r I� PROPERTY INFORMATION IMPROVEMENT AND OPERATION PERMITS � Permit e ' . Name: ec�lt_:c� "+� °.-4``w' Subdivision Name:0 Directions to property: ' ` ii`J �f . Section: T Lot: r ' IMPROVEMENT PERMIT Tax Office PIN:k! r _ I i _ -s, Road Namea. 4: k 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/installation of a system or the issuance of a building permit. (Incompliance 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 M. NN # BEDROOMS_ # BATHS 2 # OCCUPANTS GARBAGE DISPOSAL:, Yes o o . COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No i z LOT SIZE y L TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE FEPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE Q 0 GAL. PUMP TANK GAL. TRENCH WIDTH _3 ROCK DEPTH LINEAR FT. OTHER 1 > _ C I REQUIRED SITE MODIFICAIONS/CONDITIONS: N— e't IMPROVEMENT PERMIT LAYOUT O A, AL **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1;0'0 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. a OPERATION PERMIT` ,p SYSTEM INSTALLED BY:to (0 G r � Z AUTHORIZATION NO. b 6-1 OPERATION PERM Y: �^'�" 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) APPL'ICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC ****IMPORTANT**** - i Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 THIS APPLICATION CANNOT BE PROCESS'L+'Hl THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Contact Person Mailing Address � � 1. Home Phone (0' ,n,, City/State/Zip 1 � ICC' N (IQ. 1)C 9�0� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3: Application For: ] Site Evaluatiop City/State/Zip [y&provement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ Mobile Home [ ] Business [ ] Industry 5. If Residence: # People --.5— Bedrooms # Bathrooms_ [/Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing [ ] Other [td/Dishwasher [ ] Garbage Disposal 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ;County/City Well [ l Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [tilNo If yes, what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT ***T OF THE PROPERTY MUST BE 4 n SUBMITTED WITH THIS APPLICATION. Property Dimensions: d b `i- 3 U f r WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # Sg� O -1 - 1493 ;��O N - �,\ a�� --� A Property Address: Road Mame �n-,e5 CII.(rd' Rd •— City/Zip 010CIT-3ual e (1c, ��►� a� ; If in Subdivision provide information, as follows: Name: Fnr-QSM 5rok ' Section: Lot#: 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 Davie County Health Department to enter upon above described property located in Davie County and owned by DATE Revised DCHD (06-96) to conduct all testing procedures as necessary to determine the site suitability. THIS AREA MAY BE USED FOR DRAIVINC YOUR S ' F R APPLICATION FOR SITE EVALUATION/IMPROVEMENTS �►�� Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested B^yr - e V,\),\ k tt ► Mailing Address C�, ► Y OL V Cd 6 rn U C. S U t ( C Home Phone `1 �l. o �'� Business Phone �. 2. Name on Permit if Different than Above _. 3. Application/Permit for: Ili General Evaluation 4. System to Serve: I House I-] Mobile Home f \ c, R est' ❑ Business ❑Indust ❑ Oth r 5. If house, mobile home: Subdivision __Rog No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 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 ❑ Septic Tank Installatie ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing. ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal No. of Showers Water Usage Figures 7. Type of water supply: M 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 vaa what Ivna? ❑ No ❑ Community '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: (41 (\' t IV - j Ci i �C_ cc -r16i IC: e C� C> c cl .t c- J- �4N 0. This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges I urred from this application. `%4Zt— _" rpt-ul L DATE e1SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE PESCR�IBE pR, OPERTY Land ECK ONE: ❑ 1. I OWN the property. CEJ 2. 1 DO NOT OWN the property. cked Box y/2, the rest of this form jVIUST be completed by the owner or a person authorized by the owner: ive consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by �� . �� tV._ ?` r) r- 1 t all testing procedures as necessary to determine said site' suitability for a ground absorption sewage treatment al system. ATE SiONATURE y DOID (12.90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 5 - '�) ADDRESS '` 9. PROPOSED FACIILTY Water Supply: Evaluation By: \A ave On -Site Well Auger Boring DATE EVALUATED N- a,$' 1 I E PROPERTY SIZE Oy )( '6�"� LOCATION OF SITENZ Community Pit I/ Public Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH �' 2 Texture grOu2 C L C L Consistence T Structure C Mineralogy ',1 HORIZON II DEPTH (o" Texture groupC C Consistence FT F Z Structure Mineralogy1'1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON — — SAPROLITE — CLASSIFICATION LONG-TERM ACCEPTANCE RATE o SITE CLASSIFICATION: _ I C J I EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: -% REMARKS: 1',\ 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---y 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 DCHD (01-901 ■■■■■■■■■■■■■■■■Ill%ar1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Room■■■ ■■■■■■■■■■■■■RMr%�lY[��■■■■■■■■■■■ ■■■■■mM■MMM■E■■M■MM■E■■■E■■■■■■■ ■■■■■■■■■■■■■■II■■■■■■►■■■■■■■■■■■■■■■■■■■■■■ ■■■■■o■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■m■■■■AG■■\\■■oEM■■M■■■EMM■■mEE■■■■■■m■■EEEEE■■mmm■REm■ ■■■■■■■■■■■■■\■t�►�■■■Ii■■■■■■■■■■M■MM■M■MM■ MESE■M■■ ■■■■■E■OM■■■■ ■■mm■■■MM■■M■EM►�■E��IR■■m■■M■a■ ■a■mMMOMm■mEEEmm■ MERE■■EMR■■E■■ ■■■■Emm■■■■mm■■■■■i■mEEEmmm■EE■■ ■■■■■■■■■■/■■ ■■■ ■■■■■■■■■■■■■■ ■■■m■■■■■E■E■■■■■■■■■■■■■■■ ■■■■■■■■■■■■M■■EM■M ■mom ■mE■■■■■■■■■■ ■■■■EEmmmEE■■Em■■EEEmmmEE�l■■■mI�M■m■mmEM■■ EE■ ■ ■ ■■■ EEE■■■ ■■ ONE m MEN moommmom ME ■■■■■■mM■M■■■■EMM■■M■■M■■�,Ma■■11 EEMME■EH■EmmmEEE■■■■■EREE■■■mE■ Ciiii IMMEMMEMMINUCCC�C CiiiiiiiiiiiiCEiiiiiiiiiiiiiiiiiiiiiimiiim�CCCC■i■CuiiiCC■iiiC MOON IN MMMEMMCuiCno ui■ommol CCmi■CCCC ■■■■■■■■■■M■MRmM■■■E■HI/■ml.■■M■■■■■Ea■MMM■E■EE mMEM�m■■EMM■ER■o ......................■�..►,..................... ■o ME■I■M■M■EN ommosommo CCCCCiiiiiiiiiiiiiiiiiiCmiJCCC■iCmiiiiiiiiCCCCCC■■CC ■CCC■.M EMEMMMO .....................N1..7M■■■■�o■EmNEEEHNNNE■M■EEC■MEM■■■■ ■■HMR■■EEEE■■MmEM■mM■EREEI■■■■■■ MMEMHE■■■■m ■■ME Mm ■EM■■EM■ ■CCCC:CCCCCC:C:CCCC:CC:'9JCC:CCC CCCC"mo momm OMEN CCCCCCCC�■ MEMEMMEMMOMMEMEME smoi ommolmlliiC�CCim CCCC 1 CCE =CCC: ■EEa■mEEmmmEEEE■■■mEm■Em■EEEIIImmE■■■ m N nEE ■■■■■■■E■C �EM■MMm ■/aMMM ■m■mm■ EEEEmm ■■■■ ■■■■■ mom R■■E■■ . ■■ CCCCC■■N%CCC■.ICCCCCC ��CCCC■■CCCC ■ C mom mommom ■■■MEMMM■■EENEM■.Imo■■Rom■■■ImmNo MEN 0 MEMMEMM o■■■ ME ■m ■■■■■■M■ CCCCCCCCCCCCCiCEEC�'CCCCCCppCCCCCCC�� 1 /■C ■ ME SEMEN so SOMEONE EN=MmmmmmmmCCm■mosomm` . on MENEM .........�.. mlrii.lo.... ■MMOMMIMMOE ■■m ■■N■ Mm mom smsmol ■■■■MEMO■ E ■EMME■ MEMO CCCCCCCCCCCIISEEMEN■OMMINNOMMMMEMEN ■ ■■m�■CCCCC ■MENSOMENOMEN E■■■■■HOME■II MNAMM IMMMMMMMII u�■m::u : MEMEME. �..CC...... 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