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820 Pinebrook School Road Lots 3 & 4Davie County, NC Tax Parcel Report Thursday, December 29, 2016 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: WARNING: TIIIS 1S NOT A SURVEY Parcel Information E50000003305 Township: Farmington 5851067119 Municipality: County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to arising out of the use or Inability to use the GIS data provided by this website. 82530392 Census Tract: 37059-802 WHITE CATHERINE RENEE Voting Precinct: FARMINGTON 820 PINEBROOK SCHOOL ROAD Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 NC Zoning Overlay: DAVIE COUNTY QD 27028-0000 Voluntary Ag. District: No 5.523AC LOT 4 FURCHES FAR Fire Response District: FARMINGTON Land Value: Total Assessed Value: 5.52 Elementary School Zone: PINEBROOK 12/2008 Middle School Zone: NORTH DAVIE 007770544 Soil Types: MrB2,EnB 0010 Flood Zone: 032 Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Freatures Value: Total Market Value: Davie County, All data Is provided as Is without warranty or guarantee of any Idnd either a:pressed or Implied Including but not limited to the Impliedwarnrdles of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the 101 NCor County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to arising out of the use or Inability to use the GIS data provided by this website. Davie County, NC Tax Parcel Report Thursday, December 29, 2016 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: WAKIVIING: 'tills IN INU'I' A hUKVL+'Y County, Parcel Information E61 E50000003304 Township: Farmington 5851160017 Municipality: 82530392 Census Tract: 37059-802 WHITE CATHERINE RENEE Voting Precinct: FARMINGTON 820 PINEBROOK SCHOOL ROAD Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAME COUNTY R-20 NC Zoning Overlay: DAVIE COUNTY QD 27028-0000 Voluntary Ag. District: No 12.429AC LOT 3 FURCHES FA Fire Response District: FARMINGTON 12.43 Elementary School Zone: PINEBROOK 12/2008 Middle School Zone: NORTH DAVIE 007770544 Soil Types: EnB,IrB 0010 Flood Zone: 032 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: County, All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to thewarrantiesDavie Implied wanties of merchantability or Illness for a particular use. All users of Davie Coun y's GIS website shag hold harmless the E61 NC County of Davie, North Carolina, its agents, consultants, contractors or employees from anyandaltdaimsorcausesofadlondueto GIS data by or arising out of the use or inability to use the provided this website. ^- DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990005226 Tax PIN/EH #: 5841-97-7322 Lot 3 & 4 Billed To: Dienst Custom Homes Subdivision Info: Furches Farms Lot # 3 & 4 Reference Name: Location/Address: Pinebrook School Rd. -27028 Proposed Facility: Residence Property Size: 16 acres ATC Number: 4945 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. � System Type: S.T. Manufacturer Tank Date '� Tank Size, 060 Pump Tank Size &M -Edon, 4111 System Installed By: E.H. Specialist: AJ (ADate: ZI DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH �� a P.O. Box 848/210 Hospital Street ✓, Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005226 Tax P€N/EH #: 5841-97-7322 Lot 3 & 4 Billed To: Dienst Custom Homes ` Subdivision Info: Furches Farms Lot # 3 & 4 Reference Name: Location/Address: Pinebrook School Rd. -27028 Proposed Facility: Residence Property Size: 16 acres ATC Number: 4945 !! Site Type: F ew ❑Repair ❑Expansion (�ly **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental 2 Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems), THIS AUTHORIZATION TO 34 CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms > # Bathrooms 2► S# People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Sizee"�ES Type of Water Supply: C9ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank ' Size J� GAL. Pump Tank 1100 GAL. Trench Width ID t� Max. Trench Depth p Rock Depth [I Z t� Linear Ft. wo l Site Modifications/Conditions/Other: As stated M 15A NCAC 18A.1969(5 accepted Um� 1110Y �r!s- —e --e" Contact the Davie County Environmental Health Section for final inspection of this system between / 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. ~7 (ivtts $5' x3' t5lcwt 30� Ffa i ( l 3, ► in 4'1 PVC,P►��fio 9VVLC,V,T dyNwe vv � � �ec-� l inns a►� Con�uY �lce v Environmental Health Specialist Date: DCHD 11/06 (Revised) TRACT 5 I rr Ail PICS TIO I I I� TRACT 6 I o 1Drt sar MW PACU YIO wr � � I AU _� 2 i7'867i9' E tea. tl f3'9'w E nM 719f ,�OS7'"3S � l:137� . soc "O tl �� E _ H `—� T CT -4 d AREA = 523 ACRES � AREA NCLUD S.R. 1436 1IE Q sat a + TRACTS AREA = 12.429 ACRES A2] NCWDES S.R. 14 & RIW 86 w BRUCE PUROJUS WK 2003-B-242 BFERENCES: W PAM — 63, PC. 38 63 , m 40 63, M 41 it OW mon found to co nilly aueh Variances. l 8w! R hos bsr� R v 1 -*b -"d>n latd and uslxs 0800 or o1 X I=* 19L79 N nz v N TRACT 2 AREA = 10.733 ACRES ARIA arcu ES S.R. 1436 R/Jr M722 lo"D TRACT 1 AREA = 9.983 ACRES AREA NUUMS S.R. 1436 RIF Nap \ tohDf- ROBERT 0AYNS BOGBR 1+e D.B. 1f0 � ROBERT )FAY" BOGFR 381 x ..."' S!?... D.B. 645. Pa 777 l m L Om* L VA scow, oa r W tli ill ws droia C • -. now aw supwYkka "m sat vifw�sn srly the�•(N "^�:Q ' j(: ar+oei sir soo' w toaidorNs sot aavaw �s d�te o bowl to p :/y T ma va c "m or now CIA dowe VA -Jr ao+rd�i fele.: cep atord .q�au.., W S EAL wpWafm eaescr and Md 06-= dq of �-+� �p �,<,�L_ 52-t Q, TRACT 6 AREA = +-10.45 ACRES AREA' INCLUDES R/1I TRACT 3 AREA = +-10.17 ACRES AREA INCLUDES R/ll TRACT 2 AREA = +-10.73 ACRES AREA INCLUDES RIW TRACT i AREA = +-9.99 ACRES + AREA INCLUDES R/IP TRACT 5 AREA = +-5.92 ACRES AREA INCLUDES RJ11 ; O u O490 13 N TRACT 4 AREA = +-5.44 ACRES AREA INCLUDES RIA' TRACT 6 AREA = +-10.45 ACRES AREA' INCLUDES R/1I TRACT 3 AREA = +-10.17 ACRES AREA INCLUDES R/ll TRACT 2 AREA = +-10.73 ACRES AREA INCLUDES RIW TRACT i AREA = +-9.99 ACRES + AREA INCLUDES R/IP DAVIE COUNTY ENVIRONMENTAL HEALTH • . +' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 10� (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990005226 Tax PIN/EH #: 5841-97-7322 Lot 3 & 4 Billed To: Dienst Custom Homes Subdivision Info: Furches Farms Lot # 3 & 4 Reference Name: Location/Address: Pinebrook School Rd. -27028 Proposed Facility: Residence Property Size: 16 acres ATC Number: 4945 Site Type: 9New ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms 3 # Bathrooms Z•S # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size QcX-eS Type of Water Supply: PCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 3(DO Tank Size ItU(ii GAL. Pump Tank )1000 GAL. Trench Width 3V'/ Max. Trench Depth_3 /o„ Rock Depth 17-" Linear Ft. %p As stated in 15A NCAC 18A.1959(5� Site Modifications/Conditions/Other: accepted Systems may also be uses! Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (3361751-8760. Environmental Health S DCHD 11/06 (Revised) : 3-3-0rl Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005226 Tax PIN/EH M 5841-97-7322 Lot 3 & 4 Billed To: Dienst Custom Homes Subdivision Info: Furches Farms Lot # 3 & 4 Address: 9606 Caldwell Commons Circle Location/Address: Pinebrook School Rd. -27028 City: Cornelius Property Size: 16 acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G:S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: L(New ❑Repair ❑Expansion Permit Valid for: &Years ❑No Expiration Residential Specifications: # Bedrooms 3 # Bathrooms Z.S # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People '# Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 360 Type of Water Supply: RCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As stated in 15A NCAC 18A.1969(5j ,=� pted Systems ;ytay b'so tin toss Initial r. o. . Site Plan �- Run Power � w a-1� On iw% 5 Side 6 ►1+' dr-1vewa4( oppo'sIk of lolz�. sept=,c: C�rea�� LTAR 9 Environmental Health Specialist Date3-3-09 i.p.l l-06 E C u U APPLI'CATI6N FOR SITE EVALUATION/IMPROVE Davie County Environmental Health FEB 1 8 2009 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 ENMONMENTAL HEALTH DARE COUNTY Application For: 0, Site Evaluation/Improvement Permit AtAuthorization To Construct(ATC) ❑ Both Type of Application: )Mew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION 170 y �� (P - 5W& Name to be Billed 944s4AM lkow-S Contact Person % Billing Address %tib Ca6144W ( Circ% H`!Z Home Phone 70Y— F- ?V!(6 (e) City/State/ZIP &v^4ws L 2 31 Business Phone &cy GDrNe !ks mmQ�S Name on Permit/ATC if Different than Above Mailine Address PROPERTY INFORMATION -5AV-+ Ci *Date House/Facility Corners Flaeaed 4r-s,o9 NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid'for 60 months with site plan, no expiration with complete plat.) Owner's Name entf- "1k, Phone Number WY— Owner's Address /y/ &Ame,d w , (14-4 103 City/State/Zip mta.ace-- t(fCi Property Address City Lot Size r /13 auuS Tax PIN# Subdivision Name(if applicableL A. -^s Section/Lot# J Directions To Site: If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes 19No Does the site contain jurisdictional wetlands? ❑YesVNo Are there any easements or right-of-ways on the site? ❑Yes BNo Is the site subject to approval by another public agency? ❑Yes 1gNo Will wastewater other than domestic sewage be Qenerated? ❑Yes ANo IF RESIDENCE FILL OUT THE BOX BELOW # People _� # Bedrooms _3— # Bathrooms ,2 . S Garde Iu Whirlpool 4Yes . ❑No Basement: ❑Yes kNo Basement Plumbing: ❑Yes XNo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:, Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: X County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?)( Yes ❑ No If yes, what type? dwy— &rn. This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking ,k/ cility location, proposed well location and the location of any other amenities. Property ogn*'s or Date Sign given []Yes ❑No Revised 11/06 s legal representative signature Site Revisit Charge Date(s): Client Notification Date: EHS: Account # 5ZVO Invoice # 4J Q OqZ Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005156 Tax PIN/EH #: 5841-97-7322.3 Billed To: Ellen Furches Subdivision Info: Furches Farms Lot # 3 Address: 128 Pinebrook Drive Location/Address: Pinebrook School Rd. -27208 City: Mocksville Property Size: 10.17 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion[ Permit Valid for: K5Years ❑No Expiration Residential Specifications: # Bedrooms ! # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) . Design Flow(GPD):1164, f Type of Water Supply: aunty/City ❑Well ❑Community Well As stated in 151 NCAC 13A.1969(5) Site Modifications/Permit Conditions: pecented S'ystcrns may also be u.)' .ai Site Plan System Type LTAR Initial cc ecl f ? 5 Repair 0 1-�*� O / ? '- 4., fAreq 54 40, Environmental Health Specialist i.p.11-06 Date APPLIeATION FOR SITE EVALUATION/IMPROVEMENCoo Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786408 Application For: �. Site Evaluation/Improvement Permit ❑ Authorization To Construct� Type of Application: kNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facilit ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION "r Rv6uf 9--a- Ft, Name to be Billed i 1,14 V Contact Person YN 64 4 Billing Address Home Phone � �/" - r City/State/ZIP /'% 42t' j j Z,r /`,C 9 7 ;1 Business Phone Name on Pemiit/ATC if Different than Above Mailing Address City/State/Zip YKUYhK 1 Y 1N P UKIWA 11UN TDate House/lactitty Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Pen -nit is•valid for 60 months with site plan, no expiration with complete plat.) Owner's Name Phone Number Owner's Address City/State/Zip Property Address ,,, _, City Lot Size Tax PIN# 55q 111"711-32 2 Subdivision Name(if applicable) , - H b1 jarfil S Section/Lot# •3 Directions To ite: S� = I') !c` J' ' d'V e cS If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes NNo Does the site contain jurisdictional wetlands? ❑Yes &No Are there any easements or right-of-ways on the site? ❑Yes KNo Is the site subject to approval by another public agency? ❑Yes SNo Will wastewater other than domestic sewage be generated? ❑Yes $No IF RESIDENCE FILL OUT THE BOX BELOW i # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: IPConventional Vccepted ❑Innovative ❑Alternative ❑Other Water Supply Type: U County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? This is to certify that the inforniation provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge `P 6perty �s or owner's legal representative signature D -- I _ 0 Date Sign given ❑Yes ❑No Revised 11/06 ate(s). Client Notification Date: EHS: Account # V Invoice # TRACT 6 AREA = 4--10.45 ACRES AREA INCLUDES RIY TRACT 3 AREA = t - f 0.17 ACRES AREA INCLUDES R/W TRACT 2 AREA = +- f 0.73 ACRES AREA INCLUDES R/A' TRACT 1 AREA - +-9.99 ACRES AREA INCLUDES R/JF q TRACT 5 AREA - +-5.92 ACRES AREA INCLUDES R/A' C � O u 33 03 O � 490 13 TRACT 4 AREA - +-5.44 ACRES AREA INCLUDES R/W TRACT 6 AREA = 4--10.45 ACRES AREA INCLUDES RIY TRACT 3 AREA = t - f 0.17 ACRES AREA INCLUDES R/W TRACT 2 AREA = +- f 0.73 ACRES AREA INCLUDES R/A' TRACT 1 AREA - +-9.99 ACRES AREA INCLUDES R/JF APPLICANT_ INFORMATION Account #: 990005156 Billed To: Ellen Furches Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5841-97-7322.03 Subdivision Info: Furches Farms Lot # 03 Location/Address: Pinebrook School Rd. -27208 Property Size: 10.17 Date Evaluated: ILLI —//,O/ On -Site Well Community _ Auger Boring Pit V Public Cut FACTORS 1 2 4 5 6 7 Y r . APPLICANT_ INFORMATION Account #: 990005156 Billed To: Ellen Furches Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5841-97-7322.03 Subdivision Info: Furches Farms Lot # 03 Location/Address: Pinebrook School Rd. -27208 Property Size: 10.17 Date Evaluated: ILLI —//,O/ On -Site Well Community _ Auger Boring Pit V Public Cut FACTORS 1 2 4 5 6 7 Landscape position Slope % HORIZON I DEPTH In Q — Texture group(, Consistence Structure Mineralogy HORIZON H DEPTH _ to Texture groupC (� Consistence —UL ° Structure Mineralogy HORIZON III DEPTH - Texture group(� L Consistence Structure Mineralogy HORIZON IV DEPTH Texture group, Consistence Structure i Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: l LONG-TERM ACCEPTANCE RATE: Q ` REMARKS: EVALUATION BY: k�o' b a,1 o Pq ---, 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 CONSISTEN . , Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3ya NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic 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 LYQtc� 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) T TAD rnrrr% Heine Davie County Environmental Health — P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005156 Billed To: Address: City: Reference Name: Ellen Furches 128 Pinebrook Drive Mocksville Tax PIN/EH #: 5841-97-7322.4 Subdivision Info: Furches Farms Lot # 4 Location/Address: Pinebrook School Rd. -27208 Property Size: 5.44 Acres Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: E New ❑Repair ❑Expansion Permit Valid for: E15 Years ONo Expiration Residential Specifications: # Bedrooms # Bathrooms • # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) i Desigrt Flow(GPD):/-/M Type of Water Supply: E1 ounty/City ❑Well ❑CommunityWell As stated in 15:; NCAC 18A.1^69(5� Site Modifications/Permit Conditions: T t„d r7...«..,_ i. —1 M .,4 System Type LTAR Initial cce-c O . a— Re air 0 Site Plan it 0 ri 4 .(J C1 Environmental Heal h Specialist Date i.p. 11-06 i { APPLICATION FOR SITE EVALUATIONAMPROVEMEN Davie County Environmental Health P.O. Box 848/210 Hospital Street AUG Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786R�NME D Al y Application For: X Site Evaluation/Improvement Permit ❑ Authorization To Construct( TC) TY Type of Application: )0qew System ❑Repair to Existing System ❑Expansion/Modification of Existing System 'lily ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION WvU r N64 CrwcL 4G -S i Name to be Billed A -4e ti' ��y, Y Contact Person ei4 q� Billing Address ,c9 i'c7C// Home Phone City/State/ZIP 1 ?t? /' ' ''� Business Phone Le V3.5— Name 3.`Name on Permit/ATC if Different than Above Mailing Address City/State/Zip rKurr,K 1 Y ENV UKNIA I IU1N --)ate Housen acinty corners rl NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is -valid for 60 months with site plan, no expiration with complete plat.) Owner's Name 4' t k, j, p ejy2� Phone Number_ Owner's Address JsU 1>-6-- City/State/Zip Property Address -4AL-i�e., City Lot Size Tax PIN# f5 q I Subdivision Name(if applicable Directions To Site: / S ' r. 4 Section/Lot#_ a 51 f,rlrfpx— AN,- If JNv If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes NNo Does the site contain jurisdictional wetlands? ❑Yes b1No Are there any easements or right-of-ways on the site? ❑Yes KNo Is the site subject to approval by another public agency? ❑Yes NNo Will wastewater other than domestic sewage be generated? ❑Yes $No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:. 5K-'onventional VAccepted ❑Innovative ❑Alternative ❑Other Water Supply Type: (County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? This is to certify that the inforniation provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and riles. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. ^'t= Site Revisit Charge ,"Pioperty o er's of owner's legal representative signature Date Date(sy Client Notification Date: EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # C TRACT 5 AREA = +-5.92 ACRES AREA INCLUDES R/Ir /❑ TRACT 4 AREA = +-5.44 ACRES AREA INCLUDES R/r TRACT 6 AREA - +-10.45 ACRES AREA INCLUDES R/Ir TRACT 3 AREA = +-10.17 ACRES AREA INCLUDES R/K TRACT 2 AREA - +-10.73 ACRES AREA INCLUDES R/1I TRACT 1 AREA = +-9.99 ACRES AREA INCLUDES RI -W. r PPLICANT INFORMATION Account #: 990005156 Billed To: Ellen Furches Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5841-97-7322.04 Subdivision Info: Furches Farms Lot # 04 Location/Address: Pinebrook School Rd. -27208 Property Size: 5.44 Acres Date Evaluated: 16-11,1-0q Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit V Cut SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: (l . 1110 .EVALUATION BY- ��.�i"e OTHER(S) PRESENT: i 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 05 M, VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3e' t 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 LYQY�S 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) TTAV T ...... re-....,..----..-- -..ro ....1/.1... 141 Tl/NTTTI /1C/AC m_•..__�� Slope lko HORIZON I DEPTH MW F01 rim 0000 FJA� PAW"M W -Mm Consistence HORIZON 11 DEPTH _ ..'��1l��i��[�lL��1 Consistence MineralogyHORIZON III DEPTH -Texture group Consistence Mineralogy HORIZON IV DEPTH Texture group Consistence SOIL WETNESS CLASSIFICATION «�� 090 «�=1111111111M�� • SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: (l . 1110 .EVALUATION BY- ��.�i"e OTHER(S) PRESENT: i 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 05 M, VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3e' t 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 LYQY�S 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) TTAV T ...... re-....,..----..-- -..ro ....1/.1... 141 Tl/NTTTI /1C/AC m_•..__�� APP�I.I�CaA�NrTI_N"dON Billed To: Ellen Furches Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Tax PIN/EH #: 5841-ORM)?R'Bt I&FIDRMATION Subdivision Info: Furches Farms Lot # 3 & 4 Location/Address: Pinebrook School Rd. -27028. Property Size: 16 acres Date Evaluated: 70Ci Auger Boring ✓ Community Pit Public -✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 'L HORIZON I DEPTH 0 -4 Texture grow Consistence f i Structure 5 K Mineralogy 5 HORIZON 11 DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence S tructure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE o 2 SITE CLASSIFICATION; PS LONG-TERM ACCEPTANCE RATE: ` 2 REMARKS: EVALUATION BY: 6V^Ah\.l &qar - 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 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 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) TTAR - T.nna_term arrentanrP rate - aal/dau/ft? 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