138 Boxwood Church Road Lot 2Dai
2016
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WARNING: THIS IS NOT A SURVEY
All data la provided as is wlthoutwnmdy or gumardee of any kind eltherexpre rated or Implied including bul not llmked to the
Implledwarrardes M merchantability orgtness for a parNwler use. All users of Davie Count's GIS webalte :Iholdhamleu the
County of Davla, North Carolina, Im agents, consultant, contractors or employees from any and all dalms or oases of aetlon due to
oraddng out of Mouse or Inability to use Me GIS datprovided by this webalte.
�1.'
Parcel Information.
'
Parcel Number:
N60000004103
Township:
Jerusalem
NCPIN Number:
5755210270
Municipality:
Account Number:-
- 82523113
Census Tract:
37059-807
Listed Owner 1:
FLORA HERBERT III
Voting Precinct:
JERUSALEM
Mailing Address 1:
138 BOXWOOD CHURCH ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-6611
Voluntary Ag. District:
No
Legal Description:
LOT 2 CARMAN VALLEY
Fire Response District:
'JERUSALEM
Assessed Acreage:
1.00
Elementary School Zone:
COOLEEMEE
Deed Date:
7/2004
Middle School Zone:
SOUTH DAVIE .
Deed Book IPage:
005630295
Soil Types:
PcB2,PcC2
Plat Book:
0006
Flood Zone:
Plat Page:
098
Watershed Overlay:
DAVIE COUNTY
Building Value:
95570.00
Outbuilding & Extra
Freatures Value:
2150.00
Land Value:
21000.00
Total Market Value:
119720.00
Total Assessed Value:
119720.00
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Davie County,
NC
All data la provided as is wlthoutwnmdy or gumardee of any kind eltherexpre rated or Implied including bul not llmked to the
Implledwarrardes M merchantability orgtness for a parNwler use. All users of Davie Count's GIS webalte :Iholdhamleu the
County of Davla, North Carolina, Im agents, consultant, contractors or employees from any and all dalms or oases of aetlon due to
oraddng out of Mouse or Inability to use Me GIS datprovided by this webalte.
-w fir` DAVIE COUNTY HEALTH DEPARTMENT
s IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
#*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 oust 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 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal•Systems)
/J n 7dAy
NAME R AtJ�.I So C2'�1�� PROPERTY ADDRESS /�7/ YM001 C..AWre h WOE, DATE
LOCATION / 6 / -�- -
SUBDIVISION NAME �AQ Cc�.e� �1 A��Q LOT NUMBER �_ SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION. BUILDING TYRE N BEDROOMS # BATHS M OCCUPANTS _ .GARBAGE DISPOSAL: YesQ
COMMERCIAL SPECIFICATION: FACILITY TYPE ' t PEOPLE _ B PEOPLE/SHIFT 8 SEATS _ INDUSTRIAL WASTE: Yes{No'x'
LOT SIZE 7 4�, TYPE.WATER'SUPPLY
DESIGN WASTEWATER FLOW (GPD) 3 LD NEN SITE ✓ REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE. DOo'GAL:. PUMP TAN(_ GAL. TRENCH WIDTH 3 ' ROCK DEPTH IQ � LINEAR FT. OU
OTHER .. " i i
REQUIRED SITE MODIFICATIONS/CMITIONS: '
L k,
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE -INTENDED USE CHANGE. YDUR'kASTERWATER SYSTE-M-CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
,,
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d d,
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PousP-
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y.
Y IMPROVEMENT PERMIT BY
**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 A ISS(7O4) 634-876O.p n
OPERATION PERMIT SYSTEM INSTALLED BY YL �JJlsd.�
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p.
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6 U 1
-AUTHORIZATION NO. OPERATION PERMIT BY `?
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 13OA, 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 10/95
Davie County Health Department (�
� J �i'3Ntnf.T
y r * s } ENVIRONMENTAL HEALTH SECTION a. �� J
'P.O. Box 665
M,ocksvilleq N.C. 27028 `•
AUMIZATION FOR WASTEWATER SYSTEM CONSTRUCTION )
"(Issued in compliance with Article it of
G.S. Chapter 130A,,Wastewater Systems)
***This Authorization For Wastewater System Construction must he issued by the. Davie County Environmental Health Section prioWo
issuance of any Building Permits., .This Form/Authorization Number should he presented to the Davie County Building Inspections
Office when. applying for Building Permits.***
/it V G b'b DATE AUTHORIZHTIOl1NUMBER
NATE CA Ku
NAME DN IMPROVEMENT PERMIT (If different than above)
SITE LDCATIaI �,OX
COMMETTS/COIDIITIONS ON A6HRIZATION TO CONSTRUCT WASTEWATER SYSTEM r
*HNDTICE*** THIS AUTHORIZATION.FOR WASTEWATER SYSTEM CONSTRUCTION IS,VALID FORA PERIOD.OF FIVE (5) YEARS.
VIRONENTACHEALTH-SPECIALISTi`, '^;; DATE.:.
DCHD,10/95
I
1 +R APPLICATION FOR SITE EVALUATIONAMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Perm
Mailing Address
2. Name on Permit
3. Application for:
Business Phone ,5n/ �e
G1Ueneral Evaluation ❑ Septic Tank Installation Permit
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry�/� ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision L4mwe(? UA11eu Section Lot #
❑ B 6101 b'
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 Showers
7. Type of water supply: I'Public
8. Property Dimensions
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Private
Sewage Disposal Contractor
asemen um ing
❑ Basement/No Plumbing
24Nashing Machine
❑ Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes RrNo
If yes, what type?
El 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: 6761 -S
ob o�►�,
This is to certify that the Information provided is correct to the best of my
Incurred from this application.
DATE
and I understand i am responsible for all charges
CONSENT FOR 51MEVALUATION � BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (1183)
DAVIE COUNTY HEALTH DEPARTMENT'.
Environmental Health Section'
.. Soil/Site Evaluation
NA
ME a \ \7 �"` DATE EVALUATED
ADDRESS S'��� PROPERTY SIZE
PROPOSED FACIILTYLOCATION OF SITE l Gli7nC?l ALLV t;�-1-tea
Water Supply: o On -Site Well - - Commirnit Public _V '
Evaluation Bycic. Auger Boring Pi iS - Cut - -
FACTORS
1ft23
4Landsca
a osition
Sloe 1®HORIZON
I DEPTH
dlTexture
rou
C L
Consistence:
Structure
Mineralo
HORIZON II DEPTH
Texture groupt_
Consistence
7
Structure
\c
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
-
Mineralogy
HORIZON IV DEPTH ..
.Texture' gr up
;Consistence
Structure
Mineralogy
SOIL WETNESS
SS
6
RESTRICTIVE HORIZON
SAPROLITE
—
--
CLASSIFICATION
S
_S
LONG-TERM ACCEPTANCE RATE
tt-t.
SITE CLASSIFICATION: EVALUATED BY:
LONG-TERM ACCEP ANCE RATE: A OTHER(S) PRESENT: N bN
REMARKS:
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 -Finn 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
e