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1544 Boxwood Church Road Lot 3Dai ?016 9 Vr,, til data Is provided as Iswithoutwarramyorwarent.0any ldndelmerexpressed orImplied mdudinybu<not IT d.1 the Davie County, Implied wemamiesofmerchantability orithressfor aparnmlaruse. All users ofDadeCounty's GIS webeneaht1hddhamleesthe Coumy of Dante, North Carolina, Ila ageritn, eonwlbma, rnnfredon or employees (mm any and err daima oration M actlw due to �GUN'� NC wadslnpauto? the use or Inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel.Information - Parcel Number: N60000604110 Township: Jerusalem NCPIN Number: 5755211070 Municipality: Account Number: 82528937 - Census Tract: 37059-807 Listed Owner 1: DYSON MARTY ALLEN JR Voting Precinct JERUSALEM Mailing Address 1: 154 BOXWOOD CHURCH ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: - Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 3 CARMEN VALLEY Fire Response District: JERUSALEM Assessed Acreage: 1.01 Elementary School Zone: COOLEEMEE Deed Date: 11/2007 Middle School Zone: SOUTH DAVIE Deed Book / Page: 007360785 Soil Types: PcB2,PcC2 Plat Book: 0006 Flood Zone: Plat Page: 098 Watershed Overlay: DAVIE COUNTY Building Value: 101770.00 Outbuilding &Extra Freatu►es Value: 3530.00 Land Value: 21000.00 Total Market Value: 126300.00 Total Assessed Value: 126300.00 9 Vr,, til data Is provided as Iswithoutwarramyorwarent.0any ldndelmerexpressed orImplied mdudinybu<not IT d.1 the Davie County, Implied wemamiesofmerchantability orithressfor aparnmlaruse. All users ofDadeCounty's GIS webeneaht1hddhamleesthe Coumy of Dante, North Carolina, Ila ageritn, eonwlbma, rnnfredon or employees (mm any and err daima oration M actlw due to �GUN'� NC wadslnpauto? the use or Inability to use the GIS data provided by this website. t�xa •" DAVIE COUNTY HEALTH DEPARTMENT 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 must he 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) =is LOCATION SUBDIVISION NAME PROPERTY ADDRESS DX7-!%/ID DTE � LOT NUMBER �If SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE OI BEDROOMS t M BATHS o2 M OCCUPANTS _ GARBAGE DISPOSAL: Yes/ COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE _ M PEOPLE/SHIFT _ R SEATS _ INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY o DESIGN WASTEWATER FLOW.iGPD) 3(a NEW SITE &,-REPAIR -SITE _ SYSTEM SPECIFICATIONS: TANK SIZE eLE 6AL. PUMP TANK _ GAL. TRENCH WIDTH ROCK DEPTH 'LINEAR FT, 749 OTHER REQUIRED SITE MODIFICATIONS/CDNDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. i F 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:W-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE 8 IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY IR A`1J QV 1 s 1"1 I e 2 AUTHORIZATION NO. d 33P OPERATION PERMIT BY �. �w7J�A DATE 3 **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 SHALT. 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 r�O ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 AUMIZATIOW'FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System l;dostruction must be issued t�fthe 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 whe applying for Building Permits.*** / RIIMIZATION NLIMBER �/ ��w �,/ DATE s/��. N2 0330 - NAME ' NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT #� Davie County Health Department Environmental Health Section P. O. Box 665 Mocksvilyrle, NC 27028 1. Application/Permit Requested By1 Mailing Address nn/�30 Kin 1 �.i9fnnL E//��, Home Phone &yg/ kst/iVe- /yZ Business Phone e- 2. 2. Name on Permit if Different than Above 3. Applloation for. lasneral Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: 96HOuse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown S. If house, mobile home: Subdivision /rijr9yiFl? 4AI�eI/ Section Lot # No. of People No. of Bedrooms No. of Bathrooms 04 Dwelling Dimensions 6. If business, Industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories . ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: If'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 yes, what type? eNo ❑ 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: This is to certify that the Information provided Is correct to the best of my Uz/oxw� dge, and I understand I am responsible for all charges incurred from this application. G DATE `SIGNA URE CONSENT FOR SITE EVALUATION !Q aE DONE 4N ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I 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 (1193) ,•- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation, NAME C\3\'S�J DATE EVALUATEDI "1Z g ti ADDRESS S Q vie PROPERTY SIZE PROPOSED FACIILTyr LOCATION OF SITE Water Supply:On-Site Well Community✓ - - Public - Evaluation'ByZ`�j1 Auger Boring - Pit$ ✓ - Cut - FACTORS 1 2 3 4 Landscape position Slope R 5° -` 5 HORIZON I DEPTH " t, Texture group CL Consistence XFa Structure C Mineralogy1`el A HORIZON'II DEPTH 3 b° Texture groupC. C Consistence Structure Mineralogy)' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON — — SAPROLITE CLASSIFICATION Q S LONG-TERM ACCEPTANCE RATE 1J1 y SITE CLASSIFICATION: �� EVALUATED BY: 01� 9 LANG -TERM ACCEPTANCE RATE: \ L OTHER(S) PRESENT: 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 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(01-90)