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1126 Williams Road Lot 1Dav 016 04 All data is provided as b vMhoutwamtdy or guarnde, of any kind etther expressed or Implied Including but not limited to Me Davie County] Impliedrmmdle,ofinechantabgityorMnasafor,apaNwWrusa,AllusersofDavieComdysGISmbstteshallholdharmlessthe County of Daft North Carolina, its agents, cunwgatris, cotdradont oremployeea from any and all ddms orcauses d action due to °oh 2 NC or arising out of Meuse or Inability to use Me GIS data provided by this vnebdte. - WARNING: THIS IS NOT A SURVEY Parcel Number. 170000004314 Township: Fulton NCPIN Number: 5778164620 Municipality: Account Number: - 82515627 Census Tract: 37059-804 Listed Owner 1: SHULTZ JAMES PAUL Voting Precinct: FULTON Mailing Address 1: 1126 WILLIAMS ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-7133 Voluntary Ag. District No Legal Description: LOT 1 CARTERS COURT Fire Response District: FORK Assessed Acreage: 0.93 Elementary School Zone: CORNATZER Deed Date: 9/2000 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 003460928 Soil Types: WeC,PcB2 Plat Book: 0007 Flood Zone: Plat Page: 086 Watershed Overlay: DAVIE COUNTY Building Value: 99300.00 Outbuildi Va uextre FreaturesLand 0.00 Value: 17500.00 Total Market Value: 116800.00 Total Assessed Value: 116800.00 04 All data is provided as b vMhoutwamtdy or guarnde, of any kind etther expressed or Implied Including but not limited to Me Davie County] Impliedrmmdle,ofinechantabgityorMnasafor,apaNwWrusa,AllusersofDavieComdysGISmbstteshallholdharmlessthe County of Daft North Carolina, its agents, cunwgatris, cotdradont oremployeea from any and all ddms orcauses d action due to °oh 2 NC or arising out of Meuse or Inability to use Me GIS data provided by this vnebdte. - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001404 Billed To: James & Betty Shultz Reference Name: Proposed Facility: Residence P�7^a(o-U o Tax PIN/EH #: 5778-16-4620 Subdivision Info: Carters Court Phase I Lot # 1 Location/Address: Williams Road -27006 Property Size: see map ATC Number: 2566 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type � #People #Bedrooms #Baths :— Dishwasher: fi!r Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People_ #People/Shift #Seats Industrial Waste: ❑ Lot Size 9A e, Type Water Supply(0777 Design Wastewater Flow (GPD) sl�6d Site: New 91Repair ❑ i System Specifications: Tank SkVjW GAL. Pump Tank GAL. Trench Width 36 `Rock Depth 9 Linear Ft.M Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 - BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990001404 Billed To: James & Betty Shultz Reference Name: r1uNuacu FOWIl Ly. RWbIYCIJ J ATC Number: 2566 P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5778-16.1620 Subdivision Info: Carters Court Phase I Lot # 1 Location/Address: Williams Road -27006 alze: see AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ital Health Specialist's Signature: 4W4 Date: 6%'/y CERTIFICATE OF COMPLETION The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. D r Septic System Installed By: ,1.,L�,/(A0 Health Specialist's Signature: �iLvG�Y/ Date: /1R `,-7 DCHD 05/99 (Revised) 2 APPLICATION FOR SttE EVALUATION/IMPROVEMENT pERMR & Davie County Health Department Envitmmenfa/Health SMUM7 P.O. Box 848/210 Hospital,8treet Mockaville, NC 27028 (336)751-8760 IZContaot person. Mailing addressp(d1 S. -K Q 1C '60nsome Phone 7/n/0 501 City/stat./LIP 1.1)" s ( %)S�l�-� Pt� 22>2 /61. SaePhone I 5-P -335 O Name on Permit/ATC it Different than Mailing Address City/state/xip 3. Application For: ❑ Site Evaluation �i BImprovement Permit/ATC ❑ Both e• system to service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other /� s. If Residence: # People ��, _ , / Bedrooms # Bathrooms of J Dishwasher El Garbage Disposal I weshr.ng Machine ❑ sesesent/Pl,mbing ❑ Basement/No Plvabing S. If Business/Industry/Others Specify type # Pele oP # Birks # Commodes Showers # Urinals # Yater Coolers IF FOODSERVICE: # Seats Eatimated Water Usage (gallons per day) 7. Type Of water supply: Ui.County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑yes yo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESVBMITPED by the client with THIS APPLICATION Property Dimensions: -.sev_ l m Q / Tax Office PIN: Property Address: Road Name w % \ ,x. s City/Zip 42!� V/ An a Supe vision provide information, as follows: - i I oL Name: Section: Block• Date Pr l Lot: openly Flagged: �/0 O 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 1, also, understand that 1 ant rrsponsJble for all charges inc arrcd from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departmeat to enter upon above described property located in Davie County and awned by to conduct all testing procedures as necessary to determine the site suitability. Q DATE `? - I I ` iY) SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). WRITE DIRECTIONS (from MockAville) to PROPERTY: Site Revisit Charge Client Notification Date: EHS: Account No. Revised DCHD (07/99)0✓ Invoice No. JJ i A PNAL{°a�E� Y/�At' i A.4 TRaL � 9 � X��3.a�o °o � �trEtP 5 O�oy q8 0 ti N�F ° JEFFREV W. ° AMO ANGELA � ROMIHG>aR ? OB 2I6 P0,738 E .�'ZtA!ia 3t r fl0- Lc7 1' AREA N TRX LOT 43 Nolt 4n-6763 307.03' %%K 0"J X41.. Gr I F .J A N- r'S Fr. WILLIAMS S 0 Z i30 PC .I?1 TIE To 2"EIP S o1=57I=SVrW 1!48.77-' ADDRESS OFOW)JERS GRAY quo Rudy aRRTHR IAdy Wll I la%ftc "nri rcL l 7- fes' " LEGEIJD R/W RIGHT OF WAY EIR Et(515Tlj4G IRON ROD E1P EXSIST/A/G IRo&I PIPE • 8E7' 1/80 SRoM PIPE G• 38,83S.5791 C CURVE DATA • ' 30,0ao.00 - --- MOM -SUAVEYBDMMES • 3Z,141.0115' N/F NOW OR FORMALLY ., . 85,345•. 1,009 08 DE£D BOOK > 30,060.00 PG PAGE N6. NuMIR CS +. Woo DCD RREA �"- STREAM CH. C140RO LE/J. LEe1GTH. R.C.P. REWPORS90 CositRaTE PIPE OfWILLIAMIS R6ADoP.K. Ao. N70' -/S'-1309 lite. 49' :P Aa/OW/LLMMS AONDt. :94' Csss A.As►K.) CP, uaIOM'R WIAAIA1-13 RO.VD. a. ADDRESS OFOW)JERS GRAY quo Rudy aRRTHR IAdy Wll I la%ftc "nri rcL l 7- fes' " O ' 310.701 140 21422 I cd 5+ dcd (r 8 AC.)2 � I-AT 1 8 °' , -1.47 ci eC,+4 .T_ . P�; n y ,, 5' :ti,�x;T �• � 5 AC. �'.f-t.U5<op7u i �p., e40.1eQ 5 AC330.'. 3 49 a 42.03 ;;a 8 81 5Ac. d 1 a(;Zt Y m 5Q.h l,_ .<. - e, 177ACdt v 928.62 j 356.9 U 0 CE) a'.�5 , � 79 N 2 AC N 3.8 AC. i` •; �i7 fro. o, �:t74 375.39 t �Mv l 231 a6 t n 401 C.0✓- 3Ao. d �ll1 1L A m a Ga8.46' co 17 co zlo� I A 426 N - Q— c xk r tOD�N3.27AC.)�° t - 9,, f .: N o +► 93' `l`E w 46 a 83 4 VA 55,7 AC 1 ?�! ° I 8.5' r it 14169 I 92 i (8AC 28-3.3 Acmr M 7` ) 2 2 I � I h O f245q �P/0'/8 9. Y +R • ` �. . -y \ ~•f r ', '• 9) 9, 3 907 5 1213 30 N - - 189-02 56(' N 1213,: C.d 5 �i �1; e 9.2 AC 8= . 600.6' t rr.. ,* Y . k _ _ • ee�_ N 1155 �4 D 0 -R _ V,i - 874.5 r ) - 36It ' ' M14 Fav Y y "iwt 1 APPLIC. TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATCI I=JUN2 LKMisUv Davie County Health Department II`JI-j{�I et Environments/ //ea/th Section ( G P.O. Box 848/210 Hospital Street �l n Mockaville, NC 27028 ✓ 1� /I �� (336) 751-8760 ENVIRONMENTAL AICNTY AI , ***IMPORTANT'*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed / n Contact Parson '7 Mailing Address �/ Q 1 24J �YY✓� /L� / Boma Phone city/state/zIP ��Y �/--n-a'�-f c { [�% �. �% d 6).6 Business Phone .�- 2. Name on Permit/ATC if Different than Mailing Address 3. Application For: ❑ Site Evaluation 4. system to Ssrvice: AHouse ❑ Mobile Home s. If Residence: ❑ Dishxashar # People City/state/zip ❑ Improvement Permit/ATC "o ❑ Business ❑ Industry ❑ Other # Bedrooms .3 # Bathrooms 2- 0 ❑ Garbage Disposal ❑ Mashing Machine ❑ Bassmant/Plumbing ❑ Baaament/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Shoxers # Urinals # People # sinks # Mater Coolers IF FOODSERVICE: # Seats Estimated Slater Usage (gallons per day) 7. Type of Mater supply: ❑ County/City ❑ Well ❑ Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. ZIvX o6 / ��c 1W5 Property Dimensions• �' L, ��a WRITE DIRECTIONS (from Mocksville) to PROPERTY: �9 Tax Office PIN: #577 '- 06, - %/g7•ol b14 Z- d -' Jo Property Address: Road Name W .z - 10& City/Zipe YID C - 27od 641L9•1t4 If in a Subdivision provide information, as follows: lJ / Name: CR2ters CotAr t Section: I Block: Lot: �_ Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. 1 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 4 also, aii,�Ertaif% ihaC: C.^.: P2�1'ii.T:i:Ji�j::'C�i ::PWrees 6arurredfrom 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 to conduct all testing procedures as necessary to determine the site sui ility. DATE,?,/,",C ' 3 - �I / SIGNATURE ^ t THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) n �i Account No. Invoice No. too fN. i r1 •ifVVi ,-- �� L o,AG 481 1, .:s Cl _ 1,5 1 fl��4 5,13oGAc2ES RQEA°:5�7G7S --- �� `2z3,y4o,c.z3y AC�r 2sl X33, rF +v '5Q. F'T,' f r jai. m � N EASEM E"T 8'11.. z.!-" O � D z.!-" • v Aofl I 1011f I A DAVIE COUNTY HEALTH DEPARTMENT group Environmental Health Section Structure SoiVSite Evaluation. APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900562 ?ax PIN/EH #: 5778406-7187.01 Billed To: Gray Carter Subdivision Info: Carters Court Lot # 1 Reference Name Gray r Location/Address: ss Williams Road-27006.. . Proposed Facility. Residence Property Size: Date Evaluated:. Water SuPP1Y� On -Site Well Community Public Evaluation By: Auger Boring Pit' ./ Cut Structure ®®®®®®® SOILWETNESS FACTORS 1 2 _; 3: q 5 6 7 i Landscape position Slone % l Sl • v Aofl I 1011f I A group Consistence Structure Mineralogy HORIZON II DEPTH Texture group ConsistenceTexture StructureMineralogy HORIZON III DEPTH Texture group Consistence ®®®®®®® StructureMineralogy ®®®®®®® IV DEPTH Texture group ConsistenceHORIZON ®®®®®®® Structure ®®®®®®® SOILWETNESS SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ` SITE CLASSIFICATION EVALUATION BY: LONG-TERM ACCEPTANCE RATE: . t / '' / 7 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 -L cam SI -Silt SICL - Silty clay loam SII, - Silty loam CL - Clay loam SCL _ Sandy clay loam SC - Sandycay SIC - Siltycay C - Clay .. ' CONSISTENCE of ; VFR - Very 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 SC -Single grain M - Massive CR - Crumb OR - 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 -tern acceptance rate'- gal/day/ft2 DCHD 05/99 (Revised) ■■MEN■EENOMME ■NNO■■■■■■UM■ MEMENNOMMMEE■ ■■■■ENNNNUse■ ■EN■■■■■■■o■■ ■NMEMEM■■■■■■ ■NM■■■■■■EM■■ ■NNNEEMEMEME■ ■■■EM■■■■s■■e ■MaassaMMEMEN ■EMEMEMEMEMEN ■■■E■■■■ME■■■ ■■em■o■■■■um■ e■■■■■ENNOM■■ s■a■■■■■EMEME ■■■■■■■MM■■■■ ■■NNOMMEM■■■■ ■■■■NNOMMoo■■ ■OMMMME■■■■■■ ■■■■■E■■■M■■■ ■WEENEE■■■■■■ ■■■■MEN■■■■■■