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
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ADDRESS OFOW)JERS
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CURVE DATA
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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
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f r jai.
m �
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8'11..
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• 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)
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