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225 Palomino Road Lot 5S Davie County. NC Tax PnrePl R ennrt Thursday, January 26, 2017 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: TMS IS NOT A SURVEY Parcel Information H9090A0005 Township: 5789854006 Municipality: 82528583 Census Tract: GRACHEN JOSEPH T Voting Precinct: 225 PALOMINO ROAD Planning Jurisdiction: ADVANCE Zoning Class: NC Zoning Overlay: 27006-0000 Voluntary Ag. District: LOT 5 HIDDEN MEADOW Fire Response District: Land Value: Total Assessed Value: 5.11 Elementary School Zone: 9/2009 Middle School Zone: 008051036 Soil Types: 0007 Flood Zone: 238 Watershed Overlay: Outbuilding 8r Extra Freatures Value: Total Market Value: Shady Grove 37059-804 EAST SHADY GROVE Davie County DAVIE COUNTY R -A ADVANCE SHADY GROVE WILLIAM ELLIS PcB2,PcC2 DAVIE COUNTY IkTP All data Is provided as Is without wan" or guarantee of any Idind either expressed or Implied Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department '0 1836j� Environmental Health Section h / P.O. Box 848 C� 210 Hospital Street O U �'S Courier # : 09-40-06 1911 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection Name: In . Phone Number (Home) Mailing Address: �(o 3 �o. ' ,co (Work) Email Address: Detailed Directions To Site: d Vol S -e G 0I ✓, / M. i p! Property Address: �P fua�. ✓/ ' /` , p/v /I ,S Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: ` { `G h co 15 Type Of Facility: i Date System Installed (Month/Date/Year): Y 1,9,0/0 Number Of Bedrooms: �/ Number Of People: Is The Facility Currently Vacant? Yes If Yes, For How Long? Any Known Problems? Yes If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Number Of Bedrooms: Number of People Pool Size: arage Size: _ Other: Requested By:ture)45 Date Requested: (Stg �T For Environmental Health Office Use Only . Approved Disapproved Comments: Environmental Health Specialist J.a 1.aZA Date:f If i l *The signing of this form by the Environmental Health Staff is it no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash 65 ec Money Order # 4C Amount:$ �yCZQy Date: Paid By: M Cg [ k, c 01C ( I. e ✓ �j 7-t4 6 Received By:JQ� p I ju 0 ,J i'0 L4 G� Account #: Invoice #:O o t DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 OPERATION PERMIT Account #: 989900093 Billed To: Shelton Construction Services Reference Name: Proposed Facility: Residential Tax PINIEH #: 5789-83-2266.05 Subdivision Into: Hidden Meadow Lot # 5 LocationiAddress: Hidden Meadows Trail -27006 Property Size: See Map ATC Number: 5007 **NOTE** The issuance of this Operatio-1permit shaIl 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. �+ a System Type: S.T. Manufacturer ��� Tank Date !f Tank Size Pump Tank Size System Installed By: &-ei ot—bQA E.H. S ecialst: �ate: , 7 I &C .gin.! DCHD 11/06 (Revised) 690' M M rl 278' 6" 40' N Ln l0 841' SCALE: 1"= 60' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT Account #: 989900093 Tax PIN:EH#: 5789-83-2266.05 Billed To: Shelton Construction Services Subdivision Info: Hidden Meadow Lot # 5 Reference Name: LocationiAddress: Hidden Meadows Trail -27006 Proposed Facility: Residential Property Size: See Map ATC Number: 5007 / **NOTE** The issuance of this OperatiojfPermit shad 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. D System Type: S.T. Manufacturer Sk a -F Tank Date , Tank Size O Pump Tank Size System Installed By: tt h A4 — ►✓ qa1 i E1 E.H. Specialist: % �" Date: � — r l �n 11, DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION J in 5 % q -$s - y Co 4 CI�� Account #: 989900093 Tax P€N/EH #: bTit''4%(0 Billed To: Shelton Construction Services Subdivision Info: Hidden Meadow Lot # 5 : ?c10mi()a ltd LocationiAddress: Hidden Meadows Trail -27006 Proposed Facility: Residential Property Size: See Map ATC Number: 5007 Site Type: ❑ rw— ❑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 -I #Bathrooms 3'5# People__Z Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 6'? Type of Water Supply: ❑County/City Well OCommunity Well System Specifications: Design Wastewater Flow (GPD) 1 lX/ Tank SizeGAL. Pump Tank�/AL. Trench Width.3(,r Max. Trench Depth Z Rock Depth Linear Ft. 4� w) F,3 stated in 15A NCA 16A.1i 69(5) Site Modifications/Conditions/Other: accepted Systems may also be used �&r 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. 4) q�d E Environmental Health Specialist `/�� / % Date: DCHD 11/06 (Revised) f Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 989900093 Billed To: Shelton Construction Services Address: 1257 Highway 64 West City: Mocksville Reference Name: Proposed Facility: Residential T Tax PIN/EH #: 5789-83-2266.05 Subdivision Info: Hidden Meadow Lot # 5 Location/Address: Hidden Meadows Trail -27006 Property Size: See Map **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: Years ❑No Expiration Residential Specifications: # Bedrooms I # Bathrooms 3 •-People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): /-/ 0 Type of Water Supply: ❑ County/City 4eiii tommunity Well As stated in 15A NCAC 18A.1969(5) Site Modifications/Permit Conditions: accepted Systems may also be used fM/f1 Enviro �a cti®11-06 r ICAR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ti� Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 r (336)751-8760/ Fax (336)751-8786 A licati or: ❑ Site Evaluation/improvement Permit /Authorization To Construct(ATC) ❑ Both T Application: ❑New 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 Name to be Billed .S �, s _ ._.. -i-,.,, .. ; .. Contact Person C�o Bilfing Address 12S-7 V S wI/ 1,`P W Home Phone City/State/ZIP y J z.,- e 4 .:. I I r. , e J- C.. -2--7 0 Z V Business Phone 3 '4 V- Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: B-STe—Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name ----Ye *- - & r o, C L p.-. Phone Numbet -12`i) I S Y- Zy t, E Owner's Address City/State/Zip Property Address_L 6 '� Ai J,/`s. /WC,- J - w City Lot Size3bu-t lop. TaxPIN Subdivision Name(if applicable) — e ./..,.r Section/Lot# .S Directions To Site: to.. -J,- . L � � SIC J- . S �....... � L� �9 � � .L� ICS �G,� _ .� /_•_ . 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 5tl'o Does the site contain jurisdictional wetlands? ❑Yes C<o Are there any easements or right-of-ways on the site? ❑Yes C o Is the site subject to approval by another public agency? ❑Yes [�<o Will wastewater other than domestic sewage be generated? ❑Yes 2<0' IF RESIDENCE FILL OUT THE BOX BELOW # People 4— # Bedrooms 44 # Bathrooms 3 �5­ Garden Tub/Whirlpool ['es ❑No Basement: []Yes 54 o Basement Plumbing: ❑Yes 14 ' 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: ❑ County/City Water 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 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 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 Prop owner's or owner's legal representative signature Date Date(s): Client Notification Date: EHS: Sign given ❑Yes ❑No Account # �0 / 100093 Revised 11/06 Invoice # K41 L. 'APPLICATION FOR SITE EVALUATION/ISIPROVEMEN,. FEli'ilI & AT Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Ul�' Mocksville, NC 27028 (336) 751-8760 tNVIRO NA9EArT ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE IRVTy INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �•.�. 1. Name to be Billed iN h n1(t6'1 t1 I'(_ 1 •� /I�, Contact Person _ Mailing Address' y Z�J Home Phone LJV le 1 t1 r City/State/ZIP 11 t6Z�2�(� Business Phone 3N _'(1/1 2. Name on Permit/ATC if Different than Above Mailing Address���� City/State/Zip 3. Application For: M"Site Evaluation ❑ Improvement Permit/ATC Cl Both 4. System to Service: /House ❑ Mobile Home ❑ Business Ll Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms 3 IJ Dishwasher 1.1 Garbage Disposal CI Washing Machine U Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usa a (gallons per day) 7. Type of water supply: ❑ County/City v Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: L� A(V-I,S WRITE DIRECTIONS (from Mocksville) to PROl'I:R'IN: Tax Office PIN: # 7A"I - `6 Z:Z- 0 S Property Address: Road Name �i�.`►'l.�j C��%'>%k �-�1a a^'� 2-0 City/Zip A ►G�� 2 Z(3o If in a Subdivision provide information, as follows: Ido %� Name Section: Block: Lot: Date Property Flagged: 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. I, also, understand that I am responsihle fur all charges incurred from 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 s�uita�bi it . 2 0 7 i� DATE � OC 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). , inD EcEOME '.i LIMAY 2 002 ENVIRONMENTAL HEALTH DAVIE COUNTY Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No.(� / Invoice No. �'/ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002073 Tax PIN/EH #: 5789-83-2266.05 Billed To: Norman Building Subdivision Info: Peoples Ck. Farm Lot # 05 Reference Name: Location/Address: Peoples Creek Rd. -2706 Proposed Facility: Residence Property Size: see map Date Evaluated: i b2 _ Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 J 5 6 7 Landscape position Slope % HORIZON I DEPTH — A 10 Texture grouptr Consistence Structure G Mineralo 1 • p HORIZON II DEPTH 47 Q — 4120, Texture group ` C Consistence `, n Structure Mineralogy b HORIZON III DEPTH 3 Texture groupte- ' G ConsistenceIVi f ' Structure t% Mineralogyu HORIZON IV DEPTH Texture group Consistence v Structure MineralogyG SOIL WETNESS 32 - RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE fl . SITE CLASSIFICATION: 0-- EVALUATION BY: l7 LONG-TERM ACCEPTANCE RATE: O� �OTHER(S) PRESENT: REMARKS: ?2j ld� 11.1 Landscape Position LEGEND 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 - 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 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 05/99 (Revised)