Country Estates Lot 6Davie County. NC
Tax PnrrPl RPnnrt
Tuesday, November 29. 2016
WARNING: TRIS 1S NOT A SURVEY
Parcel Information
Parcel Number: K401OA0020 Township: Mocksville
NCPIN Number: 5727741743 Municipality:
Account Number: 8300474 Census Tract: 37059-801
Listed Owner 1: BECK ANGELA D Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 1828 JERICHO CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 6 COUNTRY ESTATES
Fire Response District:
MOCKSVILLE
Assessed Acreage:
0.78
Elementary School Zone:
MOCKSVILLE
Deed Date:
4/2005
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
2005EO123
Soil Types:
EnB,IrB
Plat Book:
0004
Flood Zone:
Plat Page:
057
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding 8r Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
1:01
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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 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.
Tax PIN/EH #: 5727-74-1743
Subdivision Info: L' U U-1) ko
LocationlAddress: Sunset Circle -27028
Property Size:
ATC Number 5112 Site Type: BNew FID %'F" Fir xpansion ;
**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 # Bathrooms 9 # People Basement❑ Basement plumbing❑
Account #: 990005573
Billed To: Glen Baysinger
Reference Name: Glen Baysinger
Proposed Facility:
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size %S Type of Water Supply: gCounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) 3 60 Tank Size ICOOGAL. Pump Tank /00c' GAL.
Trench Width Max. Trench Depth ' Rock Depth V/ Linear Ft. 3(y o F 0S'��pAd�sh,
Site Modifications/Conditions/Other:
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Teleahone # (336)751-8760.
Environmental Health Specialist.
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
OPERATION PERMIT
Account #: 990005573 Tax PIN EH #: 5727-74-1743
Billed To: Glen Baysinger Subdivision Info:
Reference Fume: Glen Baysinger LocationiAddress: Sunset Circle -27028
Proposers Facility: Property Size:
ATC Number: 5112
**NOTE** The issuance of this Operation Permit shall 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.
System Type:_
Pump Tank Size_
System Installed By:
GPS Coordinate:
DCHD 11/06 (Revised)
S.T. Manufacturer Tank Date Tank Size
E.H. Specialist: Date:
R
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336)753-1680
IMPROVEMENT PERMIT
Account #: 990005573 Tax PIN/EH #: 5727-74-1743
Billed To: Glen Baysinger Subdivision Info:
Address: 1828 Jericho Church Road Location/Address: Sunset Circle -27028
City: Mocksville
Property Size:
Reference Name: Glen Baysinger
Proposed Facility:
**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: ?New ❑Repair ❑Expansion Permit Valid for: g5 Years ❑No Expiration
Residential Specifications: # Bedrooms # Bathrooms # People Z Basement❑ Basement plumbing&
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD):..� Type of Water Supply: ZCounty/City ❑Well ❑Community Well
Site Modifications/Permit Conditions:
System Type LTAR
Initial .:2s -
Repair
2s -
Re air
Site Plan
Environmental Health Specialist
i.p. 11-06
Date ��16
A R SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
O 3 P.O. Box 848/210 Hospital Street
�lp Mocksville, NC 27028
_.,� (336)753-6780/ Fax (336)753-1680
iplicrib ion/Improvement Permit ❑ Authorization To Construct (ATC) 0,do- t
`pe of A n: ❑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.
A PPT .TC ANT TNRCIR ?%/rA TTfIAT
Name Contact Person V �e_1.l5, /019 4-1`
Address r 87 Home Phone X 3 6 93 A -- 9 d9 7
City/State/ZIP G =276ZF Business Phone 334, - 2.6 51- / / 76
Name on Pennit/ATC if Different than Above
Mailing Address
1_6 51A 111d Ci C< l< d a
Iffh6 answer to any of the following questions is "Yes",supporting documentation must be ttached.
Are there any existing wastewater systems on the site? Yes /No
_
Does the site contain jurisdictional wetlands? _Yes X o
Are there any easements or right-of-ways on the site? _Yes //o
Is the site subject to approval by another public agency? _Yes ��o
Will wastewater other than domestic sewage be generated? , Yes No
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms 3- # Bathrooms Garden Tub/Whirlpool ❑Yes lido
Basement. ❑Yes o Basement Plumbing: ❑Yes o
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: r_ County/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B
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
1= ,d and flaggin or staking th ouse/facility location, proposed well location and the location of any other amenities.
Property owner s or owner's legal rep senta e signature Site Revisit Charge
'
Date(s):
Client Notification Date:
Date P P EHS:
A `t.��6 2010 A
BY.
Sign given ❑Yes ❑No 02� Account # J573
Revised 11/06 Invoice # 9 q
7V I
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990005573 Tax PIN/EH #: 5727-74-1743
Billed To: Glen Baysinger Subdivision Info:
Reference Name: Glen Baysinger Location/Address: Sunset Circle -27 28
Proposed Facility: Property Size: Date Evaluated: &_W
Water Supply:
Evaluation By:
On -Site Well
Auger Boring
Community
Pit _
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L
Slope %
< m ��
HORIZON I DEPTH
Texture grow
Consistence
Structure
j
Mineralogy
HORIZON H DEPTH
Texture group
Consistence
Structure
Mineralogy
X_
"L t j
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: ?S
LONG-TERM ACCEPTANCE RATE: • 2S_
REMARKS:
LEGEND
EVALUATION BY: lvj A)av
OTHER(S) PRESENT:
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 - Firm VS - Very firm EFI - Extremely firm
Ad
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
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)
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SHOWN G S BPGKEN LIVES PLOTTED URRENT, REG/STEREG LANG SURVEYOR H/� DAY, RICHARD CLARKS
60 RW �— FOUND IN Q9RO -� FROM INFOR&ATION , AND DULY ACKNOWLEDGE '
OE dTEN , PAGE _^- - --. THAT THIS MAP THE MAKING OF THE MAP AS SHOWN HFREO;1✓ FOR THE PURPO��
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