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109 Cedarwood Place Lot 1Davie County, NC Tax Parcel Report Tuesday, January 10, 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: WAKNI1VCT: '1' i1N IN 1VUT A SURVEY Parcel Information J7080B0001 Township: Fulton 5768197764 Municipality: CORNATZER 25334550 Census Tract: 37059-804 FERGUSON DARIN E Voting Precinct: FULTON 109 CEDARWOOD PLACE Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC 27028-7163 LOT 1 HERITAGE OAKS PHASE ONE 0.75 3/1999 002100671 0007 005 Zoning Overlay: Voluntary Ag. District: oA !� No Fire Response District: FORK Elementary School Zone: CORNATZER Middle School Zone: WILLIAM ELLIS Soil Types: Gn132 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: Davie County, All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the �O CNS� NC County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or inablltty to use the GIS data provided by this website. Pefmittee's' f1 DAVIE COUNTY HEALTH DEPARTMENT Natne:- `�" �� t I'1 < q L" 5 G P1 Environmental Health Section PROPERTY INFORMATION L f E �' P.O. Box 848 ,�; / l ',, Directions to property: Mocksville, NC 27028 Subdivision Name: 1A r-11-1 ,C Cir! cw -f 0 1,tff( L.L. �� Phone #: 336-751-8760 Section: I Lo[: je, r • ( Ct A AUTHORIZATION FOR WASTEWATER Tax Office PIN:# & j <� �� ,[ AUTHORIZATION NO: Q `..1 A SYSTEM CONSTRUCTION Road Name: ` f L Zip: . **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the 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 when applying for Building Permits. (In ccppliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED r- RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOM # BATHS # OCCUPANTS �- GARBAGE DISPOSAL: Yes or Nc COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or, No LOT SIZE TYPE WATER SUPPLY D SIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE l OGG CY�� ✓�� r � ' ( SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP -7L6 AL. TRENCH WIDTH 34� ROCK DEPTH,4/A [L,INEAR FT. crtQ-� 6._f OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT i/ ----p 1,,r3 ('i lJ t 1 U e L-0 L} �k A ,Ill i �, (, � �5 s s� 00 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. V OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 1 I 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. DG7iD0?l02(Revised) Permittee's DAVIE COUNTY HEALTH DEPARTMENT �Islame:+ 6( I �'`� �J s + r} Lk 5 c: ri Environmental Health Section PROPERTY INFORMATION / P.O. Box 848 Directions to property: hlocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: I a ` AUTHORIZATION FOR / C , :; c � .� ; Y..:� ; )r, e / oil WASTEWATER Tax Office PIN:# r��' - /rJ %'f'jr�/ SYSTEM CONSTRUCTION 6 ,n / ryry ��yy AUTHORIZATION NO: 2 ., A Road Name: L Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ENVIRONMENTAL HEALTH SPECIALIST j ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 1'� IS VALID FOR A PERIOD OF FIVE YEARS. TE ISSUED L RESIDENTIAL SPECIFICATION: BUILDING TYPE -a - # BEllROOMS # BATHS � # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE ice. 4 a SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK AL. TRENCH WIDTH ROCK DEPTH �' LIfN��EnnAR FT. 6-1 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r L 1,5- ---Zp -/,- L,/ //"-- FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **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 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. DCHD 02/02 (Revised) {.,'�• t(/ r -f l' / �.[.../'l Y.'.�ri f ti,� J, l C i v {J� FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **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 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. DCHD 02/02 (Revised) {.,'�• t(/ r -f l' / �.[.../'l Y.'.�ri f ti,� J, l COUNTY HEALTH DEPARTMENT nvironmental Health Section PO Box 848/210 Hospital StreetL � �% 61 r- SEp Mocksville, NC 27028 d� tC�wiROi:wjT ;E.,,,,,1,L 4 «lam Phone: (336)751-8760 Uuoee(C�l II/� �•�-- QST -SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING A RECONNECTION ❑ Name:_ D_ai k>1. �� <<'i S o pp Phone Number: (Home) Mailing Address: 10 1 Cle c rwL t.� la C = S(ca 21 S� (Work) 01 a_lksinti Il`- Detailed Directions To Site: ra k e ��'�-ti �l (c% / J�../� �f"�� �!i t -A kC ZL.1%W1 h E'V 2' 4CL�rslf°v [ d'� ►f' I 1 a_r jteinl­ 0a L k- f A, Property Address:_ ck7r4"(�)yd Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under:AkA N Al 9 Type Of Dwelling: I• Date System Installed(Month/Day/Year): Number Of Bedrooms: ' -q.lAkNumber Of People:_ Is The Dwelling Currently Vacant? Yes ❑ NoA, If Yes, For How Long? Any Known Problems? Yes ❑ NoX If Yes, Explain: f-�1 , 0home.,, J/D cSINAJI lUf e - v be,,rv9 6,haA4d 40 Q mlls / B/z • dd;11� 4 5/m// 8 41 Please Fill In The Following Information About The New Dwelling: Type Of Dwelling: �.t' S :c�.r��4, Number Of Bedrooms: Number Of People: Requested By: �� �r - " r Date Requested: (Signature) For Environmental Health Office Use Only Approved 9 Disapproved ❑ Environmental Health Specialist ./%!i! _ _ _� Date �O *The signing of this form by the Environmental Health Staff is in 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. !'..,.1- n !'l-...,.1. n L.f.._..._. rl_.7._.. n u n -...,__-_ i. Q / /t9l)i TI.. L,.. . uy _y .,. .... W_ - ..� Paid By: f Received By: Account #: 510 Invoice #: C AUTAORIZATION NO: 4 0 4 DAVIE COUNTY HEALTH DEPARTMENT =I-1X'O Environmental Health Section PROPERTY INFORMATION Permittee's P.O. Box 848 Name: U' Mocksville, NC 27028 Subdivision Name: / Phone #: 704-634-8760 Directions to property: �!� ` " / ~ Section: Lot: AUTHORIZATION FOR Jif 4 r Q WASTEWATER Tax Office PIN# SYSTEM CONSTRUCTION z � Road Name: r'- 'Jr� M Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the 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 when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION [7`� .^%LCj '� ; •.` IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED V: `, DAVIE COUNTY HEALTH DEPARTMENT�'_�� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION -Name:- Subdivision Name: �Wr,r�j?*.,," rig; Directions to property: ,t `" of, Section: Loty/ t s IMPROVEMENT PERMIT Tax Office PIN:#. 17 iRoad Name. , f ° K ,? ,; . > Zip: **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 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST.` DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE & # BEDROOMS 1-5? # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No . COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE.,/w1' TYPE WATER SUPPLY _ DESIGN WASTEWATER FLOW (GPD) L I CL NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS:. TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH LINEAR FT. +y� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONSr "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE #IS (704),634-8760. OPERATION PERMITS SYSTEM INSTALLED BYi ZQ— N©�s� AUTHORIZATION NO. OPERATION PERMIT BY: DATE: • �� "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 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. ' DCHD 05/96 (Revised) .,; APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI Davie County Health Department D ' Environmental Health Section P. O. Box 848 Mocksville, NC 27028 (336)751-8760 EI ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS b ALL THE REQUIRED INFORMATION IS PROVIDED MAY - 4 1998 1. Name to be BilledTrig /N -OA Contact Person Jewv//V �d.�✓ � /�6) r Mailing Address llq6) i vP� ,.�? Home Phone 3A/P - 787- 1:51,19 City/State/Zip AX I � Ike- v27,-7, 9J Business Phone y� e 2. Name on Permit/ATC if Different than Above Mailing Address _ 3. Application For: 4. System to Serve: 5. If Residence: dishwasher 6. If Business/Other: # Commodes _ If Foodservice: 93' Site Evaluation _ City/State/Zip Improvement Permit & ATC Uk"House ❑ Mobile Home ❑ Business ❑ Industry # People 7 ❑ Garbage Disposal Specify type _ # Showers # Seats 7. Type of water supply: # Bedrooms Clr"'Washing Machine ❑ Basement/Plumbing ounty/City # Urinals ❑ Other # Bathrooms 2� alg-asement/No Plumbing # People # Sinks # Water Coolers Estimated Water Usage (gallons per day) ❑ Well 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ If yes, what type? ❑ Community Yes W- lsl o t 1 111t K A rLtl1 UK J L l t rl-AA PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A HWS THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. `I �� 30 � f3-- IG�,�I �' r Property Dimensions: F • fS `�.5'� R- 171, 60 L - � 1 WRITE DIRECTIONS (from ,7 7� 1 Mocksville) TO PROPERTY: Tax Office PIN: # ,76 9 - - 1IAI 45 Property Address: Road Name 1,i 13.Y (ti a f� �I . ; / Al City/Zip 1U 1 If in Subdivision provide 'nformation, as follows: 1 Name: P'r d O N P 1 Section: Lot #: 1 1 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 responsible for 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 /N4d /i% �}y rNG (�!'J�l /-9 qIr ( to conduct all testing procedures as necessary to determine the site suitability. DATE :%- - /c r� SIGNATURE - \�� 0' Revised DCHD (06-96) ou YOU MAI,J. USE THE BACK OF THIS FORM FOR PRAWING YOUR SITE PLAN. ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTYS DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well _ Community Public- f Evaluation By: Auger Boring Pit 41____ Cut FACTORS 1 2 3 4 Landscape position I- .L Slo e R HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH F f Texture group Consistence Structure MineralogyC.' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I Ir LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: /23 EVALUATED BY: //—&/Z LONG-TERM ACCEPTANCE RATE: I / 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- V+ --.-y 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 3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralomy 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 watef 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(01-901 r wc7C: �r of w'--v.1g�� Co4-5 /��%7 fllf 5 G1t� � ��� • *� r 33� - 7'3 7- 5';'71