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132 Oakshire Court Lot 50Davie County. NC Tn%r Parral P,-"n*4 Tuesday, January 10, 201 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: THIS IS NOT A SURVEY Parcel Information J7080B0050 Township: Fulton 5768202423 Municipality: 8305235 Census Tract: 37059-804 RANDOLPH THOMAS JEFFERSON VIII Voting Precinct: FULTON 132 OAKSHIRE COURT Planning Jurisdiction: Davie County MOCKSVILLE Land Value: Total Assessed Value: NC 27028 LOT 50 HERITAGE OAKS PHASE TWO 0.68 10/2007 2007EO323 0008 139 Zoning Class: DAVIE COUNTY R-20 Zoning Overlay: Voluntary Ag. District: 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: 9 �u�.tcp All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All user: 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 • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003561 Billed To: S& S Construction Reference Name: Proposed Facility Residence ATC Number: 4036 Tax PIN/EH #: 5768-20-2423.50 Subdivision Info: Heritage Oaks Lot # 50 Location/Address: 64 E-27028 Property Size: see map %3Z oQ.taiiire-,, AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** 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 CON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: bdfooms CERTIFICATE OF COMPLETION **NOTE** 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 NON tthat the system will function satisfactorily for;ngiven period of time. \ / �7 &hx�V4�� '9 0,�, Septic System Installed By: y2 A 6i'Y�%%%t/ X- /K '2 Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003561 Billed To: S& S Construction Reference Name: Proposed Facility Residence Tax PIN/EH #: 5768-20-2423.50 Subdivision Info: Heritage Oaks Lot # 50 Location/Address: 64 E-27028 Property Size: see map ATC Number: 4036 **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 f/ #People #Bedrooms #Baths �: Dishwasher: � Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Sea}ts Industrial Waste: ❑ Lot Size Type Water Supply L 0 Design Wastewater Flow (GPD) Site: New 0-'Repair lWRepair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench WidttjV� Rock Depth ,�r Linear Ft.. O 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.**** !o' Environmental Health Specialist's Signature: Date: S DCHD 05/99 (Revised) r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section LS P.O. Box 848/210 Hospital Street Mocksville, NC 27028 APR (336)751-8760 4 2005 I ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS LALL TH1t;4%K INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN lrtY�, LTj! 1. Name to be Billed Coo S I C'4 C r 0 n Contact Person 1 Yl -1 Y11 r Mailing Address S ��J�� e, ✓1 r— y S ` Home Phone 3 3 (n -/�j / / `J 3t t, City/State/ZIP Y. OC S 11 i 'le 11 [ 22Ci�O Business Phone '�3 Ly 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 0 Improvement Permit/ATC ❑ Both 4. System to Service: 14 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: ® Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms �3 # Bathrooms 13Dishwasher ❑Garbage Disposal ®Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks _ # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: M County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes JIM No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: M'-06" X Zai • 75 Tax Office PIN: # 5 7 (P K '-';?-0" -:� Lr/ �a 3 Property Addre s: Road Name City/Zip If in a Subdivision provide information, as follows: Name: Ner.'4-et4e d. k3 Section: �_ Block: Lot: 50 WRITE DIRECTIONS (from Mocksville) to PROPERTY: 141vv-Y �, L/ -44 7/ r � L. r n le -161 it ,z Ne isyQ G'a k . -'Q ;� k� a -i Sip S�'�n 9"YA-i '12�- 11'6w S � re �' 7� 3 r � Lo -/- ci n tV % A f. Date home corners flagged: q 4 r U' s 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 ani responsible for all charges hicurred 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 suitability. /) DATE /t!/��• 0� SIGNATURE TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of theiollowing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). � Lv f Kr �70 /oj 2 r' Sign given Revised DCHD (05/03 ►`T / �l LJ Site Revisit Charge Date(s): Client Notification Date: EHS: / Account No. Invoice No. NAME /„ �G l�a ADDRESS PROPOSED FACIILTY DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section S '1/Site Evaluation DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit (--*' Cut FACTORS 1 2 3 4 Landscapeposition_ 4 Slope % -2 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 0 V Y Texture group Consistence r / Structure e Mineralogy 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 RATEJ , SITE CLASSIFICATION: EVALUATED BY: �/?� L/ 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 S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty :lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Vc-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 MineralosEy 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/f12 DCHD(01-901