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