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120 Covington Drive Lot 3Davie County NC t Tax ParrPl R Pnnrt Wednesday, November 30, 2016 WARNING: THIS 1S NOT A SURVEY Parcel Information 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: Land Value: Total Assessed Value: H8060A0003 Township: Shady Grove 5789343500 Municipality: 82526076 Census Tract: 37059-804 CROWLEY JASON L Voting Precinct: EAST SHADY GROVE 120 COVINGTON DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R-20 NC Zoning Overlay: 27006-0000 Voluntary Ag. District: No LOT 3 COVINGTON CREEK PHASE ONE Fire Response District: ADVANCE 0.72 Elementary School Zone: SHADY GROVE 312006 Middle School Zone: WILLIAM ELLIS 006540682 Soil Types: WeB,PcB2,PcC2 0007 Flood Zone: 057 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 1:01 �TC All data Is provided as Is without warranty or guarantee of any Idnd either expressed or implied including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users or 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 1� or wWng out of the use or Inability to use the GIS data provided by this website. "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 (336)751-8760. i i�ri it i DCHD 051% (Revised) � .;,.., t,ss�`«vI� N°4.,n.•,9. tv� r , r t!' tr ..Ng . a.• « .;.s..� o .� a i+A s .. .. . .. , ; vx+�y.R AUTHORIZATION.NO: 1957 DAVIE CPUNTY HEALTH DEPARTMENT. jEnvironmental Health Section PROPERTY INFORMATION Permrttee's P.O: Box 848 Name: -' r• Mocksville, NC 27028 Subdivision Name:-�✓t/t��u"� E .y4-f Phone # 336-751-8760 Directions to property:" w �_e;CA/4r7 c tY �j Section: Lor. .. Iry ' AUTHORIZATION FOR � /h17U t,t�Vl/�G7�'� WASTEWATER' Tax OfficePlN:#� `p 1- �`'( - SYSTEM CONSTRUCTION C_k& 14 Road Name: u"IiM�£�7v+� i.�4Zip, **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 ',Building Permits: (In compliance with Article 11 of .S Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) !. 1 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION a jX, Lr7114 : IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRO A 1, AC HSP ,CIA � DATE fSSULD, ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT -4 Soil/Site Evaluation APPLICANT'S NAME ��i 8 0' DATE EVALUATED PROPOSED FACILITY %�%� PROPERTY SIZE SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit ROAD NAME est Z Public Ll --l' Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 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 RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: , REMARKS: DCHD (01.90) EVALUATION BY: 3`Yc�✓� OTHER(S) PRESENT: ';�y es' 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 - 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 Mineraloev 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 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 , (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNI 1 THE REqUIRED INFORMATION IS PROVIDED. Name to be Billed +M Contact Person �/ �-� <►f Mailing Address I t1 X o�3 C� t� Home Phone City/State/Zip , �oi t aia ce- ? %Vt)( Business Phone %��'' y77• -Z /813-��%/8' (�'�i�'l t, 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ ] Other c2 -;Z / 0+ y is /O •) 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ 1 Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 0641*0'unty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes If yes, what type? 1 1 1111:1 ;1 I1—A I OR III PIA14 PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***`A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: r+ C�- 66 &C, PAC -,e WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # 789 - 9-4/— 9LtW 261 :SbIA K CS Qd-J4 Iu Le Property Address: Road lame ��!/ — City/zip ASU • Z ?o oAss Z�rzm Inde - If in Subdivision provide information, as follows: Name: C /n 'del Oreelc %r etz�t ? i Section: Lot #: ..J 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 ve of the Davie County Health Department to enter upon above described property located in Davie County and owned 1.11-4 r Revised DCHD (06-96) SIGN all testing proceOuFs as necessary to determine the site suitability. 71118 AIATA ,%tll LIF. 11SEb 1"01%' L)IMIPIN6 J0111Z 5I71i PL,IN: 0 ---D. S 62026'47"E 287.09' Ir Z 0 �N 3 No . C7 N 6.:141'17'1�N 280.11' Q r— I 1 SITE \ cmft►bN t LOCATION \ \ omaOo \ \ O X4°4- �1 \ Ncp \ 'O \ bO'o K CARO r t=" ••og rcQ•�tiky % 30 0 30 60 SEAL z7 i.2WO �. GRAPHIC SCALE - FEET J -4p,,.= MAP VOGLER'S CONSTRUCTION FOR APPLICATION FOR SITE EVAIIIATION/IMPROVEMENT PERMIT & A x,7.57 6 Davie County Health Deparbnent d [ Envitvamenta/ Health SftWon P.O. Bos 818/210 Hospital Street FEB ( 1999 Mockaville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***DWCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE INFORMATION I3 PROM ED. Refer to the INFORMATION BULLETIN for instructions. 1. Same to be Billed I /QA 1-0- Mailing QMailing Address , , City/state/ZIP a 2. Same on Contact Person I �[ 0 A / Some Phone 9 , A)C %CJ b Co Business Phone Different than Above Mailinr Address City/State/Zip 3. Application For: U Site Evaluation f3Yl'mprovement Permit/ATC 0 Both 4. system to service: 13-- ouse ❑ Mobile Home 0 Business 0 Industry 0 other a. if Residence: -Dishrasher # People # Bedrooms � # Bathrooms 1 0 Garbage Disposal A-1rashing Machine 0 Basement/Plumbing 0 Basement/So Plumbing S. If Business/industry/other: Specify type # Commodes # People # Sinks # showers # Urinals # Nater Coolers Ir FOODSERVICE: () Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 0-County/City 0 Well 0 Coammmity e. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes G44-0-1- If -No U yes, what type' ***IMPiORTA1I/ ' 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: �� I�l�c �'!W11117,V11tECTIONS (From Mocksville) to PROPERTY: / Qd� Ta:Office PIN: Property Address: Road Name < i e 9D City/Zip/yi► _r,2 6 �c r If in a Subdivision provide information, as follows: Name: 1 t./ Section: Block: Lot: Date Property Flagged: �/ f / S I" This is to certify that the information provided is correct to the best or 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 inrormation submitted in ibis application is falsified or changed. I, also, understand that I am responsible for all charges incurred front this application. I, bereby, give consent to the Authorized Representative or the Davie ty Health epartmeot� to enter upon above described property located in Davie County and owned by f SS fo- to conduct all testing procedures as necessary to determine the site suitabil' DATE SIGNATURE -� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the fo lowing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. � Z Invoice No. #93