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120 Roxbury Court Lot 47Davie County, NC I r Tax Parcel Report Wednesday, November 30, 2016 City: ADVANCE State: NC Zip Code: 27006-7877 Legal Description: LOT 47 COVINGTON CREEK PHASE ONE Assessed Acreage: 0.97 Deed Date: 9/2003 Deed Book / Page: 005120822 Plat Book: 0007 Plat Page: 057 Building Value: Land Value: Total Assessed Value: Zoning Class: DAVIE COUNTY R -A Zoning Overlay: Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: PaD,PcB2,PcC2 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 161 �T 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 Illness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ail claims or causes of action due to l� C or arising out of the use or inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H806OA0047 Township: Shady Grove NCPIN Number: 5789240191 Municipality: Account Number: 82521518 Census Tract: 37059-804 Listed Owner 1: TISCHLER MATTHEW JASON Voting Precinct: EAST SHADY GROVE Mailing Address 1: 120 ROXBURY COURT Planning Jurisdiction: Davie County City: ADVANCE State: NC Zip Code: 27006-7877 Legal Description: LOT 47 COVINGTON CREEK PHASE ONE Assessed Acreage: 0.97 Deed Date: 9/2003 Deed Book / Page: 005120822 Plat Book: 0007 Plat Page: 057 Building Value: Land Value: Total Assessed Value: Zoning Class: DAVIE COUNTY R -A Zoning Overlay: Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: PaD,PcB2,PcC2 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 161 �T 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 Illness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ail claims or causes of action due to l� C or arising out of the use or inability to use the GIS data provided by this website. �'S�'�si'w t'��. E -ti: s 's - �.+' '�+ ^•'1 � xa�,:l�l. N 00"V'',btivi ' ` DAVIE OU�iTY _ . 20- HEALTH DEPARTMENT " # �` • ` ,, IMPR'OEMtNT AND OPERATION PERMITS PROPERTY INFORMATION ttee s� 0AAs Subdivision Name: Y *0'�— irections fo property:L.� I t r°✓� Lot: Section. PERMTT. Tax Office PIN: "l) Road Name: Zip: **NOTE** This Improvement Permit DOES NOT audio rize`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 constructioAfi stallation of a system or the issuance of a building permit. (In compliance with Article I 1 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 # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No . LOT SIZE P A e TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) �6 NEW SITE v REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE wor GAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH /i LINEAR FT. ©� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: DCHD 03/96 (Revised) ' i i, 'rM'f� Y'i h' `iY 1"Y �s'i`? d i-. N"�i�'�''St'�iti`f':it � x�' t,•Y.".t'/aw t•t : a e .. i�,UTI ORIZPyTION NO: 824, DAVIE C UNTY HEALTH DEPARTMENT /- Environmental Health Section PROPERTY INFORMATION Periaitteeti._•Y I ' P.O.' Box 848 Name:` Mocksville,NC 27028 Subdivision Name: Ie 1/�• . �.+Le Phone # 336-751-$760 - Directions to property:Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN: SYSTEM CONSTRUCTION r �• Road Name: 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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ? ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION Xi Xaa l r, i'al/ ��' '� IS VALID FOR A PERIOD OF FIVE YEARS ENVIRONMENTAL HEALTH SPECIALIST, DATE ISSUED . • DAVIE (COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION L_LOTYZ Soil/Site Evaluation APPLICANT'S NAME 7�� '�4 DATEEVALUATED li PROPOSED FACILITY �! PROPERTY SIZE SUBDIVISION � i /J / D �% f C eA ROAD NAME Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit t/ Public l� Cut FACTORS 1 2 3 4 5 6 7 Landscape position J, 4 Slope % Ae HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH '/ 3G 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 r , SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: I 5 REMARKS: DCHD (01-90) EVALUATION BY: A-& OTHER(S) PRESENT: LEGEND Landsgape 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 is 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 Mineralouv 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 PERMI' Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE UIRED INFORMATION IS PROVIDED. 1. Name to be Billed E q Contact Person Mailing Address fes• A ,� [1 >l :)L3 d 1) Home Phone City/State/Zip _'06) vaid Ca NC . 2700 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip i 3. Application For: ite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ l Other / 0+ St., 41 t//.S'la"o S. If Residence: # People # Bedrooms # Bathrooms ( ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] 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: County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes o If yes, what type? I � ►rip r; .'. 17. 11 �`�; 1 it �� t:l PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***'A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions. ('Jals o 66 4'C' 0'r c -e ; WRITE DIRECTIONS (from Mocksville) TO PROPERTY. Tax Office PIN: # 789- t�ft,1 a 22 -SA lu-V 000 ad -J4 w C.e Property Address: Road Oame'ideaf Q City/Zip 8 U • Z?ao If in Subdivision provide information, as follows: I-aAJ reek. % Name: b t rarJoSzcl ; r Section: Lot #: i This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter ar subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified ) changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Author.'. e of the Davie County Health Department to enter upon above described property located in Davie County and ow.te i r Revised DCHD (06-96) all testing procS�Wu es as necessary to determine the site suitability. Ill1 :V; F.1 ,1111[ L;T: IISLU J"UI% DI{,Ill'INci !J011k .ti11F MAN: APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC • Davie County Health Department Envimamental Nea/th Seg W017 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***ndPCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �1�� i7?/1(/ eo►�✓s SsJYicas �cC.'. Contact PersonS/7%� Nailing Address 12-$-7 f 11 4yeS� Boma Phone City/State/ZIP /�/�(� S!// � y J6//< 2 -?d Business Phone 2. Name on Permit/ATC if Different than Above Nailing Address City/State/Zip 3. Application For: Site Evaluation improvement Permit/ATC ❑ Both e. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms _ # Bathrooms "2... Dishwasher 0 Garbage Disposal A('Nashing MachineBasement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type 7� # People # Sinks # Commodes # Showers # Urinals # Nater Coolers Ir FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: K County/City ❑ well e. Do you anticipateadditions or expansions of the facility this system Is intended to serve? If yes, what type? ❑ Commmity ❑ Yes I(No ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ane- WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # S-71(-'9 21/ $/3 5` �{' D7 7PJ 705. Property Address: Road Name City/Zip '4' If in a Subdivision provide information, as follows: Name: ax, Section: _� Block: Lot: -7� Date Property Flagged: 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 to conduct all testing procedures as necessary to determine the site suitability. DATE 3 — i 2:� SIGNATURE l/�_ J, lzz-� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account Na I J Invoice Na