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117 Cumberland Court Lot 43Davie Countv. NC Tax PnrrPl RPnnrt Tuesday, December 20; 016 k - WARNING: THIS IS NOT A SURVEY Parcel Number: - H806OA0043 Township: Shady Grove NCPIN Number: 5789240515 Municipality: Account Number: - 8303528 Census Tract: 37059-804 Listed Owner 1: -- RODRIGUEZ FREDY A Voting Precinct: EAST SHADY GROVE Mailing Address 1: 117 CUMBERLAND COURT Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006 Voluntary Ag. District: No Legal Description:Dt_OT�� OVINGTON CREEK PHASE TWO Fire Response District: ADVANCE Assessed Acreage: 1.10 Elementary School Zone: SHADY GROVE Deed Date: 5/2014 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 009580824 Soil Types: PaD,PcB2,PcC2 Plat Book: 0007 Flood Zone: Plat Page: 139 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: O vI� 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 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 all claims or causes of action due to �'p Nq NC or arising out of the use or Inability to use the GIS data provided by this website. (Address/Road #: 117 Cumberland Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: "Water Supply: PUBLIC Subdivision: Covington Creek Phase: 2 Lot: 43 Directions Hwy 64 East, left on Hwy 801, left into Covington Creek to Cumberland Court CONSTRUCTION a 4 Inches For Office Use Only AUTHORIZATION Saprolite System? OYes eNo 'CDP File Number 202457-1 ' 1 a Inches Davie County Health Department Maximum Trench Depth: County ID Number. Soil Application Rate: 0 - a 7 5 210 Hospital Street a 4 Inches Evaluated For. HDRNWIC .��,. P.O. Box 848 TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Township: Mocksville NC 27028 PERMIT VALID UNTIL: 1 -Piece: Phone: 336-753-6780 Fax: 336-753-1680 0 4/ 1 1/ a 0 a 1 Applicant: Fredy and Luisa Rodriguez Property Owner: Fredy and Luisa Rodriguez Address: 117 Cumberland Court Address: 117 Cumberland Court City: Advance City: Advance StatefZip: NC 27006 Statefzip: NC 27006 Phone #: (336) 406-3941 Phone #: (336) 406-3941 Aggregate Depth: inches Property Location & Site Information (Address/Road #: 117 Cumberland Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: "Water Supply: PUBLIC Subdivision: Covington Creek Phase: 2 Lot: 43 Directions Hwy 64 East, left on Hwy 801, left into Covington Creek to Cumberland Court Donn 4 of Z Minimum Trench Depth: a 4 Inches Site Classification: Provisionally suitable Saprolite System? OYes eNo Minimum Soil Cover. 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - a 7 5 Maximum Soil Cover: a 4 Inches System Classification/Description: 'Distribution Type: GRAVITY -SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Gallons *Proposed System: 25% REDUCTION 1 -Piece: OYes ONo Pump Required: OYes @No OMay Be Required Nitrification Field Sq. ft. Pump Tank: Gallons No. Drain Lines 1 -Piece: OYes ONo Total Trench Length: 1 7 0 ft GPM—vs— ft. TDH Trench Spacing: _ 9 In cht 0 C C. Dosing Volume: _ Gallons Trench Width:_ 3 Inches @Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -I OTS -II Septic Tank Installer Grade Level Required: 01 011 07111 OIV Donn 4 of Z CDP File Number 202457-1 / County ID Number. ❑ Open Pump System Sheet Kepalr bysiem Kequireo:v r Cs vwu vwu, uu� nas rwanau�C �NacC , --_r— –'--.. Trench Spacing: 9 Inches 0.1 *Site Classification: Provisionally Suitable – Feet O.C. Design Flow: Trench Width: OInches 3 4 9 0 _ (.� Feet Depth: Soil Application Rate:Aggregate 0 a 7 5 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover 1 2 Inches Maximum Trench Depth: 3 6 *Proposed System: 25% REDUCTION Inches Maximum Soil Cover: a 4 Nitrification Field 1 7 4 5 Sq. ft. - Inches No. Drain Lines *Distribution Type: GRAVITY -SERIAL 5 Total Trench Length: 4 3 6 Pump Required: Oyes @No OMay Be Required ft. Pre Treatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department "Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Penult, not to exceed five years, and may be issued at the same time the Improvement Permit Issued (NCGS 130A -336(b)} If the Installation has not been completed during the period of validity of the Construction Permit, the information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature Date: / / *Issued By: 2140 -Nations, Robert Date of Issue:. 0 4/ 1 1/.2 0 1 6 Authorized State Agent: Malfunction Log Oyes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 202457 -1 County File Number: Date: 0 4/ 1 1/ 2 0 1 6 Qlnch Scale: COBlock QN/A I t+1 aS'� r �1 tci i - - ------- - - F F—i 7! 1 1 g iC., � �I I I CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street P.O. Box 848 Mocksville NC 27028 CDP File Number: 202457 - County File Number: Date: .s .a ./ 1 1/ a 0 1 6 Click below to import an Image from an external location: Drawing Type: Construction Authorization Phone: (336) - 753 - 6780 Davie County Health Department Environmental Health Section PAID Date; n. .71 Zola -v' P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement emode i Reconnection Fax: (336) - 753-1680 Name: r SL uPhone Number-;3[p-Uix4- SSU (Home) Mailing Address: 1 1 " 7 A A"QA 10 CC( C� . ��o LI 662 — S SZP (Work) Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: < kflA.Al Type Of Facility: Date System Installed (Month/Date/Year): Number Of Bedrooms:_ Number Of People: Is The Facility Currently Vacant? Yes /No J If Yes, For How Long? Any Known Problems? Yes a If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Number Of Bedrooms: Number of People Pool Size: 147 )LW 1 Requested By: (Signature) Approved Disapproved Comments: Size: Other: Date Requested: For Environmental Health Office Use Only Environmental Health Specialist Date: *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. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: Account #: ���,��� Invoice #: W 0 LO N a 5A 44 42 PB07_PG 139 2� Account #: 990001299 Billed To: Con Shelton Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 / / 7 & a, Tax PIN/EH #: 5789-24-0515 Subdivision Info: COVINGTON CK *L Lot # 43 Location/Address: Cumberland Court -27006 Property Size: see map ATC Number: 2630 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 CONSTRRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �G?�U/�U/ Date: * PgIzM4 A 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 NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. /OD Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) r— Date: -% ~ 0 -a 4`— DAME COUNTY HEALTH DEPARTMENT 14 * ©0 AN. Environmental Health Section .' P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001299 Tax PIN/EH #: 5789-24-0515 Billed To: Con Shelton Subdivision Info: COVINGTON CKI Lot #43 Reference Name: Location/Address: Cumberland Court -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2630 **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 1-30A, 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 CON'T'RACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms 7 #Baths 13 Dishwasher: e Garbage Disposal: E Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 1 f A G Type Water Supply Design Wastewater Flow (GPD) Site: New.1211Repair ❑ System Specifications: Tank SizeaV GAL. Pump Tank GAL. Trench Width 1�/" Rock Depth ,5?,Y/ Linear Ft.--/-&) / Other:L— Required Site Modifications/Conditions: soO''a 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 daaf-installation. Telephone # is (336)751-8760.**** D r Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: ) I—)— � v ',- I APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT do ATC a �% Davie County Health Department D Environmental Hetr/th Section P.O. Box 848/210 Hospital Street OCT 2 4 200 MOcksville, HC 27028 (336) 751-8760 ***nWVRTAHT*** THIS APPLICRTION CAM OT BX PRO SMW UNLESS AM TiQ REQVIRED nWOTM11TI0H IS PROV IDED. Refer to the IM'ORNDITIOH BULt3T111 for instructions. / 1. flare to be Billed �^ / - - 7" �• �1► a - _ Contact Doreen Mailing Address / Z S i V 2-1 ►� y •` y ��% sane Pboae S- e- z � city/state/:Zp %'% �s J rel _ C _ Z ! 0 2 Business Pbone 2. flaw on Persit/USC it DUfferent than above Hailing Address a. AWlioation tor: CkIffi• =valuation my/s tate/sip L.z-lsrovasent permit/A2c 4. states to servioev 0 -to -`use O Mobile Home O Business O Indus s. i! Residence: # people � # Bedrooms ishwuher B-oasbage Disposal ihi:►g Machine ^'U Buernt/Ol�sbinq 6. 29 Business/industry/others steady type # commodes # showers O Both try O Other # Bathrooms 3 O sasemnt/so Plusbing # People # sinks # Urinals # Water Coolers Ir >I'OODSERVICs: li seats estimated Nater Osage (galea per day) 7. Type of water supply: 0 County/City 0 Well 0 Community 8. Do you anticipate additions or expansions of the facllity this system Is intended to serve? 0 Yea qMW Uyes, what type? ***IMPORTANT*** CLIENTS MUST CIDMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BESVBIWTTED by the client with THIS APPLICATION. Property Dimensions: /• y (a A r c 5 Tax Office PIN: 0 S -7 � ?- ZY - 0 S / Sr Property Address: Road Name Clty/Zip H In a Subdivision provide information, a follows: Name: Zai:_���_ Section: Lr Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flared:y/z .0'/0 -6 This Is to certify that the lufbrmadon provided Is correct to the best of my knowledge. I understand that any permits) Issued hereafter are subject to suspension or revocadon, if the site plans or Intended use cbauge, or If the Information submitted in this application is falsified or changed I, also, understand that I ani responsible for all charges Incurredfrom this application. li, hereby, give consent to the AutborbW Representative of the Davie �h' ealth partment 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 l V —Z& LD SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and Imelsions, structures, setbacks, and septic locations). e N7'p"'S4 rRev*bed I�—A c+ DCHD (07/99) 0 c' Site Revisit Charge I Date(e): Client Notiiiestion Date: I ERS: Account No. Z ` Invoice No. �� APPLICATION FOR SITE EVALUAT ON/f.MPROVF1V ENT ?ERN.: ' 8 Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 t Uk ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE�UIRED INFORMATION IS PROVIDED. �Ze. L-�5+ar" 1-77) - - 1. Name to be Billed lyD rn S Contact Person<►f Mailing Address?,) ,))� S t) )l Home Phone City/State/Zip ! t UAII.I CC NC . 270 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip - 3. Application For:Ml'ite Evaluation [ ] Improvement Permit & ATC (] Both 4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ ] Other 10+ 814a ► -Ee sla'y__ 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disnosa" [ ] 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 (1 Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes If yes, what type? 1 11111 I, '. 1-1-11 ('!; *111 .11 t:; PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: fir+ d -F 61) 44, 04iCe WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # 789 - --y3uy91JV1 Property Address: Road Dame 9,01 ( D n e nkp City/Zip 1Q�U• Z?oo rti,s trt ��e 11 lel4ers If in Subdivision provide information, as follows: Name: 2 ' -- Section: I Lot #: 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 o changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorize of the Davie County Health Department to enter upon above described property located in Davie County and owne b -..,...T;�A-L3T� � c SIGN Revised DCHD (06-96) all testing procSoWs as necessary to determine the site suitability. 111I.s Al"FA ,1111( I;F; I1" F[► (()It hIt,111'INci IJc.�ll/t .til IP PIAN: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY _ SUBDIVISION Cjt%/� Water Supply: On -Site Well Community Evaluation By: Auger Boring Pity� SECTION__ LOT AV -21W DATE EVALUATED/ ! 6 PROPERTY SIZE ROAD NAME Public Cut L� FACTORS 1 2 3 4 5 6 7 Landscape position L 21 Sloe % 12�. HORIZON I DEPTH I Texture group IL Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure /7/ . f 513 / Ahk/Z Mineralogy ail HORIZON III DEPTH - Texture group Consistence Structure Mineralogy HORIZON IV DEPTH . Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSir,CATION LONG-TERM ACCEPTANCE RATE -Z Si'?:_, CLA3��IFICATION: !> > LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) EVALUATION BY: OTHER(S) PRESENT: r�i= 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 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 Mineralq= 1:1, 2:1, Mixed No=e 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