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123 Cumberland Court Lot 42U Davie County, NC Tax Parnel Rennrt Wednesday. November 30, 2016 WAKNiNG: I'Mh lh NUT A hUKVLY Parcel Information Parcel Number: H8060A0042 Township: Shady Grove NCPIN Number: 5789149470 Municipality: Account Number: 82523684 Census Tract: 37059-804 Listed Owner 1: MIKULSKI ROBERT A Voting Precinct: EAST SHADY GROVE Mailing Address 1: 123 CUMBERLAND COURT Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: LOT 42 COVINGTON CREEK PHASE TWO Fire Response District: ADVANCE Assessed Acreage: 1.06 Elementary School Zone: SHADY GROVE Deed Date: 12/2004 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 005860879 Soil Types: PaD,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: 161 N`' 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 of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consulta"W6 contractors or employees from any and all claims or causes of action due to Cor arising out of the use or Inability to use the GIS data provided by this website. PermitteeTs r DAVIE COUNTY HEALTH DEPARTMENT Name - I ,l/15, EnNronmental Health Section PROPERTY INFORMATION ' P.O. Box 848 _ t Directions to property: Mocksville NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: - Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - SYSTEM CONSTRUCTION AUTHORIZATION NO: 2435 A Road **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by She Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should V presented to the Davie County Building Inspections Office when'applying for Building Permits. (In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NOTICE THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION — t1 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRO9ML`N •A TH SPECIA IS S DATE ISSUED l / RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS _—S:—/# OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE I'+&RE TYPE WATER SUPPLY& DESIGN WASTEWATER FLOW (GPD) (:.tet- Q NEW SI TE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH II ROCK DEPTH O/4. LINEAR FT. 120 r OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: l"'�'�w �'" �'v � ' � / y ` �, Gid h2 " UW ' IMPROVEMENT PERMIT LAYOUT 1 I _- Dal � d **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. AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 02/02 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Names 1, "�/E , );nvironmental Health Section PROPERTY INFORMATION ` P.O.. Box 848 Direct �sA property, Mocksville, NC 27028 Subdivision Name: y�� •, Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - 25 AUTHORIZATION NO: A Road Name **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 .l l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIROIGM9NT4LHEALTH SPECIALIST.' DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE MV # BEDROOMS ' # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY'lii 3 Y.DESIGN WASTEWATER FLOW (GPD) +%'L') NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE_ GAL. PUMP TANK GAL. TRENCH WIDTH—' = ROCK DEPTH LINEAR FT. ff OTHER i 1.L 1 !�`l, Ili �Jt4&f REQUIRED SITE MODIFICATIONS/CONDITIONS: )t�1-^U�t/W�' �+�-L 111 �i{ f"f'C,•�R L1n1.r IMPROVEMENT PERMIT LAYOUT ` r "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:60 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. f - - AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE'I I 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. DCHD 02/02 (Revised) ttu DAVIE COUNTY HEALTH DEPARTMENT PROPERTY'INFoxMATION Environmental Health Section 4x6 P.O. Box 848 ••`Direw on'9-;; property Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN;. SYSTEM CONSTRUCTION 2401 AUTHORIZATION NO: A Road 1�"e:�^� iP: **NOTE** This Author4ation 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 Offic wh plying for Building Permits. (In compliant'/ lth e I }'of G. ap r 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) , ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ' IS VALID FOR A PERIOD OF FIVE YEARS..' VIR N E I`A HEALTH SP.,ECI LIST DA ElSS� ED ) 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 TYPE WATER SUPPLY 0 i'mDESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: 'TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH >CW ROCK DEPTH LINEAR FT. OTHER ' ( S j 2.j b 10-x( REQUIRED SITE MODIFICATIONS/CONDITIONS: 1'" r �'��G SI4 L•(• a14 "a`I yzvk IMPROVEMENT PERMIT LAYOUT • •1,t" p tO ... 5 **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY A H DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM a BETWEEN 8:30 - 9:30 A.M. OR 1:00 = 1:30 P.M. ON TI) D OF INSTALLATION. TELEPHONE # IS (336)751-8766. DCHD 07102 (Revised) a �!Y : ay.. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900141 Billed To: Michael Wayne Myers, Inc. Reference Name: Mike Myers Proposed Facility: Residence Tax PIN/EH #: 5789-14-9555.42 Subdivision Info: Covington Creek Sec,-RLot #42 Location/Address: Hwy. 801 S.-27006 Property Size: See Map ATC Number: 2181 **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 C.� #People #Bedrooms #Baths `2 Dishwasher: Garbage Disposal: ET*"�Washing Machine: 0"" Basement w/Plumbing: ❑ Basement/No Plumbing: Er' - Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size CrL AC-94Type Water Suppl4—ylyDesign Wastewater Flow (GPD) '5&c7 Site: New L2' Repair ❑ System Specifications: Tank Size 1� � GAL. Pump Tank GAL. Trench Width"51 ' Rock Depth IZ'1 Linear Ft.-2>CC>' Other: _3 ►S"f21&jJT1Ey-1 Required Site Modifications/Conditions: W5!ml-L- uJ CC>41:?a%X, �P US' I -&E l-�oJS�, iG�P Its ocF � L;-)& 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.**** r 01 lAeP ,8 4 Environmental Health Specialist's Sign e: z Date: g G'9 DCHD 05/99 (Revised) \ i ' y Account #: Billed To: Reference Name: Proposed Facility: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 989900141 Tax PIN/EH #: 5789-14-9555.42 Michael Wayne Myers, Inc. Subdivision Info: Covington Creek Sec.ALot # 42 Mike Myers Location/Address: Hwy. 801 S.-27006 Residence Property Size: See Map ATC Number: 2181 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 buildmi permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .19 Sewage Trai ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER -CO AXT IS V OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's CERTIFICATE OF COMPLETION Date: **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. l zQ r� i Ste+ �-X Z , Fae, 4P4 i Q T t Septic System Installed By: + W i -i l ��14-E�� Environmental Health Specialist's Signature : Date: DCHD 05/99 (Revised) APPUCAMON FOR SITE EVALUATION/IMPROVEMENT PERMIT d ATC Davie County Health Department Envlronmentd Health Section 1.0. Box 846/210 Hospital Street Moaksvillo, NC 27026 (336)751-6760 v SEP 2 0 1� i * * * nW01RZU;V * * THI8 fl> nICIITION CAEM 8R PRO=BE= U1=88 M& = REQUIRED nNOM=1014 16 PROVIDED. Rater to the iNPOiMUZON BU=TIN for instructions. 1. hang to be pilledlG�/fr�,�/► ��-U/AyY—=1! S''z�A.7 ,�i1'lJ Contact "coca al�r` "' Nailing address _ lee4e some mme 17YI1 � city/state/sly Yl i /QUSc� purine.. phone s. pass on vo a it/M It Disserent than above Wiling address Citi tete/sip a. Awliaation sort O site ivaluation ffuvrovenent wermit/aze fl Both e. sy.tea to s.s.ioss iT House 13 Mobile some O Business 0 Industry 0 Other a. It R+egidenaet i Reople s Bedrooms a Bathrooms ahwaeher 17 garbage Disposal AlWashing Wohiae 0 paessant/praising fl i; sGwa ►tMo plumbing s. is pusimsss/Industry/Others Specify type t# people f Simko i Commodes # Showers 1 urinals s water coolers IIT F=8EBVICi: 5 Seats -..__ Estimated Nater Usage t9a11ooa pw d"I 7. TAM of crater supply: O'County/City 0 well 0 comm"nity a. Do you anticipate additions or expausions of the facility this system Is intended to serve? 0 Ya "to V yes, what type! I***IMPORTANT***CLIENTSMWCiOMPLETBTHE REQlAMPROPERTYINFORMAMONREQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client witb THIS APPLICATION. Property Dimensions: Z&!4 -- Tax /— Tax Oflice PIN: # 5791- k1 — 21--4 �-�- Property Address: Road Name ' / -,v citylzip U in a Subdivision provide Information, as follows: WRITE DIRECTIONS (from MocWlle) to PROPERTY: Name:la!//,lf4���j���1� n n Section: Bloclu *,ot: Date Property Flagged: Tho IS to certify that the Information provided Is correct to the bat of my knowledge. 1 understand that any permits) Issued hereafter are subject to suspension or revocation, If the site planivr intended use change, or if the information submitted In this application is &bilked or changed 1, also, riaderstend that I am responsible for alt cicala lacurrcd pom tits applkadoa 16 hereby, give consent to the Authorized Representative of the Davie Canty Health Department to enter upon above described property located in Davle county and owned by to conduct aU testing procedures a necessary to determine the site suitability. DATE 9-- " 9 9 SIGNATURE 0AVAC,1 THIS AREA MAYBE USED FOR DRAWING YOUR 817M PLAN (incl call of the following: Eibting and proposed property lines and dimensions, structures, setbacks, and septic loattio Site Revbkt Charge I Cllent Notification Date: 1EHS: Revised DCHD (07199) Account No. '1411 Invoice No. �� 2 - , -• `_ � - - -- -� y � � ��� ,_ tl,,v7 Ib' - �' x.01 -•x _ ' � J ;;-"'Ano b..'-- - 24 4 277, .�f,+ r ,..130 1 . { � — ��!• �� —` .` ' � ^ _ +2 .` \ � L + ` � .,�� ' ill 37 /` • is Z- �� 1 1 v 6t JV 94 NIP 36 of. map 4 / • � � J/ � \` rte -„-R /"'^....�..�/ �s ( ( t 1kL. Eft A � `-----� PHASE ACRES NO. OF LOTS _LOT.NO.S ROAD LENGTH 1 23,580 2* 1-4 45-64 1680 2 24.141, 25 5-23. 40-44 .2380 3 13.033 - 15 4;39 870 TOTAL 60.754 64 4930 RECREATION & MMMON, AREA 1 7 ACRES . PLAT KEYNOTES: , O1 YW. BUILDING SETBACK + TYP. 6' UTIUTi EASEMENT AT R/M V11UTY EASEdENT W/ 4' SIDE�ALJ<,, O COMMON AREA & "AGE EASDOT O5 +' 10'x 70' SIGHT EASEMENT + 6D ORAINAGE EASEMENT• ALN�j0 CKpK x 025' WIDE DRAINAGE EASEMENT CENTERED ON CULVERTS, DITCHES i O TYP. 70'x50' BUILDING FOOTPRINT EXCEPT LAT 32 NiICN IS WxW, e "4 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 1 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE UIRED INFORMATION IS PROVIDED. ��Ii- , I'S rv, ' �?��kf1. Name t* be BilletHb r v% S Contact Person g Mailing Address ?1) g t) X 3 0i) Home Phone City/State/Zip 06 unld CC WC . 27001; Business Phone18/3-a9le ("f+k/ 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 [ J Other %0+ SU6441yi.SJo•J 5. 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 [ J Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes Hilo If yes, what type? I I 1 , '. PL 1 1 !'r: ,. 1 I r 1,I l:l PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***`A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. L t Property Dimensions. t7 46 6t.0 . DAVc-e WRITE DIRECTIONS (from Mocksville) TO PROP07,TY. Tax Office PIN: # 78`3 - u Property Address: Road lame �I D j p�.mr�_r X / m It City/Zip 2Zao e- ; _ 0Iry &.C' nde 11 mAe r.5 - If in Subdivision provide information, as follows: �I-a�l reek Name: ,1l y�rtDoSed ; Section: Lot #:-dnal. 2 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 ve of the Davie County Health Department to enter upon above described property located in Davie County and owne et v I all testing procourps as necessary to determine the site suitability. DATE IL' -'"9 Z Revised DCHD (06-96) IIII; AIJ'A ,1111/ br- 11; Tb /-ok I)IM117NI T !/()I 1/? .tiI it 1'1-.i N: �. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_,_ LOT,? Soil/Site Evaluation APPLICANT'S NAME � � � DATE EVALUATED ZF96 —?? PROPOSED FACILITY PROPERTY SIZE SUBDIVISION t/i /! �Di✓ f G elt ROAD NAME Water Supply: On -Site Well Community Evaluation By: Auger Boring Pity� Public l---**' Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH ff f Texture group Consistence Structure Mineralogy/ r ' 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 i SITE CLASSIFICATION: '/2i_ — LONG-TERM ACCEPTANCE RATE: REMARKS: 'HD (01-90) T Landscaue Position LEGEND EVALUATION BY: '&j OTHER(S) PRESENT: 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 Mois 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 Mineraloay 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 ,a.e - gal/day/ft2