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137 South Hemingway Court Lot 36Davie County, NC Tax Parnf-1 R Pnnrt Tuesday, November 29, 2016 WAKNhNG: '11ii51S f40T A SURVEY Parcel Information Parcel Number: H8060A0036 Township: Shady Grove NCPIN Number: 5789145394 Municipality: Account Number: 82519164 Census Tract: 37059-804 Listed Owner 1: SOUTHERN CLYDE WARD JR Voting Precinct: EAST SHADY GROVE Mailing Address 1: 137 SOUTH HEMINGWAY COURT Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-7049 Voluntary Ag. District: No Legal Description: LOT 36 COVINGTON CREEK PHASE TWO Fire Response District: ADVANCE Assessed Acreage: 0.73 Elementary School Zone: SHADY GROVE Deed Date: 7/2002 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 004280095 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: 1:01 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, Impliedwaan es of merchantability or fitness for a particular use. Ali users of Davie County's GIS website shall hold harmless the �TCounty of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to 1� C 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 IMPROVEMENT/OPERATION PERMIT Account #: 989900317 Billed To: Glory Home Builders Reference Name: Proposed Facility: Residence Tax PIN/EH M 5789-14-5394 Subdivision Info: Covington Ck Lot # 36 Location/Address: HEMINGWAY COURT -27006 Property Size: see map **NOTE* iiIsgmprovement/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 #People #Bedrooms #Baths 5 Dishwasher: Or*" Garbage Disposal: ❑ Washing Machine, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: NeWO-IRepair ❑ System Specifications: Tank Size.%GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Widtho Rock Depth Linear Ft.� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** 6w f 6--p r' Environmental Health Specialist's Signature. Date: DCHD 05/99 (Revised) ' ' DAME COUNTY HC7EALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900317 Tax PIN/EH #: 5789-14-5394 Billed To: Glory Home Builders Subdivision Info: Covington Ck Lot # 36 Reference Name: Location/Address: HEMINGWAY COURT -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3168 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, S ion .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: a Date: 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. �� t , S d w F Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) u J00 Yolyr Date: JO APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department En vifonmentaiffeaith Section J P.O. Box 848/210 Hospital Street (� Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE INFORMATION IS PROVIDED. /R`nefer% to the INFORMATION BULLETIN for ins 1. Name to be Billed (3'�br'� ,f j li ;(�P�S Contact Person Mailing Address �'7 _`� (, �/� �/ CY/y✓� ��if , Home Phone REQUIRE'I )y\, .ruction . h� City/State/ZIP Cleml,7ot2f IVC—. Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: ` 0 -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms _ # Bathrooms 2, 5— b'trishwasher garbage Disposal Wishing Machine [e'sasement/Plumbing n Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 42'County/City ❑ Well ❑ Community" e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes H -Ko` If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: //P X .Z'Wt� Tax Office PIN: #_�7 c� / I / -5U9 / Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: ��� V i J'� q '�D C r e P K Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: r Date Property Flagged: O', //- d 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 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 fran 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 v" " D 3 - 4'-12-- SIGNATURE ZA/.���lu�,�, A/I 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). IN Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS' Account No. 16 7 ?o66 3 Invoice No. 7�3 0 ; S A► -.. 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 REgUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Q E C Contact Person / of e- k rwr Mailing Address PA ,IA d X � ,3 I) Home Phone City/State/Zip ,lam/[ U'liJ Ce NC J2 760 Business Phone 91k -Y77:2- 1813-2Nik C 4,L1 If 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: M4fie Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ ] Other %O+ Sq& 1yiS'O•J 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ 1 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 [�j1Vo If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***`A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: A>ar+ 04 66 &C. lucc.e WRITE DIRECTIONS (from Mocksville) TO PROPEP7Y: Tax Office PIN: # 781 - �& c1'2; ?6 1 ?� Ir-} K 0:C 0J V 4 Pu C.f Property Address: Road Dame j D r 1( / m 'I — t. aS 4 t'Icar .4 Cit rzi A Z?oo b �e I f IUI u� rS Y P If in Subdivision provide information, as follows: Name: [ b1 in %a+y C�ree.k J�RODQAced r Section: Lot #: 3 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 . Revised DCHD (06-96) all testing proc oWs as necessary to determine the site suitability. 1111,5 :II;T•1 .11 111 LIF 11"T.1) J"UR LWAIPIN(i lint .` i II: PIAN: r - DAPI iE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_Z LOT Soil/Site Evaluation APPLICANT'S NAME �� DATE EVALUATED . a PROPOSED FACILITY PROPERTYSIZE SUBDIVISION _Lj /1 �ll i✓ f� C �� ROAD NAME6 Water Supply: On -Site Well Community. Evaluation By: Auger Boring Pit t.� Public 1� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH k '� Texture groupG C 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:(1;12: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ' / OTHER(S) PRESENT: REMARKS: LEGEND Landscane 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 Mineralo 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of 611- 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 DCHD (01-90)