210 Byerlys Chapel Road Lot 2Dav
2016
gt.vl�. All data Is provided as Is whhoutwerramy, or guarantee or any Idnd eNheresq'ssed or Implied Including but not limited to me
Davie County, Implied wamntles mmerohadabll ywflNeaa fora particular we All uses of Gads CoumyaGlS webabe shall hold ha mless tha
County or Cavle, North Carolina, Its agents, conwhama, wobadora or employees from any and all dslms or causes of action dua to
�CUN't NC or arising outofthe use or Inability to use the GIs data provided by this vebsite.
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number.
K30000000310
Township:
Calahain
NCPIN Number.
5717508885
Municipality:
Account Number.
8301140
Census Tract:
37053801
Listed Owner 1:
KOONTZ JOAN HUTCHENS
Voting Precinct:
SOUTH CALAHALN
Mailing Address 1:
210 BYERLYS CHAPEL ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 2 BYERLY CHAPEL EST
Fire Response District
SCOTCH - IRISH
Assessed Acreage:
2.22
Elementary School Zone:
COOLEEMEE
Deed Date:
6/2012
Middle School Zone:
SOUTH DAVIE
Deed Book I Page:
008930355
Soil Types:
GnB2
Plat Book:
0007
Flood Zone:
Plat Page:
185
Watershed Overlay:
DAVIE COUNTY
Building Value:
71110.00
Outbuilding & Extra
0.00
Freatures Value: .
Land Value:
12600.00
Total Market Value:
83710.00
Total Assessed Value:
83710.00
gt.vl�. All data Is provided as Is whhoutwerramy, or guarantee or any Idnd eNheresq'ssed or Implied Including but not limited to me
Davie County, Implied wamntles mmerohadabll ywflNeaa fora particular we All uses of Gads CoumyaGlS webabe shall hold ha mless tha
County or Cavle, North Carolina, Its agents, conwhama, wobadora or employees from any and all dslms or causes of action dua to
�CUN't NC or arising outofthe use or Inability to use the GIs data provided by this vebsite.
DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002040 Tax PIN/EH #: 5717-50-8867.02 SH
Billed To: ScHult Housing Advantage Subdivision Info: Byerly Chapel Est. Lot # 02
Reference Name: Location/Address: Byerly's Chapel Road -27028
Proposed Facility: Residence Property Size: 2.19 acres
ATC Number: 3734
**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 I1 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
Dishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type . #Peeoople #People/Shift #Seats Industrial Waste:
Lot Size Type Water Supply ! Design Wastewater Flow (GPD) Site: Nev;.121`0�Repair ❑
System Specifications: Tank SizeGAL. Pump Tank GAL. Trench Width � Rock Depth Linear Ft.5`�
Other:
Required Site Modifications/Conditions:
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 theda of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002040
Billed To: Schult Housing Advantage
Reference Name:
I:L-1-9tfta11*1
ATC Number: 3734
Tax PIN/EH #: 5717-50-8867.02 SH
Subdivision Info: Byerly Chapel Est. Lot # 02
Location/Address: Byerly's Chapel Road -27028
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 COW4U TI I� IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: //`QQ''�� / Date:
CERTIFICATE OF COMPLETION
The issuance of this Certificate of ComplImprovement/Operationit
has been installed in compliance with Article 11 of I.S. h to 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be tak s gu an that the system will function satisfactorily for any
given period of time.
`pS .ti's -�
a �� •
Septic System Installed By:
Health Specialist's Signature :
DCHD 05/99 (Revised)
rvl APPLICATION FOi
D
P.O.
E EVALUATION/IMPROVEMENT
County Health Department
'onmental Health Section
: 848/210 Hospital Stre
--ksville, NC 27028
(336)751-8760
Poo? o E Lbw
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS'ALL THE REQUIRED
INFORMATION IS PPRROVIDE^D. l !Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed �]i6� /1 SLh O-7H�.YvI Contact Person ti trry 5...I L
Mailing Address 3? T
A )
City/State/zip /r1a ,$ ✓� ( .Q
Name on Permit/ATC if Different than Above
2
Mailing Address
3. Application For: ❑ Site Evaluation
a. system to service: ❑ House Mobile Home
IS. I£ Residence: # People
Dishwasher U Garbage I
6. If Business/industry/Other:
# Commodes
Home Phone
Busi/n9.g�s� �Ph�on�e 2 a 4- 4t a L- 1 8 3 6
City/State/Zip
❑ Improvement Permit/ATC
❑ Business ❑ Industry ❑ Other
# Bedrooms
Disposal ` washing Machine U Basement/Plumbing
Specify type # People _
# Showers # Urinals
IF FOODSERVICE: # Seats
7. Type of water supply:
A Both
# Bathrooms —11
II Basement/No Plumbing
# Sinks
# Water Coolers
Estimated Water Usage (gallons per day)
❑ County/City K Well _ LI Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Yes 7,IV0
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BBSUBMITTED by the client with THIS APPLICATION.
Property Dimensions: I. I R 04.r -.Q- WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: #57/7—SO —$g67 HW (e'{ Qt (Z, w. Cr. reew.i I Rel.. 1Z. e.v
Property Address: Road Name PJ G!I l Ady�t Q e9t�a _v 1 L� 0� Mf NanYy
City/Zip 2d o� 0 0. Sww"��+ n , a ¢.JRA 7_
If in a Subdivision provide information, as follows: C_14h�OCI (�do 0� Z*.i �2
Name:
Section: Flock: Lot: � Date Property Flagged:
3 sJ
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. 1, 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 2 D fia st L 0 SIGNATURE .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).
Revised DC HD (07/99)
Date(s):
EHS:
Account No. C:Z / y��"
Invoice No. �� 7'�
\ bullldings or atruc
• "\ - Director. Davie Cc
The Davie County Planning t
\ the final plat for the_'E
Subdivision.
b `
Data
Chairman, i
f
1 \
2.185 Acres +/—
S
�1
2js�0 O s��e
<\ 1.485 Acres +/— �X•r
3 I0,
368.22' N
L_2 L-1
Mr. Henry Road -.
t
1 (we) hereby certify that i am (we are) the owner(a) of the property
deuribed hereon, which is located N the subdivision )udadicdon of
Dans County and that1 heMry adopt thiseubdhdslon plan with my free
consent, eetaWWW minimum-b lidl" setback lines and dedicate as
streets, a6syc, we", parka and VOW AM and sasemente to pubf+c or
privote use as noted. - - SCA
agne0 Owners:
Date Wayne M. Waller, Sr.
Mary. T: Wailer
etryred
" APPLICATION FOR SITE EVALUATION/IMPROVEMENT PEI
Davie County Health Department
Environmental Healtii Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
( (336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLE
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLE4
l.. Name to be Billed lli�n /ot/.rll I/VQ Illi✓
Mailing Address M r/R -/"Ylr j�/�n 1{�/Aa��d
City/State/ZIP ►/Inccsyi Ile /� fC (Jl-Ma$
2. Name on Permit/ATC if Different than Above
Mailing Address
Contact Person
Home Phone
pat -Ci—/ ;k- —a /
JUN 1 2001 � Dt
Business Phone 161' 95/171
City/State/Zip
3. Application For: 'Site Evaluation ❑ Improvement Permit/ATC ❑ Both
4. System to Service: X House X bile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People ZZ # Bedrooms i Bathrooms
O Dishwasher ❑ Garbage Disposal D Washing Machine ❑ Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/Other: Specify type
# Commodes
# Showers
# People # Sinks
# Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: ❑ County/City q Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo
If yes, what type?
***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: # Jr%l7`Jr0—/�gOwe/
}%'- o v
Property Address: Road Name 13t�EVI U (�tY� I FCl
City/Zip � SpI d l' f& oZ`/D
If in a Subdivision provide information, as follows:
Name:
TT_r
Section: Block: Lot: O
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Myle,
mI 1)" • leh Q
11. ►�-Bqe�-
proppr4VII ♦I ai
P26 N4 6iCtn)i' # 1/ 4 ~
I
Date
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
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 Da +ie County Health Department
to enter upon above described property located in Davie County and owned by •l
to conduct all (testing procedures as necessary to determine the it�tis ility.
DATE U�l D SIGNATU
THIS AREA MAY BE USED FOR DRAWING YOUR STTE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Revised DCHD (07/99)
Account No.
Invoice Na dL 3 3
DAVIE COUNTY HEALTH DEPARTMENT
" ` + Environmental Health Section
Soil/Site Evaluation.
APPLICANT INFORMATION.a PROPERTY INFORMATION
•
Account #: 990001771 Tax PIN/EH #: 5717-50-8867.02 .
Billed To: Wayne & Mary Waller, Subdivision Info: Byedy Chapel Est. Lot # 02
Reference Name: Lobation/Address: Byerly's Chapel Road -27028
Proposed Facility : ' Residence 113roperty Size: see map, •;. Date Evaluated: � :5
Water Supply: On -Site Well Community Public
By: g g t
Evaluation B 1 Auger Bonn Pit Cu
FACTORS 1_'- 2 3 4 5 ... 6 7:
Landscape position L
'Slope %
HORIZON I DEPTH c ii
Texture groupL
Consistence
Structure
Mineralogy
HORIZON II DEPTH IYV f, . 1W.
Texture group
Consistence r
Structure _ k.
Mineralogyr
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: PS EVALUATION BY:
IV
LONG-TERM ACCEPTANCE RATE: / 0THER(S) PRESENT:"
J.
REMARKS:'
a PositionEGEND
Landsca
p L
R - Ridge S - Shoulder L - Linear slope - - FS - Foot slope N - Nose slope
P.. �'... P .. P
CC - Concave sloe CV - Convex'slope T - Terrace FP - Flood lain 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
'..', TENCE
VFR -Very friable FR - Friable FI -Firm VFI - Very firm EFI
' -Extremely firm
NS Non stick SS -Slightly htl stick S y
Vet
Y g Y Y Stick 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
Mineralogy
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
DCHD 05/99 (Revised)
■■
■■■
NEON
MEMO
■■ ■
MEMO
■
..I
DihhIE, OUNTY.HFJUTH DEPARTMENT.. _ a
Environmental Health Section
P. 0. Box 848/210 Hospital Street
Courier 09-40-06
Mocksville, NC 27028
^;:.. `(33ti)7518760 a
June 6, 2001
Wayne and Mary Waller
548 Mr. Henry Road
Mocksville, NC 27028
Re: Site EvaluationsByerly Chapel Estates, Lots 1 and.2
Tax Office PIN: #5717-50-8867
Dear Mr. and Mrs. Waller:
As requested, a representative from this office visited the aforementioned site on,
June 5, 2001. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the sites were found to be
provisionally suitable for the installation of on-site sewage systems.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
$obert B. Hall, Jr., R.S.
Environmental Health Specialist
RBH/dli
Enclosure(s)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account; #; 990002040 Tax PIN/EH #: 5717-50-8867.02 SH
Billed To: Schult Housing Advantage Subdivision Info: Byerly Chapel Est. Lot # 02
Reference Name: Location/Address: Byerly's Chapel Road -27028
Proposed Facility: Residence Property Size: 2.19 acres Date Evaluated:
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
SITE CLASSIFICATION: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: - OTHER(S) PRESENT:
REMARKS: .. .
LEGEND
Landscape Position
R - Ridge S - ShoulderL - 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
VFR - Very friable FR - Friable FI - Firm' VFI Very firm EFI - Extremely firm
Wet
NS -Non sticky SS -Slightly sticky S - Sticky ' VS - Vey 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
Mineralogy
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
DCHD 05/99 (Revised)