121 Bentbrook Drive Lot 1Davie County, NC Tax Parcel Report Thursday, October 20, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book ! Page:
Plat Book:
Plat Page:
Building Value:
WA-RN1NC-'• !'H!S 1S NOT A SURVEY
Parcel lnlbrtnation
G8060A0001 Township: Shady Grove
5880103546 Municipality:
82521235 Census Tract: 37059-804
BAILEY MICHAEL W Voting Precinct: EAST SHADY GROVE
121 BENTBROOK DRIVE Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY 1-1,R-20
Land Value:
Total Assessed Value:
NC
Zoning Overlay:
27006-7287
Voluntary Ag. District:
LOT 1 BENTBROOK
Fire Response District:
1.00
Elementary School Zone:
7/2003
Middle School Zone:
005000111
Soil Types:
0006
Flood Zone:
112
Watershed Overlay:
152190.00
Outbuilding & Extra
Freatures Value:
40000.00
Total L111arket Value:
210380.00
ADVANCE
SHADY GROVE
WILLIAM ELLIS
PcB2
DAVIE COUNTY
18190.00
210380.00
No
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I County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
nC U N'�y
NC !{ or arising out of the use or Inability to use the GIS data provided by this webslte,
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001730
Billed To: E.R. Beauchamp Builders
Reference Name:
Proposed Facility: Residence
Tax PIN/EH #: 5880-10-3546
Subdivision Info: Bentbrook Lot # 1
Location/Address: Bentbrook Drive -27006
Property Size: 1 acre
* * NOTE * -This Nprovement/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 7� #People #Bedrooms #Baths "-s
Dishwasher: )2r"' Garbage Disposal:.0 Washing Machine: 000' 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) "' ed Site: New -Er Repair ❑
System Specifications: Tank Size /W GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Widt�Rock Depth Linear Ft.�Qjl
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISERS) IF 6 u 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 da 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. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001730
Billed To: E.R. Beauchamp Builders
Reference Name:
Proposed Facility: Residence
ATC Number: 2832
Tax PIN/EH #: 5880-10-3546
Subdivision Info: Bentbrook Lot # 1
Location/Address: Bentbrook Drive -27006
Property Size: 1 acre
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 WASTEWATfk CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature:.;vv �I , -1 ": 4,14e Dater ff
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. �
P
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
R.-
APPLICATION FOR SITE !+VALUATION/IMPROVEAIENT PERMIT & ATC
Davie County Health Department
Environmental Health Section N 3
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 ENVIRONMENTAL H
(336) 751-8760DAVIE W,
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS
PROVIDED. Refer to
the INFORMATION BULLETIN for
innstruct)iions.
1. Name to be Billed
Vc /74
f/ c� S Contact Person
L n
�/i�i �'� Pte{ .tJ e,aUL ILL
f/ ! /
L
1—
Mailing Address
Y s ! e ✓✓i./
Home Phone
YQ�
/�
City/StatejZIP
ftdt/A✓>LL IuC� Z7DUto
Business Phone _'/�IL3�'71�/}
g�
2. Name on Permit/ATC
if Different than Above
Mailing Address
3. Application For: (Site Evaluation
Cltty/State/Zip
•H/Improvement Permit/ATC
4. system to service: VHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
L
s. If Residence: # People # Bedrooms # Bathrooms _ Z
I.Io"Dishxasher 11 Garbage Disposal LeWashing Machine U Basement/Plumbing l:l Basement/No Plumbing
6. If Business/Industry/Other: Specify type L# People
# Commodes # Showers
# Urinals
# Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: El County/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes U -No
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION.
Property Dimensions: —Jacy"t--
Tax Office PIN: # 1B n %Q "
Property Address: Road Name 13&7 by-6ok
City/Zip ✓iCe,
If in a Subdivision provide information, as follows:
r.
II ,
Name: &0 T 6ron
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksvillee)) to PROPERTY:
-.r P1, /-o L f16 14 Ile �P
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. 1, also, understand that 1 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 ° `7NATURE
TH" 'VAN (Include all of the following: Existing and proposed
cations).
Site Revisit Charge
Datc(s):
Client Notification Date:
Account No. I / as
Invoice No.
4u�yy
(POO,
89,
60,
N
ACRES /olv_Ov
2'
O
RZ�
C29
C3
/o.(��
1.0001 ACRES
348.51
N 86025109"W 496.13'
DELTA CHORD CH.BEARING
60016'56" 60.26' S 42°27'42"W
48°11'23" 24.49' S 48030'29"W
21032'15" 142.51' S 35°10'55"W
90000'00" 28.28' S 00°57'03"W
20014'24" 165.17' S 54°10'09"E
-25013'55" 144.15' S 51040'2311E
85008'46" 27.06' S 79052'38"E
3. CONTROL CORS
THE, NORTH WE
4, ' - 28.75' ACRES
5. 19 LOT 1.3 4
1 A 6.. FEMA COMMU
7s3so091F NO FLOOD Hi
7. ZONING 20R
o,�s 97.5 SQ.FT. 8, . LOTS SERVED[
�o �� o
°'
o 100
\ ooh
S 83007.0 „E � ,�;
8.78' �45.0
�. GRAPHIC SCAL
C3 0
�00, A co,
MAP ;
c1� �•' �o_, FOR .
o�� SCALE TO
°���� 1 p 100' $A
C. T." ROBERTSON AN
P.40BOX' .168 . ADVAN(
\�2
P.O. BOX 276 A
F�
1. Application/Pern
Mailing Address
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Boz 665
Mocksville, NC 27028
2. Name on Permit if Different than Above
3. Application for: XGeneral Evaluation ❑ Septic Tank Installation Permit
4. System to Serve: Houses ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Jodustry / ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision`-- -'/ 4-'-00 . Section Lot #
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms _
No. of Bathrooms _
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks _
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: ❑" Public ❑ Private
8. Property Dimensions Sewage Disposal Contractoi
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
❑ Yes ❑ No
❑ Community
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
-4V--2--t2-!-52K
DATE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. I OWN the property. ❑ 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (1193)
ll
' DAVIE COUNTY HEALTH DEPARTMENT. to
Environmental Health Section
Soil/Site Evaluation
NAME 9'z24?;L �el
ADDRESS
PROPOSED FACIILTY &AI,
DATE EVALUATED W- /-Cl S
PROPERTY SIZE /.6C
LOCATION OF SITE /5.gl1 4W,,
Water Supply: On -Site Well Community Public t/
Evaluation By: Auger Boring Pit f/ Cut
FACTORS
1 2 3 4
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
11- -?->`
Texture group
/111G
Consistence
Structure
i1 6 /Cl
Mineralogyi
.-
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: EVALUATED BY:
LONG-TERM ACCEPTANCE RA
REMARKS: _P.�%/✓ten
DCHD (01-901
OTHER(S) PRESENT:
LEGEND
Landscape Position
R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope
CC-ConcavP Onne. 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
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