183 Bentbrook Drive Lot 12Davic County, NC 1 'Fax Parcel Report Thursdav, October 20. 2016
State:
Zip Codi:
Legal Description:
Assessed Acreage:
Decd Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Lang Value:
Total Assessed Value:
NC
V11--l~i11\tea t=Z*aJ i-- 1-1 U1 f1 AJViM V Z,Y
27005-0000
Voluntary Ag. District:
No
LOT 12 BENTBROOK
Parcel Number:
G806OA0012
Township:
Shady Grove
NCPiN Number:
5880016283
tlunicipality:
WILLIM.1 ELLIS
Account Number:
8439000
Census Tract:
37059-804
Listed Owner 1:
BOLIN BENNIE LEE
Voting Precinct:
EAST SHADY GROVE
r0ailing Address 1:
183 BENTBROOKE DRIVE
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning, Class:
DAVIE COUNTY 1-1,R-20
State:
Zip Codi:
Legal Description:
Assessed Acreage:
Decd Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Lang Value:
Total Assessed Value:
NC
Zoning Overlay:
27005-0000
Voluntary Ag. District:
No
LOT 12 BENTBROOK
Fire Response District:
ADVANCE
1.80
Elementary School Zone:
SHADY GROVE
1211995
F idd!c School Zonc:
WILLIM.1 ELLIS
001910195
Soil Types:
WeC,WeB
0006
Flood Zone:
112
VvIatershed Overlay:
DAVIE COUNTY
205890.00
Outbuilding & Extra
3300.00
Freatures Value:
40000.00
Total Llarkat Value:
249190.00
249190.00
All data is provided as is vgthout warranty or guarantee of any kind either expressed or implied Including but not limited to the
9 ; [-avii.''- County, 1 implied warranties of merchantati � y or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
i �T I Countyof Davie, Nort7i CarG:ina, its agents, consutfants, contractors or employees from any and all claims or causes of action due to
nUN'� E i f or arising out or the use or inabiiity to use Lite Gi5 dais provided by this website.
i
=I
DAVIE COUNTY HEALTH DEPARTMENT
:.� }
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT' PERMIT
• DO
**NOTE** This improvement permit DOES NOT authorize the construction or installation 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)
NAME PROPERTY ADDRESS /6.�2('617 (v"N��f �! (•' V,: J
DATE
LOCATION
SUBDIVISION NAME G<i LOT NUMBER SEC./BLOCK NUMBER %
RESIDENTAL SPECIFICATION: BUILDING TYPE ddCi f # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE /1G TYPE WATER SUPPLY //'P DESIGN WASTEWATER FLOW (GPD) NEW SITE � REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE /.4/,b GAL. PUMP TANK �I GAL. TRENCH WIDTH 4 ROCK DEPTH ,'7, LINEAR FT. :12L
OTHER 1.
R6UIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MAST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY ,%,f✓tJ
**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 (704) 634-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
F -D F-)e!u
i
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Q_ y
AUTHORIZATION N0. 1__Aj 1 i j OPERATION PERMIT B /'��� - _x DATE —
r; ,
**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 10/95}
�N
IMPROVEMENT PERMIT BY ,%,f✓tJ
**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 (704) 634-8760.
OPERATION PERMIT SYSTEM INSTALLED BY
F -D F-)e!u
i
�^r
n ,
Q_ y
AUTHORIZATION N0. 1__Aj 1 i j OPERATION PERMIT B /'��� - _x DATE —
r; ,
**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 10/95}
• APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P 2 Onn
Davie County Health Department D L5 lJ
Environmental Health Section
;�V
�� P. O. Box 665 DEC 2 7 199•i
Mocksville, NC 27028
4 l
1. Application/Permit Requested By
Mailing Address 1,",'42 �
Home Phone gaQ�-2 Oaf o�
Business Phone
2. Name on Permit if Different toan Above
3. Application for: ❑ General Evaluation a Septic Tank Installation Permit
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: SubdivisionSection Lot # �2
❑ BasemenUPlumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms y
No. of Bathrooms
Dwelling Dimensions 7517
6. If business, industry, place of public assembly, other: Specify type
No. of People Served '7
No. of Commodes J
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
7. Type of water supply: Public ❑ Private ❑ Community
8. Property Dimensions G tic.-,eff - Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? OP Yes .R3 No
If yes, what type?
'NOTE: . Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989. , 1
Directions to Property:
This is to certify that the information provided is correct to
incurred from this application.
o� 7
TE
PROPERTY INFORMATION REQUIRED:
Tax Office PIN #
Road Name
Box # (if available)
City
of myJgkowledge, and I understand I am responsible for all charges
TURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: "P 1. 1 OWN the property. ❑ 2. 1 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.
ATE
DCHD (1193)
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EASEMENT 59 147.6'1'' N y ur y
)IUS TANGENT DELTA CHORD CH•BEARING • ' ' N 86925'09
60.00' 21.54' 39029'56" 40.55' N 74023'28"E CURVE RADIUS TANGENT r' DELTA CHORD`
'30:00', 13.42' 48°11'23". 24.49' N 70°02'44'E
X20:00'. 9.61.' 51°19'04" 17.32' S 18°36'35'W
130.00'- 15.39'• 5°20'25" 30.75' S 04"22'45"E C-24 60.00' 34 84' '' 60°16'SC:';. 60
70.00' ' ' 10.31.' 4°22'20" 20.60' N 04°51'47"yy C-25 :'30.00' 13 42' `, A$°11.'23'.'. 24 ;
20.00' 9.61' . 51 019'04" 17.32' N 32°42'29"W C-26 381'.36' 72.53' 21°32'15" .141.
21.36' 61.12' 21032'15" 120.09' N 35°10'55"E
C-27. 20.00' •.' 20 00 190°.00'00", .28.
30.00' 13.42' 48°11'23" 24.49' N 00°19'06"E . C-28 470.00' : 83 89' ': ti20°14'24" 165
60.00' 98.30'. 117°12'04" 102.43' N 34°49'26"E C-29 330.00' 73.86- 25°13'55" 144•
34.26" 59026'46" 59.50' S 56051'09"E C-30 20.00' 18.37' 85°08'46" '27,1
;60.00' 21.51' 39027'00" 40.50' S 07024'16"E
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EASEMENT 59 147.6'1'' N y ur y
)IUS TANGENT DELTA CHORD CH•BEARING • ' ' N 86925'09
60.00' 21.54' 39029'56" 40.55' N 74023'28"E CURVE RADIUS TANGENT r' DELTA CHORD`
'30:00', 13.42' 48°11'23". 24.49' N 70°02'44'E
X20:00'. 9.61.' 51°19'04" 17.32' S 18°36'35'W
130.00'- 15.39'• 5°20'25" 30.75' S 04"22'45"E C-24 60.00' 34 84' '' 60°16'SC:';. 60
70.00' ' ' 10.31.' 4°22'20" 20.60' N 04°51'47"yy C-25 :'30.00' 13 42' `, A$°11.'23'.'. 24 ;
20.00' 9.61' . 51 019'04" 17.32' N 32°42'29"W C-26 381'.36' 72.53' 21°32'15" .141.
21.36' 61.12' 21032'15" 120.09' N 35°10'55"E
C-27. 20.00' •.' 20 00 190°.00'00", .28.
30.00' 13.42' 48°11'23" 24.49' N 00°19'06"E . C-28 470.00' : 83 89' ': ti20°14'24" 165
60.00' 98.30'. 117°12'04" 102.43' N 34°49'26"E C-29 330.00' 73.86- 25°13'55" 144•
34.26" 59026'46" 59.50' S 56051'09"E C-30 20.00' 18.37' 85°08'46" '27,1
;60.00' 21.51' 39027'00" 40.50' S 07024'16"E
h
1.
APPLICATION FOR SITE EVALUATIOWIMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, NC 27028
Mailing Address
2. Name on Permit if Different than Above
3, Application for. General Evaluation O Septic Tank Installation Permit
4. System to Serve: House5 ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑dustry ❑ Other ❑ Unknown
S. If house, mobile home: Subdivision e-h;4r00 � Section Z Lot # ZQ
No. of People
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 Sinks
No. of Urinals
❑ BasemenUPlumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: 121 Public ❑ Private ❑ Community
8. Property Dimensions _ ~ 2,eq Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem Is Intended to serve? ❑ Yes ❑ No
If yes, what type?
'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.
DATE
[�Z!P►���11T��7��iT��l1>�sl'jiLel►�%�=I��Zi ► • ► � : • � ; : � - - � - : ti
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 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:
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 said site's suitability for a ground absorption sewage treatment
and disposal system. .
DATE
WHO PAM
SIGNATURE
+ '{ •• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
So /Site Evaluation
NAME 9`�7 �rc�,� / -
ADDRESS
PROPOSED FACIILTY✓�/�f C
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Water Supply: On -Site Well Community Public f1�
Evaluation By: Auger Boring Pit t/_ Cut
FACTORS
1
2 3 4
Landscape position
Sloe Z
HORIZON I DEPTH
Texture groupS
G
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC�
C'
Consistence
r
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S
LONG-TERM ACCEPTANCE R.ATEJ
I3
SITE CLASSIFICATION: _ /rY EVALUATED BY: —Ila e��
LONG-TERM ACCEPTANCERATE- OTHER(S) PRESENT:
REMARKSf�� /�/�>7 Dr i/d/�/il�l�»�,✓
LEGEND
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
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
DCHD(01-901
}
Davie County Health Department
ENVIRONMENTAL HEALTH SECTION . 3V
P.O. Box 665 _
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEW 4--SYSTEN CONSTRUCTION;'
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***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.*** /
P% DATE �j��®�'� AUTHORIZATION�NUMBER
NAME i l'� Ar/J' i/I .Y 1112 J� 171
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION
COMKNTS/CONDITIONS ON AUTHORIZATION D/CONSTRUCT WASTEWATER SYSTEM
***NOTICE*** THIS AUTHORIZATION FOR WA 5TE 7ER SY�S'T"EMM CONSTRUCTION I5 VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE
DCHD 10/95