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205 Bentbrook Drive Lot 14Davie County, NC. 1, 'lax Parcel Renori ThUrsdav, October 20, 2016 Parcel Plumber: NCPiN number: Account Number: Listed Owner 1: Mlailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Dccd Datc: Deed Book 1 Page: Plat Book: Plat Page. Building Value: G806OA0014 Tovmship: Shady Grove 5860019417 Municipality: 46037090 Census Tract: 37059-804 LONDON THOMAS MARK Voting Precinct: EAST SHADY GROVE 205 BENTBRO01< DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY 1-1,P.-20 Land Value: Total Assessed Value: NC Zoning Overlay: 27006-7294 Voluntary Ag. District: LOT 14 BENTBROOK Fire Response District: 1.06 Elementary School Zone: 7/2005 Middic School Zone: 006180911 Soil Types: 0006 Flood Zone: 112 V..'atershed Overlay: 148770.00 OutL--ilding S Extra Freatures Value: 40000.00 Total Market Value: 193510.00 ADVANCE SHADY GROVE WILLIAM ELLIS WeC,WeB DAVIE COUNTY 4740.00 193510.00 • nY ♦ I No All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the i County, I implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the ' - is agents, consultants, contractors or employees from any and all claims or causes of action due to y y to use the GiS data provided by this websile. ,.........,_ ____._.._�....__._...�.�..._.__......__.....___�,......__..__, ooin"ofDatoflh�useormauu+l..._._.�,..._.._.._v.,�.._._.._»....._,_._.......�_.....______.__._.,_._____......_..____....._.�..,._.__.�_..__._,....._.._, County _ _ - ,4.�-Cie AUTHORIZATION NO: DA16VIE OUNTY HEALTH DEPARTMENT rQ Environmental Health Section PROPERTY INFORMATION Permittee s—. . ,�✓ P.O. Box 848 _ ,r Name: yw'A�1" Mocksville, NC 27028 Subdivision Name: e� Phone # 336-751-8760+ Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATERy 'm SYSTEM CONSTRUCTION Tax Office PIN:44T - ' Road Name: Zip: **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 FonrdAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION G -4 };. ` ,� �� ' IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED DAVIE qOUNTY HEALTH DEPARTMENT . r1 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION .A Name: Subdivision Name:.t.i,*1,�t� T Directions to property:: x� Section: 1� Lot: A, IMPROVEMENT PERMTT Tax Office PIN:# `" W/ Road Name: ip: **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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE <_ PLANS OR THE IN ENDED USE CHANGE YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS J # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPES # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE. -REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1a:�—)GAL. PUMP TANK GAL. TRENCH WIDTH -Ft' ROCK DEPTH LINEAR OTHER // L /! /I C.;: / ` !r%� E REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "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. OPERATION PERMIT S-1? h� SYSTEM INSTALLED BY: g AUTHORIZATION NO. �.� OPERATION�� PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED W COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A; SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05196 (Revised) APPLICATION FOR SITE EVAUlAT10N/IMPROVEMENT PERMIT C Davie County Health Department EnvironmentalIfealth SL-cffon P.O. Box 848/210 Hospital street a7GJr 2 5 Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH I ***Ii PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I ` INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. e,. 1. Name to be Billed Contact person Nailing Address v /(/ ?IHome Phone City/State/ZIP C. -i /VC- - 27oo c, Business Phone 2. Name on Permit/ATC if Different thanAbove__ _ z0-/- 417 �Nrj %jr-nnK Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 4. system to Service: k Nouse ❑ Mobile Home 5. If Residence: # People Improvement Permit/ATC ❑ Both ❑ Business 0 Industry ❑ Other # Bedrooms _1 # Bathrooms Dishwasher 0 Garbage Disposal JV Washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sims # Commodes # Shovers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated hater Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes *No If yes, what type? ***IMPORTANT"** CLIENTS AIUST COAfPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBMI17ED by the client with THIS APPLICATION. Property Dimensions: /f' WRITE DIRECTIONS (from Mocksville�) to PROPERTY: Tax Office PIN: # �� tll ��� / ! . GY1 / f�� %�� 7�0 ?0 So 4,A 7t1 Property Address: Road NameaQ&,Tr&�YA;11-0 oT_/��P� City/Zip f✓l�/I t�'� Yi©�7S oh G/�����1onK �D//oma di` 17,��/`,Q�� If in a Subdivision provide information, as follows: �y ,�� �P '5ek- la n n l� ✓ Name: _7 eA-ry a/ Section: Block: Lot: /V Date Property Flagged: eebb Mott • um'-�- 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 1 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 sultabillm DATE % J�-/ 0 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the foftwing: Existing and proposed property lines and dimeusions, structures; ,setbacks, and septic locations). Account No. Revised DCHD (07/98) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME lt_2/7 a�tb% ADDRESS PROPOSED FACIILTY Av&_1-1— DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public -t---' Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position 2— Sloe % Slope Y HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH t �G Texture groupL� Consistence i Structure 12 /C 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: �� EVALUATED BY: ,&—AIZ LONG-TERM ACCEPTANCE RATE: REMARKS: c/,-e4�ku t //' Z DCHD (01-901 OTHER(S) PRESENT: 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 3C -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 watet' 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 . .14 8oi11�•470.0' 40.16' /�� !Q•D0� :'.. •� v�\iV�i r� v 3344 JJ J � w ��� • f� 233.84 Eo 10. 113 , fj 13 ?� 1.0241 ACRES o t; 1.8296 ACRES C21r \ , .0 ROS `�`y 1 E 4i o C23 z t , , AS o C20J S ry o �a✓ a N, 1.6120 ACRES 25 Ct,. R ° rya °�(�•/. '.. ••I �' ^ y.yi, •Ihv , A/ _ I t . Off/ ` ca r I >�t� s 1.6125 ACRES �, • ; �, �-.` '� r .7 �h�°r 1:0108 'ACRES to 20'j' DRNNAGE EASEMENT I '10' EAM SIDE. OF CREEK 1:6533, ACRES ,. s .. .a ..� / °, / 1� ,� � // '� �•7Y • do T r t• r. +. y� �o�r� �o' /^ .-o l0, 1.0100 ACRES . t �G ydi� / •A O C5 'ro, Ao C�4 CJ C13._ - JC 1.0001 ACRES lip C10♦ C9 15 r°a cb'0 44 I h i+`i�E• : moo° ;P O� ..ev �Q• m70v 1.6723 ACRES •' .� , -ACRES-*"wry 1.2525 ACRES 1:0001. z.�: C17 -X0.21' C16 196.68' ' 77 87.21'5 1 "W EMENT 88 .6T N 193.04' 30.59' f/lg,- � '"iiADIUS TANGENT. DELTA CHORD CH BEARING "'"` N 86025109 .60.00' 21.54' 39°29'56" 40.55' N 74023'28"E CURVE RADIUS TANGENT ;:DELTA ' .. CHORD .;:•.3000' 13.42' 48°11'23" 24.49' N 70002'44"E �`20:00' .9.61.' 51°19'04." 17.32' S 18°36'35"W600.16156!1.'~ �a C-24 60.00 34.84 60.'`. "330.00 15.39 5020'25 30.75 S 04022'45"E" C-25 30.00' ° " t 270.00' 10.31' 4°22'20" 20.60' N 04°51'47"W 13.42 4$.111 23 • 24. C-26 381.36' 72.53. `21`32:15" 142 20.00 9.61 51019'04" ° �� 17.32 N 32 2 29 W C-27 20.00' 20.00' :'90°00'00" ; 28 61.12' 21032"15" 15" 120.09' N 3501055"E C-28 470.00.' 83.89:.-"'.""':',' 3.89': • 20"14'24 165. 13.42 48 11 23 24.49 N 00019'06"E C-29 330.00' 73.86' 25.13'55" 144.1 '60.00' 98.30' 117012'04" 102.43' N 34049'26"E C-30 20.00' 18.37' 85°08'46" 27X :. 60.00' 34.26' 59026'46" 59.50' S 56051'09"E W.W. 21.51' 39°27'00" 40.50' S 07°24'16"E ; T. 1. APPLIPATION FOR SITE EVALUATIONIIMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 Business Phone 2. Name on Permit if Different than Above 3. Application for. General Evaluation O Septic Tank Installation Permit 4. System to Serve: 0 Houses ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑IF-h ustry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision -T /'o0� Section Z Lot # O 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 Sinks No. of Commodes No. of Lavatories No. of Showers —/ 7. Type of water supply: to Public No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private 8. Property Dimensions _'1-02 � Sewage Disposal Contractor ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is Intended to serve? ❑ Yes ❑ No If yes, what type? ❑ 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 1 am responsible for all charges Incurred from this application. DATE 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: 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. . DCHD (IRM DATE SIGNATURE