154 Greenfield Road Lot 11Davie County, NC
Tax Parcel Report Monday, December 19, 2016
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9amyAAg dab, Is provided as Is without mnardy or guarantee of any Idnd elNereapressed or implied Including but not [Imbed to the
Davie County, Impliedura w "of merehantablity orfltness form pargwlar um All users of[krde County's GIS websge shall hold harmless the
County or Davia, North Carolina, lis agents, consultants, wrNactors oremployees from any and all dabas orcauses of action due to
nOb N2 NC or arising out ofthe use or inabifdy to use the GIS data provided by this vmbslte
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
D301OA0011
Township:
Clarksville
NCPIN Number:
5822146840
Municipality:
Account Number:
82523220
Census Tract:
37059-801
Listed Owner 1:
COOK TERESA W
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
154 GREENFIELD ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R -AR -20
State:
NC
Zoning Overlay:
Zip Code:
27028-4769
Voluntary Ag. District:
No
Legal Description:
LOT 11 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
1.04 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
8/2004
Middle School Zone:
NORTH DAVIE
Deed Book IPage:
005670017
Soil Types:
MnB2,MdE
Plat Book:
0007
Flood Zone:
Plat Page:
0190
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
9amyAAg dab, Is provided as Is without mnardy or guarantee of any Idnd elNereapressed or implied Including but not [Imbed to the
Davie County, Impliedura w "of merehantablity orfltness form pargwlar um All users of[krde County's GIS websge shall hold harmless the
County or Davia, North Carolina, lis agents, consultants, wrNactors oremployees from any and all dabas orcauses of action due to
nOb N2 NC or arising out ofthe use or inabifdy to use the GIS data provided by this vmbslte
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
- _ - - - - Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002706 Tax PIN/EH #: 5822-14-6840
Billed To: Jeff Hayes Subdivision Info: Dutchman Hills Lot # 11
Reference Name: Location/Address: 154 Greenfield Rd -27028. .
Proposed Facility: Residence Property Size: 1 acre
ATC Number: 3615
**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 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 e �#People #Bedrooms
Dishwasher: Er .Garbage Disposal: M/ /� 3�#Bc�atFhis
1 /Ztp
Washing Machine: E?r Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type "My
� � M �#P,eople #People/ShiB #Seats Industrial Waste: 13Lot Size �• Type Water Supply l.(-J(]Design Wastewater Flow (GPD) ASite: New Repair 3oor
rt n
System Specifications: Tank Size IDMGAL.,,�Pump
,Tank
, GAL.
Trench Width Rock Depth 12 Linear Ft.
IT
Other: I`7/I�Ir olof �_J
Required Site Modifications/Conditions: I/J�rA(L (� ✓/ Dl✓igCEcJgT�2, F-rtA' E1
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
em between :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.****
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Environmental Health
Signature:
Date:
DCHD 05/99 (Revised) l
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002706
Tax PIN/EH #:
5822-14-6840
Billed To: Jeff Hayes
Subdivision Info:
Dutchman Hills Lot # 11
Reference Name:
Location/Address:
154 Greenfield Rd -27028
Proposed Facility: Residence
Property Size:
1 acre
ATC Number: 3615
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization far 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 WASTEWA U AL FORA PERIOD OF FI ARS,
Environmental Health Specialist's Signature: te:
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.
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rtalled
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"MOTEnvironmental Health Specialist's Signatur Date: tsk
DCHD 05/99 (Revised)
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• County ID. 03010A001I
- - • Amoun/Nember.D3010A0011
• PIN:5822148840
• Legal LtOT 1t OUTCHMM HILLS
• Owner Name: CANA GROUP LLC
• OwtW1Addre86 l: CANA GROUP LLC
e aim w1Address 21870 UNDERPASS ROAD
e ').,n.n7Addnass 3:
— .i:.—i.5:0ta zip: ADVANCE, NC 2-7006
a ;and Va0x. S12,000A0
ea:was Vdrve:30-00
. o A; Sod Va:de: S12,000.00
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Dead 86ok(Pago: 00335/0341 -
•
DeedDale:200010528
•
Sales Price:S0.00 -
•
PropemyAddress
000154 000154 RD
•
County7onmg: R-20
•
Census Cede.
•
City Coda:
•
Fire Dishict -
•
, Flood Zane: ZONE X
•
Hood Community.' 370308
•
Flood Panel'. 00250
•
FloddMapData: 12-17-1993 -
•
Sall., MdE
•
Township: CLARKSVILLE -
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION' PROPERTY INFORMA
Account #: 990002706 Tax PIN/EH #: '5822-14-6840
Billed To: Jeff Hayes Subdivision Info: Dutchman Hills ` Lot # 11
Reference Name: - Location/Address: Greenfield -27028
Proposed Facility: Residence Property Size: 1 acre Date Evaluated:.
7.
L,dnUSUdPC PUSILIU11
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON H DEPTH
Texture group
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: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
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
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 05/99 (Revised)
d " APPLICATION FOR SITE EVALUATION/iMPROVEMENF PERMIT & ATCVL2c
f
Davie County Health Department Envfmirmenfe/HealthSeatlan
P.O. Box 868/210 Hospital Street%—z
Mockeville, RC 27028
(336)751-8760
***I!B?ORTMfT*** THIS APPLICATION CANNOT BE PROCESSED UNIEBB IiLL RE REQDIRED
INIMM ATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Mame to be sill" C h �-N .j - contact "Ween rArAU4 J
u.iling address b�7 /y�r. ss ,CPV No" "Mme 9"
city/state/sxa _ Uy- Ale o?70e16 Business shone
2. Mame on permit/ATC it Diefersnt than above
_ Mailiaq Address city/state/sip .
3. Application sort 58ite Evaluation ❑ Improvement Permit/ATC ❑ Both
e, system to service, P-16ouse ❑ Mobile Rome ❑ Business O Industry ❑ Other
S. If Residence: / People I Bedrooms / Bathrooms
D Dishwasher 13 Garbage Disposal D Washing Machina D Basement/plmA Lnq D auement/tto pl,mbing
S. Ie Business/Industry/Other, apenify type
/ comodes
I showers
IP I'OODSERVICE: tl Seats
/ people / sinks
I urinals I Nater cooler.
Estimated Nater Usage (gallons per day)
7. Type of water supply: bounty/City
❑ Well
e. Do you anticipate additions or expansions of the belllty this system D Intended to serve?
If yea, what type?
❑ Community
❑ Yes ❑ No
***IMPORTANT*** CLIENTS MUSTCOMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITIED by the client with THIS APPLICATION.
Property
Tax Office PIN: fl -$ is - N�SJ�
Property Address: Road Name ad /� '� I i Yon/ 2A
CITyrup Mod'5,/1VP-1
If Is a Subdivision provide Information,/ass follows -
Name:
Section: Blocks Lot:
WRITE DIRECTIONS (from MocksAlle) to PROPERTY:
/D/ NiVY-A T 9.4ioti /A
Date Property Flagged: _7O /vet' f6c'X
This Is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permll(s)
Issued hereafter are subject to snspesshm or revocation, If the site plane 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 applicadom 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.
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN
property Imes and dimensions, structures, setbacks, and septic toe
Revised DCHD (07/99)
following: Existing and proposed
Site Revisit Charge
I Client Notification Date:
Account No. —///
Invoice Na
411
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
' Soil/Site Evaluation
"APPLICANT INFORMATION " PROPERTY INFORMATION
Account #:. 989900111 - Tax PIN/EH #: 5822-14-6855.11
Billed To: Gray Potts . : , Subdivision Info: Dutchman Hills Lot # 11
Reference Name: Gray;Potts Location/Address: Eatons Church Road -27028 �
Proposed Facility: Residence Property Size:. 51 Acres Date Evaluated:,
Water Supply: On -Site Well. Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3. q 5' :. 6: 7
Landscape position
Slope
HORIZON I DEPTH . Z Texturegroup ei C
Consistence
Structure Sv <
Mineralogy;
HORIZON II DEPTH 2tF �i 1 • Z
Texture groupGi +
Consistence
Structure 5b
Mineralogy E I
HORIZON III DEPTH - SZ
Texture group
Consistence
Structure a
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS ... .
RESTRICTIVE HORIZON r
SAPROLITE
CLASSIFICATION j
LONG-TERM ACCEPTANCE RATE `p
SITE CLASSIFICATION: PS EVALUATION BY: Atl-'4'0" d
LONG -.TERM ACCEPTANCE RATE: 0
.5S ' O. Y OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape
Position
R
Ridge -; S -Shoulder i 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
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 LM - Massive CR - Crumb GR - Granular ABK - Angular blocky -
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineraloav
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)