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176 Greenfield Road Lot 9Davie ,NCi , Tax Parcel Report Monday, December 19, 2016 9hm.�AAll WARNING: THIS IS NOT A SURVEY data Is provided as Is without wemmy or guarani" of my Idnd ehher expressed or Implied Including but not limited to the implledwarantles ofinerchinumbllity, orflNeesfor a particular use Ali users of Davie Courdys GIS website shall hold harmless the W NC Parcel Informat>on Parcel Number: D3010A0009 Township: Clarksville NCPIN Number: 5822156068 Municipality: Account Number. 82525816 Census Tract: 37059-801 Listed Owner 1: CARTNER AMY H Voting Precinct: CLARKSVILLE Mailing Address 1: 176 GREENFIELD ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 9 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.17 Elementary School Zone: WILLIAM R DAVIE Deed Date: 2/2006 Middle School Zone: NORTH DAVIE Deed Book / Page: 006470927 Soil Types: Mn132,MdE Plat Book: 0007 Flood Zone: .PlatPage: 190 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 9hm.�AAll Davie County, data Is provided as Is without wemmy or guarani" of my Idnd ehher expressed or Implied Including but not limited to the implledwarantles ofinerchinumbllity, orflNeesfor a particular use Ali users of Davie Courdys GIS website shall hold harmless the CODH•t� NC Courtly of Davie, Norge Carolina, lis agents, consultants, contractors or employees from my and all dalms orcauses of adim due to or addng out ofthe use or lnabllyto use the GIS data provided by this websge. DAVIE COUNTY 11EALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 PA (336)7518760Y — p ,3 ' L!j F • IMPROVEMENT/OPERATION PERMIT- C.•stiP. 14 -z8 -o3 Account M 990002147 Tax PIN/EH #: 5822-14-6855.09WG Billed To: The Ward Group of NC, LLC Subdivision Info: Dutchman Hills Lot # 9 Reference Name: Comfort Quality Homes Location/Address: Greenfield -27028 rProposed Facility: Residence Property Size: 340'x 150' ATC Number;; 3246 "**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 Typefl#People�`C, #_ rooms _ #Baths 3 Dishwasher: 12"" Garbage Disposal: ❑ Washing Machine: ❑' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type n #,P,e�ople #People/Shift #Seats Industrial Waste: ❑ Lot Size . �7 n'( Q Type Water Supply �.o�-+ni � T Design Wastewater Flow (GPD) 3(60 Site: New e Repair ❑ �.�..WCi(�� System Specifications: Tank Size �I lAL. Pump Tank _GAL. Trench Width 31,� Rock Depth Linear Ft. Other: 14 1'0►s'-R1b0 loj I1-rs(au- t-wes Required Site Modifications/Conditions: Au. keep 5, ox Oex)3k'edo b' IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER, RISER(S) IF 6 - BELOW FINISHEDGRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. tom. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** YICDi'. U+1� qa, tW 7�'--- jSi5afist,s mental Health 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 #: 990002147 Billed To: The Ward Group of NC, LLC Reference Name: Comfort Quality Homes ATC Number: 3246 Tax PIN/EH M 5822-14-6855.09WG Subdivision Info: Dutchman Hills Lot # 9 Location/Address: Greenfield -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 WASTEWATE TI FOR, PERIOD OF VIVE ARS. Environmental Health Specialist's Signature: ate: 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. , Septic System Installed By: Environmental Health Specialist's Signature: Date: �L1rJ�S F�� 1 t9 •'�L t) 9-b�X Ft FAM APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & A D Davie County Health Department (SS d Environmental Health Section w6 f! P.O. Box 848/210 Hospital Street Mooksville, NC 27028 - 19 D (336)751-8760 t7tNlRp� ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE. INFORMATION IS PROVIDED. Refer.to the INFORMATION BULLETIN for instructio - 1.. Name to be Billed A) vv7� L & F P h LLC Contact Person TTi� Mailing Address r0_. uO,C 1767 Rome Phone �,lT// - c��p City/State/ZIP _C(�,.,�ShVL 17) 0(Z - Business Phone b36-? S_,Pa � 2. _.Name on Permit/ATC-if Different than Above . Mailing Address i�O. QoK J: y./ - - City/State/ZipC, Z')O/Z.. 3. Application For: ❑ Site Evaluation Improvement Permit/ATC El Both - 4. System to Service:. P< House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People .Z- - # Bedrooms ,�j # Bathrooms 3 - yi Dishwasher I:I Garbage Disposal Washing Machine 0 Basement/Plumbing fl Basement/No Plumbing 6. if Business/Industry/Other• Specify type # People # Sinks # Commodes # Showers - # Urinals # Water Coolers - IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7.., Type of water supply: - XCounty/City.. - ❑ Well -❑ Community. - a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNO . iryes, what type? ***IAfPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: J / d h X 13,61 W RITE DIRECTIONS (from MockslIviille-) to PROPERTY- Tax ROPERTY- TaxOfticePIN: # g�2. l�%.(d Sfo (.l �7 �� be ark/ U2tF tf\0l1� Property Address: Road Name `7f ezW: (ffi- E( 1 (p AA; ``� FZS t '� 4V6 City/Zip MD c�S(fv1(,(� N� �`f') h3ylhlD �})ZDvJS L' i}z4-2��, I`'r'� If in a Subdivision provide informations �F�- o``; as follows: Name: )l _(' / anTL`l'enAhy:l-h�1S ` JvlatY12i0(—%('f�lb7T7�a+-ee11e'b Q P -L p Section: Block: Lot: I Date Property Flagged: 2 - this 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 froihh 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 7-k l to conduct all testing procedures as necessary to determine the site suitability. �Sl2' P` DATE SIGNATURE 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). s - APPUCATION FOR SHE EVALUATION/IMPROVEMENT PERMIT & ATC r I- " 1- Davie County Health Department D �`'.-I / Envlrvnmenfof Health Seaton P.O. Box 868/210 Hospital Street n : enc/ �•� j�� Maokoville, HC 27028 -T ' 7 (336)751-8760 ***IHPCRTANT*** THIS (APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED IHrORMATIOH I8 PROVIDED. Refer to the I'H1t'ORMATION BULLETIN for instruations. 1. Name to be allied Nailing address S'70 Awl City/state/alp GQ Z. Nene en perait/LTC It Different then Nailing address contact Vernon (Ar M4 UP 11,D eons phoneS�ye r 9 Business Mums 9! p - d'�y� City/state/Zip 3. Application ror: Elite Evaluation D Improvement Permit/ATC 0 Both e. Prow to service, PAH6011841 0 Mobile Home 0 Business 0 Industry 0 Other 5. If Residence: 1 People s Bedrooms i Bathrooms D Dishwasher D Garbage Disposal U Mashing Naobine D Basesrnt/pluabing 0 sasaaent/No Vlusb:.ag 6. I! susiness/Industry/other, specify type 6 People a Pinks ! C000des 6 Sharers 6 Usinals a Nater Coolers Ir IWDSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: I9 County/City O Well 0 Community e. Do you anticipate additions or expansions of the faclllty this system Is Intended to serve? 0 Yes 0 No If yes, what type? e11IMPOBTANT'** CLIENTS MUSTCOMPIETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW, Either a LAT or SITE PLAN � MUST BESUBMIT1W b the client with THIS APPLICATION. Property Dimenelo / ��7 (. / 3 ro�� 5 I WRITE DIRECTIONS (from Mockrvllle) to PROPERTY - Tax Offee PIN: ROPERTY:TaxOffeePIN: # 141 - In95JJ5/��Q% AIC 'A T S.t-iy ei e'A Property Address: Road Name ad% City/up -4&e esyi,Le-1 At P' if If in a Subdivision provide Information, as follows: Name �w/J/y1CL/L/%lS 1 Section: Blocks Lot: Date PropertyF4ggedt 70 177ee-/ ScmL-r to This Is to certify that the Information provided Is correct to the beet of my knowledge. I understand that any permlt(s) Issued hereafter are subject to suspension or revocation, if the site plans or Intended me change, or If the Information submitted In this application Is f lsifled or changed I, also, understand that I am responsible for all charges lncumd 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 suits Ilty. DATE ^r2AQ-4LJ SIGNATOR THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (loci a all of the fellowlag: Existing and proposed property lines and dimensions, structures, setbacks, and septic loado , Site Revisit Charge Client Notification Date: EHS• e Account No. (° Revised DCHD (07/99) QUI" i(I Invoice No. G� w9 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH #: 5822-14-6855.09 Billed .To: Gray Potts Subdivision Info: Dutchman Hills Lot # 9 -'Reference Name: Gray Potts" Location/Address Eatons Church Roap-27028 Proposed Facility: Residence Property Size: 51 Acres Date Evaluated: j FACTORS 1 2 3 4 5 6 7 Landscapeposition "L L Slope % Zv HORIZON I DEPTH - Texture groupG Consistence :5 Structure S C Mineralogyt: HORIZON H DEPTH 11- ev, Texturegroup ; gr Consistence ` Structure 5 Mineralogy HORIZON III DEPTH Texture group Consistence Structure . Mineralogy HORIZON IV DEPTH Texture rou ... Consistence '. Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE -Q 3 ©. • 0 •� D SITE CLASSIFICATION:`5 EVALUATION BY: 1 LONG-TERM ACC,E�PTANCE RATE: C/ n OTHER(S) PRESENT: REMARKS: �tftL 1. �1Gn0. i!%eP Ia 1I LEGEND Landscape Position ` R = Ridge S - Shoulder L - Linear slope FS -'Foot slope N - Nose slope Texture' p p . T,,.Terrace FP - Flood lain H - Head slope CC -Concave sloe . CV - Convex'slo e p 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 andy clay, 'SIC - Silty clay C - Clay - SC -,3 CONSISTENCE Mist - VFR - Very friable FR - Friable . FI Very y firm Firm VFI - Ve firm EFI - Extremely 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) co LOT #6 3 411 1,161 AC. CD oc, 1 N CD LOT #9 1.171 AC. 2. CDv o� ,o I Lo 339 29 1 q r LOT #10 d 1, 084 AC. Co CD.