111 Landis Court Lot 27Dav
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All dam Is provided as Is vithout wemnty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, hnplied aamnde, of merchantability or gmess for a particular use. All users of Davie County's GIS website shell hold harmless the
CountyofDawe, North Carolina, Ito agents, consultants, contractors oremployees free anyandallclaimsorcausesofactiondueto
NC - _ or arising out ofthe use or lnabVilyto useme GIS data provided by Mls"hall.
WARNING: TIUS IS NOT A SURVEY
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Parcel Information._LL�_�,
W��
Parcel Number.
D301OA0027
Township:
Clarksville
NCPIN Number:
5822145468
Municipality:
Account Number:
82528647
Census Tract:
37059-801
Listed Owner 1:
RATLEDGE ALAN CLAY
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
111 LANDIS CT
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 27 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.69 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
8/2015
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
009980613
Soil Types:
MnB2
Plat Book:
0007
Flood Zone:
Plat Page:
190
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
[all
All dam Is provided as Is vithout wemnty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, hnplied aamnde, of merchantability or gmess for a particular use. All users of Davie County's GIS website shell hold harmless the
CountyofDawe, North Carolina, Ito agents, consultants, contractors oremployees free anyandallclaimsorcausesofactiondueto
NC - _ or arising out ofthe use or lnabVilyto useme GIS data provided by Mls"hall.
v . DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Moclrsville, NC 27028
(336)751-8760
Account #: 990002390 Tax PIN/EH #: 5822-14-6855.27
Billed To: Benjamin Frye Subdivision Info: Dutchman Hills Lot # 27
Reference Name: Location/Address: 601/Eaton Ch. Rd. -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3226
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 WASTEWA F.R E9 A IS VAL OR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: �Z
CERTIFICA'
**NOTE** The issuance of this Certificate of Completion s Il' dicat the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 f .S. Ch pier 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be a gu antee that the system will function satisfactorily for any
given period of time.
X
Septic System Installed By:.
Environmental Health Specialist's Signature: _
DCHD 05/99 (Revised)
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Date:
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Septic System Installed By:.
Environmental Health Specialist's Signature: _
DCHD 05/99 (Revised)
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Date:
./
J DAV_ IE COUNTY HEALTH DEPARTMENT Z
Environmental Health Section
_ P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
'— (336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002390 Tax PIN/EH #: 5822-14-6855.27
Billed To: Benjamin Frye Subdivision Info: Dutchman Hills Lot # 27
Reference Name: Location/Address: 601/Eaton Ch. Rd. -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3226
**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 Type#People _� #Bedrooms #Baths Z
Dishwasher: 0 Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Pt»� n_� 13
Commercial Specification: Facility Type #People _ #People/Shift #Seats Industrial Waste: ❑
Lot Size L9 -(,A 6rkcS Type Water Supply Design Wastewater Flow (GPD) Site: New Repair ❑
System Specifications: Tank Size1 VCVGAL. Pump Tank GAL. Trench Width �o Rock Depth �r Linear Ft3�r
Other: - 3)1�5f h)ttoj feijtt�S.1 ISN- LL UAes 1 to•e. Myo.
/�
I
Required Site Modifications/Conditions: I aTMI OA C�IJTOX, r�a S t ice: Y-,Ze IOC Ortr fed.
IMPROVEMENT/OPERATION MMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 - BELOW
FINISHED GRADE. ""NOTICE: C61ftct a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. tq 9:30 a.m. or 1:00 p.m.4o,1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
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t�
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
: APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT
Davie County Health Department
I
Environmental Health Section
I P.O. Box 848/210 Hospital Street" G
.Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLE
INFORMATION/IS PROVIDED. Refer to the,INFORMATION BULLETIN :
1: Name to be Billed r/ t / (7 Jt U
Contact Person ue rx n1 4L
Mailing Address �A U rry� ,swortlyl RA, - Home Phone N 1'U
City/State/ZIP _Adyr rt _Aft . a ?Do& Business" Phone (330 !/ 1 -I -o7 G'
2. Name on Permit/ATC if Different than Above -
Mailing Address " City/State/Zip
3. Application For: ❑ Site Evaluation ""VImprovement Permit/ATC ❑Both
4: System to Service: &(House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
s." If Residence: # People # Bedrooms. # Bathrooms,_ -
P/Dishwasher 1.1 Garbage Disposal V(Washing Machine ❑ Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/Other: Specify type - # People # Sinks
., N Commodes' # Showers # Urinals # Water Coolers
IF FOODSERVICE: B Seats Estimated Water Usage (gallons per day)
7. Type of water supply: E/ County/City ❑ Well ❑ Community
H. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 1. No
If yes; what type?
°**IAIPORTANT*** CLIENTS MUSTCOMPLCTFTHE REQUIRED PROPERTY INFORMATION REQUESTED
1ELOW. Either a PLAT or SITE PLAN MUSTBFSUBM17TF.D by the client with THIS APPLICATION.
Properly Dimensions- 5 -CL Map WRITE / DIRECTIONS (from Mocksville) to PROPERTY: - -
Tax Office PIN: # ,r8� a -/'/—L dSs Z % t0Y/ 1 At4
k +0 FdVA ChuiZA M
Property Address: Road Name ��t �a —c� � fa kc r 10 rc4, o rY
City/Zip
If in a Subdivision provide information, as follows:
Name: �1.� r -k rvw� ��c �•f' //
Section: Block: Lot: Date Properly Flagged: N O "?-
This is to certify tbat 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, roulerstmrd that I ant 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
(o conduct all testin{g procedures as ncccssary to determine the site suitability.
DATE, //J X94Q&QQ SIGNATURE �
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
properly lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge .
Datc(s):
Client Notification Date:
EHS:
L
APPLII`ATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Lr -))[E
rDavie County Health Department
Environmental Health Section
p.0. Boz 868/210 Hospital Street J Mockeville, HC .27026
lay (336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS 1
INFORMRTION I8 PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Nu. to be Milled i content Person lAi//LM 01/3
Meiling Address Rome Phone SAY o 9
city/.tate/:IP __/a P���g Ale, ,y7ea6 business Phone 9991- ��ao
1. Name on Petaait/ATC At Different than Above
Nailing Address City/state/lip
3. Application For: 0 its Evaluation ❑ Improvement Permit/ATC ❑ Both
a. eysten to eervicet jT/House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
s. If Residence: 1 People 1 Bedrooms a Bathrooms
D Dishwasher D garbage Disposal D Mashing Machine 0 saawnt/Plumbing D Saeetunt/tto Plumbing
a. Is ausimoss/Industry/others "airy type s People a Sinks
e C000dee a showers a Urinals a Nater Coolers
IF FOODSERVICE: # Seats Eatlmated Nater Usage (gallons per day)
7. Type of water supply: bounty/City ❑ Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑ Yea ❑ No
If yes, what type?
***1MPORTANT***CLIENTS MUSTCOMPIETETHE REQU/REDPROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION
li
Property Dimensld / R�7 t .rpt / 3 )a".:5 / WRITE DIRECnONS (from MockrA le) to PROPERTY:
Tax OMce PIN: q 95-5 /Ol My tL T E.e. iv c, e%
Property Address: Road Name ae l 4 irtt Yon/ lit 04,044py&h 4
City/Zip%YIBGAsiw,CL �e'6120e
If ID a Subdivision provide Information, as follows:
Nome: 0a'1T1X 1nCl'0'1'
Section: Block: Lot:
Date Property Flagged:e�i`C
This 1s to certify that the information provided Is correct to The best of my knowledge. f understand that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plans or Intended we change, or If the Information
submitted In this application Is falslRed or changed 1, 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 properly located In Dsvle County and owned by
to conduct all testing procedures as necessary to determine the alta suitsl�lity.
I i n ��-
DATE_ _ l -12ro)-60&%
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (lneleill of the following: Existing mud proposed
property lines and dimensions, structures, setbacks, and septic locado
Revised DCHD (07/99)
I EHS•
Site Revisit Charge
Notification Date:
Account No. ///_
Invoice No.
#z7
z DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANTINFORMATION PROPERTY INFORMATION
Account #: 989900111 Tax PIN/EH #: 5822-146855.27
sSubdivision Dutchman Hills Lot#27,'...
Billed To: GrayPotts,, ion Info: ,
" Reference Name: Gray Potts "' Location/Address: ' Eatons Church Road -27028
Proposed Facility: Residence Property Size: 51 Acres Date Evaluated: S &o
Water Supply: .6n -site Well Community Public
Evaluation By: Auger Boring Pit Cut
j FACTORS .: 1 2 '3 4 „5 :- .. .- ( .._ '. 7
Landscape position .. L - _- .. .
Slope % t470
HORIZON I DEPTH 22
Texture groupL t
Consistence.
Structure lC
Mineralogy
HORIZON II DEPTH'
Texture group
Consistence Grss15 V
Structure IC
Mineralogy1:
-'HORIZON III DEPTH -JO
Texture groupk
Consistence
Structure . k
Mineralogy
HORIZON IV DEPTH _.
Texture group..
Consistence
Structure .
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE .
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE O
SITE CLASSIFICATION: PS' EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: tL 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 ' ' SCI. -Sandy clay loam
-SC - Sandy clay" SIC - Silty clay C - Clay _
CONSISTENCE
Moist
,VFR - Very friable -Very EFI - Extremely firm
' FR Friable FI -Firm VFI - Ve 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 05199 (Revised)
LOT # �
I �
1
T2 � .
$.E. TYP.
S7*
LOT # 12
ILIT
/ LO?' X27 �►
Q 0. 691 AC, c �,
ti S >9
50A 40'
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Lo
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