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117 Highland Road Lot 23Davie County, NC Tax Parcel Report Monday, December 19, 2016 [all All data Is provided ssis withoutwermnty or guarantee of any land tldrereapreased or implied Including but not limited to the Davie County, Implied vramndes of merchantability orllmess for a padioularuse. AN users of Davie county's GIS website shag hold harmless the County of Davley NorthCarolin, ib agerds, consultants, contractors or employees from any and a0 claims or causes ofaction due to NC or arising out ofthe "a or Inability to use Me GIs data provided by thiswehsita. WARNING: THIS IS NOTA SURVEY L .. -- _ _ Parcel Information . Parcel Number: D3010ACO23 Township: Clarksville NCPIN Number. 5822147062 Municipality: Account Number: 82522770 Census Tract 37059-801 Listed Owner 1: JAMES THEODORE Voting Precinct: CLARKSVILLE Mailing Address 1: 117 HIGHLAND ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028-4766 Voluntary Ag. District: No Legal Description: LOT 23 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 0.83 Elementary School Zone: WILLIAM R DAME Deed Date: 5/2004 Middle School Zone: NORTH DAVIE Deed Book / Page: 005520144 Soil Types: MnB2 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: [all All data Is provided ssis withoutwermnty or guarantee of any land tldrereapreased or implied Including but not limited to the Davie County, Implied vramndes of merchantability orllmess for a padioularuse. AN users of Davie county's GIS website shag hold harmless the County of Davley NorthCarolin, ib agerds, consultants, contractors or employees from any and a0 claims or causes ofaction due to NC or arising out ofthe "a or Inability to use Me GIs data provided by thiswehsita. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Boz 848210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001248 Billed To: Mike Hester Building Co. Reference Name: Proposed Facility: Residence �L 3 310 Tax PIN/EH M 5822-14-7062 Subdivision Info: Dutchman Hills Lot # 23 Location/Address: Highland Road -27028 Property Size: see map ATC Number: 3514 **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 �lDl�SC #People #Bedrooms' 3 #Baths 2 Dishwasher: Er Garbage Disposal: ❑ Washing Machine: ff� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification:Facility Type #People #People/Shift #Seats Industri ast [3Lot Size 0•$ 3(v 4Uk 1'ype Water Supply �^ItYDesign Wastewater Flow (GPD) Site: New" ❑ rr . � System Specifications: Tank Size lbo0 GAL. Pump Tank GAL. Trench Width' Rock Depth 12 Linear Ftp Other: U DIST(11WrtO-) P -01-S WS'1A.U. U JZS 9'0.C-. r, r•J . Required Site Modifications/Conditions: 0STAU-- O.J LoJ�J� i� P IAx VA -- Id L eFF . LI o IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF6"BELOW FINISHEDGRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 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.**** :3 l9k uses t� o v .sr got j U s 50u� Environmental Health Specialist's Signature: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bos 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001248 Tax PIN/EH M 5822-14-7062 Billed To: Mike Hester Building Co. Subdivision Info: Dutchman Hills Lot # 23 Reference Name: Location/Address: Highland Road -27028 :r--Trrrit&I ATC Number:. 3514 b1ze: see 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 WASTEWATERUC I?N iSD FORA PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION Date: **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 jaken as guarantee that the system will function satisfactorily for any given period of time. DOJ F—C-1, 2, .41 i �n.3tc�nE -7-Z,<� Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) I ATION FOR SITE EVALUATION/IhIPROVEhIENT PERMIT 3 AI -C �r Davie County Health Department (�11 Environmenta/Bea/tliSection Illi dMt;r 1 -.3 P.O. Box 848/210 Hospital Street J Mocksville, NC 27028 �NIRONMb^TDL4EALTN (336) 751-8760 *-MPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED - INFORMATION IS PROVIDED. -Refer to the INFORMATION BULLETIN for instructions. - 1. Name to be BilledI/ ��/QQ;-�t7w)(4/UCG. Contact Person {�'1WE Mailing Mailing Address el_ tCI 'S S C, r%y ilio VC t. -9'r Q' Home Phone City/State/ZIP 46/✓"C Ir /t/. r d--) aria Business Phone 2. Name bn Permit/ATC if Different than Above - - - - - Mailing Address,... City/State/Zip 3. Application For: .,ttdsite Evaluation ❑ Improvement Permit/ATC El 4. System to Service: P -'House ❑:Mobile Home ❑ Business ❑ Industry - ❑ Other S. Type system requested: Conventional ❑ conventional modified ❑ innovative - „ 6. If Residence: tt People it Bedrooms - 3 It Bathrooms (V<shwasher []Garbage Disposal 015shing Machine ❑Basement/Plumbing ❑Dasoment/No Plumbing 7. I£ Business/Industry /Other: verify type It People It Sinks It Commodes it Showers - -It Urinals- It'Water Coolers IF FOODSERVICE:. tl Seats - Estimated Water Usage (gallons per day) B. Typo of water supply: [J County/City " ❑ Well ❑ Conununi L -y' 9. Do you anticipate additions or expansions of the facility this syslan is intended to serve? ❑ Yes 2<) If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPER'T'Y INFORNIATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTEDbytheclient with'I'MISAPPLICATION t Properly Dimensions: I CI6 ^ a 6 O r WRITE llIREC'1'IONS (from h•loelsvillc) to fIt01'lilt'1'1': Tax Office PIN: S SFSali�70(�1 �O/ ;Locus -/S I/S�Ifrtt.r'l�4 Property Address: Road Name ��rr/j �g y o/ i?� G P,vl f j S woven - C/o '1twVw City/Zip ry►r-&T(. ql'e I-)Wr cn/d, G��4ToNIS If in a Subdivision provide information, as follows: O I--., y � S ti rJ t t/V , Name: D c.,- cH r,,7 n / Section: Block: Lot: d 3 Date bane corners flagged: This is to certify that the information provided is correct to the best of my Knowledge. I understand that any pernnit(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if (lie Information submitted in this application is falsified or changed. 1, also, understand that I am responsible for all charges incurred /rail !Iris application. I, hereby, give consent to the Authorized Representative of the Davie Coolly Health DeparOneN ( to enter upon above described property located in Davie County and owned by _ to conduct all testing procedures as necessary to deternnfne the Site suitability. DATE f 1 ` 3 SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given - Revised DCIID (05/03 Site Revisit Charge Datc(s): Client Notification Date: EIIS: Account No.� Invoice No. 3 s APPUCATION FOR SITE EVAUJAIION/IMPROVEMENT PERMIT IL ATC r ' Davie County Health Department D 15 f I � EnNrvnmentalHealthSm fon ��_,C, lt /�t� , `P.O. Box 868/210 Hospital Street Mockeville, NC 27028 y (336)751-8760 '"IMPORTANT"* THIS APPLICATION CANNOT BE pROCEBSED UNLESS ALL THE REQUIRED I rOM ATION I8 PROVIDED. Haler to the IHJrORMATIOH BULLETIN for instructions. 1. Naw to be billed g. Contest peraen J Mailing sear... �'7 /!/ rpi < eons Mums 9"V S/' S(V D 9 City/atete/e1p 1_ //dJ,y� Ale, .:?%oa6 au.in... phos. 1019v- 2. ! v-2. Naas on pereit/ATC it Dleeerent than Above Wailing Address City/state/sip 3. Application Ibr: B Site Evaluation ❑ Improvement Permit/ATC ❑ Both 6. eyaten to services whouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residancet s People m Bedrooms m Bathrooms O Dishwasher D Garbage Disposal O Mashing Machine D Dassaant/Plumbing D aasetant/No plunbirf 6. It Business/Industry/other, epaoify type s Cousodaa 6 showers 6 urinals m people m Broke I Mater Coolers Ilr Ir00DSERVICE: #i Beats Estimated Rater Usage (gallons per day) 7. Type of Mater supply: Ercounty/city ❑ well ❑ community e. Do you anticipate additions or expansions of the facility thin system Is Intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT***CUENTS MUSTCOMPLETETHE REQWRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PWT or SITE PLAN MUST BESUBMITIED by the client with THIS APPLICATION. 1Rv PropertyDimenslo •lf'1��93 Tax Office PBV: —,u— Property Address: Road Name O/d/ 4•16iYon/ d% AV City/Zip /J C' J71l�f( If In a Subdivision provide Information, as follows: Name (/GL�Gt`-lr/ /�/S WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: poi Noi'A T �-c Icer, Cti r^ Section: Block: Lot: .21? Date Property Finned: �D /nor' f ScrnCcn e ��i`� This is to certify that the information provided In correct to the beet of my knowledge. I understand that any permli(s) Issued hereafter are subject to suspension or revocation, If the site plans or intended at 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 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 mad owned by to conduct all testing procedures as necessary to determine the mile suitat�llty. I - DATE 0^1Vr9-0r/ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN property lines and dimensions, structures, setbacks, and septic loc of the following: Existing and proposed Site Revisit Charge Client Notification Date: Account No. Revised DCHD (07/99) 111 D Invoice No. ,t# -z3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account:#: 989900111. Tax PIN/EH #: 5822-146855.23 :"Billed To: Gray Potts ' ',;,; Subdivision Info: Dutchman Hills Lot # 23. Reference Proposed Facil Name: Residence Property Size: 51 Action/Addresh Date Evaluated: ' ( �� Water Supply:. On -Site Well Community 'Public Evaluation By: 7 AugerBoring, Pit y� Cut FACTORS 1 2: 3 q g 6 Landscape position Slope HORIZON I DEPTH Texture group(� L Consistence Structure Mineralogy HORIZON II DEPTH D 6 'l " Texture group Consistence Structure yL u Mineralogyr 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 - Floodplain 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 , Mineraloev Ll, 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) " e■e■■e■ ■■s■■■■ ■e■■■■■■ o #I 0 o n 0, 835 AC, f a lop urn IrY S $I • N EASEMENT . 7 o 260.07 cr c a S 81 48 10' UTILITY_..'� ~- O 0 N o EASEMENT _. - __�� I �' rr tr ,:5 LOT #2s 4 ' TYP. BUILDING SET -BACK oz 0,836 AC. LOT #20 q 0,835 AC, U_ S 81'57 `13• � m 0 260.07 o S 81'39'48' - 260. OQ"".--�.__ O LOT #22 ! 0, 786 AC. . o 0 q LOT #21 0 ' 6' NEGATIVE ACCESS EASEMENT 10 N 87.39' 23' W, M W s1GFf? X �0. 0,835 ACS N 8I ' 39'481 W TRIANrLF TYp NEGgrrVE 50.0 yACCESS EASEMENT MAG NAIL N 81 39' 484 w R H _ 71�x- 60 MAG NAIL x'60.00D838' WEST TU7