118 Highland Road Lot 20Davie County, NC Tax Parcel Report Monday, December 19, 2016
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WARNING: THIS IS NOT A SURVEY
data is provided "Is without warranty orguarardee of any Wnd etthereapressed or Implied Including but not limbed to the
Implietim a, es ofinerchantabllttyoritnessfor apadlwlaruse.Allusers ofDavie County's GIS websiteshallhotdharmlessme
County of Davie. Nodh Carolina, its agents, consultsrds, contrast. oremployeea fmm any and aG doms orwuses a action due to
orarteingoa0theuseorinabirdytouuthe GlSdata provided by this website.
Information. .. .
-.
Parcel Number:
D301OA0020
Township:.
Clarksville
NCPIN Number:
5822230999
Municipality:
Account Number.
82531117
Census Tract:
37059-801
Listed Owner 1:
KING PATRICIA HARRIS
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
118 HIGHLAND ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 20 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.83 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
8/2009
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
008050279
Soil Types:.
Mn62
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:
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Davie County,
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NC
data is provided "Is without warranty orguarardee of any Wnd etthereapressed or Implied Including but not limbed to the
Implietim a, es ofinerchantabllttyoritnessfor apadlwlaruse.Allusers ofDavie County's GIS websiteshallhotdharmlessme
County of Davie. Nodh Carolina, its agents, consultsrds, contrast. oremployeea fmm any and aG doms orwuses a action due to
orarteingoa0theuseorinabirdytouuthe GlSdata provided by this website.
-"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYS
BETWEEN 8:30.- 9:30 A.M. OR 1:00. 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE #.IS (336)751-8760. ,
DCHD 02102 M.I.-M
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DAVIE COUNTY HEALTH DEPARTMENT t%-1
Environmental Health Section
P. O. Boa 848/210 Hospital Street,
Mocksville, NC 27028
(336)751-8760
kccount #:.990002706 Tax PIN/EH #: 5822-23-0999
Billed To: Jeff Hayes Subdivision Info: Dutchman Hills Lot # 20
nce Name: LocationlAddress: 118 Highland Rd-27028
ed Facility: Residence Property Size: 0.835 Acres
'C Number: 3502
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
'E** 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 I 1 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CONSrMONJS VALI FOR A PERIOD OF FIVE YEARS.
mental Health Specialist's Signatur : e:
CERTIFICATE Olt MP ETION
The issuance of this Certificate of:Completion shall iridic tha� tem described on ImprovementlOperation Permit
-has been installed in compliance With Article I I of G.S. C apter 30A, Section .1900 "Sewage Treatment and
-"Disposal Systems," but shall in NO WAY be taken as a g ant that the system will function satisfactorily for any
given period of time. ��
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TIA V(
Septic System Installed By:
t lealth Specialist's Signature: Date:
Nised)
�DAVIE COUNTY HEALTH DEPARTMENT
` ' • Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002706
Tax PIN/EH #:
5822-23-0999
Billed To: Jeff Hayes
Subdivision Info:
Dutchman Hills Lot # 20
Reference Name:
Location/Address:
118 Highland Rd -27028
Proposed Facility: Residence
Property Size:
0.835 Acres
ATC Number: 3502
**NOTE** This ImprovementlOperation 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 2
Dishwasher: 12 Garbage Disposal: 17" Washing Machine: Gy" Basement w/Plumbing: 121'� Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #PeopletShift#Seats Industrial Waste: ❑
Lot Size P W�'S Type Water Supply Design Wastewater Flow (GPD) cW Site: New e Repair 13
u
System Specifications: Tank Size IWOGA�GAL.
:PPu/�m�p Tank GAL. Trench Width � Rock Depth 12" Linear Ft�� r
Other: 3�p' X1'—,1 ��ri 3,46, 41J��1(�la- ur ks
Required Site Modifications/Conditions:
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
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.****
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�Ith Specialist's Signature:: ��`� 7 _ Date:
�. DAVEE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002706
Billed To: Jeff Hayes
Reference Name:
Residence
ATC Number: 3502
Tax PIN/EH #:
5822-23-0999
Subdivision Info:
Dutchman Hills Lot # 20
Location/Address:
118 Highland Rd -27028
Property Size:
0.835 Acres
�a.Y.M�'� �_�u CRL0] Ms3l41101 e1
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 WASTEWATER CONS VAL OR A PERIOD OF FIVEnYEARS.
ital Health Specialist's Signatur� e:
11
CERTIFICATE 01'
**NOTE** The issuance of this Certificate of Completion shall iddica the em described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G�. C apter 30A, Section 1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be taken as ante that the system will function satisfactorily for any
given period of time. r
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s�
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date:
'..
APPLICATION MR SITE'EVALUATION/IMPROV131ENT PERMIT 3 AT `
Davie County Health Department
Environmenta/Hea/ih Section D
P.O. Box 848/210 Hospital. Street
Mocksville,.NC 27028 D
(336)751-8760 J��',� 3 2003
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL THE
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN fo struc ALHFjuTM
1: Name to be Billed'' ',-1� Contact Person
&-FF_
Mailing Address l� - Home Phone
City/State/ZIP /X✓iJ rirV_ (+i EJ /L/u% Business'Phone
2.'Name on Permit/ATC if Different than Above—
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation 5Yimprovement Permit/ATC -❑ 'BoL-h
4 system to service: ousee - ❑ Mobile Home 11 Business '13 Industry El Other
5. Type system requested: I CH+ onventional - ❑ conventional modified ❑ innovative
6. If Residence: s People _'. p Bedrooms. It Bathrooms_
'IIGDishwasher W.'rbage Disposal NJWashing Machine ItlBasement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type It People It Sinks
'N Commodes It Showers It Urinals It Water Coolers
.IF FOODSERVICE: $ Seats .Estimated ,Water Usage (gallons .per day)'
8. Type of.'water supply: M.County/City ❑ Well - ❑ ..C__ommmunity
9. Do you anticipate additions or -expansions of the facility this system is intended to serve? L7]'cs ❑ No
If yes, what type? Nr,)V�/lovthl i1LUA i1Ei3A5y�ir Sl"�G� ?Ai�DtnE"0!✓1��7Zi25HLs
To _SJf�.
***1AIP0RTANT*** CLIENTS AIUST C0AIPLCTETHE REQUIRED PROPERTY 1NRORMATiON REQUESTED '
BELOW. Either a PLAT or SITE PLAN AIUSTBESUBMITT@D bythe client with "I'llIS APPLICATION.
Properly Dimensions: / V S3Y 246� WRITE DIREC'T'IONS (from Mocksville) to PROPERTY:
Tai Office PIN: # drTTi?T
Property Address: Road Name lr.7t�i✓S i��¢j/��2o�ti
City/Zip.
If in a Subdivision pro/vide information, as
follows:
Name:jt/G
Scctioi: Block Lot Date home corners Ragged:
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 orchanged. 1, also, tuederstand that 1 ani responsible jar all charges incurred from
this application. I, hereby, give consent to the Authorized Representative'of the Davie Comity 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. i
DATE �' ,7 SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include 211 of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).'
�. •; 1 I I I I
_
LOT #13 1 I LOT x'14 I I I
LOT #1
5
I I
LOT m12 1 I I I I
i I 1 1 I I
I I I I I
cREE1►rFlELD — �. _ _ I 1
1 S 83.16'19. 1I If
G u ` — - 260.01
o W
o N
O P
W
v
r
S.E. TYP.J
I
LOT #26
0.929 AC.
LOT #25
0.836 AC.
LOT .#24
0.836 AC.
LOT #23
0.836 AC.
'LOT #22
0.786 AC.
c.• NEA7`.39323GA.C_.C.ESS
87_EASEMENT
p LOT #21
108 l0 _ 81p39'4g•
4 I' 'SIGHT/ TRMC M,0.835 AC. of
MAC NU, 50.0 1 H 81 39 4SS Eggc1ENT v. v
MAC NvL 260.008,
D• 839 �� IN �� y cc
io INTX. u.s. 60. �-� _ 20• PAVED--
r
AVED
I
�
I
I
259.90-_
gROUND
-
I
*� TYP.
CORNER BUILDING SET -BACKS -
LOT # 17
o
o =
1 9 v
L IA P
39._4a
IP
•�-_s
83.16.19" Epi
TURNAVED
S.E. TVP.`
259.90-_
gROUND
-
I
*� TYP.
CORNER BUILDING SET -BACKS -
LOT # 17
0.917 AC.
o =
1 9 v
L IA P
39._4a
LOT #18 - __ _
0.835 AC < z�onm R 20
LOT #19
10' UTIUTI 0.835 AC.
EASEMENT
- 260.00
Ito r'-�� __
I TVP. BUILDING SET -BACKS
LOT #20
LI 0.835 AC.
8j8j9'4j-
-319 _ 3D•
r
OWNER'-
CRAY;.
CORN
aN ERC .. .1870 UNDF
ADVANCE, .A
(336) 99
_ ^ APPLICATION FOR SUE EVALUATION/IMPROVEMENT PERMIT & ATC r D ��, I I • ^ (?
-4 Davie County Health Department
/1 Enteltvnmental Health SeWon
10/' -4 -Se .tea. P.O. Box 868/210 Hospital Street Z- 7
e� / ��� Mockoville, HC 27028
,ay �+ (336)751-8760
***XWMTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL HIE REQUIRED
IHrORM11TIOH I8 ryPRROVIDED./�Rater to the IMMRMATIOH BULLETIN for instructions.
(s p l�-1.l
1. Wass to be billed _. �9A- CContact."toon a&V
./ J
;7'J Yrs
Wailing address 1R'
��s�II(e/ none mono _9P5P-�S•�''f 09
city/state/sip 1ddUdJ�- Ale. oV7,w6 ousiness ?bene
a. Ness en perait/ATCit Different than above
Nailing address - City/state/nip
3. application For: l9 lite Evaluation D Improvement Permit/ATC O Both
e. eystea to serwiss: pd-1110use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S. If Residence: i People 1 Bedrooms 1 Bathrooms
D Dishwasher D garbage Disposal D washing uschiss D eaaeaact/plvabl.ag D sasassnt/No plumbing
6. If Business/industry/other: specify type I 1 people 1 sinks
e Commodes 1 Showers 1 urinals a water Coolers
IF r00DSERVICE: # Beats Estimated Yater Usage (gallons per day)
7. Type of water supply: bounty/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 MUSTCOMPLETETnE RE
BELOW. Either a PLAT or SITE PLAN MVSTBESUBMIn
PropertyDlmenslo •� 1 (. 9 3 /�lLS
Tax once PRH: a
Property Address: Road Name wld l d !N Yoe/ h A)
CltyrLip4[B u11LLe__
If in a Subdivision provide Information, as follows:
Name: j0IGT 1711)7oe7 /1/11,i
PROPERTY INFORMATION REQUESTED
i cheat with THIS APPLICATION.
WRITE DIRECTIONS (from MockrAlle) to PROPERTY:
�Pvf�e�
Section: Blocks Lot: o424-'_� Date Property Fogged:
This is to certify that the Information provided h correct to the best of my knowledge. I understood that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plana or Intended we change, or If the Information
submitted Is this application is fiislfied or changed 1, also, understand that I am respons/6Ie for aR charges Incurred from
this applicatlon. 1, hereby, give consent to the Authorized Representative of the Davie County Health Deportment
to enter upon above described property located In Davie County and owned by
to conduct all testing procedures as necessary to determine the site sulolillty.
DATE 1 z2rQ-a0&)
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (loci e'all of the following: Existing and proposed
property Hoes and dimensions, structures, setbacks, and septic locado ;
IP, �
1� O
6t-1 �
Site Revisit Charge
Client Notification Date:
I ENS:
Account No.
Revised DCHD (07/99) Invoice No.
ttZa
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
Soil/Site Evaluation
APPLICANTINFORMATION PROPERTYINFORMATION`
Account .#:,989900111 Tax PIN/EH #:: 5822-14-6855.20
Billed To: Gray Potts : , ' Subdivision Info: Dutchman Hills Lot # 20
Reference Name: Gray Potts Location/Address: Eatons Church Road -2702$ '
Proposed Facility:. Residence Property Size: 51 Acres Date Evaluated: d !7 D
PP Y; ate Well . Community Public
Water Sul. On -Site
Evaluation By: = . Auger Boring " Pit Cut -
FACTORS l 2 3 q 5 6 „7
Landscape position _
Slope % Ay
HORIZON I DEPTH �, r
Texture groupG'
Consistence :.
Structure,..
Mineralogy
HORIZON II DEPTH i7 " y4 U "
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: 1� " EVALUATION BY:
LONG-TERM ACCEPTANCE RATE OTHER(S) PRESENT
REMARKS:
LEGEND
Laridscape Position.
...
R - Ridge "r S - Shoulder - - L - Linear slope FS - Foot slope N -Nose slope
- CC _ Concave slope CV -Convex slope ,T- Terrace FP - Flood plain HL- 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 $ =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
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 chroman or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LIAR - Long-term acceptance rate - gal/day/ft2
DCHD 05/99 (Revised)
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