137 Landis Court Lot 29Davie County, NC Tax Parcel Report Wednesday, October 12, 201(
qr;v f6, All data Is provided as Is without warranty or guarantee of any kind either expressed or implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, Norm Carolina, its agents, consultants, contractors or employees from any and all claims or "uses of action due to
�OUN't4 NC or arising out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
Earcel Information `
Parcel Number:
D301OA0029
Township:
Clarksville
NCPIN Number: -:
5822145232
Municipality: .
Account Number::
8303262
Census Tract:
37059-801
Listed Owner 1::
MARTINEZ DAVID -
Voting Precinct:
CLARKSVILLE
Mailing Address 1: __
137 LANDIS COURT -
Planning Jurisdiction:
Davie County
City: _ - - MOCKVILLE= `-
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description: -
LOT 29 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.79
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
3/2014
Middle School Zone:
NORTH DAVIE
Deed Book/ Page:
009520771
Soil Types:
MnB2
Plat Book:
0007
Flood Zone:
Plat Page:
190
Watershed Overlay:
DAVIE COUNTY
Building Value:
145290.00
Outbuilding & Extra .Freatures Value:
4360.00
Land Value:
30000.00
Total Market Value:
179650.00
Total Assessed Value:
179650.00
qr;v f6, All data Is provided as Is without warranty or guarantee of any kind either expressed or implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, Norm Carolina, its agents, consultants, contractors or employees from any and all claims or "uses of action due to
�OUN't4 NC or arising out of the use or Inability to use the GIS data provided by this website.
0
Davie Colnity Health Department
9 1836 Environmental Health Section
P:O. Box 848
SCE 210 Hospital Street
0 ifVk er # i 09-40-06 1911
v3oDaw Rocksville, NC 27028
�n.
Phone: (336) - 753-6780 - Fax: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
ck
(Check One) 1 Replacement Remodeling Reconnection
Name:--�Ulj I � CA/ +kVVC-`l- - Phone Number3J% S7Sj D(Home)
Mailing Address: 151 laVic( IS CT - (Work)' -
MOC96ville- NC- 2-70Zf
Property Address: fi
Please Fill In The Following `I,n/formation About The EXISTING Facility: ����Jj�
Name System Installed Under: Wood (rl Type Of Facility:=/1jasp—
_ Date System Installed (Iylont6/DateJYear)/' /��Q Z Number Of Bedrooms: Number Of People ------
Js
- =Is The Facility Currently Vacant? Yes (N0 If Yes, For How Lone?
Any Known Problems? Yes1 fo If Yes, Explain:
Please Fill In
Type Of Facilit
Pool Sizer
Requested By:_
Approved Disapproved
Environmental Health
Information About The NEIVFacility:
Number Of Bedrooms: Number of People
For Environmental Health Office Use Only
,�y
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Mo&4AQrarer # J"'I'S(o Amount:$ .400-00 Date:
Paid By: Received By: r �,t
Account #: 1 Invoice #: �j 3Cp -I
9/20/2016
* III Parcels
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125
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Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002147 Tax PIN/EH #: 5822-14-5232.29
Billed To: The Ward Group of NC, LLC
Reference Name:
?roposed Facility: Resiaence
ATC Number. 3062
Subdivision Info: Dutchman Hills Lot #29
Location/Address: 137 Landis Church -27028
t-9,ANEWvza
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 CO STRUCTI IS VALID FO" PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature:Akskl Date: OC /l7) Z
CERTIFICATE OF COMPLETION
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�S; (guarantee that the system will function satisfactorily for any
given period of time. I /
106
Septic System Installed By: . /�� 9: /G
Environmental Health Specialist's Signature :
DCHD 05199 (Revised)
Date:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
- _ P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 990002147 Tax PIN/EH M 5822-145232.29
Billed To: The Ward Group of NO, LLC Subdivision Info: Dutchman Hills Lot # 29
Reference Name: Location/Address: 137 Landis Church -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3082
**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 (m 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 .�
Dishwasher Garbage Disposal: ❑ Washing Machine.' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People . #People/Shift #Sfeats Industrial Waste: ❑
Lot Size Type Water Supply 4— Design Wastewater Flow (GPD) C?& D Site: N7;3'Repair ❑
System Specifications: Tank Size GAL. Pump Tank _GAL. Trench Width-�" Rock Depth/ Linear Ftr�
Other:
Required Site Modifications/Conditions:
IMPROVEMENVOPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 k 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.****
Environmental Health Specialist's Signature: Date: [ - �/� 2
DCHD 05/99 (Revised)
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FEB 5 2002
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APPLICATION FOR SHE tVAI 11ATI0N/IMPfl011EMENT PERMIT & ATC D MIFF? f
Davie County Health Department -
EnPltenmenfa/Healfb sftwon
'a P.O. Box B40/210 Hospital Street2�� 7
JP�`� ��� Mockaville, HC 27028
(336)751-8760
***rJMPCRTANTA** THIS APPLICATION CANNOT BE PROCZSSZD UNLZSS LLL HZ REQUIRED
IMMMSTION I8 PROVIDED. Refer to the INTOPMTIOH BULLETIN for instructions.
1. Masa to be milled �] contort person J
Meiling Addrsss?7, LSI ss IC� tone ehen.. %9�'- S'�09
City/state/a1P _) "Iree_ Ale, e2?;W6 Business Phone OFF- V97OLO
s. uveae on Persdt/LTC if Different than Above
Mailing Address City/state/aip
s. Application Tor: l9 its Zvaluation ❑ Improvement Permit/ATC ❑ Both
s. system to serrinel P16ouse ❑ Mobile Home ❑ Business ❑ Industry ❑Other
a. If Residence: I People I Bedrooms I Bathrooms
D Dishwasher - D Garbage Disposal D washing Machine D asseaent/Plumbing D Baseaent/No Plumbing
a. xf Business/Industry/other: specify two I people / Rinke
I commodes I showers I Urinals
e were! coolers
Ir rOODSERVICZ: N Seats Estimated Nater Usage (gallons per day)
7. Type of water supply: l9 County/City ❑ Well ❑ Community
e. Do you anticipate addlHom or expansions of the facility this system Is Intended to serve? ❑ Yea ❑ No
If yes, what type?
*"IMPORTANTA11 CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either • PLAT
�or SATE PLyAA MUST BE SUBMITTED by the client with THIS APPLICATION
PropertyDlmenslo / - /. /.3 WRITE DIRECTIONS (from MaWvllle)toPROPERTY:
Tax Office PRH: to ,11RAa - iU -%/I In9SJS/�2l
Property Address: Road Name % edit Yoe1
city/zip%✓/B v� Li�� Al e "217ae
If las a Subdivision provide Information, as follows:
Name- Al helh I a a /7i /l --T
Section: Blockt Lot: '- 9
Date Property Flagged: _ lU /nc'e / 6cvxecW e mo/"I--
This
`I--
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 Ibis application Is folslled or changed. 1, also, understand that I am responsible for all charges Incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located las Davie County and owned by
to conduct AR testing procedures as necessary to determine the site suitalolty.
THIS AREA MAY BE USED FOR DRAWING YOUR SrM PLAN
property lines and dimensions, structures, setbacks, mud septic loo
Revised DCHD (07/99)
of the following: Existing and proposed
Date(s):
EHS•
Site Revisit Charge
Notification Date:
Account No.
invoice Na
n�
a �
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900111 Tax PIN/EH #: 5822-14-6855.29
Billed To: 'Gray Potts . Subdivision Info: Dutchman Hills Lot # 29
Reference Name: Gray Potts Location/Address: Eatons Church Road -27 28
Proposed Facility: 'Residence Property Size:' . 51 Acres Date Evaluated: x/11 va
"•-
.:Water Supplyi On -Site Well Community Public
Evaluation By: Auger Boring - - Pit I Cut
FACTORS 1 2
3 4 5 (> 7
Landscape position . ...-1.
L l
Slo % _.
HORIZON I DEPTH -
Texture group
Consistence ..• : $
Structure 5612 -
Mineralogy l t1-1
HORIZON H DEPTH . Z -4 30 _
Texture groupG Ck
Consistence.:. Fr SSP --
Structure $IG
Mineralogy.
HORIZON III DEPTH - q8
Texture group
Consistence
Structure.
Mineralogyl
HORIZON IV DEPTH
Texture group
Consistence
Stmcture .
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE .
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE' 3J
SITE CLASSIFICATION: P S EVALUATION BY: °'Nurr- A"
L)
LONG -,TERM ACCEPTANCE RATE: D'� �•`� 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 - Loam
y 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 - Finn 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
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)