145 Landis Court Lot 30Dav
D16
hit ; All data Is provided as Is wghoulwarrardy or guarantee or any ldnd either expressed or Implied Including but not limited to the
Davie County, Implledwamntlss otmerchardablllty stiffness form parscularuse. All users of Davie Countys GIS website shall hold harmless the
County of Oahe, Nodh Carohns ib agents, comultmt%contmctors oremployesshom any and alicialms orcauses of action due to
C S NC or adcing out oldie use orinablllty, to use the GIs data provided bythis%%lute. 11
WARNING: THIS IS NOT A SURVEY
Parcel Number:
D301OA0030
Township:
Clarksville
NCPIN Number:
5822145047
Municipality:
Account Number:
8302765
Census Tract:
37059-801
Listed Owner 1:
RAY WILLIAM EUGENE II
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
145 LANDIS COURT
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAME COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 30 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.83 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
11/2013
Middle School Zone:
NORTH DAVIE
Deed Book I Page:
009420933
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:
hit ; All data Is provided as Is wghoulwarrardy or guarantee or any ldnd either expressed or Implied Including but not limited to the
Davie County, Implledwamntlss otmerchardablllty stiffness form parscularuse. All users of Davie Countys GIS website shall hold harmless the
County of Oahe, Nodh Carohns ib agents, comultmt%contmctors oremployesshom any and alicialms orcauses of action due to
C S NC or adcing out oldie use orinablllty, to use the GIs data provided bythis%%lute. 11
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002706
Tax PIN/EH #:
5822-14-5047.30 JH
Billed To: Jeff Hayes
Subdivision Info:
Dutchman Hills Lot # 30
Reference Name:
Location/Address:
Eaton Church Road -27028
Proposed Facility Residence
Property Size:
see map
ATC Number: 3881
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: Date:
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.
7WcK
Septic System Installed By:r�—
Environmental Health Specialist's Signature:
ry Adan
hi
- - DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street Zo -S
MocksviHe, NC 27028 o y
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002706 Tax PIN/EH #: 5822-14-5047.30 JH
Billed To: Jeff Hayes Subdivision Info: Dutchman Hills Lot # 30
Reference Name: Location/Address: Eaton Church Road -27028
Proposed Facility Residence Property Size: see map
ATC Number: 3881
**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 #,Peeople #Bedrooms �� #Baths �_
Dishwasher: ;2( Garbage Disposal: ❑' Washing Machine:y! Basement w/Plumbing-,2r' Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply _69 Design Wastewater Flow (GPD) clYd Site: New Repair ❑
System Specifications: Tank Size PdbGAL. Pump Tank GAL. Trench WidthU"&/ r'kock Depth /-I el Linear Ftt�'ed
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 K BELOW
FINISHEDGRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspectionofthi)
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:
DCHD 05/99 (Revised)
iil)[MMI Loi In1MUT Y70 44Y[ MV. )))D r. 4
i5
A. Name to be gilled
Mailing Address
city/state/Irp
APPLICATION FOIL SIZE EVALUATIONJIM'110yEh11M I'MIf y ATC
Davie County Health Department
Environmenb//Iealthsectinn
P.O. Dox 846/210 Hompital Street
Hockavillo, HC 27028
(336)751-0760
Refor to the
D WLESS ALL THE RSQUI'RLD
DHLLSTIR for 3nDtxuctionu.
Contact Parom
flame gbonc ...-- -..
OOvtwao- - M--�tP,V•-
1. Mem oa gerait/Aic iP nireernnt tbaa
Mailing Address aty/aweo(//J�Y is
1. Application ror. kSite Evaluation X -T -DI v64 L' pe t/ATC 0 nuth
f. Systea to Sanito, How* ❑ Hebile Home 0 business C7 Industry ❑ Other
�r W.
S. 'Type oyatem requasted,y rmyencinwl ❑ nosvene3on4 ao uod 13 iomovativo _
6. if Mcaidmc.:1 I People yyyyy,,,,,�_� a Bedroom.^. • 1 Bathrool
C WOU.aaher dcanatb-go Disposal )*aabiag Maracas [ aemmt/plumbing Dganedant/no rluaaing
7. IP noplacaa/leduatrY /Othcze vttily Cypc d Yaoplo P 9inka __
F Ca®odm _—� i sh rats L Urinals I natty Cool..
IF FOODSERVICHC A Seata HMtiMatOd Mater Usage (9allena per day)
e. T"a of .at. supply ty/City L] Mo11 D you Connm,nity.,
I. Do anctoipate aodlu. or cYpanrlons of filo facility thissyslinl is fuleuded to SMUZ O t
yrs / 61,10
lfyws what type? � V
••'IAIFORrAN7C CLIFA=AIUSTCOMPLE=THL• REQU/[1f:BPROPMCYINFOILMATlONItL•'QOR51'1{0
UELOW. PLO,a a PLAT or SITS PLAN AAFIZSrBE�5UUBdfrT Dby We Want vita THIS APPLICATION.
1'rol)er(y Diaimtdolls: y'��T1 WRITE DIH6CTIONS(Wn, hladovi1h/1y 1�It�tll'p;lt'I'T:
Tar 0 M m 1.11,1: 0 V -y-
. Pro polyAddress. RoadNgme `--e'^-""•�'-�---- /"_
LStyrzip (0 6's� ow/
lfluaSAM visionprgm a albrmallop,st,ul[tf(WU
spm: yLj Y(/" ' (J ;/�=.��.._.._.•--/-
Sedimc Dlod:: LoC'_i'9�✓" Date home tarnets flagged. Oy
Thu Is to Cerfffy that theinlormatloeproyided is correct to the but ormy Lnowtodge. I uadmilud UML Any ptrndt(O
issued hereafter are mbjcct to Sespeauon orrevoahga,if Mesitoplaus orinlcuded use ebangq or Lf Ola fnrurmallon
submitted in Ods applialiou isfa dIlcd or changed. 1, 940, Budavand 0idrl gm rerpgBliLkjdrnl[d mgcs6mnrrrd jrsm
This rcp[Uicuriom 1 kereby, girt tojgut to IhCAM(I,oidzdd Rq rescAtaUYa of the Davie County health Ocparhucul
to coltrupou abovedesrribed properlyloCAod iM DAvleComly and owned by
to conJucl all lcsGn pmlures dncccssary to dt(Prnlinc Ote silesuitaLgit}•. �-
DATE— SIGNATURE
- TIDSAI(CAMAY33EUSIIDTORDItAR'IIVCYOURSTrEP cl OcallbrWDfu olriug: Erisliugaudpropu,t:d
. Property Liam anddinmigions, structures, setbacks, audscpheloatios).
Sign elven
1tabODOM05103
Site Revisit Chargr
Datc(s):
QlcutNodBaOoiiDatct
BIIS:
Accounirro.
W. 11. 1 UU4111 I: J JAM. CarojGb I IKIAUt 9913 44V er NV. 97 )13 pr, %of2
O ssv $
S pa>ial Data [= pV@rer
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Click on the Map (o:
(2) Zoomin C ZoamOut C, RamrdalMap C Identify: Parcels Ir
Zoom Factor. 25 R r'. ,Radius Search Qeel)
NW
106
/S
495
47 30 1�24
sw
Parcel Data
Find Adjoinia P r-rels
• CounylD.-MOt0AW50
• Account Numbwa2515152
• FIN., 5022145007
• Logo] 11OT 30 DUTCHMAN HILLS
• Owne/Nam•;CANAGROUPLLC
• OwnerlAddmss 1: CANAGROUP LLC
• Ow v'Addrvsa 2:
• Dwmr1Addnss8: 1870 UNDERPASS ROAD
• CNy,S/ete2ip:ADVANCE,Nc27008-0000
• Land Value: 512.000.00
• Building Value: $0.00
23
22
7176
NE
7062 a
• lend Ue/Type. D301OA0070 l LT
• Deed BookFage: 0033510541
• Dead Date: 20DOMWS
• Sal•s Place, $ODS
• PropertyAddresa:
000145 000145 CT
• CotmyZening R-20
• Cornus Code:
• Cfy Code:
• FimD1strktWILLIAM R. DAVIE
• Fbod Zom:ZONEX
• Flood Cormm V. 3703)S
• Flood PAW 0025C
• Flood Map Date: 12-17.1905
26(
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Census Tra
City Bound
County Zor
MDlli Syt
E911 Fre D
[' Flood Pane
r; Flood Zone
[J Parcels
School Dist
Multi Syl
F, Soils
[' Town Zonn
[; Townships
Multi Syl
r Voting Poor;
r Ddvewaya
r Rail lines
[- Street Cent
USMO Higt
MDtti syr
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r Creeks and
Addre
r Fire Depart
r Schools
I11-1bi l'aL'
MAP CL
Inventory of reel l
within this jurisda
compiled from ref
plats, and other F
and data. Users <
hereby notified th
http://66.208-132-254/servlet/com.esri.esrimap.Fsrimap?Namem-Davie&Cmd=Clk&Left=1... 9/21/2004
! . ` APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC rFLW2—'�F
Davie County Health DepartmentEntrliOnmenta/ Health SeWon
/e4 -5e ,G�� P.O. Box 868/210 Hospital 8traat
Ay_,n�e��f C ie Mocksville, HC 27028
'/� (336)751-8760
***IHPORTANT*** THIS APPLICATION CANNOT BE PltOGZBtiSD UNLESS ALL THE REQDIRED
INFORMATION I8 PROVIDED. Refer to the IM MRMATXOH BULLETIN for instructions.
1. Nees to be Silted Content Person ,�
ilalling Addy... /b'7 g//y �I�ss � eom,e shoes 99�'- 5f -
City/state/sIp_old_ //Q/n/[� /�/� a2%oaPJ
Business peons
a. Naw on perm,!!/ATC it Dillarent than Above
Nailing Address
3. Application sort _L9 Site Evaluation
c. system, to aervioe, House ❑ Mobile Home
City/state/sip
Fr
❑ Improvement Permit/ATC 0 Both
❑ Business ❑ Industry ❑ Other
5. If Residence: I People I Bedrooms I Bathrooms
D DishwesMr D Garbage Disposal D Machina Machine D sasenent/vluabing O naeeaant/No plumbing
e. I! ausinsss/Industry/Other, speoily typo a people I pinks
I Commodes I Showers I arivals I Mater Coolers
Is I'OODSZMCZ: # Seats Estimated Nater Usage tgallons par day:
7. Type of Mater supply: 8 County/city ❑ Nell ❑ Community
e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑Yea ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE711C REQUIRED PROPERTY INFORMATION REQUESTED
BELOW, Either a PLAT or SITE PLAN MUST BESUBMITPED by the client with THIS APPLICATION.
Property Dlmensiorl R •�<9 93 A2fi!.5
Tax Office PIN:q ,�R as - JU - G ?S,S13D)
Property Address: Road Name _ 1 41,,dog/ 2A ?a
city/zip 4eAs,-11VP .� n/ e X7;7
If In a Subdivision provide Information, as follows:/
Name: ///A k / /1JCs /7 m //J
Section: Block: Lot: �Fo
WRITE DIRECTIONS (from Mocluville) to PROPERTY:
ipf184 e7/U K,Cy7
Date Property Flagged: �U /nc't 7<�crn�on e��
This Is to certify that the Information provided Is correct to the best of my knowledge. I underotsud that any permit(s)
Issued hereafter are subject to suspension or revocation, if the site plans or intended we chsuge, or It the Information
submitted la this application is Glsified or changed. I, also, understand that I ant 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 In Davie County and owned by
to conduct all testing procedures as necessary to determine the site sailaq(lity.
DATE _ 17 —'V A) --Q&)
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN
property lines and dimensions, structures, setbacks, and septic loci
Revised DCHD (07/99)
Of the following: Existing and proposed
Site Revisit Charge
Client Notification Date:
Account No. ///_
Invoice No.
r > 436
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section'
'...
Sol]/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900111 Tax PIN/EH #: 5822-146855.30 .
Billed To: Gray Potts Subdivision Info: Dutchman Hills Lot # 30
Reference Name: Gray Potts Location/Address: Eatons Church Road -27028
Proposed Facility:perty Size: 51 Acres Date E��jfi0
Residence Pro valuated:
'Water Supply: On -Site Well Community Public
Evaluation By. Auger Boring- Pit ✓ -Cut
,
FACTORS 1 ..' .2 3 4 5 t 6, 7
Landscape position __ r L
_ .
Slope %
HORIZON I DEPTH
Texture groupGL
Consistence
Structure l<
Mineralogyl'
HORIZON H DEPTH 4 2.0 it- 17
Texture group t=
Consistence . S r S f
Structure, 5 )
Mineralogy;
HORIZON III DEPTH
Texture group 5-10 +- cX
Consistence r S
Structure
Mineralogyi
HORIZON IV DEPTH
Texture group
Consistence
Structure. .
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION — -
LONG-TERM ACCEPTANCE RATE 1 0- 5S I
SITE CLASSIFICATION: EVALUATION BY: �>' � )x-10
LONG-TERM ACCEPT 37
ANCE RATE. �' OTHER(S) PRESENT:
REMARKSZZ-2, . f J ell
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 SH. -Silty loam CL -'Clay loam SCL - Sandy clay loam
SC - Sandy claySIC -Silty clay ... ' C - Clay . ,
,
CONSISTENCE
oist :
VFR - Very friable FR - Friable FI Firm VFI - Very firm EFI - Extremely firm
Wet'
NS - Non sticky SS - Slightly sticky y Very y
S -Stick VS - Ve Stick
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
tructure
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)