156 Highland Road Lot 17Davie County, NC Tax Parcel
GREENFIELD RD '
ROD CT
I
r
\_
111 Q
-----------
156
p
4
_T
_(D
Z
143
i
I
Monday, December 19, 2016
All data is provided as la vrithour"nanty or guarantee of any kind abhor expressed or Implied Including but not limited to the
Davie County, Implied vam Nes of merchantability ortbness for a particularuse. AD users of Davie County's GIS velebe shell hold harmless Ne
l�T
County of Davie, Nath Carolina, bs agems, consultants, contractors orepoyees from any and aclaims or causes M action due to
cpDNq NC or arising out of the use or Inability tome Me GIS data provided by this website -
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number.
D301OA0017
Township:
Clarksville
NCPIN Number:
5822241412
Municipality:
Account Number:
8304695
Census Tract:
37059-801
Listed Owner 1:
VANNOY SAMANTHA
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
156 HIGHLAND ROAD
Planning Jurisdiction:
Davie County
City:
Mocksville
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 17 DUTCHMAN HILLS
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.91 Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
1/2015
Middle School Zone:
NORTH DAVIE
Deed Book/Page:
009780942
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 data is provided as la vrithour"nanty or guarantee of any kind abhor expressed or Implied Including but not limited to the
Davie County, Implied vam Nes of merchantability ortbness for a particularuse. AD users of Davie County's GIS velebe shell hold harmless Ne
l�T
County of Davie, Nath Carolina, bs agems, consultants, contractors orepoyees from any and aclaims or causes M action due to
cpDNq NC or arising out of the use or Inability tome Me GIS data provided by this website -
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002147 Tax RN/EH #: 5822-41-4112.17
Billed To: The Ward Group of NC, LLC
Reference Name:
Subdivision Info: Dutchman Hills Lot# 17
Location/Address: 156 Highland Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number. 3060
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 R CONSTRUCTION IS VALID FOR A PERIODOFFIVE YEARS.
Environmental Health Specialist's Signature: 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 i l of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be taken as gu antee that the system will function satisfactorily for any
given period of time.
'-t-r
v
Septic System Installed By:
Environmental Health Specialist's Signature: Date: ^z2 8
DCHD 05/99 (Revised)
— DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
_ Mocksville, NC 27028
(336)751-8760
.IMPROVEMENT/OPERATION PERMIT
Account #: 990002147 Tax PIN/EH #: 5822-41-4112.17
Billed To: The Ward Group of NC, LLC I Subdivision Info: Dutchman Hills Lot # 17
Reference Name: Location/Address: 156 Highland Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3060
**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 I1 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 S? #Baths
Dishwasher:/ Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People_ #People/Shift #Seats Industrial Waste: ❑
Lot Size Typ Water Supply Design Wastewater Flow (GPD) Ce P Site: Newer` Repair ❑
System Specifications: Tank Size /�%% GAL. Pump Tank /071 GAL. Trench Width,(L Rock Depth/'�` Linear Ft.3o d
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT -
FINISHED GRADE. ****NOTICE: Contact arepresen
system between 830 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30
:D EFFLUENT FILTER. RISER(S) IF 6 " BELOW
Davie County Health Department for final inspection of this
day of installation. Telepho e # is (336)751-8760.****
Health Specialist's Signature: Date:!
DCHD 05/99 (Revised)
APPLWA nW FM stEHMXUWlN)WPBOWWa P RW &AW
oavi000unty Heft D"NO S
EfirJV vZmmWAtWt& SaWW
V.G. Sas 849/210 Smpitsl Stmet
Yadkevinal we 27029 -
(336)791-9760
I9 NOW==. nates b 12M XIMCF30MM ae77.== tar is.tvat(me.
/1. fra to a: mllw a+, W ARD GaoLLP o� N C.lc.�at.a>: itantaa
v - aaaisaawn 711 W.AJpaWMT•'81yb. 5• 8s -
cite/seaws8 W:nsi.n$aQon rwlC_a�%I of eaaaa. mm S3_3b) 7827• l8
✓1. am a. "adt/As it Name" tu. at.twt QnM A-Q�,a.a: Ho Ma.s
a ui.a adaaas 5- a as ab ve nght eys(y San c is alaw�
tea. applimtim goat 0 site ioaloatim )(mwr&v®ant ee=it/a= 0 Both
�.. sqto s mimt )(MUSS 0 Mobile Boma ' 0 Baain.aa 0 mdwtsy 0 osh.r -
ytl:' Ze @aaidato.s s 7aw7w a 6 sod70ams - 3 - i 8atbsooss oZ
)(Viammew- u QUSae. ntws .. - X 1. "Oo it fa...eli imd.te„ 1164asNao Aa.aSa6
s: u WXO q/ftft'Wct"*t Opaatil Sot° . wan+a.,__ - e • •
4 COMA&" s et>e>m . a s uae cools.
la :LGA: a aeab Sstla ted Aster us"o wain V- 4w -
v7. 21" at aC.r .opelye �'Comty/nty 0 wsu O Catmamity
.-.. Doy" andelpaUndfitiou or"#=dewo(Se 9s98y Sb ryaeo b isftow town? ova ig)Va
((ya,tr6at type') t ��
v eae.,quim.<<r.> F-Isbtks-abp -Bts7 (�wu(sB)u®c(tasc9.a)aexoeeent`
�,rr,;otBe.euvt s SBaaa�f/tea. �� 7'A* Gol -6wr3s YaAWkwAp
vPieparUAddteas BsaaNme/$�nd", Onco fou cao oV0-r 2-`10 +%4ii 11
avap AAoLkst.al[t A(.TW be - (oNctles . -r.,m Ej5l.{'
�FMaB.hdhidw eealdsa9.m8ea,m a0e.c _ EATOWS Church.. �. 7-Ae i
rb.e Du�clvrnox� 1;���s I `4- Le anA Wo)('" .
sembc Bad tar 17 '�Baaer6pee47)aAsd: a/�/a
OATEN `3(CNATURE �•Al�1 CJ.`F.O/
TMASBAMAYB80BBDYOSffiAWII(GYOOB:BQEeIdNQtd6desSatse E"yrd .
Mmpe�4:amasdr8«d®, abeam. wool , adwpSetrabm4
SbAniwamlv
CSeatWeeDtic
EB&
Asamm)rkk.
Aaatdncuoio��) (ttw:er(a
�F9
;6
?p0?
UX I I I
I I
I I I I I
LOT 013 i LOT =14 1 LOT X15 I
1 I I I I
I I I I I
LOQ' 12 I 1 I I
I I
I I I I I
I I I I I
21 GREENFIELD ROAD ROD COURT -4--TURN AROUND
PAYED
f
VN
P
LOT #2
~ o 0.929 AC.
0Z
W
o
9 N
Y a
oZ
S E.
<^ tt? CORNER BU"ol""' SE1_9r.C�c
LOT #17 m
m N 0.917 AC
I ^
i
3a
"Y S 81.:9CPAW
__ I
LOT #25
0.836 AC.
---------_ AG _ ZONED RA
LOT #18 — zoNm zo
R-
0
0.935 o in
P <
I I
'LOT #22 3D
0
LOT #21
;r v; Q,786 AC. oo c oN a
\ n = o' a 20' 0.835coNTNo:-
0 5' NEGATIVE ACCESS EASE NE41 I ISIGHI 'RIANCEE iYP.
� o CGF.�(a
W- — N 81' 39' 48' V 5' NECATNE ACCESS EASEMENT EVSTINO
N $7.39'23' _ v IRON
108.36— - — 152.02 50.0 N 81 * 9'46' V m
MAG N'L NAG NAI: 20' PAVED
u
I,
LOT #24
LOT #19 0
0.836 AC,^
Q
�
= 0.835 AC, o
m
Y
•P
�
o
o
Z
Y
p UIILIi`.' ..
�
o
N
-
EASEMENT
N
81.57.13' E
s
S 81.39'48' E
260.07
0
f 260_00
~
1
0
a0 -BACKS
TP. BUILDING
3
LOT #23..
a
I I
LOT #20 $
e
0.836 AC.
0.
Q 0, 835 AC -
C. g
—
30'
o
H
m
_
81'57'13' E
_
I I
'LOT #22 3D
0
LOT #21
;r v; Q,786 AC. oo c oN a
\ n = o' a 20' 0.835coNTNo:-
0 5' NEGATIVE ACCESS EASE NE41 I ISIGHI 'RIANCEE iYP.
� o CGF.�(a
W- — N 81' 39' 48' V 5' NECATNE ACCESS EASEMENT EVSTINO
N $7.39'23' _ v IRON
108.36— - — 152.02 50.0 N 81 * 9'46' V m
MAG N'L NAG NAI: 20' PAVED
u
APPLICATION FOR SHE EVALUATION/IMPROVEMENT PERMIT & ATC r �' ^ r
J Davie County Health Department D C- F 1
�Env/tunmenta/Health Sectlon
lo/e4_Se G 1s) P.O. Box 846/210 Hospital Street 2- % C
ys #ems /44- Mocksville, NC 27028
r r (336)751-8760
***IMPORTANT*** THIO APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
IIiI'ORM 210H IS PROVIDED. Refer to the INfORIIATION BULLETIN for instructions.
1. Msec to be billed content Person J
Mailing address some Phone
city/asst./axP JUd1N�. Ale, 9226 Business Phone 91`'x- S�96D
2. wen en Permit/ATC if Different than Above
Mailing Address City/state/sip
3. Application Tore I9 ate Evaluation ❑ Improvement Permit/ATC ❑ Both
e. Brat" to services yr Mouse ❑ Mobile Home 0 Business ❑ Industry ❑ Other
a. If Residence: / People I Bedrooms I Bathrooms
D Dishwasher D as -begs Disposal D washing Machine - D Basement/plumbing D Basement/Ho Plumbing
6. xf Busineee/radustry/others Specify type
comaodes
I showers
Urinals
People I Sinks
/ water Coolers
IF rOODSERVICE: Ii Seats Estimated Water Usage lgallone 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? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESVBMITTED by the client with THIS APPLICATION -
Property Dlmensioel:l n.7• t . g %.5
Tax Office PDN: N 6-3 Aa - N - � K55-'�2
Property Address: Road Name U 14 / k Yon/ 1A A/
Cltymp 4l0 rVe rLP,�7�ft
If in a Subdivision provide Information, as follows:
Name Va 7ZC//n/U'/_/ 121I11S
Section: Blocks Lot: %%
WRITE DIRECTIONS (from Mocksviile) to PROPERTY:
/o/ AleAL TS... iv e, A
RPP64
Date Property Flagged: - %0 /nc'c' f6crnCone /'C
This Is to certify that the Information provided is correct to the best of my knowledge. I understand that any permll(s)
Issued hereafter are subject to suspension or revocation, If the site plans or intended use change, or If the Information
submitted is this application Is falsified or changed I, also, understand that I am responsible for all charges incurred from
this appllcatlom b 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 saitagllity.
DATE (7-r�)ID-401%
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN
property lines and dimensions, structures, setbacks, and septic loo
Revised DCHD (07/99)
of the following: Existing and proposed
Site Revisit Charge
Client Notification Date:
EHS:
Account No.
Invoice Na_ti�
St
c/'� Ali
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900111 -Tax PIN/EH #: 5822-14-6855.17
_
Billed To: Gray Potts . Subdivision Info:, Dutchman Hills Lof# 17
Reference Name: Gray Potts Location/Address: Eatons Church Road -27028
Proposed Facility: Residence Property Size: 51 Acres Date Evaluated: S:Z a�!
Water Supply: On -Site Well Community Public '
Evaluation By: Auger Boring Pit jl Cut, , .
FACTORS 1 2 .3 4. -. 5 6 7
Landscape position ... �.. .
Slope %
HORIZON I DEPTH
Texture group
.`Consistence
Structure.
Mineralogy
HORIZON H DEPTH
Texture groupC
C
Consistence
Structure
dh/G
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
. HORIZON IV DEPTH
Texture group
Consistence
Structure ..
Mineralogy
SOILWETNESS r
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE IT
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 - Flood plain H - Head slope
Texture
T- Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt
SICL - Silty clay loam SIL - Silty loam CL Clay loam SCL - Sandyclay loam
SC -Sandy' clay ' SIC - Silty clay C -Clay
CONSISTENCE
i
VFR - Very friable FR - Friable FI - Firm VFI - Veryfirm 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 OR - 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)
NEEM■■■■■■■
■■MEMS■■■■■
■
■■■
■■■S■■S■■■SS
■■■■■■S■■■■■
■■■SM■S■■■■■
■■NEEM■■M■■■
■■■■■■■■■■■■
NEEM■■■■■SS■
■ESS■■E■■■■■
NESE■■E■■■■■
■■■■■■S■■■■■
■■M■■
SOMME
■■M■■
■■■■■
■■■■