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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. 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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■■ ■■■■■ ■■■■