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146 Landis Court Lot 32Day. 016 9aate nUUN't� WARNING: TIHS IS NOT A SURVEY All data Is provided as la withadwamldy, or guarantee of any Idnd ekha expressed or Implied Inducting but not Ilmked to the Implied wamantles of memhardabilky or fitness for a parkcularuse. AU users of Davie county's GISwebsite shell held harmless the County a Davis, Nath Carolina, Its agents, wnwhada, mrntradas or employees from any and all dalms or causes aaction due to or adsing od ofthe use or lnabifdy, to use the GIS data provided by this websth, -- Parcel Information��. Parcel Number. D301OA0032 Township: Clarksville NCPIN Number: 5822133906 Municipality: Account Number. 6302310 Census Tract: 37059-801 Listed Owner 1: SHULAR STANLEY Voting Precinct: CLARKSVILLE Mailing Address 1: 146 LANDIS COURT Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: LOT 32 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 0.89 Elementary School Zone: WILLIAM R DAVIE Deed Date: 6/2013 Middle School Zone: NORTH DAVIE Deed Book / Page: 009280938 Soil Types: MnB2 Plat Book: 0007 Flood Zone: Plat Page: 0190 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: 9aate nUUN't� Davie County, NC All data Is provided as la withadwamldy, or guarantee of any Idnd ekha expressed or Implied Inducting but not Ilmked to the Implied wamantles of memhardabilky or fitness for a parkcularuse. AU users of Davie county's GISwebsite shell held harmless the County a Davis, Nath Carolina, Its agents, wnwhada, mrntradas or employees from any and all dalms or causes aaction due to or adsing od ofthe use or lnabifdy, to use the GIS data provided by this websth, -- ATC Number: 3769 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 Treatipent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS IS V4LID FOR A PERIOD OF FIVE 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 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. Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) Date: / DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003176 Tax PIN/EH #: 5822-13-3906 Billed To: Jeff Hayes Subdivision Info: Dutchman Hills Lot # 32 Reference Name: Location/Address: Landis Court -27028 Proposed Facility Residence Property Size: see map ATC Number: 3769 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 Treatipent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS IS V4LID FOR A PERIOD OF FIVE 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 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. Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section —2, P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 r' IMPROVEMENT/OPERATION PERMIT Account #: 990003176 Tax PIN/EH #: 5822-13-3906 Billed To: Jeff Hayes Subdivision Info: Dutchman Hills Lot # 32 Reference Name: Location/Address: Landis Court -27028 Proposed Facility Residence Property Size: see map ATC Number: 3769 **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 1 I 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 fl ` >_ #People #Bedrooms --f:> #Baths �— Dishwasher: Garbage Disposal: ❑ Washing Machine: 13"� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People _ #People/Shift #Seats Industrial13JWaste: Lot Size �.�� Q`"LE \ Type Water Supply�� Design Wastewater Flow (GPD) ZUV Site: New Repair ❑ System Specifications: Tank SizeL0CY'AL. Pump Tank _ GAL. Trench Width 3to C Rock Depth 1Z' LinearFt. Other: 3 S eV 77fJ I�7i9,/�s Required Site Modifications/Conditions: )rSrALL GO.JTO> eFF FI.`tx IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 - BELOW FINISHEDGRADE. ****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.**** u -t If'3 coeq 7 Environmental Health�peciah 's Signature: Date: 5 DCHD 05/99 (Revised) \ f Q, z Li_%___99 •s£ i o ( Y CO a. .861) 3 . .,50,0$ . TO N f _CUURT .6£ ,t,2.po S TO S C To:�O:� 90 i£ )b ----------- Cl)C7 t ) ( I a Lo MOD Ocua �; a �1 �'� N c'> ago a � � '��d'. ! (')CD s � � . N � 9s L 1N3YY3Sv3 3dvis o � .0I.68 .S0 S SS300b. ONS 00�'OS I � 6C .SQ S 00 d`r � . �� 582. f �. APPLICATION P011 SITZ• EVALUATION/Ih111110 hIENT PLlilli11• Davie County Health Department ED vi�onmenta/Hen/ih Section P.O. Bole 848/210 Hospital. Street. Mockaville,.NC 27028. i (336)751-87d0 UUN l7 ***IOIPORTANT*** THIS APPLICATION CANNOT Dl PROCESSED U21LESS ALL THE REQUIRED -INFORMATION IS PROVIDED. Refer be the INFORMATION BULLETIN for instructions 1. Time to be Billed Contac L Person _ Mailing Address Zotl4/1� T�vN me Phone City/State/ZIP awl 0"nosa Phone 2. Name on Permit/LTC if .Different than Above Mailing Address e— City/Stata/Zip -r-- - 3. Application For; ite Evaluation - ❑ Improvement Permit/ATC ❑ Both 9. Spstem to Service: ,av House ❑ -Mobile Home ❑ Dusineaa ❑ Industry ❑ Otller 5. Type system requested:/1l/Conventional ❑ conventional modified ❑ innova Live - _ 6. If Residence: .S people 9 Bedrooms �. 11 Bathroom:; v _ �Vishwanher ❑Garbage DisposalWashing Machine ❑Basement/Plusbing ❑Basement/No l+lumbing 7. If Busiaoss/Industry /Other: verify type 6 People USinls - �— II Commodes 6 Showers - i( Urinals ---_-� It Wa L•or Coolaru IF FOODSERVICE: 1{ Sesta Estimated Water Usage (gallons par. day) S. Type of water supply:County/City ❑ Well - ❑ Colmnunity 9. Do you aatieipato additions or CxpallSions of the flcinty this Sys tell, Is le(elldell to sel•ve? ❑ yes OIVn if yes, }that type? ***IDIPOIfliINLx**CLIENTS AIUSTCOAII'LETETHE IU,QUIItEDI'ItOPllt'1'YINU'Olth•IA'l'10NItLQIJIiS'1-1iD BEL01Y.. Either a PLLATT-oorSIT�'E PLAN 51USTEESUMVITTEclient D by the client u•illl'I'IIIS APPLICATION. Property DimJ ensions: '7�) /�6 jC 2z kECPIONS (from hluel6ville) to Tax orrfe i'iN: iE/,/2.2� ProperlyAddress: Road Name- 0_r City/Zip llft'-'�Lfyi��Q If in a Subdivision provide inrornlalion, as folloWS: Nano: _ //!�3-�CGi /Yr /2 di/ �i �� Section:�3 b /Block: 2 Lot: j� Date llomccorllcrsllaggcd: This Is to certify that the information provided is correct to the best of Illy l(noivledgc. I understand (hat any 11crildI($) issued hereafter are subject to suspension or revocation, itthe site plans or intended use change, or if the infornlaliall subl(litted in this application is falsified or changed. 1,, also, «tlderstand that I «al responsiblefor all charges iucllrri�d.%rnnl this iyiplicdtfull. I, hereby, give consent to the Authorized Representative of the Davic County Ii.iiil Dcpar(IucMt to cuter upon above described property located in Davie County and olvncd by to conduct all testing procedures as necessary to determine (lie site suitability. I)ATl - 6 CF SIGNATURE T"IS AREA MAY BI's US1 D TOR DRAWING YOUR SITE PLAtlxi ludo 11 u the following: Lxisting and proposed properly lines and dimensions, structures, setbacks, and Septic locations). Site Revisit Charge Sign given Revitori nr l -TT) reC/n1 Client Notification Date: EIiS: Account'No. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PER MR & ATC rIF �, P. Davie County Health Department ' /q;� Envllvnmenfa/ Health Section 4 ' `� P.O. Bo: 868/210 Hospital Street Z-� 7 �IPG�J C F��_ Mocksville, NC 27028 ,ay, f�P (336)751-8760 ***XWCRTANT*** THIS APPLICATION .", CANNOT BS PROCESSED UNLESS ALL TRIC REQUIRED INIM MRTI011 I8 PROVIDED. Refer to the INr0R91TI0H BULLETIN for instructions. 1. Mess to be billed V S Content brawn J Mailing Address nnnn''/�PQ b eiA;90SS / �c' noir none 9911- kV09 eitp/state/ai? _ //d//y Ale 97,9a6 Business shone OPP- X `/OLO p. Wase on peruit/ASC if Different than Mailing Address City/stat/Zip 3. Application ror: 0'Hite Evaluation O Improvement Permit/ATC 0 Both *• systa to Service: ys Mouse 0 Mobile Home 0 Business O Industry 0 Other S. If Residence: 1 People s Bedrooms a Bathrooms n Dishwasher D -Garbage Disposal D Washing Machine D sasssant/dubbing a basesent/No plumbing e. if Business/Industry/other: apsaify typo 6 people a links a Co®odes / showers I Urinals 6 Water Coolers Ir r00DSERVICE: t Seats Estimated Water Usage (gallon■ per day) v. Type of water supply: bounty/City 0 well O 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 COMPLETETIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PWT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATtnN_ v�,y Property DimensloQ4 Rif Ta: Office PBV: Properly Address: Road Name CIty21pl[i B 3/ii'LLe- If In a Subdivision provide Information, as folfllo[ws: / Name: Va71z //1V&4 Section: Block: Lot: 2z WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: /o/ Nose 7e S,-ioti lti rope Y � 1 Date Property Flogged: This Is to certify that the Information provided Is correct to the beat of my knowledge. 1 understand that any permit(s) Issued hereafter are subject to suspension or revocation, if the site plans or Intended we change, or If the Information submitted In this application Is falsified or changed. 1, also, understand that I am responsible for all charges Incurred from this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department to ester upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suits fly. DATE_'�%�—�� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN property line and dimensions, structures, setbacks, and septic too Revised DCHD (07/99) of the following: Existing and proposed Date(s): ENS: Site Revisit Charge Notification Date: Account No. _ _/ Invoice No. H # 32' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION . Account #: 989900111 Tax PIN/EH #: '5822-146855.32 Billed To: Gray Potts Subdivision Info: Dutchman Hills Lot # 32. Refe' ., y renceName:-'Gra Potts Location/Address: EatonsChurch Road -27028 Proposed Facility: Residence Property Size:; j 51 Acres Date Evaluated:. 4713 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2- 3 4 5 -. 6, ;7 .. Landscape position . - .. L Slope % Wo HORIZON I DEPTH Texture groupG Consistence r✓r $ Structure _ Mineralogy 1 7 v) HORIZON II DEPTH. 12.Z7— 17,­3 Texture group C G + Consistence Structure L 5 MineralogyI : 1 HORIZON III DEPTHlip3 - Texture group _ � 0 Consistence Structure' .. . Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE : 5 CLASSIFICATION, PS LONG-TERM ACCEPTANCE RATE O . SITE CLASSIFICATION: EVALUATION BY: NG -TERM ACCEPTANCE. . I.o_ , 1 RATE: O� `[ 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,- TerraceFP Flood plain H = Head slope Texture S=Sand'. LS -Loam y sand SL _ Sandy loam L - Loam .SI Silt SICL - Silty clay loam SII.. - Silty loam - CL - Clay loam SCL - Sandy,clay loam SC - Sandy clay SIC - Silty clay C- Clay CONSISTENCE . . VFR - Veryfriable FR - Friable FI -' Firm VFI -Very fum 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 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)