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217 Greenfield Road Lot 42Dav ie County, NC Tax Parcel Report 'Tuesday, December 2U, s 218 123 tit ---- -- ----- - -- --, 217 ' �Q 4179 601 i t� `----- _j W �\ LL. 200 :W W 0'_ 193 016 [all IhidataIsprovidedulsWthoutwamndyorguaraMee ofuyIdnd eftherexpressed orimplied Including but nathmhed to the Davie County, implied wamtNes of memharddflbly orfMeufora partimlaruse.M users of Davle County's Gla websfte shall hold harmiess the1�T County of Deals, North Carolina, hs agents, eonwlbnts, conbrs rs or employeeshom any and all dahns orwuses efallon due to ,. C "arising out afthe use orinabllltyto uu the GIS data provided by We yehsNe WARNING: TIHS IS NOT A SURVEY Parcel Information.--- _.-----_--;____ Parcel Number. D301OA0042 Township: Clarksville NCPIN Number: 5822153522 Municipality: Account Number: 8302916 Census Tract: 37059-801 Listed Owner 1: GRAY STEFANIE L Voting Precinct: CLARKSVILLE Mailing Address 1: 217 GREENFIELD ROAD 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 42 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.14 Elementary School Zone: WILLIAM R DAVIE Deed Date: 12/2013 Middle School Zone: NORTH DAVIE Deed Book / Page: 009450153 Soil Types: MnB2,MdE 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: [all IhidataIsprovidedulsWthoutwamndyorguaraMee ofuyIdnd eftherexpressed orimplied Including but nathmhed to the Davie County, implied wamtNes of memharddflbly orfMeufora partimlaruse.M users of Davle County's Gla websfte shall hold harmiess the1�T County of Deals, North Carolina, hs agents, eonwlbnts, conbrs rs or employeeshom any and all dahns orwuses efallon due to ,. C "arising out afthe use orinabllltyto uu the GIS data provided by We yehsNe DAVIE COUNTY HEALTH DEPARTMENT n V Environmental Health Section f ` P. O. Boa 848/210 Hospital Street Mockwille, NC 27028 (336)751-8760 Account #: 990001248 Tax PIN/EH #: 5822-15-3522 Billed To: Mike Hester Building Co. Reference Name: Proposed Facility: Residence ATC Number: 3613 Subdivision Info: Dutchman Hills Lot#42 Location/Address: 217 Greenfield -27028 Property Size: 1.162 Acres 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 WAS R C N IS ✓ALM FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: '� �Y{11�feGi -�D,e cS��QO0iY1�' CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Com ion shall indicate the system described on Improvement/Operation Permit has been installed incompli with Article f G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in N taken arar¢ee that the system will function satisfactorily for any given period of time. r� 8 _kc3 Es FIZ6�15r Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) (-O / ,X12 t Top, D. W . - DAVIE COUNTY HEALTH DEPARTMENT i - Environmental Health Section P. O. Boa 848/210 Hospital Street - MocksviHe, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Clc K yo -� -, Account #: 990001248 Tax PIN/EH #: 5822-15-3522 Billed To; Mike Hester Building Co. Subdivision Info: Dutchman Hills Lot # 42 Reference Name'. Location/Address: 217 Greenfield -27028 Proposed Facility: Residence Property Size: 1.162 Acres ATC Number: 3613 **NOTE** This Improvement/Operation Permit DOES NOT authorizgthe 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 Rouse. #People #Bedrooms 3 #Baths 2 - Dishwasher: Dishwasher: l " Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: 121` Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size • (b S Type Water Supply t-6yt—ar Design Wastewater Flow (GPD) 3160 Site: New � Repair ❑ `` rr , System Specifications: Tank Size 4000GAL. Pump Tank GAL. Trench Width 3(o Rock Depth I Z" .Linear Ft. 3� Other: 7iSTQ !>V-nDA -EDx,--S I Required Site Modifications/Conditions: ALI_. - C Z 000T- 00Q vek�:p IS FIt�Si e- s tot �-F . t�rJu IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED jFFLUENT FILTER RISER(S) IF 6 - BELOW FINISHED GRADE- ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this (Systern between $:30 . to nhor_1:00 p.m, to 1:30 p.m. on the dayl installation. Telephone # is (336)751-8760.**** r to ,„„-1. i� I �o�S �t:cslo� Pt)nAP S Z I Health Specialist's SignXture: , Imo' I • 1 / Date: DCHD 05/99 (Revised) t APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department �S Elivironmenta/Hea/th Section P.O. .Box '848/210 .Hospital Street NOtl Mocksville, NC 27028 (336)751-8760 1 i ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL Al " INFORMATION IS [ PROVIDED. -Refer to the INFORMATION BULLETIN foriinstru o 1. Name to be Billed I� I tKF t1^7�n Qcl IcO I� c-- *Contact Person 1v747' :I♦47 �GJ Mailing Address 4 It �e - fS�C(f 64"7 a Home Phone 3 3b—�io 0 — City/State/ZIP '6'- C% D m I Business Phone. 3 36 —3! ( 2. Name on Permit/ATC if Different than Above Mailing Address City/State/zip 3. Application For: ❑ Site Evaluation ILY mprovement Permit/ATC ❑ Both 4. System to Service: ZI-H��ousse�e E3 mobile 'Hoide' El Business IJ Industry 13 Other - 5. Type "system -requested: IS.Conventional ❑ conventional modified '❑ innovative t 6. I��f��Res idence: #People � l��. # Bedrooms 3 #Bathrooms llii iMshwasher ❑Garbage' Disposal " aching Machine "Dement/Plumbing ❑Basement/No Plumbing' 7. If Business/Industry /Other: verify type #eople #Sinks '. ' # Commodes '# Showers # Urinals. 4 it water Coolers y IF FOODSERVICE:: # Seats- Estimated Water .Usage (gallons per day) B. 'Type of water suppyd,ll-County/City ❑ Well ❑ .Community 9. Do you anticipate tditions or expansions of the facility this system is intended to serve? ❑ Yes 91-?r`ti— J If yes, what type? b "*IMPORTANTf*.*CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a'PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions:SPe// WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: a �7 � 1Q /'-Ccetib TGl?NProperty Address: Road Name - 1 0 i4l-e5Q City/zip mot-4C'i%lf $lc'J1 OiE4,a-, 4ce" tC% / If in a Subdivision provide information, as follows: % V l4 r5 i n U n� 5 o ` r, Name: 0e4l CIJM4A/S' 44I15 S! 5 h .`Tctvvt./lcJ 9C' rf-o -e Section: Block: Lot: Date home corners flagged: C7 3 This is to certify that the information provided is correct to the best of my knowledge. I understand that any pertnit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. .I, also, understand that I ant responsible for all charges incurred fi•oni 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 suitability. DATE / /' S =a 3 SIGNATURE c 7 4e - THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inc ude all of the following: Existing and proposed property lines and dimensions, structures, setbacks,, and septic locations): . 1 Sign given Revised DCHD (05/03 Client Notification Date: APPLICATION FOR SITE EVALUATION/IMPROVEMENF PERMIT & ATC D BE F� Davie County Health Department EnvffVntnenfat Health Swdon P.O. Box 868/210 Hospital street Mockeville, HC 21028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSZD UNLESS ALL HE REQUIRED XIM MIITIOH IS PRROVIDED. Refer to the INVOM ATION BULLETIN for instructions. 1. Nase'to be Billed C,- A' Contact "me= Nailing address /?7 Vlpe/e/'40SS ICc� Rose Phone - _. 99S'' �Y ./ b 9 2. City/state/BIp Naso on Pernit/ATC if Different than Above Nailing Addre Application rort `a Site Evaluation ar■tem to service, P-iouse D Mobile Home If Residence:' 1 People Business Phone 9! r- P'9�010 City/state/Bip 7 F= D Improvement Permit/ATC O Both 0 Business 0 Industry O Other I Bedrooms 6 Bathrooms O Dishwasher O garbage Disposal O Mashing Machine It B sinasa/xndwtry/other, specify type I comdas i showers 0 Basement/plumbing O Basement/No plumbing e Urinals B People s Binks _ a Mater Coolers Ir IWDSERVXCZ: # Seats Estimated Nater Usage (gallons per day) 7. Type of Mater supply: E County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? 0 Yea 0 No If yes, what type? ***IMPORTANT***CLIENTS MUSTCOMPLETBTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PWT or SITE PLAN MIST BESUBMITIED by the client with THIS APPLICATION. v Property Dlmensis�'� 1. g 9.3 /ogle.5 / Tax Office PIN: t1 ,1R,0a - 1q ^ In ?$,s( �tZ Property Address: Rad Name d -%i 10e1 Cltyrup Moet se,,,LL- nl c',�7�1'll If in a Subdivision provide Information, as follows: k/<l/ Name: hl4e l -IS Sections Blocks Lot: i�/.Z WRITE DIRECTIONS (from Mocksville) to PROPERTY: tv 11,6 ON a)4 Date Property Flagged: - 76 1we-e / 6trn'non—e This Is to certify that the information provided Is correct to the best 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 I, also, understand that I am responsible for aft charges Incurred from this applfcalfon. 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 sultalpity. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN property lines and dimensions, structures, setbacks, and septic loo of the following: Existing and proposed Site Revisit Charge Date(s): Client Notification Date: ENS: Account No. Revised DCHD (07/99) Invoice No. Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Texture group Consistence Structure Mineralogy SOIL WETNESS . SITE CLASSIFICATION: 1 �T� �Ck� EVALUATION BY: RATE: -,. �' O ,LONGTERM ACCEPTANCE OTHER(S) PRESENT:' REMARKS:.. LEGEND Landsca a P 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 loarn SIL -.Silty loam CL - Clay loam SCL'- Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE cis VFR - Very friable FR - Friable F[ -,Firm 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 tructur 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 7 Long-term acceptance rate - gallday/ft2 DCHD 05/99 (Revised) ti Z DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH #: 5822 -14-6855.42 Billed To: Gray Potts` : Subdivision Info-. Dutchman Hills Lot # 42 'Reference Name: Gray Potts Location/Address: Eatons Church Road -27028 Proposed Facility: Residence Property Size: : 51 Acres Date Evaluated: S 0c7 Water Supply: On -Site Well Community i Public Evaluation By. Auger Boring Pit - Cut FACTORS. 1 2 3 q 5 .6 '7 Landscape position L Slope % 2 Z `HORIZON IDEPTH 12- 2Texture Texturegroup Gt, Consistence Structure G Mineralogy HORIZONIIDEPTH 1 12-22 Texture eroun - Cl Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Texture group Consistence Structure Mineralogy SOIL WETNESS . SITE CLASSIFICATION: 1 �T� �Ck� EVALUATION BY: RATE: -,. �' O ,LONGTERM ACCEPTANCE OTHER(S) PRESENT:' REMARKS:.. LEGEND Landsca a P 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 loarn SIL -.Silty loam CL - Clay loam SCL'- Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE cis VFR - Very friable FR - Friable F[ -,Firm 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 tructur 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 7 Long-term acceptance rate - gallday/ft2 DCHD 05/99 (Revised) ,Y 0, 865 AC. o ti een LOT es 'i` <o, S g3es3 0;.816 AC; -ding 3o E 169 Ind � LOT , #42 1 , 162 . AC. C 11. .SO' 1 LOT CIO1 ,.414 A �u r, LOT #4 > Y 0. 976 AC.