217 Greenfield Road Lot 42Dav
ie County, NC Tax Parcel Report 'Tuesday, December 2U, s
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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.
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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.****
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,„„-1. i� I �o�S �t:cslo� Pt)nAP
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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.