167 Brockland Drive Lots 67-68Davie Countv. NC
S
T..-_ n--- -1 T _— _ —
Tuesday January 1. 2017
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WARNING: THIS 15 NOTA SURVEY
Parcel Information
H702OA0002
Township:
5769864795
Municipality:
71428500
Census Tract:
STOUT JAMES R
Voting Precinct:
167 BROCKLAND DRIVE
Planning Jurisdiction:
ADVANCE
Zoning Class:
NC
Zoning Overlay:
27006-0000
Voluntary Ag. District:
LOTS 67-68 GREEN BRIER
Fire Response District:
Land Value:
Total Assessed Value:
1.84 Elementary School Zone:
4/1998 Middle School Zone:
002010662 Soil Types:
0005 Flood Zone:
099 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
Shady Grove
37059-804
WEST SHADY GROVE
Davie County
DAVIE COUNTY R -A
ADVANCE
SHADY GROVE
WILLIAM ELLIS
En13
DAVIE COUNTY
No
i
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
s Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, Its agents, consukacontractors or employees from any and all claims or causes of action due to
NC•-��-� nts, or arising out of the use or Inability to use the GIS data provided by this website
DAVIE COUNTY HEALTH DEPARTMENT
'IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary S vyage S �S�te st Permit Mar
��,17 r� ,i�, mac' ;>��► .,r` ,s`C ,,;, N�
Name Date _
Location
(� O'F'F'" h',5 -r ," �„ %_' C/o'zjr
Subdivision Name
Lot No.
Sec. or Block No.
Lot Size - ` ` ' House Mobile Home _T Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO El Spepifications for System:
Auto Dish Washer YES 3 NO E3DD
/ft'� /^
Auto Wash Ma thine YES NO ❑ va A)` �% )
A41 t:E ' f /f /cif
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
Improvements permit by
*Contact a representative of the Davie Cour'"�y Health Departme/it for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day''f co ,�tion. Telepho�(e Number 704-634-5985.
n
Final Installation Diagram:
m Installed by cll-� –
�� 1A
Nj%,, ,W y ............................. \
Certificate of Completion �~ ` Date 3 7
*The -signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
JDAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �� ��/J71i�
ADDRESS
PROPOSED FACIILTY at '0�
Water Supply: On -Site Well
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE lrr
Community
Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2 3 4
Landscape position-
1-
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
Iii
G
Texture groupL
Consistence
r
Structure
'
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
ZPT
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: , 5__ EVALUATED BY: lwez
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
S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt
SICL-Silty clay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR-Very friable FR -Friable FI -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
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(01-901
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■.■■■■■■.■.■■■■.■■■■■■■■■■■.■■■■■■■n■.■■■■■■■.n.■■.■■..■■■■..■■■
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MMEMOMMKINMEMM011 NONE
ONION
......................................................... ........
................................ ............■..............:■■■.
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i
1. Application/Perm
Mailing Address
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
Home Phone
Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for:
❑ General Evaluation
❑ Septic Tank Installation
4. System to Serve:
Ouse0-90-bile
Home
❑ Place of Public Assembly
❑ Business
❑Ind stry
� El Other
El Unknown
5. If house=obilehome:
� division
Section Lot # 7-0
❑ Basement/Plumbing
No. of People
❑ Basement/No Plumbing
9 �
No. of Bedrooms
-
❑ Washing Machine
No. of Bathrooms
2
❑ Dishwasher
/1 Y
�7
Dwelling Dimensions
/'
❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes J f
No. of Sinks _
No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: Public ❑ Private
8. Property Dimensions D o A o U Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
If yes, what type?
I
❑ Community
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
This is to certify that the information provided is correct to
incurred from this a ►ication.
DATE
of my know+ and I understand I am responsible for all charges
SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD (12-90)
Davie County. NC Tax Parcel Report Thursday, January 5, 2017
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WAKIVIINki: 'IMS IS INUI' A JUKVI;Y
Parcel Information
H7020A0002
Township:
5769864795
Municipality:
71428500
Census Tract:
STOUT JAMES R
Voting Precinct:
167 BROCKLAND DRIVE
Planning Jurisdiction:
ADVANCE
Zoning Class:
NC
Zoning Overlay:
27006-0000
Voluntary Ag. District:
LOTS 67-68 GREEN BRIER
Fire Response District:
Land Value:
Total Assessed Value:
1.84 Elementary School Zone:
4/1998 Middle School Zone:
002010662 Soil Types:
0005 Flood Zone:
099 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
Shady Grove
37059-804
WEST SHADY GROVE
Davie County
DAVIE COUNTY R -A
ADVANCE
SHADY GROVE
WILLIAM ELLIS
EnB
DAVIE COUNTY
No
9 PIS All data la provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
�O ! NC or arising out of the use or Inability to use the GIS data provided by this website.
DAVID; COUPTY HEALTH DEPARTiIEITT
ENVIRONMEATAL HEALTH SECTION
SOIL/SITE, EVALUATIOP
VAIM /To PC BiP �c,eS DATE 3 " 2,3
ADDRESS
LOCATIO14
A,, '-ew 8,e;9,c L. / # 4;7
LOT SIZE /6 o .Ygca
TOPOGRAPHY: pS
SOIL TE:,TURE e )PS
SOIL STRUCTURE:? -r
DEPTH
RESTRICTIVE HORIZOFS a �AD ',
PERCOLATION PATE
1.
2.
3.
W67
2-V"- e(ar 2
Presoak Hark & tine I Drop Time Rate/iiin. Inch
i
***CLASSIFICATIOI? s Suitable Provisionally Suitable Unsuitable
COPS.TI?TS o Peze %lira/1J J.- L.1c - f4 Gd2 /977
SADTITARIAi-? 11-411
SITE DIA^PAM
S � ik GNta Bvnl
10-0
l2'" S,"W4t /Nat'• .3 yS4` .4/at
/Aw
Z9
to Y
tea: wJ
-ilLk
ti
DAVIT COMITY HEALTH DEPART 1EI?T
EI?VIR0IIID;cITAL HEALTH SECTION
SOIL/SITE EVALUATIOU
I?A1� f�'d pE �i$ofi�l DATE
ADDRESS
LOT SI?.r /Oo &L100
TOPOGRAPHY: ?Y
SOIL TE:,'.TURE: of
SOIL STRUCTU �,e10
DEPTH: G''
RESTRICTIVE HORIZOVS o 12-*"
PERCOLATION FATE:
1.
2.
3.
�! LOCATION
sins: c • vJ47 C/0#40 -
Sgoa,L:k a/ 8-� o
Presoak, Bark & time Drop Time nate/ dr.. Inch
* CLASSIFICATIOI?'Suitable Provisionally SuitableUnsuitable
C0111EI?TS e ,P"4 A!AoIIJ jtv L, lc . 14pf G -4 7 /9?7
SAI?ITARIAITSITE DIAGFAM
0 U /
/A