227 James Road Lot 47Davie County, NC Tax Parcel Report Tuesday. January 3.� 2017
WAKNING: TH151N INUT A SUKVEY
Parcel Information
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:
H703OA0008 Township:
5769978142 Municipality:
Shady Grove
82518196 Census Tract: 37059-804
RODGERS SCOTTY L Voting Precinct: WEST SHADY GROVE
PO BOX 315 Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
NC Zoning Overlay:
27006-0315 Voluntary Ag. District:
LOT 47 GREEN BRIER ACRES Fire Response District:
0.54 Elementary School Zone:
Land Value:
Total Assessed Value:
2/2002 Middle School Zone:
004060859 Soil Types:
0004 Flood Zone:
172 Watershed Overlay:
Outbuilding 8r Extra
Freatures Value:
Total Market Value:
ADVANCE
SHADY GROVE
WILLIAM ELLIS
GnB2,EnB
DAVIE COUNTY
No
Davie County,Implied
!!
NC 3
All data is provided as is without warranty or guarantee of any idnd either expressed or Implied Including but not limited to the
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
or arising out of the use or Inability to use the GIS data provided by this webslte.�
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
• P. O. Boa 848/210 Hospital Street
' Mocksville, NC 27028 (/
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002014 Tax PIN/EH M 5769-97-8142
Billed To: Freedom Homes Subdivision Info: Green Briar Acres Lot # 47
Reference Name: Location/Address: Brier Creek Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 2985
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 I Qj M #People Z #Bedrooms Z #Baths 2 -
Dishwasher: El Garbage Disposal: ❑ Washing Machine: M"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size 112 4CQZ Type Water Supply Design Wastewater Flow (GPD) 5Z40 Site: New Repair ❑
i
System Specifications: Tank Size /000 GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. .210
Other: Z5Z "ILT)O4 SYSrC^ -ruAT HAWS Jq �C3� ) l� t �Te+BvT10
r�44"L fj CC4Tb ��Q IQ 0 I. t-tA Krt_P 5or# 1400 -SC
Required Site Modifications/Conditions: � Q, 4
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ****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.****
nOfx. Fn' �PRir4
PaOF,Z w U,s�.
* b0 -1H 3o„
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date: 1q
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002014 Tax PIN/EH #: 5769-97-8142
Billed To: Freedom Homes Subdivision Info: Green Briar Acres Lot # 47
Reference Name: Location/Address: Brier Creek Road -27028
N
ATC Number: 2985
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 WASTEWATE ONST CI LID F R A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: / �te: f E> 19 D
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 AY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
19
Q7
M
Septic System Installed By:
Environmental Health Specialist's
DCHD 05/99 (Revised)
Oct 09 01 01:35p davie county envhealth 336 751 8786 p,2
t1 PPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
U tDavie County Health Department
QC t bjll Environmental Health Section
P.O. Box 848/210 Hospital Street
,ROt,r1L`I(pt}(E%LTH Mocksville, NC 27028
E�v
�nv1F jV (336) 751-8760
I
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRL•DPROPERTY INFORMATION REQUESTED BELOW.
BELOW. Either a PLAT or SITE PLAN MUST BESUBAY17TED by the client with THIS APPLICATION.
Properly Dimensions: �/� c/t.0��'1!a WRITE DIRECTIONS (from ocluvillc) lu PROPENTI'I:
Tax Office PIN: # (� 1 �c� �`t A
'&.Lt
Property Address: Road Name [ �`J
City/Zip )l` t C C
If in a SubdiviSiion provide information, as follows:
Name: ! l,%/� douAj
Section: Block: Lot: -�-- f --
Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(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 am responsib • ur all churges incurred.lrum
this application. I, hereby, give consent to the Authorized Represcntativ of the Davie o nt ticallh Department
to enter upon above described property located in Davie County and or ed by _
AT -
to conduct all testin procedures as necessary to determine the site suit ility.
DATE 5�� SIGNATURE t
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLATY (include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
Site Revisit Charge
Datc(s):
Client Notification Dale:
EHS:
10/09/2001 TUE 12:30
Account No.
Invoice No. -2-5 -7 ✓
(TX/RX NO 84431 10002
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
INFORMATION IS PROVIDED. to the INFORMATION BULLETIN for
THE REQUIRED
instructions...
1.
/Rleffer
Name be )/L
I U4
v
to Billed
Contact Person
{ /-� fit:'
-
� �l� ,,�
l 177.x
'
IPhhoone
1 /
Mailing Address "7 / 4L �v✓0
Home j
e_,
g
City/State/ZIP /Y T``�
Business Phone,16%(Q
2.
Name on Permit/ATC if Different than Above
Mailing Address
City/State/Zip
��,�
3.
111 5
Application For: 1te Evaluation
mprovement Permit/ATC
II Both
4.
System to Service. 0 House 0 Mobile
Home 0 Business 0 Industry
L Other
5.
If Residence: # People
# Bedrooms_
# Bathrooms
1.1 Dishwasher II Garbage Disposal U,4a'shing Machine L Basement/Plumbing
II Basement/No Plumbing
6.
If Business/Industry/athor: Specify type
# People
# Sinks
# Commodes # Showers
# Urinals
# Water Coolers
IF FOODSERVICE: # Seats
Estimated Water Usage (gallons per day)
I
7.
Type of water supply: Ili ounty
City Cl Well
II Community
e.
Do you anticipate additions or expansions of the facility this system is intended to serve?
1-1 Yes 1p
If vcs. what tvDe?
I
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRL•DPROPERTY INFORMATION REQUESTED BELOW.
BELOW. Either a PLAT or SITE PLAN MUST BESUBAY17TED by the client with THIS APPLICATION.
Properly Dimensions: �/� c/t.0��'1!a WRITE DIRECTIONS (from ocluvillc) lu PROPENTI'I:
Tax Office PIN: # (� 1 �c� �`t A
'&.Lt
Property Address: Road Name [ �`J
City/Zip )l` t C C
If in a SubdiviSiion provide information, as follows:
Name: ! l,%/� douAj
Section: Block: Lot: -�-- f --
Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(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 am responsib • ur all churges incurred.lrum
this application. I, hereby, give consent to the Authorized Represcntativ of the Davie o nt ticallh Department
to enter upon above described property located in Davie County and or ed by _
AT -
to conduct all testin procedures as necessary to determine the site suit ility.
DATE 5�� SIGNATURE t
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLATY (include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
Site Revisit Charge
Datc(s):
Client Notification Dale:
EHS:
10/09/2001 TUE 12:30
Account No.
Invoice No. -2-5 -7 ✓
(TX/RX NO 84431 10002
tco I too' { loo' 1 %00' 1 too I tov {c)o
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CERT IF{GATQ OF Ao�RovM. QY TME OM+{E Co��tTY /
rl.I'll'�HI KO. 4W
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M E RMY C a QT 1 FY -m14T SAt O L.460e1R'!! OuLY AOpfidv E O
TME Ft"AL PLAT O1W TMt S~4VJlb%b i tNtt?L Ep GRf� gR1<Q
Ar -Ras oN TNS O►d`r OR j ��
GNI\ IN VIIhM
CT-LtT I F %G l.T I OtA• Oc -f He AP000YAL *OF
PR{VATlL WATca ANO sewep �sTRM;
'� I N�tttBY GE.QT 1 FY TNAT TMt WATtit SUPPLY AND SRV~
OI SOOSAL SYST tN1S I N pT ALLI q Oq PRO003RO
I MIRAL.LAT14e4� Iw1 T oft W04MOl V i S► OM t/tT %TLt0 • GUMC."
' �l{t!t Acts ruwr walls -"w a ammetc >!s of T b4c .
N WtIA C 4WjW j tilt, ft#WIL HRALTM WMIAtM? A►a0 0609
owNvlgftw Poo* o As •Mo�wa.
.....1 d
NOR:H %�A: ;.-�iNA, DAVE COLJIhJry
M fate,tcing certificaWs) of RT �iN4Y,�N �n/ivt� �/�' , y P.
NN .
a�.%�AS�//"'� C.O.u�l�! k.s� ce.t:..er. t, � -.. . `hi•, �raai•�•*ser•• •.pry
ilrLilflYllE� pr ranted fcx _€y,ft:at:Or One ►t_uresd in t; i; v:;i..e .. +Psge t
JL
�- STREET •
T --_a• .. day Oi LD F i9..�I .S. at Q- '. �� _ •�:,, A M.
AA 5�h!'ri• Repia�e�f'aeAdc
CERT I
W A
Ctf►O oil
llw K
CLOGUQI E
1 - '5,00
S NovA+0.+
FOUMO n•4
PGW-D�
W %T*• C%6
FACTORS 1 2 3 4 5 6 71
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
Landscape Position
EVALUATION BY:
OTHER(S) PRESENT:
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 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
APPLICANT INFORMATION
Soil/Site Evaluation
PROPERTY INFORMATION
Account #:
990002014
Tax PIN/EH #:
5769-97-8142
Billed To:
Freedom Homes
Subdivision Info:
Green Briar Acres Lot # 47
Reference Name:
Location/Address:
Brier Creek Road -27028
Proposed Facility:
Residence
Property Size: see map Date Evaluated:
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1 2 3 4 5 6 71
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
Landscape Position
EVALUATION BY:
OTHER(S) PRESENT:
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 05/99 (Revised)
c `, $ ''1 � t° ��� - � r---.-i•,.�}-' 'd....,_. t D i � �.d� �_f � r � � f 3 a � r 1` � f
3 e r i
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r"� a w � t �' 4x , ,a9.r� f n �- x dk v� v f s s' w. `y a r b :y 1 z '� �� r 6 n 7 ' r z x�, fi"
� eKb.. 'a'd " h , k i ,�.;, y V 1, ,'i$ f {�: ti (y. � ar t � f f >: � : P t � �.
i � ,} a � � ,y � i y A _ ➢ p. '� � Y,
�;'� i fid � rr �tlr���ul � '� S .�� t � : r,� i. 3 r': � i r f �,. ,�
Davie County, NC . . Tax Parcel Report Thursday. February 23. 2017
WARNING: THIN I5 NOTA SURVEY
161 All data Is provided as Is without warranty or guarantee of any kind 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 webslte 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
NC or arising out of the use or Inability to use the GIS data provided by this website.
Parcel Information
Parcel Number:
H7030A0008
Township:
Shady Grove
NCPIN Number:
5769978142
Municipality:
Account Number:
82518196
Census Tract:
37059-804
Listed Owner 1:
RODGERS SCOTTY L
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
PO BOX 315
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-0315
Voluntary Ag. District:
No
Legal Description:
LOT47 GREEN BRIER ACRES
Fire Response District:
ADVANCE
Assessed Acreage:
01D .0.54
Elementary School Zone: SHADY GROVE
Deed Date:
2/2002
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
004060859
Soil Types:
GnB2,EnB
Plat Book:
0004
Flood Zone:
Plat Page:
172
Watershed Overlay:
DAVIE COUNTY
Building Value:
48750.00
Outbuilding 8r Extra
5580.00
Freatures Value:
Land Value:
20000.00
Total Market Value:
74330.00
Total Assessed Value:
74330.00
161 All data Is provided as Is without warranty or guarantee of any kind 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 webslte 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
NC or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT -/o 4y
' Environmental Health Section
P. O. Boz 848/210 Hospital Street
Account #: 990000871
Billed To: Schult Home's
Reference Name: Michael Boone
Proposed Facility: Residence
Mocksville, NC 27028 t
(336)751-8760
IMPROVEMENT/OPERATION PERMIT r g
91- q oti �
Tax PIN/EH #: 5769-97-8142 V �1
Subdivision Info: Green Brier Acres Lot 8 6 J
Location/Address: Briar Creek Road -27
Property Size: 22,366 Sq. Ft.
ATC Number: 2261
**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 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 M. 0WIC #People eS #Bedrooms 3 #Baths 2—
Dishwasher:
Dishwasher: 01K Garbage Disposal: ❑ Washing Machine: [Er"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type�/!� #People #People/Shift #Seats Industri171al Waste:
Lot Size Type Water Supply 6WOV? Design Wastewater Flow (GPD)J(GO Site: New 131'. --Repair ❑
System Specifications: Tank Size 1 CCQjAL. Pump Tank GAL. Trench Width 2514; Rock Depth v -r Linear Ft. L�
Other: I 72)' SrRa&)Tio•J' .�o}G jA-fetes- Lam �'�.�•
Required Site Modifications/Conditions: ll., pp -i V&4pV Ue-3a KAZEr M. ;V
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 - BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
Vstem between 8:30 a.m. to 9:30&m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
n1�PQt -. 100' _ ��\rt�►-�. / Xl�'(tr- V.7�1- o -J wzpaZT4
WINAW
to' M►n2 .
ter rt4�
rNQ0 X0'2
Environmental Health Specialist's Signa e: Date: 1
DCHD 05/99 (Revised)
G
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to' M►n2 .
ter rt4�
rNQ0 X0'2
Environmental Health Specialist's Signa e: Date: 1
DCHD 05/99 (Revised)
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Moclksville, NC 27028
(336)751-8760
Account #:
990000871
Tax PIN/EH #:
5769-97-8142
Billed To:
Schult Home's
Subdivision Info:
Green Brier Acres Lot # 8
Reference Name:
Michael Boone
Location/Address:
Briar Creek Road -27006
Proposed Facility:
Residence
Property Size:
22,366 Sq. Ft.
ATC Number: 2261
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 WASTE NST VAL FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature Date: /I
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:
wrrtitAl ION I -OR bl l E EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department D
Endmnmenfal HeisIM Secdon
P.O. Eox 848/210 Hospital Street NOV 17 1999
Mocksville, NC 27028
(336) 751-8760 ENVIROVENTAL HEALTH
OAVIE COUNTY
***IWORTRNT*** THIS APPLICATION CANN= BE PRO=S8BD UNLESS ALL THE REQUIRED
IM8MaTIOM IS PROVIDED. Refer to the XMFMATIQH BULLETIN for instructions.
1. Diane to be LfynQS contact person JCD-tt- 1.1, 1'
mailing Address 41-7 5 N '?QAzz's o,, Now phone
city/state/a:p\t3 . � " U . Ccs X7 I D6 Business phone 1305 r r 3 `f.'S
2. Name on permit/ATC it Different than 7►bo_1�e'
Mailing 7lddrese 3 7 a• t� �� a c� r. � CJ1 City/state/Eip 444 a ., c C- I y _ e 'J-7 OD 6
3. Application lbr: ❑ Site evaluation W�nprovement Permit/ATC 0 Both
4. $ysten to service: ❑ House eMobile Home O Business ❑ Industry ❑ Other
3. If Residence: f People 3 t Bedrooms # Bathrooms
�Dishwasbar O Garbage Disposal fwaebinq Machine O 8asement/plw6ing D BasementMo plumbing
6. If business/lndustsy/Other: specify type # people A sinks
6 Commodes # showers f urinals # Nater Coolers
i!' >I'QODSERVICE: # Seats Estimated Yater Osage (gallons per day)
z. Type of water supply: 0-'County/City 0 Well 0 Communi__//ty
9. Do you anticipate additions or expansions of the facility this system k intended to serve? 0 Yes 11 No
If yes, what type?
***IMPORTANT*** CLIENTS MUST CDMPLETETHE REQU[RED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAHZ7ED by the client with THIS APPLICATION.
Property Dimensions: f 17y'� X 1 X I DD,X al t
Tal office riri: ti Sibq-97 —'3t y+Z
Property Address: Road Name >r : u t e C ee K RA
City/zip Act V-0 n c C
If in a Subdivision provide Information, as follows:
Name: G,4ee4 Ije %e1 14c 4es
Section: Block: A Lot:
WRITE DIRECTIONS (from MockrAlle) to PROPERTY:
D r:4f 4't.9.14 VU '1-f M i ( Q. 4r WI -Y
k kFall
Date Property Flagged: My ✓ /
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
Issued be;"Rer 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 1, also, understand that I ant responsible for all charges Incurred frons
this application. I, hereby, give consent to the Authorized Representative of the Davie ounty $, th 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. km3aym c �
DATE Ah v j7 1,9,9 ! — SIGNATURE c� 45�q-
THIS AREA MAY BE USED FOR DRAWING YOUR STTE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
pal
Site Revisit Charge
Date(s):
Client Notification Date:
I EAS:
Account Na IF&
Invoice No. 10,2;;'
T
1695 60' R/
W Lpubllc)
CREEK ROAD SR
BRIER
N 8p 20' 0� E
100.00
TAX LOT 9
CLIFFORD HOWARD
DB 106 PG 253
I
z U
rn_
N
ut
TAX LOT 8 �^
22366 Sq.Ft.+/- i
5
r:
N_ a
43.
TAX LOT 7
SAMANTHA SMILEY
DB 196 PG 884
N 84'
/
J
0 IRON FOUND
CID
O IRON SET
P/O DB 102 PG 604
_N80' 14' 08" W_
• / /// LSO P/O DB 119 PG 5
PROPF.P,TY LINE
60.00'
TAX MAP H-7-2
////
•�f
TAX LOTS 45A R 45D
/
TAX MAP H-7
TIMOTIIY WILLIAMS
7018 Sq.Ft.1
TAX LUT 62
DB 118 PG 5
/'/ /�/AA
D. B. WEBB
SURVEY PERFORMED UNDER
j ® POINT NOT MONUMENTED
DB 83 PG 43
50 25
/
J
0 IRON FOUND
CID
O IRON SET
P/O DB 102 PG 604
O MONUMENT
• / /// LSO P/O DB 119 PG 5
PROPF.P,TY LINE
TITLE UNDETERMINED
/
b
CA&0 ,,,
'pFES �;"
//
•�f
/�
-- — — PROPERTY LINE
CERTIFY THAT TINS MAP IS
(not surveyed)
320
Suvoe
111E RESULT OF AN ACTUAL
SURVEY PERFORMED UNDER
j ® POINT NOT MONUMENTED
50 25
0 50
0 IRON FOUND
R/W RIGNT-OF-WAY
O IRON SET
RUNNING WATER
O MONUMENT
CENTERLINE
PROPF.P,TY LINE
(nirveyed)
MY SEAL AND SIGNATURE
-- — — PROPERTY LINE
CERTIFY THAT TINS MAP IS
(not surveyed)
111E RESULT OF AN ACTUAL
SURVEY PERFORMED UNDER
j ® POINT NOT MONUMENTED
MY SUPERVISION.
VICINITY (no scale)
SR 1695
d• � T
b J
MAP FOR
MICHAEL BOONE
SCALE COUNTY TOWNSHIP DATE PREC. RATIO
1' 50' DAVIE SHADY GROVE I 1 OCT 1999 1 1 : 10,000 4
PROPERTY DESC: TAX MAP 14-7-3 TAX LOT 6 PLAT LOT 47 DR 102 PC 604
PB 4 PG 172 'GREEN BRIER ACRES'
Orner.PAUL I- BOGER D8 102 PO 604
COE FORESTRY k SURVEYING rDCRG
1
P.O. BOX 36 83
WALLBURG, N.C. 27373 DRAFTED BY: PHONE/FAX (336) 769-4673 EYED BY
MDC
too
9
(46)
99 79
CREEK.:
0
w
44-
R%1lAv
(48)
96 A P'.
100 1
APPUCATI FOR SITE EVALUATION/IMPROVEMENT PERMIT do Al J
Davie County Health Department
Q Environmental Health Sertlion
y �� Ur P.O. Box 849/210 Hospital street Wlv 8
G,/�p
Woe
�ITI
Hocksville, NC 27028
(336!751-8760 41_ ENVIRONMENTAL HEALTH
,�er �
✓ b%2 7DAVIE COUNTY
***I?P0RTAN7*** THIS APPLICATION CANNOT 8E PROCESSED UNLESS ALL TIM REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORIMTION BULLETIN for instruct
1. Name to be Billed PCL 01 O of P /' Contact person
Nailing Address SoZ a, 3Q t % o-) o r -e Home phone 33 498- $ L% 9 -7
Ci /state/zIP
hl —9d I/C� /✓G e IV C a. 7D O 6 Business phone
2. Name on Permit/Arc if Different than
Mailing Address
3. Application For:.Ksite Evaluation
City/state/Lip
0 Improv,e�nt 4:—;j LSC U Both
t. system to service: House 0 Mobile Home 0 Business ❑ Industry ❑ Other
s. If Residence: # People_ # Bedrooms 3 # Bathrooms
Dishwasher 0 Garbage Disposal Vwashing Machine FBasement/PluoibIng Basement/No plumbing
6. If Business/Industry/other: Specify type # People # Sinks
# Cotmodes # Showers
# Urinals # water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of hater supply: County/City 0 Well ❑ Community
e. Do you anticipate additions or expansions of the facility this systema Is Intended to serve? ❑ -Yes �lo
If yes, what type? —
***IMPIDRTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESURAHTTED by the client with THIS APPLICATION.
00
Property Dimensions:L-01-6-t)01� k 30. g Xyo1:► � )
n v 1 .....,�... r.sa., from ivtoci:s�vtiile/ to PROPERTY:
Ta: Office PIN: # �5 7 tog- 7 7' d l T �?
Property Address: Road Name cern 6r ick'
City/Zip ndJgruG IllC, D70010
If in a Subdivision provide information, as follows:
Name: ( recn 82)FP. AC2&s
Section: [17 638 Block: An Lot:
Date Property Flagged: '�/' -k 9 C7
This is to certify that the Inrormation provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site puns or intended use change, or If the information
submitted in this application is falsified or changed. I, also, understand that I ani reVonsible for all cha ga incurred from
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 o, u- I Er I? o � Pg rT ti/I F -e
to conduct all testing procedures as necessary to determine the site suitability.
SIGNATURE -P&e_ 7
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/98)
Account No.
Invoice No. ^ �%
100
7140
1006-
This map is for PERC TEST
and BUILDING PERMIT purposes
only. The Davie County
Tax Administrator's Office
assumes no liability for any
information contained on this ma
9132
COUNTY -ID: H7030A0008
June 04, 1999 1:58 PM
Parcel Identification Number
5769-97-8142
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
` Soil/Site Evaluation
APPLICANT-INFORMAT^ ION PROPERTY INFORMATION
Account #: 989900610 Tax PIN/EH #: 5769-97-8142
Billed To: Paul Boger Subdivision Info: Green BrierAcresA Lot # 8
Reference Name: Location/Address: Green Brier -27006
Proposed Facility: Residence Property Size: Date Evaluated:
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3 4 5 6 7
Landscape position
Slope %
2.
(010
HORIZON I DEPTH
Texture group
Consistence
SSSSP
Structure
513 V_
Mineralogy
HORIZON II DEPTH
Texture group
L
Consistence
—
F
Structure
A 11,�L
Mineralogy
l
HORIZON III DEPTH
- d
( -
Texture group
C
C—
Consistence
r S
Structure
Isuk
A bL
tT-4-k-
Mineralogy
HORIZON IV DEPTH
{
Ot
Texture grou
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
FSS
LONG-TERM ACCEPTANCE RATE
Q <7O
SITE CLASSIFICATION:
kl5
LONG-TERM ACCEPTANCE RATE: F)•>
REMARKS:
EVALUATION BY:
�-=�1•. �� „QCs.. /
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
is
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
MLet
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, ?-: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 (Revised 05/99)
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of A1.
Davie County ,Meal th Department
Environmental Wealth Section
Po Box 848 / 210 Hospital street
Mocksville, NC 27028
Phone: (336)751-8760
July 9, 1999
Mr. Paul E. Boger
522 Baltimore Road
Advance, NC 27006
Re: Site Evaluation-
GreenBrier Acres/Lot 8
Tax PIN #: 5769-97-8142
Dear Mr. Boger:
As requested, a representative from this office visited the aforementioned site on
July 9, 1999. Based on the information provided on the Application for Site Evaluation
and after the evaluation was completed, the site was found to be provisionally suitable for
the installation of an on-site sewage disposal system. In order to maintain this
classification, a well on the property must be abandoned.
Before a representative of this office will revisit the site to issue an Improvement
Permit/Authorization to Construct the appropriate application must be completed in full
and submitted to this office. The location of the facility the system is to serve must be
staked off.
If you have any questions, feel free to contact this office at (336)751-8760.
Sincerely,
C
Jeff . Beauchamp, RS.
Environmental Health Section
enc(s)