149 Bentbrook Drive Lot 3Davie County, NC -
114 G'� f %J N.
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126 y COSI
163
12 3
130
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:
Tax Parcel Report
160
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149 --�
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137 r
Thursday, October 20, 2016
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112
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LAZY B 7RL: 185
WARNING: THIS IS NOT A_ SURVEY
Parcel Infonnation
G8060A0003 Township: Shady Grove
5880009682 Municipality:
82519342 Census Tract: 37059-804
GERHARD WILLIAM J Voting Precinct: EAST SHADY GROVE
149 BENTBROOK DRIVE Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY 1-1,R-20
Land Value:
Total Assessed Value:
NC
Zoning Overlay:
27006-7287
Voluntary Ag. District:
LOT 3 BENTBROOK
Fire Response District:
1.26
Elementary School Zone:
8/2002
Middle School Zone:
004320921
Soil Types:
0006
Flood Zone:
112
Watershed Overlay:
186070.00
Outbuilding & Extra
Freatures Value:
40000.00
Total Market Value:
229750.00
ADVANCE
SHADY GROVE
WILLIAM ELLIS
PcB2
DAVIE COUNTY
3680.00
229750.00
M
� 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 website shall hold harmless the {
j County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to '
!j ��UN4s NC I or arising out of the use or Inability to use the GIS data provided by this webs@e.
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section p 0
. P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900195 Tax PIN/EH #: 5880-00-9682
Billed To: Richard Poindexter Subdivision Info: Bentbrook Lot # 3
Reference Name: Location/Address: Bentbrook Drive -27006
Proposed Facility: Residence Property Size: 1 + acre
ATC Number: 2646
**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.
L i
Residential Specification: Building Type Ti/ #People #Bedrooms_ #Baths r5
Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: New ❑ Repair ❑
System Specifications: Tank SizeA/V0 GAL. Pump Tank GAL. Trench Width,,�( Rock Depth/j Linear Ft. �ZID /
Other:
Required Site Modifications/Conditions:
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
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.****
1,11---]
Environmental Health Specialist's Signature: Date: A/ — �2 6
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Account #: 989900195
Billed To: Richard Poindexter
Reference Name:
Proposed Facility: Residence
ATC Number: 2646
P. O. Boz 848/210 Hospital street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5880-00-9682
Subdivision Info: Bentbrook Lot # 3
Location/Address: Bentbrook Drive -27006
Property Size: 1 + acre
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 WASTEW R CONSTRUCTION IS VA ID�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: --_AoEf
y�
Environmental Health Specialist's Signature -` D
DCHD 05/99 (Revised)
Date: ! L
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department NOV 2 2 -
Environmental
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed i Q. i E iv Contact Person
Mailing Address W, Home PhoneO
City/State/ZIP ..p Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation 'improvement Permit/ATC ❑ Both
4. System to Service: )d House
5. If Residence: # People
6
❑ Mobile Home ❑ Business ❑ Industry ❑ Other
# Bedrooms _ # Bathrooms
)d Dishwasher ❑ Garbage Disposal Li Washing Machine
If Business/Industry/Other: Specify type
# Commodes
# Showers
❑ Basement/Plumbing ❑ Basement/No Plumbing
# Urinals
# People # Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes -4o
If yes, what type?
k**IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: / ace L
Tax Office PIN: # 5' V000
Property Address: Road NamcL,L�rO��C c�/�•
City/zipJ� 194C.P_ 274'
If in a Subdivision provide information, as follows:
: ��,C�
Name ''/''_
Section: Block: Lot:_
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
I � oo,)I
3.-,4�2 l vy, leA
Date Property Flagged: O
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 responsible for all charges 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
to conduct all testing procedures as necessary to determine the site suita
DATE. ' aO SIGNATURE .:G�
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).
Site Revisit �Charge
Date(s):
"l Client Notification Date:
EHS:
r l a
Account No.
lfne
Revised DCHD (07/99) Invoice No.
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N 74°23'28"E
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N 700244"E
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N 32042'29"W
321.36
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48°1123"
24.49'
N 00°1906"E
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98.30'.
117012'04"
102.43'
N 34°49'26E
21722;.':::'. 60.00'
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59026'46"
59.50'
S 56°51'09"E
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21.51'
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18.37'
85°08'46"
27.1;
1.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028 `
Mailing Address
Business Phone
2. Name on Permit if Different than Above
3. Application for. XGeneral Evaluation ❑ Septic Tank installation Permit
4. System to Serve: f Houses ❑ Mobile Home ❑ Place of Public Assembly
❑ Business Odustry / ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision T�ro�� Section Z Lot #
No. of People
No. of Bedrooms
No. of Bathrooms
Dwelling Dimensions
6. If business, Industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories
No. of Showers /
7. Type of water supply: 0 Public
No. of Water Coolers
Water Usage Figures
❑ Private
8. Property Dimensions _�% ~�,��' Sewage Disposal Contractor
❑ Basement/Plumbing
❑ Basement/No Plumbing
❑ Washing Machine
❑ Dishwasher
❑ Garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes, what type?
❑ 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 the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE
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:
1 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
WHO (11W
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME e:: DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On -Site Well Community Public L/
Evaluation By: Auger Boring Pit f Cut
FACTORS 1 2 3 4
Landscape position /C •L
Sloe
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture group
Consistence
Structure l
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: EVALUATED BY: ,XA10'/f
LONG-TERM ACCEPTANCE RATE: 3 2�1
ER(S) PRESENT:
REMARKS: �c'r' ��7� A� /% �/'/1 %%
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