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204 Bentbrook Drive Lot 17 & P/O 18Davie County, NC Tax Parcel Report Thursday, October 20, 2016 %..160 f ! f � r 204 i 206 i WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: G806OA0017 Township: Shady Grove NCPIN Number: 5880112204 Municipality: Fire Response District: Account Number: 82515775 Census Tract: 37059-804 Listed Owner 1: WILLIAMS PAUL WAYNE Voting Precinct: EAST SHADY GROVE Mailing Address 1: 204 BENTBROOK DRIVE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A,R-20 State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC Zoning Overlay: 27006-0000 Voluntary Ag. District: No LOT 17 BENTBROOK Fire Response District: ADVANCE 1.55 Elementary School Zone: SHADY GROVE 11/2000 Middle School Zone: WILLIAM ELLIS 003520276 Soil Types: WeC,WeB 0006 Flood Zone: 112 Watershed Overlay: DAVIE COUNTY 252870.00 Outbuilding & Extra 5760.00 Freatures Value: 40000.00 Total Market Value: 298630.00 298630.00 9 P/� € All data is 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 I County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to l pUN i NC or arising out of the use or Inability to use the GIS data provided by this website, DAVIE COUNTY HEALTH DEPARTMENT /?j /_ 7 Environmental Health Section ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900195 Tax PIN/EH #: 5880-01-9417.001P /zap Billed To: Richard Poindexter Subdivision Info: Bentbrook Lot # W I7-f8=%w Reference Name: Richard Poindexter Location/Address: Bentbrook Drive -27006 Proposed Facility: Property Size: ATC Number: 2091 **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 4 a #People #Bedrooms #Bathsl„S— Dishwasher: e' Garbage Disposal: ❑ Washing Machine: a 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 Sizv GAL. Pump Tank GAL. Trench WidthjEg�� Rock Depth ley' Linear Ft. Other: Required Site Modifications/Conditions: 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.**** r Environmental Health Specialist's Signature: A–,4/ Date: G DCHD 05/99 (Revised) t t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900195 Tax PIN/EH #: 5880-01-9417.001P Billed To: Richard Poindexter Subdivision Info: Bentbrook Lot # Reference Name: Richard Poindexter Proposed Facility: ATC Number: 2091 Location/Address: Bentbrook Drive -27006 Property Size: 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRRUCTION IS VALID/FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �S _ �? /�� J 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 I 1 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) -5 -5 u MI- Date: 34 ' f APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT(Q L� Davie County Health Department Envdr+onmenta/ Health Section 6 P.O. Box 848/210 Hospital Street - Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS R IDED. Refer to thA INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person Mailing Address 6.//� Home Phone City/State/ZIP 2� / V ` // Toa Business Phone / 7 h' vC ©yam -�07 S ^/�.r�P 2. Norma on Permit/ATC if Different than Above 65o -.3//-')- Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation /V Improvement Permit/ATC ❑ Both a. System to Service: lid House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: I People # Bedrooms_ # Bathrooms o2 -t Dishwasher ❑ Garbage Disposal AWashing Machine 6. If Business/Industry/Other: Specify type # Commodes # Showers ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals # Water Coolers IF FOODSERVICE: #k Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: 'County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? I***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: //L FiJ _ WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # d}� Property Address: Road Name.,49�,17/ l 4 City/Zip A&ele P ItIC D/, i If in a Subdivision provide information, as follows: Name: Section: Block: % Lot: % /� Date Property Flagged: 7 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 1 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 suitability. DATE ���— rn1 SIGNATUREi��` 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): Client Notification Date: EHS• Revised DCHD (07/99) Account No. Mf Invoice No. ` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department 10 ` Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1. Application/Pern Mailing Address 2. Name on Permit If Different than Above 3. Application for. General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: f Houses ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑dustry / ❑ Other ❑ Unknown 5. If house, mobile home: Subdivisions? -h ,1.0 Section ___L� Lot # 17 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 Water Coolers No. of Showers Water Usage Figures ❑ Basement/Piumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 7. Type of water supply: ❑ Public ❑ Private ❑ Community 8. Property Dimensions �% �e'?��' Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? *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 1 am responsible for all charges Incurred from this application. DATE CONSENT EM ,B E EVALUATION IQ aE DONE Qt ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 QM the property. ❑ 2. 1 MNOT 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 0CH0(1193) SIGNATURE DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPOSED FACIILTYL/-rte' PROPERTY SIZE LOCATION OF SITE /r�G�/l% �� IV Water Supply: On -Site Well Community Public c/ Evaluation By: Auger Boring Pit i/ Cut FACTORS 1 2 3 4 Landscape position .L Sloe 7. .c HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 3 �` 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 RATEI SITE CLASSIFICATION: ✓ EVALUATED BY: ,!Lz LONG-TERM ACCEPTANCE RATE: REMARKS: Scam,- X710,' Xi DCHD(01-901 _ OTHER(S) PRESENT: 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 . DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation NAME(/ l.22Ae 1, ✓✓ ADDRESS PROPOSED FACIILTY ,/6l -&J DATE EVALUATED // / ",--I � Community PROPERTY SIZE ZAl LOCATION OF SITE Pit Water Supply: On -Site Well Community Public L ---- Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L Sloe % HORIZON I DEPTH Texture gropp Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence i Structure S 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: /1- EVALUATED BY: YaG� LONG-TERM ACnCEE TANCE RATE: i- OTHER(S) PRESENT: REMARKS: �'7 i S �/C/r_S"G, `y5 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 fine Wet NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic Structure ;iC-Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mi neralotty 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 aAN I ACRE ± o� 1.6 AC E±' _ 2O' , /f/ 'O `/ �I 0' DRAINAGE EASE- r RAINAGE EMEN R -ea / 19 • o. �', / , \ ` '�,' �\��OP /rte 's•'� :I I ACRE Q�F.i DRAINAGE! 37g• ZQ ✓' O �C. r •�J - _�Y� G 6l / ADVANCE TAYLOR HOWARD D.B.45 PG. 575 ZONING R-20 / CHARLES TALBERT D.B. 53 PG. 221 WOLTZ D.B.126 PG.528 ZONING ZONING R-20 LI - - E 47p Co' .3g13 258 70• 1// N ` 375' S 92•� 43 E g21.n` 1.1 ACREt glapEt :. 5 1.7 ACRE± 1.8 ACRE± I R = 6o' tiEt'A i' 420' \ 1.7 ACRE± oil z -4v �1.2 I7 ACO 0 10, 300' 16 AC aAN I ACRE ± o� 1.6 AC E±' _ 2O' , /f/ 'O `/ �I 0' DRAINAGE EASE- r RAINAGE EMEN R -ea / 19 • o. �', / , \ ` '�,' �\��OP /rte 's•'� :I I ACRE Q�F.i DRAINAGE! 37g• ZQ ✓' O �C. r •�J - _�Y� G 6l / ADVANCE TAYLOR HOWARD D.B.45 PG. 575 ZONING R-20