126 Pen Court Lot 4Davie County, NC
4204
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Tax Parcel Report
Monday, December 19, 2016
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number. D301GA0004 Township: Clarksville
NCPIN Number. 5822250686 Municipality:
Account Number. 82524384 Census Tract: 37059-001
Listed Owner 1: JONES JAMES S Voting Precinct: CLARKSVILLE
Mailing Address 1: 128 PEN COURT Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
Legal Description:
LOT 4 DUTCHMAN HILLS
Fire Response District
Assessed Acreage:
2.29
Elementary School Zone:
Deed Date:
%412005
Middle School Zone:
Deed Book / Page:
006060012
Soil Types:
Plat Book:
0007
Flood Zone:
Plat Page:
0190
YVatershed Overlay:
Building Value:
Outbuilding & Extra
Freaturce Value:
Land Value:
Total Market Value:
Total Assessed Value:
WILLIAM R. DAVIE
WILLIAM R DAVIE
NORTH DAME
MnB2,MdE
DAME COUNTY
No
M doh h ptovldad se h wtlbout wwrmdy or or any Mod dOwr wwwoned or' " IneludIng but nae OmIled h the
Davie County, bled w wantlse of m , - - bMW ortitnase for a pmOeWa usa. M nue ar Dsele Gawdya OIs wabaih dw1 hold iwrn . the
NC Co'a't/ ar DxW0. IIoM thrw�w, ib pmda, emmdb^ contractors or empbysas wom any and o elabse or causes or action dusto
or ■na out orthe
�use or brabaty to we the 08 doh provided by this wabalts
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Bea 848810 Hespital Strut
Mocicuville, NC 27028
(336)751-8760
1A
/ ;Z (o pin C7` -
Account M. 990002706
Tax PIN/EH #:
5822-25-0686.04 JH
Billed To: Jeff Hayes
Subdivision Info:
Dutchman Hills Lot # 04
Reference Name:
Location/Address:
Eaton Church Road -27028
Proposed Facility Residence
Property Size:
see map
ATC Number: 3885
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/Autharization 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 W Tl VAL . FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature te:
A.0',
COMPLETION
**NOTE** The issuance of this Certificate of led 1 ' icate the system described cn Improvement/Operation Permit
has been installed in compliance withrc 1 G.. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in NO W as guarantee that the system will function satisfactorily for any
given period of time. , J.W COMA ►`-
O r�
10
'tAA-LA9 Zc7 RGJT
Septic System Installed By: IL_._
Environmental Health Specialist's S• Date: A2Z
DCHD 05/99 (Revised)
'•; a DAME COUNTY HEALTH DEPARTMENT
♦, Environmental Health Section
P. O. Boa 848/210 Haapital Street o
Macksvllk, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002706 Tax PIN/EH #: 5822-25-0686.04 JH
Billed To: Jeff Hayes Subdivision Info: Dutchman Hills Lot # 04
Reference Name: Location/Address: Eaton Church Road -27028
Proposed Facility Residence Property Size: see map 12,U F64 C"r
ATC Number: 3885
**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 . #People #Bedrooms ---*3 #Baths 3
Dishwasher: B Garbage Disposal: ❑ Washing Machine: 2( Basement w/Plumbing: &( Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #PeopleJShift #Seats Industrial Waste: ❑
�p�
:NODLot Size 2.2$ XkSType Water Supplyowaq Design Wastewater Flow (GPD) Site: New e Repair ❑
System Specifications: Tank Size /uW GAL. Pump Tank GAL. Trench Width V Rock Depth )Z:/ LinewFt.4589'
Other:
-- -
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 K BELOW
FINISHED GRADE. ****NOTICE: Contacfa representative ofthe Davie County Heahh 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.****
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avir—ental pecialist's Signature: Date:
DCHD 05/99 (Revise • ��
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P.O. nasi 148/210 Soepitid. Sonet
Mockoville, RC 27020
(336)751-0760
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bussed kcrertler arc A*jW to smpcuston or rovdce any per uil(s)
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Is eu(er upon above described properly, l0atled iu D2vle Cosnly and otvunl by
to conduct all lesdng proediures as to dekrmiae we silo s")IabLV. -
DATE D SIGNATIJU
TIM AREA MAY IN UM FOA DRAWai(i yGMSM PLAN an of into
PIP" ty Onesa"d duntalaions, stl'attnt0i3 66thadtt, and ScpUC toeatiWr i stag ally proposal
Silo ltevidl charge
Date(s):
Ciionst Noulicasa:i Date:
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POVW Data
Adjoining Parcels
• Cam* I& W&I 0AWW
• Ac=udNwabwlW15152
• Fw. UnraM
• LOW 1.'LCiT 4 DUTCHMAN HILLS
• Ow wNaaa: CANAGROUP LLC
• OWMWAWmm 1. CRNA GROUP LLC
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• CwnmffidS•ss r 1570 UNDERPAss ROAD
• Ryser ZW ADVANCE AD 27008 -0000
• Lura Va" =18.000.00
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• P" Dib t WILLIAM R. DAVIE
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• Find MWDal-12-17.1988
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http!/66.209.132.2541servlet/coitn.esri.esrimap.Bsrimap?Name-Davie&Cmd-Ok&Ldt-i... 9/21=04
APPLICATION F Wer SITE EVALUATION/IMPROVEMENT PERMIT & ATC D—� • ^ r=
Davie County Health Department
Envltnntnenta/ Health SeciYon
P.O. Box 848/210 Hospital Street
Mooksville, RC 27028
,feyJ12kacd (336)751-8760
***Ii1PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TRE REQUIRED
INPOMTIOH Ili PROVIDED. Refer to the IHrO MATiOH BULLETIN for instructions.
1. NW to be Billed C). yyGGI� Contact Person
e Nailing addressF;7'J.SS JCd Bone phone 9G9+s,-
City/state/alp JUe9Nee_ Ale, oCr17e06 Business phone
2. Uses on werait/arc it Different than Above
Nailing address city/state/Zip
s. Application ror: 19 Bite Evaluation ❑ Improvement Permit/ATC ❑ Both
4. systae to service( House ❑ Mobile Home O Business ❑ Industry ❑ Other
5. If Residence: i People a Bedrooms i Bathrooms
O Dishwasher O garbage Disposal O Washing Machine O Baeeesnt/slushing D Basaeant/Ho plumbing
6. If Business/Industry/othart specify type
1 people 1 Sinks
1 Consodes 1 Showers 1 Urinals i Water Coolare
IF rOODSERVICE: # Seats Estimated Nater Usage (gallons per day)
7. Type of Water supply: bounty/City 0 Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system b Intended to serve? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUST COAIPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT
or SITE Pt ANMUST BESUBMITTED by the client with THIS APPLICATION
Property DimenslO� ��7' t. g / .3 49 S / WRITE DIRECTIONS (from Mocksvllle) to PROPERTY:
Tax OBlee PRN: a__:I-mo — iU — /n �JJJ � � `/l l0� .9-A�A �� G'.a 1/o.li l�
Property Address: Road Name %d / ti• 44 Yoe/ 1A Ptrioe4 0'V�, C�
Clty1zip_4&e,e:syiL% NleJ7ae
If In a Subdivbll00%B provide information, as follows:
Name:
Section: Block: Lot: Date Property Flagged: _ /U /nc 6' 7 &S c zW
r
This is to certify that the Information provided b correct to the best of my knowledge. I understood that any permit(s)
Issued hereafter are subject to suspension or revocation, if the site plass or Intended me change, or If the Information
submitted In this application b falslRed or chsuged. I, also, understand that I am responsible for ail 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 oultslty.
DATE - , — r2eO— D!J
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN
property lines and dimensions, structures, setbacks, and septic loo
Revised DCHD (07/99)
of the following: Existing and proposed
Date(s):
EHS:
Site Revisit Charge
Notification Date:
Account No.
Invoice No.
G/c:V SII
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
_. ;Soil/Site Evaluation
APPLICANT INFORMATION ' - , ' PROPERTY INFORMATION
. -; Account #:._ 989900111. ,
Tax PIN/EH #:'5822-14-6855.04
Billed To: Gray Potts Subdivision Info: ' Dutchman Hills Lot # 4
Reference Name: Gray Potts Location/Address:. Eatons Church Road -27028
Proposed Facility: Residence Property Size: 51 Acres Date Evaluated: J
Water Supply: On -Site Well Community Public
Evaluation By: i, i Auger Boring PitCut
FACTORS I 2 3 4 g 6 7.
Landscape position LL
Sloe % 70 (01A51
HORIZON I DEPTH _ I
Texture group 64.h
Consistence :5
Structure
l`
Mineralogy
HORIZON II DEPTH 2-7—S 9
Texture group
Consistence r $
Structure ., - (9
MineralogyI t
HORIZON HI DEPTH Z ' 5-7
Texture group 2aac
Consistence
Structure (�
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS ..
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE .o• D•3
SITE CLASSIFICATION P S EVALUATION BY: '104 -
LONG -TERM ACCEPTANCE RATE: ` A7.3 OTHER(S) PRESENT:
REMARKS:�F
- LEGEND
Landscape Position ,
L - Linear sloe FS -Foot sloe N
- R -Ridge S -Shoulder p p -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 SII. - Silty loam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay ', SIC - Silty clay I C - Clay
CONSISTENCE'
Moist -
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
�. .1 s
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
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 - Long-term acceptance rate - gal/day/ft2
DCHD 05/99 (Revised)