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164 Greenfield Road Lot 10Davie C minty_ W. Tax Parcel Rennrt A4nndav T)ecetnher 19 '7016 phm l8- WARNING: THIS IS NOT A SURVEY All data b provided as b wtimMy an houtwaor guarantee of y kind either expressed or Implied Including but notilmhed to the Implied warrarNes of merchanbbgflyorfiNessrora particularuse All usersof Davie County's GISwebstie shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ag dalms or causes of action due to or arising out afthe use or Inability to use the GIS data provided by this webshe 176 r . D301OA0010 / Township: r NCPIN Number. 5822146944 Municipality: Account Number: r Census Tract 37059-801 Listed Owner 1: BURCHAM TRAVIS Voting Precinct., CLARKSVILLE 169 164 GREENFIELD ROAD Planning Jurisdiction: t� City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A R-20 State: NC Zoning Overlay: -------- - 27028-4769 Voluntary Ag. District: No Legal Description: LOT 10 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.08 Elementary School Zone: WILLIAM R DAVIE Deed Date: 8/2004 Middle School Zone: t1! 164 005680106 LL MnB2,MdE Plat Book: Z Flood Zone: W 0190 Watershed Overlay: u Building Value: Of Freatures Value: 157 --------, Total Market Value: - Total Assessed Value: 154 phm l8- WARNING: THIS IS NOT A SURVEY All data b provided as b wtimMy an houtwaor guarantee of y kind either expressed or Implied Including but notilmhed to the Implied warrarNes of merchanbbgflyorfiNessrora particularuse All usersof Davie County's GISwebstie shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ag dalms or causes of action due to or arising out afthe use or Inability to use the GIS data provided by this webshe Parcel Information Parcel Number: D301OA0010 / Township: Clarksville NCPIN Number. 5822146944 Municipality: Account Number: 82523246 Census Tract 37059-801 Listed Owner 1: BURCHAM TRAVIS Voting Precinct., CLARKSVILLE Mailing Address 1: 164 GREENFIELD ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A R-20 State: NC Zoning Overlay: Zip Code: 27028-4769 Voluntary Ag. District: No Legal Description: LOT 10 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.08 Elementary School Zone: WILLIAM R DAVIE Deed Date: 8/2004 Middle School Zone: NORTH DAVIE Deed Book / Page: 005680106 Soil Types: MnB2,MdE Plat Book: 0007 Flood Zone: Plat Page: 0190 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: - Land Value: Total Market Value: Total Assessed Value: phm l8- Davie County, �T NC All data b provided as b wtimMy an houtwaor guarantee of y kind either expressed or Implied Including but notilmhed to the Implied warrarNes of merchanbbgflyorfiNessrora particularuse All usersof Davie County's GISwebstie shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ag dalms or causes of action due to or arising out afthe use or Inability to use the GIS data provided by this webshe DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street ' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900111 Tax PIN/EH #: 5822-14-6855.10 Billed To: Gray Polls Subdivision Info: Dutchman Hills Lot # 10 Reference Name: Gmy-Potts Location/Address: Eatons Church Road -27028 Proposed Facility: Residence Property Size:, 51 Acres ATC Number: 3714 **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 ND>se #People #Bedrooms 3 #Baths 3 Dishwasher: Q' Garbage Disposal: 0Washing Machine: d Basement w/Plumbing: M" Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 1 Lot Size+ACA— Type Water Supply CvtNIT`? Design Wastewater Flow (GPD) 3600 Site: New RK Repair ❑ System Specifications: Tank Size IKD GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. 3!E> Other: 4 STOP W(G,3 f sX.Ti Required Site Modifications/Conditions: 64sfI4U� D-) Veep 1 :!� d4- lig.-? (p, EbF- 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.**** Specialist's Signature: DCHD 05/99 (Revised) 11 �-i��5 la .--� A. _ / Date: — i Account #: 989900111 Billed To: Gray Potts DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street MocksvMe, NC 27028 (336)751-8760 Tax PIN/EH #: 5822-14-6855.10 Reference Name: Cfey-PottsQ%uAa— ezwS musluence ATC Number: 3714 Subdivision Info: Dutchman Hills Lot # 10 Location/Address: Eatons Church Road -27028 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 Tr tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA N IS ALID 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 f12o- has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and 110 Disposal Systems," but shall in NO WAY be taken as a gua_ ranteetha�tem will function satisfactorily for any given period of time. 110 8 3 ,PSL gva-,S Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) _ C2 _ 135,51__ _ GREEN.FIE 150.00 - (637.18 t 40 PUP 150.00 S 06` 43' 41' 135.00 N 06' 43'41,-, ` E 85.00 S' 06'43'41 W 55.00 S 06.43'41' N Q �w OW► *� " " m w o d w o co b- w o -4ro Com': `o tai cn � ru ' - © i rq - _ m 150.00 S 06` 43' 41' 135.00 N 06' 43'41,-, ` E 85.00 S' 06'43'41 W 55.00 S 06.43'41' N Q �w OW► *� " " o � Com': `o tai m 150.00 S 06` 43' 41' p�C�ov� n MAR 12 2004 (TION roll SITE EVALUATtoNiiMp(toV41lL•Nr i'elihlrr Davie County Health Department Enviromnenta/Hes/t// Section P.O. Dox 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 VA[." 12 2004 acicv�caruva^^^ 11114 {LL'YL1l:KT1 VN Cl1NNV'1' DTs PRQCL•SSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refor to the INFORMATION BULLETIN for'ins L-ruc Lions. 1. Name to be Billed —Ch" ti Contact Person r�Q ,i/�„ Mailing Address Memo Phone 009-1s5., , City/State/ZIP Business phone 3. Name on Pormit/ATC it Different than Above 't ;,(..C, Qan d,-kt/�` Mailing Address City/ State/Zip 1. Application For: ,,ous 8 Suite Evaluation B -Improvement: Permit/ATC CJ Both 4. spatem to service; .ICS He ❑ Mobile Home ❑ Busine8m ❑ Industry ❑ Other - S. Type system requested: ❑ Conventional ❑ conventional modilicd ❑ innova Live 6. ,If Residence: It People - 4 Bedrooms j p Ba.throonu: 4'JDislnwasher 'C(Garbago Disposal l3"Washing Machina ❑Basement/PlwWb1ng ❑Basemen L'/No Plumbing 7. - If Dualaass/Induatry /Other: verify. type It People If'Sinks tl Commodea A Showers A Urinals I! Water Cooloro IF FOODSERVICE: tF Seats -Estimated Water Usage (gallona par day) S. Typo of water supply: 2-County/City - - ❑ Well ❑ Comniuni L -y s. Do you anticipate additions or eSpallslons or the facility this systcM, is wtende(( to sel-ve? ❑ yes' u if ycs, what type? "**IAIPORTAIVP**CLIEN'fSAIUSTCOAIPLETETIIEItEQU/1i6U1'1tOPllt'1'YhVRO1tNIA'l'1ON121sQ111s5'1'IiU 3ELOW. Either aPLATorSITE PLAN AIUSTUESURAMTEDbythe client reidiTHISAPPLICATION. Property Dinlnnsions: Tax Office PIN: i{��-2.2 Properly Address: Road Nanlc (0of Cfty/Zip If in a Subdivision plrovide inforn tion, as follows: . Nanon ic: VG/ in )J I/ l)� MUTE DIRECTIONS (rrunl blucl(sville) (u 11ItU1,1."1 (moo t N {-o D d � Section: i Block: Lot: V -D_ Date homccorners flaLLed: �-2' I )—D% This Is to certify that the information provided is correct to the best of illy knowledge. I understand (hat any perulil(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if the inl'ornla (iou submitted in tills application is falsified or changed. I, also, understand 1halI aaf responsiblefor all cllalbaS this application. I, hereb)-, give conscut to tllc Aulhoriied Representative of lilt D:n'ic County Il9allh llcp:u-tumu( to enter upon above described property located in Davie County and owned by ,r/ Q z� to conduct all testing procedures as necessary to determine t c site suit' ility. DXrI; %6C ''� f% SIGNXI` ' THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Includ all of the fulloiviug: Eliding and prop used property lines and dimensions, structures, setbacks, and septic locations). . Sign given , nrim tnetni Site Revisit Charge Dalc(s): Client Notification Date: EIIS: Account No. `O ! Y D o 111 Ybs v T APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC / r'. ^ I ' Davie County Health Department D �' Envlronmenta/Health Sectfon L/ ��4 � >t.0. Box 868/210 Hospital Street 2' � /� �1P�cJ C / , �=ockaville, He 27028 ,(/uy3 (336) 751-8760 ***XWCRTANT*** THIS APPLICATION CRNNOT BE PROCESSVD UNLE88 RLL THE REQUIRED INTORMATION I8 P R OVIDED. Refer to the INPOM&TION BULLETIN for instructions. 1. same to be silled _So_�i�-L/ 'q. A [[j Content "ram J Nailing rear...S—� /b�er < �s ('.�c� Some Phone- 99�- rS1/�0 9 city/state/axp _ UdlrY� /I1e a`17Dd6 business shone Z. Vane on Permit/ATC it Different than Above Nailing Address City/state/rip 3. Application Tor: mite Zvaluation ❑ Improvement Permit/ATC 0 Both *. system to service: PHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other a. If Residence: I People I Bedrooms a Bathrooms O Diahwasbsr U Oarbega Disposal O washing Machine D sasement/plumbing O saseeant/Vo Plumbing S. I! Business/Industry/Other: specify type s people a sinks e Commodes 6 showers a urinals I water Coolers IT IWDSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 13 County/City . ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yee ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLANMUST BESVBM 77FD by the client with THIS APPLICATION PropertyDimensi: / - / . / .3 A" 5 WRITE DIRECTIONS (from MockrAlle) to PROPERTY; Tax Office PIN: 0__i-17Oa - N - Property Address: Road Name 1,eod I Ti C4Joe/ eA ,P�) City/Zip_%%pgyi� IT in a Subdivision provide Information, as follows: Name: /-iLLIO IZ/%7 // a-1 A111,11- Section: Block( Let: �� � 1 Date Property Flagged: This b 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 plane or Intended we change, or if the Information - submitted In this application b falsified or changed 1, also, understand that I am responsible for all charger Incurred from this application. 1, hereby, give consent to the Authorhed Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct Ali testing procedures as necessary to determine the site suital�lity. I i n DATE 0 -2,Q -4t? THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclelall of the following: Existing and proposed property linea and dimensions, structures, setbacks, and septic locations . Revised DCHD (07/99) f/t06�L 0 10 /it Site Revisit Charge Client Notification Date: EHS: Account No. Invoice No. l : n � a.r_ •t t � . • rill _.rI Environmental Health Section S oil/Site Evaluation '. APPLICANT INFORMATION PROPERTY INFORMATION Account #: '.989900111 Tax PIN/EH #: 5822-146855.10 Billed To: Gray Potts. Subdivision Info: Dutchman Hills Lot # 10 Reference Name: `Gray Potts Location/Address: Eatons Church Road -27028 Proposed Facility: Residence Property Size: 51 AcresDate Evaluated: i ©o Water Supply: -Community Publicn-SiteWell ` Evaluation By: Auger Boring Pit Cut FACTORS-: . 1 2 3 4: '5 6 7. Slope 410 HORIZON I DEPTH 'Texture group Consistence Structure HORIZON ,group DEPTH:����®®S®®, ME "M ® Consistence X33?J®®®®® HUKILUN 111 ll1;Y1 ki Texture group Consistence Fr Structure $ Mineralogy HORIZON IV DEPTH Texture group Consistence ,.Structure ... Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE . rMw_�.xyiarw:v•rac��ica�scs�s®®®v®� SITE CLASSIFICATION: PS EVALUATION BY:A��' LONG-TERM ACCEPTANCE RATE:—O. 3S OTHER(S) PRESENT: REMARKS "LEGEND Landscape Posidon 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 Tex re SI- S nSilt Loamy sand SL - Sandy loam. ' L - Loam' . SI'- Silt Silty clay loam- SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC -;Sandy clay SIC = Silty clay . C - Clay CONSISTENCE MOW . 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)