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107 Highland Road Lot 22Davie County, NC ' t Tax Parcel Report Monday, December 19, 2016 rr-- --- - -L10 117 107 S ---- EATONS CHURCH RD EATONS CHURCH RD ghylA An data Is provided as is wh nnAmrremy or guarantee of any kind ehher expressed or implied including but not limited to the Davie County, Implied wamantiea of merchantability or guess for a paMoularuse. All users of Davie Courdys GIS website shall hold harmless the comely of Davie, North Carolina, Us agems, consubarda, contractors or employees hon, any and all dales or causes of action due to �p UNC NC or addng out of the use or Inability to use the GIS data provided by this webshe. WARNING: THIS IS NOT A SURVEY Parcel Information�� 5 Parcel Number: D301OA0022 Township: Clarksville NCPIN Number: 5822137950 Municipality: Account Number: 8305100 Census Tract 37059-801 Listed Owner 1: NICHOLSON ROBERT C 11 Voting Precinct CLARKSVILLE Mailing Address 1: 107 HIGHLAND ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class:. DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District No Legal Description: LOT 22 DUTCHMAN HILLS Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 0.63 Elementary School Zone: WILLIAM R DAVIE Deed Date: 6/2015 Middle School Zone: NORTH DAVIE Deed Book/Page: 009910308 Soil Types: MnB2 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: ghylA An data Is provided as is wh nnAmrremy or guarantee of any kind ehher expressed or implied including but not limited to the Davie County, Implied wamantiea of merchantability or guess for a paMoularuse. All users of Davie Courdys GIS website shall hold harmless the comely of Davie, North Carolina, Us agems, consubarda, contractors or employees hon, any and all dales or causes of action due to �p UNC NC or addng out of the use or Inability to use the GIS data provided by this webshe. Account #: 990002780 Billed To: Blake Hope Reference Name: ATC Number: 3751 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5822-14-6855.22 Subdivision Info: Dutchman Hills Lot # 22 Location/Address: 601/Eaton Ch. Rd. -27028 . AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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 S S VALL FORA PERIOD OF FIVE YEARS. ital Health Specialist's Signature: n —tel llate: 07 **NOTE** The issuance of this Certificate otGempli has been installed in compliance with Disposal Systems," but shall in NO WAY given period of time. �-'Q!1c,Ty3K ��-i Ip i7+�P'T� 7-L � Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) OF COMPLETION V the system described on Improvement/Operation Permit ter 130A, Section .1900 "Sewage Treatment and . that the system will function satisfactorily for any kwsa I. ?S` 3' J Account #: Billed To: Reference Name: Proposed Facility: DAVIE COUNTY HEALTH DEPARTMENT s � 6— Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT 990002780 Tax PIN/EH #: 5822-14-6855.22 Blake Hope Subdivision Info: Dutchman Hills Lot # 22 Location/Address: '601/Eaton Ch. Rd:27028 Residence Property Size: . see map **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. i Residential Specification: Building Type �St #People #Bedrooms 3 #Baths 2 - Dishwasher: Dishwasher: Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: IK Basement w/Plumbing: ❑ Basement/No Plumbing: 171 #People_ #PeopletShift #Seats Industrial Waste: 0 Lot SizeQ•1 VsType Water Supply �-LLnIt'f Design Wastewater Flow (GPD) , Site: New Repair171 System Specifications: Tank Size 1XIDGAL. Pump Tank 1060 GAL. Trench Width 3(i Rock Depth '� Linear Ft. ,Other: �1STQ a9TLo J`Ss t Required Site Modifications/Conditions: t t=\LL C).,]C&4T-tjQ1 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) r Date: O D S81 'S7' X23 LOT #30 0 260, 07 3 R 0, 830 AC, o t1! ;7 q 10' UTILITY M o EASEMENT ►1 er O s LOT #23 0. 836 AC, a U LOT #31 s' $1 •s7�13. E m 0. 923 AC,' 0 260 47 a ci STOP LANDSCAPE' 'LOT #22 1 4 1 EASEMENT' 0. 786 AC. o N $7° 39' 2.3'v W d Q ', fJECATIVE ACCESS EASEMENT 240. G0 --�_. N 87 39 23 W, . SPI E 108, 36 _ N 8I 'S39,4$0 ' 2. 0,2 w Tom MA 0 HRC. R '� , R 1338, WEs --;- 14 1 INTX. (/:S. 601 ION 1`011 SITE EVALUATION/IhIPROValENT NL:lihll l St Davie County Health Department !lP I Environments/Hes1t/lSCCtiOn :� y ,pP`" Nihl4FFItIN �' P.O. Dox 848/210 Hospital Street' ' 's Em-M" �� '.: ry • blocksva' 'NC 27028 EN All, LF W �(336)751-8760 -1...f,OnsrJY `***IMPORTANT*** TIiIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TILL REQUIRED INFORMATION IS PROVIDEDRefer to the INFORMATION BULLETIN for-instructionD Name to be Dillad _919e0 Contact Person 1 Mailing AddressY� /( j/i A CM: //%I /i/ / Homo Phone .33 90. 9 8.,. $a 33,. city/State/zIF 1/Q /) [r e- , A/X .� %DD CD Business Phone 0'.S/S 2. Namo on Permit/ATC if Different than Above Mailing Address C1 ty/State/Zip .I T. Application For:. Site Evaluation 4 ImprovemonL Perinl L/ATC ❑ De L$ 4.- 5pstem to service:' 0-Souse ❑ 'Ilobile Home 13Dusineta - ❑ Indu tly. ❑ .;other - 5. Type system requested: h"Conventional ❑ conventional awdificd' - -❑ innovativo 6. If Residence: - It People - 4 Bedrooms � II BaLhioontu � _,•_ ''Disposal QW eb hing Machine ❑Basement/I'lwisg ❑Oa •mnoatIN0 Plumbing l� iahwasher ❑Garbago 7. If Duaincas/Industry /ethor:'verify type - - yt People C Commodes �:<'p Showers . It Urinals - •SII We tci coolms IF FOODSERVICE;: $ Seats - Estimated Water Usage (gallons par day)'.___ 6. Typo of water supply: a County/City ❑ Well ❑ ColmnuniL'y 9. Do_ you anticipato additions or expansions of tile facility this systcili i5 111(c11ded to serve? ❑ Yes iryes, what type.' ***IArF0.RTi1NT***.CLIINTSMUSTCOAIPLL•TETHCRCQUIIU,•DPROI'L•'R'1'Y1NFORMiVr10NREQUESTED - BBLOIV. LidieraPLAT'orS1TrPLANAfUSTBCSUIJAII77,CDbytheclialt ni01.1'IIISAPPI ICATION Property Ditnensimisc }� iMITE uiliEC•rromiONS (rnlodstl8(t) to N(OPrTV: Tal office rlN:. ILTE 2- R--/ PropertyAddress: Road Naine �a / ��1> d r City/Zip If in a Subdivision Provide iuforntati�Joll�l, as'follo}vs: Nan1c: Section: Bloch: Lot: c2 0, Date bomccorners flagged: This is after that thec inform issued hereafter ation provided is correct to the best of Illy h nonledge. I understand that lily perniit(s) are subject suspension or revocation, if the site plans or intended use change; or if the infornia(ioln subntiticd in this application is falsified or changed.' 1, also, understand that.1 rau'resjrurtsiGle ja all charges hicur� rrl,jrnul: 1111sapplicadon. I, hereby; give consent to the Authorized Representative or tine mivic Coiully IIeal(li Ilcp:irqucul: ' to enter upon above described property located in Davie County and owned by to conduct all testing procedures as'necessary to determine (lie site suitability. DATE SIGNATURE _. TIIIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Include all of ilio folloivntg Exishug lid proposed property lines and dimensions, structures, setbacla, and septic locations). Sign given . AccouutNo: Revkori nrmn rnsmz .J APPLICATION FOR SITE EVAUlAT10N/IMPflOVEMENT PERMIT & ATC F D I Davie County Health Department EnWionmenral HOSIM Sewon P.O. Bo: 868/210 Hospital Street J l#e J �� tt� Mockeville, HC 21028 (336)751-8760 ***IMPCRTANT*** THIS APPLICATIOH CAUNor HE PROCESSED UHLESS ALL ift REQUIRED IHftRMATIOH IS PROVIDED. Refer to the IHIPORMATIOH BULLETIN for instructions. 1. Nar to be Rifled Cr " A /�j . eon Nailing address �(rled S Contactaoa■�pho:m City/state/ala 1a P,0,Ye¢_ Ale, ,97eL16 Business phone 1 97r �- X900 -- 2. Maes on permit/ASC ie Different than Above Mailing Address City/state/zip z. Application For: a Site Evaluation O Improvement Permit/ATC ❑ Both e. Oystea to service, Douse ❑ Mobile Rome ❑ Business ❑ Industry ❑ Other 5. If Residence: s People s Bedrooms a Bathrooms 0 Diehwaaher O Garbage Disposal D washing Machine O Dasssank/plumbing 0 assement/Mo plumbing 6. i! Busmen*/Industry/Other, specify type s people 6 Oinks e Coimodes a showers 6 urinals 6 water Coolers IP i'OODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: t3 County/City ❑ well ❑ Community e. Do you anticipate additions or expansions of the facility Ibis system Is Intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION PropertyDlmensionk' -J'F1. ot 73 5 Tax OIRce PIN: Property Address: Road Name 0/0/ d-fi ip4l 2h Clty/Zip I%6 /,Cie_ A/P„ Wg' If In a Subdivision provide Information, as follows: Name: , aklirnu11-1 %f< // S Section: Block: Lot: -2 -9-- WRITE WRITE DIRECTIONS (from Mockrvllle) to PROPERTY: Date Property Flagged: This Is to certify that the information provided V correct to the beat of my knowledge. I understand that any permit(s) Issued hereafter are subject to smpenslon or revocation, if the site plans or Intended we change, or if the information submitted in this application Is f billed or changed. I, also, understand that I am responsible for all charges Incurredfront this appllcallom 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 The site sultsvity. DATE -1:210-4&) THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (loci a/all of the followlag. Ezisting and proposed property lines and dimensions, structures, setbacks, and septic load Revised DCHD (07/99) Site Revisit Charge Client Notification Date: EHS: Account Na Invoice No. ire -r P22_ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 'Soil/Site Evaluation APPLICANTTNFORMATION PROPERTY INFORMATION Account #:'989 900111 Tax PIN/EH #: 5822-146855.22 ' Billed To: Gray Potts Subdivision Info: Dutchman Hills Lot# 22 Reference Name: , Gray,Potts Location/Address: ' Eatons Church Road -27028 Proposed Facility: Residence Property Size:51 Acres Date Evaluated: G% Water Supply:.' On -Site Well Community / Public Evaluation By Auger Boring Pit / Cut LFACTORS 1 2 Landscape 3' . 4 5 6 7 cape position : _. Slone% /< I, 11, .. . HORIZON I DEPTH I/ Texture group .' Consistence . Structure Mineralogy HORIZON II DEPTH w" ' Texture group Consistence Structure ✓ua aaa Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOILWETNESS' .,:.:.. RESTRICTIVE HORIZON QADDnr1 V -'l.Lt1JJIDal.t11aV1\' �- L( TERM ACCEPTANCE RATE 1 -o SITE CLASSIFICATION: EVALUATION BY: ." LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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. - Silt loam CL - Clay loam SCL' - Sandy clay loam . tY Y Y . Y SC -Sandy clay . SIC = Silty clay C - Clay, CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm . VFI - Very firm EFT - 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 Structor 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) ii■