291 Ivy Circle Lot 16Davie Countv. NC
I
Wednesday. October 26. 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City: BERMUDA RUN
State:
WARNING: THIS 1S NOT A SURVEY
Parcel Information
D802OA0005 Township: Farmington
5872746632 Municipality: BERMUDA RUN
82526267 Census Tract: 37059-803
COFFEY PATRICK J Voting Precinct: HILLSDALE
291 IVY CIRCLE Planning Jurisdiction: BERMUDA RUN
NC
Zip Code: 27006-0000
Legal Description: LOT 16 BERMUDA RUN GOLF&COUNTRY
Assessed Acreage: 0.84
Deed Date:
Deed Book I Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
4/2006
006570803
311440.00
75000.00
386440.00
Zoning Class: BERMUDA RUN CR
Zoning Overlay:
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
Voluntary Ag. District:
No
Fire Response District:
CLEMMONS
Elementary School Zone:
SHADY GROVE
Middle School Zone:
WILLIAM ELLIS
Soil Types:
MrB2,GnB2
Flood Zone:
Watershed Overlay:
BERMUDA RUN
Outbuilding & Extra
0.00
Freatures Value:
Total Market Value:
386440.00
Davie County,
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
10:1
NC
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
or arising ou t of the use or inability to use the GIS data provided by this website.
ATC Number: 4127
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Tlf y / Date: '
3 ,Kedraams
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:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
C)Imm&�f
Date:
v
.w
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account M 990003599
Tax PIN/EH #:
5872-74-6632
Billed To: Matt Menzi
Subdivision Info:
Bermuda Run Lot # 16
Reference Name:
Location/Address:
Ivy Circle -27006
Proposed Facility Residence
Property Size:
see map
ATC Number: 4127
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Tlf y / Date: '
3 ,Kedraams
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:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
C)Imm&�f
Date:
v
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003599 Tax PIN/EH #: 5872-74-6632
Billed To: Matt Menzi Subdivision Info: Bermuda Run Lot # 16
Reference Name: Location/Address: Ivy Circle -27006
Proposed Facility Residence Property Size: see map
ATC Number: 4127
**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 # aths Qf_
Dishwasher: Garbage Disposal. d 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) 'WD Site: New 0" Repair ❑
l�
System Specifications: Tank Size /62 jGAL. Pump Tank GAL. Trench Width d'4;, ""Rock !"Linear
Other:. /�.,�1
Required Site Modifications/Conditions:
i ; W also be
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTI E: Contact a representative of the Davie Count3 Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.i i. or 1:00 p.m. to 1:30 p.m. on the day of install tion. Telephone # is (336)751-8760.****
Qco�
vie
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
Apr 12 05 01:49p
davie county envhealth 336 751 8786
APPLICATION FOR SPIE EVAIIATION/UIPROVUIENT PE[tlHif & ATC
Davie County Health Department
Envlivnmental Health Section
P.O. Boz 848/210 Hospital. Street
Mocksville, NC 27028
(336)751-8760
11,P� Y� 0S
r •**XWV TAItr*** THIS APPLICATION CANNOT BE PROCESSED WAE 3 ALL 788 REOUIRKD
INFORMATION 1:3 pROVIDJO7. Refer to the JZIFORIATION BUXXZ IN for instructions.
I
✓�1. Nam to be Billed N IVV Z vt Z,l 1 t
`�1 contact Person 1� (.a t"�.. ��` 2 'lZ/. (
l v
✓x.111119 addrosa .� G lTJ� : �� A (S' (� r }nose phone
`'/City/Stato/ZIP L� w� �v�l+ h �' �-`�C t %. Business P Tic .. (• -
•�2. Nam an Poimit/A= if Differam 9-111 above
k,— Ccs fJL
/
xalling address Ciwsute/s1D'
_—:. ApplieaCioa Pdr: 83 Evaluation Smprovemeat permit/ATC (O. Both
5� '
r
.tet: system to Services Rouse ❑ Xobile Rome Businosa ❑ Industsy C3 Other
/
,.,%
S. Type system requested: a CUwentlaoai ❑ conventional modified ❑ itmovatiw
—.A. I_f��Residences t Peoplon u:ltr s Bodrooms W I Bathrooms
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`�'Qoisbwaalser IgOas:bage l�.usposal 4Ataahing Rachlne t33asement/Plumbing ❑easemazt/ito Plumbinu
.
7. zr aumineialloduatry /Others •:*rUr type I People P Sinks
i cow"des I shiners / Urinals I Nater coolers
XF FOODSERVICSs 3 Seats _ Estimated Water Wage (galloon per day)
��. Type of nater suppiys td County/City ❑ well ❑ community
40
..-9. no you anticipate addition, or erpausiosu of the facility this system is intended to serve? ❑ Yes
If yes, wvLat type? -
ti I —s"4WATANT*** CLI6N'15JJ USTCOyFL=TJJX REQUIRED PROPEM INFORMATION REQUESTED
DEWW, EltheraPLATerS(TEPLWAfZZTBESV8AItTTEDbrthe dient withTH4SAPP1.1CA170N.
L_,rPoperty Uimensionr. i S Lr�X , SD A I I C A 9-l7A J JC -WVM D)RFCT)ONS (from lltodsvilte) to PnROPERM
Tax0McePIN: g �. �Li�' 3 l SD fU j3u�nsdrx�V t'Cvv�
__-Propaly Adtlrrss: Road Name EVY L: •' ,V 1 2 a- ' S l v •i
Qtymp lweteAtV Lsl
... If in a Subdivision proviclainfomt26031, as follows:
fame: ! `? t .- J %` C, 1,
Section: Block: Lot: Date home comers iia=ped: 0
This 1s to certify that the LJfornsatiou provided Is correct to the best of my knowledge. I understand flint any pemstt(s)
(cued herfler are subject to suspension or revocation, if the site plans or intended use chauM or if the infarnui tion
submiiied Ls this appUcatiou)s tak(tied or changed. 1, also, undemead Ikallaat rerpezxWeforall charger Incurred frost
th4 applicarlou. 7, hereby, give consent to the Autliorized Represcotative of the Davie County Health Departmcut
to enter upon above described property locat:d in Davie County and owned by
to conduct all testing procedures as necessary to deterndue the site suitability.
L -
,,HATE i � � �' � . �--s�[ctvAT[If�c
TIUS AREA MAYBE USED FOR DRAM ING YOUR SITE PLAN (Include aA of the following: Existing and proposed
property lines middiutlalsions, structures, selbacla, and septic locations).
Site Revisit Cbargc
3c, —0
Sign giv
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Revised DCUD (05103
Client Notilleation Date: r ------
Ins:
Account No. /9)
invoice No.
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APPLICANT INFORMATION
Account #: 990003599
Billed To:. Matt Menzi
Reference Name:
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 5872-74-6632
Subdivision Info: Bermuda Run Lot # 16
Location/Address: Ivy Circle -27006
Property Size: see map Date Evaluated: c5�13 �O
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS
I
2 3 4 5 6 7
Landscape position
L
Sloe %
HORIZON I DEPTH
Texture groupS-
Consistence
Structure
Mineralogy•
/
HORIZON II DEPTH
l/ /1
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 RATE
,
SITE CLASSIFICATION: EVALUATION BY: &ala
LONG-TERM ACCEPTANCE RATE: 1 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
exture
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
oist
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
Mineralog
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
DCI ID 05/99 (Revised)
1
gm^..sMT,^`e y m^•+? rv'." ' _:,. Et*^ -.,
_777
I CtU_`T �I�Tl1V T
Environmental Health %Section
P. 0. Box 848/210 Hospital Street
Courier 09-40-06
Mocksville, NC 27028
May 6, 2005
Matt Menzi
7700 Hollyfield Road
Clemmons, NC 27012
Re: Site Evaluation/ Lot 16 Ivy Circle Bermuda Run
Tax Office PIN: #5872-74-6632
Dear Client(s):
As requested, a representative from this office visited the aforementioned site on,
May 5,2005. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
provisionally suitable for the installation of an on-site sewage system.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RBH/dlf
Enclosure(s)