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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 ���// `�'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 Nd YT Revised DCUD (05103 Client Notilleation Date: r ------ Ins: Account No. /9) invoice No. (- •t . i A;. i. r �� t .� -5 +�� � 'e S 1� 1. 5 1� ,. t 1 } d C .t 7. 7 � �� �� 1 � y fi.%�w fix:%{ � Y a ."� ti y R� M1- � •�A 3 1 �a"' ,� �' b A Y1y N i��h�L �'T ���� �.,,,�, k�r A �ti �� �fip'. 5 -xyY N y i '1* r � �'�}'� o'`iK, p. .t ^ i.. ....�.... ._ ,..s.,. .. i' • ,�.Y � , w�i ,. ,F r� '° � 1 y.. �N � �.; i�PFi s; �. .� _ . i �. -��, � 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)