550 Beauchamp Rd (2)Davie Countv, NC
TaY ParrPl R Pnnrt
Wednesdav, October 12, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 7:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WAKIVIN(T: '1'H1515 NU1' A �UIZVEY
Parcel Information
F80000000801 Township: Shady Grove
5870782609 Municipality:
50985500 Census Tract: 37059-803
MILLER M DAVID Voting Precinct: WEST SHADY GROVE
PO BOX 2170 Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNN R-A,H-B-S
Land Value:
Total Assessed Value:
NC 2oning Overlay:
27006 Voluntary Ag. District: No
4.12 AC BEAUCHAMP RD Fire Response District: ADVANCE
3.98 Elementary School Zone: SHADY GROVE
11/1989 Middle School Zone: WILLIAM ELLIS
001510413 Soil Types: GnB2,EnC,MsD
Flood 2one:
Watershed Overlay: DAVIE COUNTY
179880.00 Outbuilding 8� Extra 30280.00
Freatures Value:
47780.00 Total Market Value: 257940.00
257940.00
q�u t�, � All daU Is pmvfded as Is wHhout warraMy or guarantee o( any klnd either expresaed or Implled including but not Iimited to the
Davie County� Implled wamnties o( merchaMability or fitness fw a particular use. All users of DaNe County's GIS webslte shall hoid harmless the
County of DaNe, Nwth Carollna, ib egents, consultants, contractors or employees from any and all clalms or wuus of actlon due to
�o�N�S� NC or arising out of the use or inability to use the GIS daW provlded by this websita
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� AUT�IORIZATION NO: 'i �j � � � DAVIE COUNTY HEALTH DEPARTMENT ��` /' �' ���
, < Environmental Health Section PROPERTY II�TFORMATION
Permittee's �%�� ��% ! P.O. Box 848
Name: XJ� l%�(�y �• �/r'"� Mocksville, NC 27028 Subdivision Name:
�;%' � Phone # 336-751-8760
Directions to property: �,...� �',s��i' i� ��.' f�ji i�� l Section: Lot:
AUTHORIZATION FOR
�� f` f�.� ��-, � WASTEWATER Tax Office PIN:# - -
SYSTF,M CONSTRUCTION —
Road Name: �L�k� �+'� Zip: Z 700G
**NOTE** This Authorization for Wastewater System Conswction MUST BE ISSUED by the Davie County Envuonmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(ln compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
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ENV[RONMENTAL HEALTH SPEC(A
i j, ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
�� `..�% lJ IS VALID FOR A PERIOD OF FIVE YEARS.
DATE ISSUED
_ :. . .
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�'" `''� � " `� �j �� �, DAVIE COUNTY HEALTH DEPARTMENT '
"� �; TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
�'ermittee's �' , � � .
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Name: r��,�'� ✓-'` � �`'r'y/. %/�'%� Subdivision Name: ` '
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Directions to property: �.� !' � ' > - - � . Section: Lot:
Il1�IPROVEMENT
; � , PERMIT Tax Office PIN:#
RoadName: ����r���y>� Zip: 7_ 7Ao�
**NOTE** This Improvement Pernut DOFS NOT authorize the construction or installation of a sepdc tank system or any wastewater system. An
AUTHORIZAT'ION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
':� � r` � ***NOTICE*** TiIIS PERMIT IS SUBJECT TO REVOCATION IF SI1'E
.' 1 ��� .� . � '" �' �`.�� : ; � f ' :f ��' �' SYSTEM CONTR CTOREMUST SEEATHIS ERMIT BEFORE �R
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �STALLING THE SYST'EM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE _�_� # BEDROOMS �� # BATHS _� # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY ` O DESIGN WASTEWATER FLOW (GPD) �—{��/ NEW SITE REPAIR SITE 1�
/ ��+ y
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH�c' / ROCK DEPTH _/ O LINEAR Ff;.a��� �
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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**CONTACT A REPRESENTATIVE OF THE DAVIE CO FOR FINAL INSPEC p�(��'�'��I �YSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P. . ON THE DAY F INS ALLAT N. TELEPHONE #;S, �Q4� C�4 �7 .T��
t .s u r �
OPERATION PERMIT ( � �j ��L� �! �
SY M INSTALLED BY: �l��11�1iru� UI/ ;d7�-
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AUTHORIZATION NO. ,�/,��OPERATION PERMIT BY: DATE: � •..
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD OS/96 (Revised)
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::. DAVIE COU _,
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.6. ,� �,4,-y�. , � e '� �} � •_• . � C r �+' , !�J
- ; � a,� � �, NTY HEALTH DEPARTMENT �� � ��
J IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's ,, "� _
Name: •.� ;�- ;�; �,,. *; ���:`f..
Directions to property: '�� '} r
IMPROVEMENT
PERNIIT
Subdivision Name:
Section: Lot:
Tax Office PIN:#
Road Name: ��'���r ��•.•�
Zip: � ?n,a(-�
**NOTE** This Improvement Perrnit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AiJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
' ***NOTICE*** THIS PERNIIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST • DATE ISSUED SYSTEM CONTRACTOR MUST SEE TEIIS PERMTI' BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE �# BEDROOMS 3� # BATHS .�_ # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY r<� DESIf'iN WASTEWATER FLOW (GPD) �� NEW SITE REPAIR SITE 1/
� y
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH�� / ROCK DEPTH �,.�, LINEAR Ffrl�`
0
REQUIRED SITE MODIFICATIONS/CONDITIONS:
, �
,' J . ,� ,,,;... �,���,c f (/. ` . �� ,,r,�M.
IMPROVEMENT PERMIT LAYOUT�' r '-`t�iM +r'� -!' �i�
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j� !� -'�/:,r'.. 1� .i, %! � j,'
F 3{ 51: t 7. C3 `' 'Ci�. !! ,1 V.7�':sr. 7i>i—Y.lii. -
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**CONTACT A REPRESENTATIVE OF THE DAVIE COtTN'i'v uFAt �
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 130 P.I�I.ON THE DAY
m
OPERATION PERMIT
INSTALLED BY:
�- .
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FOR FINAL INSPEC'Tj�OAJ�pF���HI� �SYSTEM
iN. TELEPHONE # �S�(�Q4� ��87C���
, C-%�)�/ �� /�� //
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,,� \� ; ' �,,� �. � ,��j�
AUTHORIZATION NO. �' � OPERATION PEEtMIT BY: / � DATE: `" ' ~�- /
"`*THE ISSUANCE OF THIS OPERATION PERMITSHALL,INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAP'TER 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.
DCHD OS/96 (Revised)
_ �;:3�.....,
�' � DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME ��/% ��+����G" !� PHONE NUMBER
_ Z7oo�
DIRECTIONS TO SITE
BDIVISION NAME
LOT #
DATE SYSTEM INSTALLED % NAME SYSTEM INSTALLED UNDER
TYPE FACILITY �� NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED X'���%� INFORMATION TAKEN BY ��T
Thia ia to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
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