105 Clayton DrDavie County, NC Tax Parcel Report a Tuesday, September 27, 2016
5745
A
Deed Book f Page:
001610374
WARNING: THIS IS NOT A SURVEY
Plat Book:
Flood Zone: X
Pdreerinforma4on
_.
Parcel Number:
E40000004401
Township:
Farmington
NCPIN Number:
5831775745
Municipality:
Freatures Value:
Account Number.
20971500
Census Tract:
37059-802
Listed Owner 1:
DEMAREST WILLIAM D
Voting Precinct:
FARMINGTON
Mailing Address 1:
105 CLAYTON DRIVE
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
19.32 AC CLAYTON DR
Fire Response District:
FARMINGTON
Assessed Acreage:
18.96
Elementary School Zone:
PINEBROOK
Deed Date:
10/1991
Middle School Zone:
NORTH DAVIE
Deed Book f Page:
001610374
Soil Types: GnB2,GnC2,GaD
Plat Book:
Flood Zone: X
Plat Page:
Watershed Overlay: -
Building Value:
295580.00
Outbuilding & Extra
56740.00
Freatures Value:
Land Value:
223660.00
Total Market Value:
575980.00
Total Assessed Value:
381600.00
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harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
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f
.Davie County Health Department
D1836 'nvironmental-Health Section
P.O. Box 848
210 Hospital Street
Courier # : 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
(` �y y
Name: ' ..(r ! .t =" VV�C� �' Phone Number 33 `a T / ( (Home) ,.
1
Mailing Address: C) S7 c� 11C . (Work)
C. s, Email Address:
Detailed Directions To Site:
Property Address: to
Please Fill In The Following Information Aboui •The EXISTING Facility: v 0DUUDD 7 y(')l
Name System Installed Under: W 1 �('r'i �e /jijG� /P S f Type Of Facility: ((5�
Date System Installed (Month/Date/Year):�f' dumber Of Bedrooms:, Number Of People:
Is The Facility Currently Vacant? Yes . '1 •) If Yes, For How Long? -'
Any Known Problems? Yes o If Yes, Explain: r f
Please Fill In T FolloMn Information About The NEWFacility:
i
hle` ,gr tY: w
Type Of Facility: k(k) i C Number Of Bedrooms: Number of People
Pool Size: Garage Size: ,Other:
,(
f --Requested BrI, rp oe ate Requested: — F-121
Signature)
,Environme tal Health Specialist UDate:
*The signing of this form by the Environmental Health Staff is in^no Way intended, nor shottld.be taken as a guarantee
(extended or limited)�that the on le wastewater system will function properly for any
`given period of time.
e
Payment: Cash. Chec Mone Order # Amount:$/,00,00 Dater
Paid By:,^ rz ( Received By:
!J 4117Invoice #
Account #:
k
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
0, *-MOTE: IsWqd.%iP Compliance with G.S. of NQrthXarolina Chapter 130 Article 13c
A
Sew6g§,.Treatment and Disposal Rules (10 NCAC 10A -1934-.1968) a>sPermit -NL(mber
I-
Name r,
Date �51 - 0 Z)
Location
Subdivision Name /V -v Lot No. —'-Sec. or Block No.
Lot Size House Mobile Home -- Business — Spe6u"lation
No. Bedrooms No. Baths No. in Family S
Garbage Disposal, YES ,NO ❑
Specifications for System:
Auto Dish'Washer YES NO
0
Auto Wash Machine YES NO
Type Water Supply
"This permit Void if sewage system described ber6W, is not installed within 36 months from date of issue.
Improvements it b. y
*Contact a representative of the Davie County Health Department for final inspection of this' system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
X\
-1q
Certlii.at�f completion Date
. - I le 1 1
*Th 19/ign sh I indj'66te that d sys descf/ibed above has been installed in compliance with
I q, i g of this certificate Z
e standards'set forth in thea o"ve regulation, but shal <vay be taken as a guarantee that the system will function
/� e 0 il
satisfactorily for any given p ' od of time.
p L
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department �1% in Z
Environmental Health Section pvC,
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
\ � \ Home Phone 9127G6-220
1. Permit Requested By d ` 1l x�.t^ACIff S� Business Phone 7/// �/ 7
2. Address 130 A. H. (� t �.���C�c� �S�ie_►,� f�%C, �1i1 �1
3. Property Owner if Different than Above
Address
4. Permit To: a) Install-LZAlter Repair
b) Privy EZ Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No. -
5.
o. 5. System used to serve what type facility: Houser Mobile Home Business
IndustryOther
b) Number of people
6. a} If house or mobile home, state size of home and number of rooms.
House Dimensions A y /, X 3=5- `_A )
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodesurinals garbage disposal Z
lavatory __I showers washing machine T
dishwasher I sinks
8. a) Type water supply: Public Private ✓ Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions y y(a U X 7
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? n0
What type? -*'( '
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
i�
o COY (t,�,
In o \
cct
DCHD (6-62)
4ew
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPE 15
�1 DATE RECEIVED
/St, c �eS ��—.ay R«Q� cQ� (office use only)
es no 1. 1 am the owner of the above described property.
yes n0: 2. 1 am not the owner of the above described property, however, I certify that
have consent from , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described propertyand conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
DATE
SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
Owner only
ZOwners designated representative
_ Anyone requesting results
Only those listed below
DATE
DCHD (11 /84)
SIGNATURE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name C�' Date --��
Address Lot Size
CAPTnoc AREA I APPA 9 AREA R ARFA A
Topography/ Landscape Position
S
S
S
F
U
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
�
S r
IT
�S
U
��
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
UUU
S
6jp
U
Soil Depth (inches)
S
S
®
U
PS
U
U
Soil Drainage: Internal
Ll
SS
U
U
External
S
US
U
�) Restrictive Horizons
Available SpaceS
S
PS
PS
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE S—SUITABLE PS Provisionally Suitable
Recommendations/Comments:��
/ o
Described by —� 1� Title �/�/� Date t_ r
SITE DIAGRAM
DCHD (8.82)
/ v pj836jC'
Phone: (336) - 751- 8760
Davie County Health D -
Environmental He
P.O. Box 818
210 Hospital Stre
Courier #: 09-4.0-
Mocksville, NC 270 8
Fax: (336) - 751- 8786
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement 0 Remodeling ❑ Reconnection ❑
Name: l j Phone Number_ 33G L ? 8-q �538 (Home)
Mailing Address: 0 G IG CP 71 — 2 �s (WorkM C At
Detailed D' ct' s To Site: /�� v
C� cwt t til e k4t < � Ur4 Ll Sit.
Property Address: An, 57 G�ta �•
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility7N—+'-S Cl h
Date System Installed (Month/Date/Year): Number Of Bedrooms: Number Of People:
Is The Facility Currently Vacant? Yes ❑ No ❑ If Yes, For How Long?,
Any Known Problems? YesEl No❑ If Yes, Explain:
Please Fill In The Following Information About The. NEW Facility:
Type Of Facility: Number Of Bedrooms: Number of People
Requested By: Date Requested: -2,-3 QD- 0
(Signature)
For Environmental Health Office Use Only
Approved, Disapproved 0
Comments:
Environmental Health Specialist
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check PYMoney Order ❑ # ey J Amount:$ ZhQl
Paid By:2 Received By:
Account#: Y/ r ` 7 Invoice #: '7151