2590 Davie Academy Rd Davie County,NC Tax Parcel Report 4U99— Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: 110000002701 Township: Calahaln
NCPIN Number: 4798988067 Municipality:
Account Number: 82522995 Census Tract: 37059-801
Listed Owner 1: HERNANDEZ RUBEN Voting Precinct: SOUTH CALAHALN
Mailing Address 1: 388 OAKLAND AVENUE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,H-B
State: NC Zoning Overlay:
Zip Code: 27028-8315 Voluntary Ag.District: No
Legal Description: 0.560 AC DAVIE ACADEMY RD Fire Response District: COUNTY LINE
Assessed Acreage: 0.41 Elementary School Zone: COOLEEMEE,WILLIAM R DAVIE
Deed Date: 6/2004 Middle School Zone: NORTH DAVIE,SOUTH DAVIE
Deed Book/Page: 005580491 Soil Types: CeB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 19610.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 17860.00 Total Market Value: 37470.00
Total Assessed Value: 37470.00
161 All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
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40, DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name /��/ 1 ✓.�f1_�r.✓ ' `i�y'_� nrll Date � -y �� w'iA 4 Ui�'�
Location l=' %Gid — / ,t w �,f✓, r - f �'�' _
0?00 iL
Subdivision Name Lot No. Sec. or Block No.
Lot Size //-f4- 2 House Mobile Home _ Business --�'�� Speculation
No. Bedrooms — No. Baths No. in Family,
Garbage Disposal YES ❑ NO 4 Specifications for System-
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 nonths from date of issue.
Improvements permit by
*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: Syst m Install d by
d
ID
Certificate of Completion ` Date J r
*The signing of this certificate shall indicate that the system described above has been installed in compliance/
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will fs�
satisfactorily for any given period of time.
.i
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT /
Davie County Health Department 1/ 97
Environmental Health Section 7
R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone Ll 'S�
1. Permit Requested By o h r&Dh SPo mnr Business Phone - 5
2. Address J
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ✓ Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House 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
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other,
State: Number of persons served
What type business, etc. U C Akk Shn�
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions Z 0.5 k .-2-10 f
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? O
What type?
This is to certify that the information is corre t to the best of my know) ge.
OK D to ner Signature
OWNER IS SOLELY RESPONSIBLE FOR COP IANCE W6tPALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD(6-82)
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 PROPERTY: DATE RECEIVED
(office use only)
e
yes no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the/above descried property, however, I certify that I
have consent from /�a+� -R!' A- - �7r��' , 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 property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and dispos 7system.
44,s7 IW7A.A �.
DATE SIG AtIJRE
4. 1 hereby authorize the Davie County He Ith Department to release site
evaluation results from the above described property to the following:
Owner only '! t
miners designated representative
—Anyone requesting results
Only those listed below
�.
DATE �S GNATURE
DCHD(11/84) /
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
,v SOIL/SITE EVALUATION
Name ` Date
Address Lot Size &f'%1' �
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S
PS PS PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) PS PS PS
U U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils dD PS PS PS
U U U U
4) Soil Depth (inches) S S S S
PS PS PS
U U U
5) Soil Drainage: Internal S S S S
PS PS PS
U U U
External S S S
PS PS PS
U U U
6) Restrictive Horizons
7) Available Space S S. S S
PS PS PS
U U U U
8) Other(Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by / Title Date1J11
SITE DIAGRAM
DCHD(6-82)