137 Elrica Ln (2)Davie County, NC Tax Parcel Report Friday, October 7, 201(
Clarksville
Account Number:
82530185
Census Tract:
37059-801
Listed Owner 1:
SNELL PAUL SR
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
4606 SAXONBURY WAY
Planning Jurisdiction:
Davie County
City:
CHARLOTTE
Zoning Class: DAVIE
COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
28269-0000
Voluntary Ag. District:
No
Legal Description:
9.00 AC WAGNER ROAD (4.301 AC) TR 2
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
4.30
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
10/2008
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
007721026
Soil Types: MnC2,MnB2,MdD
Plat Book: 11 Flood Zone:
Plat Page: 194 Watershed Overlay: DAVIE COUNTY
Building Value: 298030.00 Outbuilding 8r Extra 3740.00
Freatures Value:
Land Value: 44700.00 Total Market Value: 346470.00
Total Assessed Value: 346470.00
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Davie County,
All data is provided as Is without warranty or guarantee of any kind 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
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County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
or arising out of the use or inability to use the GIS data provided by this website.
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336)753-1680
Accnunt #: 990005397
Billed To: Integrity Builders
Reference Name: i qu / 5NL11
Proposed Facility: Residential Well
WELL PERMIT
Tax PIN,EH #: 5811 -80 -5925 -Well
Subdivision Info:
LocationiAddress: Wagner Road -27028
Property Size: 5.0 Acres
ATC Number: 0046
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there
has been a material change in any fact/circumstances upon which this permit was issued.
Permit Type: New [fi Repair ❑ Abandonment ❑
Proposed Well Location Diagram
Certificate of Completion Diagram
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LAJ
L "�%o�
,i K lba
Comments:
Driller: 2VIC,
Certification #: 3
Grout Inspected:
Well Head Inspected:
GPS Coordinates:
HS: ate:
EHS: Date: / `/
W.P. 7-08
t
9 CATION FOR TE WELL PERMIT
-iliaEn ` �irdriental` ealElb.'�
P.O.;Box 84 10 Hos ctal Street'��s�'
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1, THiS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name to be Billed Contact Person
Billing Address Home Phone
City/State/ZIP Business Phone
Name on Permit if Di erent than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE: A survey pt ora p must accompany is application.Included:Site an a o sca e
Owner's Name 4 J I Phone Number
Owner's Address S City/State/Zip U..11l ji** )C -
Property Address City. M JpjtLu o
Lot Size S . o (,,�rrp _Tax PIN#
Subdivision Name(if a plicable) Sec ion/Lot#
Directions To Site: , �; >nn \ I _�S -i— /�� PP V :.,n� 1� /1 ��i� -I- nn ki hL�L�G'
DEVELOPMENT INFORMATION
Facility Type: Residential Food Service Church C mmercial Other
Are There Any Septic Syste Currently On The. Site? YES NO
Do You Intend To Install A New Septic System On This Site? YES _ C NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and comers. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
ine the best location for a well.
W -S �Ial S'1C, ��-1170 -020 �
Signed Date
Date(s):
Client Notification Date: _
EHS:
7/30/09 Account #
Invoice
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax #(336)753-1680
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms # Bathrooms3# People / BasementC'Basement plumbinge-
Non-Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size 1q.3 Type of Water Supply: ❑County/City ell ❑Community Well
/ d -O c
System Specifications: Design Wastewater Flow (GPD) Tank Size � GAL. Pump Tank GAL.
Trench Width 3 Max. Trench Depth Rock Depth Linear Ft. It v`
Site Modifications/Conditions/Other: As stater! in 1511 NCAC
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
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Environmental Health Specialist
DCHD 11/06 (Revised)
/ )- - /,/ / -d7
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990005397
Tax PINIEH #:
581.1-80-5925
Billed To:
Integrity Builders
Subdivision Info:
Reference Name:
Paul and Julie Snell
Location/Address:
Wagner Road -27028
Proposed Facility:
Residence
Properly Size::
4.302 Acres
ATC Number:
5017
Site Type:
i ew ❑Repair ❑Expansion
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms # Bathrooms3# People / BasementC'Basement plumbinge-
Non-Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size 1q.3 Type of Water Supply: ❑County/City ell ❑Community Well
/ d -O c
System Specifications: Design Wastewater Flow (GPD) Tank Size � GAL. Pump Tank GAL.
Trench Width 3 Max. Trench Depth Rock Depth Linear Ft. It v`
Site Modifications/Conditions/Other: As stater! in 1511 NCAC
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
\ �aopc�
L/
Environmental Health Specialist
DCHD 11/06 (Revised)
/ )- - /,/ / -d7
' DAVIE COUNTY
WELL CERTIFICATE OF COMPLETION
CHECKLIST
Applicant:
File
Site Address:
Subdivision: Lot:
Permit Type: New Well Well Repair Well Abandonment Other
Facility Type: Residential Food Service
Church Commercial Other
Initial Inspection
Were Setbacks Maintained? Yes No
What is the-Grout Depth? ft.
If No, Explain:
What is the Grout Thickness? in.
What is the Type of Well?
Was a Well Screen Installed?
What is the Casing Type?
Type of Drilling Fluids Used:
What is the Casing Depth? ft.
Well Grout Inspection Date:
What is the Well Diameter? in..
GPS Coordinates:
What is the Well Depth? ft.
EHS ID:
' Well Head Inspection
Is There an Access Port? _
Is There a Vent?
Is There a 4" Pad? ,i
Is There a Hose Bibb?
What is the Casing Height? f y
Is There any Grout Settlement?
What is the Static Water Level? ft.
What is the Yield? ioo GPM
Is the Well Contractor I Plate Complete?
Is the Pump Installer ID Plate Complete? r
Contractor Name: r`
Pump Installer Name:
Contractor Certification �&S9
Date Installed: /a
Depth of Well:
Depth of Pump Intake:
Casing Depth and Inside Diameter:
Pump Horsepower Rating:
Screened Intervals: N/19
Opening for Piping & Wiring >12":
Packing Intervals (Sand Packed Wells):
Yield in GPM or GPM/ft.-dd: lao ge
Static Water Level and Date Measured:
Date Well Completed: o
Well Head Inspection Date: �/?W)
EHS ID: 2?yy
Construction Completed Date: T-7110
Contractor Reports Received Date:
Sample Date:
Results Mailed Date:
Certificate of Completion Date:
Authorized Agent:
STArr •
r
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Wat'Rtud t��'VED
WELL CONTRACTOR CERTIFICATION # NCWC 2839-A f n nnCn
c�2010
1. WELL CONTRACTOR:
Brian Lillev
Well Contractor (Individual) Name
Aaua Drill. Inc.
Well Contractor Company Name
4137 Moores Mill Road
Street Address
SDencer VA 24165
City or Town State Zip Code
( 336 ) 767-0747
Area code Phone number
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#
OTHER ASSOCIATED PERMIT#(if applicable)
DAVIE COUNTY HEALTH DEPARTMENT
g. WATER ZONES (depth):
Topf/iZ? Bottom /10 Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
7. CASING: Depth Diameter Weightaterial
Top _ Bottom:Zl
& Ft._ �V�,
Top Bottom Ft.
Top Bottom Ft.
8. GROUT: Depth Material Method
Top— L— Bottom Ft. �/ es.,Z;L� 711 �, 4-17%'
Top Bottom Ft. .*4�
Top Bottom Ft.
SITE WELL ID #(if applicable) / 9. SCREEN: Depth Diameter Slot Size Material
3. WELL USE (Check Applicable Box): Residential Water Supply l Top Bottom Ft. in. in.
—I ,6 Top Bottom Ft. in. in.
DATE DRILLED `2-17 _
TIME COMPLETED
Z� G AM ❑ PM D Top Bottom Ft. in.
4. WELL /L CATION: 10. SANDIGRAVEL PACK:
1" Ll COUNTY. Depth Size
CITY: 1 Top Bottom Ft.
16 1 l am, f 1 - 23D - Top Bottom Ft.
(Street Name. Numbers, Community, Subdivision, Lot No., Parcel, Zip Code) Top Bottom Ft.
TOPOGRAPHIC / HAND SETTING: (check appropriate box)
❑ Slope C'J Valley ❑ Flat ❑ RRidge ❑ Other
LATITUDE SS" 5 C . " DMS OR 3X.XXXXXXXXX DD
LONGITUDE 67' dl(- " DMS OR 7X.XXXXXXXXX DD
Latitude/longitude source: SPS Dropographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. W5?WNER
Owner Name
Street Address
or Town State Zip Code
Area code Phone number
6. WELL DETAILS: _,
a. TOTAL DEPTH: ) s
b. DOES WELL REPLACE EXISTING WELL? YES D NO L-'
11. DRILLING LOG
Top Bottom
�--/-mss`---
C' l 1�
7C7
/
/
12. REMARKS:
Material
��Formation Description
/-'"
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: L� �' FT. ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
(Use "+" if Above Top of Casing) ST DS, AND THAT A OPY OF THIS RECORD HAS BEEN
OVI D TO THE WEL NER.
d. TOP OF CASING IS FT. Above Land Surface' 1
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.,x. 1 SIGN URE O CERTIF WELL CONTRACTOR DATE
e. YIELD (gprn): 7 ET D OF TEST t (0 Brian Lilie
f DISINFECTION: Type 0-1p Amount Jy PRINTED NAME—OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW -1a
1617 Mail Service Center, Raleigh, INC 27699-161, Phone: (919) 807-6300 Rev. 2/09