2455 Farmington RdDavie rnunty NC . - ' Tax Parrel Renort - ...! 1( Wednecriav Rpntemhpr 9R 9016
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ParcefInformation"
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 County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
Parcel Number:
B50000008301
Township:
Farmington
NCPIN Number:
5843745929
Municipality:
Account Number:
8303064
Census Tract:
37059-802
Listed Owner 1:
WOOTEN ALLEN G SR
Voting Precinct:
FARMINGTON
Mailing Address 1:
2455 FARMINGTON ROAD
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
.969 AC FARMINGTON RD
Fire Response District:
FARMINGTON
Assessed Acreage:
0.97
Elementary School Zone:
PINEBROOK '
Deed Date:
512015
Middle School Zone:
NORTH DAVIE
Deed Book f Page:
009900240
Soil Types:
GnB2
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
WS -IV -P
Building Value:
107740.00
Outbuilding & Extra
7560.00
Freatures Value:
Land Value:
22380.00
Total Market Value:
137680.00
Total Assessed Value:
137680.00
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Davie County, NC
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 County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
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causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
Davie County Health Department
� � 8r� Environmental Health Section
�^ : P.O. Box 848
1 S„ 0 210 Hospital Street
PCourier # : 09-40-06 1911
O tT ��, r ; , � ocksville, NC 27028
� r�r�J(�l � � Z01'l.
Phone: (336) - 753 - 6780 P ON -SIT STEWATER CERTIFICATION Fax: (336) - 753-1680
BY+--� --
(Check One) Replacement Remodeling Reconnection
Name: M ac wincA Phone Number Im �., -577-30a l (Home)
Mailing Address: tNrM�v'(Work)
�(. L mb, 410-V Email Address: (►¢ �`I AAA (p L•t(l�noO,cC M
Property Address:
Please Fill In The Following Information AbWut The EXISTING Facility:
--� "
Name System Installed Under: ti-CCkN Type Of Facility: �b� *IV ^te�tj�
Date System Installed (Month/Date/Year): t 2 Number Of Bedrooms: Of People:_
Is The Facility Currently Vacant? �Yes� No If Yes, For How Long? I rGt,� r f%
Any Known Problems? Yes [No cif Yes, Explain: j if j
Please Fill In The Following Information About The NEW Facility:
Type Of Facility::\,00 * �\O y'se' Number Of Bedrooms: cQ, Number of People
Pool Size: f` Garage Size: /' Other:
Requested By: (j SLA Date Requested:
(Si atur
(:: F
d Disapproved
omments:
Environmental Health Specialist.
For Environmental Health Office Use Only
Date:
*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 heck Money Order # Amount:$
Paid By:A . I* d 00� Received By:.
Account #: 'M 30 Invoice 4
/%-ipe �t6l-n
Date:
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Davie County Health Department
q Ps I�' Environmental Health Section
P.O. Box 848
210 Hospital Street
O U �'S Courier # : 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION
r (Check One) Replacement Remodeling Reconnection
Fax: (336) - 753-1680
Name: VA Cur W 6 Phone Numbers 3 �3, -:5 75 -2(-!! I(Home)
Mailing Address: f't- n (Work)
Y� G OAI-V i ltT�t�� Email Address: v C, C' .�((�
Detailed Directions To Site: (� , r� ..�; .+ t -� r, A ; I(' \ `i-
Property Address: ��� {- i�� t1�e.,y`�r� f, ��f`1 19Xyrn 1 r 2 A ti
Please Fill4n The Following Infoormation Abut The EXISTING Facility:
l
Name System Installed Under: C( t-C�' Type Of Facility:- �C���`{= \r�rc,�'!� �tI'C'
\
Date System Installed (Month/Date/Year): t ? r SR Number Of Bedrooms: .._'� Number Of People:
:i
Is The Facility Currently Vacant? Gi S No If Yes, For How Long? I r& r : !� '� a / t -n '
Any Known Problems? Yes [No ,If Yes, Explain: /� r
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: \\ CC C k Number Of Bedrooms: Number of People
Pool Size: _,.--''" Garage Size: -- Other:
Requested By: u Date Requested:
(Si atur „
E
For Environmental Health Office Use Only
Approver� Disapproved
-Comments:
Environmental Health SpecialistL( (f r� �. ��(: t) �� %(�; ; (; �: r! Date:
*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 Money Order # Amount:$
Paid By: A , 11V6 0C%f Received By: �
Account #;go
� Invoice #:
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(U Date:
2 D3.,, Df VIE COUNTY HEALTH DEPARTMENT a ; 0 0
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
1
Sewage Treatment and Disposal'Bules (10 NCAC 10A .1934-.1968) Permit Number
Name �-, e �� �. Date t� ���� NO .t
Location, ` \ j \` \ U �;, J ��� GJ_ 1 7•rf :.
Subdivision Name
Lot No.
Sec. or Block No
Lot Size r). House Mobile Home Business Speculation
No. Bedrooms No. Baths _ I No. in Family l_ ►i
Garbage Disposal YES ❑ NO d Specifications for System: _
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES Er NO ❑ -
Type Water Supply r," r7"� �, - .
*This permit Void if sewage system described below is not installed within 36 months 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:
Certificate of Completion Z Date V -!b xc��4
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
1. Permit F
2. Address
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
„JL
Davie County Health Department 2 9e”"
Environmental Health Section ®SEP
P. 0. Box 665 R��E1VE�,
Mocksville, N.C. 27028 G�
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone '7 i -3 O 7s D1 4 yff)
nested By c—"e V -a e- (A ul Business Phone ?1?!" %S�(�,_
Z o X / 33 -J oG,rS1// d z Er
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
Industry Other
b) Number of people �'"
6. aj If house or mobile home, state size of home and number of rooms.
House Dimensions 12- X 6S_
Bed RoomsBath RoomsDen w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hou
7. Number and type of water -using fixtures:
commodes
lavatory
dishwasher
urinals
showers %
sinks 2
8. a) Type water supply: Public ✓ Private Community
b) Has the water supply system been approved? Yes ✓ No
9. a) Property Dimensions ac u -,o,
b) Land area designated to building site '0�9 ��-
c) Sewage Disposal Contractor
garbage disposal
washing machine
10. Do you anticipate any additions or expansions of the facility this sewage system.is intended to serve?
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:
qqY-3673'
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DCHD (6-82)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date 10
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/ Landscape Position
PS
PSS
S
PS
S
PS
U
U
U
U
�) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1Clay)
PS
T
S
PS
S
PS
�
-D
U
U
3) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
cf-APS3
PS
U
PS
U
U
1) Soil Depth (inches)
ep_7;��S
S
S
PS
PS
U
U
U
U
i) Soil Drainage: InternalS
-P%
PS
S
PSC
--S)
PS
U
U
U
ExternalS
`
PS
S
( PS
s
PS
U
U
U
1) Restrictive Horizons
�---_
Available Space
S /
S
PS
S
PS
S
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
1) Site Classification
U—UNSUITABLE S—SUITABLE S—Provi ' ally Suitable
Recommendations /Comments:
� 0
Described by Title S�2: � � t�`T« Date
SITE DIAGRAM I
)CHO (6-82)
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