523 Beauchamp Rd Davie County,NC Tax Parcel Report Friday, December 16, 2016
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WARNING: THIS IS NOT A SURVEY
._� Parcel Information..
Parcel Number: F800000010 Township: Shady Grove
NCPIN Number: 5870688317 Municipality:
Account Number: 51417000 Census Tract: 37059-803
Listed Owner 1::' MOCKS UNITED METHODIST CHURCH Voting Precinct: WEST SHADY GROVE
Mailing Address 1: - 523 BEAUCHAMP ROAD Planning Jurisdiction: Davie County
City: ADVANCE - Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: - 5.282 AC BEAUCHAMP RD '. Fire Response District: ADVANCE
Assessed Acreage: 4.71 Elementary School Zone: SHADY GROVE
Deed Date: - 12/2008 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 007780628 Soil Types: GnB2,GnC2,GaD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
9 A1� All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not I1mlted 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
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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
�'opty4 NC or arising out of the use or Inability to use the GIS data provided by this website.
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1
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
t'`N,QTE-"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 �C,.o� �. �� t,�• �, r, �..� c�� \\ :y L bate 7r ac.
Locationy ",1..
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ' Specifications for System:
Auto Dish WasherYES NO ❑ �� ,._.-
Auto Wash Machine YES 4 NO 'q
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
t
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: System Installed bye "-�%/(
K
Certificate of Completion _ ' - Date
'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.
APPLICATION FOR SITE EVALUAT N/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
R 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUMrr-
\\-9 �-
,-y1 JI/ / Home Phone
1. Permit Requested By / "�o�G _r Business Phone
2. Address f Z 7 0 0 6
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 HomeBusiness
Industry Other
b) Number of people 1/5-D
6. a) If house or mobile home, state size of home and number of rooms.
+fouwDimensions _38 x 97
Bed Rooms Bath Rooms 3 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:
commodes L� urinals Z garbage disposal
lavatory y showers washing machine —'
dishwasher sinks
8. a) Type water supply: Public Private ✓ Community
b) Has the water supply system been approved? Yes W__1 No
9. a) Property Dimensions
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?
What type?
This is to certify that the information is correct to the best of my knowledge.
� W.
�111211aoz e4ue4t- Z���7 'Z';�/
Date Owner gnature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: L4 6�
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
T7�ccsec7�,i.. opt /Yla�lcs C ti���� �- eAC4 4— (office use only)
yes no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that]
have consent from 9114s C'Lr���� ���-�4•.s�/�o , 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 disposal system.
D E 691�–
SIGNATdRE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
Owners designated representative
Anyone requesting results
✓Only those listed below
00,
DATE SIGNATURE
DCHD(11/84)
DAVIE COUNTY HEALTH DEPARTMENT
;.i Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name �`�`\ a =�\� � Qom ` Date ` g
Address Lot Size
FACTORS ARE41 ARE 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
P ' P PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) PS PS PS
U U U
3) Soil Structure (12-36 in.) SS. S S
Clayey Soils & PS PS PS
U U U U
4) Soil Depth (inches) S S S
PS P PS PS
U U U U
5) Soil Drainage: Internal SS S
P;) (Z)
PS -PS PS
U U U U
External S S
PS) PS PS
(U' U U U
6) Restrictive Horizons
7) Available Space \ S S
4 PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
C U U
9) Site Classification S
U-UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title Date
SITE DIAGRAM
DCHD(6.82)