170 Jarvis Rd 3avie County, NC Tax Parcel Report Friday, September 23, 201 f
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WARNING: THIS IS NOT A SURVEY
Parcel Number: F800000130 Township: Shady Grove
NCPIN Number:' 5880466589 Municipality:
Account Number: 55987250 Census Tract: 37059-803
Listed Owner 1: PEEBLES LAWRENCE B JR Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 170 JARVIS 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: 2.00 AC JARVIS RD Fire Response District: ADVANCE
Assessed Acreage: 1.59 Elementary School Zone: SHADY GROVE
Deed Date: / Middle School Zone: WILLIAM ELLIS
Deed Book/Page: Soil Types: PcB2,PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 47430.00 Outbuilding&Extra 1530.00
Freatures Value:
Land Value: 37090.00 Total Market Value: 86050.00
Total Assessed Value: 86050.00
9l; t� Alldata 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
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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
�ovN c� NC or arising out of the use or Inability to use the GIS data provided by this website.
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Davie County Health Department
Environmental Health Section
�.. D P.O. Box 848
jVE 210 Hospital Street ry
off;.. : �� Courier# : 09-40-06
Mocksville, NC 27028
Phone:(336)-758-6780 Fav:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
-(Check One) Replacement Remodeling Reconnection
Nance{�
Phone Number 3No n b5 ^- g (Home)
: t*�r1C�Q^ - ���CS • -_ - /
Mailing Address: 1 ) J�lJ is Iq C� n/I� (Work)
&ya nCe _N 1 0—• cg nmo Email Address: �}
_ D
-,-DetailedDirections To Site:
' ren. $�,�ver 'ire 0. L- rte_ -�sar N
_--rno
-- _Property Address:J_W. S;&cu($ Aolia ' Ctl� P� iV r C-
_Please Fill.I:n The Following Information About The EXISTING Facility: � L
_ Name System Installed Under.( 1�7 f'C;nC Q P'e_('b 14,,6 Type Of Facility
Date System Installed(Month/Date/Year): )d Number Of Bedrooms: � Number Of People:
Is The.Facility Currently Vacant? Yes._ No if Yes,For How Long?
Any Known Problems? Yes No If Yes,Explain:
Flease Fill In The/F'�ollloowing Information About The NEWFacility:
Type Of Facility: C2 ; fq.. Number Of Bedrooms:—t— —Number of People
pool Size: Garage Size:S0kL15k110 Other:
Requested By: Date Requested: L5 O�b
ignature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist 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:$ Date:
Paid By: Received By:
Account#: 3 bG Invoice#:
fL'1&a01$ ' C 20.d l7
i 'Pastels: • i '
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Deed: -' r'.
foo Buffer
Reference APE
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perty! . Creaite E= red;
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C64 Report Adjvineis ReferenceMINI =' :':Fi '•, '` ,,: 8.
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DAVIE COUNTY HEALTH DEPARTMENT
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems \ Date Permitp L be
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' �•, N Va 1� e t�c e y Q o S�� �� � + i� ����
Name N
ocation
�J 4'.
Subdivision Name Lot No. , Sec. or Block No:
Lot Size House Mobile Home Business __ Speculation
No. Bedrooms No. Baths
the No. in Family _
Garbage Disposal YES Q NO ❑ S ecificatiow for S stem
Auto Dish.Washer YES p, NO ❑ g ' �"
Auto Wash Ma:hive YES [� NOy c,u ' k t x .�1 t PuSA,
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use.change.
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 by
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a
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Certificate of Completion Date 1\
'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 EVALUATION/IMPROVEMENTS PERMIFRECEOVED
Davie County Health Department Environmental Health SectionP. O. Box 665
Mocksville, NC 27028
M.UAL2N NO A
1. Application/Permit Requested
�Byy�
`-1
Mailing Address 1��y % (�w l.(J/ WV/ . �.l 1! l�� 7 VnnC '4?• C - 0 116
Home Phone "� )U4U� Business Phone`-+)'? -ala lUag
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation Septic Tank Installation
4. System to Serve: ❑ House Y Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other. ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
❑ Basement/Plumbing
No.of People 3 ❑ Basement/No Plumbing
No. of Bedrooms 3 Washing Machine
No. of Bathrooms Dishwasher
Dwelling Dimensions Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served .3 No. of Sinks
No. of Commodes No. of Urinals o2
No. of Lavatories No. of Water Coolers
No. of Showers °L Water Usage Figures
7. Type of water supply: /PJ uubllicc� W Private El Community
8. Property Dimensions c /t V l o Sewage Disposal Contractor
9. Do you anticipate additions/expansionof the facility this/s/yltem is intended to serve? NJ Yes ❑ No
If yes,what type? (_+ lam( h Cy'/� ll 1C��Qfl
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property: t!Q C l FO/ ut6 60APCt .JOJa Lan
VIAL JJL &J-a r
ont Mt
1 r v�.-
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from t 's application. P'�'
DATE SIGt#TURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
["anddisposal
CK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
ve consent to the authorized representative of the Davie County Health Department to enter upon above described
cated in Davie County and owned by
all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
al system.0.
4 ?�Ab
-DATE
SIGNATURE
DCHD(12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME DATE EVALUATED
ADDRESS Che PROPERTY SIZE
PROPOSED FACIILTY N tr� LOCATION OF SITE
Water Supply: On-Site Well_ Community Public
Evaluation ByCf-L Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe % �- -
HORIZON I DEPTH �� `► `�
Texture group L
Consistence V V Fri.
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence N IV -a-
Structure
Mineralogy `i
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS - S
RESTRICTIVE HORIZON —
SAPROLITE �-
CLASSIFICATION
LONG-TERM ACCEPTANCE RATEI ► C l
SITE CLASSIFICATION: / ' 11 EVALUATED BY:
LONG-TERM ACCEPTANCE�RAS,TE: , `1' OTHER(S) PRESENT:
REMARKS:
%EGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
Texture
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralo¢y
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD(01-901
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