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174 Peaceful Valley Rd3avie County, NC Tax Parcel Report Friday, October 7, 201 f 3i2 ♦. 1. ,. {� 182 "-"e \ 174t .. S 292 0 158 �/ _ ................... ....................................................................... ................ .--------------- .........................1........., .............. .,.............. ............_........ _....._. WARNING: THIS IS NOT A SURVEY } Parcel Information Parcel Number: B700000034 Township: Farmington NCPIN Number: 5863374420 Municipality: Account Number: 80512000 Census Tract: 37059-802 Listed Owner 1: WISHON RONDA G Voting Precinct: FARMINGTON Mailing Address 1: 397 GRIFFITH ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006-0000 Voluntary Ag. District: Legal Description: 1.350 AC PEACEFUL VALLEY Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 1.33 Elementary School Zone 3/2004 i Middle School Zone: 005370909 Soil Types: Flood Zone: Watershed Overlay: 25620.00 Outbuilding & Extra Freatures Value: 14030.00 Total Market Value: 42350.00 FARMINGTON PINEBROOK NORTH DAVIE WeB,RnC,RnD DAVIE COUNTY 2700.00 42350.00 No 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 UvS NNC 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)751-8760/ Fax (336)751-8786 WELL PERMIT Account #: 990005072 Tax PIN/EH #: 5863 -37 -4420 -Well Billed To: Ronda Griffith Wishon Subdivision Info: Reference Name: Location/Address: 174 Peaceful Valley Road -27006 Proposed Facility: Residential -Well Property Size: 1.33 Acre ATC Number: 0028 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 E?r Repair ❑ Abandonment ❑ Proposed Well Location Diagramll F- QKd�' © SS Comments: py LJ -5f 0-bcl 14J i EHS: D. W.P. 7-08 Certificate of Completion Diagram NNW 4. On Driller: v Certification #: �9U/ Grout Inspected: Well Head Inspected: (-) GPS Coordinates: EHS: Date: TION FOR PRIVATE WELL PERMIT Davie County Environmental Health P.O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name to be Billed i1 o/y jD.-q LJ j51fo/V^ Contact Person Billing Address ­�S91y CL:(:( Home Phone City/State/ZIP A-nyj,3-Nc I- /V C- 2.7 c211r Business Phone -7, 3Gr - f/ 7 - V'772 Name on Permit if Different thanAbove Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plot or s'te plan must ccompany this application. Included: ❑ Site Plan ❑Plat (to scale) Owner's Name % ) \tv Phone Number_ "� (, I i =� %2 Owner's Address 3(" - 'G ) -6b l- tW City/State/Zip &rgkhiv c c-" &c 7 zer-)L Property Address 7 L� Uc -(? �- city- ( t: / Lot Size <-:� -«ice �p � /. X346 Tax PIN# 5 - % 2 D Subdivision Name(if applicable) Section/Lot# Directions To Site: -�-- �') .. 5�+2 SS r (,l DEVELOPMENT INFORMATION Permit Type: New Well X Well Repair Well Abandonment Other (specify) Facility Type: Residential -\< Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO Do You Intend To Install A New Septic System On This Site? YES 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 corners. 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 determine the best location for a well. Signed 7/1/08 -�� Date Site Revisit Charge Datc(s): Client Notification Date: EHS: Account # D'72 Invoice 4 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? _,/l/ Is There a 4" Pad? _ t� Is There a Hose Bibb? What is the Casing Height? �_ Is There any Grout Settlement? What is the Static Water Level? ft. What is the Yield? GPM Is the Well Contractor ID Plate Complete? _ Is the Pump Installer ID Complete? Contractor Name: 4 f i ' Pump Installer Na e: Contractor Certification #: �2W Date Inst Iled- Depth of Well: Depth of mp Intake: rr �� Casing Depth and Inside Diameter: lD Pump Horsepower Rating: Screened Intervals: N Opening for Piping & Wiring >_12": Packing Intervals (Sand Packed Wells): Yield in GPM or GPM/ft.-dd: Static Water Level and Date Measured: Date Well Completed: Well Head Inspection Date: a #11200 0 EHS ID: Construction Completed Date: Contractor Reports Received Date: Sample Date: Results Mailed Date: Certificate of Completion Date: Authorized Agent: "DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Q 6 Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ Name: (�t4t7,p, i �� r � l � . �. j r Phone Number: , ' �r .`=� c' %-~�' (Home). Mailing Address: `�i -1 ,I !_� ►1,r_(� '�= (_o i) �/ % 7- - (Work) Detailed Directions To Site ` ��°/ � � „ -� `�t > E X S n 2f / '" �l Please Fill In The Following Information About The Existing Dwelling: f a Name System Installed Under�)?'l.rrk ! �;r i �> �' f -t 1C 1 t;"f� Type Of Dwelling: 114 ;k ,�/c 1 �_A c ? Date System Installed(Month/Day/Year): Number Of Bedrooms:) Number Of People: 2 - Is The Dwelling Currently Vacant? YeSZ,, No ❑ If Yes, For How Long? L4 -- i, a�12 Any Known Problems? Yes ❑ No 1q If Yes, Explain: Please Fill In The Following Information About The New Dwelling: Type Of Dwelling: i-v_e ` i i. e (A Number Of Bedrooms: `^� Number Of People: r �6 Requested By: t J —Date Requested: ­4 ) 2-, 1 03 (Signature) For Environmental Health Office Use Only Approved air Disapproved ❑ Comments: /( fi/';1 14, 01(/ :!� � r r Environmental Health Specialistr!' %�'� ''� Cf''�!'% ' f•� �. - -' Date f 'Me 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 ❑ # f l w 0 Amount:, $ % <%' . /) iI Date: r 4 Paid By: Fid>r) o o3 ��J i s ,/wl %' � Received By: V// � ` Ay,' G 1 ( Account #: �0 / 1_- Invoice #: �t`l