1277 Underpass Rd�
Davie County, NC ,
Tax Parcel Rennrt
Wednesdav, October 12, 2016
WAK1VllVCT: '1'ttl� l, IVU'1' A �UKVL�' Y
Parcel Information
Parcel Number: F80000014003A Township: Shady Grove
NCPIN Number: 5881108815 Municipality:
Account Number: 6572000 Census Tract: 37059-803
Listed Owner 1: BERRIER LINDA H Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 1266 NC HIGHWAY 801 SOUTH Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag. District:
Legal 79.750 AC UNDERPASS RD(75.240
Description: AC)
Assessed Acreage: 75.24
Deed Date: 4/1993
Deed Book / Page: 001670892
Plat Book: 11
Plat Page: 381
Building Value:
Land Value:
Total Assessed Value:
37240.00
519180.00
150800.00
°"�'�' Davie County,
°o� NC
Fire Response District:
ADVANCE
No
Elementary School Zone: SHADY GROVE
Middle Schooi Zone: WILLIAM ELLIS
Soil Types: SeB,PaD,ApB,WeC,Gn62,GnC2,PcC2,GaD,ChA,RwA,WATER
Flood Zone:
Watershed Overlay: DAVIE COUNTY
Outbuilding & Extra 2p4g0.00
Freatures Value:
Total Market Value: 576900.00
411 data Ic provided as Is without warra�rty or guaraMee ot any Idnd efther exprcssed or Impiled Including but not IimRed to the
mplfed warraMiea of inerchaMabilfty or fitness fw a pardcular use. All users oT Dav(e County's GIS webslte ahall hold humlesa the
�ouMy of DaWe, North Carolina, its ageMs, conwt[a�rts, contractors or employees irom any and all dafms or causes of aedon due tc
�r aAsing out of the use or Inabfllty to use tfie GIS data provided by this website
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"�" _ - -• DAVIE COUNTY HEALTH DEPARTMENT
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a �� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '
*NOTE: 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
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Subdivision Name � ?� Lot No. Sec.�or Block No.
Lot Size House Mobile Home �!� Business __ Speculation
No. Bedrooms , __ No. Baths — t\', _ No. in Family �J _.
Garbage Disposal YES ❑ NO�� Specifications for System:
Auto Dish Washer YES [i,�' NO p ,r,-, �, �; ' - `` . �
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Auto Wash Machine YES � NO ❑ - , .^� 1�
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Type Water Supply ___ -
"This permit Void if sewage system described belo is not installed within 36 months from date of issue.
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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:
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System Installed by - `�-�' � > �r.� r.i�; �'
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Certificate of Completion �- _=� '�'1� `���� Date Y� - �", " , _r
"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.
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, ..��. � �;•. - DAVIE COUNTY HEALTH DEPARTMENT .
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s , � . � IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION '
"NOTE: 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 �, A Q��i �- ,�. A���� � �,1"'�' Date �o � 4C - �� `�' r ���t��
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Subdivision Name � ,Z?? �t1��,1�:�_Lot No. _ Sec�or Block.Noti-; J
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� Lot Size . House Mobile Home +�._ Business Speculation
No. Bedrooms ?� No:Baths �, No. in Family 7' _
Garbage Disposal, YES �❑ NO �
Auto Dish Washer �YES� p� NO p S��f4Ut'�o� for System: . ^ h�
Auto Wash Machine •. YES � NO fl , . ��� ��'�c �1► � �� �
Type Water Supply. \ ►� •,4�Q _ _ � c�u �C : X �� .
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'This permit Void if sewage;system described belo is n t installed within 36 months from date of issue.
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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 �'.-�-�.�- �,•�-.w�.�or
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Certificate of Completion � • � Date - � ' Q�
'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. ,
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.• APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department r�.,�
Environmental Health Section ��"�` \
P. 0. Box 665 � �� �
Mocksville, N.C. 27028 �
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requested By
2. Address��
3. Property Owner if Different than Above ����'s�=' N�--�'�f`'��'.J1
Address
4. Permit To: a) Install
b) Privy_
Alter Repair
Conventional Other Type
Ground Absorption
Home Phone �� �' � � � �
Business Phone
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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. a) If house or mobile home, state size of home and number of rooms.
House Dimensions SL�K � �
Bed Rooms�— Bath Rooms a 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 ✓ urinals garbage disposal
lavatory ✓ showers ✓, washino 'ne ✓
dishwas e � ✓ sinks b�
8. a) Type water supply: Public Private—� Community
b) Has the water supply system been approved? Yes No �
9. a) Property Dimensions
J 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.
�t r� � �, � � R � � �x -e � s� —�-
Date wner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD (6-82)
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE PECEIVED
1.v�ci�-�S� �c! � �d r�cc7-�c� (office use only)
yes no 1. I am the owr�er of thE above described property.
yes no 2. I am not the owner of the above described property, however, I certify that I
have consent from �,_n P��---+���r�� , 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. I hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above describe� property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
DCHD (11 /84�
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DATE
/i�� . �. _/��� /,.� _/'
4. I 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
�
DATE SIGNATURE
. . •�' ' DAVIE COUNTY HEALTH DEPARTMENT
L Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
, SOIL/SITE EVALUATION
Name—
Address
1) Topography/Landscape Position
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
3) Soil Structure (12-36 in.)
Clayey Soils
4) Soit Depth (inches)
5) Soil Drainage: internal
External
6) Restrictive Horizons
7) Available Space
8) Other (Specify)
9) Site Classification
U—UNSUITABLE
Recommendations/Comments:
PS
PS
S:
. <PS
UJ
PS
U
PS
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U
S
PS
S—SUITAB
ARE�
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U
S
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U
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U
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U
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U
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U
S
PS
P
Date � � ^ ��
Lot Size
S
US
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
US
S
US
S
PS
U
ionaily Suitable
AREA 4
S
US
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
� � G���s� Date � – � � C57
Described by _ Title
SITE DIAGRAM
DCHD (6-82)