1134 Yadkin Valley RdDavie Countv. NC
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Tax Parr.Pl RPnnrt
Wednesdav, October 12. 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
WAKNiNG: TlilS 1S NOT A SUKVEY
Parcel Information
B70000007201 Township: Farmington
5863740649 Municipality:
47248000 Census Tract: 37059-802
MARSHALL ANGELA D Voting Precinct: FARMINGTON
1134 YADKIN VALLEY ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNN R-A
NC Zoning Overlay: DAVIE COUNTY QD
27006-0000 Voluntary Ag. District:
2.07 AC YADKIN VALLEY RD Fire Response District:
,�°"�'�' Davie County,
�o— �'� NC
1.95 Elementary School Zone:
1/1992 Middle School Zone:
001620403 Soil Types:
Flood Zone:
Watershed Overlay:
231240.00 Outbuilding 8� Extra
Freatures Value:
45760.00 Total Market Value:
277000.00
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FARMINGTON
PINEBROOK
NORTH DAVIE
ApB,WeC
DAVIE COUNTY
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277000.00
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����• T � - ' DAVIE �COUNTY �HE/1L'TX DEPAR7MENT ��� 'V C� y
�_�� �,e.t' "' r �IIiAPROYEMENTS' PERMIT AND�CERTIF7CATE: OF COMPL'ETION �,
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•'+, �` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
� Davie County Heaith Department /�, l�r��
Environmental Health Section l � �
P. O. Box 665
Mocksville, NC 27028 � ���M � r
1. Application/Permit Requested By
Mailing Address
; _ ,C"� c;�.... `��-;t .,. , �-� ,•,,
Home Phone � r� " � f ; ��i 3 F *`� Business Phone `� � �'�� ' � ��-�� t"
2. Name on Permit if Different than Above f}i <.� ���:'t ��� �� 4''?` �
� "_'"_�,°
3. Application/Permit for: {,�General Evaluation C�eptic Tank Installation
4. System to Serve: �House ❑ Mobile Home
❑ Business ❑ Industry ❑ Other
5. If house, mobile home: Subdivision �i.� � l`�
No. of People f��'
No. of Bedrooms ����
No. of Bathrooms � ` "�.�
Dwelling Dimensions o� � � a n.�b ,�J �;�, �i`� X 3�
❑ Place of Public Assembly
❑ Unknown
� 4
Section �� } Lot # �`:. � �',
❑ BasemenVPlumbing
(�'�BasemenUNo Plumbing
[�IVashing Machine
� ishwasher
❑ Garbage Disposal
� S�,q
6. If business, industry, place of public assembly, other: Specify type ��= t`
No. of People Served
No. of Commodes _
No. of Lavatories _
No. of Showers
�-
No. of Sinks `��
r•
No. of Urinals
No. of Water Coolers _
Water Usage Figures
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7. Type of water supply: �°"Public p Private ❑ Community
8. Property Dimensions � -'��!„t".� F.-�''� Sewage Disposal Contractor �{ F e� ��'� a : : �._'"R G:�t ��. �j:� � � •='.,� �rv � -
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes �No
If yes, what type?
*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.
e t �
Directions to Property: � i� �, ���.t j`�:,,(� r"� ���� t°� � }-�f..�i� �� °" �' ;� (� 1 L�,���G''�'
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This is to certify that the information provided is correct to the best of my knowledge, and I understand t am responsible for all charges
incurred from this application.
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DATE GNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: �1. I OWN the property. ❑ 2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DCHD (12-90)
DATE SIGNATURE
� �._ t '' '�_� �
DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section
Soil/Site Evaluation '
NAME �� DATE EVALUATED �`�L.�°�,
ADDRESS PROPERTY SIZE �r� G
PROPOSED FACIILTY ,������ LOCATION OF SITE _)i� !/. G� �'�r
Water Supply: On-Site Well Community Public ��
Evaluation By: AugerBoring ,/ Pit Cut
FACTORS 1 2 3 4
Landsca e osition L �- L �
Slo e 7. — �
HORIZON I DEPTH � � � � < �' � ��
Texture rou � �'L s'.� r
Consistence
Structure
Mineralo
HORIZON II DEPTH L/�r �r d,yr- /�-
Texture rou i /
Consistence ,1- -� � �
Structure _�' ,c� h ��
Mineralo /,• • / -/ �, - /
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralostv
HORIZON IV DEPTH
Texture qroup
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASS.LFICATION
LONG-TERM ACCEPTANCE RATE ,
SITE CLASSIFICATION:
EVALUATED BY: /7l= �
LONG-TERM ACCEPTANCE RATE: � z/ OTHER(S) PRESENT:
REMARKS•
LEGEND
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
Textnre
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-AnBular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
MineraloltY
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)
5oi1 wetness - Inches from land surface to free watef 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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, DAV�IE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS' PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I of G.S. Chapte 130a
Sanitary Sewage S ste sn �� Permit Number
Name �i//i/ /G /%%/�/..r'�`��/�'f������ � Date �/� �� NO 1 G 7 0
�ocation /9��-�:., �i% c y G2�— - j� �G� • �✓%✓.�i�r� �Jr' -��'� ,��r' ��f� �
l%� �
Gri'��� F�%/�.�'.r - --
�-���
Subdivision Name Lot Na Sec. or Block No.
��
Lot Size
No. Bedrooms �
Garbage Disposal
Auto Dish Washer
Auto Wash Ma^hine
Type Water Supply
House Mobile Home _T Business _— Speculation
_.No. Baths � �� No. in Family � _
YES ❑ NO [� Specifications for System:
YES NO p p�.rX 6 X�' �
YES � NO ❑ �
�'
` ---
'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. �, { �
I - y� � W,�� s
.1--�---'_.._..-----
/�
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Improvements permit by _ �/r �/
'Contact 2 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
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. �.,, ,
�
, . .. .. .' .. �� . .. � .� n � _. � . � . . ,
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� -�= - �� DA1�IE COUNTY HEALTH DEPARTMENT
- :. _
�' -� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
�'NOTE:�Issued in Compliance With Article I I of G.S. Chapter 130a
F_ � � � Sanitary Sewage S�ystems;� � , �%�'��'` ,.y� _ Permit�JV� � �b�e�
. . . .� jr/��/Lf !/����. �*` r f �f / �`�-%�.. d�,V t�- .��•/�,,' �. ...�. . .�;�''_.� � O �
- Name � — Date N� �
. J' , ., ..� / � � r" ..- r� . ���,� .i ' ; ) `.
!. ,�','/i ,. � � ,'./i ,!' , . �"! '' l,;. '/� <� ,.f'. ./i'�/�/��::�..�..+l�.. ,.� � .;r,�. / �.,�r �'✓ tr, C:
Locatio,n �' —
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Subdivision Name Lot No. Sec. or Block No.
��
Lot Size House � Mobile Home _�_ Business _— Speculation
„ ,
�.,�_' ; % �? �-�-
No. Bedrooms No. Baths = No. in Family _
e
Garbage Disposal YES [� NO p S ecifications for, S stem:
R , . , ;- . Y
Auto Dish Washer YES [i]r NO ❑ ,_ . ->+; � -�� :�: �?"
Auto Wash Ma^hine YES p NO ❑
,
Type Water Suppty � ` ___
'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. -y
I�1 F / � � _ M1 � ,
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Improvements permit by
, �" !
i�s`, � � �
'Contact 2 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
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.
�.* �"� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
..
• ` ' APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME �S%� �M� /�1��3'�l i PHONE NUMBER
ADDRESS !G� G� lG� /g� • Z7� °�' SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE 1/,�1r1/l�► v�/�s., /%� •y^`' ,P'�! - �i�s T ��P• i�'d� /� ' .ti• leO� �iFrcL
1faLiW �d�
DATE SYSTEM INSTALLED ��'� Q'1 L NAME SYSTEM INSTALLED UNDER /7ngic aiy*,�,
TYPE FACILITY �� NUMBER BEDROOMS .3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY �"�'� SPECIFY PROBLEM OCCURRING1� '.�.� �� Q- �--
s� 6� �/.�1�,.. ��c�, G�- �H G�� ,,����► z�- -�. w��►�/ y� ��,�....
DATE RE�UESTED P�'�7"9Z- INFORMATION TAKEN BY
This is to certify that the informatlon provided is corcect to the best of my knowledge, and that I understand I am responsible for all charges incurred from this appiication.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93