258 Shallowbrook Dr Lot 41 Davie County,NC Tax Parcel Report Tuesday,November 22,2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: E6040AD009 Township: Farmington
NCPIN Number: 5861086215 Municipality:
Account Number: Census Tract: 37059-802
Listed Owner 1: Voting Precinct: SMITH GROVE
Mailing Address 1: Planning Jurisdiction: Davie County
City: Zoning Class: DAME COUNTY R-20
State: Zoning Overlay: DAVIE COUNTY QD
Zip Code: Voluntary Ag.District: No
Legal Description: LOT 41 COUNTRY COVE Fire Response District: SMITH GROVE
Assessed Acreage: 0.62 Elementary School Zone: PINEBROOK
Deed Date: 1/1979 Middle School Zone: NORTH DAVIE
Deed Book/Page: 001070074 Soil Types: En13,MsC
Plat Book: 0005 Flood Zone:
Plat Page: 012 Watershed Overlay: DAVIE COUNTY
Building Value: 99950.00 Outbuilding&Extra 1690.00
Freatures Value:
Land Value: 30000.00 Total Market Value: 131640.00
Total Assessed Value: 131640.00
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l data Is provided as Is without warranty or guarantee of any Idnd 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
County of Davie,North Carolina,Its agents,consultants,contractors or employeesfromanyandagdaimsorcausesofactiondueto
NC or arising out of the use or Inability to use the GIS data provided by this website.
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yAUTHQRIZATIO 'NO: ` �, ,� 'DAVIE COUNTY HEALTH DEPARTMENT/, �
Environmental Health Section :. „ PROPERTY INFORMATION
Permittee's�`�, P.O.Box'848
Name: ���= �~- - M�% Mocksville,NC 27028 Subdivision Name: _-1 j1 C_Y �L+tSi
Phone#,336-751-8760 .,.
Directions to property: Section:—' Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION Z�
RoadName:�11�i�t uy1 %1CZip
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building-Permits.This Forin/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 l f G.S.Chapter 130A.Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIR6 EALTWSPEL`IAl\IST ATE,SSUED
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r�DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY R
_ INFORMATION
Permittee=s- ' ,
Name:+ Subdivision Name.
Directions to property: Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:# _
# ! 1 ) Road Name:
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In,compliance with Article 1 I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
r......,, .' / ` £Y PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
-_"ENVIROE AI; SSU
HEALTH SPECIALIST ATE IED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE o 0 #BEDROOMS_ #BATHS 2—#OCCUPANTS�' GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE 84Z TYPE WATER SUPPLY V DESIGN WASTEWATER FLOW(GPD),_ NEW SITE 1 REPAIR SITE
T- ' ,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCWWIDTH ROCK DEPTH 24 LINEAR FT. _
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: 4`.-+ I t J FC-
IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BELOW FINISHED GRADE
P1.-A C14-
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fa►�S ���► *^A�r tJ t%��.
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OF SVST,..M-- f
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**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 THE DAY OF INSTALLATION.TELEPHONE#IS(704)63A--$M9xXXX
OPERATION PERMIT �i I. �,`J
SYSTEM INSTALLED BY:
'hs �►-�ca-J .
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AUTHORIZATION NO. I Q OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATETHAT THE STEM DESCRIBE VE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL.IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised) �; t
'W ,jy Yy^,ryi F ..;,� � pi 'LM P�'"� f':'.L = r`�� 'Y+ 'mow E^� � may. 'ii r-��'" v y ...;.' :- q r•. t,;. t' ..
- "•� r ' ►;; '. y ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION --
Per:mi-tee=s
Name: k. { Subdivision Name:
Directions to property: Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
t * ' Road Name:
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the ;
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
+ ;a ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL'HEALTH SPECIALIST DATE tSSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
{ 1 I INSTALLING THE SYSTEM.
"RESIDENTIAL SPECIFICATION:BUILDING TYPE O #BEDROOMS_4�_#BATHS #OCCUPANTS GAkBA6E DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No ,-
LOT fZE TYPE WATER SUPPLY,:+ ; DESIGN WASTEWATER FLOW(GPD)"" 0 NEW SITE REPAIR SITE �k
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. 'TRENCH'WIDTH 6P I ROCK DEPTH G LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: �^^+*-t►�' I ` C + (- '^O
IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BFI OU FINIStiED GRADE* 4
R
ta
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**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 THE DAY OF INSTALLATION.TELEPHONE#IS(704)6 �
�}�J7:�#.0 YXXXM
122 1751-P_7&e
OPERATION PERMIT
- SYSTEM INSTALLED BY: "���-`Q-'�A� `���
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AUTHORIZATION NO. L OPERATION PERMIT CBY:Zj9?1DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT STEM DESCRIBE VE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY.GIVEN PERIOD OF TIME.
DCHD 05/96(Revised) "+
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME �t5 r � PHONE NUMBER
ADDRESS 7Z-� sl.�Qa.�-o1�P�cao�� 'OP- SUBDIVISION NAME
(\)C_ 'Z'1 oD LOT#
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED " NAME SYSTEM INSTALLED UNDER
TYPE FACILITYNUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY C00r►Ty SPECIFY PROBLEM OCCURRING
DATE REQUESTED �-� is )&D INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge a d that I understand I am responsible for all charges incurred from this application.
f
SIGNATURE OF OWNER OR AUTHORIZED AGENT r
Rev.1/93
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION �.
`NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c !
Sewage Treatment Jand Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
- /%...• �- j �, jr:- n fir*, 4 �
Name �.�� Date
a r s
Location C —
Subdivision Name Lot No. "��f Sec. or Block No.
Lot Size ln)y�7 ?- � House Mobile Home _ Business __ Speculation
No. Bedrooms �-..fi No. Baths --_ No. in Family _
Garbage Disposal YES ❑ NO g--
Specifications for System:
Auto Dish Washer YES ` NO ❑ �� s"= �� �i _ )
Auto Wash Machine YES NO ❑ `' "` '� ` /�
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
-- - _
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;,.� �(/�K2?L�L/�Y1�
• ltlCW
t
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.
.� •4..., •••ewEa..d..yy.W .:..:..1.a.r'JR`'�YANPtj. .r�.- 7.j'fr[}A K ,..,!`•J .O. V:4+..r .-, s as . ..Yl .. .. ,:uh`.e1 d. , ,: .. ... - ..
n ,DAVIE COUNTY HEALTH DEPARTMENT
•';,'_. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION I
*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
Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size ,%`.° L62- House ;/ Mobile Home — Business Speculation
No. Bedrooms = No. Baths No. in Family S�
Garbage Disposal YES ❑ NO ❑'" Specifications for System:
Auto Dish Washer YES - NO ❑ ,, ��, ) �i _�;l ..y,
Auto Wash Machine YES NO ❑ 25/
-
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit b
*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, ✓z1124/�,'
i
1 J`4cJ
r.
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 HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
-3 'a U
(Ground Absorption Sewage Disposal System - .G.S. Chapter 130-Article 13C)
OW14ER OR CONTRACTOR ?C N l��l.lr�rC DATE O / 7 76�' PERMIT r-�
LOCATIONS k .,; - '� ,T.r�, ('�..,C~ N� 1761
-- — --
S.R. NO.
SUBDIVISION NAME E.;.�. r (`t�tiJ C... LOT NO. U 1 SECTION OR BLOCK NO.
HOUSE Mt MOBILE HOME E3 BUSINESS [:J .
N0. BEDROOMS NO. BATHROOMS L House ,Trailer 800 Gal. 400 Sq. Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO Three Bedroom House900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q` NO ❑ Four. Bedroom House 1000 Gal.. 1200 Sq. Ft.
AUTO. WASH. MACHINE YESQ,,,�r NO ❑ e c 1,4 .,�,c.
SITE SUITABLE YES LJ NO ❑ "'"
SIZE OF TANK gal. e}� ��l ec C. .
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public (� `' "`'7/
IMPROVEMENTS PERMIT BY T;.0 y",+'"'�t�.....o��s INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) , *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT /l� �
P. 0. BOX 57 �/
MOCKSVILLE, N. C . 27028
i (704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations'
NAME Jjfn ( �,1cJrc.cs DATE ISSUED f1
ADDRE-SS �,�_ }} PERMIT N0,
MUcl'sj, lie- 24Au
Explanation of charge (_1A 4Q
�4
AMOUNT DUE /S, SANITARIAN
`PLEASE REMIT',THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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