157 Brier Creek Road Lots 48,49,50, & 51a
Davie County NO t
Tnv Anrnn1 i? ---t
Tuesday, January 3, 2017
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:
WA CINUNG: `1T IS IS NOTA SURVEY
Parcel Information
H7030A0007 Township: Shady Grove
5769979132 Municipality:
66632220 Census Tract: 37059-804
SMILEY SAMANTHA M Voting Precinct: WEST SHADY GROVE
157 BRIER CREEK ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAME COUNTY R -A
NC Zoning Overlay:
27006-7151 Voluntary Ag. District:
LOT 48 GREEN BRIER ACRES Fire Response District:
0.56 Elementary School Zone:
Land Value:
Total Assessed Value:
6/2015 Middle School Zone:
009920526 Soil Types:
0004 Flood Zone:
172 Watershed Overlay:
Outbuilding 8r Extra
Freatures Value:
Total Market Value:
ADVANCE
SHADY GROVE
WILLIAM ELLIS
GnB2,EnB
DAVIE COUNTY
Va
9 PIS All 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. Ali users of Davie County's GIS website shall hold harmless the
�r
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
7��
nOU N�4 1\ C �� or arising out of the use or Inability to use the GIS data provided by this websha -�—
0
Davie County. NC
Tax PnrrPl R Pnnrt
Tuesday, January 3,'2017
WARNING: THIS IS NOT A SURVEY
Parcel Information
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:
H703OA0006 Township:
5779070151 Municipality:
Shady Grove
66632220 Census Tract: 37059-804
SMILEY SAMANTHA M Voting Precinct: WEST SHADY GROVE
157 BRIER CREEK ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
NC Zoning Overlay:
27006-7151 Voluntary Ag. District:
LOT 49 GREEN BRIER ACRES Fire Response District:
0.79 Elementary School Zone:
Land Value:
Total Assessed Value:
6/2015 Middle School Zone:
009920526 Soil Types:
0004 Flood Zone:
172 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
ADVANCE
SHADY GROVE
WILLIAM ELLIS
GnB2,EnB
DAVIE COUNTY
No
[Davie County,
Cor
All data is prodded as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the.
implied warranties of merchantability or fitness for a particular use. Ali users of Dade County's GIS website shall hold harmless the
County of Dade, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
arising out of the use or inability to use the GIS data prodded by this website
I
Davie County_ NC
Tax- Parr -Al R Pr r%rf
Tuesday. January 3. 2017
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:
VYARNIA is "1MS IS AUT A SURVEY
Parcel Information
H7030A0005 Township: Shady Grove
5779071069 Municipality:
66632220 Census Tract: 37059-804
SMILEY SAMANTHA M Voting Precinct: WEST SHADY GROVE
157 BRIER CREEK ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
NC Zoning Overlay:
27006-7151 Voluntary Ag. District:
LOT 50 GREEN BRIER ACRES Fire Response District:
0.89 Elementary School Zone:
Land Value:
Total Assessed Value:
6/2015 Middle School Zone:
009920526 Soil Types:
0004 Flood Zone:
172 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
ADVANCEi
SHADY GROVE
WILLIAM ELLIS
GnB2,EnB
T-WL*90111 n
IN
All 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 employees from any and all claims or causes of action due to
�pUt3� NC or arising out of the use or Inability to use the GIS data provided by this website.
a
Davie Countv. NC
Tax Parcel Report
Tuesday, January 3, 2017
128 120 � 1
I ti 14 138 1624
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170 I ��
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125
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193
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209 1595 I X
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15-x' I ----- -
156
L-219-219 U)
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
H703OA0004
Township:
Shady Grove
NCPIN Number:
5779072078
Municipality:
No
Account Number:
66632220
Census Tract:
37059-804
Listed Owner 1:
SMILEY SAMANTHA M
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
157 BRIER CREEK ROAD
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-7151
Voluntary Ag. District:
No
Legal Description:
LOT 51 GREEN BRIER ACRES
Fire Response District:
ADVANCE
Assessed Acreage:
1.01
Elementary School Zone:
SHADY GROVE
Deed Date:
6/2015
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009920526
Soil Types:
GnB2,EnB
Plat Book:
0004
Flood Zone:
Plat Page:
172
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
9�AAll data is prodded 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 Dade County s GIS website shall hold harmless the
County of Dade, 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 prodded by this websfte.
AUTHORIZjATION N-0: DAVIE LUNTY HEALTH DEPARTMENT
Environmental Health Section
PROPERTY INFORMATION
Permittei?'%..ww P.O. Box 848
Name: Mocksville, NC 27028 Subdivision Name:
Phone# 336-751-8760
Directions to property: a, Section: Lot: gay—
AUTHORIZATION FOR 17 -:t
WASTEWATER
Xic PIN -V
SYSTEM CONSTRUCTION Tax O
er;Yw . 1- -
Road Name: ZipQ1A
**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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pen -nits. i
(In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
oIS VALID FOR A PERIOD OF FIVE YEARS.
-,
MENTAL HEALTH SPECIALIST DATE ISSUED
**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 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
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
`a t INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS,_ # BATHS S' # OCCUPANTS ' GARBAGE DISPOSAL: Yes or No
COMMERCIALL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE
Z} ` TYPE WATER SUPPL /�Z_ DESIGN WASTEWATER FLOW (GPD) NEW SITE �C X' �t
' REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH —� v-- ROCK DEPTH_ LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
i
IMPROVEMENT PERMIT LAYOUT
�la
"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 (336)751-8760.
OPERATION PERMIT �B
•• /�' �, �j SYSTEM INSTALLED BY: f
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AUTHORIZATION NO. OPERATION PERMIT BY: �� DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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 ;,OUNTY HEALTH DEPARTMENT
TMPROVTMENT AND OPERATION PERMITS PROPERTY INFORMATION
—Permitt
1`1ame:
\,,\ Subdivision Name: . �c
a�3e L
Directions to -property: s
f r- - ' , r'
/ A4 , Section:
Lot:
IMPROVEMENT
/
PERMIT r Tax icg,PIN #'
t er K
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 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
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
`a t INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS,_ # BATHS S' # OCCUPANTS ' GARBAGE DISPOSAL: Yes or No
COMMERCIALL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE
Z} ` TYPE WATER SUPPL /�Z_ DESIGN WASTEWATER FLOW (GPD) NEW SITE �C X' �t
' REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH —� v-- ROCK DEPTH_ LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
i
IMPROVEMENT PERMIT LAYOUT
�la
"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 (336)751-8760.
OPERATION PERMIT �B
•• /�' �, �j SYSTEM INSTALLED BY: f
14 rY'�
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dtk,v6
AUTHORIZATION NO. OPERATION PERMIT BY: �� DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***n-1PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed �/Yj i Contact Person
Mailing Address 7-76 IICL Rome Phone
City/State/ZIP/_.4Qq o, ti r. )bot Business Phone
2. Name on Permit/ATC if Different than Above
Hailing Address
3. Application For: ❑ Site Evaluation
4. System to Service: ZHouse
City/State/Zip
Improvement Permit/ATC ❑ Both
❑ Mobile Home ❑ Business
❑ Industry
# Bathrooms
5. if Residence: # People 13 # Bedrooms 3
i
VDishwasher 0 Garbage Disposal ashing Machine 0 Basement/Plumbing
6. If Business/Industry/Other: Specify type
# Commodes # Showers # Urinals
# People
❑ Other
"asement/No Plumbing
# Sinks
# water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
v. Type of water supply: I County/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes A0
***IMPORTANT*** CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN h1UST BE SUBS II7TED by the client with THIS APPLICATION.
Property Dimensions:6_
W2I?'E DIRECTIO*3S'Lrom Mocksville) to PR""?ERT1f
Tax Office PIN: #
Property Address: Road Name Y.ri ?r
City/Zip 4lyl/G:4Ge
If in a Subdivision provide information, as follows:
Name: 6iveyi,
Section: Z Block: Lot:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health De arty nt
to enter upon above described property located in Davie County and owned byetl-41
to conduct all testing procedures as necessary to determine the site syltability. n
DATE ! �2 7 �� SIGNATVIWE
"i HIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN:
yq
-- ,5,77 - '� r7 G�7
S�--<
Invoice No. 0
Revised DCHD (07/98)
Y, Y APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM o 22 I
I h Department ill
l D
Davie County Heat p V 0�%� 2
Environmental Health Section ,( i� t • N 1 e 71'..114TAL HFJ
P. O. Box 665
Mocksville, NC 27028 % 33
S. f �C �' I le�Aa
�y� r rh5 f
1. Application/Permit Requested By
Mailing Address
/Z Home Phone
Business Phone 7L"-)(1-
2. Name on Permit if Different than Above _5,nc 5 /014A/F
3. Application for: General Evaluation d Septic Tank Installation Permit
4. System to Serve: WHouse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ In)aslry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision ` �► rie- r 144' J 11-7-3 Section o6_ Lot #
,EC1 Basement/Plumbing
-No. of People ❑ Basement/No Plumbing
No. of Bedrooms ,
No. of Bathrooms ' ->
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
7. Type of water supply: Public
8. Property Dimensions
Washing Machine
Dishwasher
❑ Garbage Disposal
No. of Sinks ti
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Private
Sewage Disposal Contractoi
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Yes ❑ No
❑ Community
'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directionperty,
This is to certify that the information provided is correct to the best
incurred fro this application.
DATE
— PROPERTIJ INFORMATION REOUIRED:
Tax Office PIN: #
PROPERTY ADDRESS, as follows
Road Name:�ri1-r(,!k-k ,
City: Al Va-Xee-
SU13AIlT A PLAT WITH THIS APPLICATION.
Revisions effective October 1, 1995.
my knowledge, and I understand I am responsible for all charges
'fie ''l --
SIGNATUP�-'tfrr-
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: X 1. 1 OWN the property. ❑ 2. 1 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. , A A „ . / A // ,
DATE
DCHD (1/93)
3 �
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