111 Jordan Lane Lot 10Davie County, NC '
Tax Parcel Report
Tuesday, January 10, 2017
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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:
WARNING: THIS IS NOT A SURVEY
Parcel Information
E8060B0003 Township: Shady Grove
5881051550 Municipality:
82520180 Census Tract: 37059-803
LEINBACH MARK L Voting Precinct: EAST SHADY GROVE
111 JORDAN LANE Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R-20
NC Zoning Overlay:
27006-7605 Voluntary Ag. District:
LOT 10 GREENWOOD LAKES Fire Response District:
Land Value:
Total Assessed Value:
Davie County,
NC
0.84 Elementary School Zone:
2/2003 Middle School Zone:
004650595 Soil Types:
0003 Flood Zone:
053 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
ADVANCE
SHADY GROVE
WILLIAM ELLIS
GnB2,GnC2
DAVIE COUNTY
No
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• DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name L19,/ Date` �/� G. O I I
Location
Subdivision Name."� % '. ,tet,, .icy j='" r Lot No. f Sec. or Block No.
Lot Size House !' Mobile Home _ Business Speculation
No. Bedrooms �� No. Baths No. in Family
Garbage Disposal YES ❑ NO p Specifications for System:
Auto Dish Washer YES p NO ❑
Auto Wash Ma:hine YES 0` NO ❑ �r� -k,,-,� J��j✓ � ���5/r J /
Type Water Supply
*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. \
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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
' /.V� «� L�� �� r
OP
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Certificate of Completionlit
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.
Y e- I f tt (' �- ,
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
'•. �. ' Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mockaville, NC 27028 /
1. Application/Permit Requested ByJ'tA
0r-
Mailing Addressl �� �!-.�` y I � b i7r��/0Y+ elry 4/'C-7DLz
Home Phone /%�79� ��% i Business Phone �G rm Pi
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation S/Tank Installation
5. System to Serve:House
n
Mobile Home
0 Business
LL3 Industry
u
Other
0 Unknown
If
Subdivision
(n�
amen
6. house, mobile
home:
W0t/4'
Sec. Lotic ,
No. of People
Dwelling
Dimensions _ T 2
)eq
No. of Bedrooms��
Basement/Plumbing
No. of Bathrooms��
_
Basement/No Plumbing
(41 Washing Machine
J Dishwasher
0 Garbage Disposai
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
8. Type of water supply: Public
9. Property Dimensions C
10. Sewage Disposal Contractor
No. of Sinks
No. of Urinals
No. of Water Coolers
0 Private
C) Community
11. Do you anticipate additions/expansions of the facility this system 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.
This is to certify that the information provided is correct to ttie
best of my knowledge, and I understand I am responsible for all
charges incurred from this applica on. �
7-1i -qd
Date Signatu e
Directions to Property:
DCHD (10-89)
i
DATE
NAME
LOCATION
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
FINDINGS: HOLE NO. COIRIENTS
(hl 1. 's.UZI �.7 �.y
3.
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LOT DIAGRAI
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tadvc���('e, NC a;oot�
DAVIE COUNTY HEALTH DEPARTMENT
SITE EVALUATION CONSENT FORM
INSTRUCTIONS/PREREQUISTES
1. Complete the form below and return it to the Davie Co. Health Department.
2. Along with the form, remit the amount due as shown on enclosed statement.
3. Carefully follow the procedures as outlined in the enclosed "Information
Bulletin".
4. Notify Health Department upon completion of item number 3.
NOTE: ALL THE ABOVE MUST BE DONE BEFORE A SANITARIAN WILL BE ABLE
TO BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETUR14 TO THE(DAVIE COUIITY HEALTH DEPARTHIENT,P.O. BOX 9T)
(MOCKSVILLE, N.C. 27028)
DAVIE COUNTY HEALTH DEPARTMENT
SITE EVALUATION CONSENT FORPI
LOCATIUN OF PROPERTY: orreeN wi6cl lakes - AA 410
I_o{ Size — alas x1url Take Ut,3, ass RJ. Trom 4LU1.841
a+5 x 155 -b River Rd. -i -1 v r.r.► \e�-+ — Cro
ouP(�cox�ma{e\� ''}mile +-e 'IS
�(kC w ow C'Or mer or, (ever Rd. 4 SordaN 1 aN e
DATE RECEIVED
(office use 6nly)
yes no, (1.) I am the owner of the above described property.
J7✓�
yes no (2.) I am not the owner of the above described property, however, I
certify that I have consent from Th kel,owner to
i`' 1 1D owner's Iname
obtain a site evaluation by the Health Department for the purpose
of determining the suitability for a ground absorption sewage
disposal system.
yes no (3.) I hereby give consent to the authorized representative of the
`` Davie County Health Department to enter upon the above described
property and conduct all testing procedures necessary to
determine its suitability for a ground absorption sewage
disposal system.
.� I Wo
DATE
SIGNATURE
(4.) I hereby authorize the Davie County Health Department to release
site evaluation results from the above described property to the
following:
CUs 1
n
DATE
SIGNATURE
[I Owner Only
Owner's designated representative
Anyone requesting results
�`{ Only those listed below
Richard Poindexter
P. 0. Box 168
Advance, NC 27006
Davie County NealK De arfinent
and
en
.dome .�fealtfi 9 cy
210 HOSPITAL STREET I P.O. BOX 668
MOCKSVILLE. N.C. 27028
PHONE: (704) 634-5988
July 23, 1990
Re: Site Evaluation
Greenwood Lakes - Lot 10
Dear Mr. Poindexter:
On July 20, 1990, as you requested a representative from this office
visited the above mentioned site. The soil was found provisionally suitable
for the installation of a ground absorption sewage system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure
- - DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME 2Z,2 'Z c/ DATE EVALUATED 7- IG - IaP - % 96 , 00.q
ADDRESS
PROPOSED FACIILTY
Z� PROPERTY SIZE
3 LOCATION OF SITE
�c
Water Supply: On -Site Well Community Public G�
Evaluation By: Auger Boring ✓ Pit Cut
FACTORS I
2 3 4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
5-2-
LConsistence
Consistence
Structure
Mineralogy
HORIZON II DEPTH
.t e- -Ilk r t 8 �-
Texture group
Consistence
Structure
/ b
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
a d
SITE CLASSIFICATION: EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESE T:
REMARKS: .S S /''°1 �✓ �/ �� r 7— / .✓
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
Texture
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
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-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineraloity
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)
Soil wetness - Inches from land surface to free water 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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