284 Pleasant Acre Drive Lots 96-97Davie Countv. NC
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Thursday, November 3, 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:
WARNING: THIS 15 NOTA SURVEY
Voluntary Ag. District:
Parcel Information
LOTS 96-97 PLEASANT ACRE
M5120A0006 Township:
Jerusalem
5745875671 Municipality:
Elementary School Zone:
82513021 Census Tract:
37059-807
COFFEY BRIAN M Voting Precinct:
JERUSALEM
143 CANTON ROAD Planning Jurisdiction:
Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -8,R-20
NC Zoning Overlay:
DAVIE COUNTY CZOD
Land Value:
Total Assessed Value:
27006-7865
Voluntary Ag. District:
No
LOTS 96-97 PLEASANT ACRE
Fire Response District:
JERUSALEM
0.78
Elementary School Zone:
COOLEEMEE
12/2007
Middle School Zone:
SOUTH DAVIE
007400153
Soil Types:
PcC2,CeB2
0006
Flood Zone:
011
Watershed Overlay:
DAVIE COUNTY
92210.00
Outbuilding 8r Extra
3280.00
Freatures Value:
21000.00
Total Market Value:
116490.00
116490.00
E61
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-�' DAVIE COUNTY HEALTH DEPARTMENT
` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With rtic)e II o�.G.S. Chapter 130a
_Sanitary Sewage System �+.�aJ r� Permit Number
Name Q4 d � `'` ti' i/� Date N2 5989
Location/ "'FP r.'
Subdivision Name T Lot No. �� "' Se Block No.
Lot Size ��� X` House— Mobile Home _ Business — Speculation
No. Bedrooms No. Baths __ No. in Family
—
Garbage Disposal YES ❑ NO [� Specifications for System:
Auto Dish Washer YES NO ❑��� -,`� �;4�
Auto Wash Machine YES NO ❑ U
Type Water Supply r 4 4h __L_
X3�'1,
*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 -inter ed use change.
Improvements permit by
'Contact a representative of the Davie County Health Department for fi al inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone NymbTr: 704-634-5985.
Final Installation Diagram:
156
InstAlled by
'SD
Certificate of Completion ,2�� 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.
x-11 'fO APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
lot P. 0. Box 665
Mocksville, NC 27028
1. Application/ Permit Requested By YO-'?
Mailing Address A4, evvlee"ee if,-,
Home Phone �-W—g5-ov`L Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: lC) General Evaluation ff"S/Tank Installation
5. System to Serve: '[House Mobile Home (] Business
L Industry Other 0 Unknown
6.
If house, mobile home: Subdivision
No. of People 3
No. of Bedrooms 3
No. of Bathrooms /
'Washing Machine
Sec. Lot#
Dwelling Dimensions /ODS so.
Basement/Plumbing
Basement/No Plumbing
J Dishwasher 0 Garbage Disposal
7. If business, industry, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of
No. of
No. of
Sinks
Urinals
Water Coolers
S. Type of water supply: Public 0 Private Q Community
9. Property Dimensions to Taal
10. Sewage Disposal Contractor
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? o Yes B/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
best of my knowledge, and I
charges incurred from this
S -/ �- - 9D
information provided is_correct to the
understand I am responsible for all
application.
4':- -
Date nn / Signature
(ov l $d,,fi`i Qleary� Ao let
Directions to Property:
DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
�J
Name__ Akl//e11'o t' �� �✓ C I�/S i✓�i ' ��2{, d/9n (lei :vim Date y///Aw
Address Lot Size /65 1",0
FAr.Tr1RC ARFA i APPA 7 ARFA :1 ARCA A
1) Topography/ Landscape Position
&)
S
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q
S
U
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
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S
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S
U
U
3) Soil Structure (12-36 in.)
Clayey Soils
S
'�
S
eio)
S
c�
U
U
U
U
1) Soil Depth (inches)
S
U
i) Soil Drainage: Internal
S
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S-�
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C
U
U
External
AS
PS
IIJJ
U
U
1) Restrictive Horizons
Available Space
PS
PS
PS
PS
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U/
/TUU
9) Site Classification
U—UNSUITABLE
Recommendations/Comments:
S—SUITABLE PS -Provisionally Suitable
Described by -� ��� �� Title �' Date —IZx
SITE DIAGRAM
t9D
A
OCHD (6-82)
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Form rliA -N(. 424-2
(i-45;•71)
UNITED STATES DEPARTMENT OF AGRICULTURE
Farmers Home Administration
PROPOSED INSTALLATION OF INDIVIDUAL SEWAGE -DISPOSAL AND/OR WATER SUPPLY SYSTEM
Name of Property Owner
Property Address
(If this property is in a development, give lot no. and block no.
Number of bedrooms proposed �e Approximate area of lot square feet.
House is to be set back feet from the boundary. I propose to construct on
the above -captioned property an individual type sewage -disposal system
well .This installation will be constructed so as to meet allt:�e require-
ments of the local Health Department and the State Board of Health.
WELL:
Site location approved by Health Department ( ) yes ( ) no.
Type Size of storage tank
(Drilled, r -Nen, Bored, Dug)
Make: Type and capacity pumps
Septic system to be installed to accommodate: Garbage Grinder ( ) yea (e) no
Washing Machine (p'yes ( ) no
Date:
(Signature of PropertyOwner)
SEPTIC TANK: Working capacity ZIN gallons
NOTE: If tank has not been specifically approved by the State Board of Health,
submit plans and specifications.
PERCOLATION TEST RESULTS (If considered necessary by local Health Department)
Hole No. 1-2— 3-4—(Minutes per inch of fall)
SUBSURFACE ABSORPTION FIELD
No. of nitrification linessE_; total length-&?e(Lfeet; width inches;
total nitrification lines bottom areaLaquare feet.
A representative of the d.` Health Department has
inspected this site and finds it suite a unsuitable for the
proposed installation.
Well Site Location Approved by Health Uepartment ( ) yes ( ) no.
Date: (Signature) &L&-zags�=
(Title) '4FA/et ,x...1144 , C;2 e"",
If there i:, any pertinent information which the Health Department desires to convey
to the reviewing officials, which is not covered above, use the back of this
application.
Return ori.;inal and one copy to Farmers Home Administration County Office.
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