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122 Hidden Creek Drive Lot 2Davie County, NC 0 Tax Parcel Report Thursday, January 26, 2017 WARNING: THIS IS NOTA SURVEY Parcel Information Parcel Number: E9150A0002 Township: Farmington NCPIN Number: 5871584284 Municipality: BERMUDA RUN Account Number: 19248750 Census Tract: 37059-803 Listed Owner 1: CROUSE LARRY WAYNE Voting Precinct: HILLSDALE Mailing Address 1: 122 HIDDEN CREEK DRIVE Planning Jurisdiction: BERMUDA RUN City: ADVANCE Zoning Class: BERMUDA RUN,DAVIE COUNTY R-20,CR State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC Zoning Overlay: DAVIE COUNTY QD 27006-0000 Voluntary Ag. District: LOT 2 HIDDEN CREEK Fire Response District: ADVANCE 0.84 Elementary School Zone: SHADY GROVE 411991 Middle School Zone: WILLIAM ELLIS 001580905 Soil Types: GnB2 0005 Flood Zone: 179 Watershed Overlay: BERMUDA RUN,DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: No 9 h :rAAll Davie County, NCor data is provided as is withoutwarranty or guarantee of any kind either expressed or Implied Including but not limited to the 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 arising out of the use or Inability to use the GIS data provided by this website. ;Y- DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE,-Jssued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.11968) Permit Number Name '� ,.� %�i. , i h r.L-,t . Date d N. Location Subdivision Name / �� ri � ('n, Lot No. Sec. or Block No Lot Size House 4-1 Mobile Home _ Business Speculation No. Bedrooms- No. Baths No. in Family Garbage Disposal YES p NO p'" Specifications for System; Auto Dish Washer YES r NO Auto Wash Machine YES NO {] Type Water Supply (lit, • �,f G�(' XT A y. *This permit Void if sewage system described below is not insl a the 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 J 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. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 RECEIVED JUL 0,, 6 y99 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. r- �} Home Phone ��h�'�3� 2 1. Permit Requested By B -V 10 Business Phone 2. Address R!t :? 4 D -K '79 -13 C'.l_ 67M 1Y0 D K -)-'c, M - C • 27F1 12 3. Property Owner if Different than Above G(LeUPT VA91 1'7 Ait 4-1 i 6W Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub -Division 1-11D1 E0 (192k Secs Lot No. - 5. System used to serve what type facility: House_i4:::�Mobile Home Business Industry Other b) Number of people `+ 6. ay If house or mobile home, state size of home and number of rooms. House Dimensions 1AL ls;zoESA m(i ?ate 6Af�1Co� Bed Rooms_ Bath Rooms Den w/Closet ✓ b) If Business, Industry or Other, State: Number of persons served What type business, etc. N 1A Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals garbage disposal NO lavatory 3 showerswashing machine V63 dishwasher / sinks �- 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? Yes L,"'No 9. a) Property Dimensions �� /.3DB fRiclf7si6i 2�� yS ��(°�T�/pF �2y�, / ,9Qlp )So' b) Land area designated to building site I 9A 'X Z71-6 c) Sewage Disposal Contractor ICER MAf.�S i3AC�4►�F S�rzist�£ 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? �d What type? 'ri'O a! 1 - This is to certify that the information is co rect to the 00t of my knowledge. c 1111CIRS2z C lUC Date caner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: SO/ Alf -2 .COT ©'�u klov se �,9,4�4 a, -tb cq�, c2v civ ,/-�, y h f DCHD (6-82) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. 0. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above descped property, however, I certify that I have consent from Ze-tr z�,F owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conductall testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. 5? A11,11""J'al—Ap e�le�� ,,�'4ATE IGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: — Owner only Hers designated representative Anyone requesting results — Only those listed below c DA E SIGNATURE URE �tlUM BER sr,QEC ?' WALK .NOT /NCL lJOEO /N CON TRA c_ T n . �4 , / NO SC A6. E E DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name Date Address Lot SizeltX7��f'%��TiY� FACTORS AREA 1 ARFA 9 ARFA R AREA A 1) Topography/ Landscape Position SS S PS S PS U U U U ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay)—t7) S S S PS U U U 3) Soil Structure (12-36 in.) Sc'�> S S S Cla Soils 4,6�„ � PS PS U U U 1) Soil Depth (inches) t .. S ek S PS S PS, U U U i) Soil Drainage: Internal SS S S PS PS U U U External S S S �S c. U PS U PS U i) Restrictive Horizons / Available Space S PS S qF) S PS S PS U U {) Other (Specify) S S S S PS PS PS PS U U U U 1) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: 0 Described by Title Ji% Date AMe-K SITE DIAGRAM 'V6 DCHD (6.82) i VP k �a