125 Springfield Drive Lot 961
Davie County, NC
Tax Parcel R e.nnrt
Wednesday. November 23. 2016
WAKNILN is 11111' 111VV1 A bUKV.LY
Parcel Information
Parcel Number: E8140A0009 Township: Shady Grove
NCPIN Number: 5881130005 Municipality:
Account Number:
Census Tract:
37059-803
Listed Owner 1:
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
Planning Jurisdiction:
Davie County
City:
Zoning Class:
DAVIE COUNTY R -A
State:
Zoning Overlay:
Zip Code:
Voluntary Ag. District:
No
Legal Description:
LOT 9 COUNTRYSIDE
Fire Response District:
ADVANCE
Assessed Acreage:
1.43
Elementary School Zone:
SHADY GROVE
Deed Date:
6/1989
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
001480815
Soil Types:
GnB2
Plat Book:
0005
Flood Zone:
Plat Page:
210
Watershed Overlay:
DAVIE COUNTY
Building Value:
311190.00
Outbuilding & Extra
Freatures Value:
0.00
Land Value:
52500.00
Total Market Value:
363690.00
Total Assessed Value:
363690.00
91 All data is provided as Is wkhout warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, impaled warran as of merchardabllity or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
�o County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
�T
l� C or arising out of the use or Inability to use the GIS data provided by this webslte.
0.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTt: 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 L7 �:_ N ) �� \ SxN 5 to N Date. ' N2
Location t- �, t' �� �; �l s, � _ V)
VA Vi�
Subdivision Name-��=h�a �._'�. Lot No. Sec. or Block No.
Lot Size House Mobile Home_ Business Speculation
No. Bedrooms No. Baths �,r No. in Family_
Garbage Disposal YES ;❑i NO ❑ Specifications for System:
Auto Dish Washer YES [Et/ NO ❑ _.. �. o
Auto Wash Machine YES pJ NO ❑;< 1 r, + �l
I
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
• k � '3
y
Ybk
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
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
R O. Box 665
Mocksville, N.C. 27028
RECE1�� �uN o a �
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
/Home Phone
1. Permit Requested By , ��� �i✓, Z_11A'4,q -so.cJ Business Phone '72 -3- "7/32-
2.
322. Address .51-32_5_ � g2�,._;L "J br -Z7 sA fil A/C,
3. Property Owner if Different than Above _
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Grnd M�'
tion,
c) Sub -Division Sec Lot No.�_
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people % )/✓ o
6. ar If house or mobile home, state size of home and number of rooms.
House Dimensions31XS/_3 .11
Bed Rooms -7 Bath Rooms --Z Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc,
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes C IU6 -- 1-4S eo/ urinals garbage disposal d Ne_
lavatory cONL-- showers_ �'���' washing machine _0 A/ �
dishwasher U�lC,' sinks e_ -✓_j - GcS�
8. a) Type water supply: Public t/ Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions -Z2o `Sicf�2b'S -� -22cD -
b) Land area designated to building site %3�j AC
c) Sewage Disposal Contractor ,�� //--
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
ate Owner Signature�--
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS U
Directions to property:
o'�
DCHD (6-82)
Allow 5 days for processing
r ' `
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. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: Co r�,��i-ySic�� DATE RECEIVED
(office use only)
Ts)
s no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from , 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 conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
/I�ATE
SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation resultssff om the above described property to the following:
Owner only
— Owners designated representative
Anyone requesting results
— Only those listed below
DATE
DCHD (11 /84)
SIGNATURE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section,
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name �� \� ���� Date ( 19 _g
Address Lot Size • -A �\
FACTORS
RFA 1 ) AREA 2
1) Topography/ Landscape Position
PS
PS
PS
PS
U
U
U
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
U
U
U
U
3) Soil Structure (12-36 in.)
S
`—PS
Clayey Soils
PS
-U -'
PS
CP
U—
U
U
I) Soil Depth (inches)
PS
�--KS
U
U
U
U
i) Soil Drainage: Internal
S
PSPS
P
U
U
External
S
PS
<Z;
U
U
U
i) Restrictive Horizons
t----
-------,
Available Space
PS
,
PS
S
P
PS
U
U
U
U
1) Other (Specify)
S
PS
S
_ PS
S
PS
S
U
i) Site Classification
S
------------
U—UNSUITABLE S—SU ATI L PS—Provisio4naQlly1S it le
Recommendations/ Comm ents:\
Described by �Z— Title Date
SITE DIAGRAM
DCHD (6-82)