163 Country Circle Lot 17Davie County, NC 1 Tax Parcel Report Tuesday, November 29, 2016
WA tN1A is '1t1I1J 1l AU -1-A NUKVEY
Parcel Information
Parcel Number:
E8140A0017
Township:
Shady Grove
NCPIN Number:
5881113336
Municipality:
Account Number:
8304369
Census Tract:
37059-803
Listed Owner 1:
JOLDERSMA DELANA DAVIS
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
163 COUNTRY CIRCLE
Planning Jurisdiction:
Davie County
City: ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
No
Legal Description:
LOT 1710.34 AC COUNTRYSIDE
Fire Response District:
ADVANCE
Assessed Acreage:
10.46
Elementary School Zone: SHADY GROVE
Deed Date:
11/2014
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009731062
Soil Types: SeB,GnB2,GnC2,ChA,WATER
Plat Book:
11
Flood Zone:
Plat Page:
304
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Building Value:
g
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
9 h
Davie County,
NC
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Implied warranties of merchantability or fitness for a particular use, Ali users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina. Its agents, consultands, contractors or employees from any and all claims or causes of action due to
the use or inability to use the GIS data by this website.
or arising out of provided
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P 0DAVIE COUNTY HEALTH DEPARTMENT 1 p,
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With A icle II of G.S. Chapter 130a
Sanitary Sewage S stems vt��e�r Permit Number
Name /di. f�G/�/ /�i tt1� G�D.'Al Selz ��%rte Date �-�` �3 N0 7102
Subdivision Name e"0411 LSE J, re Lot No. /7 Sec. or Block No.
Lot Size ��� Housey� Mobile Home Business -- Speculation
No. Bedrooms SZNo. Baths a /2 No. in Family_ .
Garbage Disposal YES •❑ NO 2'' Specifications for System: _
Auto Dish Washer YESNO .❑
Auto Wash Ma^hine YES �] NO ❑ -T
Type Water Supply
*This permit Void if sewage syster'ft� creS ibed beloW1s not installed within 5 years from date of issue.
This permit is subject to revocation if site p m nded use Chan e.
Improvements permit by —,Z�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 day of completion. Telephone Number 704-634-5985.
Final Installation Diagram:
System Installed by
Y
4�,s /e6a s': dr 46 a edare 0- `pass: 6�P foo
S t 1D�ve)` Very poCJ/ GJ�r7! tys9/or r.JRt
// el 9-�71-Q.f
r�yrs �a��� �. -V *a�'�X/9''/i✓rts 'n s- e
le-
e,4
c
h�Ort.aOwnir��r,e,4r✓�0V-
�rA ¢ /O,r ye)
/�a200XYXi2 _ ,�k// �K�/ i/a�✓r
4
itG
sISe
ewe/
F
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.
1. Application/Permit
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT _
Davie County Health Department r
Environmental Health Section
P. O. Box 665 MAR Z 3 1993
Mocksville, NC 2 028
aquqpted By
Mailing Address / L- dp `�'�� %� �G Z7a�.
Home Phone 266, - 56, 46 Business Phone .5d 7-
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation Septic Tank Installation
4. System to Serve: V House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ In stry ElOther [IUnknown
5. If house, mobile home: Subdivision ii71rB/t„L� Section Lot # % 7
No. of People
No. of Bedrooms 3
No. of Bathrooms Z /X2
Dwelling Dimensions 40x 30 Z��-Sm�i
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: V/Public
8. Property Dimensions 6C'3 A
ejuz
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Private
Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No
❑ Basement/Plumbing
❑ Basement/No Plumbing
94ashing Machine
5? D' ishwasher
❑ Garbage Disposal
If yes, what type?
❑ Community
"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.
Directions to Property:
AJ
' not,
This is to certify that the information provided is correctt best of
incurred fro this 7plication.
z ,�3
DATE
, 4nd I tAderstand I am responsible for all charges
SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: X1. I OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MU T 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
If
disposal system.
DATE SIGNATURE
DCHD (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
.t Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY , Zi%Z5;�!
Water Supply: On -Site Well
Evaluation By: Auger Boring_
DATE EVALUATED � % JFS
PROPERTY SIZE ���i��G
LOCATION OF SITE
Community
Public —1
Pit / Cut
FACTORS
1
2
3
4
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
f
(r
41,
2
Texture groupC
Consistence
Structure
Mineralogyi
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
. 3
SITE CLASSIFICATION: �/"� EVALUATED BY: Z-�d
LONG-TERM ACCEPTANCE RATE: o OTHER(S) PRESENT:
REMARKS:
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
CONSISTENCE
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
Mineraloey
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(01-90)
Vlw• :'Sp RJ'^'- g 4t` :: -" - nl 1 _ _ g�
S 390 49. 2-"E 34266 = - ` --38.32 I S -�S 00`' S 57 E
DAVIE COUNTY 78.15: H. g1�99 TOTAL 1 v m 0T 7 1 ro z
:1ATED THE 5 27°22 2i E_ CHORD = 232J9��� 41°I•/' Ems' 40'319 1 m a L5090G / g w � � ` S 06°29 29 W ^ r
6802 ARC = 232"2 S w W ^ LCT 21'-
y -�� S 31°43 S7"E� _ 20886 1 m L7. 1 U 4'-%'�••J J VICINITY- MAP
CONDITIONS W _ z woo O1 , I r S 37°09'00"E-+ o -v
R PROMULGATED Z. v a= 4.92 R' 1525 -CO ,,, o, o I u o -
o / w 329.89 LOT 20 50 R/w.
0
i FOUND TO �1 a 0 ,p u 3 N I"o LOT II b �.-.N 33° 09 00• W 'I -. O
AND CONDITIONS��Ip 1. a LOT I n,J" tc N `LOT IO ,w u 2.560 NO 3 g g 2.402 AC j=.
-4 EVALUATION. '^�' mo o C. ^ri`! c � 2545 at. `I 1 ` '- '� z N d
r
•�- P N 1.409 % zim rp O Q i ft 8 "'
-ION AND FOR 3-0� o m S a 1 z Y'o a is'At F
SC^d g: jC�� mConrot Cal 1 g 8 8 -N 34°09 00 w CaKret Corer
REPORT ON - �' o o �" I
�N 29 33� 08"W f �-N 3a°09 00"W OT
VT -�• I W -N 34109 00" W 1 ,Qoi •--N 34° 09 00" W 379.98
ni h W 30061 r 1 ) 28500 1 400.00 3
w z 5 SS° Si 00" w
-IFICATE DOES c- o $ i L . �¢ 8
R APPROVAL OFr,c � N LOT 2 Ase. � � F......- � u LOT 12 87.42 � � N 34° 09. OO" W �+ p�4 T 19
DIVISION FOR __. -.?t:- 0 2415 AC.;'.'!2- �° ro LOTS N 2.031 AC S 46°41 50 W 339.44 LCT o. �_ 0 035 AG H
�CILITIES. m�_a °^N P $� 0 2439 AG $ <_/� ARC = 13239 t �, .'_'515tF \ oo °
'k.. o _ o g _,r CHORD • 13203 • 1. 8
; �-N 27 5d 00" W £ m _014. C1 st �- N 34° 27• tfi W c ,y t N w LOT 23 z g 2 34° 09 ao w f F_ N 34°09 Ofd w
-60• R/1V_ S IDGF _ r -N 34°09 00 w 42201 R•�9g9� oiler 10 329.89 LN 55°51 004" E
�� i• 60.3 �/ D W 28500 S [• O. o a' m
HEALTH OFFICER E + n4'p `4dop �1°• `9 t m" y as lyT2 10'x0 56'54 LOTIO
S n°54 /u.,o. _ o a ,r s o o v S L (i' N
wESTRIOGE < 30152E �° Z N LO N p� r ' \ `' "o o + ro :. 2548 AC LSSC;° 6 L 2028 aC� ALICE A. HARTMAN
sectrop IMO O! Y •T' Yi'p uo 0 N7 25• 4"E o
A ��� O �,� v 0 N �- 4v I c 'L. CP 4R: 13306 b
11te, 1 p9.5�0 LOT 3-5 o w Q. -�b 2538 AG $ z>a LOT 13 '9cb o �� P m �°�'�ti1 cHo D 13121 o DB. 41 PG. 36f
I + 62 J63
ARE THE OWNERS ,� N + o� o �,(p ' 3a65 AC. e4� �P 1 �ti-N 2S° }ax•N-
2490 aC.,�•� 8 0 uu �� s �� -•--� ? 29 28 -IV 28 151
DESCRIBED HEREON Nz is°•�- 1 �N seed od W wo c4-9, S . COUNTRY CIRCLE pPo ti s ;-9*
4q�7
THIS PLAN OF 3m -N 34°09' Od'w E d ti
:ONSENT, ESTABLISH 29997 I4 2e50Q� go �O j`28`f apo c4R93,. m
DEDICATE ALL w y sP/ m� ZO�eq T `' �- (r a .a\tD =9RO,E u NOTE 1)LATS 1,10. 11.21.24 620 NAVE a
u E o g N 6 q i y' n Iw c� �'a99d3 m- ZIA010 X 70 SIGHT EASEMENT 1S
AND OTHER. SITES. LOT �a 5 �0 W $ o
'iD AS SHOWN JW •+ LOT 4 X10 1m t. 370 AC_ o y o 0 osD w INTERSECTIONS.
-TING JURISDICTION 4n , L635 AC. ply $ NOo� �o o -mo ��� O�p� I 3)MINIMUM SETBACK LINES- 40' 1
0.v" _pp Ease."I f 15 F
m e i V �-• laW
N 33° Sd 41" W 3 ,��4C p ro w O - - I S' .
o y o •° m / 4)ALL ROADS ARE PUBLIC.
000 - - A 284.99 /i vj• N �,mo
C. PAGE 7RUITT 0o -N 3009 00 W 8 �•••N 32°33*58"E m LOT 14" Er 4 m�-' 5)24 TOTAL LOTS IN THIS DIV151'.
D8. 107 PG. 567 'z ^ 277.51 0. D AROC�-s2032 m 7.596 AG 'a o rn I / + 61TOTAL AREA s 84.883 ACRES
m C R = 25.009]]66
N •,`` \ 207 6
2.300 AC. o
W N m 0
5 0. Z SG�O m ` ^Q LOT I5 m LOT 16 a LOT 17. _ r
N 55°Si 00"E 5.509 4C. 9 °- - - 8.569 AC. .+ - - - - O = IRON P:N
79.65 �.�N>a,�, z h m 7.922 AC. 0 10.343 AG +wp
- -UNMARKED POINT IN CENT(
C% s• _ W w� ,wp m CREEK OR ON R/W, SR 16•.
y AOS _ - � ZONE A FLOOD LINE TAKEN c -
pavro s/JaRPE CARTER'S CREEK 1 , o-
0 o C FROM U.S. DEPT. -OF HOUSING 8 .4
DB. 107 PG 3301e� A g0� r /j . T -40.87 - 3 URBAN DEy. MAP o .
5 Aq N 13°384j �-
X34"w,. ,z �9a, A COUNTRYSIDE
N 42°15' 39-W� •+• •9'
+ 14Nz$`+ 1\-5.12°50 s7"w N 21°13 2s w� \�O��SQ� CARTERS CREEK o, OWNERS OEVELOPI
- • • • +-+� 87.19 N 67111 Ofi w
1 P_ OTTS INVESTME
N 12 IS 19`W JO
N 42°Sd 53"lti ♦ 4 +
S 6711911 w 72.44 N 56°31 02rE � ADVANCE N.C. 27006
3438
p 5�
N 17°59 03 w - BOAS TOTAL +� 4 of 50 w ; ��� - PHONE i(919)998-881
N 3e3lfi 19"w 702 50'DO
+-+ 11Q� SHADY GROVE TOWN`
N 484&95 3"w N 25°56'-r + 5008 SAT p9
p CUL-DE-SAC INFQ N 37°26 I7"W 18428 TOTAL ••P p , + -DAVIE COUNTY
N 28532157" W A` S 7 OB' OI W- o a Y.
ARC • 20 11125.00 N 09 56 51
m 32 E a s a
CHORD •79.76 �•-'
8-S 6Ao,2.3,"W---"_ N Sd°3T'43"E 70831 •+ NORTH CAROLIN'
ARC = 2728 POTTS INVESTMENTS - + * �`'• p +
CHORD . 2700 DB. 145 PG. 557 p 11 N 56°27' 1i W
C=S 06°5530"w--- N 3i 5117 367 E �n+ 200 [Do 0 200
ARC a 12878
CHORD = 101315gr. N 29°40' S3 E
D ARC s•1064E_- N 31°05 4fi w N 59°21 22"W SCALE IN FEET
CHORD = 9042
S 84°57 46: w N 77°739035" w TAX MAP : E-8 PARCEL: Pt
N 2P2516"E
9253 TUTTEROW SU
ROUTE 6 BOX
MOCKSVILLE , I
704 - 492 - 56i"
CASTLEGATE CONSTRUCTION
o f Clemmons, Inc.
SEPTEMBER 22, 1993
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. BOX 665
MOCKSVILLE, NC 27028
RE: SEPTIC SYSTEM
LOT 17 COUNTRYSIDE
DEAR SIRS:
t
SEP 2 7 1993
DEPARTMLNT
PER OUR CONVERSATION ON THIS DATE, I, THE UNDERSIGNED,
HEREBY RELEASE THE DAVIE COUNTY ENVIRONMENTAL HEALTH
DEPARTMENT AND RICK MABE GRADING FROM ANY DAMAGES OR
MALFUNCTIONING OF THE SEPTIC SYSTEM LOCATED ON THE ABOVE
NAMED LOT. I UNDERSTAND THIS SYSTEM WAS INSTALLED IN A
LOCATION NOT RECOMMENDED BY THE HEALTH DEPARTMENT AND AGREE
TO ACCEPT FULL RESPONSIBILITY, AS GENERAL CONTRACTOR AND
HOMEOWNER, IF THE SYSTEM FAILS TO FUNCTION PROPERLY. I
CERTIFY THIS IS MY ERSONAL HOME.
4
1 4
l'
MARS ALL ORTON DAT
_ _ _ - _-_-_ - _
SUSAN B. HORTON DATE
SIGNED AND ACKNOWLEDGED THIS -OoL DAY OF SEPTEMBER, 1993.
NOTARY PURL C
MY COMMISSION EXPIRES:
4929 Country Ridge Road • Clemmons, NC 27012 •919-659 3021
SEAL'