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112 Covington Drive Lot 2Davie County, NC Tax Parcel Report Wednesday, November 30, 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: Land Value: Total Assessed Value: WAR1 ING: '1'MN 1S NU1' A SURVEY Parcel Information H8060A0002 Township: Shady Grove 5789343602 Municipality: 82524177 Census Tract: 37059-804 FALEK TOMASZ J Voting Precinct: EAST SHADY GROVE 112 COVINGTON DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R-20 NC 27006-7866 LOT 2 COVINGTON CREEK PHASE ONE 0.72 3/2005 006000471 0007 ,057 Zoning Overlay: Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: WeB,PcB2,PcC2 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Freatures Value: Total Market Value: F -aAll datais provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to theDavie County, Implied wamnties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless theCounty of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due toNC or arising out of the use or Inability to use the GIS data provided by this wets • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section I I 1 J P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900035 Tax PIN/EH #: 5789-343602 Billed To: Richard Short Subdivision Info: Covington Creek Sec.1 Lot # 2 Reference Name: Richard Short Location/Address: Hwy. 801 S.-27006 Proposed Facility: Residence Property Size: 210x 110 ATC Number: 2184 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type D G #People #Bedrooms S #Baths 2 • S� Dishwasher: M" Garbage Disposal: Washing Machine: Ef"-- Basement w/Plumbing: 0 Basement/No Plumbing: El Commercial Specification: F�acciil0 lity Type #People #People/Shift #Seats Industrial Waste: Lot Sizeq`��� "T' Fe Water Supply�f-1V Design Wastewater Flow (GPD) —3GC� Site: New 0 Repair 13 System Specifications: Tank Size 100C16AL. Pump Tank GAL. Trench Width Rock Depth ��� Linear Ft.t Other: ( ,1�1g tiTian3 e / `,, Required Site Modifications/Conditions: ��[!zP ©� 14D se, 1 , jzss 1 /1%5T4 C.0J IMPROVEMENVOPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 u BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m, to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** LOT 4� L-o`t" 4 Environmental Health Specialist's DCHD 05/99 (Revised) Date: Account #: 989900035 Billed To: Richard Short Reference Name: Richard Short Proposed Facility: Residence ATC Number: 2184 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5789-34-3602 Subdivision Info: Covington Creek Sec.1 Lot # 2 Location/Address: Hwy. 801 S.-27006 Property Size: 210x 110 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WAS7,UCTION I VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa re:7) Date: '�'/9 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Q ' zMd! i . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_%_ LOT, Soil/Site Evaluation APPLICANT'S NAME �1i$ PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By: On -Site Well Community. DATE EVALUATED PROPERTY SIZE J�IA(s ROAD NAME Public Auger Boring Pit 8 Cut FACTORS 1 2 3 4 5 6 7 Landscape sition L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure U .� 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 1 411 REMARKS: DCHD (01-90) r n EVALUATION BY: T— OTHER(S) PRESENT: 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 Mineralp= 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 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIVIE • Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 1 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed 1 yb -A £' S Contact Person � el G C'V4 Mailing AddressX '-L36?) / [l Home Phone !'J'/[ City/State/Zip Uald Ce WL 2766 () Business Phone %19-'y77.•1- �8/3-�z//8 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ ] Industry [ ] Other c2 -'k 10+ 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes If yes, what type? 1:1 1111 ! •1 III -Al Ch '5111 1 'L. 11.' PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: A>44 o�- 66&c, aairc-e WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # S" 789 - _-q - � � guk�-261 IN K+ K n:� %Od V 4 lu Le Property Address: Road lame 910_D�,mrP r z( / m �1 — 1A.1L5 4 S �Ad P 14 1 City/Zip /Q U Z?oo =0CA rt dell M ije c5 l - If in Subdivision provide information, as follows: Name: ti-a�l %yam � b / reek. rtroc+Szci' ;• Section: L Lot #: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized ve of the Davie County Health Department to enter upon above described property .located in Davie County and owned Revised DCHD (06-96) all testing procedws as nefessary to determine the site suitability. TIIIS ,11MA MAI/ 13E- IISE-b 1701? b1ZA11'IN(j 1/0111: SITZ PLAN: P It Y11 T S 7.44' 23" 240.00' _ G y�O � In DA OE COUNTY, NORTH CAROL /NA. ��` • y.� �� 1, a Notary of the County and State aforesaid, — - B6RZC O8 certlfy that John C. Grey and G. Robert Stone Registered Land Surveyors, personally appeared �-,^� Q before me this doy and ooknowledgeo the execution 3 of the foregoing instrument. witness my hand and 7. official stomp or seal, .� ; th I S9; this A day Of November, 1998. - -�W /,,.,,��• My commission eNpires LOT 20, MAP H-8 LEWIS M. CARTER & WIFE OOROTHY P. CARTER DB 59, PG 393 FUTURE -- 1" EIP ryATI"T ADVANCE UNINCORPORATED RD l O \�\ 3 UTT RD Notary Puolic CP ARKLA RD s�, 2Q T4 PHASE 1 y� N \ F� PROJECT pLEs ao @AfLEy, CPP 153TOT I .27' Y11 T S 7.44' 23" 240.00' _ G y�O � In RICHARD C. SHORT COVINGTON CREEK — - B6RZC O8 °• FUTURE PHASE 2?� �-,^� Q 3 S �"�'• CONTROL g \ I S CORNER I S9; O 9. �1 LE x � �r. N I 'ATR W z OWE \ \ S G? \•4 T/ / `''� 2 1 4' 4' / i � � O•� ?o 00 /W /W �\ \�� 5 4 �� \ 3 s \ ` HES CONTROL `Q _ CORNER I I ON, 1 74'- c°�r_ 3 .34.- _ 1 74 ? � c � ¢i 3' 35•— � � 83.21' 44.79^ 12887755'27-- Q .00' S 87' S5' 27 r , I r�v� N jz rn v I 4Ir•� J ?�8� _ N 1 FUTUREv TENNIS ��1 Cf 3 N 69 _ v) I COURTS 8 G; I 3� /9• J o I A C Ch- _ N ---------- 4 5 / / 62 �Z 4 5 � — 168.79 { i/60 L9 1 =49,17 N G ♦ � C � SE . � I Z�. 4 100.00- 98.00' 50.00' 8 I AL I \ \ Iw I iw Iw I i I /�3L \ \ 60 IN I N Z 56 iz i 57 I� I 58 ,�' z r.2 -4P' A Iz I 1g \ O 1 'IC'4'C14 07 L-- - - -- '- -- - - -- --- u • arruual IONWit 8111 - le County Health Department PLAMR &ATC D &vimnmentv/Hea/M Secd►on P.O. Box 848/210 Hospital Street SEP 2 71999 Mocksville, ITC 27028 (336) 751-8760 - I ---- � [ ***IMP01tnNT*** THIS APPLICATION C RNNOT BE PRO 8MW MUZ88 ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nacos to be Billed Contact Person /G lir-4 db.�t failing Address D Glx a-3da now shone 92E- V 7 Citr/stat•/ZIP _ Z4 VA .Jl-e- � 766b Nhssiness phone 2. Naas on Permit/A= if Different than Above Nailing Address City/state/sip 3. Application For: O Site Evaluation rovemsnt Permit/ATC O Both 4. Brutus to service: 640use O Mobile Home O Business O Industry O other 3. If Residence: # People # Bedrooms_ # Bathrooms clvla- e.'Ulwasher 1�'oa�rbage Disposal @'Tfashing Naohine O nasement/Plumbing 0 nassaant/No Plumbing 6. If ausiness/Industry/others speoify type # People # sinks # Commodes # showers # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated hater Usage (gallons per day) 7. Type of water supply: M'County/City O hell O Community s. Do you anticipate additions or expansions of the facility this system Is intended to serve? O Yes two If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQb7RED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SLMWTTED by the client with THIS APPLICATION. Property Dimensions: / ,-rrX c>-' 16 Tax Office PIN: #�- Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: AJ C reO Section: �_ Block: Lot: c�- WRITE DIRECTIONS (from MockrAlle) to PROPERTY: Date Property Flagged: A)eP,,t 4-i) oteu,+ ., u (-t This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(,) Issued hereafter are subject to suspension or revocation, If the site plans or intended use change, or If the information submitted in this application Is falsified or changed 1, also, understand that I am responsible for all charges Incurred from this application. 1, hereby, give consent to the Authorized, Representative of the Da De rtment to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site solybiliiy. DATE I ' C;' 7 - 7 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge `Date(,): I Client Notification Date: IEHS: Revised DCHD (07/99) Account No. a S Invoice No. y U