125 Cumberland Court Lot 41Davie County, NC r Tax Parcel Report Wednesday, November 30, 2016
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All datais provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or Mess 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
NC or arising'out of the use or inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
Parcel Information
_
Parcel Number:
H8060A0041
Township: Shady Grove
NCPIN Number:
5789148249
Municipality:
Account Number:
82530989
Census Tract:
37059-804
Listed Owner 1:
HUGHES TIMOTHY R
Voting Precinct: EAST SHADY GROVE
Mailing Address 1:
125 CUMBERLAND COURT
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class: DAVIE
COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
LOT 41 COVINGTON CREEK PHASE TWO
Fire Response District:
ADVANCE
Assessed Acreage:
1.05
Elementary School Zone:
SHADY GROVE
Deed Date:
7/2009
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
008010785
Soil Types:
PaD,PcC2
Plat Book:
0007
Flood Zone:
Plat Page:
139
Watershed Overlay:
DAVIE COUNTY
uildin& Extra
Building Value:
FO eatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
F-a
All datais provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or Mess 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
NC or arising'out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section J Y Z v
P. O. Bog 848/210 Hospital Street G�
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001299 Tax PIN/EH M 5789-24-4344.41
Billed To: Con Shelton Subdivision Info: Covington Creek Lot # 41
Reference Name: Location/Address: Cumberland Court -27006
Proposed Facility: Residence Property Size: 1 acre
**Nt)TE" *'Ttiisgmprovement/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 #People #Bedrooms LS #Baths oC.�
Dishwasher: Garbage Disposal: ❑ Washing Machine;J:� Basement w/Plumbingl❑--� Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial
Waste: 171Lot Size Type Water Supply! Design Wastewater Flow (GPD) Site: New 1r Repair ❑
System Specifications: Tank SizeIP&O GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width ,?O/ ff Rock Depth11 / 11LinearFt
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " 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�i8�p [h. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: Date: 'An —12
OP /
DCHD 05/99 (Revised)
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Bog 848/210 Hospital Street
MocksviBe, NC 27028
(336)751-8760
Account #: 990001299 Tax PIN/EH #: 5789-24-4344.41
Billed To: Con Shelton Subdivision Info: Covington Creek Lot # 41
Reference Name: Location/Address: Cumberland Court -27006
Proposed Facility: Residence Property Size: 1 acre
ATC Number: 2650
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
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 I I of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in Y be taken as a tee that the system will function satisfactorily for any
given period of time.
70
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
�14�r /, fir
�cc
Date: 6 --f � � j �,--
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & All I
R Davie County Health Department DEC 200
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 ENViRO,�,',1ENTAl HLAITH
(336) 751-8760 DAv')E CDl1tJTY
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be BilledLo n I -v— /L—Contact Person �� — �h /71
Mailing Address% //�-%y\/ _ Home Phone S S� ZA-
City/State/2IP _ // 10 `/C 5 ����GZ / 7 •
Z s� Business Phone 2 O V G
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For:
4. System to Servic4% 21 -NO" ❑
S. If Residence: # People
a.shwasher LLAOC age Disposal
City/State/Zip
'Improvement Permit/ATC
Home ❑ Business ❑ Industry ❑ Other
# Bedrooms
9- IEgbing Machine C,BasVment/Plumbing
❑ Both
# Bathrooms .�
O Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: ## Seats Estimated Water Usage (gallons per day)
7. Type of water supply: 1 0, ounty/City ❑ Well ❑ Community
o. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED I
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: I J tt -C c
Tax Office PIN: # 5� D 9-,a 4- 3 '
Property Address: Road Name
City/Zip T=4' ✓-. , c 2700(o
'WRITE DIRECTIONS (from Mocksville) to PROPERTY:
If in a Subdivision provide information, as follows:
Name: Coo (
ri l� 9 .
Section: Block: Lot: % / Date Property Flagged: Z 9 U
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 Representative of the Davie County Heal hZepa"ent
to enter upon above described property located in Davie County and owned by c
to conduct alltestingprocedures as necessary to determine the site suitability.
DATE / v v 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).
Revised DCHD (07/99)
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. /
Invoice No. a
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
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 RE UIRED INFORMATION IS PROVIDED.
1. Name to be Billed HD ,•+n E i Contact Person lel e- A r'(4
Mailing Address?A 9 tl >1 �, d 1) Home Phone
City/State/Zip !* UAII! Ce N( . X706 C Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ite Evaluation C)
rr [ ] Improvement Permit &ATC � [ ]Both
4. System to Serve: [ 1 House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 10+ Ute l y�.SiOnJ
5. If Residence: # People # Bedrooms # Bathroom$ [ ] Dishwasher [ ] Garbage Disposal
[ 1 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?
I I! rlj 1; 1. 17. 11 t `r: . 1 I r I I t::
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***`A FLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: _qtr+ 64 68 aC , QGtrc-e 'WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax Office PIN: # S ci22 zh Ir•} a-f-_Adya h: ce
Property Address: Road Dame j Dw r n X % m �t —I.J Lis
City/Zip ��tJ • Z?oo ; c a -C` �c�n-t tie 1 J IUl u�° r5
If in Subdivision provide information, as follows:
Name: '
r
Section: 1 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 ar
subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified o
changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorize
ve of the Davie County Health Department to enter upon above described property located in Davie County and owne
Revised DCHD (06-96)
all testing proceoui;cs as necessary to determine the site suitability.
11116 :I 1; T.1 ,II I IS Lir U I U ]"Ul,' 1)1t,1II'I N6 /0IIk s71117 PIAN:
10L`' DAV .7 COUN'T'Y HEALTH DEPARTMENT
Environmental Health Section SECTION _ LOTS
Soil/Site Evaluation
* DATE EVALUATED
PROPERTY SIZE Z_
174 r C / ROAD NAME
..:!a.e..- Sa?ply:
On -Site Wel_ Community
"aliation By: Auger
Pity
Public L�
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH ! y
Texture group
Consistence /
Structu.e >
Minera_ogy__
HORIZON:
Texture g up
Consistence ,' 1
Structure
_Mineralogy
HORIZON IV DEPTH i
Texture group
Consistence
Structure
Mineralogy t
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE . t
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE i
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
CHD (01-90)
EVALUATIOXBY: - !
OTHER(S) PRESENT:
LEGEND
.Landscape Position
t - Ridge S - Shoulder L -Linear slope FS - Foot slope N - Nose slope
�,C - Concave slope CV - Convex slope T - Terrace FP - Flood Main H - Head slope
`:'exture
S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt
Silty clay loam SI:, - Silty loam CL - Clay loam SCL - Sadly clay loam
-Sandy clay SC - Silty clay C - Clay
CONSISTENCE
i`Roist •
VFR - Very friable ..?R - Friable FI - Firm VFI - Very firm EFI - Extremely firm
W
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
iructure
SC - Single grain M - Massive CR - Crumb GR - Granular ABK,-Angular blocky
S13K - Subangular blocky PL - Platy PR - Prismatic
Mineralm
1:1,1:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolhe - S(suitable), U(unsuitable)
-Soil *&ness - 4no1m *'ice UA WWhft 4o4me al &h ohmma ZKar km
Ciussification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2