145 Boxwood Circle Lot 162Davie County, NC
Tav Parer 1 R pinnrf
Thursday. October 27, 2016
WA"MU: lMb lb PIV1 A bU1CVL' Y
Parcel Information
Parcel Number:
D803OA0007
Township:
Farmington
NCPIN Number:
5882052446
Municipality: BERMUDA RUN
Account Number:
8302605
Census Tract:
37059-803
Listed Owner 1:
THE BIG W REV TRUST 9/13/13
Voting Precinct:
HILLSDALE
Mailing Address 1:
3600 COUNTRY CLUB RD STE 100
Planning Jurisdiction:
BERMUDA RUN
City: WINSTON SALEM
Zoning Class: BERMUDA RUN CR
State:
NC
Zoning Overlay:
Zip Code:
27104
Voluntary Ag. District:
No
Legal Description:
LOT 162 BERMUDA RUN GOLF&COUNTRY
Fire Response District:
CLEMMONS
Assessed Acreage:
0.73
Elementary School Zone:
SHADY GROVE
Deed Date:
9/2013
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009390235
Soil Types:
MrC2
Plat Book:
0004
Flood Zone:
Plat Page:
079
Watershed Overlay:
BERMUDA RUN
Building Value: 207110.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 75000.00 Total Market Value: 282110.00
Total Assessed Value: 282110.00
All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, $ Implied wanan es of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the I
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
OUly4 NC or arising out of the use or inability to use the GIS data provided by this webalte.
DAVIE COUNTY HEALTH DEPARTMENT r
IMPROVEMENTS"PERMIT. AND CERTIFICATE: -OF- COMPLETION
i,
OTJ:Issued Compliance with G..S: of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC'10A•..1934-.19 8) P®�11111t Nulrnb®r''
Nam l Z6 �r:�, .z+�1 1 Date „ .. �458
Location �� `W40
Subdivision Name :�4 rlV Lot' -No. Aksi Sec. or Block No.
Lot Size ..!w House'Mobile Home - JBusiness Speculation. (�
U ,A�
No.. Bedrooms No. Baths' No. in Family v
Garbage Disposal YES NO p' Specifications forsystem:
•AutoiDish,Washer YES �_ NO
Auto. jWash Machine .YES NO p r'
Typ'e'' Water Supply ��. _ •
*This permit Void if sewage system'desdribed below is not installed within 36 months from dale of issue.'
' - it - .. •
IL' F
VP
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: A' System Installed by `►
p it
`- .' �+ , �� lam•`" '
7.
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 ih the above regulation, but shall in,NO way,be taken as a guarantee that the'system,will function.'
satisfactorily.forany given period of time.
ti
010
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department- -
Environmental Health Section
P. O. Box 665 RECEIVED J U L 2 2 1986
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
9/9
Home Phone
D k 71/- TMA
1. Permit Requested By .^-a' II ** - ,- usmess one
2. Address <</ (L) +-'r44JA
3. Property Owner if Different than Above V cnm o S 4- as c c �.-
Address '::�_ V
4. Permit To: a) Install Alter Repair
b) Privy Conventionally Other Type
Ground Abs rption
c) Sub -Division f+V'— Sec. L( Lot No.1�
5. System used to serve what type facility: House* Mobile Home Business
�, `Ind-ustry Other
b) Number of people •4 ��Z—cz s��c • �oss�.
6. a) If house or mobile home, state size of home and number of rooms. ,\r
House Dimensions Q (04, 3�� Sr J
Bed Rooms— Bath Rooms— 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 3 urinals garbage disposal
lavatory showers 3 washing machine
dishwasher I sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yesy No
9. a) Property Dimensions 126 X 2� S
b) Land area designated to building site
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.
7(0
Date', Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
a vl
�,�{-er 3ermv c. �vr�
C.r cIG. ice,
Wk �ay.1rn UY\ JeD W 0Q4 --tree, ` acae-) ;vv. eevvtec e�
1 %1%3C%r3 ��an-� , '\v.ece ace saes ova
DCHD (6-82) ,
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Freeman, Ferrell and Smith Date
Address 854 W. Fifth St.Lot Size 120' x 265'
Winston-Salem, NC
rAnrr%M ADCA i AREA 9 ARFA 3 ARFA A
Topography/ Landscape Position
®
P
S
�
C�
Pp
U
U
U
!) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
P
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
S_,�
g'
U
S
P
U
1) Soil Depth (inches)
S
PS
U
`�
Soil Drainage: Internal
S
S
PS
A�2
U
U
U
External
S�
PS
'
U
S
P
S
U
U
1) Restrictive Horizons
') Available Space
S
�
U
S
.��
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
UU
U/
U
U
1) Site Classification
U—UNSUITABLE S—SUITABLE
Recommendations/ Comments:
Described by _
SITE DIAGRAM
DCHD (8.82)
PS—Provisionally Suitable
Title Sanitarian Date /
;'A
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section 10
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name X Date
Address �G[ Lot Size
CAf'rnoe ARCA I ARFA 9 ARFA R ARFA 4
Topography/ Landscape Position
S
S
S
PS
PS
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
4PD
PS
PS
PS
U
U
U
U
Soil Depth (inches)
S
PS'
S
PS
S
PS
S
PS
U
U
U
U
�) Soil Drainage: Internal
S
S
S
p
PS
PS
PS
U
U
U
U
External
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Restrictive Horizons
') Available Space
S
S
PS
S
PS
S
PS
C7
U
U
U
3) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
t) Site Classification>.
�U'
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by _
SITE DIAGRAM
Title
DCHD (6-82)
go
W
Date
Y A
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT U'2
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home ho e -76%1'�
1. Permit Requested_By - oe- 5 BusIne7s/A- ne 7 7 7 - 7 76'F
2. Addressc-
3.
• a %"dam
r
3. Property Owner if Different an Above
Address �2`7y% �-���D-rr i GC �l.[Jcn,o7�� ' 4e x
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub- Division 'ge"Lt-da "Sec Lot No.�
5. System used to serve what type facility: House Mobile Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions �� /r''`'am
Bed Rooms 446 5 Bath Rooms 3 I��- 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 wate -using fixtures:
commodes urinals
garbage disposal
lavatory showers 3 washing machine %
dishwasher sinks `7"
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions
b) Land area designates
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.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Directions to property:
DCHD (6-82)
f" 15 a 2
Allow 5 days for processing
-&' Cl a /eLc-,� 7ZCI
DAVIE COUNTY HEALTH DEPART LENT
SITE EVALUATION CONSENT FORM
INSTRUCTIONS/PREREOUISTES
1. Complete the form below and return it to the Davie Co. Health Department.
2. Along with the form, remit the amount due as shown on enclosed statement.
3. Carefully follow the procedures as outlined in the enclosed "Information
Bulletin".
4. Notify Health Department upon completion of item number 3.
NOTE: ALL THE ABOVE MUST BE DONE BEFORE A SANITARIAIT WILL BE ABLE
TO BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO THE(DAVIE COU11TY HEALTH DEPARTDIENT,P.O. BOX 57)
(MOCKSVILLE, N.C. 27028)
DAVIE COUNTY HEALTH DEPARTMENT
SITE EVALUATIOU CONSENT FOP11
LOCATION OF PROPERTY:
DATE RECEIVED
(office use only)
yes not (1.) I am the owner of the above described property.
yes no (2.) I am not the owner of the above described property, however, I
i certify that I have consent fro t ,owner to
i owner's name
obtain a site evaluation by the health Department for the purpose
of determining the suitability for a ground absorption sewage
disposal system.
T-A.:
no (3.) I 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 necessary to
determine its suitability for a ground absorption sewage
disposal system.
DATE
-"awoz -
SIGNATURE
(4.) I hereby authorize the Davie County Health Department to release
site evaluation results from the above described property to the
following:
A±2 94 /9
D1
W4&4,4�
SIGNATURE
0 Owner Only
rj Owner's designated representative
Anyone requesting results
[i Only those listed below
-,�,� 1?. d. t �.