392 Armsworthy RdDavie Countv. NC
Tax Parcel Report Friday. October 7. 20 1 f
9 tixVislL�' All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, implied warranties of merchantability or fitness 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
�O tJ 1V'S4 NC or arising out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
�_. _,__.. _,__ _ .
_.r. r_ _ _b -"� Parcel Inform ation
f. v_ _ _. _ -. ,
Parcel Number:
E700000090
Township:
Farmington
NCPIN Number:
5861643316
Municipality:
Account Number:
82530190
Census Tract:
37059-803
Listed Owner 1:
WILLIAMS PHYLLIS G TRUSTEE
Voting Precinct:
SMITH GROVE
Mailing Address 1:
PO BOX 1199
Planning Jurisdiction:
Davie County
City: COOLEEMEE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27014-0000
Voluntary Ag. District:
No
Legal Description:
93.04AC US HWY 158 P/O LOTS 2-3
Fire Response District:
SMITH GROVE
Assessed Acreage:
90.27
Elementary School Zone:
SHADY GROVE,PINEBROOK
Deed Date:
6/2007
Middle School Zone:
NORTH DAVIE,WILLIAM ELLIS
Deed Book / Page:
2007EO138
Soil Types: GnB2,GnC2,EnB,GaD,MsC,ChA,WATER
Plat Book:
0003
Flood Zone:
Plat Page:
083
Watelrshed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Building Value:
162720.00
Freatures Value:
200.00
Land Value:
614120.00
Total Market Value:
777040.00
Total Assessed Value:
386330.00
9 tixVislL�' All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, implied warranties of merchantability or fitness 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
�O tJ 1V'S4 NC or arising out of the use or Inability to use the GIS data provided by this website.
0 • .. ; 004 .
Account #: 990005180
Billed To: Phyllis Williams
Reference Name:
Proposed Facility:. Residence -Well
ATC Number: 0014
Davie County Environmental Health
P.O. Boz 848/210 Hospital Street
Mocksville, NC '27028
(336)751-8760/ Fax (336)751-8786
WELL PERMIT
Tax PIN/EH #: 5861-64-3316
Subdivision Info:
Location/Address: 392 Armsworthy Road -27006
Property Size:
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there
has been a material change irk any fact/circumstances upon which this permit was issued.
Permit Type: NewjZ Repair ❑ Abandonment ❑
Prnnn�Prl Well Location Diagram t`(A
rAfMCC,
f a 5�
wjj)k cIV
Comments:��u/
EHS:
W.P. 7-08
Date:
Certificate of Completion Diagram
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'15
64,row
Driller: Qk t/h )A" -J g►ZyJn- Wi (f r v -
Certification #:
Grout Inspected: O c4 41n
Well Head Inspected:
GPS Coordinates:
EHS: Date:
ICATION FOR PRIVATE WELL PERMIT
Davie County Environmental Health
t- P.O. Boa 848/210 Hospital Street
200 Mocksville, NC 27028
�CT (336)751-8760/ Fax (336)751-8786
Z
TN ***IMPORTANT***
THIS API&ATI ROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name to to be Billed 49JY �C�i»�� Contact Person ? G���•��C' ��rl��
Name to be Billed . l��c�' � -
Billing Address Home Phone enlrie)-\7116
City/State/ZIP ) A Business Phone
Name on Permit if Different than Above
Mailing Address 7-u— City/State/Zip
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE: A survey plat or site plan m st accompany this application. Included: ❑ Site Plan ❑Plat (to scale) _
Owner's Name c �. R �,ry Phone Number:3,- -91M
Owner's Address .3,2 a3 "i4 -enc -&Itk�j Zr City/State/Zip l��e?u-:r: ,,;e z- ,17 . C --4 je)flc'
Property Address 1-74%40:�c. �3 c �,� X c� City Qc� �k;4 t�� _ 41C2 7� c) v
Lot Size Tax PIN #
Subdivision Name(if a
Directions To Site: tai,
DEVELOPMENT INFORMATION
Section/Lot,
;r) 2z,
Permit Type: New Well �V •• Well Repair Well Abandonment Other (specify)
Facility Type: Residential :/ Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES _ . NO
Do You Intend To Install A New Septic System On This Site? YES NO �.
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission
for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary
to determine the best location for a well.
Signed!
�ee�-p 5ryU
7/1/08
AP L1710i
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account #
Invoice #
GoMAPS - Davie County NC Public Access
Davie County, NC - GIS/Mapping System
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DAVIE COUNTY
WELL CERTIFICATE OF COMPLETION CHECKLIST
Applicant: ,P], q 1 I"s W ►r 11, � 1,-s
File #:
Site Address: rrns o
Subdivision: Lot:
Permit Type: New Well _ Well Wepair
Well Abandonment Other
Facility Type: Residential� Food Service
Church Commercial Other
Initial Inspection
Were Setbacks Maintained? Yes No
What is the Grout Depth?_ ft.
If No, Explain:
What is the Grout Thickness?o_ in.
What is the Type of Well? dt- I ud
Was a Well Screen Installed? �<S
What is the Casing Type? IVCG
Type of Drilling Fluids Used: tnl�-kV
What is the Casing Depth? 00 ft.
Well Grout Inspection Date: 10-.23-0%
What is the Well Diameter? (o in..
GPS Coordinates:
What is the Well Depth? 0_S ft.
EHS ID: al < 0
Well Head Inspection
Is There an Access Port?
Is There a Vent?
Is There a 4" Pad?
Is There a Hose Bibb?
What is the Casing Height?/ „
Is There any Grout Settlement?
/
What is the Static Water Level? ft.
What is the Yield? 5' GPM
Is the Well Contractor ID Plate Complete?
Is the Pump Installer ID Plate Complete?
Contractor Name: iPex rmy d b7wt, {., d t e o.
Pump Installer Name:
Contractor Certification #:
Date Installed:
Depth of Well: L f 0 S
Depth of Pump Intake:
Casing Depth and Inside Diameter: /0d (n �
Pump Horsepower Rating:
Screened Intervals:
Opening for Piping & Wiring >_12":
Packing Intervals (Sand Packed Wells):
Yield in GPM or GPM/ft.-dd:
Static Water Level and Date Measured:
Date Well Completed:
Well Head Inspection Date:
EHS ID:
Construction Completed Date:
Contractor Reports Received Date:
Sample Date:
Results Mailed Date:
Certificate of Completion Date:
Authorized Agent: