109 Camden Court Lot 1 Davie County,NC Tax Parcel Report Wednesday,November 9, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number. G703OA0001 Township: Shady Grove
NCPIN Number: 5860835584 Municipality:
Account Number: 82515878 Census Tract: 37059-803
Listed Owner 1: SHAW BARRY D Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 109 CAMDEN COURT Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: LOT 1 CAMDEN YARDS Fire Response District: ADVANCE
Assessed Acreage: 0.92 Elementary School Zone: SHADY GROVE
Deed Date: 2/2004 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 005350489 Soil Types: GnB2
Plat Book: 0006 Flood Zone:
Plat Page: 169 Watershed Overlay: DAVIE COUNTY
Building Value: 122200.00 Outbuilding 8r Extra 1700.00
Freatures Value:
Land Value: 18000.00 Total Market Value: 141900.00
Total Assessed Value: 141900.00
91 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 warranties of merchantability or fitness for a particular use.All users of Davie County's GIS webshe 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 N�4 NC or arising out of the use or Inability to use the GIS data provided by this website.
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.,
ATION NO; 15 6 9 ' DAVIE C UNTY HEALTH DEPARTMENT
;Environmental Health Section PROPERTY INFORMATION
Permrt[eeP.O.Box 848
Namer� `'�1��.�OiJ YR eywi Mocksville;NC 27028 Subdivision Name: CAAQE4 VarAw
Phone# 336-751-8760
Directions to`property: I1 LT�1� 1 t�E. Section: 1 Lot:
t AUTHORIZATION FOR ^,
WASTEWATER Tax Office PIN:# -57&0-
SYSTEM CONSTRUCTION
U7r .' !
f, Road Name: ('f1 Yw�t�Cn, 4tJt i r Zip: Z 706
*NOTE**Thi s''Authorization'for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building-Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S.'Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ;
( ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
A `' a r : IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRO.*ENTAL HEALTH SPECIALIST :'::DATE ISSUED
69"z WMEOUNTY HEALTH DEPARTMENT
IMPRO EMENT AND OPERATION PERMITS . PROPERTY'INFORMATION
PeA41 s 4
Name= ��'t? '�"i3�_ 1S f'i�1/1 Subdivision Name PA F_A) �Lelr
Directions t�o property.' }t l'��1,7 t`tit ` Section: 1 Lot: ,
-q i, IMPROVEMENT, ,�>
T, i 1 i'�(? :' PERMIT ";1,r jro_ L{ . . :j.�.>�?y",
t' Tax Office PIN:# - \
Road Name. op, qtr i•.t dip;., ,7�4
**NOTE**,This improvement Permit DOES NOT authorize the construction or installation 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)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRO MENTAL HEALTH SPECIALIST ': DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE 1 UbISt-#BEDROOMS #BATHS Z #OCCUPANTS GARBAGE b1sPosAk!j5Ejj>o
COMMERCIA1L SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No .
LOT SIZE' ( uC-• TYPE WATER SUPPLY �0U n j y DESIGN WASTEWATER FLOW(GPD) 36D NEW SITE t REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE d UD GAL. PUMP TANK `GAL. TRENCH WIDTH 3 LO i ROCK DEPTH 19,1 LINEAR FT.' Sol,
OTHER 444-'
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT ,
. V�G
loos
**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 THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
b
AUTHORIZATION NO. OPERATION PE BY: DATE:.
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 05196(Revised)
APPLIerATION FOR SITE EVALUATION/IMPROVEMENT PERMIT
Davie County Health Department
Envit»nmentaiHeaith Section ,. 3 0 1998
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 E1�'ili1�O'dA4fNTA1 NEl11TH
QWE COUNTY
***DW0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. �R^efer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed ->-k,I�- (.._ „_ , /--- .f," �e�u:* $contact Person k� �/•
Mailing Address /Z V 7�/U S , Y let..) Home Phone
City/State/ZIP /� r�S 1 i✓ . Com. 2 7 0 2 Business Phone
2. Name on Permit/ATC if Different than Above
?failing Address City/State/Zip
3. Application For: ��,, ❑ Site Evaluation �ovement Permit/ATC ❑ Both
a. System to Service: &'Rouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: ## People _ # Bedrooms 3 # Bathrooms Z
�,3 '6a a42xer fTGarbage Disposal UW.5-`hing Machine 0 Basement/Plumbing 0 Basement/No Plumbing
6. Ifsc �. •<:�/::t d I/c her: Specify type !� # People # Sinks
# Commodes t Showers # Urinals # water Coolers
IF FOODSERVICE: $ Seats Estimated Water Usage (gallons per day)
7. Type of water supply: 9,<ounty/City ❑ Well ❑ commounity
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes U 40
'IMPORTANT'CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SInTE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PIN: # S'��Gy- �3'S� �
P-roperty Address: Road Name.(,---, CJ. �
City/zip a - c 27 b Z>to
If in a Subdivision provide information,as follows:
Name: c� .� _ �d S
Section: Block: Lot: 2
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 1 am responsible for all charges incurred from
this application. 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 C- _ rF �•'a S -�;
to conduct all testing procedures as necessary to determine the site suitability. Tom_
• DATE �� Z. SIGNATURE
TNIS AREA MAY BE USED FOR DRAWING YOUR SITE PLN:
E�
Application No. /
Invoice No.
Revised DCHD(07/98) _0
APPL'KATION FOR SITE EVALUATION/IMPROVEM
` Davie County Health Department Ll
Environmental Health Section
P. 0. Box 665 JAN 4 1995
Mocksville, NC 27028 +�`Y` ^
1. Application/Permit Requested By _ v G n
Mailing Address 1.Z�� �l 4,q &3 Home Phone ZC2-8
Business Phone
2. Name on Permit if Different toan Above
3. Application for: General Evaluation d Septic Tank Installation Permit
4. System to Serve: C'�iHouse ❑ Mobile Home+ �BA Place of Public Assembly
❑ Business El Industry her ,/!� 9 ❑ Unknown
5. If house, mobile home: Subdivision �Q h �i Section Lot#
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing Machine
No. of Bathrooms 'Z ❑ Dishwasher
E
Dwelling Dimensions ❑ Garbage Disposal i
6. If business, industry, place of public assembly, other: Specify type r
No. of People Served No. of Sinks ;.
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers f.
a:
No. of Showers Water Usage Figures `
F.
7. Type of water supply: tele- Pt'Publied . El Private ❑ Community
8. Property Dimensions Sewage Disposal Contractor r
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes KNo i
If yes, what type?
i
i
*NOTE: . Improvements Permits are subject to E
revocation, if site plans or the intended use change. Effective October 1, 1989. I
is
is
Directions to Property: PROPERTY INFORMATION REQUIRED:
�7
Tax Office PIN ;+6J���(/-
Road Name ,
r Box # (if available)
I"f�'�1�, city Ad✓Qih-os-
This is to certify that the information provided is correctto t e o le e and I understand I am responsible for all charges j
incurred from this application.
- V4�
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. P-12. I DO NOT OWN the property.
If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative of th avie Cou ty Health Qepartment to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determin said si ui bili y for a grounbsor n sewage treatment
and disposal system.
4—,w i
DATE SIGNATURE
.j;
P
DCHD(1/93)
i
DAVIE COUNTY HEALTH DEPARTMENT " ✓
Environmental Health Section
Soil/Site Evaluation
NAME -�'�lrD DATE EVALUATED ���A�
ADDRESS PROPERTY SIZE lJ��Qd
PROPOSED FACIILTYLOCATION OF SITE _ XXL!//f✓Qi '� rI( n
S
Water Supply: On-Site Well _ Community Public �
Evaluation By: Auger Boring Pit 61_� Cut
FACTORS 1 2 3 4
Landscape position L .1
Sloe %
HORIZON I DEPTH 6/, mol'
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH r
Texture group
Consistence
Structure lSiC
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: EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: k? 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 :lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-Vary 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
.3C--Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prisrriatic
Mineralogy
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(01-901
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streets, alleys, walks, parks, and other sites and easer
y, + to public or private use as,Qnoted.
APPROVED // �//
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c/ DATE Owner
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �� l
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME !L�'haO�U c� ��-� PHONE NUMBERa""
ADDRESS f 7 ��'� CiGu✓y� SUBDIVISION NAME �C��
QI U GMC C---�� oZ'UU o� LOT# J l •�/
DIRECTIONS TO SITE AaV IJe'r /v ���� a�' d• !�� 71a !tee�S'
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED -�
TYPE WATER SUPPLY C""y SPECIFY PROBLEM OCCURRING
DATE REQUESTED Gd INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193
11
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