1426 Peoples Creek RdDavie County, NC -
Tax Parcel Report 6 q 4 9 Wednesday, October 5, 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:
WARNING: THIS 15 NOTA SURVEY
Parcel Information
G90000000806 Township: Shady Grove
5789794096 Municipality:
82523283 Census Tract: 37059-804
TREMBLAY RUSSELL W Voting Precinct: EAST SHADY GROVE
1426 PEOPLES CREEK ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
Land Value:
Total Assessed Value:
NC
Zoning Overlay:
27006-7450
Voluntary Ag. District:
No
4.680 AC PEOPLES CREEK RD
Fire Response District:
ADVANCE
3.91
Elementary School Zone:
SHADY GROVE
8/2004
Middle School Zone:
WILLIAM ELLIS
005680916
Soil Types:
WeB
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
255800.00
Outbuilding & Extra
101300.00
Freatures Value:
55510.00
Total Market Value:
412610.00
412610.00
9 A��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
�pUl3'�4 NC or arising out of the use or Inability to use the GIS data provided by this website.
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Davie County Health Department
lis t� Environmental Health Section
.J P.O. Box 848
210 Hospital Street
. Courier #: 09-40-06 g
Mocksville, NC 27028
Phone: (336) - 753 - 6780
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Fax: (336) - 753-1680
Name: re r,7 4 lau Phone Numbe 33 6 [ ��-02 ,� --Y (Home)
Mailing Address: l E'oj9e YQ �K �J s '7� In
(W/ork)ccj�
Email Address: f YI VnLU Ih C vc � l��• 6ovzl
Detailed Directions To Site: QCD je b S Cr" U
Property Address:
Please Fill In The Following Informatiion About The EXISTING Facility:
/ V/
Name System Installed Under: amm'W Type Of Facility: �Use_-
Date
System Installed (Month/Date/Year): Lq q�Number Of Bedrooms: J Number Of People:
Is_The Facility_CurrentLy Vacant? Yes L If Yes, For
Any Known Problems? Yes P If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
, „i'GT
Type Of Facility: /U I ed (-1Q 1 "P— Number Of Bedrooms: umber of People
Pool Size: 500 -5 arage Size: Other:
Requested By: Date Requested:
(Signature)
For Environmental Health Office Use Only
Environmental Health Specialist
Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken a§ a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order # Amount:$ Date:
Paid By: Received By:_
Account #: Invoice #:
-a.,dmAo
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NQw `J�DAV E COUNTY HEALTH D PARTMENT �"
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name ; -1 `fit a Date —L N2 7 ,i'1 �'
Location
Subdivision' Name Lot No. Sec. or Block o.
Lot Size > `r House i Mobile Home _ Business Speculation
No. Bedrooms —' No. Baths No. in Family j.
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES (0' NO
Auto Wash Machine YES p' NO ❑ ,
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
3
Improvements permit b
*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: System Installed by
t
Certificate of Completion 1 �' Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
�; • . • - DAVIE COUNTY HEALTH DgPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems
Permit Number
Name ' ,
_ `�\1
L'
�`'� c ,-j Date
N –
Location
Subdvision'Name
Lot No. Sec. or Block No.
Lot Size ��
House
!,'`
Mobile Home _ Business _—
Speculation
No. Bedrooms
— No. Baths
— `" —
No. in Family -Y —
Garbage
Garbage Disposal
YES ❑ NO
❑
Specifications for System:
Auto Dish Washer
YES ❑" NO
❑
Auto Wash Machine
YES Q-, NO
❑
( , `
�,
Type Water Supply
,.
{._� Iii �` .�\ 1�
� `✓ �.. P'•,`^,
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
1
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13
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:
System Installed by
' G
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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 in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
.. Davie County Health Department
C
Environmental Health Section R�
P. 0. Box 665 j AW ( a,�,-% V0
Mockraville, NC 27028
1. Application/Permit Requested By
Mailing .Address -L aV/- t c:970vh
Home Phone a�q� -I� g --1 tS Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above J�4`
/
4. Application/Permit For: General Evaluation0 S/Tank Installs i '
5. System to Serve: House Mobile Home (] Business
Industryu Other Unknown
6. If house, mobile home: Subdivision
No. of People 'T
No. of Bedrooms
No. of Bathrooms _
AWashing Machine
Sec. --" Lot#
Dwelling Dimensions S ,
Basement/Plumbing
Basement/No Plumbing
Dishwasher 0 Garbage Disposai
7. If business, industry, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
8. Type of water supply: Public 0 Private 0 Community
9. Property Dimensions //'('a �O 8
10. Sewage Disposal Contractor
11. Do you anticipate additions/expansions of the facility this system is
intended to serve? Yes o
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5
years from date issued. Improvements Permits are subject
to revocation, if site plans or the intended use change.
Effective October 1, 1989.
This is to certify that the information provided is correct to thee
best of my knowledge, and I understand I am responsible for all
charges incurred from this apple ation.
ZL() '�
Date Signature
Directions to Property:
Y
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DCHD (10-89)
DAVIE COUNTY HEALTH DEPARTMENT `' °'
ENVIRONMENTAL HEALTH SECTION it
919
SITE EVALUATION CONSENT FORM�'o J
1. Complete the form below and return to the Davie County Healt De artment.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
(office use only)
yes 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from dCc�e 2 )� , owner to obtain a
owners name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described propertyand conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
VIVA6 - q&4 W,
DATE SI NATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
_ — Owner only
_ Owners designated representative
&Anyone requesting results
Only those listed below
P"; 90.
DATE
DCHD (11 /84)
E
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. 0. Box 665
Mocksville, N.G. 27028
SOIL/SITE EVALUATION
Name
�`�s
A
Date
S
Address
%�" Q
Lot Size
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
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FAr:TnRl4 AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/ Landscape Position
j
PPS
kus
S
U
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
<
S
PS
U
3) Soil Structure (12-36 in.)
Clayey Soils
S
(2D
PS
S
O
U
U
U
1) Soil Depth (inches)
SS
SS
�_T
U
U
i) Soil Drainage: Internal
Q
PS
S
U
S
S
U
External
PS
PS
PS
PS
U
U
U
U
1) Restrictive Horizons
^ /
�.�
Available Space
PS
S
S
PS
U
U
U
U
1) Other (Specify)
S
g
S
PS
S
PS
S
PS
U
i) Site Classification
lJ
PIS
c
S
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments: d
Described by \ �_-?� Title S Date
SITE DIAGRAM
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DCHD (6-82)