1673 Yadkin Valley Rdt
Davie Countv. NC
Tax Parcel R ennrt
Wednesdav, October 12. 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 i Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
WAKNIN(T: 1tllS 1S NU1 A SUlZV�:Y
Parcel Information
C70000000601 Township:
5863218610 Municipality:
Farmington
82521120 Census Tract: 37059-802
BAILEY KYLE W Voting Precinct: FARMINGTON
1673 YADKIN VALLEY ROAD Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R-20
NC Zoning Overlay: DAVIE COUNTY QD
27006-0000 Voluntary Ag. District:
0.935 AC YADKIN VALLEY RD Fire Response District:
9��'�' Davie County,
`'ovr��c� NC
0.94 Elementary School Zone:
7/2003 Middle Schooi Zone:
004940650 Soil Types:
Flood Zone:
Watershed Overlay:
187730.00 Outbuilding 8� Eutra
Freatures Value:
23320.00 Total Market Value:
213620.00
No
FARMINGTON
PINEBROOK
NORTH DAVIE
GnB2
DAVIE COUNTY
2570.00
213620.00
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Davie County Health Department
Environmental Health Section
� � � � 0/ � P.O. Box 848
201� 210 Hospital Street
MAY � 5 Courier # : 09-40-06
Mocksville, NC 27028
�Y�_
Pl�one: (336) - 753 - 6780
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
F�ix: (336) - 753-1680
Name: �j� �j. �� �E� Phone Number % 3�' ��%,�'77� (Home)
Mailing Address: % �%R�/ �' 33� � J�'l -�`,S'c�i (Work)
/ � ' lvC: '7 Email Address:
Detailed Directions To Site:
, � Il9 �iz� i�ai��;f
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: S1R�r Type OfFacility:�b1�1.
� Date System Installed (MonthlDate/Year): �� Number Of Bedrooms: � Number Of People: %
Is The Facility Currently Vacant? Yes � If Yes, For How Long?
Any Known Problems? Yes (�Id if Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: (���� q� Number Of Bedrooms: Number of People
Pool Size: Garage Size: %iA )( 2.� Other:
� equested By:
�
Approve Disapproved
Comments:
Environmental Health Specialist
Requested: S��JZoJ�
For Environmental Health Office Use Only
Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as 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 #
Paid By:
Amount:$ , �1C� Date: ' �v /
Received By: ,�; „
�
Account #: � �'Z Invoice #:
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� "' �CIUNTY HEALTH DEPAR �
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. % IMPROVEMENT$ PERMIT AND CERTIFICATE OF COMPLETION
"NOTE:• Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c . �
� Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
4-� �- (o ' c6-� '`'� � �0
Name ���,.r: ..�, ��>,M=� ���.�:.s. Date '�••• t� s
�ocation �� 1 � .� c�'�1.�'}��1!� � c.��� r,� c.•� N �� �,'�c� �,c v•..., �.
. � ,
• � � \ _ � ���(:S1 `� ,w'�'►.r\�C'3.' 'ti� � �I!i•.� C��? � � �� l"t\ �h/.1��JC' ,��.. V \'1��i7._ �'y�\ -
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�, �.-ti.-�,.�--a. �� �`.:�.- �.� r�.,� • � �
Subdivision Name Lot No. Sec. or Block No.
Lot Size � �� ' �-� �` House Mobile Home _V� Business Speculation
• No. Bedrooms � No. Baths ` No. in Family �� _
0
Garbage Disposal YES �❑ NO ❑ Specifications for System:
'Auto Dish Washer YES ❑ NO ❑ /4o r� - �.� �:�-._�_ ' r..3 � � ��'i
Auto Wash Machine YES p NO {] � �� � x � t X ` ��
Type Water Supply . O� t�'�� , _ . �
�.a� � �`
��� ��� ' ��'�.�;.:;,y
'This permit Void if sewage system described below is not installed�within 36 months from date of ssue.
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Improvements permit by — • ���
*Contact a representative of the Davie Cou�ty 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 c m�let�bn. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by /�-���ui1 �
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1
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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 �1
Davie County Health Department ��p� 3 A
Environmental Health Section ��c1v�,
P. O. Box 665 � Y�
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone Qa�' - �q� S
1. Permit Requested By �'71 i�s Tr c�,.�� �r Ic e. r Business Phone
2. Address �� � C-�c'�x �y,5 Qdvr�n�P ,�� �7l�bLo
3. Property Owner if Different than Above
Address
4. Permit To: a) Install ✓Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home� Business
Industry Other
b) Number of people a
6. a) If house or mobil�ome. state size of home and number of rooms.
House Dimensions � U K� �
Bed Rooms�— Bath Rooms� Den w/Closet�_
b) If Business, Industry or Other, State: Number of persons served ►�A
What type business, etc. u�
Estimate amount of waste daily (24 hours) ►-�A
7. Number and type of water-using fixtures:
commodes � urinals �►� garbage disposal No
lavatory � � showers � washing machine �
dishwasher � sinks �
8. a) Type water supply: Public ✓ Private Community
b) Has the water supply system been approved? Yes� No
9. a) Property Dimensions � S4 X�'7�
b) Land area designated to building site 1�I X l nD
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? No�l a.J-prrsen-�-
What type?
This is to certify that the information is correct to the best of my knowledge.
Date
��Jt,Q./C'.�-� , I��,%[�.�_
Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD (6-82)
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Hea�th Department.
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 P,ECEIVED
(office use only)
'�dk i,� ti� [(� � �,�-c�
es no
yes no
yes
1. I am the owr�er of thE above described property.
2. I am not the owner of the above described property, however, I certify that I
have consent from
, owner to obtain a
owner's 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.
no 3. I hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above describE�i property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
�'�7
DATE
�.1I� �2 � . �"Cvt�'� .��
� SIGNATURE
4. I hereby authorize the Davie County Health Department to release site
evaluation resu ts from the above described property to the following:
► Owner only
�Owners designated representative
_ Anyone requesting results
— Only those listed below
3-3�..87
DATE
DCHD (11 /84�
/
♦ La. .. _� :
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name ` ` Date � b � �
Address � �- `'� � Lot Size � '� U ^ �--��
FACTORS
1) Topography/Landscape Position
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
3) Soil Structure (12-36 in.)
Clayey Soils
4) Soil Depth (inches)
5) Soil Drainage: Internal
External
6) Restrictive Horizons
7) Available Space
8) Other (Specify)
9) Site Classification
U—UNSUITABLE
Recommendations/Comments:
Described by �' �
SITE DIAGRAM
ARE 1
PS
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U
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U
S
�
�P
�
U
S
PS
BLE
S
�
S
�
�
U
�
S
�
�
U
S
U
S
PS
S
AREA 3
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
PS
U
S
PS
U
onally Suitable
AREA 4
S
PS
U
S
PS
U
PS
U
S
PS
U
S
PS
U
S
PS
U
PS
U
S
PS
U
Title � Date � F � !��
DCHD (6-82)