251 Brier Creek RoadDavie County, NC
Tax Parcel Renort
Friday. December 30- 2016
CFt=K l24) —
223
�----251
i
0
= 176
174
166 175 —
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
H7030A0028
Township:
NCPIN Number:
5769960926
Municipality:
Account Number:
29174320
Census Tract:
Listed Owner 1:
GILBERT TERRY L
Voting Precinct:
Mailing Address 1:
149 WHITEHEAD DRIVE
Planning Jurisdiction:
City:
ADVANCE
Zoning Class:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
NC Zoning Overlay:
27006-0000 Voluntary Ag. District:
1.423 AC GREEN BRIER RD Fire Response District:
1.41 Elementary School Zone:
9/2000 Middle School Zone:
OWILLBOOK Soil Types:
0004 Flood Zone:
173 Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
Shady Grove
37059-804
WEST SHADY GROVE
Davie County
DAVIE COUNTY R -A
No
ADVANCE
SHADY GROVE
WILLIAM ELLIS
En13
DAVIE COUNTY
All data is provided as Is without warranty or guarantee of any Mnd either expressed or Implied Including but not limited to the
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County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
� Permittef,s DAVIE COUNTY HEALTH DEPARTMENT
Pj�, j�!d � PROPERT INFORMA ON
Name: A ; - �'z�
�
Environmental Health Section
q
P.O. Box 848
Directions to property: ,r
Mocksville, NC 2702E
Subdivision Name:.�1
f
Phone #: 336-751-8760
Section: Lot:
0 P
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Tax Offt e PIN:# - -
002900 A
G
AUTHORIZATION NO:
Road Name: Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pen -nits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pen -nits.
(In compliance with Article 11 sof G.S. Chapter 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems)
/j (� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
-
tNVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
Al
RESIDENTIAL SPECIFICATION: BUILDING TYPE At # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE I' �3 `LTYPE WATER SUPPLY v DESIGN WASTEWATER FLOW (GPD)3(r0 NEW SITE REPAIR SITE
/f I
SYSTEM SPECIFICATIONS: TANK SIZE GAL• PUMP TANK l V /74 GAL. TRENCH WIDTH 3 (!� ROCK DEPTH LINEAR FT. ` �O
OTHER F" ti 1 {: In 15A f1C/%C 18A.19C0!5)
Eee p' ,.! May y Hi:".C7 ., uSG
REQUIRED SITE MODIFICATIONS/CONDITIONS:
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. OPERATION PERMIT 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.
DOM 01102 (Revised)
�Pewrmittee's;'1 /i f' '% / .*
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PROPERTYNFORMA ON
P
P.O. Box 848
C'
&fee/I
Directions to property:
--
"`f Mocksville, NC 27028
Subdivision Name:
3 :
i Phone #: 336-751-8760
r k�,
�"�,�)
,
,
Section: Lot:
! AUTHORIZATION FOR'
WASTEWATER
r..
," ..
SYSTEM CONSTRUCTION
Tax Office PIN - -
0 0 2
9 g A
AUTHORIZATION NO:
E:
Road Name: Zip:
**NOTE** This Authgrizatign for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any BLiilding Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
41ri compliance with Article 11 1f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 4� # BEDROOMS # BATHS � # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
• I
t lLiE
LOT SIZE TYPE WATER SUPPLYy DESIGN WASTEWATER FLOW (GPD) 3 U NEW SITE REPAIR SITE
f 1
SYSTEM SPECIFICATIONS: TANK SIZE GAL• PUMP TANK 'V GAL. TRENCH WIDTH ! I ROCK DEPTH JIV LINEA�{R FT.
` L
OTHFR /1
REQUIRED SITE MODIFICATIONS/CONDITIONS:
OPERATION PERMIT
I AUTHORIZATION NO.
OPERATION PERMIT BY:
SYSTEM INSTALLED BY:
DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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 02!02 (Revised)
APPLICANT INFORMATION
k�c (lot 62
Water Supply: On -Site Well
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
Community
Evaluation By: Auger Boring / Pit
PROPERTY INFORMATION
Public
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L
Slope %
HORIZON I DEPTH —
Texture grow
Consistence y C
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
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:
LONG-TERM ACCEPTANCE RATE:
U''t)
EVALUATION BY:
OTHER(S) PRESENT: Ajl_.P�
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 clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C - Clay
CONSISTENCE
i
I aLq
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3�t
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralog
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 05105 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
f PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
41
ASTEWATER CERTIFICATION FOR DWELLING
(ecck' a REPLACEMENT ❑
ecl�
REMODELING ❑ RECONNECTIO
Mailing Address: l fi o er CY e. e Xf
Adv C�_&C& VC 270 06�
Detailed Directions To
Property Address: a S-/ &- t c -r C—!— ea 4 -
Number: —7-36 � y,y`i1V � (Home)
n6 k& /7 16 (Work)
Please Fill In The Following Information About. The Existing Dwelling:
Name System Installed Under: Vo e //��Z– ,C/ spa e i7 , Type Of Dwelling:
Date System Installed(Month/Day/Yeaz! vG��): Number Of Bedrooms:
—e? -_Number Of People: t5
Is The Dwelling Currently Vacant? Yes ❑ No V If Yes, For How Long?
Any Known Problems? Yes ❑ NW If Yes, Explain:
N, 9a. WoYZ. 76_,7?, X
Please Fill In The Following Information About The New Dwelling:
umber Of Bedrooms: t3 Number Of People: Is
Type Of Dwelling: ��Z• , !�
Requested By:
(Signature)
For Environmental Health Office Use Only
Approved Disapproved ❑
?J
's O
Requested: /D "Z-? -02'
"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 ❑ # Amount: $ 106,6 b Date:
Paid By: Received By:
Account #: Invoice #: '7//q