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111 Country Circle Lot 20Davie County, NC • Tax Parcel Report Tuesday, November 29, 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: Land Value: Total Assessed Value: WAMNIUrh: IMb ll 1NU1 A IUKVET Parcel Information E8140A0020 Township: 5881221024 Municipality: 82512917 Census Tract: WOLVERTON CHRISTOPHER N Voting Precinct: 111 COUNTRY CIRCLE Planning Jurisdiction: ADVANCE Zoning Class: NC Zoning Overlay: 27006-7456 Voluntary Ag. District: LOT 20 COUNTRYSIDE Fire Response District: 2.39 Elementary School Zone 811999 Middle School Zone: 003110205 Soil Types: 0005 Flood Zone: 210 Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: Shady Grove 37059-803 EAST SHADY GROVE Davie County DAME COUNTY R -A ADVANCE SHADY GROVE WILLIAM ELLIS Se13,GnB2 DAVIE COUNTY (m 1@7j All data Is provided as Is without warranty or guarantee of any Mnd either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. Ati users of Davie County's GIS website shalt hold harmless the �T�yCounty of Davie, North Carolina, its agents, consultants, contractors or employees from any and ag claims or causes of action due to l� C or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001627 Billed To. Chris Wolverton Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5881-22-1024 Subdivision Info: Countryside Lot # 20 Location/Address: Property Size: see map q 11t1�ber, 2747 **NO T�*This lm provement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type i- #People #Bedrooms _�K #Baths `S 5 Dishwasher- Garbage Disposal: Washing Machine: Basement w/Plumbingasement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size Type Water Supply _ Design Wastewater Flow (GPD) Site: NewoleRepair System Specifications: Tank Size _&_0GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width_~ Rock Depth , �4 Linear Ft��—f IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) • - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001627 Tax PIN/EH #: 5881-22-1024 Billed To: Chris Wolverton Subdivision Info: Countryside Lot # 20 Reference Name: Location/Address: Proposed Facility: Residence Property Size: see map ATC Number: 2747 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION NAM **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE WATE O STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 0.3 /S�--0 ! CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. �ll r a7' Septic System Installed By: Environmental Health Specialist's Signature: Date: A2 DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT Davie County Health Department EnOfvnmenta/Healtfi Section P.O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH flninr nn....... ***IMPORTANT*** THIS APPLICATION CANNOT HE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nasty to be Billed Hailing Address City/State/ZIP e— 2:7oob 2. Name on Permit/ATC if Different than Above Hailing Address 3. Application For: ❑ Site Evaluation *. system to service: A House ❑ Mobile Home 5. If Residence: # People _ 6. Contact Person Home Phone 221 F 7 S 70 Business Phone 70`-` 359 /52 ,v City/state/Zip Improvement Permit/ATC 0 Both Business ❑ Industry ❑ Other # Bedrooms ADishwasher n Garbage Disposal , "Hashing Machine If Business/Industry/Other: Specify type # Commodes # Showers AV-B—ement/Plumbing # Urinals # Bathrooms O Basement/No Plumbing # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes XNo If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name City/Zip If In a Subdivision provide Information, as follows: Name: Cid SI 4z�2 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Section: Block: Lot: 2-0 Date Property Flagged: 311 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. 1, also, understand that I 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 to conduct al testingroced res as necessary to determine the site suitability. DATE v SIGNATURE 1A THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07199) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. ko Invoice No. '�l D v .4A S 19047' 11"E C\ b + S IOo 40' 00" E S 000 51 57' E 9 Z 0�6 \ S 060 29' 29' W '�T o L 0 50 R/W. rn l 2.402 AC. _ v I�1� A W g �— N 340 09 00 � W Control Corner a 379.98 Z+*71.36 PS "" N A N LOT 19 7� a'o I ��/Jq3w2.035 AC. g N 0 a� f m —N 340 09 00' W 390.86 vri•T+� N 55051 04 E 56.94 LOT 1 2.028 AC.N ARCO 2513306E `� b CHORD = 131.21 1 , 0 �— N 25029 28" W 445.17 S ?g0 N ➢0 CNORD - gOOOE w �0- _ 894 g 43 0 M- 20 Drainage ^'- Easement f Ln 0 co 0 1 a LOT 17 Dr C. 0 10.343 AC. 0 ca D C tO N lD qD C®UNTRYS I DE Wo Name_ Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date %CY6 Lot Size�O/r��Q�d��� FACTORS AREA 1 AREA 2 AREA 3 ARFA 4 9) Site Classification 1) Topography/ Landscape Position (� ® S S PS PS PS PS U U U U ?) Soil Texture (12-36 in.) Sandy, ��,,,,,...,� S S S Loamy, Clayey, (note 2:1 Clay) (PSS / PS PS 3) Soil Structure (12-36 in.) S S S Clayey Soils b ® PS PS U U U U 1) Soil Depth (inches) L��� �l © © S S PS PS PS PS U U U U i) Soil Drainage: Internal S S S SjT PS PS U U U External S, PS PS Q U U 1) Restrictive Horizons { Available Space S S PS PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U U—UNSUITABLE Recommendations/Comments: S—SUITABLE 4_S--, Provisionally Suitable Described by Title Date SITE DIAGRAM 1-14' DCHD (6-82) o13V 3 L V -QS U—UNSUITABLE Recommendations/Comments: S—SUITABLE 4_S--, Provisionally Suitable Described by Title Date SITE DIAGRAM 1-14' DCHD (6-82) o13V 3 L V -QS S 38°04 16'E� � \��S\47' ICE 1(wn 471.59 72.07 91.98 g IO°40' 00" E 41° 17 34342.66- 38.32 9�� S 00° 51' 57"E z '96 ` o LOT 21 . w t 2.596 AC w .A N _34° 09 00' 1 340.00 LN 55° 51' 00" E N LOT 24 LaLo 16561 �' to L"0(D 2.793 AC. W- LOT 23 � c LOT 22 mv' z 3.293 AC. CS R• - ,c 0 8 0 ���/� CHORD = 13203 ROAO A CDO 0 ' uNOERo ws ,, z p c 0_ c m TOTAL c 17 34 E x.,..611:99 403.13 c S 41° Control 'LOS g -N 34° 09' 00" W z CA LOT 11 w�- o "N N LOT 10 0 cn - 2.560 AC. NO '-` 0 1.545 A C. 0 0 0 8 0= I i ' m Control Corner 1 N 34° 09 00' W 28500 z 4S 55° 51 00' W S 38°04 16'E� � \��S\47' ICE 1(wn 471.59 72.07 91.98 g IO°40' 00" E 41° 17 34342.66- 38.32 9�� S 00° 51' 57"E z '96 ` o LOT 21 . w t 2.596 AC w .A N _34° 09 00' 1 340.00 LN 55° 51' 00" E N LOT 24 LaLo �' to L"0(D 2.793 AC. W- LOT 23 � c LOT 22 mv' z 3.293 AC. o N Q - o 0 0 0 8 0 ���/� CHORD = 13203 2.832 AC. Ln Ao CDO 0 0 ,, z p c 0_ 0, m c M c Control Corner g -N 34° 09' 00" W 2 S 06 29 29 W w �6� N 3? LOT 20 50 R/W. 2.402 AC. A w -•- N 340 09 00' W Control Corner 379.98 'i!! LOT 12 87.42 t 87.42 U 04w N LOT 9 ^' 1 N ^� 0 1.439 AC. �° 2.031 AG ° cn y S• 46 41 50" W -'�"! ARC = 132.59 LOT 23 � c LOT 22 mv' z 3.293 AC. o N Q - o 0 0 0 8 0 ���/� CHORD = 13203 2.832 AC. Ln Ao o, . 0 0= `�/� ,, z p c 0_ f m LOT 19 2.035 AC. VICINITY MAP m - N 34° 2T 16' W a•+ v ..� •• 1, _ - f -N 34° 09' 00' W C`y oD N z 39G86 28 00 421.01 kp �.9�Ac'Pp4�, ED -4 ado o � p0 � L -N 55°51' 04" E ' C+ y co �;. �u'o.• 3 7�v! 0, Ate° O. 0 56.94 LOT 1 `z SO A(+ �o p � S Fess 0 m cn �1 0� pro 2.0 8 AC. N \o''�' o_ N 7..Lr•` o ALICE A. HARTMAN N LOT _$.. w �a °�A ��' O �'i'O7 0 - wo O' ,, eV, a N 72025' 2 }" E o w %, � p O g 0- P ARC = 133306 o 3. `} 0 1.538 AC. p z� LOT 13 ��$ �'- O F Q`�G'oti1 CHORD = I 21 o DB. 41 PG. 361 0 0 � 3.465 AC. qi G`t'PQ`,�6 ,`L� N 25029,62 163 J „ °o �� S 03�°S CQ p� 4451728 W 2 8 15 1 �N 341 28500 o w o 0 0 cy Ro2e•. UNTRY CIRCLE S X9047, N ° 4 RC _ 3 N m� 6,7.09 $g Qp�� r' o��o CNO 0 8943 c NOTE: I)TOTS 1,10,5fi21,24 8 20 HAVE A NEGATIVE ACCESS o N LOT 7 _ h w O, o 4,) p - n vi Cb, w_ 2)A 10'X 70 SIGHT EASEMENT IS LOCATED AT ALL _ 1. 370 AC. h �a o INTERSECTIONS. N_ g tim0� oN ��� N_ 3)MINIMUM SETBACK LINES: 40' FRONT LINE o-20'.Droinoge 30 REAR LINE • N 33°54 41'W .3 e �,QO o _� „"p Easement 15' SIDE LINE 284.99 �d COP? (co v,�o I 4)ALL ROADS ARE PUBLIC. �N 32°33' 58" E LOT 14 om-= +t 5)24 TOTAL LOTS IN THIS DIVISION. D ARC = 20.32 p o� p m 6)TOTAL AREA= 84.883 ACRES CHORD =1976 m 7. 59 6 AC. ` m ` 'f; Q co R = 25.00 0 / PGI 1 �4A 0 as cn LOT 6 -� w �V!1 o ` \ . 2.300 AC. - > / ^0 y mo cu OD LOT 15 a) al LOT 16 p LOT 17r- _ 1---� y yr 8.569 AC. ` 0 7922 AC p IU.343 AC. P o O =IRON PIN f =UNMARKED POINT IN CENTER OF VyAQ o ��°` _ w Nr00 bD CREEK OR ON R/W, SR 1656 ZONE A FLOOD LINE (TAKEN 0 9 o o FROM U.S. DEPT. OF HOUSING 8 m_ 3� 1+ URBAN OEV. MAP o Z ---------------- COUNTRYSIDE . 16��+ �+ N /g3 �o N 42° 15' 51'W •+. OQOi� 6� z (D° N ?-I* I3' �So'�+ 50.00 , ='- OWNERS -DEVELOPERS 87.19 2s' w N 67 11 os w CARTERS CREEK 0- N 45411tr 53"� 94.10+ �" 2°POTTS INVESTMENTS 72.44 N 56°31' 02'E�•(A + •4 ADVANCE N.C. 27006 N 06010 WE •320 6� . 80.48 TOTAL +� 49° ` 3 + �,� j PHONE _ !(919) 998-8816 50.00 +7-°z + 11400 + SHADY GROVE TOWNSHIP. 5.,2556sw N.37°28' 17"W 184.2 T8 OTAL '.s+ 50.00 �/� DAVI E COUNTY 25. 00 N 09°56 51 E ap + Z ' _ N 50° 37' 4 3" E �' � ' +� �`ao 'A so. NORTH CAROLINA - POTTS INVESTMENTS + 31 + 108. / 4 o \\ 2�N 56°27' 12"w D8. 145 PG. 557 N 3 51' 36" E "" + F 200 100 0 200 400 !- N 29° 40 53 • E N 3100 5' 46' W c 64.54 F FF