137 Country Circle Lot 19Davie County, NC I Tax Parcel Report Tuesday, November 29, 2016
122 1326
205
138
154
187
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rri
131
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1
171 55
163--
1277
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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, Impliedwairan es 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, consultants, contractorsor employees from any and all claims or causes of action due to
1:01 NC or arising out of the use or Inability to use the GIS data provided by this websft
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
E814OA0019
Township:
Shady Grove
NCPIN Number:
5881119824
Municipality:
Account Number:
56327000
Census Tract:
37059-803
Listed Owner 1:
PERKINS DAVID DUANE
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
137 COUNTRY CIRCLE
Planning Jurisdiction:
Davie County
City: ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
LOT 19 COUNTRYSIDE
Fire Response District:
ADVANCE
Assessed Acreage:
2.03 Elementary School Zone:
SHADY GROVE
Deed Date:
3/1994
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
001730012
Soil Types:
Se13,GnI32
Plat Book:
0005
Flood Zone:
Plat Page:
210
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
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, Impliedwairan es 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, consultants, contractorsor employees from any and all claims or causes of action due to
1:01 NC or arising out of the use or Inability to use the GIS data provided by this websft
s .
Pennittee's� : DAVIE COUNTY HEALTH DEPARTMENT
Nie; V �L� `'t' 1' t� tfl�' Environmental Health Section PROPERTY INFORMATION
(' f P.O. Box 848 /
Mocksville, NC 27028Directions toproperty: Subdivision Name:
Phone #: 336-751-8760
Section: Lot:
r f t4 AUTHORIZATION FOR
{• 1§' "� WASTEWATER Tax Office PIN:#er-
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 003033 A Road Name: 131 (rtA Zip: c
**NOTE** This 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)
r� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH . ECIALIST DA E ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS � # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
f�e 1cc aP O n OV f AAA.
LOT SIZE TYPE WATER SUPPLY ` Q�� DESIGN WASTEWATER FLOW (GPD) 1/0 NEW SIT REPAIR SITE
C%xI 5 � 11
SYSTEM SPECIFICATIONS: TANK SIZE ��AL. PUMP TANK GAL. TRENCH MgBTH— ----R YrDEP7H. LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
Q.xisk 6e p1«11,;�<
11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1
OPERATION PERMIT
SYSTEM INSTALLED BY:liC
�r r
AUTHORIZATION N0203(f' OP TION PERMIT BY: AN W DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM D SCRIBED 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 02102 (Revised)
' .! � Q a S _ {,� r t v aii; 9`P `' s Cly+,'"., �':1: [A. ♦ / � aY i ,. A - M1 _ t - P .,. - .ab
°Peintitl s�._ i ;
' r AVIE CVUI'N l HEALTH DEPARTMENT
Its PROPERTY INFOR
Na
v
Environmental Health Section
i �
to property: ' J ' l
r �'
P.O. Box 848
Mocksville, NC 27028
jATION
Subdivision Name
,, ^Directions
~ 1.IT I./ r
t.!
..
Phone #: 336-751-8760
.,,
Section: Lot:
r•
AUTHORIZATION FOR
WASTEWATER
Tax Office PIN:#`,"
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 003013
A
Road Name: i 3'� ((I'' / = `III � "ff'Zip:
**NOTE** This 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 withArticle11 of G.S. Chapter 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH S ECIALIST DA E ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS // #`.BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL W4STE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) L/ NEW SITE -"' REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE �' t GAL. PUMP TANK GAL. TRENCH.AIEPTH_. LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
I IMPROVEMENT PERMIT LAYOUT
r -
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT SYSTEM INSTALLED BY:%UGt
-� Nibd ex pw felt 1k .
fPERMIT
AUTHORIZATION NO.OPEt/ - -- DATE: / G
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM D SCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALT: IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102 (Revised)
v
i �
I�
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT SYSTEM INSTALLED BY:%UGt
-� Nibd ex pw felt 1k .
fPERMIT
AUTHORIZATION NO.OPEt/ - -- DATE: / G
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM D SCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALT: IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102 (Revised)
9
:Nr
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PERMIT SYSTEM INSTALLED BY:%UGt
-� Nibd ex pw felt 1k .
fPERMIT
AUTHORIZATION NO.OPEt/ - -- DATE: / G
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM D SCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALT: IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02102 (Revised)
Y
Phone
aunty Health Department
nmental Health Section
P.O. Box 848
210 Hospital Street
Courier # : 09-40-06
Mocksville, NC 27028
rm: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One Re lacement Remodeling Reconnection
Name 7` (/ OW�( ���Ki�Us Phone Number, 7 0' W / (Home)
Mailing Address: 1.9-7 u J 7612 (Work)
Detailed Directions To Site:
6A1 ff R /. -Mf az
nj (50 Ta 7bhp
Property Address: Z97�
) .17-�6C ' 7-0 CY f i fi�/8t
Please Fill In The Following Information About The EXISTING Facility:
tfW v ff0t)6o 46 fk'50 L'1q
10 /.5fitf Les
.J r#�C- 6Rn o '�7REE i
dN LF��
Name System Installed Under: 6 fai-Jo#A.�5ooJ &14iY, Type Of Facility: A9"6 -
Date System Installed (Month/Date/Year): Number Of Bedrooms:_& _Number Of People:
Is The Facility Currently Vacant? Yes No If Yes, For How Long?
Any Known Problems? Yes No If Yes, Explain: '
Please Fill In The Followi nforTatin bo 9W�a ilitt
Type Of Facility: E u1�I�AT)'t'L'�ber Of Bedrooms: Number of People
Requested B Date Requested: -7110 //0
gnature)
For Environmental Health Office Use Only
fpompr—ove�—ments:_ QAC 1'VICuI�N� Q i�F 1arr _/I�i Gth(%l(rn
Environmental Health Specialist - 4Date: r7��3�ZC5/D
T
*The signing of this form by the Environmental Health Staffis in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for ^ n��ove�nXer o rof�i�me]I_
Payment: Cash Check Money Order #
Amount:$
Paid By: Received By:
Account #: Invoice #:(�'
hzmoP�
Date:
_'Se;> -- � -.'f 'F, �'i� �, j •� .c > .t`n i .-.ry+"..r � e.4-
A
-
' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
SanitaSewage Systems
Date
ate
Location
Permit ,�I�u�bGer
N\o (jj
\ ,.qo 1::
Subdivision Name' Lot No. Sec. or Block No.
Lot Size House Mobile Home— Business -- Speculation
No. Bedrooms .No. Baths No. in Family —
Garbage Disposal YES [j NO ❑ Specifications for yste�m:
Auto Dish Washer YES NO 171
Auto Wash Ma^hine 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.
1=
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.'TeIephone Number 704-634-5985.
Final Installation Diagram:
System Installed by //C4itr�^
Certificate of Completion Date 1� - 1
*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.
i
Y ,
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By S �C> �nhn50n
Mailing Address WRCTT Q rY -(2 Qct -kPmry, L,c�� C a`lfll Z
Home Phone Business Phone IL OSS
2. Name on Permit if Different than Above Onr\ Ori ):U\ �
3. Application/Permit for: ❑ General Evaluation
4. System to Serve: House ❑ Mobile Home
Septic Tank Installation
❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision ys`Je SectionLot #
No. of PeopleY
No. of Bedrooms 7
i
No. of Bathrooms a��-
Dwelling Dimensions TPmy • 3g X3-3 J s-(ojz! �
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
❑ Basement/Plumbing
❑ Basement/No Plumbing
2 Washing Machine
dishwasher
B' Garbage Disposal
7. Type of water supply: 2 -Public ❑ Private _ ❑ Community
8. Property Dimensions 430�C - � Sewage Disposal Contractor �ie4�t 5DJ
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2 -No
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.
Directions to Propelie-?O1 fa (JndeR P9--5 R�- J . RdX (` Wt: je3 Sov O"
�ov/t�f2 Se d P . �q �e v�d E,014KCI CZ ofl 7La COU 4 �Ry
u,�d�rz�g55 �d2.
V youd� e f s
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 9 1. 1 OWN the property. rJ 2. 1 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 the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE
DCHD (12-90)
SIGNATURE
Q DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
IS DATE EVALUATED q y �-, �
NAME -5
�
ADDRESS PROPERTY SIZE X1]6 x -390
PROPOSED FACIILTY os LOCATION OF SITE d" N� Ell e" �9
Water Supply: On -Site Well / Community Public ✓
Evaluation By!�� Auger Boring V Pit Cut
FACTORS
1
2
3
4
Landscape position
S
1
S
Sloe Z
O-�
HORIZON I DEPTH
I 1)
g '
Texture group
Q_L
1—
Consistence
_L.
-1--
_
Structure
C iZ
Mineralogyi
% 1
HORIZON II DEPTH
Texture group
C,
Consistence
_
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
-5 s
�'
RESTRICTIVE HORIZON
SAPROLITE
--
-�
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
�-c
)T I
L4
SITE CLASSIFICATION:
W's
LANG -TERM ACCEPTANCE RATE:
REMARKS:g � NA
DCHD(01-901
cq
EVALUATED BY: \ ��
OTHER(S) PRESENT: 'k-1--.1 o
31
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
T-vt»r-
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
Moist
VFR-Very friable FR -Friable FI -Finn 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
SC -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineralo¢y
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
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size,
FACTORS AREA 1 ARFA 9 ARFA 3 APPA A
1) Topography/ Landscape Position
S
S
S
PS
PS
U
U
?) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
S
PS
PS
65
U
U
I) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
P
(P5J
PS
PS
U
U
1) Soil Depth (inches)
S
S
S
S
PS
PS
PS
U
U
U
i) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
U
U
External
S
PS
S
PS
S
PS
U
U
i) Restrictive Horizons
Available Space
S
S
PS
S
PS
PS
U
U
U
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Site Classification
,S
U—UNSUITABLE S—SUITABLE
Recommendations/ Comments: ,,491�� 1a�4 44W
PS—Provisionally Suitable
.-
Described by Title ��/ Date
SITE DIAGRAM
DCHD (6-82)
).O -t I I