373 Covington Drive Lot 80Davie County, NC
0
Tax PnrrPl R Pnnrt
Wednesdav, November 30, 2016
WARNING: THIS 1S NOT A SURVEY
Parcel Information
Parcel Number:
H806OA0080
Township: Shady Grove
NCPIN Number:
5789047712
Municipality:
Account Number:
8303406
Census Tract:
37059-804
Listed Owner 1:
TEUSCHER SCOTT C
Voting Precinct: EAST SHADY GROVE
Mailing Address 1:
373 COVINGTON DRIVE
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class: DAME COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
No
Legal Description:
LOT 80 COVINGTON CREEK PHASE THREE
Fire Response District:
ADVANCE
Assessed Acreage:
0.70
Elementary School Zone:
SHADY GROVE
Deed Date:
4/2014
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009560289
Soil Types:
WeB, PcB2
Plat Book:
0007
Flood Zone:
Plat Page:
171
Watershed Overlay:
DAME COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
p�uVia/�` All data Is provided as is without warranty or guarantee of any Idnd 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
NC no ty C 1\ or arising out of the use or inability to use the GIS data provided by this webslte.
T'
DAVIE COUNTY HEALTH DEPARTMENT �� t�
• Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT Cr -4 7D
Account #: 989900317 Tax PIN/EH #: 5789-04-7712
Billed To: Glory Home Builders Subdivision Info: COVINGTON CK Lot # 80
Reference Name: Location/Address: Covington Creek Drive -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3589
**NOTE** This Improvement/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 I I 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 _ HUC5 #People #Bedrooms � #Baths 2-�
Dishwasher: u Garbage Disposal:
Commercial Specification: Facility Type
Washing Machine: Basement w/Plumbing: El Basement/No Plumbing: 13
#People #People/Shift #Seats Industrial Waste: 13
Lot Size L4 AC12L Type Water Supply ' Design Wastewater Flow (GPD) SW Site: NewRepair
System Specifications: Tank Size `CCOGAL. Pump Tank GAL. Trench Width 25 o Rock Depth �2 Linear Ft. 3L�
Other:Si�tQ�TIO,J `tZfj}.S
Required Site Modifications/Conditions: j,)!!—j—AL ,�o
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:
DCHD 05/99 (Revised)
J
N
s
1
Date: D
,4
DAME COUNTY HEALTH DEPARTMENT
` Environmental Health Section
P. O. Bog 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 989900317
Billed To: Glory Home Builders
Reference Name:
Proposed Facility: Residence
ATC Number: 3589
Tax PIN/EH #: 5789-04-7712
Subdivision Info: COVINGTON CK Lot # 80
Location/Address: Covington Creek Drive -27006
Property Size: see map
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**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 WASTEWATE T c S V ID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature:
Date:
U FT -
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.
IK D4Tf
2-Zg
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
CIL_
Date:
1^v?•22 �
7a ' E
01 18' i'"
ROAD
LENGTH
1680
3250
98.12 S 847' 20 E Q7
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EXIST. q DIRT ROAD _ l-
OLL
DATA TABLE
LINE
DISTANCE
I BEARING
L:1
21.42'
S 78' 35' 2' W
L: 2
21.95'
N 78' 35' ?' E
Lot 42, Map H-8
Alan M. Bailey _
DB 167, PG 901 -_
PLAT KEYNOTE
01 IiYP. BUILDING SETBACK
OTYP. 5' UTILITY EASEMENT AT R/W
GENERAL NOTES:
1'. NCGS.-MONUMENT 'PO'
DISTANCES FROM 1/2
IS N 79'21'08"E 193:
l ' k
APPLICATION FOR SITE EVALUATION IMPROVEMENT PERMIT & A
Davie County Health Department FP 2 6 ZO(
EnvironmentaiHea/th Section
P.O. Box 848/210 Hospital Street ENVjRD
Mocksville, NC 27028 vzec
(336) 751-8760 NJy
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed : J Contact Person -XI.//'f J T yrPY
Mailing Address 93 ilke".lVel-r I ove- Home Phone2.?/ e z- /
City/State/ZIP G le m m bo I zzL -6 - 2= 20 /a _ Business Phoneo'i:`-
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation Ll-'Ilprovement Permit/ATC ❑ Both
4. System to Service: ® House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. Type system requested: 0 --Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People # Bedrooms # Bathrooms
L116ishwasher ❑Garbage Disposal Ckashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type It People tt Sinks
t.
# Commodes # Showers # Urinals # Water Coolers
1
IF FOODSERVICE:. #Seeaats Estimated Water Usage (gallons per day)
8. Type of water suppiy: -u- County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes G-R'o
If yes, what type?
r
***IMP0IZTAJV1'#** CLIENTS h1UST COMPLETE THE REQUIRED PROPER'L'Y INFORMATION REQUES'T'ED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client witli THIS APPLICA'T'ION.
Property Dimensions: & X J O
/
Tax Office PIN: # S'- 7 9 - g4'2 24 q. I
Property Address: Road Name. C Ov,'e?4 Z", X�r -
City/zip Lla"Il e e- .1 )z2
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot: go
WRITE DIRECTIONS (from Mocksville) to PROPER'T'Y:
fo
f 10 T
L� ✓lliC d [� GKo�u�
Date home corners flagged: L— 2i'-> "ate
This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernnit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the fufornnation
submitted in this application is falsified or changed. 1, also, understand that I am responsible for all charges incru•red frons
this application. I, hereby, give consent to the Authorized Representative of the Davie County IIe• I h Dcpartmcut
to enter upon above described property located in Davie County and owned by
to conduct aalllll' testing procedures as necessary to determine the site suitabi 'ty.
DATE / SIGNATURE
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).
_S
V
Sign given
Revised DCHD (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No.
Innvoice No.
ff'
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT '�
` Davie County Health Department
Environmental Heald( Section A I g
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760 z-
***IMPORTANT*** THIS APPLICATION CANNOT BE PMMSSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. flame to be Billed Zs)yit- Contact Parson Q!eO/cz
!ailing Address -?b'e()X �oa Rome Rhona 917? -
3-cit2)
y/state/LIP 0L& AJLe, A)L-, �-71)/ nusiness Rhone
`7► 1 d
Z. llama on Permit/ATC it Different than Above
Mailing Address
3. Application For: Site Evaluation
t, system to service: House ❑ Mobile Rome
S. if Residence: i People
City/state/Lip
❑ Improvement Permit/ATC ❑ Both
❑ Business ❑ Industry ❑ Other
0 Bedrooms # Bathrooms
it Dishwasher n Garbage Disposal L1 washing Machine U Basement/Plumbing ❑ Basement/No Plumbing
S. if Business/industry/other: specify type i People i sinks
i Commodes i showers urinals # !rater Coolers
IF FOODSERVICE: # Seats/� Estimated Water Usage (gallons per day)
7. Type of water supply: /bounty/City ❑ Well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUST CIDMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either it PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 1y . ts y f�'L
Tax Office PIN: # .S —77 r7 - 9 2/'
Property Address: Road Name
City/Zip
If In a Subdivision provide information, as follows:
Name: bA) 2C' � Z - L
.!�-d Jlo4n5
Section: Block: Lot:D
WRITE DIRECTIONS (from Moclaville) to PROPERTY:
('i' /I A -X -X r )e S) eS
Date Property Flagged: +0 S 6l'l 4 -
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 ant 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 all testing procedures as necessary to determine the site suit _
DATE SIGNATURE •�
C
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).
Site Revisit Charge
Date(s):
I Client Notification Date:
`EHS:
Revised DCHD (07/99)
Account No. j�
Invoice No. / p -7 5
APPLICANT INFORMATION
Account #: 990001288
Billed To: Richard Short
Reference Name:
Proposed Facility: RESIDENCE
Water Supply:
Evaluation By:
On -Site Well
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 5779-942269.80
Subdivision Info: COVINGTON CK III Lot # 80
Location/Address: Covington Creek Drive -27006
Property Size: SEE MAP Date Evaluated: 3� -:?-8a
Community /
Auger Boring Pit V
Public 11�
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH ''
Texture group
Consistence rJ
Structure J
Mineralogy 7
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 i
SITE CLASSIFICATION: 0
LONG-TERM ACCEPTANCE RATE: r
REMARKS:
EVALUATION BY:
OTHER(S) PRESENT:
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
Moist
VFR - Very friable FR - Friable FI - Firm 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
Mineralogy
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 05/99 (Revised)
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