127 Wills Road Lot 3/
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:
M6
WARNING: THIS IS NOT A SURVEY
Zoning Overlay: DAVIE COUNTY QD
Parcel Information
Voluntary Ag. District:
No
0700000147
Township:
Farmington
5862779330
Municipality:
PINEBROOK
22516385
Census Tract:
37059.802
BRYANT BARBARA S
Voting Precinct
FARMINGTON
PO BOX 1750
Planning Jurisdiction:
Davie County
CLEMMONS
Zoning Class: DAVIE COUNTY R-20
Land Value:
Total Assessed Value:
NC
Zoning Overlay: DAVIE COUNTY QD
27012-0000
Voluntary Ag. District:
No
LOT 3 CREEKWOOD ESTATES SECTION 3
Fire Response District:
SMITH GROVE
0.46
Elementary School Zone:
PINEBROOK
3/2001
Middle School Zone:
NORTH DAVIE
003610002
Soil Types:
CeB2
0005
Flood Zone:
023
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
[all
All data is provided as Is withoutwummy or guarantee of any Idnd aitharezpressedor implied Including bud not limited to the
Davie County, Implied wsmantles ofmarchantabgity orfilnecs for a partict,aruss. Ali users of Davie CourhdysGlSwebaite shall hold hamdess the
County of Davie,North Carolina, Ib agent, consultants, contractorsoremployeasfrom any andall claims or causes of actiondueto
NCor arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Account #: 990005931
Billed To: Barbara Bryant
Reference Name: REPAIR PERMIT
Proposed Facility: Residential Repair
j14k,4f,d ap
Tax PINIEH #: C700000147
Subdlvlsion:Info Creekwood Section 3 Lot # 3
Localibr€iAddcess ;.127 Wills Road -27006
Property;Sizf;�.::. 0.46 Acre
ATC Number. 5971
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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.
System Type: S.T. Manufacturer Tank Date ✓ Tank Size ,/
Pump Tank Size / Bedrooms J�
System Installed By: Inspector#: Date:_?'p_la
GPS Coordinate:
Environmental Health Specialist:
DCHD 11/06 (Revised)
vj,4,�w.
✓ v P.O. Box 848/210 Hospital Street
- Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005931 Tax PIN/EH #: C700000147
Billed To: Barbara Bryant Subdivision 1nfo:,'Creekwood Section 3 Lot # 3
Reference Name: REPAIR PERMIT Location/Addri-w; 127 Wills Road -27006
Proposed. Facility: Residential Repair Prope 1%e'-%-.T4Iypair ❑Expansion
**N�QT ** Thi ��}}''thorization to Construct (ATC) MUST BE ISSUED,by the Davie County Environmental
AT�ea7Moni ibll to.issuance of any building permit(s), (in compliance with Article l I of G.S. Chapter 130A
Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms '3 # Bathrooms # People y BasementO Basement plumbing❑
Non -Residential Specifications: Facility Type # People _# Seats_
Square Footage(or Dimensions,of.Facility)
Lot Size _( / Type of Water Supply: 4County/City ❑Well OCommunity Well
System= Specifications: Design Wastewater Flow (GPD).?60 Tank SizeI AL. Pump Tank / GAL.
- Trench Width �tOk Max. Trench Deptf4LRock DeptlrA2/a Linear Ft. 360' ZZA
Site Modifications/Conditions/Other: FC6vt
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 - 9:30a.m. on the day of installation. Telephone # (3361751-8760.
Environmental Health Specialist
DCHD 11/06 (Revised)
G� D��Otn72
f '
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR fly-!_ -?L: c . ;' : //L ;)ca,., DATE I I 17 PERMIT
LOCATION (' /_._.._1✓Ac 17 ( L 1- � 1Z-7 wail Pd, N9.
SUBDIVISION NAME
LOT NO.
. L\• 1\V•
SECTION OR BLOCK NO.
1522
HOUSE El MOBILE
HOME ❑
BUSINESS ❑
House Trailer
800
Gal. 400
Sq.
Ft.
NO. BEDROOMS 5
NO. BATHROOMS .'/
Two Bedroom House
800
Gal. 600
Sq.
Ft.
GARBAGE DISPOSAL UNIT
YES ❑
NO 0-
Three Bedroom House
900
Gal. 900
Sq.
Ft.
AUTO. DISHWASHER
YES ❑-
NO ❑
Four Bedroom House
1000
Gal. 1200
Sq.
Ft.
AUTO. WASH. MACHINE
SITE SUITABLE
YES if
YES O
NO ❑
NO ❑
/� ''�Z.�CL1
�_
r
SIZE OF TANK "/.1 i%
gal.
/
NITRIFICATION FIELD"t
(
'sq. ft.
J ;
(/
N -
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑
Public ❑
IMPROVEMENTS PERMIT BY
0,1
INSTALLED BY
a.
CERTIFICATE OF COMPLETION
I 8
BY
Date
(8/16/73) *Construction must comply wi all
Xther applicable state
and
local egu
ations
LOT AREA
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C. 27028
.(704) 634-5985
4� Z-�;, 7 -"Oz
d=l/J/77
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME��i4-��c���� DATE ISSUED
ADDRESS�Q�,)G PERMIT NO. S� Z
Explanation of charge
AMOUNT DUE A .'- " SANITARIANS
\ PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF T
-- — — — — — — — — — — —
--
STATEMENT.
P,o, �6xIIN LI61100?lys PC- yoff
+ ' ' DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST
- APPLICATION IP/ATC OSWW REPAIR
le rITI �
Address
Telephone Number
Mailing Address (if different from above)
Email Address:
Subdivision Name (.L.0,kt00 od Lot #
Directions
Date System Ins led /Vjj4zU 9 j M 1� 6 1�1 l X Name System Installed Under
Type Facility Se. Number Bedrooms_ Number People Served
Type Water Supp Specific Problem Occurring � f�/J 0d C 1
Q71_ - LIAA Lt Ah/ e In
Date Requested Klzo I/ 2 y"55 Info Taken By
THIS IS TO CERTIFY THAT THETNFORMATION PROVIDED IS CORRECT TO THE BEST OF MY
KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date
REHS
Revisit Charge Date--Reason-
-
ateReason_
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
Environmental Health Survey For Sewage Treatment and Disposal Systems
Subdivision Name al ze4o/0 d Lot #_ Block
/orr Section
Date System Installed Name of Installer
Number of Previous Owners &'g/f/
Name of Present Owner /�L Number of People_
Address
Phone No. r
System Originally Designed For System Now Serving
No. Bedrooms
No. Bathrooms a
Dishwashery
Disposal lUa
Washing Machine
No. Bedrooms Q
No. Bathrooms 6x
Dishwasher oo ,/Im*r USS
Disposal )JO
Washing Machine
Number Times Septic Tank Been Pumped Average Monthly Water Usage G
Present Condition of System
Any Known Repairs to System, If So When and By Whom?
Comments:
Environmental Health Official Date