Hickory Hill Clubhouse Repair ShopDavie Countv. NC
Tax Parcel Report Tuesday. January 24. 2017
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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 o►fltness for a particular use. All users of Davie County's GIS website shall hold harmless the
/'rCounty of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of'action due to
NCor arising out of the use or inability to use the GIS data provided by ads website.
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
J60000005401
Township:
Shady Grove
NCPIN Number:
5768027464
Municipality:
Account Number:
8306111
Census Tract:
37059-804
Listed Owner 1:
BLUE DOG HOLDINGS LLC
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
324 NORTH SPRING STREET
Planning Jurisdiction:
Davie County
City: WINSTON SALEM
Zoning Class: DAVIE COUNTY R-12-S,R-20
State:
NC
Zoning Overlay:
Zip Code:
27101
Voluntary Ag. District:
No
Legal Description:
183.285 AC HWY 64
Fire Response District:
FORK,CORNATZER - DULIN
Assessed Acreage:
185.78
Elementary School Zone:
CORNATZER
Deed Date:
3/2016
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
010130249
Soil Types: MrB2,GnB2,GnC2,EnB,MsC,WATER,MsD
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
1-W—j
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 o►fltness for a particular use. All users of Davie County's GIS website shall hold harmless the
/'rCounty of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of'action due to
NCor arising out of the use or inability to use the GIS data provided by ads website.
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DAVIE COUNTY HEALTH DEPARTMENT
„ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in .Compliance with G:S. -of North Carolina Chapter 130 Article '13c `
Sewage Treatment and Disposal Rules (10 NCAC 10A ..1934-.1968) Pel'mit. Number
Name Date
Location
yam,,, �3 \ �.
--i \AN
Subdivision Name ' Lot No. Sec. or Block No.
Lot Size __ House-_ Mobile Home ____ Business Speculation
No. Bedrooms - No. Baths, — _ No. in Family
Garbage Disposal YESE] NO_°[] Specifications for System:
Auto Dish Washer' YES E] NO '
Auto Wash Machine YES .0 NO �[]
Type Water Supply" : -- -- Cif f( D) :+(
*This permit Voidjf- sewage system described below is not installed within 36 months, from date of issue.
x.
,a
Improvements permit by
i
*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. onr day of completion. Telephone Number: 704-634-5985. .
Final Installation Diagram: System Installed by
• Certificate of. Completion- = — Date
*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' betaken as a guarantee that the system will function,: '
satisfactorily for any given period of time.
3 APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department 4
Environmental Health Section GG
40
P. 0. Box 665 6v
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
,,`` a ci'`f Home Phone
1. Permit Reque ted By rT7 � % �ar/- Business Phone _ �19�'
2. Address - 6 d
9 F
3. Property Owner if Different than Above
Address
4. Permit To: a) Install-ZAlter Repair
b) Privy Conventional Other Type
Gro.�!nd Absorption
r'71 c-ka rm t 11
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other ✓ 7y(q ihfeha NC e,
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms Bath Rooms Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc. /We re"a v`
Estimate amount of waste daily (24 hou
7. Number and type of water -using fixtures:
commodes ( urinal
lavatory
dishwasher
showers
sinks
A
8. a) Type water supply: Public ✓ Private ` Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions -ln - -die k/
b) Land area designated to building site
garbage disposal
washing machine
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? `716
What type?
This its to certify that the information is correct to the best of my knowledge.
C1 — tAp're'J", 6q�;
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
5. J i_&rL 0i ��
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DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name—
Address
ame Address
Date
Lot Size
FArTOP.q ARFA 1 ARFA 9 ARFA 3 ARFA d
Topography/ Landscape Position
9)
S
S
P
PS
PS
U
U
U
') Soil Texture (12-36 in.) Sandy,
ct)
AF
S
PS
S
PS
Loamy, Clayey, (note 2:1 Clay)
U
U
U
U
1) Soil Structure (12-36 in.)
Clayey Soils
P
S
PS
S
PS
U
U
U
U
i) Soil Depth (inches)S
fks
PS
S
PS
PS
U
U
U
�) Soil Drainage: Internal
S
PS
S
PS
U
U
U
U
External
(I
(A
S
PS
S
PS
U
U
U
U
i) Restrictive Horizons
Available Space
P^
S
PS
S
PS
U
U
U
U
1) Other (Specify)
A)
c P�
S
PS
S
PS
U
U
U
Site Classification
S
S
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by Title ��'* �'`� Date
SITE DIAGRAM
DCHD (6-82)
AU7110RIZATION N3: 13 0 6 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Ferm ee's ll P.O. Box 848
Name: IC (A I It�' ( Cnt n �' i t Mocksville, NC 27028 Subdivision Name:
?. O. S LeyC 2.7a X Phone #: 704-634-8760
Directior-s to property: �a 4 t Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
Road Name: A ✓ /, y� ZiD: 170 ?d''
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
�}y ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
.11-13-w-
" %3 - /U IS VALID FOR A PERIOD OF FIVE YEARS.
HEALTH SPECIALIST DATE ISSUED
J.
RESIDENTIAL SPECIFICATION: BUILDING TYPE 0 BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
S'k,
COMMERCIAL SPECIFICATION: FACILITY TYPE OFflze # PEOPLE a # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes No
LOT SIZE rr tTYPE WATER SUPPLY ��^ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE �"
SYSTEM SPECIFICATIONS: TANK SIZE Lo00 GAL. PUMP TANK GAL. TRENCH WIDTH 3 I° I ROCK DEPTH W LINEAR FT. )SO
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
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**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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT � 2 j Zc�
SYSTEM INSTALLED BY:
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20
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AUTHORIZATION NO. -'fes— OPERATION PERMIT BY: DATE: S
**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.
DCHD 05/96 (Revised)