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199 Tifton Street Lot 204Davie Countv. NC . I Tax Parcel Report Thursday, October 27, 2016 City: BERMUDA RUN State: NC Zip Code: 27006 Legal Description: LOT 204 BERMUDA RUN GOLF&COUNTRY Assessed Acreage: 0.85 Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 4/2013 009240263 0004 092 318070.00 110000.00 429190.00 Zoning Class: BERMUDA RUN CR WARNING: THIS 1S NOT A SURVEY All data Is provided as Is without warranty or guarantee of any Idad either expressed or Implied Induding but not limited to the Implied warrannas of merchantability or twKss for a particular use. AN users of Davie County's cis 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 or arising out of the use or Inability to use the GIS data provided by this website. Voluntary Ag. District: Parcel Information Fire Response District: CLEMMONS Parcel Number: D806OA0026 Township: Farmington NCPIN Number: 5882035284 Municipality: BERMUDA RUN Account Number: 8302144 Census Tract: 37059-803 Listed Owner 1: WILEY GABRIEL CHRISTIAN Voting Precinct: HILLSDALE Mailing Address 1: 199 TIFTON STREET Planning Jurisdiction: BERMUDA RUN City: BERMUDA RUN State: NC Zip Code: 27006 Legal Description: LOT 204 BERMUDA RUN GOLF&COUNTRY Assessed Acreage: 0.85 Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 4/2013 009240263 0004 092 318070.00 110000.00 429190.00 Zoning Class: BERMUDA RUN CR Zoning Overlay: All data Is provided as Is without warranty or guarantee of any Idad either expressed or Implied Induding but not limited to the Implied warrannas of merchantability or twKss for a particular use. AN users of Davie County's cis 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 or arising out of the use or Inability to use the GIS data provided by this website. Voluntary Ag. District: No Fire Response District: CLEMMONS Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: GnB2,GnC2 Flood Zone: Watershed Overlay: BERMUDA RUN Outbuilding 8h Extra 1120.00 Freatures Value: Total Market Value: 429190.00 Davie County, NC All data Is provided as Is without warranty or guarantee of any Idad either expressed or Implied Induding but not limited to the Implied warrannas of merchantability or twKss for a particular use. AN users of Davie County's cis 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 or arising out of the use or Inability to use the GIS data provided by this website. t DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Se a e Tfeatment a�nnd1�1 sal Rules (10 NCAC 10A .193 Permit Number AGI vz�f Name Dater 12 Location Cithrlivicinn nlomn Lot Size _ House Mobile Home _ Business Speculation No. Bedrooms No. Baths3 Z No. in Family Garbage Disposal YES NO ❑ Sp}fir, tions r..8X�ste Auto Dish Washer YES NO ❑ / Cit'/ I Auto Wash MachineV �.A YES NO ❑ Type Water Supply *This permit Void if sewage system described below is lied within 36 onths from date of,issue../ 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. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by�i�%�%/ 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 be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone q74- 4S'9 I 1. Permit Requested By W • �•� u++� '�• w�• 4 Business Phone 2. Address 51e 7l0• t�o`� I A R L4� a , `i7 FPFF 'Taws n c- z-7 04 o 3. Property Owner if Different than Above Address 4. Permit To: a) Install -'- Alter Repair -'� °" 430 f=L� nT U Q t I� �• b) Privy Conventional ✓ Other Type l,� -Z .Z -7 Ground Absorption c) Sub -Division belt—Ja tKx Sec. Lot No. 04- 5. System used to serve what type facility: HouseMobile Home Business IndustryOther b) Number of people 3 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms— Bath Rooms 3 �h- Den w/Closet � b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals lavatory showers dishwasher sinks garbage disposal washing machine 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? Yeses No 9. a) Property Dimensions 15'0 F X Zzo s X 2-405 b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? Al o This is to certify that the information is correct to the best of my knowledge _ a 4 -3n -gam I Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: w•, t 1 DCHD (6-82) L, vti w L q, r e e-- 6 MI t- C%_ tt P 4- DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED tic r.a www �, zoo} (office use only) t— 30 —4S yes no 1. 1 am the owner of the above described property. yeS no 2. 1 am not the owner of the above described property, however, I certify that I have consent from - ea tj e%f LVA << I.w , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. . yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE ONATURE 4. 1 hereby authorize the Davie County. Health Department to release site evaluation results from the above described property to the following: — Owner only — Owners designated representative Anyone requesting results — Only those listed below DATE SIGNATURE DCHD (11 /84) Address . . . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date ' � 5 � Lot Size Gerrn0c AREA 1 APPA 9 ARFA R APPA A 2) 3) 5) 6) g) Site Classification Topography/ Landscape Position �.� SS S S ('D PS PS U U U Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) < IPJS US US U Soil Structure (12-36 in.) S S S S Clayey Soils 'S� PS U � U U Soil Depth (inches) S S S PS PS PS U U Soil Drainage: Internal S S PS PS IJ �j-� U U External S S S S PS PS PS PS U U U U Restrictive Horizons ') Available Space S S PPS S PS PS U U U U d) Other (Specify) S S S S PS PS PS PS U (�UU U - `- U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: Described by Title SITE DIAGRAM DCHD (8-82) Date U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: Described by Title SITE DIAGRAM DCHD (8-82) Date +� G v� Sa L� 130 I r i � ,�cPDCrvry �� PU,4,L P aC(Y+�L..ddt.✓