158 In & Out LnDavie County, NC
Tax Parcel Report
Wednesday, December 14, 2016
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9Aw fAM All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
S j Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
E /'+ F County 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 this website. i
WARNING: THIS IS NOT A SURVEY
Parcel Information .
Parcel Number:
F80000011010
Township:
Shady Grove
NCP -IN Number:
5880274622
Municipality:
Account Number:-
- - '8307070
Census Tract:
37059-803
Listed Owner 4:-- -
DOBY CHARLES EDWARD Ill
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:-
158 IN AND OUT LANE
Planning Jurisdiction:
Davie County
City: -
ADVANCE
Zoning Class:
DAVIE COUNTY R -A
State: -
NC
Zoning Overlay:
Zip Code: -
27005
Voluntary Ag. District:
No
Legal Description:
- TRACT 1 DOBY C 1.249 AC
Fire Response District:
ADVANCE
Assessed Acreage:
1.21
Elementary School Zone:
SHADY GROVE
Deed Date:
1012016
Middle School Zone:
WILLIAM ELLIS
Deed Book ! Page:
010330222
Soil Types:
PcB2,PGC2
Plat Book:
0009
Flood Zone:
Plat Page:
235
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
9Aw fAM All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
S j Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
E /'+ F County 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 this website. i
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) Permit Number
Name Date
Location
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 C] NO
Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO F-1
Type Water Supply
This permit Void if sewage system described below is not installed within 36 months from date of issue.
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. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed b
L
k
Certificate of Completion Date
*The signing of this certificate shall indicate that the system clescribed 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 functi
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name (HW -c f -'s C41vJr--0r-rD Date 1 - 3— ��
Address P D - &< 16-3 Lot Size
FAr.TORR ARFA t AREA 2 AREA 3 AREA a
A
Topography/ Landscape Position
SJ
S
S
5
` PS
PS
PS
U
U
U
U
!) Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
U
U
U
1) Soil Structure (12-36 in.)
__-S
S
S
Clayey Soils
L�
PS
PS
U
U
U
U
Soil Depth (inches)
S
S
S
S
PS
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S
S
�--rev
PS
PS
U
U
U
External
S
S
S
S
PS
PS
- U
U
U
U
i} Restrictive Horizons
Available Space
S
S.
S
S
PS
PS
PS
PS
U
U
U
U
I) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
Described by
S—SUITABLE PS—Provisionally Suitable
Title Date
DCH❑ (6-62)
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Req
2. Address _
3. Property
Address
Home Phone'°'%
By dlAkl)" .�avis' AW.A01- JI -Business Phone
4. Permit To: a) Installlter Repair
b) Privy Conventional ✓ Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions j Arja
Bed Rooms Bath Rooms Den w/Closet—�
b) If Business, Industry or Other, State: Number of persons served
What type business, etc
Estimate amount of waste daily (24 hou
7. Number and type of water -using fixtures:
commodes urinals
lavatory
showers
garbage disposal
washing machine
dishwasher J sinks !
8. a) Type water supply: Public Privatekoo'-*01 Community
b) Has the water supply system been approved? Yes Nom
9. a) Property Dimensions ) 7 X A _41,0
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?
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
Pwj 4 -1-D
DOHD (6-82)
j:�AJ'7� 4kc f 0
HEALTH DEPARTMENT RELEASE For Office Use On
*CDP File Number 232928-1
Davie County Health Department 5880274622
i f 210 Hospital Street County ID Number:
P.O. Bax 848 '
�- Evaluated For NEW
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID i s/ a 1/ a 8 a 1
UNTIL'
Applicant: Scott Smith
Address: 828 Piedmont Drive
City: Lexington
State2ip: NC 27295
Phone #: (336) 782-1647
",Property Owner: Charles Doby
Address: 1582 Russel Creek Rd
City: Stuart
State/Zip: VA 24171
Phone #:
Property Location & Site Information
Address 158 In & Out Lane Subdivision: Phase: Lot
Road 4 Advance NC 27005
SINGLE FAMILY Township:
'Structure: Directions
got Bedrooms: s ' # of people: 3 - Hwy 158 east right on Hwy 801 south left on Potts Rd. In & Out lane on
right
-Water Supply: EXISTING WELL
easement: ❑ Yes ❑ No
'Proposed Improvement:
Type of Business:
Total sq. Footage: No. Of Employees:
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
ApplicanVLegal Reps. Signature Required? Oyes G 10
Applicant/Legal Reps. Signature: *Date:
*Issued By: 2140 -Nations, Robert *Date of Issue: 1 a a l 2 0 1 6
Authorized State Agent:
**Site Plan/Drawing attached.**
Hand Drawing 0 Import Drawing
Drawing Type:
HEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Health Department Release
CDP File Number. 232928 " 1
County File Number: 5880274622
Date: 121011 2 0 1 6
0Inch
Scale: Oalock
()N/A
***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name Sn,A, Contact Person, ->&f-
Address 90 P,,6 ; e w\K„ a r Home Phone
City/State/ZIP tv C- a -t -2.R5 Business Phone ) u"
Email C'j-p Aa t."v--- Email: Cara\: rg,,.�. Lo of t3 cow
Name on Permit/ATC if Different than Above Q iA,� t -
Mailing Address \5 cb -�, A + " City/State/Zip J &g. L, N _ C -7-loo,.
PROFEKI-Y 1NFORMATION *Date House/Facility Corners Flagged �k• 9 •lu
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑ Plat(to scale)
(Permit is �(alid for 60 months with site plan, no expiration with complete plat.)
Owner's Name Phone Number
Owner's Address }, �s drtik RA City/State/Zip�5\%kar*-Ua Mt-tI
Property Address lS;b�a0•4 L�... cit}' cAya+�uc (t1�—
Lot Size . Z, A c Tax PIN#_�541+b o 2n
Subdivision Name(if applicable) Section/Lot#
Directions To Site: AW4 l5Co [ 'Ba L } VA av R
If the answer to any of the following questions is "Yes",supporting documentation must be attached:
Are there any existing wastewater systems on the site? ✓Yes No _
Does the site contain jurisdictional wetlands? Yes �No
Are there any easements or right-of-ways on the site? lyes _No
Is the site subject to approval by another public agency? Yes / No
Will wastewater other than domestic sewage be generated? Yes /No
IF RESIDENCE FILL OUT THE BOX BELOW
# People 7�, # Bedrooms 3 # Bathrooms -Z, Garden Tub/Whirlpool 4es ❑No
Basement: ❑Yes grNo Basement Plumbing: ❑Yes Flo
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: CXceepted Ll Innovative [I Alternative Ll Other
Water Supply Type: ❑ County/City Water ❑ New Well XfE Ling Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes e No
If yes, what type?
Davie County, NC
Tax Parcel Report Tuesday, October 4, 2016
WARNING: TMS IS NOT A SURVEY
Pa��llnf b
Parcel Number: F80000011010 Township: Shady Grove
NCPIN Number: 5880274622 Municipality:
Account Number: 21360000 Census Tract: 37059-803
Listed Owner 1: DORY CHARLES E JR. Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 1582 RUSSELL CREEK RD Planning Jurisdiction: Davie County
City: STUART Zoning Class: DAVIE COUNTY R -A
State: VA Zoning Overlay:
Zip Code: 24171-3759 Voluntary Ag. District: No
Legal Description: TRACT 1 DOBY C 9.249 AC Fire Response District: ADVANCE
Assessed Acreage: 1.21 Elementary School Zone: SHADY GROVE
Deed Date'. 611987 Middle School Zone: WILLIAM ELLIS
Deed Book 1 Page: 001380199 Soil Types: PcB2,PcC2
Plat Book: 0009 Flood Zone:
Plat Page: 235 Watershed Overlay: DAVIE COUNTY
Building Value: 34370.00 Outbuilding & Extra 5060.00
Freatures Value:
Land Value: 21780.00 Total Market Value: 61210.00
Total Assessed Value: 61210.00
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
1 Davie County, 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 i
o j NC or arising out of the use or Inability to use the GIS data provided by this website. '
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