1238 Angell Rd (2)Davie Countv, NC
Tax Parcel Report Fridav, October 7, 201 f
WARAIIN T: THIS IS 1VUT A SURVEY
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Davie County,
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Parcel Information
Parcel Number:
F400000056
Township:
Mocksville
NCPIN Number:
5831417530
Municipality:
Account Number:
8302536
Census Tract:
37059-806
Listed Owner 1:
MAYO TOMAS DIAZ
Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1:
1238 ANGELL ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
.60 AC ANGELL RD
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
0.62
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
8/2013
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
009360553
Soil Types:
EnB
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
61640.00
Outbuilding 8r Extra
890.00
Freatures Value:
Land Value:
12870.00
Total Market Value:
75400.00
Total Assessed Value:
75400.00
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Davie County,
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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
or arising out of the use or Inability to use the GIS data provided by this website.
Account #: 990005425
Billed To: Rebeez Anerve
Reference Name:
Proposed Facility: Residential Well
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax(336)753-1680
WELL PERMIT
Tax PINIEH #: 5831 -41 -7530 -Well
Subdivision Into:
LocationiAddress: 1238 Angell Rd. -27028
Properly Size: .60 Ac. ".
ATC Number: 0049 ;
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years :from the date of issuance. This permit may be revoked if it is determined that there
has been a material change in any fact/circumstances upon which this permit was issued.
Permit Type: New Repair ❑ Abandonment ❑
Proposed Well Location Diagram
Certificate of Completion Diagram
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41
h
Comments: r /Y\. Driller:
r�
Certification #:t
Grout Inspected:
Well Head Inspected:
GPS Coordinates:.
EHS: Date: � l' 15) EHS: Date:
w. P. 7-08
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APPLICATION FOR PRIVATE WILL PERMIT
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
.(336)753,-6780 / Fax (336)753-1680
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name to be Billed 'r` �r�. ? -! ' r. " Contact Person
Billing Address t2&2j Home Phone C C - "'
City/State/ZIP IuZOC' � l Z7C)Le ' Business Phone / -) �l '} -f - �-i 15, 3 ,)
Name on Permit if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION .*Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat (to scale)
Owner's Name JA k e? Phone Nu ber 3 3 4 - 7,9Z - 6'/806
Owner's Address City/State/Zip H NC -Z 2 D
Property Address-� City
Lot Size GO /4c cG Tax PIN# 5`83 Till 7536
Subdivision Name(if applicable) --- Section/Lot#
Directions To Site: Fmo„, C an s Q `4 -urn egti+ o,. qq - ll A-rk L r cs;� in ce is 4-41e-
% L - --- - i& _ i -rt r--- . _ ._ _tib_` -. -a- inso e -.*I- 1L ._ -.0
DEVELOPMENT INFORMATION
Permit Type: New Well�i _ Well Repair Well Abandonment Other (specify)
Facility Type: Residential — X Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES X NO
Do You Intend To Install A New Septic System On This Site? YES NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine the best location for a well.
'V, a Tue z kac v
Signed
7/30/09
0\11\109
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account #
Invoice #
'Kj'oMAPS - Davie County NC Public Access
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PARCELS (Map Tips Available)
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DAVIE COUNTY HEALTH DEPARTMENT
Pergattee's, ' �' ._
Name. �' Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property. J°? ) `' / ' ` %"" ±:W-tt Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
F
1 Mf r f,, Section: Lot:
tE� AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# -
�kj�h . ,
AUTHORIZATION NO: + ^ A Road Name: Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any. Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office wheel applying for Building Permits.
(In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
'IN" 1 JL%r.... i n is HV i rIVIVLH I i"nr"it vv HJ 1 G vY H l GK%-"vgai nu% -i i"n
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS --!L # OCCUPANTS �� GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY ��':� DESIGN WASTEWATER FLOW (GPD) `Y'2 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH " ROCK DEPTH .r ".'r LINEAR Fr.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
p �f d M1b'
"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 (336)751-8760.
OPERATION PERMIT
1
SYSTEM INSTALLED BY:
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
r'
"*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 02/02 (Revised)
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RE►SIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Enviromnent and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # )) L'i 7 4
1. WELL CONTRACTOR:
Well Contractor (Individual) Name
YADKIN WELL COMPANY. INC.
Well Contractor Company Name
1908 HAMPTONVILLE ROAD
Street Address
HAMPTONVILLE NC 27020
City or Town State Zip Code
3( 36) 468-4440
Area code Phone number
g.. WATER ZONES (depth): 1 "j`'
Top 5-Y
Bottom T > t 7Top
Bottom
Top f � .) Bottom f } 7' Top
Bottom
Top
Bottom Top
Bottom
Thickness/
7. CASING:
DepthDiameter
Weight Material
Top `F t
Bottom d _l Ftl/—.. 'Lti
J)�
Top
Bottom Ft.
l
Top
Bottom Ft.
2. WELL INFORMATION:
WELL CONSTRUCTION PERMIT#D3_ 1- 5�/ �J -1 ` C EW 4�
OTHER ASSOCIATED PERMIT#(if applicable)
SITE WELL ID #(if applicable) 04 4-061-
3.
06,-
3. WELL USE (Check Applicable Box): Residential Water Supplykr
DATE DRILLED + I! _30
TIME COMPLETED ' 5_ AM ❑ PP4�
4. WELL LOCATION:
CITY: led rks(/�r��e COUNTYllDa
(Street Name, Numbers, mmunity, Subdivision. Lot No., Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
lope ❑Valley ❑Flat ❑Ridge ❑Other
LATITUDE 3:5 ° 5 lis " DMS OR DD
LONGITUDE 3��" DMS OR DD
Latitude/longitude source: P,PS ❑Topographic map
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS)
5. WELL OWNER
(f'�12
Owner Name
Street Address
bl, 6 e— k5 ✓
City or Town State —2ip —Code
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH:
8. GROUT: Depth Materia Method
% + // //
Top Bottom S' Ft.�`: I/6'1, 7 �flr`%'-s
— - c—
Top � � Bottom --s! Ft. ��t�)fCn, 'f f%K��• -, •"4 '-" �'�
Top Bottom Ft.
9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft. in. in.
; /
Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
10. SAND/GRAVEL PACK:
Depth
Size
Material
Top Bottom � Ft.
Top Bott02-7 Ft.
Top Bottom Ft.
11. DRILLING LOG
Top Bt� toms
^r-�,
Formation
Description
l
of
/
/
12. REMARKS:
b. DOES WELL REPLACE EXISTING WELL? YESP NO ❑
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: LLU FT. ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
(Use "+" if Above Top of Casing) STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS i_1 FT. Above Land Surface` r1
*Top of casing terminated attor below land surface may require
a variance in accordance with 15A NCAC 2C .0118_ SIGNATURE OF /CERTIFIED WELL/CONTRACTOR DATE
e. YIELD (gpm): METHOD OF TEST G___� f/
f. DISINFECTION: Type HTH _Amount Cilcs PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within .(days o combttion to: Division of Water Quality - Information Processing, Form GW -1a
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : (919) 807-6300 Rev. 2/09
Date Site Visited 42 -/?-1 Z BY:V6_Permit: Yes No
What Is Height of Well Casing? Make Sure 12" Above Ground Level!!!!
ADDRESS:
PHONE NUMBER: