1421 Bear Creek Church RdDavie County, NC , TaY Parcel Report Wednesday, October 12, 2016
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: D10000001803 Township:
NCPIN Number: 5802044856 Municipality:
Account Number: 82533112 Census Tract:
Listed Owner 1: SIZEMORE JOE Voting Precinct:
Mailing Address 1: 1421 BEAR CREEK CHURCH ROAD Planning Jurisdiction:
City: MOCKSVILLE Zoning Class:
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag. District:
Legal Description: 1.25 AC BEAR CREEK CHURCH Fire Response District:
Assessed Acreage: 1.23 Elementary School Zone:
Deed Date: 12/2011 Middle School Zone:
Deed Book / Page: 008760825 Soil Types:
Plat Book: 0008 Flood 2one:
Plat Page: 0395 Watershed Overlay:
Building Value:
Land Value:
Total Assessed Value:
°" �'�' Davie County,
�o��,�� NC
118580.00 Outbuilding & Extra
Freatures Value:
20130.00 Total Market Value:
139930.00
Clarksville
37059-801
CLARKSVI�LE
Davie County
DAVIE COUNTY R-A
No
SHEFFIELD - CALAHALN
WILLIAM R DAVIE
NORTH DAVIE
Ce62
DAVIE COUNTY
1220.00
139930.00
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� AUTI,�RIZATION NO: 'j �,�j ,�� DAVIE COUNTY HEALTH DEPARTMENT
, ' Environmental Health Section
Permittee's P.O. Box 848
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PROPERTY INFORMATION
Name: � �: �`!� Mocksville, NC 27028 Subdivision Name:
w �,�r� -� �'' � Phone # 336-751-8760 �
Directions to pr erty: -��1�' i1�` �.�fa� %" Section: Lot:
, , , � / AUTHORIZATION FOR �
('�� ��s�J WASTEWATER Tax Office PIN:# bU _�� 6��
SYSTF,M CONSTRUCTION
Road Name�i'�xn C�•(`.� I�/ Zip: 27�" �
**NOTE** This Authonzation for Wastewater System Conswction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Perrnits. This Forn�/Authorization Number should be presented to the Davie Counry Building Inspections
Office when applying for Building Perrnits.
(ln compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �
���`�/��s�!� � ��. ,� /r�i��,�'�.,
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSU D
'�*•lvUl1C�**"` 7'H15 AU"1'HUHI"GATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
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� • , .. . ' . • '1MPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION �
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..�ermittee's �� ' f ; :� � 4`
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,� Na�ne: � < -� �� �`i- ,' � " � � Subdivision Name: �
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Directions to pro erty: �`;`���'`r'� ���� � Section: Lot: '
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! IMPROVEMENT
; PERMTT T� Office PIN:# 4�00 _�_p 6�5�,,'
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Road Name�:.0 C� �'.% 14�' Zip: ? 7t12 �'"
**NOTE** This Improvement Pernut DOES NOT authorize the construc[ion or installation of a septic tank system or any wastewater system. An
AUTHORIZA7'ION FOR WASTEWATER SYSTEM CONSTRUCT'ION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
As" t r�, _ ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF STI'E
; ". : . , r '' .. / : J —,,�'; —' ,' 1�.•' ! �': �-r- PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING TI� SYSTEM.
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RESIDENTIAL SPECIFICATION: BUILDING TYPE �j_ # BEDROOMS �,� # BATHS ':� # OCCUPANTS �'i4_ GARBAGE DISPOSAL: Yes or No
� COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFf # SEATS INDUSTRIAL WASTE: Yes or No
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? LOT SIZE TYPE WATER SUPPLY G�'r // DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR STfE �
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� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �C9 // ROCK DEPTH/ ,� LINEAR FTs•.�_ ��
REQUIRED SITE MODIFICATIONS/CONDITIONS:
' IMPROVEMENTPERMITLAYOUT,���g��VEA EFrLUt:P�T FIL �t�� �RIS�Rt5) IF 6" L�ELO,f FIt�IS�{:D C�AD��
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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 (9(t4);Ct3iG87bD.X
(336)751-876�3
OPERATION PERMIT
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SYSTEM INSTALLED BY: �� i1�� (_t+�.� SFLC_
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AUTHORIZATION NO. `���� OPERATION PERMIT BY: DATE:
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**THE ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT T E TEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAP'TER 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 OS/96 (Revised)
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- 1 . . � ,�� � �,� DAVIE COUNTY HEA�.TH DEPARTMENT '
-� r"'~ '�"JMPROVEMENT AND OPERATION PERMITS P�OPERTY INFORMATION
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`�errnittee's ,F'�.: ?�
`',� Name: `; A• i ; Subdivision Name:
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Directions to property: �� �'+'`r Section: Lot:
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• IlVIPROVEMENT
� ... � : . PERMIT Tax Offce PIN:#�+�/ �� - •f .7`� _r? c� c{'.%�..'�
Road Name��c. l'�! r' %�.� Zip: �'' �a? � r+'
**NOT'E** This Improvement Pemut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUI'HORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** TI-IIS PERNIIT IS SUBJECT TO REVOCATION IF SITE
. PLANS OR Tf� IlVTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING TIiE SYSTEM.
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� RESIDENTIAL SPECIFICATION: BUILDING TYPE �",� # BEDROOMS �# BATHS � # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
, COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLElSHIFT # SEATS INDUSTRIAL WASTE: Yes or No
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LOT SIZE TYPE WATER SUPPLY �'�i`' / i DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SI1'E ��
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� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH�� ROCK DEPTH�� LINEAR Ffp�_�+`�
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REQUIRED SITE MODIFICATIONS/CONDITIONS:
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IMPROVEMENT PERMIT LAYOUT ,���� ���r�� ��� ����j � a�
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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 (alldj G3�4'�6�f K
(3' ; ) 7�1—�7i.•�
OPERATION PERMIT
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SYSTEM INSTALLED BY: � f��►1F�, C�� ��{' `
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AUTHORIZATION NO. r ��'' OPERATION PERMIT BY: --�.- �; �� DATE: -Ci
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*■THE ISSUANCE OF THIS OPERATION PERMI'T SHALL INDICATE THAT TFIE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAP'TER 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 OS/96 (Revised)
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DAVI6 COUNTY ENVIRONMENTAL HEALTH SECTION
'APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER
ADDRESS � f!�I ��4� �.�eP���1j't'/�/�d SUBDIVISION NAME
a�[7 ��� L/'i ��L� l/V •-C � 2 2�G•Y LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED � NAME SYSTEM INSTALLED UNDER
TYPE FACILITY � NUMBER BEDROOMS_� NUMBER PEOPLE SERVED
TYPE WATER SUPPLY � SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION TAKEN BY
This ia to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this appiication.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1�93
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