494 Becktown Rd < �jq
Davie County, NC Tax Parcel Report �10 1 Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M60000003302 Township: Jerusalem
NCPIN Number: 5755563996 Municipality:
Account Number: 8305231 Census Tract: 37059-807
Listed Owner 1: BOLDT JAMES Voting Precinct: JERUSALEM
Mailing Address 1: 494 BECKTOWN 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: 2.731 AC BECKTOWN RD Fire Response District: JERUSALEM
Assessed Acreage: 2.46 Elementary School Zone: COOLEEMEE
Deed Date: 7/2015 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 009940349 Soil Types: PcB2,PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 45720.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 31450.00 Total Market Value: 77170.00
Total Assessed Value: 77170.00
161
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DAVIE COUNTY HEALTH DEPARTMENT
lit, IMPROVEMENTS PERMIT 'AND CERTIFICATE OF COMPLETION
*NOTE:I,gsued in Compliance With Article 11 of G.S.Chapter 130a
nitary Sewage Systems Permit Number
Name &�AlL Date _l[ ,:2-;—e, N2 5739
Location r Lt. �V`
Subdivision Name Lot No. Sec. or Block No.
Lot Size ff!f House Mobile Home _:f Business Speculation
No.-Bedrooms ? No. Baths — No. in Family _
Garbage Disposal YES ❑ NO p
Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑ �'C
Type Water Supply _3ir
*This permit Void if sewage system described below isnot installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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 Diagra System Installed bK) �Q -
2
}
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.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
R 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name 0/r�/S� Date
Address Lot Size l� Q
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Positions Q
PS PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay)
-V�
3) Soil Structure (12.36 in.) S^
Clayey Soilsd!5�/
U U U U
4) Soil Depth (inches) S S - S
U U U U
5) Soil Drainage: Internal SS S
---
U ..
External S�`�
"
P P P J
- U U
6) Restrictive Horizons ---
7) Available Space f
PS PS PS PS
U U U U
8) Other(Specify) S S S S
PS PS PS PS
QQ U T�UUp U p U
9) Site Classification 1,5- 1'"'�.
U—UNSUITABLE S—SUITABLEP, S—Provisionally Suitable
Recommendations/Comments:
Described by �� Title t� Date
SITE DIAGRAM
DCHD(6-82)
t .
s APPLICATION FOR SITE EVALUATION/IMPROVEMENTS. PERMIT
Davie County Health Department
Environmental Health Section'
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requested By Business Phone
2. Address -3 d e
-3. Property Owner if Different than Above
Address bN Jl ZI�L
4. Permit To: a) Install Alter 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 N,07,0
Bed Roomsy—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 hours)
7. Number and type of water-using fixtures:
commodes urinals garbage disposal
lavatory L showers washing machine
dishwasher J# sinks' Z
8. a) Type water supply: Public PrivatQ, Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions
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.
6.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH,ALL STATE AND LOCAL,LAWS
Allow 5 days for processing
Directions to property:
G/ hi
*NOTE: Improvements Permits shall be valid for a period of 5
years from date issued. Improvements Permits are subject )
to revocation, if site plans or the intended use change.
Effective October 1, 1989.
DCHD(6-82)
4 t 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, R O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY: DATE RECEIVED
(office use only)
K4 `tJ
no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner ofthe
"above described property, however, I certify that I
have consent from G --)CZZK ,�U ,[z , 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 conductall
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.DATE SIGNATURE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation resu s from the above described property to the following:
Owner only
Owners designated representative
Anyone requesting results
_ Only those listed below
IN
DATE SIGNATURE
DCHD(11/84)