302 Brantley Farm RdDavie�ounty, NC
.
Tax Parcel Report
Wednesday, October 12, 2016
WARNING: THIS IS NOT A SURVEY
_
' Parcel Information
Parcel Number: H30000009602 Township:
NCPIN Number: 5729355326 Municipality:
Mocksville
Account Number: 2268000 Census Tract: 37059-806
Listed Owner 1: ANGELL JAMES RUSSELL Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 302 BRANTLEY FARM ROAD Planning Jurisdiction: MOCKSVILLE
City: MOCKSVILLE Zoning Class: MOCKSVILLE OSR
State: NC Zoning Overlay:
Zip Code: 27028-4114 Voluntary Ag. District:
Legal Description: 6.62 AC OFF BRANTLEY FARM Fire Response District: CENTER
Assessed Acreage: 6.65 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 12/1983 Middle School Zone: NORTH DAVIE
Deed Book / Page: 001210430 Soil Types: PaD,PcC2,ChA,WATER
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Building Value: 147310.00 Outbuilding & Extra
Freatures Value:
Land Value: 60000.00 Total Market Value:
Total Assessed Value: 207310.00
MOCKSVILLE
207310.00
No
0.00
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County of Davie, North Carolina, its agents, consultants, contractors or employees from any and a�l claims or causes of action due to
�'O� x,�'i NC or arlsing out of tho use or inability to use tho GIS data provided by this website.
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North Carolina Department of Envirotunent and,Natural Resonrces- Division of Q a � � �
WELL CONTRACTOR CERTIFICATION # _ �����OUNTYHEA�7HDEPARTMENT
-1,YVELL GC-AITRACTOI � ' � '
M, l G � L'-` �v-"
Well Contractor (Individuai) Name
YADKIN WELL COMPANY, INC.
Weil ConVactor Company Name
STREETADDRESS 1908 HAMPTONVILLE ROAD
HAMPTONVILLE NC 27020
City or Town State rp Code
3� 36 �_ 468-4440
Area code- Phone riumber
2. WELL 1NFORMATION: j�
SITE WELL ID #(if appliwble)_,�'�'i�-''' 2 3 '
WELL CONSTRUCTION PERMIT#(f appitcable)
OTHER ASSOCIATED PERMIT #(if applicabie)
3. WELL USE {Check Appifcabte Box) Monitoring❑ Mun(c(paVPublic�
Industrial/Commercfal❑ Agricultural� Recoveryp Injection0
Irrigatior�p Othe�( (list use) ' �
DATE DRILLED � "� ` � d
TIMECOMPLETED �] �lJU � AM❑ PM�J
4. WELL LOCATION`:
CITY: I�C.I''C�'(/ril�� t°s COUNTY �'G rC.
g��,�,�/z� �,�,�. �'/
'(Street Name, N mbers, Com uni Su drv �on, Lort ,�10., arcel, Zip Code)
TOPOGRAPHIC / LAND SETTING:
� ❑ Siope p Valiey ❑ Flat �Ridge ❑ Other
(check appropriate box)
May be in degrea,
LATITUDE �5,� ��o t�3 minutes, seconds or
LONGITUDE %0g (p (� �n a decimal format
Latitude/longitude source: �'GPS � Topographic map
(location of well must be shown on a USGS topo map.and
ettached to thls form if not using GPS)
5. FACILI7Y- Is the name of lhe buslness where the wet� In located.
FACILITY ID #(if applicable)
NAME OF FACILITY�rtif'� . Ij,C.
STREET ADDRESS °� � Z, %�i�Tt w�"%�� �f..� %+�
l�'1� adt!'�, r�.'l!� � 1�� _ 2 i�.Z X
City or Town State Zip Code
CONTACT PERSON��'S`�P /% � �
MAILING ADDRESS �O 2 � h ��CT ' (�
/i1i� �,`P C t/t , l/i __/� � J �j C7.1 _ �
City or Town State Zip Code
LL�s �C�O —r �Ioo �. �frr'� _�'66Z,
Area code Phone number •
6. WELL DETAILS: � � �.
a. TOTAL DEPTH: �
b. DOES WELL REPLACE EXISTING YIlELL1 YESO NOJ�
c. WATER LEVEL Below Top of Casing: �- f�' FT. �
. (Use "+" if Above Top of Casing}
d. TOP OF CASING IS �"�`^ . FT. Above Land Surface•
•Top of castng tertninated aVor below land surface may require
a variance in accordance w(th 15A NCAC 2C .0118.
e. YIELD (gpm): � METHOD OF TEST AIR PUMP
f. DISINFECTION:TypeHTH Amount�
g. WATERZON�S(depth): /Qejp�
From�L•To,��� From To
From�� To l� 11` �Ffvfh� To
From To From To
7. CASING: Depth Diameter Thtckness/Vveight Mater(al
pp ✓
From�_To,��t. � � 10 0 �
From To Ft.
From To Ft. �
8. GROUT: Depth Materiai Method
From Q To �� �t. �r ��� � i.+'<�(
From �To��,Ft.�tn �i�i'�Q �t�sYz �
From To Ft.
9. SCREEN: Depth Diameter Slot 51ze Material
From To FL in. in.
From To Ft. in. in.
From To Ft. in. in.
10. SAND/GRAVEL PACK:
Deplh Size Mater(al
From To Ft.
From To Ft.
From To Ft.
11.DRILLING LOG
From T . Formation Description
�o. `?
.
1�1 i.:,:.�r1 rOC. � SCn ' C�Irt�
� �, ci�, y G���n� t
�--�—u
� M� E/ �lc� � .���n� -G
SIZE OFF . )
BIT SERIAL NO: +� �, - " 5�
12. REMARKS: r` ,
. ��r� � � 1 �� I �d •• � ��. cz�' �, f�"
—_ I / i
I DO HEREBY CERTIFY THAT THIS WEIL WAS CONSTRUCTEO �N ACCORDANCE VYITH
15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A CAPY OF THIS
RECORD HAS BEE PROVIDED TO THE WEII OWNER.
�'Y_1.��o7`�rw � �-r �' `� �la
SIGNATURE O CERTIFIED WELL CONTRACTOR DATE
'� / � U' �" � .
. �
PRI . T�AME OF PERSON CONSTRUCTING THE WELL
!"1 �r{��Z4� � �r �it _
Submit the orig nal to trie Division of Water Quality within 30 days. Attn: Information Mgt.,
1617 Mail Service Center— Raleigh, NC 27699-7617 Phone No. (919) 733-7015 ext 568.
Form GW-1b
Rev.12/07
BUIZDIIZS NAME :
ADDRESS:
PHONE NUMBER:
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