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125 Cattle Way3avie Countv. NC Tax Parcel Renort Friday. October 7. 201 E WARNING: THIS 1S NUT A SURVEY ParcelInformation Parcel Number: K60000001913 Township: Jerusalem NCPIN Number: 5757643543 Municipality: l� Account Number: 82514395 Census Tract: 37059-807 Listed Owner 1: SMITH WILLIAM K Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 420 FRANK SHORT ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 4.016 ac Cattle Way Fire Response District: JERUSALEM Assessed Acreage: 4.02 Elementary School Zone: CORNATZER Deed Date: 3/2012 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 008850382 Soil Types: GnB2,GnC2 Plat Book: 10 Flood Zone: Plat Page: 91 Watershed Overlay: DAVIE COUNTY Building Value: 177380.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 26700.00 Total Market Value: 204080.00 Total Assessed Value: 204080.00 9 [ Davie County, All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the �i ��UN� �T C County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to the Inability the GIS by this l� or arising out of use or to use data provided website. Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 WELL PERMIT Account #: 990005845 Tax PIN/EH #: 5757 -64 -0405 -Well Billed To: William & Cylyndia Smith Subdivision Info: Address: 420 Frank Short Road Location/Address: Cattle Way -27028 City: Mocksville Property Size: 4.016 acres Reference Name:I�I Propos cfIonscoYhe Remployeesl 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 [R Repair ❑ Abandonment ❑ Proposed Well Locati Diagram Certificate of Completion Diagram 67J j C mments: Driller:EOQ/Z &41-11V Certification #: Inspected: t nmGrout -I "----- Well Head Inspected: GPS Coordinates: S`j 2 v . EHS: Date: '' '.`` EHS: W Date W.P. 7-08 �-1-ii,41,iol1*4 IftGelvE XPPLICATION FOR PRIVATE WELL PERMIT ApR Davie County Environmental Health P.O. Box 848/210 Hospital Street -- `` Mocksville, NC 27028 gY: (336)753-6780 / Fax (336) 753-1680 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name to be Billed Vj KVr.r,, V Contact Person VJ l 14, Billing Address 426 5V%r4%, RZ, Home Phone( ac;j gaki- -K-74, City/State/ZIP NV zcttS v i -\le IV -C, 27162.9 Business Phone ��\ —1 k2. - 3 6q Name on Permit if Different than Above Mailing Address ItZO-r��a.1K- 9W14 k2, City/State/Zip /Neda'u,(\P NC. ZZOZ$ PROPERTY INFORMATION *Date House/Facility Corners Flagged iw i h: A survey plat or site plan must accompany tnts application. lnclucleo: Lite Flan LJFlat (to scale) Owner's Name ;lt.Iaw,-< <a ` � Phone Number Owner's Address 420 tL rj, 24 City/State/Zip filec{C,S'v hte tt tc. 2T6'LS PropertyAddress Ccti{-(-1e Way,, City me(-J4S%j lmc Lot Size _q_, O\V Ac. Tax PIN# r,-7S'7(o 46 Ito 5 - Subdivision Subdivision Name(if applicable) Section/Lot# Directions To Site: DEVELOPMENT INFORMATION Permit "Type: New Well W 11 Repair Well Abandonment Other (specify) Facility Type: Residential ood Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO Do You Intend To Install A New Septic System On This Site? YES t, ----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 c ion fora well. Signed 7/30/09 11/LIllZ Date Site Revisit Charge Date(s): Client Notification Date: EHS: Account # Invoice # fQ ti kti I��r3�d lik e RECEIVED DEC 0 6 2012 DC HEALTH North Carolina State Laboratory Public Health 306 .Wilmi47 ' 7 306 N. Wilmington St. Environmental Sciences Raleigh, NC 27611-8047 http://slph.ncpublichealth.com Microbiology Phone: 919-733-7834 gy Fax: 919-733-8695 Certificate of Analysis RECEIVED Report To: Name of System: 'CC 0 6 2012 DAVIE CO ENVIRONMENTAL HEALTH WILLIAM SMITH DC HEALTH P O BOX 848 420 FRANK SHORT RD MOCKSVILLE, NC 27028 MOCKSVILLE, NC 27028 EIN:566000295EH COURIER #: 09-40-06 Starl-iMS Sample ID: ES112912-0058001 Collected: 11/28/2012 10:30 Andrew Daywalt IlllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllllJill Jill Received: 11/29/2012 09:15 Angela Heybroek ES Microbiology ID: Sample Source: New Well Well Permit Number: GPS Number: 35052.113N Sampling Point: Kitchen faucet 80029.872°W Sample Description: Comment: No permit # given with sample. Environmental Microbiology - Colilert Profile Method: SM 9223B \ Test Name: Colilert Analyte t Result Analyst Date Total Coliform, Colilert Present Darneice Lyons. 11/30/2012 E. coli, Colilert sent Darneice Lyons 11/30/2012 Report Date: 12/03/2012 Reported By: Susan Beasley 2 Explanations of Coliform Analysis: If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliform bacteria are Present, the water is considered unsafe for drinking purpose. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. P.O. Box 8047 North Carolina State Laboratory of Public Health 06 N. Wilmi gton St. Raleigh, NC .n 27611-8047 Environmental Sciences http://slghcpublichealth.com Inorganic Chemistry Phone: 919-733-7834 Fax: 919-733-8695 Certificate of Analysis Report To: ANDREW DAYWALT Name of System: DAVIE CO ENVIRONMENTAL HEALTH WILLIAM SMITH P O BOX 848 420 FRANK SHORT RD MOCKSVILLE, NC 27028 Courier # 09-40-06 MOCKSVILLE, NC 27028 EIN: 566000295EH StarLiMS ID: ES112912-0088001 Date Collected: 11/28/12 Time Collected: 10:30 AM Date Received: 11/29/12 Collected By: Andrew Daywalt Sample Type: Sampling Point: Andrew Daywalt Well Permit #: Sample Source: New Well Temp. at Receipt: 3.0 GPS #: 35152.113N/80029.872°W Sample Description: Comment: No permit # given with sample. New Well I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 16 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 5 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L Nitrate < 1.00 10.00 mg/L Nitrite < 0.10 1.00 mg/L pH 7.8 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 6.50 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 66 mg/L Total Hardness 60 mg/L Zinc < 0.05 5.00 mg/L Report Date: 12/06/2012 0 RECEIVED Kc 1 1 2012 DC HEALTH Page 1 of 1 Reported By: -AwoU qa&