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414 Crescent Dr (2)Davie County, NC Tax Parcel Report Friday, October 7, 201 E WARAIAG: TH15 15 AUT A SURVEY Parcel Information Parcel Number: J10000004301 Township: Calahaln NCPIN Number: 5708101268 Municipality: Account Number: 82527380 Census Tract: 37059-801 Listed Owner 1: NICHOLS JASON BLAKE Voting Precinct: SOUTH CALAHALN Mailing Address 1: 414 CRESCENT DRIVE 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: 2.656AC NORTH OF 1-40 Fire Response District: COUNTY LINE Assessed Acreage: 3.18 Elementary School Zone: COOLEEMEE Deed Date: 12/2006 Middle School Zone: SOUTH DAVIE Deed Book / Page: 006920600 Soil Types: PaD,PcC2,CeB2,ChA Plat Book: 0008 Flood Zone: Plat Page: 293 Watershed Overlay: DAVIE COUNTY Building Value: 218490.00 Outbuilding & Extra Freatures Value: 0.00 Land Value: 22580.00 Total Market Value: 241070.00 Total Assessed Value: 241070.00 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 articular use. All users of Davie County's p ty p GIS website shall hold harmless the 1�7 1� C 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. .a ` Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 WELL PERMIT Account #, 990005649 Billed To: Blake Nichols Reference Name: Proposed Facility: Residential - Well Tax-hlN.,EH #: 5708 -10 -1268 -Well Subdivision Info: LocationiAddress: Cresent Drive --27028 Property Size;' -2 '686 Acres ATC Number: 0075 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 ❑ Prbposed Well Location Diagram Certificate of Completion Diagram \Y .) I � I InaComments: Driller: • u pL wA Certification =6A__ 11 ` Grout Inspected: Well Head Inspected: �ht'tt! GPS Coordinates: EHS: Date: EHS: Date:cS Lel/ N W.P. 7-08 �. jjjDiG,e. %M I APPLICATION FOR PRIVATE WELL 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 E k -Ali did /S Contact Person ti k /4 Address 01 fidtlmK aj2 Home Phone City/State/ZIP-441)- -1 — 6 Business Phone 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 ust accompany this application. Included: ❑ Site Plan ❑Plat (to scale) Owner's Name Plk ��� /� /Ucl2nls Phone Number Owner's Address City/State/Zip Property Address 01246" City Lot Size Tax PIN# /G� Subdivision Name(if applicable) Section/Lot# Directions To Site: DEVELOPMENT INFO ON Permit Type: New Well Well Repair Well Abandonment Other (specify) Facility Type: Residential Food 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 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. Signed 7/30/09 Date Site Revisit Charge Date(s): Client Notification Date: EHS: Account # Invoice # ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 ATC Number: 5754 Site Type: JXNew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Seefion .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO COgSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms 3 # Bathroom4�4 People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size 2 •(A oz Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) _Tank Size 1090 GAL. Pump Tank #X GAL. Trench Width) Max. Trench Depth_,_ K, , Rock Depth Linear Ft.'Vop Site Modifications/Conditions/Other: AS stated in 15A NCIAC ^''a^of 3 a0Ce ..ys-te51S 11"3;.ay also be use Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. DCHD 11/06 (Revised) /Xl� 0 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005649 Tax PIMEH #: 5708-10-1268 Billed To: Blake Nichols Subdivision Info: Reference Nance: LocationiAddress: Cresent Drive -27028 Proposed Facility: Residence Properly Size:: 2.686 Acres ATC Number: 5754 Site Type: JXNew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Seefion .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO COgSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms 3 # Bathroom4�4 People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size 2 •(A oz Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) _Tank Size 1090 GAL. Pump Tank #X GAL. Trench Width) Max. Trench Depth_,_ K, , Rock Depth Linear Ft.'Vop Site Modifications/Conditions/Other: AS stated in 15A NCIAC ^''a^of 3 a0Ce ..ys-te51S 11"3;.ay also be use Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. DCHD 11/06 (Revised) /Xl� 0 •JILILESIDE'NTML WELL CONSTRUCTION RECORD c I EGEIVED North Carolina Department of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # �Q 3 6.4 AUG 10 2011 DAVIE COUN I YHEALI t1VENAkt(t ENE 1. WELL CONTRACTOR: Mu'f>-/74'IV 'A. ZroW/) 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 336 468-4440 Area code Phone number 2. WELL INFORMATION: WELL CONSTRUCTION PERMIT* OTHER ASSOCIATED PERMIT#(if applicable) SITE WELL ID #(if applicable) 3. WELL USE (CheckApplicableBox): Residential Water Supply DATE DRILLED7— — 6 — // TIME COMPLETED 4'36 AM ❑ PMX g. WATER ZONES (depth): �^ Tap .2 / ' Bottom --49 /a T�pjren Bottom Top -2 7`' - Bottom .2 80 Top Bottom Top Bottom Top Bottom Thickness/ 7. CASING: Depth Diameter Weight Material TopV:f4 Bottom / 7y Ft. 6 Top Bottom Ft. Top Bottom Ft. 8. GROUT: Depth Material Method Top O Bottom Top 3 Bottom Top Bottom Ft. 9. SCREEN: Depth Diameter Topottom Ft. in TopB ItFt. in Top / Boo Ft. in otlo 4. WELL LOCATION: 10. SANDIGRAVEL PACK: Depth Size CITY: v G l( r /.,I COUNTY n L f Top Bottom Ft. ��lC�—rSJ Top Bottom Ft. (Street Na e, N tubers, Community, Subdivision, Lot No., Parcel, Zip Code) TO BottomFt. TOPOGRAPHIC / LAND SETTING: (check appropriate box) Slope ❑Valley ❑Flat ❑Ridge ❑Other LATITUDE °_' " DMS OR D LONGITUDE °_' "DMS OR ��DD Latitudellongitudesource: MGPS ❑Topographic map (location of well must be s own on a USGS topo map andattached to this form if not using GPS) 5. WELL OWNER 1'4(,6 Zr /"/ e, �/%/ Owner Name / Street Address 1?4&cFc5-,,l,Y - hG 2 r2o City or Town State Zip Code (3 4) !i? - I //� o Area code tho e number G. WELL DETAILS: a. TOTAL DEPTH: 322 � 11. DRILLING LOG Top Bottom / %M Is G / 322 / 12. REMARKS: Slot Size Material in. in. in. Material Formation Description /tee/ SIZE OFF (_; , 00 t " BIT SERIAL NO: Q 6 +� j b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOJ�r I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN L Below Top of Casing: FT. ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION c. WATER LEVE (Use if Above Top of Casing) STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. d. TOP CASING IS `i FT. Above Land Surface /)' 'Topp of casing terminated at/or below land surface may require r�l� �_ .�J a variance in accordance with 15A NCAC 2C .0118. SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE e. YIELD (gpm): METHOD OF TEST Q/f W4kl w j f. DISINFECTION: Type HTH _ Amount QUIDS PRINTED NAME OF PERSON CONSTRUCTING THE WELL Submit within 30 days of completion 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 f — l l By: Permit: Yew No What Is Height of Well Casing? Make Sure 12" Above Ground �Leve l!!!! BUILDERS NAME: ADDRESS: PHONE NUMBER: V Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 WELL PERMIT Account #: 990005649 Billed To: Blake Nichols Reference Name: Proposed Facility: Residential - Well RECEIVED, AUG 10 2011 DAVIE CUUN f Y HLAU HU!: titNI41F , Ta3c.PIWEH #: 5708 -10 -1268 -Well .Subdivision Iffo: / :•-LacationiAddress: Cresent Drive -'27028 Property-Sizt:: •,,2`686 Acres - ATC Number: 0075 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. i •' Permit Type: New Repair ❑ Abandonment ❑ W.P. 7-08 u Proposed Well Location Diagram; Certificate of Completion Diagram 1 Comments:'Driller: Certification #: Grout Inspected: Well Head Inspected: GPS Coordinates: EHS: Date: EHS: Date: W.P. 7-08 u