349 Gladstone RdHEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Jennifer Young
Address: 349 Gladstone Road
City: Mocksville
StatelZip: NC 27028
Phone #: (336) 284-6652
r For Office Use Only
*CDP File Number 123787 -1
L5 -090 -BO -013
County ID Number:
valuated For: HDRIMC
PERMIT VALID 1 0/ 1 8/ 2 0 1 8
UNTIL:
Property Owner: Jennifer Young
Address: 349 Gladstone Road
City: Mocksville
State[Zip: NC 27028
Phone #: (336) 284-6652
Property Location & Site Information
Address 349 Gladstone Subdivision:
Road# Mocksville NC 27025
Township:
`Structure: SINGLE FAMILY
It of Bedrooms: 3 # of People:
'Water Supply: PUBLIC
Basement: n Yes ❑ No
'Proposed Improvement:
Enclosed Metal building
Phase: Lot
Directions
Hwy 601 S. Turn Right on gladstone Rd. around sharp curve @ next
curve House on left in front of Fletcher Rd, Brick, black shutters with
attached carport.
Type of Business
Total sq. Footage: No. Of Employees:
It is the responsibility of the owner to maintain a 5 foot minimum setback between the wastewater system and any part of the structure
foundation, including porches, decks, and any other appurtenances. If you are unsure as to the exact location of the septic system, please
have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the
proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this
property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed.
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? OYes ONo
Applicant/Legal Reps. Signature: *Date: / /
*Issued By: 2244 - Daywalt, Andrew *Date of Issue:_ 1 0 / 1 7 / 2 0 1 3
Authorized State Agent: O��i
**Site Plan/Drawing attached.** Total Time:(HH:MM)
0 1 Hours 0 0 Minutes
O Hand Drawing OlmportDrawing
P
Plioue. (336)- 733 - 6780
Davie County Health Department
Environmental Health Section
P.O. Bo:: 848
210 Hospital Street
Courier ff : 09-40-06
Mocksville, NC 27028
Fax. (336) - 731- 8786
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
dumName: Aum�x Phone Number �}, cam,
Mailing Address: _ �f .b �/ `�� V
Detailed Directions To Site: PadAw'r t S-) 1 l 1 CA6J
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Property Address: h`t tj (j4j)I_A 01
\j j,U�1J('a V l) IQ �Nl, o" /U
Please Fill In The Following Information About The EXl'STI G Facili ��gc�el& 64
kll:�Iyl t45,1
Name System Installed Under -ha Type Of Facility:- of - a q
U
Date System Installed (Month/Date/Year): _ Number Of Bedrooms: Number Of People
Is The Facility Currently Vacant? Yes t'y If Yes, For How Long?
Any Known Problems? Yes No If Yes, Explain: •� O�
Please Fill In The Follow' g Information About The NEW Facility:
Type Of Facility:WW, Q9AA Number Of Bedrooms_Numb r of Peopi
Requested By: d EA AyaDate Requested::
(Sign ure)
For Environmental Health Office Use Only
Approved Disapproved
Environmental Health Specialist Date:
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment:
Paid By:
Order #
Account #:_ �3� r Invoice #:
Printed:Oct 14, 201
Alt data is provided as is without warranty or guarantee of any kind either oxpressed 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 County of r
North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the
Inability to use the GIS data provided by this website.
r
0845
0379
EXHIBIT "A"
BK845PG319
BEGINNING at a point lying within the right of way SR 1121 (Gladstone Road) and lying
South of the paved portion of said road, an iron pin, said point being the Northwest corner of
Howard Wessley Anderson (Deed Book 104, page 162), said POINT OF BEGINNING being the
Northeast corner of the within described tract, and running thence with Anderson South 02
degrees 54 minutes East 199.97 feet to point, thence continuing with Anderson (Deed Book 108,
page 354), South 02 degrees, 54 minutes East 153.95 feet to an iron pin, thence with Anderson
(Deed Book 113, page 50 8) South 02 degrees 54 minutes East 122.09 feet to an iron pin,
Southeast corner of the within tract, thence with Anderson South 87 degrees, 16 minutes, 25
second West 107.87 feet to an iron pin, Southwest corner of the within described tract, thence
North 03 degrees 23 minutes 00 seconds West 231.72 feet to an iron pin, corner with William H.
Lagle (Deed Book 83, page 317), thence with Lagle North 22 degrees 49 minutes 45 seconds
West 201.06 feet to an iron pin lying within the right of way margin of said road, Northwest
corner of the within described tract, thence North 69 degrees, 58 minutes, 45 seconds East 186.63
feet to the POINT AND PLACE OF BEGINNING, containing 1.317 acres including the right
of way of SR 1121 as per plat and survey of C. Ray Cates RLS, dated August 15, 1995.
Subject to easements and restrictions of record.
For back title, see Deed Book 441, page 584; Deed Book 313, page 609; and Deed Book 178,
page 554; Davie County Registry. See also Tax Map L-5-9, Blk B, Pcl 13, located in Jerusalem
Township, Davie County, North Carolina.
Property Address: 349 Gladstone Road, Mocksville, NC 27028
TE:TAF
real estate description\young,jennifer 25352.1
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0845
0377
BK845PG311F
NO TA A= CON=ERATIOv STAi .---;)
DATE + a - A -a(A16 BY — .
Excise Tax: $00.00
06253
FILED FOR REGISTRATION
RUQ R- gm n 3:48 P.M.
DATE TIME
AND RECORDED IN BOOK 845 PAGE 377
M. BRENT SHOAF, REGISTER OF DEEDS
E 0 NTY N pf
BY
DEPUTY
Recording Information
Drafted by: Tamara A. Fleming, Attorney at Law, Ten Court Square, Mocksville, NC 27028
Mail to: Grantees @ 349 Gladstone Road, Mocksville, NC 27028
Property Address: 349 Gladstone Road, Mocksville, NC 27028
TAX MAP: L-5-9,13lk B, Pc113
WARRANTY DEED
THIS DEED made this 3 d y of Dec.*,*
Alelxr, 2010, by and between Jennifer J. Young
formerly known as Jennifer J. Carter and husband, Andrew L. Young ;(Grantor Address: 349
Gladstone Road, Mocksville, NC 27028) hereinafter referred to as the GRANTORS, to Jennifer
J. Young and husband, Andrew L. Young (Grantee Address: 349 Gladstone Road, Mocksville,
NC 27028 ); hereinafter referred to as the GRANTEES;
WITNESSETH:
THE GRANTORS, for valuable consideration paid by the GRANTEES, receipt of
which is acknowledged, have and by these presents do convey unto the GRANTEES in fee simple,
all that certain parcel of land situated (the "property") in Jerusalem Township, Davie County, North
Carolina, and more particularly described on attached "Exhibit A."
TO HAVE AND TO HOLD the property and all privileges and appurtenances thereto
belonging to the GRANTEES in fee simple.
THE GRANTORS COVENANT with the GRANTEES, that the GRANTORS are seized
of the property in fee simple, have the right to convey the property in fee simple, that title is
marketable and free and clear of all encumbrances, and that the GRANTORS will warrant and defend
the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter
stated.
Title to the property is subject to the following exceptions:
The purpose of the deed is to create a tenancy by the entirety.
• J
0845 8K 8 4 5 PG 318
0378
Easemen and restrictions of record.
Principal Residence Not Principal Residence
The terms GRANTORS and GRANTEES as used herein include the masculine and the
feminine, the singular and the plural, as the context requires, and the heirs, successors, and assigns
of the parties hereto.
IN WITNESS WHEREOF, the GRANTORS have hereunto set their hands and seals the
day and year first above written.
GRANTORS:
******************************************************************************
C- (STATE)
COUNTY OF a o ► _
I, a Notary Public, of the aforesaid County, do hereby certify that Jennifer J. Young and
Andrew L. Young Grantor, personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed.
Witness my hand and Notarial stamp or seal, this day f 201 .
BE
Notary Sor S61• .
�..N.0 1%.11
My Commission Expiie
(__ �_ -0!�_ Ci 0 k ILLf)� ---
Signature of N ary Public
r7i_1 us
Printed Name o Notary Public