4988 Hwy 601NHEALTH DEPARTMENT RELEASE
�Ty • •. Davie County Health Department
N p��Eo
ty 210 Hospital Street
P.O. Box 848
t
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Ryan Cochran
Address: 4988 US Hwy 601 North
City: Mocksville
State2ip: NC 27028
Phone #: (336) 245-4226
PERMIT V/�ILID 1 0/ 0 a/ a 0 1 9
. UNTIL:
Property Owner. Ryan Cochran
Address: 4988 US Hwy 601 North
City: Mocksville
State2ip: NC 27028
Phone #:
1-1 Property Location & Site Information
Address4988 US Hwy 601 North Subdivision:
Road;U M„rk.,Aua Nr. 97n9A
'Structure: SINGLE FAMILY
# of Bedrooms: 3
'Water Supply: EXISTING WELL
Basement: F] Yes F-1 No
"Proposed Improvement:
# of People:
(336) 245-4226
Phase: Lot:
Township:
Directions
Hwy 601 north on right past Hwy 801
Type of Business:
Total sq. Footage: No. Of Employees:
The design. of the addition must be altered to be 1 foot less in distance from the rear wall of the existing house, thus making it meet the 5
foot setback to the septic tank and its total depth to be 15 foot or less.. That square footage may be moved to either side of the proposed
structure. See attached drawing.
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: 2140- Nations, Robert
Authorized State Agent:
*Date of Issue: 1 0/ 0 a/ a 0 1 4
**Site Plan/Drawing attached.**
• jQAPPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
_ _._._ ✓�I„✓ _Davie County Environmental Health
lV P.O. Box 848/210 Hospital Street +
�61d1 Mocksvillc, NC 27.028
(336)753-6780/Fax(336)753-1680
Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both
Type of Application: ❑New System ❑Repair to Existing System )(Expansion/Modification of Existing System or Facility
* * *IMPORTANT" * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed a r Contact Person JK1kdn�a
Billing Address Home Phone
City/State/ZIP OL a Business Phone 33G — 14,Y SQn
Name on Permit/ATC if Different than Above
Mailing Address Ll5L City/State/Zip L D
*Date House/Facility Comers
NOTE: A survey plat or site plan must accompany this application. Included: KSite Plan ❑Plat(to scale) .
(Permit is vAid for 60 months *th site plan, no expiration with complete plat.)
Owner's Name K u & v% aah r"d (•J Phone Number 3N
Owner's Address— City/State/Zip )Y) Le IL.s V
Property Address 2= us W 01 Al City ao
Lot Size P21") Aclt5 Tax PIN# -0 3
Subdivision Name(if app�lica.b,le) Section/Lot#
Directions To Site: A m � D I . w r» . I & na s -t - ,-Z f 1 n'FPtStx�
If the answer to any of the following questions is "yes", supporting documentati n must be attached.
Are there any existing wastewater systems on the site? ❑Yes) TO
Does the site contain jurisdictional wetlands? ❑Yes o
Are there any easements or right-of-ways on the site? ❑Yes No
Is the site subject to approval by another public agency? ❑Yes QINo
Will wastewater other than domestic sewage be generated? ❑Yes Wo
IF RESIDENCE FILL OUT THE BOX BELOW 4 f i &d (ZD 0 p tlj L
# People :3 # Bedrooms f # Bathrooms Garden Tub/Whirlpoo3rrMes ❑No
Basement: ❑Yes ❑No Basement Plumbintt: ❑Yes ❑No 'Yn— — I TZ t;,1 P',". I del
OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: t9tonventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: 0 County/City. Water ❑ New Well &Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes
If yes, what type?
❑ No
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand
that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use
changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized
Representativ a avie County Health Department to conduct necessary inspections to determine compliance with applicable
laws and u erstand)hat r am responsible proper identification and labeling of property lines and comers and
locati a fla ngef� Mpg tJ houseffa location, proposed well location and the location of any other amenities.
4 "ef ("— Site Revisit Charge
Prop4 o ner s or owner's legal representative signature
Date(s):
s + ( Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No
Revised 11/06
Account#
Invoice #
22
28
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WARRANTY -DEED-Forth WD401 ea Williams At Co., Inc. Yodkitivdle, N. C,
STATE OF NORTH CAROLINA. Dav s
THIS DEED, Made this 28 day of lmber ,19 83 .by,,,d,�1fry Jes S. McEwen and '
—![i1e.,Mary S; McEwen or ie ca■neat
.td maw of North caroliw, berrinafter ua[a, and 11 i l l a rd Ashley, J r .
IFa V e County and Sute of North Carolina, hereinafter
called Grantee. whose permanent Plait• addma b � '
WnWESSETH: That the Grant , for and b ennsideratmn aunt of _ One H _Iksllars
and other go d'and valuable coni stions to him In Mod paid br the (:not ri1K whereof b herein) arknnwkd�g{rrd, has Sivtn, panted, borpNed, add
and tomveyed, and by tI,eM dao She, pant• bergs a, sell, r cnn/irm unto the Grantee. Is ficin And or wccesulrs and assigns. pvembn in
Clarksvie`_- _ - avie
County. North Carolina. described aifollows:
BEGINNING at a point in the center of Highway #601, Edith Absher's
corner, and being the,Northwest corner of the within described tract
and the original Southwest corner of a certain 3.81 acre tract des-
cribed in a deed from Noah Absher and wife,' Edith Allsher, to Jesse
Stanley McEwen and wife, )clary S. McEwen, recorded in Deed'Book 81, at
page 566, Davie County Registry, runs thence with the said Edith Absher'
line North 59 degs. 52 min. 53 sec. East 299.54 feet passing through ,
an iron 'in the East edge of right of way of said highway, 30 feet from
the center to a point, an iron in said Absher line, Jesse Stanley Mc-
Ewen et ux's new corner; thence three new lines the following calls: j
South 30. degs. 07 -min. 07 sec. East 103.76 feet -to a point, an iron
pin, South 43 degs. 06 min. 41 sec. West 200.42 feet to an iron pin, i
and South 62 degs. 49 min. 00 sec. West 120.68 feet passing through
an iron pin in the East edge of right of way of said Highway 0601 to
a point in the center of said highway; thence with the center of said :.
highway North 25 degs. 22 min. 52 sec. West 155.94 feet to the BEGIN-
NING, containing one (1) acre, more or less, as taken from a plat.
prepared by Kenneth L. Foster, Registered Surveyor, dated July 6, 1983.
For back title see said deed recorded in Deed Book 81, at page 566,
Davie County Registry.
NO NA NC N UNA Ii NA
99TAT9 99TATC A $TATE
CXC199 TAX 9X092 TAX 9X6199 TAX
00.00 $4.00 _ ;4.00
1
I
Prepared by John T. Brock, BROCK & MCCLAMROCK, Attorneys at Law,Mocksvikl8:
The above land was conveyed to (motor by , See Bonk No. , Pace—-
M NAVE AND TO HOLD The above described premises, with all the appurtenances thereunto belonging, or In any wise ■pprytaining, unto the Granth•. lir
heirs and/or anteroom and assigns forever.
And the Grantee covenants that he Is seined of said premises b fee, .0 has rhe riot to convey the same in fee simrlet that said premises are free from en-
eambronces (with the exceptions above stated• if any): and that he will wa r r a n t and defend the add title to the sane against the lawful claims of all persons
whomsnevcr.
When reference Is made to the Grantor or Grantee, the Yngular shall include the plural and the masculine shall Incl de the feminine or the neuter.
I WITNESS WHEREOF. The GrayIlto has hereunto set his head and seal• the day and year first above tar to % �a '
(SEAL)
(SEAL) �_ o�.
a:s�^ _..mac -•-_-- z._--: cs�_—, c�-rte �=z-- � - .•�4�•sa3i{��s. -.,. , . .
Davie
STATE t1F NORTH CAROLINA C.ttUNTY. `
1, Erlene_W. Roberts allotary PublkoftaWCnunty,dohercby.eertifjehli►,•,•
_ Jesse 9. MCEwen and wife, Mary S.-U;E_wen
Grantee sonad a ared before me this do and acknowledged the execution of tl a fore d
I dee1 • 1
Witness my hand and notarial seal. this they 28
,
day of _� December u. '•'S
!: y�C+��q83 i
'.
My Commission Esp4rs:
-'-- ----=-ter_ --
/'
-___- -._.:_ '_- � '.__s—
V
•
STATE OF NORTH CAROLINA
COUNTY.
1,
a Notary Public of uW County do hereby cartify that
Grantor, personally approved before we this day and acknowledged the execution of the fovegoing deed
^^ - • -
Witney my hand and material sed• this the.
day of
My Commission Expires:
, N. P. )SEAT. I.
. STATE OF NORTH CAROLINA,c-'" _
The foreSoitgl cenffiea[e(1) of&Z41-_.--�.at=
Is (at) ce:tifled to be comes. This instrument. was `_jT,( l
presented for aeSlar■tbn fhb -'� day of ,190 !.
91142
'
A A. M., Iti1R., and duly clod N the ofller of the Register of Deeds of —c My.
North Carolina. b Sook �,.`L�, fallow
This the�d+T d . A. D.. 19 47
R of Deed; Ey Assistant. Deputy Register of Deed$
Thin skraten by
.d3pprai Card +
DAVIECOUNTY NC
R TERESA
R+lurn/Appul Nolu: ►artNt 83.000-00 J%
US HWY 601PLAT:/UNIQM43642D13-PZS
TO N0: 5623066115COUNTYTAX
(100), FIRE TAX (100) CARD NO. I N I
013 Tx Yur: 20151.002
AC HWY 601
0.890 AC
SRC- InspezMb
O]en 0621 007020CHURCN
TW -02
CI- FR -0J EX- AT• IASTAR1ON 20110725
CONSTRURION DETAIL
NARKET VALUE
DEPRECIATION CORRELATION OF VALUE
4n •
ER.
A4a
VA
B4SEStandare
CX
AVB
0.26000
FOTRU-
or System .4
USE 00
3572
116
81.20
127647 987
957 %GOOD
4.0 EPR. BUILDING VALUE -GRD
94460
8.0001 03
W+Ila - 30
m ISidln
29.00 TYPE: Single Family Ruldufial
Single FamiN RafldutNl EPR. OB/XF VALUE- GRD
RKE7 LANDVAW!-GRD
18,800
Strv9tu. - 03
STYLE: 1. 1.0 Story
OTAL NARKET VAWE • GRD
111,260
Co • 03
O300 TALAPPRAISED VALUE -CARD
111,260
Wall Conrtrvztion-4
wood Penal
18.00
OTAL APPRAISED VALUE - PARCEL
111,26D
wbr Wall C .dmd - 5
11Sh-r k
nterbr Fbor Cover -12
0 0
OTAL PRESENT USE VAW E - PARCEL
OTAL VALUE DEFERRED • PARCEL
ardwoodOTALTAXABLE
VALUE - PARCEL
111,260
nterlor Fbor Cover • 15
♦ ...... 24 ......
♦
PRIOR
UILDING V ALOE
95,600
aatinq Fuel - 04
laztriz
I 4 A 4
1.00 I
1
1
BXF VALUE
eatlnq Type - 10
I
I
AND VALUE
RESENTUSEVALUE
16,300
0.
'raGondi0 .' Type - 03
q 1
I
I
I
EFERRED V ALUE
1
I
rooms/Bathro4maM+If-
7
3
thr—,
I
f
1
I
Sro3FU5 -0 LL•0
t
I
1
1
athrooma
1
I
CODE I DATE OT NUMBER AMOUNT
NEiM
S - F -0
444
I
elf-Bathro4rm
AS
I U OP
f 1
.
.4;+
44P
OUT: WTRSHD:
ffize
1 7
4 4- i
SALES DATA
444
1
OTALPOINT _ALU!
06.000 1
1
TE DEED NDIGTESA3E
f
0=
PRICE
1e 3 Size
1.0200 1
l
Ol WD Q I
tM
130000
I V
I
i t--- 4
003 WD i I
He Dee n FACTOR 4 1.0500 1
MID -
1
i 1
i I
00 TO P I
WD
FACTOR
TAL QUALM INDEX
1.0]0
116 I
I
1 I
Z I
I
I 3
434•-l3•4. 10••4
0
I FOP IWDD
I
• 4
I
HEATED AREA 1,320
1 I
4-•13••4••••-31------♦
I
NOTES
EMODEL -pp
SUI AREAUNIT
ORIG %
ANN DEI % OB/XF
DEPR.
GS
OE ESCRIPTION UN TM NIT PRICE GOND
LDOi AlB EYB IGT VR COND
VALU
4 MED 5
U. 60 5.10
10 1965 1965 55 0
Al 1330 00 10]18{ OTAL OB %F VALUE
OP 6
TP I6 30
2M
BM 0
OF 38 35
568
_
DD 320 20
97
(REPLACE I•None
0
UBAREA
OTA. 2,500
2],61]
UILDING DIMENSIONS BAS -W14927 UOP- W457EIN) 528E2 FOP-S8El2N6 WI2 El2 W DD.S8E22N2DW12SL2W 10 EION22 STP-E4N4W454 N33 UBM•720 .
NDINFORMATION
THER
D]USTNENTS
IGHEST
NDNOTES
LAND
TOTAL
NO BEST
BE
USE LOCAL I
CODE ZONING
FROM
TAGS EPT
DEPTH/
SIL!
WD
MOD
COMD
FAR
BF AC LC TO
OT
tOAD
PE
UNIT
PRIG[
LAND YFIT TOTAL
UNJTS TYP AD]ST
ADJUSTED
UNIT PRICE
LALOWMIDE LAND
VANOTES
URALAC
0120
1SS 0
2.5620
4
1.1000
IO 100100100
Rp6,700.00
0.690 AC 2.818
18,880.60
1
OTAL PRlSENT USE DATA
TrOOA: wb"l'kffiA&dA
jb-[�q q&q 'v'J'p MA
http://66.226.39.229//ITSNet/AppraisalCard.aspx?parcel=B30000003 5
Page 1 of 1
Ownnrt RUDDER TERESA
9/24/2014
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage/ Systems Permit Number
Name Date N2 5824
Loca ion /�l�/fl� f'/7/�l/r� t�,J .�"t7` /-,fir- ?'"
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House �''� Mobile Home 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 ❑ /S1V'3
Type Water. Supply
*This permit Void if sewage system described below is not 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 Diagram:
Installed by t2��
7 01
Certificate of Completion __-1 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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*-NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
r.. Sanitary Sewage Systems Permit Number
Name /22,11;1' N2 �' c�',�!; ,9<� ,1%-, //.< " Date � .� %i' N 5824
Loc tioni�
ij �`_ i �. it ✓
Subdivision Name Lot No. Sec. or Block No.
Lot Size Ho se''� Mobile Home _• Business Speculation f
No. Bedrooms --S No. Baths No. in Family 5�
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ V
Auto Wash Machine YES E)NO ❑ �� �(
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
h.
t
Improvements permit by
4
*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 Diagram: SysteE Installed by
U
z,•
A.
t
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.
Parcel #: B300000035
Davie County,. NC - Basic Estate Search
Basic Search Real Estate Search Tax Bili Search Sales Search
I
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Parcel #: B300000035
Account #:82531642
Owner Information
Building:
Tax Codes
BXF•
RUDDER TERESA
Land:
ADVLTAX - COUNTY T
Market:
/O BUNCH & ASSOCIATES
ssessed:
FIREADVLTAX - FIRE TAX
Deferred
INSTON SALEM NC 27103
0
3 00164 0170 06
Property Information
Qualified
Township
FLand (Units/Type): 0.890 AC
4 00821 0354 03
CLARKSVILLE
dress: 4988 N US HWY 601
Improved
130,000
Deed Information
Local Zonin
Date: 03/2010 Book: 00821 Page: 0354
lat Book: Pa e:
Le al Description
PIN
1.002 AC HWY 601
5823066115
Property Values
Building:
117 04
BXF•
01
Land:
16 80
Market:
133 84
ssessed:
133 84
Deferred
Improved
Sales Information
No. Book Pape Month Year Instrument
Quai/UnQuai
Improved
Price
1 00467 0824 02
2003 TD
Unqualified
Improved
0
2 00485 0077 05
2003 WD
Unqualified
Improved
0
3 00164 0170 06
1992 WD
Qualified
Improved
51,000
4 00821 0354 03
2010 WD
Qualified
Improved
130,000
View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information
Page 1 of 1
oAeV,arci'
00001i's
Davie County Web Site
All information on this site is prepared for the Inventory of real property found within Davie County. All data Is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public Information sources should be
consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County,
its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
Implied, In fact or In law, Including without limitation the implied warranties of merchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnetfView.aspx?prid=1476181 8/10/2016