3063 Hwy 64EHEALTH 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: Russell c. Tallent
Address: 3063 US HWy 64E
City: Mocksville
State2ip: NC 27028
Phone 4: (336) 998-2214
For Office Use Only
*CDP File Number 124044 -1
J7 -120 -AO -003-01
County ID Number:
valuated For. EXISTING
PERMIT VALID 1 1 / 1 3 I 2 0 1 8
UNTIL
Property Owner: Russell c. Tallent
Address: 148 Cricket Lane
City: Advance
State2ip: NC 27006
Phone #: (336) 998-2214
Property Location & Site Infonnation
Address 3063 US Hwy 64, Subdivision:
Road # Mocksville NC 27028
Township:
Directions
Hwy 64 West, Near the Armory Just outside of town
'Structure:
SINGLE FAMILY
# of Bedrooms: 3
*Water Supply: WA
Basement: FlYes ❑ No
'Proposed Improvement:
Single Wide Home
# of People:
Phase: Lot
Type of Business:
Total sq. Footage: No. Of Employees:
It is the responsibility of the owner to maintain a 5' 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 released 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 1 / 1 3 / 2 0 1 3
Authorized State Agent:
**Site Plan/Drawing attached.** Total Tlme:(HH:MM)
0 1 Hours 0 0 Minutes
O Hand Drawing Olmport Drawing
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�UN�
s Printed:Oct 28, 2013
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 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.
Davie County Health Department
1�)P8r� • COPronmental Health Section -
P.O. Box 848
210 Hospital Street •�
Q ZT Courier # : 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 6780 Fax: (336) - 751- 8786
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
Phone Number %/i l 7 — ,i %" I (Home)
Mailing Address: 4 iJ _ (Work)
tJ�1 N C, -e- G Z70 P/ Email --
Detailed Directions To Site:
tzo-�10yU3-d�
/, p . o
Property Address t96Q, 3 Us M/
Please Fill In The Following Informmation.About The EXISTING Facility:
Name System Installed Under: / ►1 f rSd h Type Of Facility: /' � �yj
f/
Date System Installed (Month/Date/Year): / ?7! _ q Number Of Bedrooms: v Number Of People:
Is The Facility Currently Vacant? es No If Yes, For How Long?
Any.Known Problems? Yes No If Yes, Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility:'
S'N le N, �i e- Number Of Bedrooms: Number of People
�7 q
KRequested By: Date Requested:
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in' no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Check Money Order #
Amount:$
Paid By: Received By:_
Account #:/ 'L �� Invoice #:
Date:
Parcel #: J712OA000301
Davie County, NC - Basic Estate Search
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View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
Parcel #: 3712OA000301
Account #:72472000
Owner Information
11,194
Tax Codes
5201
ALLENT LILLIAN ELOIS& TAU -ENT RUSSELL CALVIN
11,7601
ADVLTAX - COUNTY T
[F.IREADVLTAX
23 47
148 CRICKET LANE
23 47
- FIRE TAX
ADVANCE, NC 27006
Property Information
Township
nd (Units/Type): 0.440 AC
FULTON
ddress: 3063 E US HWY 64
Deed Information
Local Zoning
Pate: 06/2016 Book: 01020 Page: 0676
Plat Book: Page:
Legal Description
PIN
10.443 AC HWY 64
5777097254
Property Values
uildin :
11,194
5201
rBXF•
nd•
11,7601
Market:
23 47
Assessed:
23 47
Deferred:
Sales Information
No. Book Page Month Year Instrument Qual/UnQual Improved Price
1 00145 0578 30 1988 WD Unqualified Vacant 0
2 01020 0676 06 2016 WD Qualified Improved 30,000
View Property Record for this Parcel View Map for this Parcel View Tax Bill Information
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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.daviecountyne.gov/itsnet/View.as-Dx?arid=1470808 6/21/2016