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240 Jack Booe RdDavie County, NC Tax Parcel Report t Thursday, September 29, 2016 I,V All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, 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 SOU N�� NC or arising out of the use or Inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY . _ .. _. .... ., __ _ Parcel Information _ ... _ ..x _....._ .... .... ..... . Parcel Number: C30000011007 Township: Clarksville NCPIN Number: 5812984746 Municipality: Account Number: 82522813 Census Tract: 37059-801 Listed Owner 1: FELTS TIM M Voting Precinct: CLARKSVILLE Mailing Address 1: 240 JACK BOOE ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-4832 Voluntary Ag. District: No Legal Description: .775 AC JACK BOOE RD Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 0.65 Elementary School Zone: WILLIAM R DAVIE Deed Date: 5/2004 Middle School Zone: NORTH DAVIE Deed Book / Page: 005530760 Soil Types: MnC2,MnB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 52580.00 Outbuilding & Extra Freatures Value: 12100.00 Land Value: 12740.00 Total Market Value: 77420.00 Total Assessed Value: 77420.00 I,V All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, 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 SOU N�� NC or arising out of the use or Inability to use the GIS data provided by this website. �i ``4 �llrtil'i'f �u'++4- ii`aPN�i s y,, ae.� ,L��. : � '+ � .� rn. --. ro.,� 1... - r�-i�-e. .,; A4. �;f..�.fd�[7��`4f45u � 4y'V'i� +tror +14'�*�.jM„� "F'.t'` m'{- `M:�+r'%r� w., �`w e ,-tt..��>D�` , � v � .. � � ir; AUT��oRizaTlori rro: ' �'� ,� � � � DAVIE GOUNTY HEALTH DEPARTMENT , . � '� x ;� _ � ' � �Environmental Health Section PROPERTY INFORMATION' Permittee't l_�.��L.�.. :' P.O. Box 848' . Name. � �t%'�' �Mocksville, NC 27028 �. Subdivision Name: ' . Phone # 336-751-8760 ' ': , Directions to property: �'��"�'�-°�-�� ``� � Q ' Sect�ori: ' Lot: ;�,,� - ' � AUTHORIZATION FOR ' � ''`-;� ,f �.��i�'f��.. �� , ` . . WASTEWATER Tax Office PIN:# �� IZ_ `'i e�, _- � ��i �.. �f�.l�:s4�, L; +�, �L' �� . SYSTEM CONSTRUCTION � " �'7 .-, C �1,�,� l.i ; nr-� �. k.rl�.:.►M" ," � Road Name�.��`'�C��. ��ip: L-7UG.C� ,• . . - ., **NOT'E** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior � , ro issuance of any.Building-PermiG�: This Foim/Authorization Number should be.presented to the; Davie County Building Inspections ' ' ' Office when applying for Building Permits. . : � = n � ` � � ' - : (ln compliance with Article I 1 of.G S. Ghapter:130A, Wastewater Systems, Section .1900 Sewage Treatment and.Disposal.Systems) .� _ � ;,� ; _ ' ` / '"'' " " ' ***NO CE*** TH1S AUTHORIZATION FOR WASTEWATER , TI CONSTRUCTION . �___� �� %[..� ��I ( �� IS VALm FOR A PERIOD OF FIVE YEARS. . ENVIRO E L,H�AL H SPECI LIS j DATE IS UE .' , � L,, ��'��#'�v��r`� `= �t a"`w" t�,;,"t"A'�.i.r�.,:;r�'^'"`?i a"4� r ^-t,r d r .a, -�a �r.,.,c`> ,� Y �`' a `�" ��.� ," ^+'�'�"w.F .. �. -,v- r r �:i� � ��F �; � r � � �. �. � fi y� o ��x p: ��OJi 'i, , � ,,,,.u.. � .� ; .' '� ,� � � , DAVIE OUNTY HEALTH. DEP R 1� NT , ,� ' , . � � " . . �� ` �� ' - IMPRO�EMENT AND OPERATION�PE��TS PROPERTY INFORIVIATION �perr'.,'�iK ��'; �`�� i ' `Nam�°" ��4 =-�-�� °�"''� ��'�"" Subdivision Naine: , F.; :; ,, ; . , . �r+ ,. f *4 �,-r 4' ��. . � � i. � 1 � �,Directions to property: � ��A°�� -"i� t "�-� ,� �-`" , Section. Lot: , , � � IMPROVEMENT � � � � � � , `c 1 , : - . k ' ., . � ,�.�t"»� . � C��, �., . �i� :;� a � i � �� , � `PERNIIT - Ta�c OffiCe PIN:# `�` ", i'°� � r, �:� �� r' , '� �� ,.�� ,;. �,•,..1 "� �,6f_.,��"r' � �— Road Name: ��;!�a:` k'. 1"'~r�r �: �i1 Zip �.' �L �' �'i _ _ ement Permit D _ , , � . , , , ; ,, . , _ . . : _. . . **NOTE** Tlus Improv ' OFS NOT authorize the construction or'installation of a septic tank system or any wastewater system An ' ,•'ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Department prior to the construction/installatiori of a system or the issuance of a building pernut ' ' �' (In compliance with Aiticle 11 of G.S, Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) . .;, , . , ,> , . ri �' �'� , �, , ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION iF SITE ; ,� . . ;:*�`, ;'. ;�, � , . ;'`� ,., , � �. _ f ,r� �, � { I PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRON�M TAL HEA H SPEC�ALIST';. . DATE I UEb SYSTEM CONTRACTOR MUST SEE TIII.�i PERMIT BEFORE,, � r : ;: INSTALLING THE SYSTEM. ��' • `�� . H.;: : ., t„ `.'; ,,�� ;�� '.� �. : �� ` . � � �. ; - RESIDENfIAL SPECIFICATION: BUILDING TYPE �V��i BEllROOMS �# BATHS �" # OCCUPANTS � GARBAGE DISPOSAL: Yes No ` COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFC # SEATS INDUSTRIAL WASTE: Yes'or No ' � � �25'�2sj xl�l�X25o' � " ` ; � , , � LOT SIZE TYPE WATER SUPPLY ' t�/�T�DESIGN WASTEWATER FL:OW (GPD) .�co� NEW SITE-� REPAIR SITE � �F tl �-SYSTEM SPECIFTCATIONS: TANK SIZE � Q��GAL. PUMP TANK GAL. TRENCH WIDTH ��' ROCK DEPTH �� LINEAR FTr �� `' OTHER � 'Z � I STP--I �"[`I O �-'� ' �C.�iLJ —�''� ��C?�JG�7 L��.4Jt�*:S? F ► l..T �:=�: ; r , � . : �c.��'' � � cF� : �IaJS,�., �.l�i� IO� v�E %��c�'LN:.�, 1�15TAGL' � � REQUIRED SITE MODIFICATIONS/CONDITIONS: :•;•. , , `' , " ` G�c>n1'YcyJ�.. : `' . **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM . ''.-'' BETWEEN $:30 - 9:30 A.M: OR 1 i00 - 1:30 P.M. ON THE DAY OF INSTALLATION: TELEPHONE # IS (336)751-87b0. OPERATION PERMIT �. ��- SYSTEM INSTALLED BY: W� Lt�L � ` ��-1�0�� G►: � f 3, '10�X3�„��_ �� o� �. �D� , l (oD' ,E% �"�� '�.Sp�xT� � � � . ��.P�c� . �1 � , . A..T IAUTHORIZATION NO. ��G OPERATION PERMIT BY: DATE: S� `+*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIB BOVE HAS HEEN INSTALLED IN COMPLIANCE :W1TH ARTICLE 11 OF,G.S: CHAPTER 130A, SECTION .1900"SEWAGE TREATMENT AND DISPUSAL SYSTEMS"; BUT SHALL IN NO WAY BE TAKEN AS A ` ' GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ', "' DCHD OS196 (Revised) ` ��; _ APPUCAMON FOR SITE EVALIJATION/IMPROVEMENT PERMIT & ATC Davie County Health Department * Environmental Health Secton P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 0 D DEC 18 19% ENVIRONMENTAL HEALTH ***ZMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. name to be Billed J zE Cqy JD Le Contact Person—3ZCflyQ L G Mailing Address 10� ? c is ' CN\C r. Phone L1q Z - Z Z %1 City/State/ZIP m(%C- k5u f (IC V 7-707% Business Phone .,, 3l0 - 60S- P7 y6 2. Name on Permit/ATC if Different than Above Hailing Address City/State/ Ip 3. J►pplication For: U Site Evaluation Id Improvement Permit /AT ;W -Bo 4. system to service: ❑ House 0 Mobile Home 0 Business ❑ Industry 34 Other �ieWa�na n6m� s. If Residence: # People # Bedrooms 3 # Bathrooms Dishwasher 0 Garbage Disposal % bashing Machine 0 Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sims # Commodes # Showers # Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimated hater Usage (gallons per day) 7. Type of water supply: XI County/City 0 Well ❑ Community S. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes ;WNo If yes, what type' ***1MP0RTANT*** CLIENTS 11lUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: x51.39, x 1qS• s9" Tax Office PIN: # 589 --9R , q 79 W, ooa) Property Address: Road Name Qui Z 40 o e- _ City/Zip 1w If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: .tool W. Le -4 on -Yack i�wc Rd (\av'Ax . i/4 rr►'� 1� 95VI Iy lol+ kt s i �-c `� 5 nC�ly araclr ovk-- a-Y---0W2A-Yiq Date Property Flagged: 4?4/ 1 D This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted In this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Heaitb Department to enter upon above described property located in Davie County and owned by Com to conduct all testing procedures as necessary to determine the site suitability. DATE / .Z -- / �A - c A SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITETLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). /V<- <I9' Revised DCHD (07/98) /2S•00' J s Account No. l0 Invoice No.