325 Jamestowne DrHEALTH 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: Justin Shaver
Address: 138 Butterfly Hill Trail
City: Mocksville
State2ip: NC 27028
Phone 0: (336) 692-4331
r For Office Use Only
*CDP File Number 120759 -1
H60000008207
County ID Number:
valuated For: HDR/WWC
PERMIT VALID 0 4/ 0 4/ 2 0 1 8
UNTIL:
Property Owner: Justin Shaver
Address: 138 Butterfly Hill Trail
City: Mocksville
State2ip: NC 27028
Phone M (336) 692-4331.
Property Location & Site information
325 Jamestown Drive Subdivision: Phase: Lot
'Structure: SINGLE FAMILY
# of Bedrooms: 3
*Water Supply: WA
Basement: n Yes ❑ No
'Proposed Improvement:
Mobile Home Repalacement
# of People: 2
Township:
Directions
hwy 64 East, Left on Comatzer Road, Left on Jamestown Drive. go to
end of raod property on left
Type of Business:
Total sq. Footage: No. Of Employees:
efease Conditions
Itis 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.
system was located but no permit found on existing system
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 @No
Applicant/Legal Reps. Signature: *Date: / /
*Issued By: 2244 - Daywalt, Andrew *Date of Issue:. 0 4 / 0 4 / 2 0 1 3
Authorized State Agent:
1 11 A'11 "I I IV Illymplo
**STotal Time: H!
'te Pla !Drawing attached. u
0 Hours Minut
Q Hand Drawing OlmportDrawing
D' County Health Department
�P� 6r� sytronmental yHealth Section
r P.O. Box 848
210 Hospital Street •
Courier # : 09-40-06 R 1911
Mocksville, NC 27028
Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
Name: 5�j1 h�2 U �-r tr Phone Number 2/N� &c�, -433 4 (Home)
Mailing Address: t R (3!A H (H T ✓ 30 `-C"�jf -,-ptq (Work)
Wk is nn Email Address:((/(�f'I i�i�Y�i,UP�' v i. lYi� I'
Detailed Directions To Site: (0q � � �C`r on l (� 1 Y a � !r 1 v`� �m
I Q �t � jah �f�e � an 1- of r06 -V, a raneWi
Property Address:
Please Fill In The Following Information About The
%EXISTING Facility:
Name System Installed Under: 674, /i a-.�d•'7Type Of Facility:
Date System Installed (Month/Date/Year): Number Of Bedrooms: Number Of People:
Is The Facility Currently Vacant? Yes No If Yes, For How Long?
Any Known Problems? Yes No If Yes, Explain:
Please Fill In The Following Information About The NEW Facility: 2
Type Of Facility: nie Number Of Bedrooms: iJ Number of People
Pool Size: � Garage Size: N Other:
Requested By: �—u Date Requested: 3 0 9 /1? 0
(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 #
Paid By:
Amount:$
Received By:
Account #: 47- Invoice #:
L' bp- iZ0 7Sq
_........----------------- r�o,- Iti
fit',/ 74
1 ,
Sl •G --Qj-
INCL
Appraisal Card Page 1 of 1
HAVER RONALD W
Return/Appeal Notes: 1146-000-00-082-07
25 JAMESTOWNE DR
UNIQ ID 13611
657680
-
ID NO: 5759700585
COUNTY TAX (100), FIRE TAX (100) CARD NO.
1 of 1
eval Year: 2013 Tax Year: 2013
1 AC OFF CORNATZER RD
1.000 AC
SRC= Inspection
Appraised by 19 on 09/04/2008 07001 SHADY GROVE
TW -07
C- EX- AT- LAST ACTION 20110712
CONSTRUCTION.
DETAIL MARKET VALUE
DEPRECIATION
CORRELATION OF VALUE
OTAL POINT VALUE
MOD
Eff.
Area
BASE
UAL RATE RCN EYB
AYB
REDENCE TO
BUILDING USE
00
% GOOD
EPR. BUILDING VALUE- GRD
ADJUSTMENTS 97
OTAL ADJUSTMENT TYPE: Vacant
EPR. 08/XF VALUE - CARD
ACTOR
ARKET LAND VALUE - CARD
OTAL QUALITY INDEX STORIES:
OTAL MARKET VALUE - CARD
OTAL APPRAISED VALUE - CARD
q22
OTAL APPRAISED VALUE - PARCELOTAL
PRESENT USE VALUE - PARCEL
OTAL VALUE DEFERRED - PARCEL
OTAL TAXABLE VALUE - PARCEL
PRIOR
UILDING VALUE
BXF VALUE
5,61
.AND VALUE
17,47
RESENT USE VALUE
EFERRED VALUE
OTAL VALUE
23,08
PERMIT
CODE I DATE NOTE I NUMBER AMOUNT
OUT: WTRSHD:
SALES DATA
FF.
ECORD ATE DEED
INDICATE SALES
LOOK IPAGE MOIYR TYPE
PRICE
0754053 4 00 CD C V
300
0122 489 4 198 WD X V
HEATED AREA
NOTES
ROM RONALD SHAVER
SUBAREA
UNIT
ORIG %
ANN DEP
%
OB/XF DEPR.
GS RPL ODE ESCRIPTION
LTH
HUNIT
PRICE
COND
LDG7tl
B
AYB EYB
RATE OV
GOND
VALUE
30
14
14
15.00
100
_
L
197 1979
S3
0
TYPE AREA IS 1 TORAGE
IREPLACE 1
TORAGE
8
8
64
15.00
100
_
L
198 1988
S3
25
24
SUBAREA 1
ORAGE
1
9
15.0
30
_
L
198 198
S
2
36
TOTALSD8
H SITE
1 4 500.0
L
198 199
5
10
450
OTAL OB/XF VALUE
5110
UILDING DIMENSIONS
NO INFORMATION
IGHEST
THERA
ADJUSTMENTS
LAND TOTAL
NO BEST
USE
LOCAL
FRON
DEPTH/
LND
GOND
ND NOTES
OA
UNIT LAND UNT
TOTAL
ADJUSTED LAND LAND
SE
CODE
ZONING
TAGELPTJ
SIZE
MOD
FACT
RF AC LC TO OT
TYPE
PRICE UNITS TYP
ADM
UNIT PRICE VALUE NOTES
H HOMES I'i
0201
0
0
2.4940
4
0.7500
10 -15 +00 +00 +00
1 PD
9 300.0 1.0 AC
1.871
17 400.3 1747
OTAL MARKET
LAND
DATA
1.0
17,470
OTAL PRESENT USE DATA
O
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=H60000008207 3/20/2013
RONALD W. SHAVER —REBAR E--LEVITY LN.
D.B. 117, PG. 828 3 W
PLACED Fled for registration at o'clock M. JAMj� ,�N DR
I hereby certify that I am the owner of the property shown o IRON
and described hereon, which located in the County of Davie
that 1 hereby adopt this plan of subdivision with my free consent. L. BARRIER �' n o
Q ��' �`� 2013 and recorded in i
established minimum building setback lines and dedicate all streets, RANDY PG. 803 "r` n �� �� �� pF�ty
alleys, walks. parks and other sites and easement to public or D.B. 388, f 1525
private use as noted. Furthermore. I hereby dedicate all sanitary 3p•11 � >j gg 9 • �y �� p�o� ___� Plat Book Page
sewer and water lines to the County of Davie p.8• ?G• 3 r+�D ,p'i
: DATE p.B• log.W PG• 8p Z,rs, ^� JAMESTOWN �g r« : pa+a u er r �+on� � cti►vl� Co. r or I�..a.
RONALD W. SHAVER 77 - �� • " by CORN.
37.3 26* E N- cr t a� r�.^.
N 81�g___ CEO I� �'� �'"^I DtPUiYW
UNMARKED r•-- u: P1ROH'j�, `� � W �pµE RD
POINT 1 _ -� I Y or- / RG
_ E_
M pRNE (A
12'
GM
.__ -? 170M PLACED
W I IRON
a- __--
PLAC�Q _ - PROPOSED j NO SCALL
n 4 40 SEr DWELLING I PAUL W. KE T CHAlII
LO iti l� r TEFON gPCK UNE LOCATION PG. 566
I D.B. 376, VICINITY MAP
m I
p I
TRACT 2 I
AREA= 0. 131 AC. H
REVIEW OFFICER'S CERTIFICATE TO
FROM D.B. 117, PG. 828 i 30' EASEMENT
TO BE RECOMBINED WITH I I AS OF APR-22-2013
PIN# 5759700585
I, Review officer of Davie County, I /
certify that the map or plat to which this certification
Is affixed meets ail statutory requirements for recording. I - - ------ ---- -
• STONE
FLOOD ZONED AREA AS TAKEN _
I FROM DAME COUNTY GIS I
REVIEW OFRCER DATE I MAPPING YEAR 2010 4
I
1
I JUSTIN SHAVEN. � �-
I D.B. 918, PG. 707 ;
I PIN# 5759700585 N
NO APPROVAL REQUIRED BY THE I I CIn
DAME COUNTY PLANNING DEPT, VER I TN�i� ; 7
RONALD
W. SHA !' EP ` .
DAVIE COUNTY PLANNING DIRECTOR D.B. 117, PG. 828 i �Dp1A 00�`COU o1Ols - � /
PINJ 5759607366 I / HENRY S. NORIIIAN
I / 1 NOTES:
n.B. 108, PG. 310
I / 1. TOTAL TRACTS- 2
1
_ 1 2. TOTAL AC.= 1.131 AC.
I NE 1
PLACED
3. NO NCGS GRID MONUMENT LOCATED WITHIN 2000 FT.
PLACED
IRON
W
i �vY L
tTWt
EXISTING
I• Grady L. Tuttarow, certify that this plat was drown
IRON PLAT MAP:
under my supervision from an actual survey made r''
Junder my supervision (deed descri tion recorded in TRACT 1 T
. �
Book ; Page —. etc.) �ther);that the =° AREA= 1.000 AC. � V �
boundaries not surveyed are clearly indicated as drown �` �L�.
from information found in PL Book Page ' , TAKEN FROM D.B. 11'7, PG. 828
that the ratio of precision is calculated as 1: +20.000 ;
OWNER -------•------------ DEVELOPER
that this plat was prepared in accordance with G.S. Z W
47-30 as amended. Witness my original signature, f.
registration nu a seal th E'-Z da of m
RONALD W. SHAVER
`v�ttrttrN�ki � t
•. 2 %%% CARO` ��,� ± t 337 JAMESTOWN DR.
`' """"••• �/ �� MOCKSVILLE, N.C. 27028
� sury ,`pQ;.•oFEssioti4.'L.9,; � L. CHRISTIANSEN
(Seal or Stamp) Registration Number �: Q' SUSAN
Finn Licence Number F-0372 SEAL �_ D.B. 166, PG• 691 SHADY GROVE TOWNSHIP
= = L-2527 = - DAVIE COUNTY, NORTH CAROLINA
— Q-
.�Q�� DATE: APRIL-22-2013
� Y N�a..P••'
��ar .�rrifigation for 4d,nc„i.3n., – ttn.,i. Cnw,ty_ North Carolina ',,��h�tfi�il��"' ```,, 200.12 ' INEW RON TAX MAP REF.: H-6, P/0 82.07
I, Grady L Tutterow, Registered Land Survey". Number L-2527 w
S X26 SURVEYED BY:
a.rtity to one or more of the fallowing a. indicated by an X: INEW RON r TUTTEROW SURVEYING COMPANY
-1—a. That this It a plat of a survey that create* a subdivision of
107 NORTH SALISBURY STREET
land within an area of a county or municipaat hos an
lity th
o�nance that rrgn,� pa,� of tend; Z MOCKSVILLE. NC 27028
b. That this plot is of a survey that is located in such a
portion of a county or nw dcNty that is unregulated as to on v a� 336) 751-5616
ordinance that regulates parcels of kind; P. r+►� FIRM# F-0372
c. That this plat is of a survey of an existing parcel or
hat
_d. kind;
t� 50'
In of a survey of another category, such as the 1" =
Ththis
recombination of dr,� porce* a court-ordered survey, or 50 25 0 50 100 150
other exception to the of a subdivision;
.. That the Informwc
Information avokibie to this surveyor is h W. SH
AVER
R
v� I am unable to make a defe atlontto t d above.my
RONALD PG.
8 ��
In a. through D.B* 117, SCALE IN FEET
Pc.S 2 527 FILE NAME: COORD NAME: DRAWING NUMBER:
Regkstration Number SHAVPLAT RON-SWA-95 5113-3
STONE