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183 Lakewood Dr Davie County, NC Tax Parcel Report ��, �'� Friday, September 23, 201E 1-U., 164. I �`LAKE V I — -` 177 179 �`----+-- � - -.-..1 7 ` -- -- ----- ..-_--------._--_-----_. 199 ,.;\ --_-- ~1 V� i 183 140 —..._..........._...__.___ — _... ___............._._.............. _.__._..._._...__.._.._......._.........._.. WARNING: THIS IS NOT A SURVEY Parcel Information77 77 Parcel Number: K5090A000801 Township: Jerusalem NCPIN Number: 5737919564 Municipality: Account Number: 8301996 Census Tract: 37059-807 Listed Owner 1: GORDON JEFFREY T Voting Precinct: COOLEEMEE Mailing Address 1: 183 LAKEWOOD DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag.District: No Legal Description: 1.670 AC LAKEWOOD DR ' Fire Response District: JERUSALEM Assessed Acreage: 1.67 Elementary School Zone: MOCKSVILLE Deed Date: - 5/2013 Middle School Zone: SOUTH DAVIE Deed Book/Page: 009250981 Soil Types: GnC2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 151450.00 Outbuilding&Extra 32640.00 Freatures Value: Land Value: 14030.00 Total Market Value: 198120.00 Total Assessed Value: 198120.00 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 Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �optyC NC or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department p INIs jfi Environmental Health Section . P.O. Box 848 .. f 210 Hospital Street RECEIVED {" ID p �► 0 ZJ �j`S Date- �0131 NCourier# : 09-40-06 ;< 0 Mocksville, NC 27028 Date: 0 Recdvedbv: Phone:(336)-753-6780 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION - (Check One) Replacement Remodeling Reconnection Name: ;,!5F6RE j 1 &oiMo✓ Phone Number. 3W.417?.33oot (Home) Mailing Address: 1$3 Work) Mocjcsuicci /Je- 2701. Email Address: Xji-0 WL 12 1# Detailed Directions To Site: 6 o I S 'To LAKt'w0j A1t A nl6fV L4Fr T To LhKi5wvafl ISI2 7o P83 oN r"le LeF-r Property Address: P93 L A K.-5WW5 Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: 3ZF1:26-1 % Cro R Do J Type Of Facility: }-10 u5 C Date System Installed(Month/DateNe.ar): h P 2 )cf9$ Number Of Bedrooms: V- Of People:_ Is The Facility Currently Vacant? Yes (2o,2 If Yes,For How Long? Any Known Problems?. Yes 0 If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: P00 L Number Of Bedrooms: Number of People Pool Size: 11 S % '346 Garage Size: Other: Requested By: �/ ,& 7 Date Requested: b3 a c T I c,/- ( ignatu For Environmental Health Office Use Only ppro Disapproved ents: 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. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: Account#: 5 _Invoice#: /D//0 /� e� /00•U� S To AjZ. -383 -.------------------ -____--------------------------- Cb ----------Cb CV RO01, 29T *. (r S Pan �(��''(J'(�nAll data Is provided as Is without wamnty or quaraS i1@kIJ sittl�dk�lre Qdl'IrAp1190111f:n.g but not limited to the ImpliedN14' warranties of merchantability or fitness for a particular use.All users of Davie County's GIS websRe shag hold harmless the County of U N Davie,North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to or arising out Printed.Sen 23 2014 S of the use or inability to use the GIS data provided by this website, r .3 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *MOTET Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name SAL d 42121) ff m2k741,'_)cY hf�/�del Date --C"/,4 / N2 5617 Location /�- �� 'r%Xf%- ��f/� �i;�/ - / 5-r �7i7� 1A4� Mod 0/2, Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home V"� Business Speculation No. Bedrooms c2 No. Baths No. in Family Garbage Disposal YES O NO 21" Specifications for System: Auto Dish Washer YES ❑ NO �1 ` J Auto Wash Machine YES ❑ NO Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. } Improvements permit by 17a *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: System Installed by Z& W4'4'2 a 0 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. APPLICATION FOR SITE-EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section RECE�Ep JUN 15 P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone '�63 l-i 3 85l 1. Permit Re ested By O /> E///7e5 Business Phone 2. Address a 7,92 3. Property Owner if Different than Above Address 4. Permit To: a) Install-!!L/Alter Repair b) Privy Conventional V Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home ✓Business IndustryOther b) Number of people 6. ay If house or mobile home, state size of home and number of rooms. House Dimensions X 7Z Bed Rooms '2— Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes / urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public_ Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions "X znz b) Land area designated to building site /7 S1 c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? � What type? This is to certify that the information is correct to th st of m knowledge. r Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR ZMPLIAN� CE WITH ALLSTATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ASW ,�� -- �� 75 2VA Qom . 4 i DCHD(6-82) ' 'DAVID COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED (office use only) yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal syste & q DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: owner only -,!t'— Owners designated representative —Anyone requesting results — Only those listed below DATE SIGNATURE DCHD(11/84) •' 'DAVM COUNTY HEALTH DEPARTMENT Environmental Health Section. P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION / Name Date Address Lot Size ldllY�Jl� FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position QS PS PS PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) <B> -(a) _(TP 1� U U U U 3) Soil Structure (12-36 in.) S S S Clayey Soils (OP PP U U U U 4) Soil Depth (inches) (!PR;' & <�Ps �. U U U U 5) Soil Drainage: Internal S,& <��P ) <�P�_ _-Ar U U U U External S Ste. PS U U U U 6) Restrictive Horizons - 7) Available Space � S. �' U U U U 8) Other (Specify) S S S S PS PS PS PS U U U . U 9) Site Classification f 40r U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by � `/ Title % Date SITE DIAGRAM �3 Y, X UCHD)6-82)