127 Legion Hut Rd �avie County, NC Tax Parcel Report 3� Monday, October 3, 201 t
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WARNING: THIS IS NOT A SURVEY
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Parcel Information
Parcel Number: M4040A0005 Township: Jerusalem
NCPIN Number: 5736617079 Municipality:
Account Number: 38643018 Census Tract: 37059-807
Listed Owner 1: HUTCHENS KENNETH E Voting Precinct: COOLEEMEE
Mailing Address 1: 127 LEGION HUT ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: LOT 5 GLADSTONE ESTATES SECTION ONE Fire Response District: COOLEEMEE
Assessed Acreage: 0.45 Elementary School Zone: COOLEEMEE
Deed Date: 9/1995 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 001830033 Soil Types: GnB2
Plat Book: 0006 Flood Zone:
Plat Page: 012 Watershed Overlay: DAVIE COUNTY
Building Value: 29120.00 Outbuilding 8�Extra 0.00
Freatures Value:
Land Value: 9150.00 Total Market Value: 38270.00
Total Assessed Value: 38270.00
[.vl All data Is provided as Is without warranty or guarentee of any kind elther expressed or Impiled ineluding but not Iimited to the
9�°� Davie County� Implied warranties oi merchantability or fltness for a particular use.All users of Davle County's GIS website shall hold harmless the
'�� �7�-r County of Davie,North Carolina,its agents,consultants,contrectors or employees from any and all ctaims or eauses of action due to
�OUN�' 1\l., or arlsing out of the use or InablOty to use the GIS daW provided by this webslte.
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Davie County Health Department
��is f� Environmental Health Section
�, = P.O.Box 848 , s��� • .
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� R'�� 210 Hospital Street
� �.�. �. Courier#: 09-40-06 �g��
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� Mocksville, NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: �,.�,��7�L, � I-�W-�c G�o,n s Phone Number �3G -�55 -�/3� (Home)
Mailing Address: �Z� C-PC►'a.� /-/y-� /�� (Work)
�ivt�^�C�„%/� (� �. Email Address:
Detailed Directions To Site:
Property Address:
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under:�..��/ �ID�� 6't�iVf1'!� Type Of Facility:� �"
Date System Installed(Month/Date/Year): C1�� Number Of Bedrooms: � Number Of People:
-�s�'-heFacility�urrentLy Vas_an�?_Ye� /Nd ffYes,For How Long?
Any Known Problems? Yes No If Yes,Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: Number Of Bedrooms: Number of People
Pool Size: Garage Size: � (.Q�'�Other:
Requested By: Date Requested: � '$�`/`�
(Signature)
For Environmental Health Office Use Only
Approve Disapproved
Comtnents:
f.:
Environmental Health Specialist Date: �
*The signing of this fonm by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function pro erly for y given period of time.
Payment: Cash Check Money Order # Amount:$ _
Paid By: Received By:
Account#: Invoice#:
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•- � - �► DA1�(E COUNTY HEALTH DEPARTMENT �� r
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION y�a �,,,-
,.�;�*�NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a ��% �' '
� �, � Sanitary Sewage Systems Permit Number �� -.
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.k Name 1.- r, .,�_ , � � �"� — Date - _'�_' �`',� N� �, r� c� ,-,
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Location ✓ _ ,r�. .r'.%=`' �- �';�� ,.. r. >� ,� _
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Subdivision Name �!%• �'�"f�'- �l � " Lot No. � Sec. or Block No.
Lot Size �%'' r-'<l House Mobile Home �% Business Speculation �-�'"�
No. Bedrooms � -� .No. Baths -� No. in Family _.
Garbage Disposal YES ❑ NO �� Specifications for System:
Auto Dish Washer YES � NO � � 1 ;:;-
Auto Wash Ma^hine YES m NO ❑ ��"��f"�`��'� � �
Type Water Supply �'^'� ___ '"�� i ;��-� ��
'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.
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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 NumbPr 704-634-5985.
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Final Installation Diagram: System Installed by '�r'j-�� ��y �' �'�
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Certificate of Completion �`� �.%�!f Date � f`�,��'��'
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"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.