191 Log Cabin Rd (2)Dav
!016
State:
WARNING: THIS IS NOT A SURVEY
Zoning Overlay:
Zip Code:
Parcel Information
Voluntary Ag. District:
Parcel Number:
E100000013
Township:
Clarksville
NCPIN Number:
5801287386
Municipality:
Elementary School Zone:
Account Number:
59504000
Census Tract:
37059-801
Listed Owner 1:
RATLEDGE SYLVIA C
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
191 LOG CABIN ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE
COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
2 AC LOG CABIN RD
Fire Response District:
SHEFFIELD - CALAHALN
Assessed Acreage:
2.45
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
5/2000
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
003330918
Soil Types:
PcC2,CeB2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value: 85010.00 Outbuilding & Extra 6610.00
Freatures Value:
Land Value: 28300.00 Total Market Value: 119920.00
Total Assessed Value: 119920.00
161
Davie County,
NC
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AUTHbRIZA71;0N NO: DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Permittee's 1 P.O. Box 848
PROPERTY INFORMATION
:C /X0
Name: •- -'K -` Mocksville, NC 27028 Subdivision Name:
e— f i Phone #:704-634-8760
Directions to property: +f i`' 71 r� Section: Lot:
/ AUTHORIZATION FOR " - `
5 " O ,� le_WASTEWATER Tax Office PIN:#' -
' SYSTEM CONSTRUCTION l
Road �Na �C�� � : l-LLI 71 1Zip
**NOTE** This Authorization for Wastewater,:•System Copsttuction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of an�Building �errmts. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALT PECIALIST DATE ISSUED
t DAVIE COUNTY HEALTH DEP!AgTM NT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's
:Name:;` Subdivision Name:
Directions to property: Section: Lot:
IMPROVEMENT
r •' .{ t i. F .a' c -P PERMIT Tax Office PIN:#;` A
- -
"'�. +' t -
>.:" t Road Name - :c , / t Zip:
**NOTE** This Improvement Permit DOES NOT authorize: the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH -SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE I't # BEDROOMS a # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE "le TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)
SYSTEM SPECIFICATIONS: TANK SIZE ,GAL. PUMP TANK GAL.
i; OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
TRENCH WIDTH
L"i
NEW SITE REPAIR SITE
_ ROCK DEPTH LINEAR FTavZO`J
"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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
r
U
AUTHORIZATION NO. OPERATION PERMIT BY:! DATE:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's
Name: Subdivision Name:
Directions -to property: - ' Section: Lot:
E%IPROVEMENT S
PERMIT Tax Office PIk-4, `s -
Road Name. r Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
y . �' r :',i" r " •' x "� r PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTHFSPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE At #BEDROOMS C # BATHS # OCCUPANTS cL GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
,. LOT SIZE ///'(: TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH/-) LINEAR
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS- _ r
IMPROVEMENT PERMIT LAYOUT
"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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
I OPERATION PERMIT
SYSTEM INSTALLED BY: �•-
f
f�;
AUTHORIZATION NO. t ` 1 OPERATION PERMIT BY:
'
DATE •(1%��. !`f `�
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR S PTIC SYSTEM REPAIR PERMIT
NAME .� " PHONE NUMBER
ADDRESS i SUBDIVISION NAME
x7yc�, P �ief
// SUBDIVISION LOT #
DIRECTIONS TO SITE �O zll1lA
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED �l�d �� INFORMATION TAKEN BY