225 Mocks Church Rd �avie County, NC Tax Parcel Report �'��) Monday, October 3, 201f
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: WARNING: THIS IS NOT A SURVEY
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Parcel Information
Parcel Number: F800000042 Township: Shady Grove
NCPIN Number: 5870886200 Municipality:
Account Number: 8300408 Census Tract: 37059-803
Listed Owner 1: TRUSZKOWSKI PIOTR Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 225 MOCKS CHURCH ROAD Planning Jurisdiction: Davie County
City: ADVANCE - Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: 1.40 AC MOCKS CHURCH RD Fire Response District: ADVANCE
Assessed Acreage: 1.45 Elementary School Zone: SHADY GROVE
Deed Date: 11/2006 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 2006E0350 Soil Types: GnB2,GnC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 97200.00 Outbuilding&Extra 27690.00
Freatures Value:
Land Value: 35090.00 Total Market Value: 159980.00
Total Assessed Value: 159980.00
�,v� All data is provided as Is without warranty or guarentee of any kind either expressed or implled Including but not Itmited to the
9�A'��' Davie County� Implled warranties of inerchantability or fitness for a particular use.All users of Davie County's GIS website shall hold hartnless the
7�7 County of Davie,North Carolina,its agents,consultants,contractors or employees from any and ail claims or eauses of action dua to
�p�N�� l�C or arising out of the use or Inability to use the GIS data provided by this website.
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Davie County Health Department
:qAB�t� Envi.ronmental Health Section '�~� h�..
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Mocksville, NC 27028
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Phone:(336)-753-6780 Fax: (336)-753-1680
ON-SITE WASTEWAT�R CERTIFICATION
(Check One) Replacement Remodeling Reconnection
`�(�%�— �'�v�o2-�—�/►1���� Phone Number���5�� !O� V����(Home)
Name: � ,
Mailing Address: �o2s /��C� C�L`C��{ �D (Work)
�/�(��/✓C�``� /f/�c„2rj�?mEj`�' Email Address:
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Detailed Directions To Site:
Property Address:
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: l Type Of Facility: ���'��
Date System Installed(Month/Date/Year): G� �G "^—Number Of Bedrooms: � � Number Of People:
Is The Facility Currently Vacant? Yes � If Yes,For How Long7
Any Known Problems? Yes No If Yes,Explain:
Please Fill In The Followin Information About The NEW Facility:
Type Of Facility: f %'i -3�X s� Number Of Bedrooms: Number of People
'Pool Size: � Garage Size: vUlcS�� Other:
;�/Requested By: �� ��� Date Requested: �q�J' / J'�
`�� (Signature)
For Environmental Health Office Use Only
Approve Disapproved � `/
Comments: G4�A'r:� S .�%��l�-� �G a��v /i� �'
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Environmental Health Speciali Date: CG � � T S
*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#: Invoice#:
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All data is provided as is without wartanty or guarantee of any kind eRher expressed or implied including but not limited to the implied �'���
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t���� ��.', warranties of inerchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of a{I t3�
" �� Davie,North Carolina,its agents,consWtants,contractors oremployees from any and all claims or causes of action due to or arising out printed:Aug 19 2015
� of the use or inability to use the GIS data provided by this website. +
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� �'�' ; . • _ DAVIE COUNTY HEALTH DEPARTRJ(ENT ` � � �' � - .
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION �� �" `
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"NOTE: Issued in Compiiance with G.S. of North Carolina Chapter 130 Article 13c '% J r "-
Sewage Treatment and_Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
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Lot Size � House � Mobile Home _ Business Speculation
No. Bedrooms ��_ No: Baths ��- No. in Family�_, ' � •
Garbage Disposal YES ❑ NO p' .�
Specifications for System: � -� \_,.,, �,�,
Auto Dish Washer YES ❑ NO d • �
Auto Wash Machine Y S p' NO �p 1^� ' ti� ., � �
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Type Water Supply -�-2=� _
*This permit Void if sewage system described be(ow is not installed within 36 months from date of issue.
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� Improvements permit by �..�j- ..�'��� ?�_ �=`�`�'��'=�
'Contact a representative of the Davie County;Fiealth 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���-�-� ��`�'���
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Certificate of Completion � ' - .Date � � 1
, "The signing of this certificate shall•indicate that'#he 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.
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�Y , IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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� `NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c % -� '
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Lot Size ' House � �''� Mobile Home _ �� Business Speculation
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No. Baths 'No. in Family�..__
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Auto Dish Washer YES ❑ NO [� .
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Auto Wash Machine YES p' NO �� ' � Y',� � �f `�
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Type Water Supply ,��•'. ___
'This permit Void if sewage system described below is not installed within 36 months from date of issue. •''����
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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 Number: 704-634-5985.
Final Installation Diagram: ��w��� System Installed by <�� ������-��- �� ��```���G,=
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� The signing of this certificate slia(f'►r�d�caf�•that�the system described above has been insf�lled in complian�e.with
�`� the standards set forth in the above regulation, but shall in�NO way be taken as a guarantee that�the system will fUnction .
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_ , INFORMATION FOR SEPTIC SYSTEM FEPAIR PERMIT / D�.3a -C�S���,�
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ADDRESS �� � � � ��,� SUBDIVISION NAP1E
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SUBDIVISION LOT 41
DIRECTIONS TO SITE j �� � " �� C�`c� � �,� �" � ��
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DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER �cz�c�.r> � ol,�
SPECIFY PROBLEMS THAT ARE OCCURRING .���}-.-.
DATE REQUESTED '.'� - �c� �� INFORMATION TAKEN BY �
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