119 New Calvary Church Way Davie County,NC Tax Parcel Report Tuesday, January 24, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Infor'mation'
Parcel Number: J60000002303 Township: Mocksville
NCPIN Number: 5757072574 Municipality:
Account Number: 82529966 Census Tract: 37059-807
Listed Owner 1: DALTON TERRY Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 335 DALTON 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: 0.918AC OFF DALTON ROAD Fire Response District: FORK
Assessed Acreage: 0.91 Elementary School Zone: CORNATZER
Deed Date: 7/2008 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 007650876 Soil Types: PaD,CeB2
Plat Book: 0009 Flood Zone:
Plat Page: 386 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
161
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 Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax#(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account M 990005383 Tax PINIEH M J60000002303
Billed To: Habitat for Humanity of Davie County Subdivisiandnfo
Reference Name: EXPANSION PERMIT 'LocafiofVAd&e8's:`'119 New Calvary Ch.Way-27028
Proposed Facility: 'Residence PiopAe eTiyyjw: D0]9,t81Ak1Vair ❑Expansion
A-rd4gWerpitch#horization to Construct(ATC)MUST BE ISSUEDby the Davie County Environmental
Health Section prior to.issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specifications: #Bedrooms�l _#Bathrooms #People_BasementO Basement plumbingO
Non-Residential Specifications: Facility Type # People #Seats
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: OCounty/City DWell OCommunity Well
System Specifications: Design Wastewater Flow(GPD) Tank Size GAL.Pump Tank GAL.
Trench Width Max. Trench Depth Rock Depth Linear Ft.
Site Modifications/Conditions/Other:
Contact the Davie County Environmental HeAlth Section for final inspection of this system between
8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760.
��Y
Ile
i�Ar� os�d
Environmental Health Specialist Date:
DCHD 11/06(Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
Account #:' 990005383 Tax PINIEH#: J60000002303
Billed To: Habitat for Humanity of Davie County Subdivision Info:
Reference Name: EXPANSION PERMIT LocationiAddress `119 New Calvary Ch.Way-27028
Proposed Facility: Residence Property Size: 0.918 Acre
ATC Number: 5927
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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.
System Type: S.T.Manufacturer Tank Date Tank Size
Pump Tank Size Bedrooms
System Installed By: Inspector#: Date:
GPS Coordinate:
Environmental Health Specialist: Date:
DCHD 11/06(Revised)
Davie County Health Department
'I'D 1836 l� Environmental Health Section
P.O.Box 848
O Z'.
210 Hospital Street
O �'C Courier#:0940-06 1911
Mocksville,NC 27028
Phone:(336)-753-6780 O WAST + T -EPhone
gCATION Fax:(336)-753.1680
(Chet nei'Replacement emReconnection
Name: /j`f� 7v— D 1`l mber ��o� y!'7 (Home,
Mailing Address: 0l J'� S� 39Z" ���7�� :' ork)
Email Address:
Detailed Directions To Site: G/A, 1,)Id 1�/
,/t) J
Property Address: �—?Q P9
Please Fill In The Following Information;Ab;ou;tTj�bWA��MS!TIN�G
Facility:Name System Installed Under: i .e�s� Type Of Facility:
Date System Installed(Month/Date/Year): �� Number Of Bedrooms:1_Number Of People:_
Is The Facility Currently Vacant? es No If Yes,For How Long?
Any Known Problems? Yes No If Yes,Explain:
Please Fill In The Following Information About �NEW
Type Of Facility: 't;' nNumber Of Bedrooms:_;�/ _Number of People
Pool Size: Garage S' e: Other:
Requested By: 6 Date Requested: /
(Signa )
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
Payment: Cashrcheckm6ney Order # I Amount:$ . O�O Date:
Paid By: l -L__ Received By:
Account#:__ � � Invoice#: �7i'
Permittee s� DAVIE COUNTY HEALTH DEPARTMENT
Name: Environmental Environmental Health Section PROPERTY INFORMATION
►,, --�a U�7
17.0 L10,l P.O. Box 848
Directions to property: Mocksville.NC 27028 Subdivision Name:
0-J,j0 AbJ Phone#:336-751-8760 Section: Lot:
AUTHORIZATION FOR
WAY WASTEWATER Tax Office PIN:# -
SYSTEM CONSTRUCTION -
AUTHORIZATION NO: 002759 A Road Name111 .: fJW CA LVA C "
**NOTE**This Authorization for Wastewater System Const ction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This Fo=l ut rization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance`with Article 11-of G-S-Gbapter 130A,Wastewater ystems,Section.1900 Sewage Treatment and Disposal Systems)
' a _ ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
i 7 IS VALID FOR A PERIOD OF FIVE YEARS.
�EFIVIR Iv1 HEALT 'SP PCC D TE I SUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE `-ba—&E#BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECCIIFIICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE "TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD)OW NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.
z) %(U 1co As stated In A5A NCAC 18A.1969(5}
OTHER I accepted ;may PIcm hp tjr
REQUIRED SITE MODIFICATIONS/CONDITIONS: �>JSTAt_L OA C p,JTOt .I 1 D1 F ""' • I,,
IMPROVEMENT PERMIT LAYOUT
tv-ST I,.1Gt
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
i
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 02/02(Revised) - 13001111-1 Z377- ZV V, 5,q(
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Perit3i tee s DAVIE COUNTY HEALTH DEPARTMENT 04
Narrie ( ` '
. } , -i;% Environmental Health Section PROPERTY INFORMATION
n..'
•.,�`,'�; ;"� P.O. Box 848
Dlrec&4 t,property: Mocksville,NC 27028 Subdivision Name: t'
Phone#:336-751-8760
J (LC+J!U AbJ
Section: Lot:
.r AUTHORIZATION FOR
LVAt`r ,�4-1 (,,�Ay WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
AUTHORIZATION NO: A Road Name: 7J��-A L VA��lp'� i;�.�t,
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
rw to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 I of CS 6hapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) v
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
,___ENV HALT P CIALIST DATE
EN IRONlvfE I� E H ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE W-3t#BEDROOMS #BATHS "` #OCCUPANTS ' GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE 0,61 � rTYPE WATER SUPPLY`"^`VhJI y DESIGN WASTEWATER FLOW(GPD)c:�(cx/ NEW SITE' REPAIR SITE i.-'
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH`- ROCK DEPTH f 2 LINEAR FT.
OTHER I L.-1 i�-I F__0 i G4 /
REQUIRED SITE MODIFICATIONS/CONDITIONS: W STAL L 6,1 CJ-T0J',1 1�c e-r I& Carr- ``'d ' L',
IMPROVEMENT PERMIT LAYOUT
(
fix%-sTl kL(a _ ... . r�GP 15U
Exi STI�k-,
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751760.
OPERATION PERMIT "
SYSTEM INSTALLED BY:
t
n'
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BUN INSTALLED IN COMPLIANCE-
WITH ARTICLE 11 OF G.S:'CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WXY:BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL Ft,7ICTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. u' �,'�•
DMD 02102(Revised> qC, l 7 L.?z z ./�'• -^ �f J V v: _ D r J<<i 1 s
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DEPARTMENT
DAVIE COUNTY HEALTH Environmental Health Section
�
PO Box 848/210 Hospital Street
TV Mocksville,NC 27028
Phone: (336)751-8760
-SITE WASTEWATER CERTIFICATION FOR DWELLING
eck One) REPLACEMENTR— ` REMODELING ❑ RECONNECTION ❑
Name:_T — A I Phone Number: •;`?G - g 2- SCf (Home)
Mailing Address:13 / o�r _ zM 4� �age -e4e (Work)
Yh�cics'J, 114 c n
Detailed Directions To Site:in a, . - q Tom-- n G' ar-r t Co n n,. e]U
tvaCA4 Dre OeA+
Property Address: G✓ C A L (L�R-u �� LA)G-..
Please Fill In The Following Information About The Existing Dwelling:
Name System Installed Under: 14, %� ;� Type Of Dwelling:
Date System Installed(Month/Day/Year)- �Jl Number Of Bedrooms: o2n_Number Of People:._
Is The Dwelling Currently Vacant? Yes ff No❑ If Yes,For How Long?
Any Known Problems?Yes❑ No 9""' If Yes,Explain:
Please Fill In The Following Information About The New Dwelling.
Type Of Dwelling: Azlt"s e___ Number Of Bedrooms: —0 Number Of People:
Requested By: Date Requested: l- 4- 61
(Signature
For Environmental Health Office Use Only
Approved ❑ Disapproved ❑
Comments: �A�tP �:�nT 0c'J�ii•• °i- (7L367
n
1
Environmental Health Specia ' Date
L V
'"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 #: _ q Invoice #:
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DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal_System - G.S. Chapter 130-Article 13C)
OWNER OR CONTRACTOR ( 1- f DATE ,4 12,17 PERMIT
LOCATION � !) (i �/'l _ . 1 '} r�I J I L �fJU �. 1734
S.R. NO.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
Ott
HOUSE ❑ MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. .BEDROOMS G�" N0. }BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE ,DISPOSAL UNIT .,YES ❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES NO [3 , j
SITE SUITABLE YES NO ❑
SIZE, OF TANK gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ -Public
IMPROVEMENTS PERMIT BY INSTALLED BY 46
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must 96mply with all other applicable State �aynd local regulations
LOT AREA •�(t�L—
()^•»�j(/
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DAVIE COUNTY HEALTH DEPARTMENT ;)
P . 0. BOX 57
MOCKSVILLE, N. C . 27028
���� � % .(704) 634-5985
Statement -fc'r Septic Tank Improvement Permits
and/or Site Evaluations
NAME ��.f tl�� (',r���r` DATE ISSUED,=,
ADDRESS �� �._- c. /, / 'c� 1 ,>- PERMIT NO. ! ;
'/ t •iii •�..�...
Explanation of charge, %:1�,� ✓�_.� u_r_r>. _.... _. r�r.� r�..� ��
t 67
AMOUNT DUE SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
2�6 PO Box 848/210 Hospital Street
Mocksville,NC 27028
ti
Phone: (336)751-8760
o,W -SITE WASTEWATER CERTIFICATION FOR DWELLING
eck One) REPLACEMENTR— REMODELING ❑ RECONNECTION ❑
Name:_^' 4_ Q/`) Phone Number: .3 �G ' 7- g f�ST(Home) `
Mailing Address:13 / •• �d r_ y L/✓ JPl 'a f 1e - �C�� (Work)
Detailed Directions To Site:��e rn� . Q T„s,.. �'l„ p G' Q.0 t t (2-0 r1 n&-eJ a
-b o e w 4 .0 LwCILh, � Q re i) --4
Property Address: .4&,LV C-4 4- UAR2 u CA LA-)o,..
Please Fill In The Following Information About The,Existing Dwelling.
Name System Installed Under: i ���� ! Type Of Dwelling:
Date System Installed(Month/Day/Year): Number Of Bedrooms: cA -Number Of People:_
Is The Dwelling Currently Vacant? Yesla"No t] If Yes,For How Long?
Any Known Problems?Yes❑ No B� If Yes,Explain:
Please Fill In The Following.Information About The New Dwelling:
Type Of Dwelling: &nu.S�L-- Number Of Bedrooms: Number Of People:
Requested By: Date Requested: /-2 6
(Signature
For Environmental Health Office Use Only
Approved ❑ Disapproved ❑
Comments:
Environmental Health Speciahr 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 #: Z3 22 Invoice
DAVIE COUNTY HEALTH DEPARTMENT
(Septic' ank) Improvements Permit and.Certificate of Completion
(Ground Absorption Sewage Disposal System - .G.S. Chapter 13 Ar ic1e .13C)
OWNER OR CONTRACTOR IL D tg "S / DATE PERMIT
i1►T
LOCATION y'L I_ �1 }' i L�- "N9
1734
S.R. NO.
SUBDIVISION NAME LOT, NO. SECTION OR BLOCK NO.
HOUSE ❑ MOBILE HOME eff BUSINESS ❑
11 House Trailer 800 Gal) 400 Sq. Ft.
• S Two Bedroom House 800 Gal. 600 Sq. Ft.
NO BEDROOMS- ,NO. BATHROC�i
GARBAGE DISPOSAL UNIT .,YES '❑ NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES Q NO ❑ Four Bedroom House '1000 Gal. 1200 Sq. Ft.
AUTO. WASH: 'MACHINE _YES_.1b .. .NO,.. ..❑ , �.�»
SITE SUITABLE YES d3 NO ❑
SIZE OF TANK _ .. gal.
NITRIFICATION FIELD sq. ft. f �/
x /
DEPTH OF. STONE IN LINES:
WATER SUPPLY. Individual .❑
{ IMPROVEMENTS PERMIT BY - _ INSTALLED. BY 40
CERTIFICATE_OF COMPLETION , B.Y Ya Date.. /•�
(8/16/73) *Construction must 96mply with all- other applicable State and local regulations
LOT AREA
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DAVIE COUNTY. HEALTH DEPART14ENT
P. 0. BOX 57
MOCKSVILLE, N. C . 27028
(704) 634-5985 ,
-Stateme / ti� fit.
nt_-f�geptic Tank Improvement Permit
and/or Site Evaluations s
NAME
DATE ISSUED,-�, .
ADDRESS
PERMIT N0.
cf
Explanation of charge
J
AMOUNT DUE
SANITARIAN , ~ '
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMRNT.
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