324 Oak Grove Church Rd Davie County,NC ' � Tax Parcel Report �`�� Wednesday, October 5, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: H50000003104 Township: Mocksville
NCPIN Number: 5749470030 Municipality:
Account Number: 8305594 Census Tract: 37059-805
Listed Owner 1: CORNETT DEREK S Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 324 OAK GROVE CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A,H-B-S
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 4.768 AC OAK GROVE CHURCH RD Fire Response District: MOCKSVILLE
Assessed Acreage: 4.61 Elementary School Zone: MOCKSVILLE
Deed Date: 10/2015 Middle School Zone: SOUTH DAVIE
Deed Book 1 Page: 010011066 Soil Types: PaD,WeC,WeB
Plat Book: 12 Flood Zone:
Plat Page: 112 Watershed Overlay: DAVIE COUNTY
Building Value: 179570.00 Outbuilding 8�Extra 0.00
Freatures Value:
Land Value: 59120.00 Total Market Value: 238690.00
Total Assessed Value: 238690.00
9�.�i�, All data is proWded as ia without vrarrarrty or guanntee of any Idnd elther expressed or Implled Including but not Iimited to the
Davie County� Implied wamMies of inerchaMablliry or Mnesa for a particular usa All users af Davie County's GIS webske ahall hold hartnless the
CouMy of Davie,North Carolina,its ageMs,conwlhMs,contradora or employees fmm any end all clalms or cauaea of act(on due to
np�N,�'d` NC or arlsing out of the use or inabflity to use the GIS daW provlded by this websita
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� Da�ie County Health Department
��►s I� i' Environmental Health Section � ,.. ,
..^ ��-' � ,� P.O. BOX 848 �`
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O U �'� Courier# : 09-40-06 '• 1911
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Mocksville, NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEW ER ATION
(Check One) Replacement Remodeling Reconnection
Name'/��`��=-¢� �1/ O-� �/�L �� Phone Number�3Y' ��� '��C (Home)
Mailing Address: 3 �9�t�� �''^"-e— (Work)
/����/If�rC-� ,l�f C 1�v� Email Address:
Detailed Directions To Site: �✓ U ��� ����� ��/r'�� /"` �
IC�G'C� u�CO� ` `�"�l�L. �.hb� �D � �
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Property Address: c� �2vu� �L
Please Fill In The Followin XISTING Facili : •
Name System Installed Under:��� �C C..�-c C l D Type Of Facility: ��S i
Date System Installed(Month/Date/Year): Number Of Bedrooms: -� Number Of People:.3
Is The Facility Currently Vacant? Yes No If Yes,For How Long?
Any Known Problems? Yes � If Yes,Explain:
Please Fill In The Following Information About�The NEW Facility:
Type Of Facility: C���Q.k,(1• � � . Number Of Bedrooms:�Number of People
Pool Size: � ; a e ' Other:
Requeste Date Requested:
(S ignature
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist I Date: �
*The signing of this form by the Environmental Health Staff i n 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 Chec MoneyOrder # �772 Amount:$ , Date: � �� ��i'
Paid By: Received By: � I�f��'
Account#: �27� Invoice#: �f�'�i�
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�� DAVIE COUNTY HEALTH DEPARTMENT
�, IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION'' ,
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c �
Sewage Treatment,and Disposal Rules (1 O NCAC 1 OA .1934-.1968) , -� Permit Number
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Name �,c _,'�°i'�'/�� �i/� Date ���%� ��- �'�=--- �,•,
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Location �r % �.%`� �'"/.% —
Subdivision Name Lot No. Sec. or Block No.
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Lot Size House �Mobile Home _ Business __ Speculation
No. Bedrooms � _ r—_ No. Baths _- =� No. in Family `•' _,
Garbage Disposal YES ❑ NO [}--�' Specifications for System: . t:
Auto Dish Washer YES [] NO �p �r �� , , � '_ � ��' � �� ���
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Auto Wash Machine YES [j� NO ❑ -,� ,�_,,;,f ^ ,, �;�� ��, ,,� __ , , ,�;:. .:,
Type Water Supply � �:.; --- -`�^��' '� '' �' r
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'This permit Void if sewage sys�em described below is not installed within 36 months from date of issue. ,'
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Improvements permit by �!r%�/� -�
"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 =�'%'`� -`:%/ ;, ,''� >
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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.
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_ , DAVIE COUNTY FIEALTH DEPARTMENT "
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` � lMPROVEMENTS PERMfT AND CERTIFICATE �DF COMPLETION
'Nofe: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
�- " � Permit Number
Name . Date --�
Location _ _
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House Mobile Home __ Business _— Speculation
No. Bedrooms —_ No. Baths - — No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO � '
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.
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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: System Installed by
Certificate of Completion __ Date —_
#The signing of this certificate shall indicate that the system described above has been installed in compliance with
ihe 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.
, , DAVIE COUNTY HEALTH DEPARTMENT
� f•' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ,
*Note: Is�ued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
: . i Permit Number
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Name = ' ��'"- Date {� -
Location - �_ -- � . � � _._ _ _ . _
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Subdivision Name Lot No. Sec. or Block No.
Lot Size � �_ _ House ' ' Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths _f�. No. in Family _
Garbage Disposal YES ❑ NO � ''r Specifications for System: ='•-�,- ;� �
Auto Dish Washer YES � NO ❑ , ;- - _ , '
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Auto Wash Machine YES � NO ❑ � � � '
Type Water SuPP�Y � --- ' . - , . . . , ._ , , , --- --.
`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: System Installed by
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.
• . DAVIE COUNTY HEALTH DEPARTMENT
� � Environmental Health Section
, ' P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
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Name �C� ,L�,,�,�/� C -� -�� ate � �
Address � t Size ��lr��
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FACTOR$ AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position . S S S
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2) Soil Texture (12-36 in.) Sandy, � S S S S
Loamy, Ctayey, (note 2:1 Clay) ��� �� 0 � PS PS
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3) Soil Structure (12-36 in.) S S S S
Clayey Soils � � PS PS
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4) Soil Depth (inches) ��/��, S S S S
r�- pg PS PS PS
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5) Soil Drainage: Internal S S S S
PS PS PS PS
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External S S S S
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7) Available Space � S S S
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8) Other (Specify) S S S S
pg PS PS PS
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9) Site Classification � U � � ,'
U—UNSUITABLE S—SUITABLE PS—Provisionaliy Suitable
Recommendations/Comments: S - 7 -� � -� � '� ' �
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Described by l � V Title �� Date -
SITE DIAGRAM �
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� e�� ' � APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
� Davie County Health Department
•-' ' � Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone - 9Q �-914
1. Permit Requested By � C � �c���a�- Business Phone �� �
2. Address �1- N � n
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec Lot No.
5. System used to serve what type facility: House Mobile Home Business
� Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions�04 X 5�
Bed Rooms�Bath Rooms�Den w/Closet�Q—
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�r�[ showers� washing machine �
dishwasher sinks a
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes�No
9. a) Property Dimensions �-S� by �d "� �
b) Land area designated to building site
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 the best of my knowledge.
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' D e Owner Signature
� OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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