163 Pool Dr . �
Davie County,NC Tax Parcel Report � 1 �`'�1�' Wednesday, October 5,2016
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WARNING: TffiS IS NOT A SURVEY
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� Parcel Information
Parcel Number: H60000008501 Township: Shady Grove
NCPIN Number: 5759904537 Municipality:
Account Number: 8302580 Census Tract: 37059-804
Listed Owner 1: SWAIN DAVID HOWARD JR Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 175 BUCK MILLER ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Ciass: DAVIE COUNN R-A,R-20
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.DisVict: No
Legal Description: 1.01 AC OFF CORNATZER RD Fire Response District: CORNATZER-DULIN
Assessed Acreage: 1.01 Elementary School Zone: CORNATZER
Deed Date: 9/2013 Middle Schooi Zone: WILLIAM ELLiS
Deed Book/Page: 009380331 Soil Types: RnC,GnB2,RnD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 90140.00 Outbuilding 8 Extra 0.00
Freatures Value:
Land Value: 21260.00 Total Market Value: 111400.00
Total Assessed Value: 111400.00
9�.��, All data is provided as Is wRhout warraMy or guanntee W any Idm1 either expressed or implied Including but nat Ilmked to the
Davie County� Impiled warraMies of inerchaMability or fltness for a particular usa All users of Davte Courrt�fa GIS websfte ahall hold harmleu the
Nr County of Davie,North Caroltna,Its ageMs,conwltaMs,coMndors w employees hom any md a6 datms or causes of acUon due to
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AUTHORIZATION NO:` � ���/� DAVIE COUNTY HEALTH DEPARTMENT y�/-oG
< Environmental Health Section PROPERTY INFORMATION
Permittee�ti,.�� " �,,�� � P.O.Box 848. `
Name:� ///9'1 �Q�l P / i r'��� Mocksville,NC 27028 Subdivision Name:
' ,/� ` /� Phone# 336-751-8760
birections to property:'!�� ����J� ' Section: Lot:
�� � � AUTHORIZATION FOR `
' WASTEWATER -
� /�i� �l^�"' Tax Office PIN:# - _ .
- , SYSTF,M CONSTRUCTION: .
Road Name: Zip:
**NOTE**This Authorization for Wastewater System Consuuction MUST,BE ISSUED by the�Davie County Environmental Health Section prior
to issuance of any BuildingPermits.This Form/Authorization Number should be presented to the Davie CounryBuilding Inspections
Office when applying for Building Permits.'` ` ' - '
(ln compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
f T . ***NOTICE**,*THIS AUTHORIZATION FOR WASTEWATER'CONSTRUCTION
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r'- �',� � . ' �-r''-.� -=pt� IS VALm FOR A PERIOD OF FIVE YEARS.'
ENVIRONMENTAL HEALTH ECIALIST DATE 1SSUED. .
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` IMPROVEMENT AND OPERATION���M��S . PROPERTY INFORMATION
.Permittee's�� ,,� �
Name� �,��1 .�,�,�°'�i�'�'r I ,"r ,/� Subdivision Name:
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Diiections to property: �+'�'�-..5� '��,r'���""� Section: Lot:
,{'� �'; ,� ' IMPROVEMENT -
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. Road Name: Zip;
**NOTE**This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An ` '
ALTTHORiZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Department prior to the
construc6o�nstallation of a`system or the issuance of a building pemut. ,
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
�.�', ,� „ ' ;{� : ***NOTICE***THI.S PERMIT IS SUBJECT TO REVOCATION IF SITE
` �',.f, �`� • r, 1�_. ��':,��;:,x,, ,.. ;;�<<i, PLANS OR TI�INTENDED USE CHANGE.YOUR WASTEWATER �
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ' 'SYSTEM CONTRACTOR MUST SEE THIS PERMTP BEFORE , .-
INSTALLING THE SYSTEM. ' � .
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RESIDENTIAL SPECIFICATION:BUILDING TYPE�. #BEDROOMS��#BATHS J''� #OCCUPANTS�_GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILI'fY TYPE #PEOPLE � #PEOPLFJSHIFI' #SEATS INDUSTRIAL WASTE:Yes or No
*LOT SIZE TYPE WATER SUPPLY �r DESIGN WASTEWATER FLOW(GPD)s?�d NEW SITE REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3l� ROCK DEP'TH� LINEAR PT.�
OTHER '�LJ ',�_y !�C
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REQLTIRED SITE MODIFICATIONS/CONDITIONS:
IM�ROVEMENT PERMIT LAYOUT. . ,� *
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�AP'FROVED EFFLU�NT FILTER� *RISERtS1 IF 6�� �E�O�1 FIIVISH�D GRADE�
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**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 INSTALLAT'ION.TELEPHONE#IS(704)634-8760.
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. t336)751-87b0 .
OPERATION PERMIT
SYSTEM INSTALLED BY: �r
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AUTHORIZATION NO. ! �/����PERATION PERMIT BY: DATE: ���•�6�
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� 't'THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TF�SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE .
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION:1900"SEWAGE TREATMEN'1'AND DISPOSAL SYSTEMS";BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OSl96(Revised) .
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- _ . , IMPROVEMENT AND OPERATION�PERMITS PROPERTY INFORMATION
' �Permittee's,�,,.,. _"� E � . ,
Name: '' >•:.`9 ' .{°`" .�` � ` � Subdivision Name:
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Directions to property:��` = .�'f`�� �=`'' Section: Lot:
�, �, � IMPROVEMENT
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f=.;� , .� , ; ,,.,.,,r'�.,.,;: � PERMIT Tax Office PIN:# `
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Road Name: Zip:
**NOTE**This Improvement Pernut DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
AiJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCITON must be obtained frc�m this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
, ***NOTICE***TEIIS PERNIIT IS SUBJECT TO REVOCATION IF SITE
"�',• , ,, `; �: , �i r`�}.. '-,' • � ;;;"_��. PLANS OR TI�INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH'SPECIALIST ` DATE ISSUED SYSTEM CONTRACTOR MUST SEE TEIIS PERNIIT BEFORE:.,-
INSTALLING THE SYSTEM. #
RESIDENTIAL SPECIFICATION:BUILDING TYPE�_ #BEDROOMS+��#BATHS�'"" #OCCUPANTS � GARBAGE DI�POSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE ' � #PEOPLF/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
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LOT SIZE TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW(GPD) t_;�,�� NEW SITE REPAIR SITE t.---'
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SYSTEM SPECIFICATIONS: TANK SIZE GAL. ,PUMP�TANK GAL. TRENCH WIDTH'�_ ROCK DEPTH� LINEAR FT�
OTHER �/'' �� . ` f ' ` ! '� ��
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REQUIRED SITE MODIFICATIONS/CONDITIONS: � '"" r r' :� " " f'
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IM'�PROVEMENT PERMIT LAYOUT ' 1 '�"
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**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.
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OPERATION PERMTT �-
SYSTEM INSTALLED BY: �1/�%6�� ��Lt�-��
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AUTHORIZATION NO. / �� �/� PERATION PERMIT BY: !�`�:Ci� DATE: �'��/i�V
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WIT'H ARTICLE 11 OF G.S.CHAP'TER 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 OS/96(Revised)
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• DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION ��-J�e-Whs i
' APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) �`s�a�s�� � ��'
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NAME /����.��(/��/j�'f�G`d PHONE NUMBS�?�J�I-.�:��Q
ADDRESS���� �O�G ��i�/� SUBDIVISION NAM�"�`S `-���
�0�/��'l/�6l��C ����� LOT #
DIRECTIONS TO SITE ���� � C���n Q�2-e/' /� G>� .� O / �%.z s� '
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DATE SYSTEM INSTALLED ���J NAME SYSTEM INSTALLED UNDER �
TYPE FACILITY �`TS� � NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED �����' INFORMATION TAKEN BY �l�
Thia fs to certify that the information provided is correct to the best of my knowledge,and that I understand I am responaible tor all charges incurred from this application. .
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1�93
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