104 Rocky Knoll LnDavie County, NC Tax Parcel Report ) 6 1 0 IT Thursday, October 6, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M500000019 A Township:
NCPIN Number: 5746301793 Municipality:
Jerusalem
Account Number: 45281500 Census Tract: 37059-807
Listed Owner 1: LEFLER MARGARET BAILEY Voting Precinct: COOLEEMEE
Mailing Address 1: PO BOX 397 Planning Jurisdiction: Davie County
City: COOLEEMEE Zoning Class: DAVIE COUNTY R-A,R-20
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code:
27014-0000
Voluntary Ag. District:
No
Legal Description:
15.4 AC HWY 801
Fire Response District:
JERUSALEM
Assessed Acreage:
12.51
Elementary School Zone:
COOLEEMEE
Deed Date:
4/1989
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
001480078
Soil Types:
GnB2,GnC2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value:
63310.00
Outbuilding & Extra
27200.00
Freatures Value:
Land Value:
99950.00
Total Market Value:
190460.00
Total Assessed Value:
190460.00
All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
9"" F 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'N orth 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.
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AUTHO,RIZATION NO.
`1 6 ;% Q DAVIE COUNTY HEALTH D6ARTMENT
Environmental Health Section PROPERTY INFORMATION
Permittee's J r�P.O. Box 848 _-
Ntime: � �i � Ayj Mocksville, NC 27028 Subdivision Name:
Directions to property: ��`� t- < (; Phone # 336-751-8760
Section: Lot:
AUTHORIZATION FOR
c„ 's k-l:C.iCY WASTEWATER
Tax Office PIN:#
SYSTEM CONSTRUCTION
t4f,�uUL L13 Ik,Road Na." 2i:Cr-Y
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
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 11 of'P.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.
ENVIRON A HEALTH SPECIAk:19f DAIFEI&ED
70A DAVIE COUNTY HEALTH D 4RTrNT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's
Dame t` ` ! het? ^ � Subdivision Name:
Directions to property: I U _ "► i. L- ( 1 !_ Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name. 1,. r :: t i' �... Zip: r
**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 # BEDROOMS 3 # BATHS G # OCCUPANTS GARBAGE DISPOSAL -Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY v/� }DESIGN WASTEWATER FLOW (GPA) �� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH I Z LINEAR FT. (�U
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMITLAYOUj_(-VPPR0VED EFFLUEI`JT FILTER* *RISER(S) IF 6" BELO J FIHISl{ED GRADE*
ww 11 1 r
L-(.
r�-V-lM. h. I c
,y
"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 # 131(ri&� wig -166.
(336)751-8760
OPERATION PERMIT
SYSTEM INSTALLED BY: bi✓ �1 AC-FOQ4>
kJ �s Flo t33
L /-QST %a, . w�1= A1, A'e F2o'— c–�c.� S r.. c7 r—. !i
AUTHORIZATION NO. OPERATION PERMIT BY: DATE:-7—Woo
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S TEM ESCRIBED 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)
1
DAVIE COUNTY HEALTH DEPARTMENT 3
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's
Name`. t '' % Subdivision Name:
Directions to property: 'r. !
Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name: 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 # BEDROOMS # BATHS d" # OCCUPANTS ° GARBAGE DISPOSAL.{Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ( TYPE WATER SUPPLY r+t tl)l � DESIGN WASTEWATER FLOW (GPD) i ( NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -L ROCK DEPTH t • LINEAR FT. f C-
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMITLAYOUI~PPPROkI D EFFLU UT (FILTERS 04ISER(9) IF 611 S LM -1 FIIIIS HED G1,RrID *
"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 # I!1(%j KA2086.
(37-6)751-8760
I OPERATION PERMIT \ O L �� A� (-0 C T>
SYSTEM INSTALLED BY: �J
A�..a' No Lj,)
^- L Li`�1 yj L, )k.Vt_ !-i,-. t Y rr-LI - Wim. l-}
AUTHORIZATION NO. -? OPERATION PERMIT BY: / ! )e ( S--- DATE: [h�
r'
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S TE 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)
A:��ATION NO: 18 0 0 DAVIE CPUNTY HEALTH DEPARTMENT
Environmental Health Section
Permittee's P.O. Box 848
J_-VXo
PROPERTY INFORMATION
Name: Mocksville, NC 27028 Subdivision Name:
Phone # 336-751-8760
Directions to property:
Section: Lot:
AUTHORIZATION FOR .
WASTEWATER Office PIN:#
Tax g
SYSTEM CONSTRUCTION t —=
-T
Road Name: O - Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Forrim/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 HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION. BUILDING TYPE OA/ # BEDROOMS _ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY D DESIGN WASTEWATER FLOW (GPD) %(j NEW SITE. REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE_ & GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 'LINEAR FT�'r
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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 (336)751-8760.
OPERATION PERMIT
• SYSTEM INSTALLED BY:
AUTHORIZATION NO. OPERATION PERMrr 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)
baa7�A-V'i
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑
Name: `�—f Q2 Phone Number: / ' % (Home)
Mailing Address: ��x /� (Work)
Detailed Directions To Site: 4J if u/`/L- G��1 d Q 11 %l1i (C-
_1
Property Address:/a y aGy , /! /""16 C'/'
Please Fill In The Following Information About The Existing Dwelling.
Name System Installed Under: L � C/ a �f0� Type Of Dwelling: / ' �. sT
Date System Installed(Month/Day/Year): Number Of Bedrooms. —Z Number Of People:_
Is The Dwelling Currently Vacant? Yes 0 N &- It Yes, For How Long?
Any Known Problems? Yes ❑ No GY.- If Yes, Explain: `^f
Please Fill In The Following Information About The New Dwelling.
Type Of Dwelling: /' ' ° - Number Of Bedrooms: '3 Number Of People:
Requested By:
For Environmental Health Office Use Only
Approved ❑ . Disapproved n❑
Comments: Sso c -Ii to— P'Te"11— x'26 j o D
Requested:
"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 #: // y