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258 Rollingwood Drive Lot 4 & P/O 5, Section 3Davie Countv. NC Tax Parcel Report � -K)v Monday. October 10. 2016 ♦♦C11%1\11\V. L111U 1111\Vl L-& L3 V1\1Aid 1 Parcel Information Parcel Number: K5020A0008 Township: Mocksville NCPIN Number: 5747250825 Municipality: Account Number: Census Tract: 37059-805 Listed Owner 1: Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: Planning Jurisdiction: MOCKSVILLE City: Zoning Class: DAVIE COUNTY,MOCKSVILLE R-A,GR State: Zoning Overlay: Zip Code: Voluntary Ag. District: No Legal Description: LOT 4+P/O 5 SOUTHWOOD ACRSECTION 3 Fire Response District: MOCKSVILLE Assessed Acreage: 1.12 Elementary School Zone: MOCKSVILLE Deed Date: 12/2015 Middle School Zone: SOUTH DAVIE Deed Book / Page: 010060705 Soil Types: Gn132 Plat Book: 0004 Flood Zone: Plat Page: 141 Watershed Overlay: DAVIE COUNTY,MOCKSVILLE Building Value: 141060.00 Outbuilding & Extra 1940.00 Freatures Value: Land Value: 20500.00 Total Market Value: 163500.00 Total Assessed Value: 163500.00 Davie County, All data Is provided as Is without warranty or guarantee of any kind either expressed or implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the npUN�'; NC County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION c, 'NE)TE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name f"'% Date Location _ Subdivision Name Lot No. S Sec. or Block No. ZZ3 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. 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 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Dispo al Rules (10 NCAj 10A .19 4-.1968) Permit Number Name L 121 1 'i I_ i rZ _ .'� `%{` l; (t a b - •' Location Y1 r, , Subdivision Name 5 Ti r 300,, A,c-c s Lot No. L Sec. or Block No. —�rl Lot Size House Mobile Home _ 1 — Business __ Speculation No. Bedrooms No. Baths 2. No. in Family Garbage Disposal YES ❑ NO E�— Specifications for System: Auto Dish Washer YES [�] NO ❑ 6 Auto Wash Machine YES NO ❑ Cw Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. u i V f 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 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 (10 NCAC 10A .1934-.1968) Permit Number NameIiDate Location Subdivision Name CUA 7110•.- > A`Q_c S Lot No. Sec. or Block No. -ff– Lot Size 710x -0z ),776 k 7' , House No. Bedrooms 3 —No. Baths. Mobile Home _ Business __ Speculation Z No. in Family Garbage Disposal YES ❑ NO E,. Specifications for System: Auto Dish Washer YES NO ❑ <.i Auto Wash Machine YES NO ❑ Jk ' Type Water Supply ('.� % --- `This permit Void if sewage system described below is not installed within 36 months from date of issue. 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: ter,, 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. L ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION n Name KE ITE-( ��i i z �— Date Address �93 I (Y\, Yk r tj S Lot Size %v\,�C-r-sY L C & "JC e FAr;TnP.R AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/ Landscape Position PS P S PS U U U ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S S r� S ds�) S PS U U U U S) Soil Structure (12-36 in.) Clayey S S S <:9�- S PS Soils �j U U U i) Soil Depth (inches)© S CS S PS S PS PS U U U U i) Soil Drainage: Internal 0� S PS S PS PS U U U U External Cv <:5 cg) S PS PS PS PS U U U U �) Restrictive Horizons Available SpaceS © S S PS PS PS U U U U 1) Other (Specify) S PS S PS S PS S PS U U U U i) Site Classification U—UNSUITABLE Recommendations/ Comments: Described by SITE DIAGRAM DCHD (6-82) S—SUITABLE C 1�S—Provisionally Suitable Title Date X, 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. 1. Permit Requested By 2. Address 63/ / S E7'zE(L ST AeocitlsV Home Phone Jlyq 60-2-779 Business Phone %0_41.-,r2V-/-3/S/Z ,f/e-_ . .2 -7 o.,,_P. 3. Property Owner if Different than A ove Address 4. Permit To: a) Install ✓ Alter Repair b) Privy Conventional `/Other Type Ground Absorption c) Sub- Division -56014-4�1© Sec. Lot No. 4-- ArJ13 5. System used to serve what type facility: House —v --Mobile Home Business IndustryOther b) Number of people 6� 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 3o ( -S°Zf +-W y2o X CJAM -E Bed Rooms 3 Bath Rooms Den w/Closet 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 _?_ lavatory dishwasher urinals showers sinks 3 P,yLr ')r- L -C i -WS garbage disposal washing machine 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes-ZNo 9. a) Property Dimensions a -f O f`iz-�-u/ X 2-02- ftp 091 ou " X27V of Lljao )'X&41 'i aap b) Land area designated to building site c) Sewage Disposal Contractor 0.617- 10. JuT10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? A/C' What type? This is to certify that the information is cor o t best o my kno ledge. Dae Owe f4ignat OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 6-->. /2Ccrc7- DCHD (6-82) fCevnc DAVIE COUNTY HEALTH DEPART11ENT SITE EVALUATION CONSENT FORM INSTRUCTIONS/PREREQUISTES 1. Complete the form below and return it to the Davie Co. Health Department. 2. Along with the form, remit the amount due as shown on enclosed statement. 3. Carefully follow the procedures as outlined in the enclosed "Information Bulletin". 4. Notify Health Department upon completion of item number 3. NOTE: ALL THE ABOVE 14UST BE DONE BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO THE(DAVIE COUcdTY HEALTH DEPARTIIIENT,P.O. BOX 57) (IIOCKSVILLE, N.C. 27028) DAVIE COUNTY HEALTH DEPARTIZNT SITE EVALUATION CONSENT FORPI LOCATIUN OF PROPERTY: 10-r :#-- PJV6 601 of 1.oT-*S 410 45-„ 5Er-7-10n1 -nE: /}S i - ref PL�.9 r Ic q ( btwie DATE RECEIVED (offiee use only) yes not (1.) I am the owner of the above described property. 11K !___ I yes no (2.) I am not the owner of the above described property, however, I certify that I have consent from ,owner to owner's name obtain a site evaluation by the Health Department for the purpose of determining the suitability for a ground absorption sewage disposal system. yes no (3.) I hereby give consent to the authorized representative of the Davie County Health Department to Enter upon the above described property and conduct all testing procedures necessary to determine its suitability for a grrund absorption sewage disposal system. �3 / 7 IuL 6 A a -L, � - DA E SIGNATURE (4.) I hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: Owner Only Owner's designated representative ( Anyone requesting results n Only those listed below