863 Wagner RdDavie Countv. NC Tax Parcel Rennrt Tnecrlav (lctnher 1 1 �(11(
WAK1VllVli: '1'Hl.�' 1, 1VU'1' A .�'UKVr:Y
Parcel Information
Parcel Number: F30000002203 Township:
NCPIN Number: 5811702149 Municipality:
Account Number: 18421000 Census Tract:
Listed Owner 1: CRANFILL BRYAN HEATH Voting Precinct:
Mailing Address 1: 863 WAGNER ROAD Planning Jurisdiction:
City: MOCKSVILLE
State:
Zoning Class:
NC Zoning Overlay:
Zip Code: 27028-4959 Voluntary Ag. District:
Legal Description: 5.537 AC WAGNER RD Fire Response District:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
�°"�'�' Davie County,
�a- U'� NC
5.53 Elementary School Zone:
8/1998 Middle School Zone:
002070674 Soil Types:
Flood Zone:
Watershed Overlay:
93060.00 Outbuilding & Extra
Freatures Value:
47630.00 Total Market Value:
154430.00
Clarksville
37059-801
CLARKSVILLE
Davie County
DAVIE COUNTY R-A
WILLIAM R. DAVIE
WILLIAM R DAVIE
NORTH DAVIE
MnC2,Mn62,MdD
DAVIE COUNTY
13740.00
154430.00
No
.
� �ermitte�'s ,,� DAVIE COUNTY HEALTH DEPARTMENT `� � �� � � ` � S
f�
Name: �.�%«'=n rj,.�''��-> i`��� �'�''�' Environmental Health Section PROPERTY INFORMATION
P.O. Box 848
Directions to property: t��%j �`-, � r:°:=' �,�`%'"�' �' �"�'�� hlocksville. NC 27028 Subdivision Name:
�r` '
f-.s f f/"� Phone #: 336-751-8760
� i` '�; ' r � . _w �� � / ,�' Section: Lot:
• . ,..: , AUTHORI7.ATION FOR
;�-,' � ; :•- i'� ,' , ' : ��: �i" WASTEWATF.R Tax Office PIN:# - -
.- - ' � � SYSTEM CONSTRUCTION
��
VTHORIZATION NO: �� a� � A Road Name: Zip:
**NOTE** This Authonzation for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section pnor
to issuance of any Building Pemuts. ThiS Forrn/Authonzation Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(ln compliance with Artide I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
f;� �' r � ...�`**NOTICE*** THIS AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION
;�'. ;,r, ���'�, ,, �` 1' , �'° �;, J,' ; Lr "`j "E�t1,y,''��_� IS VALID FOR A PERIOD OF FIVE YEARS.
�NVIRONMENTAL'HEALTH SPE�IALIST DATE ISSUED
,�� .r�'i
RESIDENTIAL SPECIFICATION: BUILDING TYPE / 1 # BEDROOMS �'' # BATHS �=°�-�� # OCCUPANTS � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
! i; , � J/''
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ��C� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE /�� G � ,(
GAL. PUMP TANK GAL. TRENCH WIDTH---� b�' ROCK DEPTH �� LINEAR FI'. � L"J
REQUIRED SITE MODIFICATIONS/CONDITIONS: '
I IMPROVEMENT PERMIT LAYOUT
�
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 930 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
I OPERATION PERMIT
SYSTEM INSTALLED BY:
— � s
/���'��,J�'
, 1= %�� ,) %�--/y�
AUTHORIZATION NO. �� �PERATION PERMIT BY: ����" l DATE: / C S l/
t7�% ""'�
I**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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)
� �i
, . , . -- . _ ,
W�:j r '�,� � . . ' ' � . . . � % j
� �� �1 �-
�Permi►te��s ,� � DAVIE COUNTY HEALTH DEPARTMENT � U l�' / U�
��; Name:; ��� �'•: � R''��k Environmental Health Section PROPERTY INFORMATION
- 't f`-t�' - P.O. Box 848
D'uections to property: '� a` � e' j` Mocksville, NC 27028 Subdivision Name:
�
"? . - � ? �! g, �• ,. Phone #: 336-751-8760
' r ' � � � Section: Lo[: '
AUTHORIZATION FOR
� ,; �; WASTEWATF,R `••y Tax Office PW:# - - '
, � • SYSTF,M CONSTRUCTION +,
, ;' �, `�w +�-, ,
AUTHORIZATION NO: �, c� e..� �: A �}; �2oad Name: Zip:
**NOTE** This Authonzation for Wastewaler System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Forni/Authorization Number should be presented to the Davie Counry Building Inspections
Office when applying for Building Permits. -
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
� �,,,***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
-�;' .� y; `,� ;'��� � IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPE'C(ALIST DATE 1SSUED �
,4, , �,. _
�w-r"'„h .^
RESIDENTIAL SPECIFICATION: BUILDING TYPE _� # BEllROOMS �'� # BATHS `"`—=—� # OCCUPANTS ---,_., � GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
�t�' �r. .
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)Ci�- ./f % NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE ! !% � � ~ � � ^ , ""��
� � j ..,-.,.
GAL. PUMP TANK GAL. TRENCH WIDTH._ ��f ROCK DEPTH �^' LINEAR FT.
OTHER ---"'� �
� -
REQUIRED SITE MODIFICATIONS/CONDITIONS: `< ' �
IMPROVEMENT PERMIT LAYOUT
:
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM II
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. �
I OPERATION PERMIT
SYSTEM INSTALLED BY: G.�"'%J �` /> Gi%fj F'/�,�1_rf "�; �l('
�
1 G r> ���,�i`�
� � , �- , �.
AUTHORIZATION NO. �f�� (��OPERATION PERMIT BY: rf'����� pqTE; f i �`_�� /. (i' S
+*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANC�'
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS �4
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02/02 (Revised)
r
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L�
AP R 2 9 2005
HEALTH DEPARTMENT
vironmental Health Section
'O Box 848/2�0 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
��� C�
� � ��
�
��� WA��dJATER CERTIFICATION FOR DWELLING
REPLACEMENT o REMODELING ❑ RECONNECTION ❑
Detailed Directions
C� � i n.� 1
Property
ma�� �, �� � �
Number: � / �' �' 3 � � (Home)
�-�-Z $' � � � - � � y � (Work)
C.v�� �-�'
Please Fill In The Following Information About The Existing Dwelling:
Name System Installed Under: G c�'Q� �� l� Type Of Dwelling: T7 ���--
Date System Installed(Month/Day/Year): S'S-Co �� Number Of Bedrooms: � Number Of People: �
Is The Dwelling Currently Vacant? Yes ❑ No`F�� If Yes, For How Long?
Any Known Problems? Yes ❑ No ��' If Yes, Explain:
�GLC.L' G � J � �r`> "' !'LQ-Q-c�S �J
Please Fill In The Following Information About The New Dwelling.
Type Of Dwelling:� tz S� Number Of Bedrooms: ���1 Number Of People: �
Requested By:
(Signature)
For Environmental Health Office Use Only
Approved � Disap�roved ❑
Environmental Health
Requested: � ��' "� S
CS'���/�T�.��
'"'The signing af this form by the Environmental Health Staff is in� way intended, nor should be taken as a
guarantee(extended or limited) that the on-site wastewater system �11 function properly for any �iven period of time.
Payment: Cash ❑ Check ❑ Money Order ❑# Amount: $ Date:
Paid By: Received By:
Account #: �� � Invoice #: