132 Will Boone RdDavie County, NC , � Tax Parcel Report Tuesday, October 11, 2016
WAHNING: TH1S 1S NUT A SUKV�:Y
Parcel Information
Parcel Number: L600000005 Township:
NCPIN Number: 5756065254 Municipality:
Jerusalem
Account Number: 48237000 Census Tract: 37059-807
Listed Owner 1: MCBRIDE FLOYD D Voting Precinct: JERUSALEM
Mailing Address 1: 132 WILL BOONE ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
2ip Code: 2702&5481 Voluntary Ag. District:
Legal Description: 1.000 AC WILL BOONE RD Fire Response District:
Assessed Acreage: 0.89 Elementary School Zone:
Deed Date: 6/1994 Middle School Zone:
Deed Book / Page: 001740802 Soil Types:
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Building Value:
Land Value:
Total Assessed Value:
9� Davie County �
f
�°uN�c NC
66360.00 Outbuilding & Extra
Freatures Value:
16170.00 Total Market Value:
100170.00
JERUSALEM
CORNATZER
WILLIAM ELLIS
Ce62
DAVIE COUNTY
17640.00
100170.00
No
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impiied wamrrt(es of inerclurrtabfllty or ittness for a particular usa All users of Davie County's GIS websRe shail hoid hartnlesa the
County o( Davte, North Carolina, its ageMs, consultaMs, contractors or employees from any and ail daims or causes ot acdon due tc
�r adWng out of the use or Inabflity to use the GIS daG provided by this webske.
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Plione: (336) - 753 - 6780
`�-�Il /��% Vl�le�rr�'� 1�..�
� � �1��i�s �a ��e �h��� .
Da�ie County Health Department
� t� � � ��� , nmental Health Section ,,� .
P.O. Box 848 . , �
��P � � ��� s-- � 210 Hospital Street �� �
; - Courier # : 09-40-06 " 1911
' � --� Mocksville, NC 27028 �
ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680
(Check One) Replacement Remodeling Reconnection
Name: � i�i �1�� Phone Number ,�(�' �9is '��QZ (Home)
Mailing Address:
�� � -Uo" �- _ v��
Detailed Directions To Site:
Email Address:
(Work)
PropertyAddress: ��� (�V/�/ ���j%�%Qil�� �1l�b���t�'�� � , �y'�
Please Fill In The Following Information A out The EXISTING Fac'lity: �
Name S stem Installed Under: � � ` `� ���` T e Of Facili : �L•�Pi
Y Yp h'
�,(� /�' C
Date System Installed (Month/Date/Year): '���"r�`-` �7 Number Of Bedrooms: � Number Of People: �
Is The Facility Currently Vacant? Yes No If Yes, For How Long?
Any Known Problems? Yes No If Yes, Explain:
Please Fill In The Following Information About The EW Facility: (` �iL�
Type Of Facility: �� ����1i �� Number Of Bedrooms: � Number of People�
Pool Size: Gar e Size: Other:
�equested By: ,�� ��J-�.� Date Requested: q'( Z' ��i
(Signature)
�'—�'
Approve Disapproved
omments:
Environmental Health Specialist.
For Environmental Health Office Use Only
Date:
*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:$ U�i, UQ Date: �/�/Z /�
Paid By: ��l 6 ��/f' � . ��1 �j/�l � Received By: � (�C
Account #: �9�,3 � Invoice #: �7 /
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s Printed:Sep 07, 2012
All data is provided as is without warranty or guarantee of any kind either expressed or implied inciuding but not limited to the imptied
warranties of inerchantability or fitness for a particular use. All users of Davie Counry's GIS website shall hold harmless the 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.
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AUTHORJ„ZATION N0: ���, �' DAVIE COUNTY HEALTH DEPARTMENT
• . Environmental Health Section PROPERTY INFORMATION
Permittee'-s� , , � � P.O. Box 848
Name: -��./f�%V��� �'��� x���' � e Mocksville, NC 27028 Subdivision Name:
/ ,,�`- f Phone #: 704-634-8760
Directions to property: �+! ���%'�y'=�'-l�`'� `` Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION ?
Ro d N�e: � Zip��a�
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Envuonmental Health Section prior
to issuance of any Building Pernuts. T'his Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pernuts.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
i` `� '" ' �' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
/�� f/ s i� ! �
��`" ;� f� ,.;%'� .���• �-� ��+. .�j�/, aj" ��.� IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPE�IALIST DATE ISSUED
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_ •`� ', �.'a -. !' ' t *�"'a� /� ' ' �[.i'� %� d
� � '� ' `�' DAVIE COUNTY HEALTH DEPARTMENT
��.Y � k� e"� •� TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
�e•r�� � Y� � Y
Permitteess ,�' y .; , .,� %
,. .
Name: �l ��": E�'r,�� t.�;� �:i r" 1�'�'`r `. Subdivision Name:
t _
; Directions to property: /f '� ' ��".' /�' C �f �' / Section: Lot:
" � r
Il1�PROVEMENT
PERM1T Tax Offce PIN:#
f ��. ✓��
Ro �d N��e: : `/ / /'�.�r 'Zip� `' �' �r-�i t+
**NOTE** This Improvement Pemut DOFS 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 pernut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
�'�� `,� .�r ;;r t``` a :r";f �.'- .� r}�� r�% i PLAN OR *TIIE INT'ENDED USE CI ANGE YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPE�CIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TEIIS PERMIT BEFORE
INSTALLING Tf� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE f # BEDROOMS �_ # BATHS _,� # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY T'YPE # PEOPLE # PEOPLE/SHIFI' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) ��� NEW SITE REPAIR SITE J/�
.
SYSTEM SPECIFICATIONS: TANK SIZE��GAL. PUMP TANK GAL. TRENCH WIDTH .�� f ROCK DEPTH �.? �LINEAR FI'. •�'`'-��
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
�
��
5������
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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.
I OPERATION PERMIT
SYSTEM INSTALLED BY:
��1
Y��
��
�
� �_
AUTHORIZATION NO. -�� OPERATION PERMIT BY: ��� DATE: l�� �
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAP"fER 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 OSN6 (Revised)
� �_;, � IC+a,... . `� . . ; a� �y4 � , . � �. .. . . ' ' . . , . . � .: : ' ' _ . � . �li � l.•
� � � �t' DAVIE COUNTY HEALTH DEPARTMENT
�..lrr • � Y:w � - 'd
, ' " ' '+�'.,....�.,.. • .
��-�'""� •' � - . TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee�s �� `: ' �
Name: i '� �' � `� • Fr ,� .�' ' 9�`� - . Subdivision Name:
-.,': Directions to property: r` '` ' Section: Lot:
_ � IlVIPROVEMENT
PE�T Tax Of�frice PIN:#
.. �'' V�� JT /
RoaddName: l��i�d` � .��.'1�,�,�,%
�' If:.i •� `,.- a
'�Zip: -� e�,-f�; �
**NOT'E** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
ALTTHOWZATION FOR WASTEWATER SYST'EM CONSTRUCITON must be obtained from 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*** THIS PERNIIT LS SUBJECT TO REVOCATION IF SITE
. �; ,= , ' �` ^ , ''� .. , f , � PLANS OR TI� INTENDED USE CHANGE. YOUR WASTEWATER
. � , , ,,,
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING Tf� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING 1'YPE �# BEDROOMS ._'� # BATHS �# OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No \
;
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) %�"���/ NEW SITE REPAIR STI'E 3�
SYSTEM SPECIFICATIONS: TANK SIZE ��` GAL. PUMP TANK GAL. TRENCH WIDTH ��� ROCK DEPTH,�,,,� `f LINEAR FI'. ,,�„j,�"'�
'REQUIRED SITE MODIFICATIONS/CONDITIONS:
I IMPROVEMENT PERMIT LAYOUT
a
r L�,J �,
� �`1 %
w
�
�(/
� �� 1 `,� �i
� � i � � � � ir,.
�
**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.
OPERATION PERMIT
't
SYSTEM INSTALLED BY: ���1' ��.,p•, ry �, -� ff
��� .,"
���
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�
���� � �7 ,
AUTHORIZATION NO. –a�!— OPERATION PERMIT BY: - /'%'J j'/ 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. CHAP'TER 130A, SECTION :1900 "S�WAGE 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 OSN6 (Revised) ,. ,
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME t/�(��I ��/'i ��PHONE NUMBER ����`rS ��U
ADDRESS f� c� //l/.'/� ./Jf.C��e � �SUBDIVISION NAME
._��tIL�,�sv: / ��' �l,�y �,
SUBDIVISION LOT #
DIRECTIONS TO SITE [/ / ' �f �� �v� �/�I�D,'1��l�'
/�,T v�•� .� �'
DATE SYSTEM INSTALLED.
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED �5 /i�/� 0 INFORMATION TAKEN BY