333 Willboone Road Section 2 Lot 5 FrontDav
Davie County,
°oNt; NC
WARNING: THIS IS NOT A SURVEY
Parcel Information-
Parcel Number,
K50000007303
Township:
Jerusalem
NCPIN Number:
5748983703
Municipality:
Account Number,
82515510
Census Tract:
37059-807
Listed Owner 1:
HOWELL RANDY SCOTT
Voting Precinct:
JERUSALEM
Mailing Address 1: -
333 WILLBOONE ROAD --
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
.719 AC WILLBOONE RD
Fire Response District:
JERUSALEM
Assessed Acreage: -
0.72
Elementary School Zone:
CORNATZER
Deed Date:
8/2000
Middle School Zone:
WILLIAM ELLIS
Deed Book/Page:
003430507
Soil Types:
CeB2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
- -
Building Value:
9
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
Davie County,
°oNt; NC
AUTIO�RIATION NO: DAVIE•,C UNTY HEALTH DEPARTMENT.
t Environmental Health Section PROPERTY INFORMATION
Permittees ` "P.O.Box 848
Name: p� iS �'re/P_�/ Mocksville,NC 27028 Subdivision Name: S'
y Phone#,336-751-8760
Direcuons[o property Section: 2 Loti '
,.AUTHORIZATION FOR
WASTEWATER TaxOfticePlN:#
SYSTEM CONSTRUCTION -
/LC1 '
Road Name. <I/f�DOAleZi
**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 FomVAuthonration Number should_ be presented to the Davie County Building Inspections
Office when applying for Building Permits
M comphance with Articled I of G S.Chapter 130A;WastewaterSystems,Secnon 1900Sewage Treatment and Disposal Systems)
NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR APERIOD OFFIVEYEARS.
ENVIRONMENTAL HEALTH SPECIALIST -DATE ISSUED
DCtm 05196(Revised)
" 549 . DAVIE OUNTY HEALTH DEPARTMENT
}b s • JMPRO EMENT AND OPERATION PERMITS PROPERTY INFORMATION
V`emmttee
/
N� �t�✓�L1S�a f
�
A.
Directions to property: f f` Section: +C Lot: Z17f/
IMPROVEMENT
PERMIT Tax Office PIN:°d - -i';
./'. Road Name: %/N/ r'C'r✓
**NOTE** This Improvement Permit DOES NOT authorize Nie construction or installation of aseptic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
constuctionlinstallation of a system or the issuance of a building permit.
(In compliance with Article I Yof G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
{r ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SrrF—
{;.' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - - SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE.
INSTALLING THE SYSTEM. r"'*`•.
RESIDENTIAL SPECIFICATION: BUILDING TYPEm 11 # BEDROOMS # BATHS 2 # OCCUPANTS GARBAGE DISPOSAL Yes or No
i
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or Io
r ,
- LOT SIZE TYPE WATER SUPPLY e d DESIGN WASTEWATER FLOW (GPD) ; G NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. -TRENCH WIDTH -?t - ROCK DEPTH % I LINEA_RFT. a�f%�t�
. OTHER
'.REQUIRED SITE MODIFICATIONS/CONDITIONS: -
IMPROVEMENT PERMIT LAYOUT
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTYHEALTHDEPARTMENT 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
M
4,
AUTHORIZATION NO.. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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) - .
:✓
!G
4,
AUTHORIZATION NO.. OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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) - .
" . APPLICATION FOR SITE EVALUATION/IMPROVEMENT' PERMIT & ATC V
Davie County Health Department n
Environmental Health Section % /99$ U
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 %: FAN VI
NM
(336)751-8760 AtHFA()y Ij
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer, to the INFORMATION BULLETIN for instructions.
1. Name to be Billed D'F nn is 1411tve.L4 Contact Person
Nailing Address .?1.1010 h4yo LSI L Some Phone gfk-5*)4
City/State/ZIP _(140C k6vi li� /11: zTnaY Business Phone 75) • zo/l
2. Name on Permit/ATC if Different than Above
Nailing Address City/State/Zip
3. Application For: 'Site Evaluation ❑ Improvement Permit/ATC R Both
4. system to Service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms # Bathrooms 2
❑ Dishwasher ❑ Garbage Disposal D Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # showers # Urinals # Water Coolers
:ZF FOODSERVICE: / Seats ` Estimated Water Usage (gallons per day)
7. Type of water supply:$ Gounty/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑ No
***IMPORTANT-** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax Office PIN: # 97 5/6 - 98.37 03
Property Address: Road Name w t l �iaow�
City/Zip
If in a Subdivision provide information, as follows:
Name: �n
Sectioa• 2 Block: S it: 5 F0040
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site pians or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that 1 am responsiblefor all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE ,/27/f a' SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN:
fl f cat e,
.A No. 7T
Invoice No.
Ravised DCHD (07/98)
18 ACRE TRACT o6
SURVEYED BY 1 EXISTING IRON 16.7' �d
DW SURVEYING CO. - 3
-C. 23, 1997 FAST OF CENTER riles 3
S 2 14 4' E :A p.
2S
LIP
310
.47 55.00 EXISTING IRON 20.5'
"38' E—S 89'52'38' E EAST OF CENTER VICINITY MA
E—+ `—i \ �S 25'11'44' E
9.
�I S 852' 38' E—� S 89.52' 38' E ` 26.24
S 00'07'22' W r 68.38 56.61
3.72 BILLY R. WALL
D.B. 71 Pg. 175 (O
AREA = 0.832 ACRE =
(SUBJECT TO S.R. 1802 R/W)irM
S 25'11'44' E Zd
\i 98.76 z i
WIC
W W
D �
_ _ _ _ _ (original -lot line) EXISTING IRON 32.2'
----------$ -- — 2 EAST OF CENTER
333.44 ^ N 85' S 50 p5. V �N✓
17'00' W 1 62 AG 0
Il .0p a_
s
HOYLE W. COMBS
D.B. 71 Pg. 231
r 2 D.B. 64 Pg. 489
tJl � Ns
a
pp n
IRON FOUND
TIFY THAT UNDER
;IDN, THIS MAP
MELD SURVEY
4G COMPANY.
--------L-2527
COMPANY
'CH ROAD
27028
1 f,
0 = EXISTING IRON STAKE
• - NEW IRON STAKE SET
•o
7t
PLAT OF SURVEY FORt
HOWELL & HO WELL CO.
REVISIONS SCALE. 1' = 50 APPROVED BY. GLT DRAIN BY, SPH
DATE. JAN. 12, 1998
BEING 2 TRACTS TOTALING 1.551 ACRES OF THE HOWELL & HOWELL CO. PROPERTY
(D.B. 198 Pg. 354,tract 1 & 0.089 AC. SURVEYED JAN. 09, 1998)
LYING IN THE JERUSALEM TOWNSHIP,
NUMBER.
498-2
2981
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