147 Aubrey Merrell Road Lot 7Davie County, NC e Tax Parcel Report Thursday. January 12. 2017
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
133
169
15
161 lk1
----------
--------
5768206253
Municipality:
Account Number:
8306347
143
143
Listed Owner 1:
11
Voting Precinct:
%
W-
Planning Jurisdiction:
_.._ f
LC
State:
NC
Zoning Overlay:
a
27028
Voluntary Ag. District:
i
151
139
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
J708OA0007
Township:
NCPIN Number:
5768206253
Municipality:
Account Number:
8306347
Census Tract:
Listed Owner 1:
MEDFORD GARY
Voting Precinct:
Mailing Address 1:
147 AUBREY MERRELL
Planning Jurisdiction:
City: MOCKSVILLE
Zoning Class:
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
Legal Description:
LOT 7 HICKORY FIELD
Fire Response District:
Assessed Acreage:
0.71
Elementary School Zone:
Deed Date:
5/2016
Middle School Zone:
Deed Book / Page:
010180909
Soil Types:
Plat Book:
0005
Flood Zone:
Plat Page:
124
Watershed Overlay:
Building Value:
Land Value:
Total Assessed Value:
Outbuilding 8r Extra
Freatures Value:
Total Market Value:
Fulton
37059-804
FULTON
Davie County
DAVIE COUNTY R-20
No
FORK
CORNATZER
WILLIAM ELLIS
GnB2
DAVIE COUNTY
9
Davie County,
NCor
ll data is prodded as Is without warranty or guarantee of any idnd either expressed or Implied Including but not limited to the
implied warranties of merchantability or fitness for a particular use. All users of Dade County's GIS website shag hold harmless the
County of Dade, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
arising out of the use or inability to use the GIS data prodded by this website.
,HEAJLTH DEPARTMENT RELEASE
DaVie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Laura Medford
Address: 147 Aubrey Merrell Rd
City: Mocksville
State2ip: NC 27028
Phone #: (336) 940-4550
For Office Use—on
*CDP File Number 219024 -1
County ID Number:
waluated For. HDR/WWC
PERMIT VALID 0 6/ 0 8/ 2 0 1 6
UNTIL:
Property Owner: Laura Medford
Address: 147 Aubrey Merrell Rd
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 940-4550
'-I'- Property Location & Site Information
Address 147 Aubrey Merrel Rd Subdivision: Hickory Field Phase: Lot: 7
Road # Mocksville NC 27028
SINGLE FAMILY Township:
'Structure: Directions
# of Bedrooms: 2 # of People: Hwy 64 East left on Aubrey Merrell
'Water Supply: N/A
Basement: FjYes o No
"Proposed Improvement:
Storage Building
"Retease Conditions
Type of Business:
Total sq. Footage: No. Of Employees:
91
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? OYes ONo
Applicant/Legal Reps. Signature; *Date: /
*Issued By: 2140 -Nations, Robert *Date of Issue: 0 6/ 0 7/.2 0 1 6
Authorized State Agent:
**Site Plan/Drawing attached.**
41 -land Drawing Olmport Drawing
Drawing Type:
HEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
IMocksville NC 27028
Health Department Release
CDP File Number: 219024 - 1
County File Number:
Date: 06/07/2016
Olnch
Scale: OBlock = ft.
ON/A
Nage 2 of Z
LLLI
i
!
!
LJ
I
I
I
I
i
t
...... A.1
IF-
1
Nage 2 of Z
Davie County Health Department
P
9 1836 ` Environmental Health Section
� P.O. Box 848 _ ,,
D 210 Hospital Street
;j
C�pUI`t�
0C Courier # : 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 678 Fax: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: a l/�k / neer J o PY, f Phone Number 33(0 -7'10- (Home)
Mailing Address: 14-0 nybY4 `i / we'ele tl �7&14'1- &38- 010,90 (Work)
lyao 4yjlle 'Qe-- �� '3-3C0 -,309 —gy4y (c elf
Detailed Directions To Site: #A/ y 6, - le-�O- O!'1 4 tlb-re /k/elze4 - Aba 5c qi /<4J ICle-
Property Address: 07 0612M WEA
Please Fill In The Following Informations About The EXISTING Facility:
Name System Installed Under: ` s Type Of Facility:(? U S�
Date System Installed (Month/Date/Year): V Number Of Bedrooms: 0 Number Of People: Z
Is The Facility Currently Vacant? Y sPes,
If Yes, For How Long?
Any Known Problems? Yes No If
Please Fill In The Following Information2,2,,V.2-,&
About The NEW Facility: o
Type Of Facility: �7 O (Q e- 8 1ti/Gl_/; Number Of Bedrooms: �)- Number of People 2
Pool Size: Ga a Si Other: _
Requested By:I Gl ele, Date Requested: V -aa
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Xe-
Environmental
eEnvironmental Health Specialist 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) thatthe n -site wastewater system will function properly for any given period of time.
Payment: Cash Check M , w r er # Amount:$ too, 0 Date:
Paid By: Received By:
Account #: 6 / 02q Invoice M I %��
IM
40
C-0
00 0 0
19
A I 8
-i
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
sir (E merchantability or fitness for a particular use. All users of Davie County'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
Is data provided by this website.
OVI
O bb�F
Printed:May 20, 2016
DAVIE COUNTY HEALTH DEPARTMENT s� ►�
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name, 1' !�/�rWil% %!f f /y/y�c Date — %�'� � N2 5 9 -'-
Subdivision Name / _'�'k Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _— Speculation
No. Bedrooms No. Baths —�T No. in Family _�—
Garbage Disposal
YES ❑
NO
[-
Auto Dish Washer
YES
EJAuto
Wash Machine
TNO
YES
NO
❑
Type Water Supply,.
Specifications for System:
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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�'>
D/
f ` 'S -
f
3
J
Certificate of Completion JV' Date 7 J �U
*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.
Address
FACTf1RC
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
APPA 1 APPA 9
Date
Lot Size?
ARFA 3 ARFA A
Topography/ Landscape Position
S
S
S
PS
PS
PS
U
U
U
U
') Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
U
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
S
PS
PS
PS
U
U
U
1) Soil Depth (inches)
S
S
S
pg
PS
PS
PS
U
U
U
�) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
�•Q-�
U
U
U
External
S
S
S
S
PS
PS
PS
U
U
U
�) Restrictive Horizons
j Available Space
S
S
PS
S
PS
S
PS
U
U
U
1) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
1) Site Classification
.r ,
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/ Comments:
Described by Title
SITE DIAGRAM
DCHD (6-82)
..APPLICATION.FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mockoville, NC 27028
1.
Appl icati onJPermit Requested By
Maihing •Address
Home Phone 0 Business Phone
2. Name on Permit if Different than .Above
3. Property Owner if Different than Above
Q//
,..
4. Appl,icat•ion/Permit For: General Evaluation S/Tank Installati(:),.n
5. System to Server House J Mobile Home Business
Industryu Other Unknown
6. If house, mobile home: Subdivision Sec. Lots
No. of People Dwelling Dimension's
No. of Bedrooms 7 Basement/"Plumbing
No. of Bathrooms / Basement/N-o. Plumbing
0 Washing Machine ;J Dishwasher Garbage Dsposai'.
7. I,f business,, industry, other:, Specify type.
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
8.. Type of water supply: Public 0 Private Q Communiry
9. Property Dimensions f"�nvT �fJ:,S"s'�_ �ET�i'6,DE- .Zl�b��S�7a,� ?7,932�SdE„30? %O
10. Sewage Disposal Contractor
"11. Do you anticipate additions/expansions of the facility this system is
intended to serve? Yes No
If yes, what type?
This is to certify that the information provided is correct to the
best of my knowledge,. and I understand I am responsible for all
charges incurred from this application.
Date: .,Signature
OT FA (/EQ P - (ND 6RPE/2 pj.y} TD )_EiC%
sections to Property