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168 Hickory Tree Road Lot 140 Davie County, NC Tax Parcel Report Wednesday, January 11. 2017 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: WARNING: THIS 1S NOT A SURVEY Parcel Information J701 OA0014 Township: Fulton 5768233090 Municipality: CORNATZER 8300392 Census Tract: 37059-804 CARTER ANDREW ROSS Voting Precinct: FULTON 168 HICKORY TREE ROAD Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: 00 27028-0000 LOT 14 HICKORY TREE SECTION ONE 0.45 6/2011 008610057 0004 170 Zoning Overlay: Voluntary Ag. District: No Fire Response District: FORK Elementary School Zone: CORNATZER Middle School Zone: WILLIAM ELLIS Soil Types: Gn132 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: Ot'iwl8All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the �r County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to �T —1\ C - ®� or arising out of the use or Inability to use the GIS data provided by this website. i a 0.,��* OTE: Issued in Cc ,S�yewage Tre Name -- --- ^^.+ sy^a1++gjR` +`�'--'�ar'�� -- -�.^ w�r+rm�sp4� �liw!*.°"#�+s�.r�- •,--- -� �-.R,:�N .-�-•,.w. �ppw� DANIE CS: 0'UN` TY H� � ` DEPARTMENT EAL�TH `E S� . v. �� 6 ? - 4 �� TION R,OUEMiENTS PERMIT AND 'CER.TIFICATE OF COMPLE np1'iance with G.S. of North Carolina Chapter 130 Article 13c fitment and Disposal Rules (10 NCAC 10A .1934-.1968) i Permit Number f,KrQ/1i2� -(411 Date ,- /. 3 5 � N,2 ! 5iilr lNy _/lhWe Location v / Suboiuisio,n, ,Name Lot,.. Sec_ o,r Block No. ' Lot Size ,V00 House Mobile Home _ Business __ Speculation No. Bedrooms No. Baths g?(-'— No. in Family _ Garbage Disposal YES i] NO �' Specifications for Syst" m: Auto Dish Washer YES E . NO Auto Wash Machine YES �]i NO Type Water Supply- _ G::��''�:.i1.S7X%�>� ��,rr;• - *This permit Void if sewage system described below is not installed within 36 months from dI} ate -of issue: �4 II , . f %h �A Improvements permit by *Contact a representative of the Davie County Health ®epartmeni .for final inspection of this �sys'tem -8.30- 9:30 between 8 30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. FTle'leplione'Num'ber: 704-634-5995. Final Installation Diagram: Sys em installed by it r Certificate ofCompletion ' f1 Date ' —_ *The signing of this certificate shall mgi.o,ate-that the system described above, -has been installed in com'plian"&p-with the sta'ndaedsset forth in the above regulation butt shall m N0 way betaken as a-gu'a`rantee that -the systewwfbac tion satisfactorily for any given period of time. p APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMITQ�9 Davie County Health Department �n Q Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone G 3V- 5'G -92., 1. Permit Requested /A/'✓S, may'- Business Phone 3S3e' 2. Address ?�7 3. Property Own gr if Different than Above di }7N Address jji/orr,,/7r/ J7/. /,'e' r7.' 4. Permit To: a) Install Alter Repair b) Privy Conventional -2- Other Type — Ground Absorption c) Sub -Division/'",/ -r /r��� Sec. Lot No. �3• 0� 5. System used to serve what type facility: Housed Mobile Home Business Industry Other b) Number of people iX 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 00 Bed Rooms ? Bah Rooms. -? , De 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 garbage disposal washing machine / 8. a) Type water supply: Public— Private Community b) Has the water supply system been approved? Yes ✓ No 9. a) Property Dimensions /410 X c: 7DJ b) Land area designated to building site �k- c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? —Ptn What type? This is to certify that the information is cor ect to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: / Y �YC DCHD (6-62) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED G!!Jl!' c,s,o—,-, (office use only) yes 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above dMY', ibed property, however, I certify that I have consent from Prr� , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 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 as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE /SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: Owner only Owners designated representative Anyone requesting results Only those listed below DATE URE /, DCHD (11 /84) � �c-Z • Daae County NealtFl (Department and .Mame Nealtfr Ayency 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-5985 February 22, 1990 David Snipes P. 0. Box 344 Cooleemee, NC 27014 Re: Sewage System Installation Hickory Tree - Lot 13 Dear Mr. Snipes: The septic tank system that serves this residence was designed, inspected and approved by this office on January 18, 1990. With proper maintenance and use it should function properly. Sincerely, kow. e�� , , Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd F, * DAVIE COUNTY HEALTH DEPARTMENT E 'IMPROVEMENTS. PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued -in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name!,t;' .e,' % .<, �''� .r Date Location Subdivision Name, { /" � - �� Lot No. �� Sec. or I' Block No. Lot Size _�+'/1 House - Mobile Home — Business " Speculation - No. Bedrooms. v No. Baths No. in Family — Garbage Disposal YES El NO ,[2f Specifications for System; Auto Dish Washer . YES g] NO '0 E Auto Wash Machine YES R NO `r Type Water SuPPIY *This permit Void .if sewage system. described below, is not installed within 36 months from (date of issue Il Y� I T I 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: istalled by C 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.