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
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County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
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—1\ C - ®� or arising out of the use or Inability to use the GIS data provided by this website.
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a
0.,��* OTE: Issued in Cc
,S�yewage Tre
Name
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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.