113 Junction Road Lot 18Dau
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WARNING: THIS IS NOT A SURVEY
All data Is provided as is utthomvramanty or guarantee m any Idnd eMhereapreswd or implied Including but not limited to the
Impliedwnramlas ofinerchanmblgryorMnesa fora pngeularuse.All usersof Davie Counq+s GISaabshe &hall hold hatmlesfthe
County of Davie. North Carolina, Reagents, consultants, contractors oremplsyees from any and all dalms or causes of action due to
or aMing out of the use or inability to use the GIS data provided by this "Idle.
Parcel Information,.._...__..,.
Parcel Number:
K305OA0001
Township:
Mocksville
NCPIN Number:
5727540463
Municipality:
Account Number:
82523613
Census Tract:
37059-801
Listed Owner 1:
FORREST PAUL TONY
Voting Precinct:
SOUTH CALAHALN
Mailing Address 1:
113 JUNCTION ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-20,
State:
NC
Zoning Overlay:
Zip Code:
27028-5314
Voluntary Ag. District:
No
Legal Description:
LOT 18 CAROWOODS
Fire Response District:
CENTER
Assessed Acreage:
0.50
Elementary School Zone:
COOLEEMEE
Deed Date:
11/2004
Middle School Zone:
SOUTH DAVIE
Deed Book / Page:
005820940
Soil Types:
GnB2,EnC
Plat Book:
0004
Flood Zone:
Plat Page:
158
Watershed Overlay:
DAVIE COUNTY
Building Value:
107360.00
Outbuilding & Extra
Freatures Value:
3790.00
Land Value:
25000.00
Total Market Value:
136150.00
Total Assessed Value:
136150.00
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Davie County,
NC
All data Is provided as is utthomvramanty or guarantee m any Idnd eMhereapreswd or implied Including but not limited to the
Impliedwnramlas ofinerchanmblgryorMnesa fora pngeularuse.All usersof Davie Counq+s GISaabshe &hall hold hatmlesfthe
County of Davie. North Carolina, Reagents, consultants, contractors oremplsyees from any and all dalms or causes of action due to
or aMing out of the use or inability to use the GIS data provided by this "Idle.
Pemuttee s, AVIE COUNTY HEALTH DEPARTMENT
Name'1 / Environmental Health Section
o)/G Sc c.Y P.O. Box 848
Directions to property: Mocksville, NC 27028 Subdivis'.
r
PROPERTY Name: // INFORMATION
l (1 0(O Wl C Cpr,
on, H U Phone k 336-751-8760 �j
/ / �AUTHORIZATION FOR .Section: Lot: /
tloirjCt OI jU✓'C�I.Cp%k WASTEWATER TaxficePIN:#/�•,�7
SYSTEM CONSTRUCTION I
AUTHORIZATION NO: 002948 A Road Name: Zip> V
**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 Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
*** OTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALFOR A PERIOD OF FIVE YEARS:.
ENVIRONMENTAL HEALTH SPECIALIST' : DATEISSUED
!�p`i/��f t /� �oS''�'r'
RESIDENTIAL SPECIFICATION: BUILDING TYPE ✓ �r # BEDROOMS L # BATHS # OCCUPANTS C� GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT.SIZE ' TYPE WATER SUPPLY b DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE r � L� AMP TANK —"GAL. TRENCH WIDTH. G ROCK DEPTH
REQUIRED SITE MODIFICA
IMPROVEMENT PERMIT LAYOUT
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II FOR FINAL INSPECTION OF THIS LEASE CALL BETWEEN 8:30.9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. II
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AUTHORIZATION
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^1!ilOPERATION PERMIT BY:
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ON �1 � I or
LipP{�
leeoa r0004s
_ D7CTE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 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 02(02 (Rtvierd)
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
),Amer/Occupant To: L30. ip 1"7"
Address
AddrQss 4—
Building Contractor Address
Gal. D Manufa/*/610s Name
Address
No. of lines Width n. Total length d'2 S� ft. No. sq. ft. Z) 2)
Type of filter material S2 9 Tota I tons used
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. lint 400
Two-bedro,om*.bouse
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without .-a--permit from the Fealth Offic
or his agent.
Date of Final Approval Signed:
S&fitar:Lan
I hereby certify that the above septic tank has been installed according to specificatioy
Signed:
4 4- C Z!
Septic Ta ffk Contractor
Note: Male sketch of disposal systemonback of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
Aib` HORI7ATiON NO: 0 8 5 O , DAVIE COUNTY HEALTH DEPARTMENT Soa
Environmental Health Section PROPERIIQFORMATION
Permittee P.O. Box 848
Name:\�%'*`'-"FMocksville, NC 27028 ..: Subdivision Name:
p Phone #: 704-634-8760
Directions to property: Section:
-AUTHORIZATION FOR
WASTEWATER Tax Office PIN* - -
SYSTEM CONSTRUCTION•
Road Name:�*�
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County. Environmental Health Section prior
to issuance of any. Building Permits, Tbis ForavAuthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pemuts: .
(In compliance with Article 11 of G.S, Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION'.
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 1
A •_^ f I!,W - , •ref,�artir v,:��04�iY �fy�'''nw""r1`h}I rt'"•Y1�J''Ym. r -T,
DAME c6UNTY HEALTH DEPARTMENT � k�>r •a a
:Tyr g N�.•• ' `' IMPROVEMENT AND OPERATION PERMITS PROPERII INFORMATION
P'ei' d
Subdivision Name: C.o n �m.8 ub Ac�N
opty: Section: Lot:Dmrectionsper
r eJ IMPROVEMENT
PERMIT Tax Of?kd PIN:#
FRoa Na�rrme: S�•. a.rs. iti , Z P
"*NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wasteWer system. An
'AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/msiallation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
". ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE' i
PLANS OR THE INTENDED USE CHANGE: YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM..
RESIDENTIAL. SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS L _ GARBAGE DISPOSAL Yves oA,
COMMERCIAL SPECIFICATION. FACILITYTYPE# PEOPLE # PEOPLE/SHIFT # SEATS - INDUSTRIAL WASTE Yes`or_No.
LOT SIZE 2 � TYPE WATER SUPPLY O • DESIGN WASTEWATER FLOW (GPD) L NEW SITE REPAIR SIZ V
SYSTEM SPECIFICATIONS: TANK SIZE - GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fr.
REQUIRED SITE MODIFICATIONS/CONDITIONS: - -
"*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) 6348760. -
OPERATION PERMIT - - -
- SYSTEM INSTALLED BY: '
�i
d�
AUTHORIZATION NO, d Gly �- OPERATION PERMIT BY: 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. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SA71SPACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
DAVIF, C6UNTY HEATH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
smut
Subdivision Name:
Directibrisitopr6p-erty: Section: Lot. 6
IMPROVEMENT
PERMIT Tax Officd PIN:#
Road Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or ins6llaiion 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 permit. -1
(Incompliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM,
RESIDENTIAL- SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS Z # OCCUPANTS GARBAGE DISPOSAL� ' yesoo
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEoPLE/SHiFr_ #SEATS-- INDUSTRIAL WASTE: Yes "orNo
LOT SIZE
'±04-3c' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE _GAL. PUMP TANK GAL. TRENCH WIDTH —,ROCK DEPTH LINEAR FT.
OTHER
q
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
-----------
3
d
**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
SYSTEM INSTALLED BY:
X1
PERATIONPERMUBi:
AUTHTAIION NO. 0
"THEISSUANCE OF THIS OPERATION PERMIT �HALLI'NDIC'k*THATj
WITH AirTT—CLEIIOFG.S.CHAPTE,RI30A,SECIION.1900"SEWAGE,TREA
GUARANTEE THAT THE SYSIIN( WILktUNCTION SAIISFACTO' RILY
TOP
DCHD 05/96 (Reviod) \_
144
Z1.
I
ti DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
AME
L{�Ti 1Cl�ff C/7Lf/'Cl� of C�r151�Sd�P ENUMBEF
Ar 411, it echl_e;/Ge-, A 1 SUBDIVISION NAME 6arr0w000LS
LOT #_
DIRECTIONS TO
DATE SYSTEM INSTALLED a NAME SYSTEM INSTALLED UNDER 5 A MQ--
TYPEFACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY
� y, I 1 SPECIFY PROBLEM OCCURRING beta/2&g) 7
Yj�elne7�� �/Hroon--L�i'�-�Y\ IV" 1�Qiy�S __pp
DATE REQUESTED ���6'9% INFORMATION TAKEN BY
This Is to certify that the Information provided is correct to the best of my knowledge, and that I understand I em responsibp for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1183
DAVIE COUNTY -HEALTH DEPARTMENT(' SEPTIC TANK PERMIT Date
OTAMer/Occupant To: .( %
Address Address �-7-- bl�
Building ContractorQ _ � v -- Address !� / /W
Cal. �^�D Manufnto r1 s Name _C,7, E& r Address
No. of lines _�_ Widthin. Total length o?6ZS, ft. No. sq, ft. ?62)
Type of filter material _ Total tons used 3l
Minimum REquirements: jHouse TrailerTank cap. 800 Sq. ft. line 400
'Two-bedropm:Chouse___
Three.bedroom house 900 900
No one shall install a septic tank -in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval - %2—) /r 7¢ ---- Signed:
Sfrfitarian
I hereby certify that tbe, above septic -tank has been installed according to specification
'Signed:�/� �dylG
Septic Tailk Contractor
Note: Male sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville,,-��N,o,,rtth Carolina 27028.
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