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206 Meadowlark Lane Lot 18Davie County, NC Tax Pnrc el R f-.nnrt Thursday. November 10, 2016 WA"I1NU: I iIN IN 1VVl A JUKVL+ Y W' Parcel Information Parcel Number: C416OA0018 Township: Clarksville NCPIN Number: 5822875270 Municipality: Account Number: 82519655 Census Tract: 37059-802 Listed Owner 1: WATKINS JEFFREY R Voting Precinct: CLARKSVILLE Mailing Address 1: _ 206 MEADOWLARK LANE 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: LOT 18 WHIP O WILL Fire Response District: FARMINGTON Assessed Acreage: 5.04 Elementary School Zone: PINEBROOK Deed Date: 10/2002 Middle School Zone: NORTH DAVIE Deed Book / Page: 004440679 Soil Types: GnB2,GnC2,MsC Plat Book: 0006 Flood Zone: Plat Page: 070 Watershed Overlay: DAVIE COUNTY Building Value: 478970.00 Outbuilding & Extra Freatures Value: 17780.00 Land Value: 105650.00 Total Market Value: 602400.00 Total Assessed Value: 602400.00 [all All data Is provided as is without warranty or guarantee of any kind 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 County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to NCor arising out of the use or Inability to use the GIS data provided by this website. I DAVIE COUNTY HEALTH DEPARTMENT N Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 .mad auJlaf-161A) Account #: 990002449 Tax PIN/EH #: 5822-87-5270 SM Billed To: S and R Moore Inc. Subdivision Info: Whip O Will Lot # 18 Reference Name: Location/Address: Meadowlark Lane -27028 Pro osed Facility: Residence Property Size: see ma ATC Number: 3279 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE WA C TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date:�� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Co has been installed in compliance with Disposal Systems," but shall in NO W given period of time. mpletio ate the system described on Improvement/Operation Permit e 11 of G. S. Cha OA, Section .1900 "Sewage Treatment and be taken as a guarantee tha system will function satisfactorily for any Septic System Installed By: 01 l 96 ' 3' I-vf vsp-1- y - &WXMI,9, v Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ^, Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 [ 6 1 G �- IMPROVEMENT/OPERATION PERMIT Account #: 990002449 Tax PIN/EH #: 5822-87-5270 SM Billed To: S and R Moore Inc. Subdivision Info: Whip O Will Lot # 18 Reference Name: &M X Location/Address: Meadowlark Lane -27028 Proposed Facility: Residence Property Size: see map l ATC Number: 3279 �� ldr��• **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type 174 #People #Bedrooms #Baths S Dishwasher: Garbage Disposal: Or Washing Machine:, Basement w/Plumbing: ❑ Basement/No Plumbing:l� Commercial Specification: Facility Type #People #People/Shift #Seats -� Industrial Waste: ❑ Lot Size Type Water Supply 00 Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank SizeA516GAL. Pump Tanko42r6GAL. Trench Width_ Rock Depth Linear Ft. Other: 4�L a!L Cs'e,r ' Y ewe -S Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISIIED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's DCHD 05/99 (Revised) EN Date: 2`,2S e-2. ' APPLICATION FOR SITE EVALUATION/IMPROVBIENT PERMIT &VSEP E Davie County Health DepartmentEnvironmentaiHeaith SectionP.O. Box 848/210 Hospital Street2Mocksville, NC 27028 20�z (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AIII ' ��1NTY INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i%n'str/uctions. 1. Name to be Billed A/t(,+ %► oo %� JAI `_ Contact Person S t Cts 1 e( Mot Mailing Address _ 0 130y / J Home Phone 3 3(- City/State/ZIP 1 ►1 , —7 Q Business Phone �� — 3 9 — 30s- 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC Fl Both 4. System to service: House ❑ Mobile Home CI Business i_l Industry 11 Other 5. If Residence: # People_ # Bedrooms # Bathrooms ishwasher Garbage Disposal Washing Machine f_I Basement/PlumbingBasement/No Plumbing. 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ;�i-Pdo (ryes, what type? ***IA1I'0R7ANT*** CLIENTS MUST COMPLE TETHE REQUIRED PROPERTY INFORMATION RLQUES•1 ED BF,L OW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client witli THIS APPLICATION. ayo Properly Dimensions: 933 X ffl i,570001L X03, ( ) o p `� ,� r34o,ryoor WRITE DIRECTIONS from Mocicsvillc to PROPERTY: L!i'1'Y: Tax Office PIN: # ,�(} �a�0 / °�� 8 TOw4r61 u 0 8m►:�es Property Address: Road Name /' t Ad ot„1 /4r{( Lune- Lea I on1 o Carl (k Rd � � � A City/Zip i'c, fir eZ OLD - 0- W 1 If in a Subdivision provide information, as follows: LeFF Dmlo M -p-adoo 6 I`. V1V Name: �/��1 P -'0--W I i I Section: Block: Lot: Date Property Flagged: 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 plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I ant responsible for all charges incurred fiont 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 (o conduct all testing procedures as necessary to determine the site suitability. DAT[: 1 d� O llSIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include 4of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) f Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. r 336_3Lj _3051 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC 02 ****IMPORTANT**** Davie County Health Department Environmental Health Section P.O. Box 848 JUI Mocksville, NC 27028 (704) 634-8760 ! ENVIRO THIS APPLICATION CANNOT BE PROCESSED ] THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed �- Q- Contact Person —S�) & o , c'(3P Mailing Address y y Home Phone S l G gni � �p - � � 25 City/State/Zip ►'-' c o = fie �� _ ��7 r a3 Business Phone / (o p� q 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [ ] Site Evaluation City/State/Zip [ ] Improvement Permit & ATC 4. System to Serve: [ ] House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other [v]'Both 5. If Residence: # People # Bedrooms _ # Bathrooms N rDishwasher [ V"arbage Disposal [,.^asking Machine ["Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes — # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: VCounty/City [ ] Well [ ] Community 8. Do you anticipate additions r expansions of the facility this system is intended to serve? [,J/Yes [ ] No If yes, what type? p r h - E I THER A PLAT OR SITE PIAN PROPERTY INFORMATION REQUIRED: ***,IMPORTANT *** AJDtX1VOF THE PROPERTY MUST BE `i$ ,1$ X aq O ,-7 0 X ` 00.00 X SUBMITTED WITH T APPLICATION. Property Dimensions: 311.11 X 2�3 hb X b' 'X lqg y 7 i WRITE DIRECTIONS (from Tr TO PROPERTY: Tax Office PIN: # - S-7 O o`. _ O _ Property Address: Road Name + 'e�\ 1N ''� t- { � �VY, �� \ IN C`\ N - ATO City/Zip C 1tS`�V� \!��Q-r)"g If in Subdivision provide information, as follows: �+n� �1�- i �- (7 - 1� �,� o ►.S Name: d W J '�S1caf.5�� ►1,0.0 'cam �d . Section: Lot #: ; 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 plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for 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 byto conduct all testing VoSpdures as necessary to determine the site suitability. DATE Li y�� 7 SIGNATURE Revised DCHD (06-96) THIS AREA MAY $E USED FOR L)RAWINC YOUR SITE I'L.AN: 1 �.co , ,4 let Zoe za- A ao3 -10d Lo N r nC-0 `3 r Z� PhD I �S z < �J 1 I .. w LJ ` o No-.S'4O'41"E i �� lv •'YG -�5.. 0 te.. a•. o�E sq.q �' ^� °o S8 �� N �2•�O'S!v':E o�'A IS c 0 L1.54� l� so 00 ��I ---�--��---- VI f/ j 1 ` Z �I � NB5'�''o3'E•�' I 438 16• 0 mos 0 t o 0 11 ol, S DO Act "� LR 4 ri NBwC �i" a i --=sem- R Qe• ,t.. �?3 � 1p , ,-IV AREA FROM FENCE TO \ //J �. C -Q EDGE OORA�$ C-Qw 1 44p.p0'-�—Nf, B'3C o0-' ,/- O� SOI-JQOO' – -G }`� � � SAA•30'00"1: ;! X034.40' 01 W O C -Q AREA FROM FENCE TO C -Q �• N t K ZI a ECOOF ROAD s O MOON AREA cr� eta U ^ 3 1 AK _ \ Z O .r--599.02.'�►2"�•'� � N � g.a5 V\• . _�--- -- — � 3rl �• a "tel "fC6U.�E�y ESTI N ` 1 11 �i ,AUTHORIZATION NO: 0920 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's P.O. Box 848 ,.Name: /1z -M`,//--"-4? I Mocksville, NC 27028 Subdivision Name:'/,/%j > Phone #: 704-634-8760 j Directions to property: ��!%f -✓ Section: Lot: / AUTHORIZATION FORWASTEWATER / SYSTEM CONSTRUCTION Tax Office PIN:#� 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. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPEtIALIST DATE ISSUED