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2504 Milling RdDavie County Health Department 4O1836 ��Environmental Health Section P.O. Box 848 COY 210 Hospital Street Q U�` Courier #: 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 Pas: (336) - 7531680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection / Name: 5`LoAad. k Phone Number 3 �J� �%� `� (Home) Mailing Address: i3% d R� �(Work) C. 27DOg Email Address: Detailed Directions To Property Please Fill In The Following Information About The EXISTING Facility: // Name System Installed Under: ; %�J✓i z -r lf. V ✓ F Type Of Facility: 41e&)Date System Installed (Month/Date/Year): Z6 e5/Number Of Bedrooms: S Number Of People: Z Is The Facility Currently Vacant? Yes e If Yes, For How Long? Any Known Problems? Yes ( If Yes, Explain: Please Fill In The Following Information About The NWFacility: Type Of Facility: Number Of Bedrooms:_A�9 Number of People / - For Environmental Health Office Use Only Disapproved Environmental Health X Date: 6� —,oW — no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order Paid By: Account#: Davie County, NC Tax Parcel Report Tuesday, June 20, 2017 WARNING: THIS IS NOT A SURVEY Parcel Number: H60000005601 NCPIN Number: 5769044154 Account Number: 82515429 Listed Owner 1: KURFEES STUART GRAY Mailing Address 1: 137 HERITAGE TRAIL City: MOCKSVILLE State: NC Zip Code: 27028-7371 Legal Description: 2.28 AC MILLING RD Assessed Acreage: 2.28 Deed Date: 4/2000 Deed Book/Page: 003310803 Plat Book: Plat Page: Building Value: 111940.00 Land Value: 26380.00 Total Assessed Value: 138320.00 Township: Municipality: Census Tract: Voting Precinct: Planning Jurisdiction: Zoning Class: Zoning Overlay: Voluntary Ag. District: Fire Response District: Elementary School Zone: Middle School Zone: Soil Types: Flood Zone: Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: Shady Grove 37059-804 WEST SHADY GROVE Davie County DAVIE COUNTY R -A CORNATZER - DULIN CORNATZER WILLIAM ELLIS WeB,RnC,RnD DAVIE COUNTY 138320.00 as EEO !I A All data is provided as is withoutwarranty or guarantee ofany kind either expressed or implied including but not limited to theDavie County, implied warmnges of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the NC 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 data provided by this website. "NO APPROV„ EOUIREO THE CO NIY PLANNING DEPARIMENP' �Pl/anet�9 meteor 1rva I wa<esa REGISTER OF DEEDS EXCISETAX (None) r.a "m a m is%:mePe',li aea.auy s"® :;y0%."nm 1. p �luba1um°...,,':"m°u"n in."ec.rari�i gnu / i lyc Naba".N„u"IMr®o..I."m"",u"n a" // w ' fi .At iglaw'...e. li eo.p"w.n ". 1... "nae".. tad „Van © ., 1MNtece".",m=1n".Mwep"nrr".p"mb Na.m rl n..ry„aM..m nd"Ail Awo,,"'tri,// ` e.,"n6 ?_bo 0 nLu. ur.m�.w.„ 1.o.uua ."nw". uII.. / �l'�GG o\ :e.nra mpr.x.in; mn"m.ax at u�w: rw,..a."r O�t�a\doe �°•��/ All, G �6. /� George R. Stone, PLS / tC d- s rmlmbn"r bqw n-]ef N J`y • Exemtlpt Recombination Survey of Exi 9s Parcels mm O o`a/'�,l ca / \to 5.677 Acral +/- ''O (Inclusive df Area in S.R. 1600 R/W) CERRFCATE OF GLOBAL POSRONING SURVEYS I, George R. Stone, PUS, certify that the site control (grid tie only) shownhereon was established under my supervisian from an actual GPS purvey mad. under my .upervi JML ontl the following information was used to perform the GPS survey: 1 Class of Survey: Chun. A 2 Position Accuracy; Does Not Exceed 0.10' 3 Type of CPS Feld Procedure: RIK-Network MS 4 Data of Survey: May 31, 2017 5 D.lum/Epoch: HAD 83 (NSRS) 2011 6 Published/Fred Control: NCGS Network VRS in accordance with the Standards as outlined by the N.C. Administration Witness my hand and official seal this: 31st day of May 2017 George R. Stang. PLS (L-3162)� NOTES: 1. Zoning: R/A 2. Minimum Building Setback Lines: Front: 40' Rear: 30', Side: 15' 3. Watershed Classification: None 4. All Distances Shown are Measured Horizontal Ground Distances. P/W - Pianl-vl-WaY 6aPla lest yr also, George R. Ston. CAR,(/ • B 5 ® PG 688 36331 �4P e. rLr,J/62x . R ® PG 803 CSS 16 FAIL - Pmpnly the "NO APPROV„ EOUIREO THE CO NIY PLANNING DEPARIMENP' �Pl/anet�9 meteor 1rva I wa<esa REGISTER OF DEEDS EXCISETAX (None) r.a "m a m is%:mePe',li aea.auy s"® :;y0%."nm 1. p �luba1um°...,,':"m°u"n in."ec.rari�i gnu / i lyc Naba".N„u"IMr®o..I."m"",u"n a" // w ' fi .At iglaw'...e. li eo.p"w.n ". 1... "nae".. tad „Van © ., 1MNtece".",m=1n".Mwep"nrr".p"mb Na.m rl n..ry„aM..m nd"Ail Awo,,"'tri,// ` e.,"n6 ?_bo 0 nLu. ur.m�.w.„ 1.o.uua ."nw". uII.. / �l'�GG o\ :e.nra mpr.x.in; mn"m.ax at u�w: rw,..a."r O�t�a\doe �°•��/ All, G �6. /� George R. Stone, PLS / tC d- s rmlmbn"r bqw n-]ef N J`y • Exemtlpt Recombination Survey of Exi 9s Parcels mm O o`a/'�,l ca / \to 5.677 Acral +/- ''O (Inclusive df Area in S.R. 1600 R/W) CERRFCATE OF GLOBAL POSRONING SURVEYS I, George R. Stone, PUS, certify that the site control (grid tie only) shownhereon was established under my supervisian from an actual GPS purvey mad. under my .upervi JML ontl the following information was used to perform the GPS survey: 1 Class of Survey: Chun. A 2 Position Accuracy; Does Not Exceed 0.10' 3 Type of CPS Feld Procedure: RIK-Network MS 4 Data of Survey: May 31, 2017 5 D.lum/Epoch: HAD 83 (NSRS) 2011 6 Published/Fred Control: NCGS Network VRS in accordance with the Standards as outlined by the N.C. Administration Witness my hand and official seal this: 31st day of May 2017 George R. Stang. PLS (L-3162)� NOTES: 1. Zoning: R/A 2. Minimum Building Setback Lines: Front: 40' Rear: 30', Side: 15' 3. Watershed Classification: None 4. All Distances Shown are Measured Horizontal Ground Distances. P/W - Pianl-vl-WaY 6aPla FC - I....1 CuA OR - Eanmy inn Pip" e"c - eaeP nl Pro aR - FtlsYng Iron Reavr pP - Pvwar P.I. IP -Ileal Pde CM- e"neml"Al-L,onl her- en, Reser Set MX - Man N"le CH - chLe Msl°nee FAIL - Pmpnly the 1/0 - Pan vl c/A - coriatiea Mae.. .R - .""a Gi CY - C.=I, Pipe CPP - e"mgmua ua"I piF" Pa - let.A"k Ra - R"eeN e""u P _cvrrvemae Plamc Alps -r- loo In,n""a C"una.y Pa - Pvy" W - c"1"n auan -o- Own, Ad LOU,, -S- sewer une -x- Pence Fal - hand WM - Waln Meter %N - Wemr Po. /I- New yr Po,maena BM - nh M h eMA- NMP -N° ... —A. P"Inl .L1 coler lin. iT..,Lwy Rmvlr Mo. RPS -Rail Rena Spike EP - I'llof Powmenl CIV - Coble Tele"Wer, Peaesl"1 W- Welv,xU'. Pvdoelal a. - sinitoo eowerl Cl.un aul IRS CC - 1/2' Rather SRI Control Corner lOiNeb / / /P k' ft` 6o\dw9 -' •� Grvssan PI vg� � G,W / i' 1/2" EIR rod old P/L laws I ; 1 R2)`0' Q Tax Lot 56 Tax Mop H-6 n/f Stewart Wilson Howell & Luvad. BDw.No Howell RB 369 ® PG 444 Tax Lot 56 Tax Map H-6 n/f Stewart Wlsan Howell & Luvada Bowens Howell RB 369 dD PG 444 I (we) hereby carllfy Met I am (we are) the awnel(s) of Me property deecribed hereon. which is located in Ibe subdidslan fudedia6an of Dole County and that OWNERS: I hereby adapt the subdivision plan with my free Stuart Gray Kurfees .lareart. established minimum building setback line. G1arlene Bowens Kurfeea , hIrma. and aetlieoall elfeeln, aileya, woIW,.OaMail [e e and ��&f '11t.gva HOGS Monument CORNATZER N: 792,2132.0427- E: 1,561.320,7339' CF: 0.99990034 Tax Lot 57.06 Tax Map H-6 /f David L. Melton R6, 407 ® PG 278 Tax Lot 57.01 Tax Mop H-6 n/f Betty Jean Colo... NO 355 ® PG 11 I•- PR^PERTY COURSE BE L -i S 2, L-2 so L-4 S 3, L-5 N BE L-6 N BE L-7 N O L-8 N Oi L-9 N 01 L-10 N 5: L-11 N 5: L-12 N 5: L-13 6 61 L-14 S 61 L-15 S 6: X - NMP (No NCGS Monument CORNATZER AZ MK N: 793.895.6310' E: 1.561.917.0559' CF: 0.99990813 GRID TIE COURSE BE GT -1 N 6( GT -2 N 14 TIE LINE COURSE BE T-1 N H T-2 N 62 T-3 N 4- T-4 N 5: T-5 N 5: X - NMP IN Recombination Si Stuart Gray K Carlene Bowen, LOT 1: Tax Lot 57.04. Tax Mop H - PIN 5769046205 RB 365 ® PG 668 Tox Lot 56.01, Tax Map H - PIN 5769044154 Record Book 331 331 ® Page E LOT 1 Total Acreage: 3.677 (Inclusive of Area in S.R. 11 Am. Computations by Coar