140 Allen RdDavie County, NC T� Parcel Report Wednesday, October 12, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City: MOCKSVILLE
WARNING: THIS IS NOT A SURVEY
ParcelInformation '
G30000008002 Township:
5820504378 Municipality:
Mocksville
82532263 Census Tract: 37059-806
HAYES LORRI J Voting Precinct: NORTH MOCKSVILLE COUNTY
140 ALLEN ROAD Planning Jurisdiction: Davie County
Zoning Class: DAVIE COUNTY R-20,H-B
State: NC Zoning Overlay:
2ip Code: 27028-0000 Voluntary Ag. District:
Legal Description: 1.011 AC ALLEN RD Fire Response District:
Assessed Acreage: 0.88 Elementary Schooi Zone:
Deed Date: 9/2010 Middle School Zone:
Deed Book / Page: 008370752 Soil Types:
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Buiiding Value: 28810.00 Outbuilding & Extra
Freatures Value:
Land Value: 69780.00 Total Market Value:
Total Assessed Value: 98590.00
9" �'�' Davie County,
`'��N�� NC
WILLIAM R. DAVIE
WILLIAM R DAVIE
NORTH DAVIE
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DAVIE COUNTY
98590.00
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AUTHORIZATION NO: '� �, DAVIE C�UNTY HEALTH DEPARTMENT
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.•,. ' � sEnvironmental Health Section PROPERTY INFORMATION
Permittee's P.�. Box 848
Name; ���►� Mocksville, NC 27028 Subdivision Name: '
' Phone # 336-751-8760
Directions to property: -��:� � Section: Lot:
AUTHORIZATION FOR � "
���� L�� G.:. WASTEWATER Tax Office PIN:# - -
SYSTF.M CONSTRUCTION � lL�
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Road Name: � ��,�
**NOTE** ThisAuthorization for Wastewater System Construction MUST BE ISSUED by the Davie Counry Environmental Heal[h Section prior
to issuance of any Building Permits. This Fom�/Authorization Number should be presented to the Davie Counry Building Inspections
Office when applying for Building Permits.
(ln compliance with Artide 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treamient and Disposal Systems)
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ENVIRONMENTAL HEALTH SPECIALIST DA E ISSUED
** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
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�;� �, ,� .;. :TMPRO EMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permittee's' * f'�
Name:. - ,f����ii�t� / !��-� Subdivision,Name: '
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� Directions to property: l Section: Lot:
IMPROVEMENT
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Road Name: /��p: �
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tanlc system or any wastewater system. An
:� AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from tlus Department prior to the
construction/installation of a system or the issuance of a building pernut.
"(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
' ***NOTICE*** TI-IIS PERMTI' IS SUBJECT TO REVOCATION IF SITE'
�- /!i` � PLANS OR THE IN'I'ENDED USE CHANGE: YOUR WASTF.'WATER
ENVIRONMENTAL HEALTH SPECIALIST D ISSUED SYSTEM CONTRACTOR MUST SEE THLS PERMIT BEFORE
INSTALLING Ti� SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE _� # BEDROOMS C # BATHS _� # OCCUPANTS _� GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFI' # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY , DESIGN WASTEWATER FLOW (GPD) ��G � NEW SITE � REPAIR SITE L---''`�
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SYSTEM SPECIFICATIONS: TANK SIZE /D�� GAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH �� LINEAR FT�
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REQUIRED SITE MODIFICATIONS/CONDITIOIY$;�
IMPROVEMENT PERMIT LAYOUT
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**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 830 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
OPERATION PERMIT
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AUTHORIZATION NO. � OPERATION PERMIT BY: �� DATE: ����
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•*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 DISPUSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
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vti �" ' �' „. �-�� IMPRO } EMENT AND OPERATION PERMITS
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PROPERTY INFORMATION
Na;ine; - ;��t�t�l� f�t��..�''--� ! Subdivision Name:
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Directions to property: r` ��-'' ' "' %/ �' ` :: ��� �'f Section: • Lot:
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� ' IlVIPROVEMENT •
» ' � �' '.�; �� � % - '�: PERNIIT Tax Office PIN:#
Road1 � ;�'
Name: � ��ip: � � U:�
**NOTE** This Improvement Pernut DOFS NOT authorize the construction or installation 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 pemut.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THLS PERNIIT IS SUBJECT TO REVOCATION IF STTE
/1.�,� �' ( PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DA�I'E ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYP� �# BEllROOMS �' # BATHS �# OCCUPANTS _� GARBAGE DISPOSAL: Yes or No
�.....,.«-�^'"''"'�
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT #'SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY �� DESIGN WASTEWATER FI,OW (GPDj -S+4'� T NEW SITE � REPAIR SITE y—�'�"'�
SYSTEM SPECIFICATIONS: TANK SIZE /��GAL. PUMP TANK GAL. TRENCH WIDTH ?'� ROCK DEPTH �<l LINEAR FT�. G�
OTHER � � �i � � �
REQUIRED SITE MODIFICATIONS/CONDITIOKS,:
**C(JNTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMk:NT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALI,ATION. TELEPHONE # IS (336)751-8760.
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I OPERATION PERMIT
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AUTHORIZATION NO. � OPERATION PERMIT BY: (''"" � DATE: �/ �� �'� d
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'•THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WTTH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPUSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD OS/96 (Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME rn ��L- � �DS PHONE NUMBER
ADDRESS � � %j� ( f.�'� �Q SUBDIVISION NAME
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SUBDIVISION LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER L���%�'/Y •�a�O
SPECIFY PROBLEMS OCCURRING ����v • v���
DATE REQUESTED � o- l 2'� � INFORMATION TAKEN BY ��
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