373 Allen Rd (2)Davie County,NC , Tax Parcel Report Friday, October 7, 201 f
WARNING: THIS IS NOT A SURVEY
Parcel Information v
Parcel Number:
G30000008203
Township:
Mocksville
NCPIN Number:
5729386559
Municipality:
Account Number:
82524710,
Census Tract:
37059-806
Listed Owner 1:
TRIVITTE GERALD W
Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1:
421 ALLEN ROAD
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:
1.879 AC OFF ALLEN RD
Fire Response District:
WILLIAM R. DAVIE
Assessed Acreage:
1.89
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
7/2005
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
006170238
Soil Types:
PcC2,CeB2
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay:
DAVIE COUNTY
Building Value: 139230.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 20280.00 Total Market Value: 159510.00
Total Assessed Value: 159510.00
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Davie County,
All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the
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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N`"�r
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.
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Davie County Environmental Health
P.O. Boz 848210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fix (3367753-1680
WELL PERMIT
Account #: 990005503 Tclx'.PINiEH #: G30000008203 -Well
Billed To: Carolina Mobile Home Service Subdivi:.,ion lntol
fie€erence Name:'• Gerald Trvitte :LocatlonrAddrbss.:: 373 Allen Road -27028
-.
Proposed Facility: Residential Well PE'operty Size";', , 1.89 Acres
ATC Number: 0116
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
.well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there
has been a material change in any fact/circumstances upon which this permit was issued.
Permit Type: New ® Repair ❑ Abandonment ❑
Proposed Well Location Diagram
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Certificate of Completion Diagram
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EHS:
W.P. 7-08
Date: Oz /
Driller
Cfftification #:
Grout Inspected: I�) bo%161 f
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Well Head Inspected:
GPS Coordinates:
EHS: Date:
z1
1 C :0 600-k
APPLICATION FOR PRIVATE WELL PERMIT
Davie County Environmental Health
P.O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax (336)751-8786
P� =DP
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***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
to be Billed epro\tNo c �,\. Akyr, 5,-t jtcc i5Fn"":T4, Contact Person -Std s/y1►-}�
Address I/:) Fas�a 11 pr Home Phone
tate/ZIPMst.Kr 11 . N. c— 2?0Z h Business Phone -7A s. • /L 4
on Permit if Different than
PROPERTY INFORMATION
*Date House/Facility Corners Flagged
L
FE: A survey,j[llat or site plan must accompany this application. Included: Site Plan P� (to scale)
per's Name l?•,rtl Phone Number
-1 Ci/State/ZpM(%Is.•11 v.Laer'sAddress `Ii
)erty Address 31 '3 AlkRai Cityt90cAS -•►1. N e ---
Size 1. 5 S A(- ax PIN#[r30mcooZ' o-3
division Name(if applicable) Section/Lot#
actions To Site: (aU I N az) A It, Rte( nh
Permit Type: New Well V /W� Well Repair Well Abandonment Other (specify)
Facility Type: Residential .✓ Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES NO
Do You Intend To Install A New Septic System On This Site? YES NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine the best location for a well.
/--7-1-7
Date
Notification Date:
7/30/09 Account 4 _
Invoice 4
---OLD CAR AXLE FOUND NEAR
REMAINING PROPERTY OF NO3c'36'55"E r• %� / 1THE WIRE FENCE CORNER POST
BILLY W. TRIVITTE 30.00'(totol) m �/ 1
,3
. AND WIFE NEW IRON PIPE SET is ol ' N 090 ------- 2 '21"E 2 )1, 72'
A NEW LOT CORNER X -- `�'
NORMA JEAN TRIVITTE e.00• d coo WIRE FENCE) X --_X
DEED BOOK 150, PAGE 631 A�
TAX PARCEL 82 MAP G3
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NEW IRON PIPE SEi IN THE TRNfiTE
UNE - A NEW CORNER
1" EIP TO NEW 11164 PIPE)
X-__. X WIRE X �X FENCE X
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251.20'
S 04045'1 411W
NAIL SET AT THE BASE OF A
TWO FEET TALL SOLID IRON
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' BOOK 150, PAGE 631
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' BOOK 150, PAGE 631
RECEiVEP
MAR 7 5 2013
SS RESIDENTIAL WELL CONSTRUCTION IMCORD
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North Carolina Department of Environment and Natural Resources- Division f Water C H EA LT H
NCWC 2241 A `
WELL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
g. WATER ZONES (de ):
Reuben William Clayton, III
Top /60 Bottom e! Top Bottom
Well Contractor pndividuaQ Name
=
Top Bottom Top Bottom
Aaua Drill, Inc.
TO Bottom. Top Bottom
Well Contractor Company Name
Thickness!
4137 Moores Mill Road
7. CASING: Depth CtLqlmetar Weight Material
Street Address
Top Q BottomFt"/f
Spencer VA 24165
Top Bottom I Ft
City or Town State Zip Code
Top Bottom Ft
3 ( 36 767-0747
Area code Phone number
8. GROUT: Depth Material Method
2.WELLINFORMATION:
!t
Top_ Bottom �- FtC�-✓GiEL�s /I�//l�
WELL CONSTRUCTION PERMIT#
Top Bottom
OTHER ASSOCIATED PERMIT#(ff applicable)
=
Top Bottom Ft
SITE WELL ID #(If applicable)
9. SCREEN: Depth I Diameter Slot Size Material
3. WELL USE (Check Applicable Boo): Residential Water Supply
Top Bottom Ft In. in.
Top Bottom. Ft tn. In.
DATE DRILLED (% /
TIME COMPLETED' 3 6Q 0AM p pMJ81
Top BottomL Ft in. in.
4. WELL LOCATION:
10. SANDIGRAVEL PACK:
CITY: Al COUNTY l.2T U/t�Depth
Size Material
Top Bottom I Ft
,373 AzZeN &V
Top BottomI Ft
(Street Name. Numbers. Community, Subdivision, Lot No., Parcel, Zip Code)
Top Bottom I R.
TOPOGRAPHIC I LAND SETTING: (cbeck appropriate boot)
[]Slope ❑Valley ❑Flat ❑Ridge ❑Other
11. DRILLING LOG
Tap Bottom Formation Description
LATITUDE tb 3S "SS DMS OR 3X.X 00000= DO
d / /'7 2�J!� �f 5►
LONGITUDE Its 69 %2"6 '• ' DMS OR 7X.=0000= DD
. Z 7--T &/ C..Z- 2W -t/ e -z-179,
Latitude/longitude source: APS Oropographic map
L l S J�� f c/ P!
(location of well must be shown on a USGS topo map andattached to
M form ifnot using GPS)
=
1,xd" .7-6S-- G!r_/�Y
5. WELL OWNER
Owner Name
/
Street Address
/
orTownState Zip Code
/
�City
Area code Phone number
12. REMARKS:
S. WELL DETAILS:
a. TOTAL DEPTH: �(
I
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOS'
=
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: Z Z FT.
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
(Use *4.r if Above Top of Casing)
STANDARDS, AND THAT q COPY OF THIS RECORD HAS BEEN
d. TOP OF CASING IS FT. Above Land Surface•
=
PROVIDED TO THE WELL WNER.
'Top
of casing terminated atfor below land surface may require
4DA
a variance in accordance with 15ANCAC 2C.0118.
`7
:
SIGNATURE OF CERTIFI WELL CTOR
e. YIELD (gpm): METHOD OF TEST
Reuben William Ciayton,lIII
L DISINFECTION: Type &/J� Amount S"O Z--
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division 'of Water Quality - information Prod sing,` Form GW -1a
1617 Mail Service Center, Raleigh, NC 27699-161, Phone; (919) 807-6300 I Rev. 2109