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222 Aubrey Merrell RdDavie County, NC, Tax Parcel Report i 191 ^' -l—�r �1UBf2cY R 1Rf:-LL RD 194 r WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: J700000011 Township: NCPIN Number: 5768306342 Municipality: Wednesday, October 5, 2016 Fulton Account Number: 54169500 Census Tract: 37059-804 Listed Owner 1: NO CREEK PRIMITIVE BAPTIST Voting Precinct: FULTON Mailing Address 1: 222 MERRILL AUBREY ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: 2.40 AC NO CREEK RD Fire Response District: FORK Assessed Acreage: 2.53 Elementary School Zone: CORNATZER Deed Date: 11/2009 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 008110374 Soil Types: GnB2,GnC2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 401120.00 Outbuilding & Extra Freatures Value: 0.00 Land Value: 31560.00 Total Market Value: 432680.00 Total Assessed Value: 432680.00 Davie County, /-+ NC All data is provided as Is without warranty or guarantee of any Idnd 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 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. Pd 7- i3- 49 AUTHORIZATION NO: '04A DAVIE COUNTY HEALTH DEPARTMENT rn ' Environmental Health Section PROPERTY INFORMATION Permittee's�.�� (��`1i� P.O. Box 848 Name:: Mocksville, NC 27028 Subdivision Name: x ,1 I c —( e, I Phone # 336-751-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN: 7&' -' - �i=�7•� SYSTEM CONSTRUCTION -2;z7 J P � t�'y�, �'Ui:t?t'i! tjn C-'.2a-u,1 co Road Name: � Jf��j�Y � " "� Zip: **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 applyihi for Building Permits. (Incompliance-with Article I I 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. "EI�TV1RQiVMENT41, HEALTH SP AL1$ DA E IS ED It DAVIE CiDUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION pERMIS PROPERTY INFORMATION 'Permittee -'s Nafpe: _ Subdivision Name: Directions to property: Section: 120t:IMPROVEMENT � , ,. f , i al fi ",tr PERMIT Tax Office PIN:# 1 Road Name. ip:7�_ **NOTE** This Improvement Permit DOES 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 permit. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r' ) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE _ . --''� r' ° PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ' - `-�1 } i SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE ""7<"# PEOPLE/SHIFT # SEATS (,O✓ INDUSTRIAL WASTE: Yes or No LOT SIZE' v l TYPE WATER SUPPLY""" `DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE t SYSTEM SPECIFICATIONS: TANK SIZE'OUD GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER i i>t l �)T���) 1 C �1 � r� �� 1 � r�P CDV V FC -0,(:'Q REQUIRED SITE MODIFICATIONS/CONDITIONS: ' �'� y,� CA) ,4T C) u(2 IMPROVEMENT PERMIT LAYOUT -1-APPROVED EFFLU UT FILTER'S -r-RISER(S) IF 611 BELM4 FINIS:421) GRADE Lv, ® V(Lt C �r6 9�� S Obi j.1'�• 4'� t "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 ('i'0`#�W 91;6R (336)751-8760 OPERATION PERMIT SYSTEM INSTALLED BY: Sly dc`ct i Lin L Arl /C 1, n In r -n -j C) 100 X/2" AUTHORIZATION NO. _ OPERATION PERMITY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT YSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 05/96 (Revised) ',-� DAVIE COUNTY HEALTH DEPARTMENT ''7 ``� . ' "'' IMPROVEMENT AND OPERATION PERMITS ,. -Permittee' PROPERTY INFORMATION Subdivision Name: "Directions to property: Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# r Road Name. ,y,w i, Zip **NOTE** This Improvement Permit DOES 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 permit. (In compliance with Article I 1 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 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFgICATION: FACILITY TYPE # PEOPLE —7' # PEOPLE/SHIFT # SEATS(,' INDUSTRIAL WASTE: Yes or No LOT SIZE'- �'` u' TYPE WATER SUPPLY"'" '"•'!" DESIGN WASTEWATER FLOW (GPD) -- �-' NEW SITE REPAIR SITE tom°' +I E! w SYSTEM SPECIFICATIONS: TANKSIZEILA-0 GAL. PUMPTANK GAL. TRENCH WIDTH"' - —Ly ROCK DEPTH ! LINEAR FF. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 I'"'tl l { r� `�.(r�7 Yj �!" 1 i i • 3 w) IMPROVEMENTPERMITLAYOUT.mfAPPP%ok)F-D EFFLUENT FILTE11 -r-RISER(S) IF 6"' BEL614 FIt-411 ED GRADE* 0' 4{:Z-1 v7 �'3 1;:-, "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 jC 'j ,M V6b .' t3..0751-0760 OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. %� OPERATION PERMIT BY: I DATE: \--- i "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICAYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED INCOMPLIANCE DCHD 05/96 (Revised) t � APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERM ATC ll Davie County Health Department Environmental Health Section JUN 15 1999 P. O. Box 848 Mocksville, NC 27028 (336)i51=760 ENVIRON^1EtITAL HEALTH DAVIE COUNTY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Is. 4f, Contact Person Mailing Address Home Phone City/State/Zip Ivy. G, 2 7 0 0 6 nB_usineess Phone 2. 2. Name on Permit/ATC if Different than Above 41& Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit & ATC I$ Both 4. System to Serve: ❑ House ❑ Mobile Home ❑ Business ❑ Industry I!d Other 5. If Residence: ❑ Dishwasher 6. If Business/Other: # Commodes .3 If Foodservice: # People # Bedrooms # Bathrooms ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing Specify type �i, # People 7.4' # Sinks # Showers # Urinals _I1L # Water Coolers # Seats Estimated Water Usage (gallons per day)�cat E2� 1 DU 1aT11 7. Type of water supply: �E( County/City ❑ Well ❑ Community 8. Do you anticipate additions or expanse ns of the facility this system is intended to serve? ❑ Yes l�No tjav ©� Grp � `� S & 14&LL alt L Pe 634&.q car 1, 3 tt: If yes, what type. t C.tSTt —,IL t L Lt1tK A MAI UK S1 Lt ULAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PkATM THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: z. 1 WRITE DIRECTIONS (from •5�(p ��`� 1 Mocksville) TO PROPERTY: Tax Office PIN: # 9#1,6 ,_ Property Address: Road Name 1 n 1 1 City/Zip Z441t& 70Z5 1 If in Subdivision provide information, as follows: Name: 1 1 Section: Lot #: 1 1 1 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 by t4f &ziYn L31/ to conduct all testing procedures as necessary to determine the site suitability. DATE g 9 SIGNATURE Revised DCHD (06-96) (JOU MAY USE THE BACK OF THIS FORM FOR DRAWING YOUR SITE PLAN. (S. R. 0 1607) NO CREEK CHURCH ROAD ,N 82-005'36" W ROBERT D. EVERHEART D.B. 96, PG. 414 72.6 t TONO -'%--N ?703FOU IRON N 880 -•-38765 PLACED 85.x,, _ _�---r a d CONC. WL . a RIWMON i t / ' ' t I � I t GRAVEL PARKING \ 1 j 'Al AREA 2.684/Acres 1 i i ,N 82-005'36" W ROBERT D. EVERHEART D.B. 96, PG. 414 72.6 t TONO -'%--N ?703FOU