377 Becktown Rd D,avie County,NC Tax Parcel Report OQq-16A- Monday, September 26, 2016
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_... _ _. Parcel Information
Parcel Number: M60000002602 Township: Jerusalem
NCPIN Number: 5755369223 Municipality:
Account Number: 1859000 Census Tract: 37059-807
Listed Owner 1: ANDERSON MICHAEL ERVIN Voting Precinct: JERUSALEM
Mailing Address 1: 377 BECKTOWN ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-6606 Voluntary Ag.District: No
Legal Description: 1.064 AC BECKTOWN RD Fire Response District: JERUSALEM
Assessed Acreage: 0.94 Elementary School Zone: COOLEEMEE
Deed Date: 5/2000 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 003350147 Soil Types: WeB
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding&Extra 4500.00
Freatures Value:
Land Value: 18410.00 Total Market Value: 22910.00
Total Assessed Value: 22910.00
�v 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
NC or arising out of the use or inability to use the GIS data provided by this website.
Permittec'sD VIE COUNTY HEALTH DEPARTMENT
Name: Al tt r4t a'eEp�� C41 Environmental Health Section PROPERTY INFORMATION
I G� P.O.Box 848
Directions to property: (r L- U Mocksville,NC 27028 Subdivision Name:
Phone#:336-751-8760
Section: Lot:
6 (�rt( `/ AUTWASTEWATER HORIZATION FOR Tax Office PIN:#
L t `k��—�' f�' / SYSTEM CONSTRUCTION ?7-76-& �����G f X 13p
AUTHORIZATION NO:
002975 A R�fd Name: �`"�-� Zip:)76 aU
**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 applying for Building Permits.
(In compliance with Article I 1 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.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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Pditnitte�e s 1 DAVIE COUNTY HEALTH DEPARTMENT
` tame Environmental Health Secfio j ��� `�!��3- PROPERTY INFORMATION
} / P.O. Box 848 _
jDirections to property: It�_i1 15 L16 Mocksville,NC 27028 Subdivision Name: "
Phone#:336-751-8760
/it Section: Lot:
—/ AUTHORIZATION FOR
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t F: 1� C.�:+( C d/ WASTEWATER ) S� �j_ `i 6 c:� a 1 3
1 t L--= 1/ r SYSTEM CONSTRUCTION Tax Office PIN:#
AUTHORIZATION NO: 002975 A Rod Nm � `l` f 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 applying for Building Permits.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
=� ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
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'",:�'..f.•. �i� __.i �'Q ` IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
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RESIDENTIAL SPECIFICATION:BUILDING TYPE r #BEDROOM _#BATHS (4 #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
5 �'
LOT SIZE TYPE WATER SUPPLY G' DESIGN WASTEWATER FLOW(GPD) NEW SITE REISAIR SITE V
SYSTEM SPECIFICATIONS: TANK SIZE� �`S GAL.; PUMP TANK fT�'_AL. TRENCH WIDTH'S•"�C' ' ROCK DEPTH LINEAR FT. lJ G(
OTHER
--REQUIRED SITE MODIFICATIONS/CONDITIONS:
f IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPE ION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT SYSTEM INSTALLED BY: J' C a k u A
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AUTHORIZATION NO.OC'?Q�3. OPERATION PERMIT'BY: t:�Z;f� DATE:
**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 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 02/02(Revised)
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Permits DAVIE COUNTY HEALTH DEPARTMENT
'Elaine: /� c (' � A t= �� +'�rV Environmental Health SectibnIQ 01`1 J � PROPERTY INFORMATION
(� f P.O. Box 848 _
Directions to property: t / Mocksville,NC 27028 Subdivision Name: '
Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
K �tt K� ftp ax WASTEWATER TOffice PIN:# 7� c� 2- 3
SYSTEM CONSTRUCTION -�7-7
AUTHORIZATION NO: 0 0 2 9 7 5 A Road Name: �` ,� ! '�Zip:, r6
**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 applying for Building Permits.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
f� ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
4, - 36 -01 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
DW^J IA
RESIDENTIAL SPECIFICATION:BUILDING TYPE r #BEDROOMS -3 #BATHS C;)- #OCCUPANTS -15 GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT / #SEATS— INDUSTRIAL WASTE:Yes or No
/' q & 41 QCI-r '5 C ?Gdtrj"j GG�ct'rrl�j %
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE RE AIR SITE t/
SYSTEM SPECIFICATIONS: TANK SIZE�`S GAL PUMP TANK/ "AL. TRENCH WIDTH 3G ROCK DEPTH,4/ LINEAR FT. p
OTHER As statcd 1 1I•iA NCAC 181.19&9'(5) e
accepted Systems may a150 DC u
�j REQUIRED SITE MODIFICATIONS/CONDITIONS:
Jti IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPE ION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760,
OPERATION PERMIT SYSTEM INSTALLED BY: A42 Cl A A d o G
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AUTHORIZATION NO.DD�rI�3`OPERATION PERM" DATE:
**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 DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A e
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. 1`
DcIID 02102(Revised) 131 0v 6�k7i
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville,NC 27028
Phone: (336)751-8760
ON-SITE WASTEWATER.CERTIFICATION FOR DWELLING
(C heck One) REPLACEMEN'1 REMODELING❑ RECONNECTION
Name G ff%1/_� / • f7� %� •�" ` Phone Number:—3�A'� �w-?y/c! (Home)
Mailing Address: 3', A'�c� /r -a. ./Pig �" 7 +a a 1 (Work)
ork
Detailed Directions To Site: �d �v� S '�`' r 'f'",r2'`•s �r
Property Address:--7 7 2 If« Tic w /�iJ
Please Fill In The Following Information About The Existing Dwelling.
Name System Installed Under: y`G A e"Ir t fType Of Dwelling:
Date System Installed(Month/Day/Year): Number Of Bedrooms: Number Of People:
Is The Dwelling Currently Vacant? Yes❑ No.E' f Yes,For How Long?
Any Known Problems?Yes❑ No 2-'-If Yes,Explain:
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Please Fill In The Following Information About The New,Dwelling.
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y Type Of Dwelling:� Number Of Bedrooms: 3 Number Of People: �
Requested By: y, Date Requested: /
R (Signature)
For Environmental Health Office Use Only
Approved Ue Disapproved El
Comments:T )1)KDu� _aeL2r i 71,'r ri �f a'vt I 'S
4�-e tj [Tl P'GL3-7 (g�7GYJI,', Z /7 TdZIII
Environmental Health Specialist Date r?
*The signing of this form by the Environmental Health Staff is in 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❑ Amount: $ L0010V Date:
Paid By: Received By:
Account #: Invoice #: ��