611 Cedar Grove Church Rd Davie County,NC Tax Parcel Report Monday, September 26, 2016
t
543
640
606
569 �...
624 611
6:32 f
,647
668: ' oP --- --�_ "`
WARNING: THIS IS NOT A SURVEY
- Parcel Information
Parcel Number: K700000027 Township: Fulton
NCPIN Number: 5767738558 Municipality:
Account Number: 79750000 Census Tract: 37059-804
Listed Owner 1: WILLIAMS ROBERT JR Voting Precinct: FULTON
Mailing Address 1: 611 CEDAR GROVE CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-7117 Voluntary Ag.District: No
Legal Description: 3.27 AC CEDAR GROVE CHR Fire Response District: FORK
Assessed Acreage: 2.77 Elementary School Zone: CORNATZER
Deed Date: 7/1976 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 000990195 Soil Types: PcB2,PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 113650.00 Outbuilding&Extra 13490.00
Freatures Value:
Land Value: 34850.00 Total Market Value: 161990.00
Total Assessed Value: 161990.00
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
N^
r'pr N,t; 1. or arising out of the use or inability to use the GIS data provided by this webslte.
__ _ .._ - .. ....-.-. -.. 1...3 - r- .moi-' -..:.•. -- v.-:..^ - _ �r � r
:., DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
t
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
S age Treatment and Disposal flules (10 NCAC 10A .1934-.1968) Permit Number
Name- aI��- �`.� , ;� Date � 3 6 1 2
Location
/VC,
Subdivision ame Lot No. Sec. or Block No.
Lot Size House --r-� Mobile Home _ Business Speculation
No. Bedrooms No. Baths -! No. in Family �1 _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ il� �',, •.. �. f ,. 1.. "� �; 1.
Auto Wash Machine YES ❑ NO {]
Type Water Supply
*This permit Void if sewage system escribed below is not installed within 36 months from date of issue.
Improvements permit by
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by �► �""^�
/V,� Ick n,4
i>
- i
C3
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
• 6 -2 7
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS'PERMIT
t Davie County Health Department
j f Environmental Health Section
r't P. O. Box 665 `�' "�
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone6V�/
1. Permit Requested By o be T I�i 1 a w`S Business Phone
2. Address 'V40iv10 vr- LF ' o 44 Alec- fro l6cale,1o F V-6\1 C. h.rc htgV • o,
3. Property Owner if Different than Above
Address
4. Permit To: a) Install-ZAlter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: HouseMobile Home Business
IndustryOther
b) Number of people a
6. a) If house or mobile home, state size of home and number of rooms. 6
House Dimensions
Bed Rooms Bath Rooms �z Den w/Closet j.
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes 3 urinals garbage disposal Q
lavatory 3 showers washing machine l
dishwasher sinks �-
8. a) Type water supply: PublicPrivate Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 3, a7 4Gfs .5
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? &O
What type?
This is to certify that the information is correct to the best of my knowledge.
A/
Date Owner Signature loor
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: j"HkC-- to Td rojeK 4Ap4-,s4-(2 kLkv�� I-LA?-iv 0lk4- cv`
G I,J*-- - G r-CN'f �1�u.�cG� /Z�Jc�o dL-f 0 ro X
O r J e )p+ W %N U.IIXv+_e 5T 14 K4;' �Yi, PC ojo-er-(•� �.
py'ap.er4,(
,�.�� cc 1 —v7 A
4' ,eL�F}R �roV� C�nuwc(1 5
N
114
/76ck5 V..'ll e-
DCHD(6-82)
DAVIE COUNTY HEALTH DEPARTMENT
y Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size -O<f
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S
PS PS PS
U U U
2) Soil Texture (12-36 in.) Sandy, S S
Loamy, Clayey, (note 2:1 Clay) PS PS PS PS
U U
3) Soil Structure (12-36 in.) S S
Clayey Soils P PS PS
U U U U
4) Soil Depth (inches) S S S
PS PS PS
U O
5) Soil Drainage: Internal S S
4P P PS PS
U U U
External S S S S
PS PS PS PS
U U U U
6) Restrictive Horizons
7) Available Space S• S S
PS' PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification _ C/_
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title Date
,SITE DIAGRAM
a -
DCHD(6-82)
. np
E P U C All
Davie Uo-un th Department .,
ftviMoner ealth Section
_; P. B x 84.8i,Imp
" 'x`'
��
ENVIRONPAENTAL NEA ospi al Street ;
a4 ,� DAVIECOUNTY
r 09-40-06 . =�
Mocksville, NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
Name: j+r:'t ) i, Phone Number � ) 7 C� 7 (Home)
Mailing Address: /Z!/j ( + ,` �;-��, rA`� (Work)
� 111-:;•1r r ;�� z'-7 .i��•
Detailed Directions To Site: C) -, g-,j� t
Property Address: (�31 C dc�ej TZJ PLO-/CS'16':lle �� ?-7c•�'
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility:
Date System Installed(Month/Date/Year): Number Of Bedrooms: Number Of People:
Is The Facility Currently Vacant? Yes No If Yes,For How Long?
Any Known Problems? Yes No If Yes,Explain: ;
Please Fill In The Following Information About The NEW Facility: Oki- &4-&-A, z.7. yy,. �„•
Type Of Facility: ou /_31•. 1c1 vim; adJ fT 1c r Number Of Bedrooms:_Number of People C!:.�
Requested By: _ _ /J
yDate Requested: '<; f
(Signature) j
For Environmental Health Office Use Only
`Approve isapproved
Comments:
Environmental Health Specialist Date:1 �/2/��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 heck Money Order # Z&31 Amount:$ AO-A Date: 0
Paid By:&.0,0 Received By:� Q
Account#: Z / Z• Invoice#: 7d D