Loading...
142 Cotton Ln HEALTH DEPARTMENT RELEASE For Office Use oniy r *CDP File Number 161575- 1 Davie County Health Department C3-000-00-110-05 210 Hospital Street County ID Number. P.O. Box 848 " Evaluated For. HDR/WWC 'a Mocksville NC 27028 Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID 1 0 / a 9 1 a 0 1 9 UNTIL' Applicant: Linda Sidden Property owner: Linda Sidden Address: 144 Cotton Lane Address: 144 Cotton Lane City: Mocksville City: Mocksville State2ip: NC 27028 State0p: NC 27028 Phone M (336)492-7273 Phone#: (336)492-7273 Property Location& site Information Address 142 Cotton Lane Subdivision: Phase: Lot: Road;9 Mocksville NC 27028 SINGLE FAMILY Township: 'Structure: Directions #of Bedrooms: 2 #of People: Hwy 601 N.Left on Jack Booe Rd,right on Cotton Lane 'Water Supply: N/A Type of Business: Basement: R Yes�No Total sq.Footage: No.Of Employees: 'Proposed Improvement: MH replacement 'Release Conditions w; MAintain 5 foot set back to any portion of the septic system 6 This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps.Signature, *Date: *Issued By, 2140-Nations,Robert *Date of Issue:_ 1 0 2 9 2 0 1 4 Authorized State Agent: 4693n -4,e2) **Site Plan/Drawing attached.** O Hand Drawing OlmportDrawing Davie County Health Department � 18�j ` Environmental Health Section P.O. Box 848 4 210 Hospital Street D ` Courier# : 09-40-06 _. Mocksville, NC 27028 r Phone:(336)-753-6780 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: L Phone Number V v 7 Z 73 (Home) Mailing Address:-144 - nn (Work) (, V WOO Email Address: Detailed Dections To Site: , `--e 6tJ .:J 1 8 r i h aN44iD t 1 [A Ne, Property Address: �. N14onA r, P.9 Please Fill In The Following Information About The EXISTING Facility: 02 6�� Name System Installed Under: AS Q©(. Roe Type Of Facility: Swmr1 Date System Installed(Month/Date/Year): 7 Number Of Bedrooms: c;�_Number Of People: Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes f Yes,Explain: Please Fill In The Following Information About�T"he NEW Facility: Type Of Facility: :S UJ 0 1 �l V1 Q Number Of Bedrooms: C=� Number of People Pool Size: Garage Size: Other: Requested By: .Date Requested: Signature) For Environmental Health Office Use Only Approved Disapproved / L_ ents: �J ✓) J -Q &G lC `7`(Ja Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in noway intended,nor should betaken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payme t. Cash' heck Money Order Amount:$ ' z ,Q� Date: Paid By: Received By: l,,(m Account#: Invoice#: J � I 4 I t yr„x 47 ,� rr QQ it} err f^} 5 r' 1 � 1 l` 4 COY J t CO 1 J tr r ; 41 Li -----------------\ 42 3097 11 _ I 1 I I 5! C 1 157 146 a tiz 246 � I 474.6 -3723 1 1 5 I V s Printed:Oct 28, 2014 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 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. • a OBD (Q�pQ, Mail Tot l•!/V �A /.S~— Cr/ j'1/v0 (/ /v-1 YI-C '2'.70 WARRANTY DIED-Form WD-601 Printed and for rale by James Williams h Co.,Inc.,Yadkidville,N.C. STATE OF NORTH CAROLINA, Davie County. THIS DEED,Madethis Sh dayof nt,g,•mr ,19-9.L,by and between Isaac E. Riffe and vifr., Sarah Frances Riffe of Davie •County and state of North Carolina,hereinafter called Grantor,and Gary Clinton Sidden and vife, ).inch C. Siddon of Davie County and State of North Carolina,hereinafter called Grantee,whose permanent mailing address is WITNESSETNt That the Grantor,for and In consideration of the sum of Sen dnllara and AVC--------------------- Dollar and other good and valuable considerations to him in hand Raid by the Contest,the receipt whereof is herby acknowledgged•has given,granted,bargained,sold aid conveyed,and by these presents don give,great,bargain,sell•convey and confirm unto the Grantee,his helm and/or successor and assigns,promises is Clarksville Townshl navie County,North Carolina,described asfollows: •REGMIMIG at on existing, Iron strike on the Cant mntp,in of n 60 ft. street whLch extends in a Northerly direction from NCSR 11330, said begimdnR point being the North- vest corner of Lot No. 7 of All uarrcordrtl pint of Robinhood Ar..rra I'Int "A" and hrluE Ibn Southwest corner of the within described trnct) thence running with the Enet margin of sold 60 ft. street the following two cournen And dlntnncent (1) llottli 09 dege. 75 ming. East 212.77 feet) and (1) Itorth 22 doge: 35 mina. East 227.25 feet to un-Iran stake, said pointbeing n new corner for Clens, Foster and being the Northvest corner of the within described It thence running with a new Line for Clenn Footer North 80 dege. 41 mine. East 200.46 feet to on iron etnke int the Ilob@on line, said point being the Northeast corner of the within described tract) thence running with the Ilobson line and then a new litre (or Cleats Foster South 03 degn. 34 mitts. Heat 435.00 feet to an Iron stake, esld'polnt being n new corner.for Clean Footer, the Nortlieast corner for Tract No. 6 of- • . Robinhood Acren, Pint "A", and the Sautheant corner of the within described tract, thence. running with tlse North line of Lots No. 0 and 7 of Robinhood Acres the following two course@ and distnncent (1) South.00 dere. JO mitts. tient 144.69 feetl and (2) Soutit 64 dege. 22 mine. West 151.26 feet to the point And place of beginning, contnining 2.55 : acrtls, more or lees, as ahown by a survey prorated by T. Roy Sheek, L-1501. Also•convayed hereto is A perpetual, nonexclunive Riglit-of-Nay Easement, fdr the purpose of ingress, egress and regress oveir that 60 ft, street leading from NCSR 11330 -to the property descrlb•d nbove. .Said 60 ft. street•bs1ng located between the property of Rill Austin (lot 15 6 16 of Robinhood Aerate Plat "A"-unteaotded) and Lot 17 of said Robiaitood Acres owned by tits Grantors herein. Prepared by Fade H. Leonard, Jr. DEED TRANSFER CHECKM s si QA?t: �••les-�r� "y� t.l._✓�� O TAX UUr1v3Y:a.;a The above hail was conveyed to Grantor by .Su IQeT: .page TO HAVE AND TO HOLD The above described premises,with an the appurtenances thereunto belonging;or In any who appettaliing,mile the Cnntee,his'. heirs and/or successors and assigns forever. And the Grantor covenants that he is seized of said premises in fee,and has the right to convey the same In fee simple;that said promises us free from cumbraaces(with the exceptions above stated,U any);and that he will warrant and defend the said title to the same■gabut the lawful chime of an persons whomsoever. When reference is made to the Grantor or Grantee,the singular shall include the plural and the masculine shall include the feminine or the neuter. 1N WITNESS WHEREO_, a raator hu hereunto art his band and seal,the day and yam first above written. (SEAL) - (SEAL) ' (SEAL) STATE OF NORTH CAROLINA (Ile COUNTY. '•n 7)7: !t!:,.,�a 1, �e�dS' rata O/t/Ge Y ,a Notary public of saki County,do hereby cattily tfid ,&Asr 1_2 .fA011.4.4yeos Grantor. ' " F Pa+o�l appeared.before ma this day and acknowled a the execution of the foregoing deed. ��.'•t.'/�C.`.�•• Witness my hand and notarial nd.tl.Is die day My commission Expires: -2 LO-96 dit'1in�aw.'•' STATE OF NORTH CAROLINA COUNTY, I, ,a Notary Public of oak County,do hereby certify that Grantor,personally appeared before me this day and acknowledged the execution of the foregoing deed. Witness my hand and notarial seal,this the day of- My f My Commission Explest SPATE OF NORTH CAROLINA, My i n COUNTY. , no foregoing certfUeate(s)fof Ri r ke_V R Rai le_V T]nt:iz:V A,t},l i r• n.f Dauin jomm1 s Is*jcertitlad to be correct.This Instrument was presented for registration this. 9 day of se 1011r, A.M.,10(X,and duly recorded In the orrice of the Register of Deeds of Dari P County, Nortk Caroli.,b Hook 160 page 35Q This the _day of Al=l " .A.D..19 21. tlp 1 L � / . Shore • _ _ By a, (_1 Register of Deeds Assistant, Register of Deeds Til Deed drawn by 4