1508 County Home Rd �avie County, NC , � Tax Parcel Report Monday, October 3, 201 f
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WARNING: THIS IS NOT A SURVEY
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y ,^ ParcelInformation
Parcel Number: J300000050 Township: Mocksville
NCPIN Number: 5728612978 Municipality:
Account Number: 82531963 Census Tract: 37059-801
Listed Owner 1: FULLER CHAD EDWIN� � Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 980 SALISBURY 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: 34.000 AC COUNTY HOME RD Fire Response District: MOCKSVILLE
Assessed Acreage: 31.01 Elementary School Zone: MOCKSVILLE
Deed Date: 5/2010 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 008270099 Soil Types: Mr62,GnB2,GnC2,EnB,GaD,MsD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 545300.00 Outbuilding&Extra 25920.00
Freatures Value:
Land Value: 176570.00 Total Market Value: 747790.00
Total Assessed Value: 599170.00
��t All data is provided as is without warranty or guarantee of any kind either expressed or Implled Including but not limited to the
9�A'�� Davie County Im Iied warrenties of inerchantabili or fitness for a articular use.All users of Davie Coun
� p ty p ty's GIS website shall hold harmless the
7�7 County of Davie,North Carotina,its agents,eonsultants,eontractors or employees from any and all claims or causes of aetion due to
�o�N�� 1\C or arising out of the use or inability to use the GIS data provided by this website.
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� Davie County Health Department
q�i���' � Environmental Health Section ��
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�: � ��: P.O.Box 848
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� , � �,,, �. 210 Hospital Sireet 'I . '
�� �.�, ,���, Courier#: 09-40-06 �g��
� . Mocksville,NC 27028 �
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Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: / �/li ���� PhoneNumber � 30 ��`/ �7�(fiome)
Mailing Address: / � F • ��D� T S � (Work)
r � QI ��C
G� Email Address:
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Detailed Directions To Site:
Properiy Address: � �dG�(�(„J�� � •
Please Fill In The Following Informatio About The EXISTING Facility:_ _ _ _ _ _
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I'�lame System Insta.11ed Under: L/h f/(��� Type Of Facility:
D�te System Installed(Mont.�/Date/Year): � Number Of Bedrooms: � Number Of People:
_�c ThP Farilitv C'i�_�_irrgnti e or How Lon 7
Any Known Problems? Yes � If Yes,Explain:
Please Fill In The Follo ' g Information About The NEW Facility:
_ _ _Type Of Facility: d Number Of Bedrooms• Number of People
Pool Size: � ara e ' _ Other:
Requested By: `� Date Requested: ,7
ignature)
For Environmental Health Office Use Only
Approved isapproved
Comments: �
Environmental Health Specialist Date: �G/� / �
*The signing of this form by the Enviro ental ealth Staff is in no ended,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:$ Date:
Paid By: Received By:
Account#: Invoice#:
v ` � DAVIE COUNTY ENVIRONMENTAL HEALTH �
��� P.O.Box 848/210 Hospital Street �(�� � �'�
Mocksville,NC 27028 `�,
(336)753-6780/Fax#(336)753-1680 ��
OPERATION PERMIT
Accou�t �: 990005515 Tax l�IP�:EH�: 5728-61-2978 � �
Biflcd`f'o: Chad Fuller �ufadivi�iarz ln�c�:
� ftefeE��[�ce f��r��e: Chad Fuller LocaiianiAddress: County Home Road-27028 �
F�ropc�sec! F��;ility; Residence �ra��riy Siz�: 30 Ac
ATC N�a�tber: 5092 .
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. '
System Type: S.T.Manufacture`�j�j6a� Tank Datea � Tank Siz����
' Pump Tank Size
S stem Installed B : . �.� E.H.S ecialist: � Z ZL Za ll .
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DCHD 11/06(Revised)
; -- . . . ... . .. � '�'"NUl�'�' lnis t�utnon�d�iun�u�..uii�uu�<<rLi�,J�v�v�� liL i.�.�vi:L vy lllV LCLYIV vvu�.�� ,..,.,.....,.. . ,
Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A �'
Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO : `
CONSTRUCT IS VALID FOR A PERIOD OF FNE YEARS. This ATC is subject to revocation if site plans,plat 's
or the intended use change. •
Residential Specifications: #Bedrooms�#Bathrooms ��#People Basement❑ Basement plumbing❑ : ;
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` Non-Residential Specifications: Facility Type #People #Seats •
Square Footage(or Dimensions of Facility) � �
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Lot Size �0 4,�. Type of Water Supply: C1�ounty/City OWell ❑Community Well #
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System Specifications:. Design Wastewater Flow(GPD)��� Tank Size_��GAL.Pump Tank GAL. � ' .
' Trench Width�_ Max.Trench Depth� Rock Deptl� .1 Z. Linear Ft. �� GUO�
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� Site Modifications/Conditions/Other: /l(,�/� .7�G�1, (;�DTh. 3�i" z`S�b ►�?��'�+:
Contact the Davie County Environmental Health Section for final inspection of this system between � .
8:30–9:30a.m.on the da of installation. Tele hone# 336 751-8760. �
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Environmental Health Specialist � '�`� Date: z� �
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� DCHD 11/06(Revised)
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