561 Davie Academy Rd Davie County,NC Tax Parcel Report 3 Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: K30000001801 Township: Mocksville
NCPIN Number: 5727050984 Municipality:
Account Number: 10081250 Census Tract: 37059-801
Listed Owner 1: BROADWAY KATHERINE ANN Voting Precinct: SOUTH CALAHALN
Mailing Address 1: 1790 JUNCTION RD 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: 1.475 AC DAVIE ACADEMY RD Fire Response District: CENTER
Assessed Acreage: 1.32 Elementary School Zone: COOLEEMEE
Deed Date: 5/2014 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 009561025 Soil Types: MsC,MsD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 20310.00 Outbuilding 8r Extra 0.00
Freatures Value:
Land Value: 22080.00 Total Market Value: 42390.00
Total Assessed Value: 42390.00
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
C County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NCDU N�; C or arising out of the use or Inability to use the GIS data provided by this website.
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AUTHORIZATION NO: :,
J9-7 DAVIE COUNTY HEALTH DEPARTMENT
�'• ':Environmental Health Section PROPERTY INFORMATION
Permittee s,;,"\ .� %P.O. Box 848
Name: �- [him r�- �'; Mocksville,NC 27028 Subdivision Name:
Phone# 336-751-8760
Directions to property:`" `���,t�,, ;1,�� Y.�T}. Section:" Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
r SYSTEM CONSTRUCTION f
�,�i��`i�'LC�►�C}��j Road Na VI
**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 Build►ng Permits.'
(In compliance with Article:l]'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.
ON t ,L EALTH SPECIALIS DAT ISSUED
,
9 7 ,j ,`DAVIE COUNTY HEALTH DE ��t,T�1V�FT
IMPROVEMENT AND OPERATIO E lit PROPERTY INFORMATION
-I�e�Cmitlge,s
Name: I`h' �`�'-'� �- + �' Subdivision Name:
Directions to property: ' ?` t '- ' Section: Lot:
x� IMPROVEMENT
PERMIT Tax Office PIN:# -
._1 t f' C c < < LL �=I !C'/ Road Name ;'P )t: i X1 ` 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 11 of.GI�S.Chapter 130A,Wastewater Systems,Section. Sewage Treatment and Disposal Systems)
i ' �' i ,•, �, ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR.THE INTENDED USE CHANGE.YOUR WASTEWATER
`^ENVIk—ONMENTALHEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE.
t INSTALLING THE SYSTEM. .
RESIDENTIAL SPECIFICATION:BUILDING TYPE Iv y_ #BEDROOMS_3 #BATHS %L #OCCUPANTS_ GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) 3 NEW SITE REPAIR SITE V11-0/
r JJ
SYSTEM SPECIFICATIONS: TANK SIZE(000 GAL. PUMP TANK GAL. TRENCH WIDTHao ROCK DEPTH' 2 LINEAR FT.Zc-n �
OTHER ��r'�T1CV t 10� L�CJfs f `hJ�`1bLl L.1^+�t.� 1,D•C�. Mlrll+.�.
REQUIRED SITE MODIFICATIONS/CONDITIONS: DO Cb i-WOa 166 -,5'0fr M•14tmti, ka -so e,;ceoax
IMPROVEMENT PERMIT OuT*nWROVED EFFLUENT FILTER* *RISER(S) IF 611 BELOW FINISHED GRADE*
"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 W104MV
(336)751-8760
OPERATION PERMIT
SYSTEM INSTALLED BY:
/00,
Ob
IM. -leo
I:g�3A 2 Co z , .
AUTHORIZATION NO. OPERATION PERMIT B DATE: o
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT STEM DESCRIBED A VE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised). .
=•" •'"" - DAVIE COUNTY HEALTH DEPARTMENT
s,y. 1
` ! '`"i�► Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville,NC 27028
Phone: (336)751-8760
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) REPLACEMENT❑ REMODELING ❑ RECONNECTION`�
Name: l�enc >`c1 �C�C\� Phone N (Home)
Mailing Address: \ n\E� S�c \-(z! K�c xr,\- (WoriF)-
C'C1cx-���\.\\�
Detailed Directions To Site: C�cti s'N \r-A
cW1
Property Address: —x o\ ZA .
Please Fill In The Following Information About The Existing Dwelling.
Name System Installed Under: Of Dwelling:
Date System Installed(Month/Day/Year): & 4 t S Number Of Bed rooms:
... Number Of People: .
Is The Dwelling Currently Vacant? Yes ' No❑ If Yes,For How Long? \ cs c
Any Known Problems?Yes❑ No 7r- If Yes,Explain:
Please Fill In The Following Informatiort-AlAt The New Dwelling:
Type Of Dwelling: C.C�� �L,KNe Number Of Bedrooms: Number Of Peo
Requested By: `�� �4-Q "`� Da quested: - Z
(Signature)
/' For Environmental Health Of�ic e Us y~
Approved ❑ Disappro ed
Comments 1 R ) - _ , ,s-.
\o
Environmental Health S 1�ialis Date.-/ _ 1 n y-
. � `�
*The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a
guarante�e(extendedor limited)tha! , e on-site wastewater system will function properly for any given period of time.
Payment: Cash &&- Roney Order❑ # f �-' Amount: $ �' Q d Date:
Paid Bt-- Received By:�,� �
Account #. v 5 Invoice #:
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