249 Deadmon Rd nn�
Davie County,NC Tax Parcel Report (�o�g a1 I� Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: K510OA0003 Township: Mocksville
NCPIN Number: 5747227431 Municipality:
Account Number: 82516740 Census Tract: 37059-805
Listed Owner 1: GRANT JAMES H Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 249 DEADMON 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: LOT 3 SOUTHWOOD ACRES Fire Response District: JERUSALEM
Assessed Acreage: 0.44 Elementary School Zone: CORNATZER
Deed Date: 5/2001 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 003680790 Soil Types: Gn132
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 84260.00 Outbuilding&Extra 1970.00
Freatures Value:
Land Value: 19000.00 Total Market Value: 105230.00
Total Assessed Value: 105230.00
l 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
NCor arising out of the use or Inability to use the GIS data provided by this website.
�Permitiee's DAVIE COUNTY HEALTH DEPARTMENT
Name: � nj I t}r;)10T Environmental Health Section PROPERTY INFORMATION7(1
P.O.Box 848 �\
Directions to property: O I• to�? �w Mocksville,NC 27028 Subdivision Name: W
Phone#:336-751-8760
Section: Lot:
p AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# -
SYSTEM CONSTRUCTION -
AUTHORIZATION NO: 002827 A Road Name Z d- .270-d
**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
�•1 t.�, l� 0 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS�_#BATHS 2�— #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE Y 7'TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) 3f-0 NEW SITE REPAIR SITE Lf—
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK// GAL. TRENCH WIDTH �o ROCK DEPTHDy
_ LINEAR FT4
OTHER ,2(fed �/ilt.s,2Jrr
REQUIRED SITE MODIFICATIONS/CONDPI'IONS:
IMPROVEMENT PERMIT LAYOUT
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT
s SYSTEM INSTALLED BY:Pl
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AUTHORIZATION NO. 2927--k—OPERATION PERMIT BY: DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE T AT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 1 I 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 awe(Revised) AAv ' _ JI. U• - &�K
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``rml DAVIE COUNTY HEALTH DEPART EN
Pemuttee s 0,1
• Name: r2 ; , l r r r.l 1 Environmental Health Sect h1 PROPERTY INFORMATION
_ P.O. Box 848 \
DirectjeRs to.property; U�.J 1• (n l !it: ;� �� Mocksville,NC 27028 Subdivision Name:
Phone#: 336-751-8760
Section: Lot:
r AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
---r— SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002827 A Road Name: 70?,t
**NOTE**This Authorization for W4stewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuancee^'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)
-Alt ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
-i,�'. �� .�'��� IS VALID FOR A PERIOD_OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
FMIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS_3—#BATHS #OCCUPANTS =1_GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE • y tI *TYPE WATER SUPPLY 0 . DESIGN WASTEWATER FLOW(GPD) 3 0 NEW SITE REPAIR SITE I--
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK I GAL. TRENCH WIDTH ROCK DEPTH&1,4 LIL+7EAR FTZ4L2?_
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT /
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FOR FINAL INSPECTION 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: P!{n.y,1J�}'1��1�^-
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AUTHORIZATION NO. OPERATION PERMTr BY: CIA&I DATE: -o
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE T AT 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 NOWAY BETAKEN ASA'
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD WM(Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)_
NAME
J_&Aw- G2Asr PHONE NUMBER
ADDRESS L � � � SUBDIVISION NAME `S ?
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED " NAME SYSTEM INSTALLED UNDER [� �C
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED�,��
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
ue
DATE REQUESTED ' INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that 1 understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date --aD
Jwner/Occupant To:
Address Address
Building Contractor li__./( Address
Cal. 90 Manufacturer's ame /.cam P S e7/ <&' Address
No. of lines > Width n. Total length r-7,3 o ft. No. sq. ft.
Type of filter material Total tons used C2 —
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800- 600
Three-bedroom house, 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installa accord to cificatior
Signed:
U_94fid Ud4Z1A'
Sept'c Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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