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153 Elrica Ln (2)Davie County, NC Tax Parcel Report Friday, October 7, 201 E City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC WARNING: THIS IS NOT A SURVEY 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 27028-4959 Parcel Information No 9.193 AC OFF WAGNER ROAD(4.72 AC) TR 4 Parcel Number: F30000000514 Township: Clarksville NCPIN Number: 5811809905 Municipality: NORTH DAVIE Account Number: 82530186 Census Tract: 37059-801 Listed Owner 1: WILLIAMS GARY R Voting Precinct: CLARKSVILLE Mailing Address 1: 896 WAGNER ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC Zoning Overlay: 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 27028-4959 Voluntary Ag. District: No 9.193 AC OFF WAGNER ROAD(4.72 AC) TR 4 Fire Response District: WILLIAM R. DAVIE 4.72 Elementary School Zone: WILLIAM R DAVIE 10/2008 Middle School Zone: NORTH DAVIE 007721038 Soil Types: MnC2,MnB2,MdD 10 Flood Zone: 144 Watershed Overlay: DAVIE COUNTY 308720.00 Outbuilding & Extra 6160.00 Freatures Value: 47940.00 Total Market Value: 362820.00 362820.00 9!I� Davie County, 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 �OUp S� NC 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. APPLICATION FOR PRIVATE WELL PERMIT Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. M APPLICANT INFORMATION Name Daa wt.; f- Contact Person Address Po 66y W35-49 5-49 Home Phone ZO �f - fp ZZ- v fxvS City/State/ZIP avid , MC- Business Phone 7o Lt -C�, ZZ - oo(p S Name on Permit if Different thani Above 1F Mailing Address !gq& Wa-!jUr 2G'o.�, City/State/Zip `' C Z d Z PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat (to scale) Owner's Name Phone Number !W0 - 3 3(0 ql a Z Owner's Address - r Za City/State/Zip fo o ckSu c'1'w . nl C o2 76,;L A Property Address City 1'Vl4,c.ks v"I to Lot Size 4,*15- Acce-s Tax P #_ r3oo0o©O5l q Subdivision Name(if applicable) Section/Lot# Directions To Site: (enl Af te-n4 /_ on1 131A-f-JeW,--LIX�' !l e5 AI 1w1Ac..Ah=-,0 IP 6 v G/ 01r 1 P,0,P"-rV , DEVELOPMENT INFORMATION Permit Type: New Well Well Repair Well Abandonment Other (specify) Facility Type: Residential Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO t/ Do You Intend To Install A New Septic System On This Site? YES v-'— NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. 1AAiJdJ,-, -:2,/.T /l 3 Si# 6d Un Date Site Revisit Charge Date(s): Client Notification Date: EHS: Account # Invoice # n 6, 7/30/09 � � � �e 14 v Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990005888 Tax PIN/EH #: F3000000514 Billed To: Gary Williams Subdivision Info: Address: 896 Wagner Road Location/Address: Elrica Lane -27028 City: Mocksivlle Property Size: 4.715 Acres Reference Name: Proposed Facility: Residence **NOTE* *This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: % New ❑Repair ❑Expansion Permit Valid for: * Years 0 N Expiration Residential Specifications: # Bedrooms �'� # Bathrooms # People '2 Basement❑ Basement plumbingZ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):Type of Water Supply: ❑County/City pWell ❑CommunityWell Site Modifications/Pertnit Conditions: System Type LTAR Initial Repair -p n Site Plan Environmental Health Specialist i.p. 11-06 r Date ` Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 `�\l (336)753-6780 / Fax (336)753-1680 WELL PERMIT Account #: 990005888 Tax F'INIEN #: F3000000514 -Well Billed To: Gary Williams Subdivision Into: Reference Name: Location/Address: Elrica Lane -27028 Proposed Facility: Residential Well Property Size:— 4.715 Acres ATC Number: 0108 Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any fact/circumstances upon which this permit was issued. Permit Type: New ® Repair ❑ Abandonment ❑ Proposed Well Comments: irc n0 W.P. 7-08 Date: Certificate of Completion Diagram t V, Driller: Certification ##: Grout Inspected: Well Head Inspected: GPS Coordinates: EHS: Date: AW/2012 07:00 4 4109223381 GRW1 APPLICATION FOR PRIVATE WELL PERMIT Davie Cennty Environmental Health P.O. Box 848/210 Hospital Street Nocksvill% NC 27028 CM0753=6789 / Fu (336) 753-1680 PAGE 02/02 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED IMRMATION IS PROVIDED. APPLICANT INFORMATION Name to be Billed irar W t 1lks m f Contact Person G" nd W r I l t -$m1' Billing Address W a4ft a ItedOL Horne Phone 33 6-123 H 294 City/State/Z[P M s-11 W" 2."1016 Business Phone -- - Y tQ - 334- 41 01, Name on Permit if D rerent than Abo a W111LOW Mailing Address _J3 6 Uvara MC $,tea City/State/Zip Mp u fi PROPERTY INFORMATION *Date House/Facility Cornets Flagged .P0109 NUM: A survey p or sip n mint accompany this application. nc : ijbittplan 1 i at (to saa e Owner's Name W r 1162 VA Phone Number , 336-193-q240 Owner's Address City/StEL _te2iRp Property A lRlr'Ll s LC my city, 1110e KS ✓i Lot Size ly ,/� Tax PIN# 3 D o 0 0 0 SI ' Subdivision Namc(if applicable) SectionUt# Directions To Site: DEVELOPMENT INFORMATION rmtt : ewe e arc a onment cr spect Facility Type: Residential �Ne Food Service Church Commercial _ Other Are There Any Septic Systems &m- ntly On The Site? YES NO _ Do You Intend To Install A New Septic System On This Site? YES _,K_ NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the ptvpeM that includes the existing and p oposed property lines with dimensions, the specific location of the facility and any existing or furore appurtenances, the location of any existing septic system, sewer lines. Water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property tines and comm. The applicant is responsible for making the site accessible. By signing this application, the applicant signifies that they understand the terms and conditions and that they give Permission for Davie County Envirunmemml Health repn:sentatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. 7!30/09 '+ i,� X012 Date " site "Mi arge Dstc(s): Client Notification Dade: EHS: Account # Invoice p 9/qZ COMMMM_ 6MCOJW REG5IVE �h .11>sealu.Y: 'ibis feels cm be usa for siols wasopis we& 1.WoellCmhaeforinfarmadion: 7 9 Inn w i1 1 1 r A I T I 1 (;farm W emsloolmsaa fficio t) om 3s° S$17-8 N wedicoolumc);eem EAL—T! 'I NCwencoe�carce:eifwtimNnmbv ,,rr�� AQ1h4 'De) u., G O IL �. & is'oiar�cAsn ids otrz Nam To n1A nga au -MIUM4 . b S $ 6- 2 ' '°� 57D t2'G1 ComQa�Nemtc 2. Won Cmostreee�on Permit : Lista)Lapplhab4>�Iaa�crac�rP�i�C°aR�f'�i a Weal use (cbe ckvraltt:ck Ili�Illi[iliitCA31I�iGaRTOBDVG 1?Re16t ?O DiAMEfJ2t I IIrA11atlAr SUBMMALM51 MONS -lzacesBly - WaterSbp*WCM DAgtiWltmal OM>miapaUPabliC 13Gcodwmal@ke tglCooU%Snppiy) wawSupply(single) . oRe�denaatwawst�piy(sbared) okfl 'en FROM TO VUPAETM SEMSEM tL I R. Ao. u` R is, IL. :.. A FRJM Tonrw�rrnmt. emsr�oa �►>rcornrr o �- t.l Won Wear Sappy WcW OMaaitnrielg DReoovay Q Ise, Yield Zo � ) 24or Fnr water Scapi. & Inie cdao Welts: ut addition to sMft the form to Inje ctim wem OAquifwRedWw ClGroun6vaWR on OAqulfcr& rageattdRecovcry osai ayB� DAe uftTcat Mwo%-AwDrohoge OlhcpexitneamiTc OSobsidrnceCarma! OGeothamd (Closed JMp) OTratnrf DGeothermat Rama OOdxr ' ttadwI21 Rte R R 19:SAMIGRAVMPACK tteoas TO I1fAli=u►L > KJM irII�D tt � tz .-2o:I:OG aa�ehttr FAM TO n> rrar trrr wB/i�dc d� a R 4. Date WA(s) •,1� %3" %3 we U M A u Name FseiTW MD(efapptlable) Ft- tz) e -,a A! qo q f �well1AM260a:fL a.FacWW !L ea: 'Aetdees%CtW.andTp cesmcy lhaeelideaoSeOallo tt'7W) IlalilllAxSS, .. sh. X&f[tnde seal Lealgitade i. leg IP, I ateshecondsordechaoldcffecs; (;farm W emsloolmsaa fficio t) om 3s° S$17-8 N ca. Dace 6. h (an) the WCI*):Xft maamt _ or OTemPorary I ha may c— that At w,dU(sJ em (.rn,) aolmrnrted m aeaoA*X= Wuh ISA C .0100 or ISA NCAC VW.WW Nell Caassruim Srssdards and rhst a 7. Is this a repair to an to Legwedr Oyes or to c�e�tmts liosibcea prootdad m tbsmUolneer. Jutedsbarepair�Marrsel.wveilcomtruc&6y(waldimandd3piaatietrmsaofdx repairaaderf21 renwirscom area AcbadcojA&fb m 2& she diagram or ad�tiam$wdidetslls L Namlxrofwdb You may = the back of this pages to provide additiwd vredl sine detat7s or Veil coastruaian details. Yetn may also amerlr addaia d pages ifneoeMy. For m*AsDalinoramwowsf po,wWbONLY"hdwsaseeasra}ae ynaaon ssbmttassfona. SUBMMALM51 MONS 9. Total wen deitb blow land sw1a= I tte:) 24a. For AD Submit this farm within 30 days of complexion of well Farm►doplewdfslluoff depdasU (esompk-3@M'md2WM montoftfoilowbw 1O. Static water level is dow top of ea I g: 4y UP Division ofwater Qao ty, Iaformatim ProcessTog Unci; ljwxwkvdisaborecaxftxso-+- 1617 Mail Service CaMw.RddgkMCXMP 1617 11. Bin Acle dna: b - Z$ (in.) ?Ab. ZK lAkfi fi 1 Wens: In addition to sending the form to lite address in 24a A above, also Pubmit ag this Sorin 30 days of wmpietian of well 12. Well conste ae" mom: ? tG�`iyRtL to thofollo (L& aaser,WOW. eabir aieextyasL, CO MvWoa of Watw Qom, Uelergrowd h&cd m C.on&d Program, FM WATM3UM%Y WEL" ONLY: 1636 Man Serrice Ceaw, RAcq6,NC27QM-1636 Ise, Yield Zo � ) 24or Fnr water Scapi. & Inie cdao Welts: ut addition to sMft the form to (gpm) Medbod of test: the addmu(es) above, also submit am copy of this form within 30 days of 13h. DisiniectlOa tip« 21 70 6 Amount: g DZ ewmpktim of wcn eenstrnaim to the county health dcpartment of the cmay where tons rucicot Fu®OW-1 Nod,CwoU-Dn-ammteFAvma eatsndNamdResomm—vmomof owgmGty Revised Jm 2013