128 Falcon Lni
Davie County, NC Tax Parcel Report I I 11 O Wednesday, September 28, 2016
A
141
Davie County, NC
WARNING: THIS IS NOT A SURVEY
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
--parcel Information
Parcel Number:
H700000050 A
Township:
Shady Grove
NCPIN Number:
5769476105
Municipality:
Account Number:
8305106
Census Tract:
37059-804
Listed Owner 1:
SMOTHERS DEBORAH NANCE
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
128 FALCON LANE
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-A,R-20
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
30.63 AC CORNATZER RD
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
30.08
Elementary School Zone:
CORNATZER
Deed Date:
2/2009
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
2009E0213
Soil Types:
PcB2,GnB2,RnC,GnC2,PcC2,EnB,MsC,ChA
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
-
Building Value:
65700.00
Outbuilding S Extra
0.00
Freatures Value:
Land Value:
188580.00
Total Market Value:
254280.00
Total Assessed Value:
101160.00
141
Davie County, NC
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.
AUTHORi.ZATION NO: 1` CU DAVIE COUNTY HEALTH
� '/� ° � DEPARTMENT S ✓ko
i Environmental Health Section PROPERTY INFORMATION
Permittee Is P.O. Box 848
Name: :!:i % �«-L ' , { Mocksville, NC 27028 Subdivision Name:
Ii'�- 7!� :!%ATr phone # 336-751-8760
Directions to property:
Section: Lot:
#— O 1.�1�
AUTHORIZATIONEWA ER OR L� // Lt U0
1 �` �' Tax Off�ic ,PIN:#�l - G
SYSTEM CONSTRUCTION ILa —
`o , f
Road Name: �R1✓eo1� Lr' Zip: 7rCZ
**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 Articlej�l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
1 IS VALID FOR A PERIOD OF FIVE YEARS.
II?�HEALT SPECTAI IST DATt ISSUE
DAVIE OUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
t
Permittee's
Name: -~ t` .'� f!, .�'� Subdivision Name:
Directions to property % < "T If r /��1� r Section: Lot:
i
IMPROVEMENT l f
PERMIT Tax Office PIN:#—,i&
Road Name: a 1-or,11I��s' Zip t
**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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
j,
`'may j ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
+yam PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRON NTAL HEALTH SPECIALIST DAtE ISSU D SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
r INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE AazT# BEDROOMS —,,� # BATHS # OCCUPANTS _ 7 GARBAGE DISPOSAL: Yes oQ!!.�
COMMERCIAL SPECIFICATION: FACILITY TYPE 1� ESIGN WASTEWATER FLOW (GPD) # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE A- C -44E WATER SUPPLY t� b NEW SITE
f
REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE I ()CO GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.y�-
OTHER \1
REQUIRED SITE MODIFICATIONS/CONDITIONS:.lt3��fNL%- o,� cori-lo J2
IMPROVEMENT PERMIT LA
X
**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 (336)751-8760.
OPERATION PERMIT Y
SYSTEM INSTALLED BY:
rtA...IK
AUTHORIZATION NO. I �Z� OPERATION PERMIT B DATE: Z
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE AT HE SYSTEM DESCRIBESABOVE HAS BEEN INSTALLED IN CO PLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAG 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 05/96 (Revised)
,
DAVIE COUNTY HEALTH DEPARTMENT
- = =
IMPROVEMENT AND OPERATION PERMITS
Permittee's
Name:
Directions to property:
i
PROPERTY INFORMATION
Subdivision Name:
Section: Lot:
IMPROVEMENT
PERMIT Tax Office PIN:#
Road Name: E�.� ;^t�-f'' 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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
t1NUliuh...itmjrb'KLNui:n.JUlSJhL;i IU1U.VUUAIWIN IrMI
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL' HEALTH SPECIALIST DA'L'E ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE G It >+# BEDROOMS _ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes o(No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ` � / \ PE WATER SUPPLY ` _,0L)
L) 1�1 Y DESIGN WASTEWATER FLOW (GPD) . U NEW SITE t REPAIR SITE
_ ,0 11 — 1
SYSTEM SPECIFICATIONS: TANK SIZE) ��Cy GAL. PUMP TANK GAL. TRENCH WIDTH -�i� ROCK DEPTH LINEAR FT. -(-'I' '
OTHER s1�`` 1 i� t) 1 1 t Z.
REQUIRED SITE MODIFICATIONS/CONDITIONS:
"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 (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: 1
rtA� k �A� ar 11 Z Z
��I Q
� ljl
FST
1
AUTHORIZATION NO. OPERATION PERMIT BcDk7550, DATE:
i
»sem ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIB ABOVE HAS BEEN INSTALLEJ IN C MPLIANCE
WITH ARTICLE I 1 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 05/96 (Revised)
• a
9
r APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & A
Davie County Health Department
Environmental Health Section
R O. Box 848
Mocksville, NC 27028 0 1900
x /
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED I""
ALL THE REQUIRED INFORMATION IS PROVIDED. "�j�JT�I
j/,lr.�llc.
1. Name to be Billed
Mailing Address
City/State/Zip M `U�' g-cwI r__ . /l)G 2?b7-9
2. Name on Permit/ATC if Different than Above
Mailing Address _
3. Application For:
4. System to Serve:
5. If Residence:
CYDishwasher
6. If Business/Other:
# Commodes _
If Foodservice:
❑ Site Evaluation
Y"House ❑ Mobile Home
# People 3
❑ Garbage Disposal
Specify type _
# Showers
7. Type of water supply:
Contact Person
Fli
Home Phone 9`''//J " 163 t
Business Phone / ` O V r7 Cf
City/State/Zip
ar I rovement Permit & ATC 56d oth
❑ Business ❑ Industry ❑ Other
,./
# Bedrooms 3 # Bathrooms 2•S
WI`W--ashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
# Seats
0 County/City
# People # Sinks
# Urinals
Estimated Water Usage (gallons per day)
❑ Well
# Water Coolers
8. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Community
❑ Yes ❑ No
L 1 1 tit L( A YLA 1 UK .511 L t'LAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A P,)WTHE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions:
1.3q� Ac-(1xS
1 WRITE DIRECTIONS (from
1 Mocksville) TO PROPERTY:
Tax Office PIN: # �27rnc1 - 4% 4 3 1
1 SPT C 11a (_e/a
Property Address: Road Name
D - 4G4 --r r
City/Zipplou
It -u%
1 �Lc.c�J
If in Subdivision provide information, as follows: 1
1
Name: 1
1
Section: Lot #: 1
1
1
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter
are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is
falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to
the Authorized Representative-- of the Davie County Health Department to enter upon above described property located in Davie County
and owned by —i-- —?> q' - 1kgxm•- to conduct all testing procedures
as necessary
//todetermine the site suitability.
DATE CY �Q/ SIGNATURE
Revised DCHD (06-96)
YOU X,Ay USE THE BACK OF THIS FORM FOR DRAWING YOUR SITE PLAN.
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Scale: 1'= •' • • • • • • • • November 03,1998 2:44 PM