205 Frank Short RdDavie County, NC ' ^ Tax Parcel 00'-'k'1G1&Thursday,September 7g20}6
[A I All data Is provided.. 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
NC or &r[sing out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOTA SURVEY
Parcel Number:
K800000017
Township:
Jerusalem
NCP|NNumbmr
5757345829
Municipality:
Account Number:
82530648
Census Tract:
37059'807
Listed Owner 1:
oYSONANN CARTER
Voting Precinct:
GOUTHMOCKSV|LLE
Mailing Address 1:
2O5FRANK SHORT ROAD
Planning Jurisdiction:
Davie County
City: W1DCKSVLLE
Zoning Class:
D/V4ECOUNTY R+A
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
157ACFRANK SHORT RD(44.58AC)
Fire Response District:
JERUSALEM
Assessed Acreage:
29.36
Elementary School Zone:
CORNATZER
Deed Date:
2/2009
Middle School Zone:
VNLL|AMELL|S
Deed Book /Page:
2009EU066
Soil Typos: MrC2.K8rB2.PoD.PcB2.GnB2.8nC2.ChA.VVATER
p|ut Boob:
10
Flood Zone:
Plat Page:
282
Watershed Overlay:
DAV|ECOUNTY
Building Value:
130240.00
��
Feohu»omOutbuilding --�otma
4610.00
Land Value:
252630.00
Total Market Value:
387480.00
[A I All data Is provided.. 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
NC or &r[sing out of the use or Inability to use the GIS data provided by this website.
**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/A`uthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pen -nits.
(In compliance with Article 11 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.
EN IRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE—# PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
114 3 , 4 L, -e r(� Wc�
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
v- 20A'
SYSTEM SPECIFICATIONS: TANK SIZE --L GGAL. PUMP TANK . GAL. TRENCH WIDTH � ROCK DEPTH 01 LINEAR FT. ` v
REQUIRED SITE MODIFICATIONS/CONDITIONS:
I 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: J
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AUTHORIZATION NO. OPERATION PERMIT B : DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN STALLED 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.
DCHD 02/02 (Revised) 0 O(
Permittee's
DAVIE COUNTY HEALTH DEPARTMENT
Name: 0 I.N. elk %
Environmental Health Section
PROPERTY INFORMATION
P.O. Box 848
Directions to property:
Mocksville, NC 27028
Subdivision Name:
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yt'l/
Phone #: 336-751-8760
Section: Lot:
AUTHORIZATIONOR
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SYSTEM CONSTRUCTION
Tax Office PIN:I -
V thw ^
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AUTHORIZATION NO:
002962 A
RoadTlJ-m t` V `-, 111C!
Zip 761 U
**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/A`uthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Pen -nits.
(In compliance with Article 11 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.
EN IRONMENTAL HEALTH SPECIALIST DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE—# PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
114 3 , 4 L, -e r(� Wc�
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
v- 20A'
SYSTEM SPECIFICATIONS: TANK SIZE --L GGAL. PUMP TANK . GAL. TRENCH WIDTH � ROCK DEPTH 01 LINEAR FT. ` v
REQUIRED SITE MODIFICATIONS/CONDITIONS:
I IMPROVEMENT PERMIT LAYOUT
I- f c-- i-
&,'I—
FOR
,fi
old loptk
604 cp U54
4- To -5 la /( 4 eu.;l l o
4✓p 4„ ,U -e L-..
MIa.
�V_ w
1 JoC,KGG� vUL�
:5- y kc SL -
106 y106
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: J
SIC 4
C/ 0-�8
G
fid.
u
8cac K o` h o,,
AUTHORIZATION NO. OPERATION PERMIT B : DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN STALLED 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.
DCHD 02/02 (Revised) 0 O(
. •-• :.•. J 3, ryf •.. _y .a 'b4 Y...;�A.`et"iR .�. .1•.�. , F 4. .'i. , st.., r .T..,,._t 4 .. .. i"� .. i �.nti
DAVIE COUNTY HEALTH DEP�RT'�1,
ENT
p. ,Pr nnittee's,1 � ; r
1 Maine: t A F Environmental Health Section' ~ PROPERTY INFORMATION
P.O. Box 848
Airections�toproperty: /� ' L Mocksville, NC 27028 Subdivision Name:
Phone #: 336-751-8760
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. 4,1 Section: Lot:
AUTHORIZATION FOR ,
WASTEWATER.
r'f Office PIN: y ��
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SYSTEM CONSTRUCTION Tax _ '
AUTHORIZATION NO V0 Q 2,9 6 2' A Ro d� ialme ` c • i' �lu.r) %} Zip. -i �;1 [0
**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/Eiuthorization 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)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 1
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS ` # OCCUPANTS ' GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
ti 3, e(,( V -,e (( %�
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE V
SYSTEM SPECIFICATIONS: TANK SIZE tY U �GGAL. PUMP TANK -GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. J (/,
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 k t-%— \
SYSTEM INSTALLED BY:
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OPERATION PERMIT B «�� DATE: Q
AUTHORIZATION NO. 6
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"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE S BEEN INSTALLED IN COMPLIANCE
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WITH ARTICLE I 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 02/02 (Revised) 6+
3 F
y .
DAVIE COUNTY HEALTH DEERTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
it 2��g Phone: (336)751-8760
,SITE ASTEWAT'ER CERTIFICATION R DWELLING
tie AGEMENT ❑ REMODELING RECONNECTION ❑
ZONA- J;
NGG U Phone Number: oNea
(Home)
Mailing Address: Kf&l Lit V11P_ (Work)
Property Address:__ 1A25;_ &,661 .7 /20iZI �( .
Please Fill In The Following Informatt�ion About ��T//h,�,e Existing Dwelling.
Name System Installed Under: L." Z�L'12 WON C" I�� Type Of Dwelling: �lS�
Date System Installed(Month/Day/Year): Number Of Bedrooms: Number Of People:
Is The Dwelling Currently Vacant? Yes 0 No B", If Yes, For How Long?
Any Known Problems? Yes 0 Nom' If Yes, Explain:
Please Fill In The Following Information About The New Dwelling:
41611aa1',1;01j .<ee P/.gNS
Type Of Dwelling: ,,a _ _. Number Of Bedrooms: Number Of People:
'Qeq
uested By;
For Environmental Health Office Use Only
Requested: (9 - 5- Q p
Avvroved 2__1%avvroved ❑ 1A J`,�/ '_-
Environmental Health
"The signing of this form by the Environmental Health Staff is in no way intended, 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: $ 00 Date:
Paid By: Received By: /,,
Account #: ' Oa.S7 Invoice #: l9' �!
Mailing
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
ASTEWATER CERTIFICATION R DWELLING
CEMENT ❑ REMODELIN RECONNECTION ❑
/ - Phone Number:(Home)
,,//
iV2- ��f' I (Work)
Property Address: 'ZQ4'y'_ Ff AAIk 5710tZl Rd.
Please Fill In The Following Information About The Existing Dwelling:
Name System Installed Under: ` (ij Zj[&7Z jkN r P/lIe6:FType Of Dwelling: us�i"
Date System Installed(Month/Day/Year): Number Of Bedrooms: Number Of People:_
Is The Dwelling Currently Vacant? Yes ❑ No Er"' If Yes, For How Long?
Any Known Problems? Yes ❑ Nom' If Yes,
Please Fill In The Following Information About The New Dwelling:
,� See PI,1,41S
Type Of Dwelling: -,a _ ,. Number Of Bedrooms: -fT Number Of People:
(Requested By:
For Environmental Health Office Use Only
Requested: 01/1?
AvvrovedL k
isannroved ❑ ,,, � e,,, � -r
Environmental Health
I
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a
auarantee(extended or limited),that the on-site wastewater system will function properly for anv given period of time.
Payment: Cash ❑
Paid By:
Account #:
)1
Order ❑ #.
By:,
#: b
00