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119 Gordon DrDavie County, NC r Tax Parcel Report I MN Thursday, September 29, 2016 WAK1 nib: '11H1, 1S 1V01' 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 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. Parcel hifbnhation . Parcel Number: D700000011 Township: Farmington NCPIN Number: 5862342647 Municipality: Account Number: 82520691 Census Tract: 37059-802 Listed Owner 1: JEFFRIES JEAN Voting Precinct: SMITH GROVE Mailing Address 1: 119 GORDON DRIVE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006-6615 Voluntary Ag. District: No Legal Description: 1 LOT GORDON DR Fire Response District: SMITH GROVE Assessed Acreage: 0.39 Elementary School Zone: PINEBROOK Deed Date: 4/2003 Middle School Zone: NORTH DAVIE Deed Book / Page: 004740772 Soil Types: Gn62 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 106130.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 30000.00 Total Market Value: 136130.00 Total Assessed Value: 136130.00 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 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. -t++..F „,., Yy..*.. i ro �• v. t-_...'�,ts•!;s-. ;.Y.::��.:.._; ��,� ..r.�n ,. ..--c>y-r a�,_..�f -'x e';:c .. "`4�,.Y"'yrii+fi.r+tv'lwA�•"r,.v�tt.:•' `Af-:i.;'T�`""''`r=a^'� AUa HCS tLA'TION NO • � S 73o DAVIE COUNTYREALTH'DEPARTMENT. �- Environmental Health Section PROPERTY INFORMATION Permittees '� i P.O.Box 848 Name: •: ` ' y�% ` Mocksville;NC 27028 Subdivision Name: Phone,# 336-751=8760 Directions to property: 1 �-' Section: Lot: AUTHORIZATION FOR : LN--3 - y ,� WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION c-Ij 11)cGE=� �r C� � 1. � Road Name: r-N !.. Zip: **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. 130A,Wastewater Wastewater S stems,Section.1900 Sewage Treatment and Disposal Systems) (in comphapce vyith-Article 1 of G.S.Chapter y ►Z� ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION AHFALT1UPECIA IS VALID FOR A PERIOD OF FIVE YEARS..ENVIRONM NTA` DATE 1 SUED x, ", Y�;���J T.rV.y�a y,� Jr '"`s"Y5k � j'.I,.0 .;' ':� z -F'! •.:v.�-.c 'a :�. _ y M _ T:`,�.fi�. .. ..�,i- F�.Y M_ ,... 1. ;.. '-_,'*. •,. jN;Y `"-F'v Tr DAVIE COUNTY HEALTH DEP4 T 11T IMPROVEMENT AND OPERATION PRMT�S PROPERTY INFORMATION •Name:' ,a k. ani-1�`�;-�+' Subdivision Name: Directions-ta�property:', Section: Lot: IMPROVEMENT PIT ' Tax Office PIN:# J Road Name: tr°. r i Zip: {:. a G, **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system'or any wastewater system. An t 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 Articl�11I of G.S. Chapter. 130A, Wastewater Systems, Section .19W Sewage Treatment and Disposal Systems) ,�w•-- wl 1 •!.,: ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE i t • , f! +� i G I PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER EN�VIRONMEN1Al. HEALT I SPECIALIST--' DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE 1- INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE ! 00-'Z' # BEDROOMS # BATHS # OCCUPANTS 1— GARBAGE DISPOSAL. Yes or No ` COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # P4.0PLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLYt_ O T DESIGN WASTEWATER FLOW (GPD NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL., PUMPTANKL GAL. TRENCH WIDTH 3LO" ROCK DEPTH 12„ LINEAR FT. OTHER V1 �T�II�Tt�� ;vim jai `�Lti1 (� �.��.'S "I t©. 'C�• r.�'. t t.i, REQUIRED SITE MODIFICATIONS/CONDITIONS:. _''�� ���'" v� �Ll , �� �lr-Y C� (jN� Y+�Ui' • �-� IJ` ,IMPROVEMENT PERMIT LAYOUT*APPROVED EFFLUENT FILTER* *RISER(S) IF 61, BELOW FINISHED GRADE*' Wim;~ .0 sc) C.k� STi til f� ...•_.....�.-,•. ._,%.T �.l L►•-) �,p . I fl - I I, - o Z . '4W f 1= LA.= M,�/�, 1 **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPEO SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (- 's 6WR51-8760 DCHD 05/96 (Revised) -` DAVIE COUNTY HEALTH DEPARTMENT ,iM10 Environmental Health Section PPR — 3 4PO Box 848/210 Hospital Street Mocksville, NC 27028 �y�� OOA M� C4� LTH Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION iiNumber: q q Y, so `�nS' (Home) ri wD 5 * 5 a -(Work) �l�ygc�.`YIC, a100U Detailed Directions To Site:. � Q k 6 , 1 <� q kl w \/ 1( > Property Please Fill In The Following Information About The Existing Dwelling. Name System Installed Under. O1M 0 d U_kA 000 Type Of Dwelling' jft � Date System Installed(Month/Day/Year): \0k _6 t)l'I 1 ? Number Of Bedrooms: 3 Number Of People:_ Is The Dwelling Currently Vacant? Yes J No ❑ If Yes, For How Long? �� ` 3 U p UAn Any Known Problems? Yes ❑ No d If Yes, Explain: Please Fill In The Following Information About The New Dwelling- Type welling Type Of Dwelling:�M 26 Number Of Bedrooms: Number Of People: a Requested By Approved ❑ S Environmental Health For Environ se Only 0 1 10 Requested: 4I 3 10 1 L I*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a Quarantee(extended or limited) that the on-site wastewater system will function properly for anv given period of time. Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ Date: Paid By: Received By: Account #: Invoice DAVIE COUNTY HEALTH DEPARTMENT T Environmental Health Section PO Box 848/210 Hospital Street _. �y J 1• • - Mocksville, NC 27028 I < .. Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ Name: Phone Number: q q x 3 (Home) Mailing Address: � r?2� (Work) 0 o U(n Detailed Directions.To Site: \ Q i+ ds— Property W 1,vsV"'� cTl _ , h PropertyAddress, \ k: 1 S Please Fill In The Following Information About The Existing Dwelling. Name System Installed Under u n R n �.�� �� _i 1 �. 4Y Type Of Dwel ing��i� Date System Installed(Month/Day/Year)t i Number Of Bedrooms:, Number Of. People: Is The Dwelling Currentl Vacant? Yes No ❑ Yes, or How Long?(•t`I� Cl g Y _ Any Known Problems? Yes ❑ o Yes, Explain: f Please Fill In The Followi Vnform. 4.- Amout The New Dwelling. Type Of Dwelling-C� t �� lS_. Number Of Bedrooms: Number Of People: R Date C_ a 1 D C� uested: 11 Requested -By:Qeq Si ature ` For Environ .ntal'1ieulft ffi se Only Approved [I'Disappro .ed Comments: 1 _ Rlo i Zi Environmental Health Specialist Date �o *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) t'Iat the on-site wastewater system will function properly for any given period of time. Payment: Cash ❑ Check ❑ Money Order Q'#, + Amount: $ Date: Paid By: Received By: Account #: ,, w - - . Ifivoice # DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT No of Bedrooms 7C' le— -I— Date This permit is granted to for the ingt llatiori -o:O a septic 'tank at the residence of ' i / 1 Address If e 44C Building Contractor Address Septic Tank Specifications: Length Width Depth Capacity Gal. o 0 Manufacturer's Name i7..t c- t + AddressT No of lines C21- width in. Total Length ,ft. No. of Sq. Ft. Type of filter material Total tons used Minimum Requirements: House Trai er Tan's 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 Officer or his agent. Date of final approval Signed: Sanitarian I hereby certify that the above septic tank has been installed according to specifications. n, r / Signed: L� Septic nk Contractor Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville. r " h w .. r r ADDRESS / DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION A APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER �7'S BDIVISION NAME 00 LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED AN TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING O "o DATE REQUESTED 3- INFORMATION TAKEN BY Qd,,d \ This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 _ CAII!! nn R! R • r z Rt.. .. ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ Name: S�_l�t �7-1-c. Phone Number: (Home) Mailing Address: 175-9,01Z 6 -6:Z9 -5L9 3 (Work) Detailed Directions To Site: L - '�YV tz5) rO / -AE26 �d-v r h A i-. pL-'1'• oar GaraCor� . �p"D/✓- ,b�5r � �mybs�s✓i9� Property Address: / / / rro rdQYI r. Please Fill In The Following Information About The Existing Dwelling: G -U 0 fi La.v ra- food 0 r - Name System Installed Under: , ) &—r- f ` y 4Jv J Type Of Dwelling: ," !� /' Date System Installed(Month/Day/Year): %2 Number Of Bedrooms: :3L Of People: y Is The Dwelling Currently Vacant? Yes ❑ NoX If Yes, For How Long?� Any Known Problems? Yes ❑ No ❑ If Yes, Explain: Please Fill In The Following Information About The New Dwelling: Type Of Dwelling: A440 IAC NO &V- Number Of Bedrooms: 'rR Number Of People: Z Requested By: 0 • �1":::5 (Signature) For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Comments: .w Requested: Environmental Health Specialist Date *'Me 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: $ Date: Paid By: p Received By: Account #: P_0 S Invoice #: �Y-..,. -. {�.�,:.. �f.y- '.x _y...,., .r.r,• r;, _.., ^Y'f's'!" , t .. 23'M— _ ��_f DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 s; ON-SITE WASTEWATER CERTIFICATION FOR DWELLING r° (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ ` Name: Phone Number: (Home), Mailing Address: I %5 %7r 117—�1 9 3 (work) L -e— Detailed Detailed Directions To Site: J- f -o /�O / ='s r� u r p f . Property Address: / / / 6-,c) rdo..l Please Fill In The Following Information About The Existing Dwelling. G-vc� �,Iz0V0- &7ood or" Name System Installed Under: 1 r C tz IzId Type Of Dwelling: Date System Installed(Month/Day/Year): r%Z Number Of Bedrooms: Number Of People: y Is The Dwelling Currently Vacant? Yes ❑ NoX If Yes, For How Long? Any Known Problems? Yes ❑ No ❑ If Yes, Explain: Please Fill In The Following Information About The New Dwelling. Type Of Dwelling:_d la (- H0, Number Of Bedrooms: Number Of People: 2- Requested By: Date Requested: ,l� —O Z (Signature) For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Comments: Environmental Health Specialist Date 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: $ Date: Paid By: Received By: Account #: "7 6 J Invoice #: AUTWDKILATJON NO: i 8 % S#4DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section PROPERTY INFORMATION Permittee'sr P.O. Box 848 Name: _��..� b �(-�� Mocksville, NC 27028 Subdivision Name: �• }�� -i� Directions to property: �• Phone # 336-751-8760 Section: Lot: AUTHORIZATION FOR ``•t_^..L�ti. -fJ ) WASTEWATER - "�` ti �• Tax Office PIN:# SYSTEM CONSTRUCTION - c..,J"1:%�..f�i:'r.> (L Road Name: �;Ci''c; �'` Zip: **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 Articlejl 1 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. RESIDENTIAL SPECIFICATION: BUILDING TYPEtI ►>._ # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY(.i)IXjly DESIGN WASTEWATER FLOW (GPDI-., (,6D NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3(pI • ROCK DEPTH 2 ,• LINEAR FT. r OTHER �`t gT�1C�•t)Tlt7� �U7G 11V °STM l t. �L—S C -i ��.C.• Ititit rJ. REQUIRED SITEMODIFICATIONS/CONDITIONS: 1L%Z-4'-t Sy CC'C' — )%;-�L49 14"r, 1L-%, 1=.a()N-. i'�L%C�• l-� r L- I IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER* "i"E 1 ra 4.1x.1 e:T TL HLLE � M, �, tp' �• t n't,n/• c% lwt�i�i 65 SG C11� AS) IF 6" BELOW FINISHED GRADE* . �Q.c,p. Ifl— Il.—oZ "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPE SkYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # l � 6T -17b0 IOPERATION PERMIT s AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT 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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised)