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207 Greenhill RdDav !016 WARNING: THIS IS NOT A SURVEY All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fltness for a particular use. All users of Davie County s GIS website shall hold harmless the Parcel Information 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. Parcel Number. 130000006001 Township: Calahaln NCPIN Number: 5728276360 Municipality: Account Number: 22904000 Census Tract: 37059-801 Listed Owner 1: DYSON ALVIN BENNY Voting Precinct: NORTH CALAHALN Mailing Address 1: 207 GREENHILL ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAME COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: Yes Legal Description: 0.989 AC GREENHILL RD LIFE ESTATE Fire Response District: CENTER Assessed Acreage: 1.01 Elementary School Zone: MOCKSMLLE Deed Date: 5/2004 Middle School Zone: SOUTH DAVIE Deed Book / Page: 005530701 Soil Types: GnB2,CeB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 120350.00 Outbuilding 8r Extra Freatures Value: 1040.00 Land Value: 20180.00 Total Market Value: 141570.00 Total Assessed Value: 141570.00 Davie County, All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fltness for a particular use. All users of Davie County s GIS website shall hold harmless the 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. 3 /0y R DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION Von I L� k APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) / NAME S iJ PHONE NUMBER IZO V-5. V4- 7.312 ADDRESS 3 1�SUBDIVISION NAME 40 2—a .3 LOT # DIRECTIONS TO SITE T Q -% C f'e /�. l: j� � '� i� c.J - DATE SYSTEM INSTALLED -7,-7j- NAME SYSTEM INSTALLED UNDER TYPE FACILITY M e NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY C-0 SPECIFY PROBLEM OCCURRING he -,0-6,( 4,0 �. r �- � / - � _ �- a '�rz✓ l: Pu"---�c_� �' e -c' �L� ) � DATE REQUESTED 10 JO -0 INFORMATION TAKEN BY, This is to certify that the information provided is correct to the best of my knowledge/+ d that I??ne SIGNATURE OF OWNER OR AUTHORIZED AGE Rev. 1/93 D I am responsible J6f all charges incurred from this application. _ M APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC `I Davie County Health Department Environmental Health Secrion OCT I J 2000 P.O. Box 848/210 Hospital Street , Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Mailing Addre Qr Contact Person Home Phone -7-0 7 - r 1/b - 7d Z Z City/State/2IP/// Q A-' Business Phone 2,.'Na3Mon Permit/ATC if'Different than Above A Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation .Improvement Permit/ATC ❑ Both 4. system to service: P House ❑ Mobile Home ❑ Business ❑ Industry 11Other S. If Residence:. # People J # Bedrooms J7 # Bathrooms 2— H Dishwasher ❑ Garbage Disposal 0 -Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes ; # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: P-<ounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: .*o 2- `=l -'T, Section: Block: Lot: Date Property Flagged: 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. 1, 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 ' to conduct all testing procedures as necessary to determine the site Suitability. ' DATE O 7` 11 '" SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the Mowing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. "( Revised DCHD (07/99) Invoice No. ]y,_. - �F..a. JY,j•{.l j'.j +NV'.\ hK`1 `:']. i61 S.�:ir,':.JI �L'. A .,+. !'.a :} L� r .L. [ t t ( �`'} ?s"y! '�' � �' -F^I AUTHORIZATION,NO: # ,fl DAVIE COUNTY HEALTH DEPARTMENT' Environmental Health Section PROPERTY INFORMATION Permittee's -.' , l P.O.,Box 848 Name:' '` � t 't �"`� Mocksville,NC 27028 Subdivision Name: Phone#• 336-751-8760 Directions to property: j`L7 Section: Lot: AUTHORIZATION FOR WASTEWATER. Tax Office PIN:# SYSTFM CONSTRUCTION Road Name i N L p: **NOTE**;This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance iof any Building PemuK This Eorm/Authonzation Number should be presented to the Davie County,Building Inspections, Office when applying for Bu' ding'Permits.-`: (In compliance.wid)Amil f G S: hapte Wastewater Systems Section 1900 Sewage Treatment and Disposal Systems) NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 00 IS IS VALID FOR A PERIOD OF FIVE YEARS. . E NM HEA t LIST,` ATE 1S UED EC / 1i 14 2fi DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee's Subdivision Name: Directions to property: 1 Section: Lot: IMPROVEMENT LL : >g:.. PERMIT 'Tax Office PIN:# _ ,7� i Ro d Name: ! . ,-& Z-z ' N i L t Zip: rt3,—, **NOTE** This Improvement Permit DOES NOT authorize the constriction 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 ll. of G.S: ChapteL130AWastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL' HEALTHSPECI�ILISTDATE ISSUE SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE h`I V Q—SCi# BEDROOMS _ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes dr No COMMERCIAL SPECIFICATION? FACILITY TYPE ` # PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY��`f 'DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE 1 SYSTEM SPECIFICATIONS: jANK'SIZE GAL. PUMP TANK GAL./TRENCH WIDTH Li ROCK DEPTH / LINEAR Fr. SOC ) IS7% fJT-00.4 ` OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: tAn1-/,l..l_'.. D C A�1T�J �L IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER• *RISER(S) IF fi" BELOW FINISHED GRADE* � f Li 4• - **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-J.11:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (763T63 XKXKXXX nr un nim mpvi—ai v _ � �Y...�e' .: .�,•-;-rr. 'h •+1•.z. �p a i#'f z.w�.`�a`3(;�..`}.v 3a •3e�+:.r-�„ l"G:�: •.,y.. ti a:,e�:e yr SY '�ry'�� f _. t: r -w„ �* - .: DAVIE COUNTY HEALTH DEPARTMENT ' r! IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee's �,.� " a -J Nacue:'" Subdivision Name: .a Directions toert : ro wl Section: Lot: P P Y , +-..�., IMPROVEMENT %% � �:"r' j s LL i `' / +� E� L PERMIT Tax Office PIN:# - - Road Namef., iM� t�+t_t,"Zip:. r/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.1 I of G.S. Chap�„I, OA„WWastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 1 r , r;, _.•., d , �/f i ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE .�� ' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST r "DATE ISSUED k SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE �` INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: $UILDING TYPE tjU_QSG# BEDROOMS # BATHS -# OCCUPANTS %Z- GARBAGE DISPOSAL: Yes br No' COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or Nd-- r LOT SIZE TYPE WATER SUPPLY0 DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL: TRENCH WIDTH (✓ ROCK DEPTH `' r „ LINEAR FT. Ulf OTHER JTt REQUIRED SITE MODIFICATIONS/CONDITIONS:ItAnfY LLL 0 Li:7N�UJ2 IMPROVEMENT PERMIT LAYOUT - �+� *AM- ROVED EFFLUENT FILTER. *RISER (S) IF 6" DEL01-1 FIMS1"1£D GRADE* )13 "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 (704)163 qy K M M M )t OPERATION PERMIT SYSTEM INSTALLED BY: r G Ver- �J� M• 1 AUTHORIZATION NO. 1 022 OPERATION PERMIT BY: DATE: GC7 DU "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DE CRI ED ABOVE HAS BEEN INSTALLED INCOMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DI POSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY�GIVEN PE OD OF TIME. r DCHD 05/96 (Revised) Y L "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 (704)163 qy K M M M )t OPERATION PERMIT SYSTEM INSTALLED BY: r G Ver- �J� M• 1 AUTHORIZATION NO. 1 022 OPERATION PERMIT BY: DATE: GC7 DU "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DE CRI ED ABOVE HAS BEEN INSTALLED INCOMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DI POSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY�GIVEN PE OD OF TIME. r DCHD 05/96 (Revised)