116 Hank Lesser Rd Davie County,NC Tax Parcel Report �3l,`� Tuesday, October 4,2016
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WARNING: TffiS IS NOT A SURVEY
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; Parcel Informahon
Parcel Number. L4130A0014 Township: Jerusalem
NCPIN Number. 5736727867 Municipality:
Account Number. 8304675 Census Tract: 3705�807
Listed Owner 1: SEAFORD DOUGLAS F Voting Precinct: COOLEEMEE
Mailing Address 1: 116 HANK LESSER ROAD Pianning Jurisdiction: Davie Counry
City: Modcsville Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNN CZOD
Zip Code: 2702&5307 Voluntary Ag.District No
Legal Desc�iption: LOT 10 GOSHEN LANDS Fire Response Dlstrict: JERUSALEM
Assessed Acreage: 0.47 Elementary School Zone: COOLEEMEE
Deed Date: 1/2015 Mlddle School2one: SOUTH DAVIE
Deed Book/Page: 009750154 Soil Types: PcC2,CeB2
Plat Book: � 0005 Fiood Zone:
Plat Page: 077 Watershed Overlay: DAVIE COUNTY
Building Value: 32850.00 Outbullding&Extra 0.00
Freatures Value:
Land Value: 10240.00 Total Market Value: 43090.00
Total Assessed Value: 43090.00
9�.�� Aq data Is proNded u b wHhout warranty or guaraMee M any Wnd Nther e�ressed or fmplied induding but not Umlted to the
Davie County� Implled w+rrarAles W merehaMabtlky or fltr�ess for a particWu uaa Ad users M Davie Co�mty'a GIS website shall hold harmless fha
7�T CouMy oT DaNe,North Carolina,lts aparts,cons�dtarKs,co�actws or employees ttom ury and aM daims or auses ot�ctlon due to
��U N'� 1�� or arlsl�9�oi fhe use ar inabilky to uae tl�e GIS dah proNded by Mia webska
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-�• DAVIE COUNTY HEALTH DEPARTMENT
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�- ` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
� "NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c -
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name�t� e �'.,2.� Date � — 1 K - u3 "" � "'''�•
S ��.��; ��r�5
Location ��E� �.a...,.� � .P� �_�". \ � �-� �� .,, �1� � � 1 �� �� (-`-1 - 1,,�- „� ,
c��,.�� i� L������� � .
Subdivision Name Lot No. - �� Sec. or Block No.
Lot Size�S.x�"�.x ��� House Mobile Home J� Business Speculation
No. Bedrooms 2- No. Baths �_ No. in Family �
Garbage Disposal YES p NO p- Specifications for System: i auo�, �,�,�i�
Auto Dish Washer YES ❑ NO [y
Auto Wash Machine YES [a— NO � �' ��'f - � 3��X 3�X i�'' i���K-
Type Water Supply r-1„���_ _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by� • �`G^���
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by ��J�4" ��rL ��N�
Certificate of Completion e�� Date `-'J ' � ' ��
#The signing of this certificate shall indicate that the system described above has been installed in �compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. : � �
,
` DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name ��Q S���� Date �� 1 g '�3
Address �'^�- �21 Lot Size �
M��GI-'!u���G
FACTOR$ AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position . �� � S S
PS PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Ciayey, (note 2:1 Clay) � �� PS PS
� U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils � PS PS
U U U
4) Soii Depth (inches) S S S
� PS PS
U U U U
5) Soil Drainage: Internal S � S S
� PS PS
� U U U
External � S S
PS PS PS
� U U U
6) Restrictive Horizons � �
7) Availabie Space � � S S
PS PS PS PS
� U U U
8) Other (Specify) S S S S
pg PS PS PS
� U U U
9) Site Classification �-� �
U—UNSUITABLE S—SUITABLE S—Provisionaliy Suitable
Recommendations/Comments: � • �
Described by��1�`�-� Title � • ��� � Date g �tg-�3
SITE DIAGRAM .
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DAVI� COUIdTY HEALTH Ds,PART:IEI�1T
SITE EVALUATION CONSEItT FORM
INSTRUCTIOTdS/PREREOUI3TES
l. Cample�e ths farm b�low and rzturn it zo the Davie C�. Health D�partment.
2. Along with ch2 farra, remit the amaunt due as shown �n enclosed statzment.
3. Carefully follaw the procedures as outlin�d in �che anclosed "Informaicicn
Bulletin".
4. tdotify Heali�h Department up�n c�mple�ion af itsm nur�ber 3.
NOTE: ALL THE ABOVE PdUST BE DOPdE BEFORE A SANITARIAPd WILL BE ABLE
TO HEGIN THE REQUESTED EVALUATIOtJ.
DETACFi HERE AND RETURPd TO THE(DAVIE COUNTY HEALTI3 DEPARTrIENT,P.O. mOX 57)
• (t�IOCKSVILLEr A1.C. 27028)
DAVIE COUNTY HEAL2H DEPARTN�NT '
SITE EVALUATION COYdSEN'i' FORP-I
IACATION OF PROPERTY: ' DATE RECEIVED
(offi�� use dnly)
yes no* (l.) I �n the awn�r of the above describ�d progerty.
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y2s no (2.) I �n nat the awner of the abave described proper�cy, hawev2r, I
� j� certify that I have consent frem ,owner to
� cwnar's nazaa
obtain a site evaluat3on by th2 health Department for the purpose
cf determining the suitability fcr a graund absorptian sewage `
disposal systera.
s no (3.) I hareby qiv� cons�nt ico the authorized representazive of the
1 ! Davie County Haaltn DapartMant tc enzer upon th$ above dascribed
1 L._� praperty and canduct all tes�ing pracedures necessary to
determine its suitability for a gr�und absarptian sewage
, disposal system.
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~ DATE SIGNA URE
(4.) I hereby authorize the Davie County H�al�h Department to release
site evaluacian r�:sults from tne above described propErty to the
follawing:
� Owner Only
�j Ownsr's designa�ed representative
(� Anyone requesting resulzs
DATE 'L,`1 Only thase listed below
� A SIGNATURE � �
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• � � • APPUCATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
� Davie County Heaith Department
Environmental Health Section
P. O. Box 665
;
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phones�'��`" ����
1. Permit R uested By � Business Phone
2. Address a 1 - � st�� ,
3. Property Owner if Different than Above
Address S��h P
4. Permit To: a) Instali�Alter Repair
b) Privy Conventional..�,�ther Type �
Ground Absorption
c) Sub-Division Sec. Lot o
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people � ,
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions � � x � �
Bed Rooms�_Bath Rooms�—Den w/Closet
b) If Business, Industry or Other, State: Number of persons.served
What type business, etc. '�
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures: �
commodes � �l�rinals garbage disposal
� lavatory 1 shrowers washing machine �
dishwasher sinks 1
8. a) Type water supply: Public—t,�Private Community
b) Has the water supply system been approved? Yes��No
9. a) ProNerty Dimensions �-, X� ���-� �� �� � �� Ga�
b) Land area designated to buildin site
c) Sewage Disposal Contractor �C' � �
10. Do you anticipate any �dditions or expansions of the facility this sewage system is intended to serve? �
What type? ��a
his is to certify that the information is correct to the best of my knowledge.
: l� � 3
� Date Owner Signature
` OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing '
Directions to property:
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