172 Hidden Meadows Trail (2)Davie County, NC Tax Parcel Report Friday, October 7, 201 f
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WARNING: THIS IS NOT 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
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
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Parcel Information
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
Parcel Number:
F20000005302
Township:
Clarksville
NCPIN Number:
5810550904
Municipality:
Account Number:
82527628
Census Tract:
37059-801
Listed Owner 1:
KOOISTRA DANIEL S
Voting Precinct:
CLARKSVILLE
Mailing Address 1:
172 HIDDEN MEADOWS TRAIL
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
1.999AC OFF R RATLEDGE RD
Fire Response District:
CENTER,WILLIAM R. DAVIE
Assessed Acreage:
2.00
Elementary School Zone:
WILLIAM R DAVIE
Deed Date:
7/2012
Middle School Zone:
NORTH DAVIE
Deed Book / Page:
008970092
Soil Types: MnC2,MnB2,WATER
Plat Book:
0009
Flood Zone:
Plat Page:
066
Watershed Overlay:
DAVIE COUNTY
Building Value: 49100.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 10240.00 Total Market Value: 59340.00
Total Assessed Value: 59340.00
O!1�
Davie County,
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
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NC
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
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or arising out of the use or Inability to use the GIS data provided by this website.
Account #: 990005913
Billed To: Daniel Kooistra
Deference Narne:
Proposed Facility: Residential Well
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax(336)753-1680
WELL PERMIT
Tax PK EH #: F20000002102 -Well
Subdivision Info:
:LocationiAddress: Hidden Meadows Trail -27028.:
Property Size: `2 Acres
ATC Number: 0110
Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this
well will produce water of any particular quantity or quality or for any amount of time. This permit is valid
for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there
has been a material change in any fact/circumstances upon which this permit was issued.
Permit Type: New z] Repair ❑ Abandonment ❑
Prop Location Diagram
Certificate pf Completion Diagram
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Comments: rrt D t `' C C ,
Driller:,/" S P"\n S Q
Certification
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Grout Inspected: 17T 1' Z
Well Head Inspected:
GPS Coordinates:
EHS: Date:
EHS. Date:
W.P. 7-08
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APPLICATION FOR PRIVATE WELL PERMIT
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780./ Fax (336)753-1680
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED.
APPLICANT INFORMATION
Name / let ' Q /S
Address Z
City/State/ZIP OC di/
Name on Permit if Different than Above.
Mailing Address
PROPERTY INFORMATION
Contact Person
Home Phone
Business Phone
City/State/Zip
*Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must accompany this application. Included: 10 Site Plan ❑Plat (to scale)
Owner's Name io Phone Number
Owner's Address City/State/Zip
Property Address City
Lot Size 2, Aell Tax PIN# OCl 6 - OZ
Subdivision Name(if�pplicable) Sectio ot# /PfN
Directions To Site: /e d/ Al - P /�/ T,ia OD /P) AA/ f1n1P_i / /_ )AA)
DEVELOPMENT INFO ON
Permit Type: New Well Well Repair Well Abandonment Other (specify)
Facility Type: Residential Food Service Church Commercial Other
Are There Any Septic Systems Currently On The Site? YES NO
Do You Intend To Install A New Septic System On This Site? YES NO
TERMS AND CONDITIONS:
This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines
with dimensions, the specific location of the facility and any existing or future appurtenances, the location of any existing septic
system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying
and marking the property lines and corners. The applicant is responsible for making the site accessible.
By signing this application, the applicant signifies that they understand the terms and conditions and that they give permission for
Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to
determine the best location for a well.
Signed
7/30/09
—7A 31-21 4 I Z ---
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account #
Invoice #