259 Bracken Rd Davie County,NC , Tax Parcel Report Wednesday, February 8, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information777
Parcel Number: F300000068 Township: Clarksville
NCPIN Number: 5821302125 Municipality:
Account Number: 8305609 Census Tract: 37059-801
Listed Owner 1: STEWART JACOB M Voting Precinct: CLARKSVILLE
Mailing Address 1: 259 BRACKEN ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 1.5 AC BRACKEN RD Fire Response District: WILLIAM R.DAVIE
Assessed Acreage: 1.43 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 10/2014 Middle School Zone: NORTH DAVIE
Deed Book/Page: 2014E1009 Soil Types: MnC2,MnB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 32920.00 Outbuilding 8r Extra 0.00
Freatures Value:
Land Value: 20900.00 Total Market Value: 53820.00
Total Assessed Value: 53820.00
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 Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
Davie COUNTY
210 Hospital Street
P.O. Box 848
Mocksville NC 27028 TEL: 336-753-6780 FAx: 336-753-1680 Request ID: 60533
REQUEST FOR SERVICE/COMPLAINT INVESTIGATION REPORT
REQUEST DATE: 10/02/2015 TAKEN BY:
SECTION: N/A TYPE:
PROPERTY NUMBER: 197670 ASSIGNED TO: Nations, Robert
ESTABLISHMENT NUMBER:
PERSON OR PREMISES TO SEE: OWNER: Larry Richard Spease
Larry Richard Spease 3228 Arlington Drive
259 Bracken Road Winston-Salem , 27103
Mocksville NC, 27028
REQUESTED BY: Neighbor HOME:
WORK:
Cell:
CONDITION REPORTED:Lines, drain field on another property owner
COMMENTS:
RECORD OF INVESTIGATION
DATE: HR/MT: COMMENTS
EHS:
EHS #: ' ACT CODE:
DATE: HR/MT: COMMENTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMMENTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMMENTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMMENTS
EHS:
EHS #:
ACT CODE:
Next Inspection Date: Status of Complaint: OPEN Resolved Date:
Complaintant Contacted: NO
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Davie County Health Department
g.is f� Environmental Health Section
D P.O.Box 848
'�, gECEivE 210 Hospital Street
0 Courier# : 09-40-06
U yaw:"t Mocksville, NC 27028
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Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling cion
Name: Iy;J Likkwd"i- Phone (Home)
Mailing Address:,:?,-:3/ 6rac I<ta R (Work)
I�s 0', (� �� �'. ;)�c4g Email Address: dtgdafEl r (,j Ct_hoc) ,CC'k`r1
Detailed Directions To Site: tpo l V -R 5 a-C k P h RA r)r\ 4,V4 �3 rn� �-es
Property Address: AVULI /?I edc ;2-3
Please Fill In The Following Information
�About The EXISTING Facility: l,,
Name System Installed Under: Ali cif'�1 `��S/,W Type Of Facility: 1-4 0,416 zm/ c6S
Date System Installed(Month/Date/Year): Number Of Bedrooms: Number Of People:
Is The Facility Currently Vacant? Yes ® If Yes,For How Long?
Any Known Problems? Yes �N If Yes,Explain:
Please Fill In The llowing/Informatiion About Th NEW Facility:
Type Of Facility: �D�PT-t' 'f(1 {� :50 t Number Of Bedrooms: Number of People
'Pool Size: A Garage Sr- e- Other:
Requested By: Date Requested: 9' (5
(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 neck Money Order # Amount:$ Date:
Paid By: Received By:
Account#: I`( 15 Invoice#:
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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 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.
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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 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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage SystemsPermit=Number
Name `i� —_ �J t' �r ;`a t ---Date �- _ NO 7900
Location �+—d�`(—t—`
61', Q.C �_'J_ 1� jv.\ __tt s, i�TtS.. �N � ti :l_�' 1•y� 1
Subdivision Name / Lot No. Sec. or Block No.
Lot Size �`�' — House �` Mobile Home ---- Business -- Industry
No. Bedrooms _ --.No. Baths —.— No. in Family -' _ Public'Assembly Other
Garbage Disposal YES ❑ NO ice- Specifications for System:
Auto Dish Washer YES Cg- NO ❑
Auto Wash Ma^hine YES ®-'NO ❑ l U ' y - k ' R `��
Type Water Supply ----- ---
This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS"
SYSTEM.
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Improvements permit by `-�
*Contact a representative of the Davie County Health Department for final Inspection of this system between 8'30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985:y/6 0
Final Installation Diagram: System Installed by
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Certificate of Completion s�S �- pate -7 -
'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 ior'ggy given period of time.
` DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) /G
NAME D N4D PHONE NUMBER 7
ADDRESS ,8��e��� - SUBDIVISION NAME.
LOT#
DIRECTIONS TO SITE &Ili . /5T �h-,�ief�C�£N i`f� • r 7 `-fJ�'/CK /?0 G(��
DATE SYSTEM INSTALLED / �� NAME SYSTEM INSTALLED UNDER �0 4y /I/Al� �o� ?
TYPE FACILITY AoG!•S&- -NUM.BER BEDROOMS 1_3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY We'll SPECIFY PROBLEM OCCURRING
a um J j� -A � e-s 0 0 o ,
DATE REQUESTED ' � _6/ INFORMATION TAKEN BY AIM
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.1/93