301 Hanes Trail (2) Davie Count,NC Tax Parcel Report Tuesday,November 8, 2016
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WARNING: THIS IS NOT A SURVEY
a Parcel Information a
--77-7777-777771
Parcel Number: B60000002602 Township: Farmington
NCPIN Number: 5863164711 Municipality:
Account Number: 82518980 Census Tract: 37059-802
Listed Owner 1: THARPE FRANK M JR Voting Precinct: FARMINGTON
Mailing Address 1: PO BOX 11845 Planning Jurisdiction: Davie County
City: - WINSTON SALEM Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27116-1845 Voluntary Ag.District: No
Legal 143.39AC SPARKS
Description: RD Fire Response District: FARMINGTON
Assessed Acreage: 143.39 Elementary School Zone: PINEBROOK
Deed Date: 6/2002- Middle School Zone: NORTH DAVIE
Deed Book/Page: 004260168 Soil RnC,PcB2,PcC2,RnD,CeB2,PaD,WeB,GnB2,GnC2,RvA,MsC,ChA,WATER,MsD
Types:
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 408740.00 Outbuilding&Extra 161700.00
Freatures Value:
Land Value: 1155640.00 Total Market Value: 1726080.00
Total Assessed Value: 692620.00
4P"'AUTHORIZATION
NO: O 6 3 8 DAVIE COUNTY HEALTH DEPARTMENT
r -, Environmental Health Section - PROPERTY INFORMATION
Permittee's/� ,/ P.O.Box 848 .S DIST r a I - ,pA Lc,�
Name: 'l`)c .'�� /�- Mocksville,NC 27028 Subdivision Name: Ino/V 7,2)
Phone#:704-634-87607LfS77/✓
Directions to property: Section: Lot: 'D1�.
AUTHORIZATION FOR.
WASTEWATER Tax Office PIN:#.5 63_
TI
SYSTEM CONSTRUCON ..a f
Road Name: `"", zip: QQ�
**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 Article 11 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.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
�a �.°f' ( nel� `., ; ,A�'a S✓i•r;.> , tiA;. •>; -i•y..a '1 t 'y. y .. ♦•, ,t;y . ... " ,. . y, .+
DAVIE COUNTY HEALTH DEPARTMENT
.' .- . IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
llernuttee's"
Name; Subdivision Name:
Directions to property: ✓'•' �`.' I Section: Lot:
IMPROVEMENTf t/
PERMIT Tax Office PIN:#r,W,-_ _ C
..»� 11
Road Name: } . rr' Zip: ` 00
**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 11 of G.S.Chapter 130A,Wastewater 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 HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
t
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS / #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:YesorNo
LOT SIZE��4 TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE (/
SYSTEM SPECIFICATIONS: TANK SIZE jgb GAL. PUMP TANK - GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. /l%6
OTHER
t
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
1 i
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
la°p
V00,L �dJ
f
AUTHORIZATION NOI O 01 ON PERMIT BY: C�� DATE:
**THE ISSUANCE OF THIS OPERATION E IT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 13(A,S CTION.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)
yy, DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name: =% r'- Subdivision Name: �L)' ' Ii�f
Directions to property: Section: Lot: f 7 `y 0
" IMPROVEMENT
PERMIT Tax Office
Road�Name: c j Zip;
**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 11 of G.S.Chapter 130A,Wastewater 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 HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS_�#BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE `, 'r/ TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) '. :• NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE G��b GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH O-J LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
"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)634-8760.
OPERATION PERMIT �
SYSTEM INSTALLED BY: !. .-l/.%a.�. f/�•--�./
r
too
AUTHORIZATION N t/(o< 0 ON PERMIT BY: DATE:
"THE ISSUANCE OF THIS OPERATION IT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 13 A,S CTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised)
r
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC
Davie County Health Department
Environmental Health Section
P.O.Box 848
Mocksville,NC 27028
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed hh'.0110 I ► I"'i,G..7 2 Contact Person 1\ -v t 47 tih e 4
Mailing Address 3 O ( iAa•,e S rS ; t Home Phone ` za q
City/State/Zip ' 0 1lG"%C-C I AL C . 7-2 O 0 Business Phone � �IS S 79 7
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: 0- Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms �_ # Bathrooms V112-
0
tl2❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine U-Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage(gallons per day)
7. Type of water supply: ❑ County/City WCVell ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 9—No
If yes,what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 2 So ac rtil 1 WRITE DIRECTIONS(from
1 Mocksville)TO PROPERTY:
Tax Office PIN: #
S'963 - 6 - U Lt 1
11 1
Property Address: Road Name 30 k VA Grp'eS �►^�� 1 1
1
City/Zip 1J Vh nC-r-- 1,l C_ 20 C70
(�
1
If in Subdivision provide information,as follows: 1
1
Name: 1
1
Section: Lot #: 1
1
1
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 1161 v ►n (V\• kc--., e-9 to conduct all testing procedures
as necessary to determine the site suitability.
DATE JZ2 j15 -7 SIGNATURE Cs-d I\/`
Revised DCHD(06-96)