1885 Jericho Church Rd Davie County, NC I ax Parcel Report Friday, September 23, 201(
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: K300000048 Township: Mocksviile
NCPIN Number: 5727643037 Municipality:
Account Number: 82532462 Census Tract: 37059-801
Listed Owner 1: LUPER STEPHEN JAY Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 1903 JERICHO CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag. District: No
Legal Description: 15.307 AC JERICHO CHURCH Fire Response District: CENTER,MOCKSVILLE
Assessed Acreage: 11.63 Elementary School Zone: COOLEEMEE,MOCKSVILLE
Deed Date: 12/2014 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 2014EI229 Soil Types: SeB,EnB,IrB,EnC
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 109570.00 Outbuilding & Extra 2840.00
Freatures Value:
Land Value: 108950.00 Total Market Value: 221360.00
Total Assessed Value: 221360.00
hyla All date Is providatl as b without warranty,or guarantee of any kind either expressed or Implied Including but not limited to the
Davie County, Implied warrendes o/merchantabllky orgmass lora particular use.All users of Davie County's GIS website aM1all 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
O •( NC or arifing out of the use or Inability to use the GIS data provided by this website.
`. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME � PHONE NUMBER
ADDRESS f/j // SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE glyk Aqhlmer� / f e-
DATE SYSTEM INSTALLED 190 NAME SYSTEM INSTALLED UNDER � ��N
TYPE FACILITY /765ef NUMBER BEDROOMS .;/ NUMBER PEOPLE SERVED
TYPE WATER SUPPLY ��ti` v SPECIFY PROBLEM OCCURRING
b s f
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DATE REQUESTED 1X`19�I� INFORMATION TAKEN BY
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
DAVIE COUNTY HEALTH DEPARTMENT f C
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 Z39-� e�. Q. Date.
1 t.
Locat
4,0 Ala
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ _ Business Speculation
No. Bedrooms ^ No. Baths r` No. in Family ^ _
Garbage Disposal YES ❑ NO \Ef Specifications for System:
r
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES [Z NO C]
Type Water Supply p._ A
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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S
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. or 1:00-1:30 P.M. on day of completidn. Telephone Number: 704-634-5985.
Final Installation Diagra System Installed by
r-
Certificate of Completion Date
"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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section ,
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. ,�
Home Phone 6-1-34- 36`�I
1. Permit Requested By ��n Cr Coat-0`�iz)
2. Address i tmElwn Irl
3. Property Owner if Different than Above
Address � � oy �O1 �1�C �11i»t• C �7va
4. Permit To: a) Install f:!� Alter Repair
b) Privy Conventional ✓ Other Type
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
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 a urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public ✓ Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 13 oute,
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? OL
What type?
This is to certify that the information is correct to the best of my knowledge.
C�Xe��—4 �_� Z_6ex�_�Date ner Sign ure
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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DCHD(6-82) .yy ,�r✓ / I
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DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
_ LOCATION OF PROPERTY: DATE RECEIVED
(office use only)
yes no 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from MZ`Niy-N Wh Ly- , owner to obtain a
wner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system. .
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
;&W' tte" --/,
DATIE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
—Owner only
— Owners designated representative
—Anyone requesting results
-LZOnly those listed below
DATE SIGNAT0RE
DCHD(11/84)
f DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
G SOIL/SITE EVALUATION L �i
Name— Date
Address Lot Size
FACTORS AR 1 ARE 2
ARE CAAREA 4
1) Topography/Landscape Position S S � S
_ S ) PS
<�'
U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) qia�) PS
U U U
3) Soil Structure (12-36 in.) S S
Clayey Soils (ISPS PS PS
U U
4) Soil Depth (inches) S S
PS
U U U U
5) Soil Drainage: Internal S S
C& S PS
U U U
External S S
P (4) PS
U U U
6) Restrictive Horizons
7) Available Space S S
PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U
9) Site Classification QJ
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by TitleDate
SITE DIAGRAM
v
DCHD(6.82)