464 Madison RdDavie, County, NC Tax Parcel Report b 31;-0 Friday, September 30, 2016
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Parcel Information
Parcel Number: H400000101 Township: Mocksville
NCPIN Number: 5729820444 Municipality: MOCKSVILLE
Account Number: 14020000 Census Tract: 37059-806
Listed Owner 1: CARTNER JAMES MICHAEL Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 280 WANDERING LN Planning Jurisdiction: MOCKSVILLE
City: MOCKSVILLE Zoning Class: MOCKSVILLE HC,OSR
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag. District: No
Legal Description: 1 LOT MADISON RD Fire Response District: CENTER, MOCKSVILLE
Assessed Acreage: 0.88 Elementary School Zone: MOCKSVILLE
Deed Date: 12/1996 Middle School Zone: SOUTH DAVIE
Deed Book / Page: 1997EO011 Soil Types: MrB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: MOCKSVILLE
Building Value: 0.00 Outbuilding & Extra 0.00
Freatures Value:
Land Value: 30000.00 Total Market Value: 30000.00
Total Assessed Value: 30000.00
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Davie County,
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NC
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
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
**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)
11-01 DATE S �s-
NAME F' ,/ � 4 L PROPERTY ADDRESS /Sa �%A /Y ! l �- . ` � 7d ag
LOCATION .0//
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS L # BATHS # OCCUPANTS Z_ GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM 5PECIFICATIDtlS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH�ROCK DEPTH-" LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
Y
IMPROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
AUTHORIZATION NO. 03'\ e OPERATION PERMIT BY
DATE b - 3 I
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .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.
DOHD 10/95
DAVIE COUNTY HEALTH DEPARTME4 61
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT
i
001
1
**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)
NAME t_ ?.' / ! �' s, PROPERTY RDDRES5` ��� % 6 /!� �Cl- • _ �� %� rDATE
LOCATIONL1121
SUBDIVISION NAME
LOT NUMBER
SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE f� P # BEDROOMS 42- # BATHS # OCCUPANTS _ GARBAGE DISPOSAL: Yes/No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) r NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH RFK DEPTHLINEAR FT.T
OTHER
REIIUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
r
L7
IMPROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT Eu Cr 6sEK4NSTAL LED-BY-�
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Ho u so
AUTHORIZATION NO. 0-,3 11
ti
OPERATION PERMIT BY
-IN1 ^�
i t
_ "'r -
DATE 3 1
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL F1NCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95_
Davie County Health Department ,
? ENVIRONMENTAL HEALTH SECTION 1 00
P.O. Box 665
Q �ir Mocksville, N.C. 27028
�� I -
AUTHDRIZATIDN FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems)
***This Authorization For Wastewater System Construction must. -be issued by the Davie County Environmental Health Section prior to
issuance of any Building Persits.__This Form/Authorizition Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.***
1 AUTHORIZATION NUd'.BER
NAME (Altq/! C .-r DATE
NAME ON IMPROVEMENT PERMIT (Ifdifferentthan above)
SITE LOCATION ��UIIJ_f"c� A,,'
COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
**{NOTICE*+* THIS IUTHIIIZIT = SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENURAMAL WAN SPECIALIST DATE
DCHD 10/95
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
L5 @
D
SAY - 7
1. Application/Permit Requested By T i.S 0 Al
Mailing Address 442 a Rd- S Home Phone ! _� —3'7 5-5
t✓ , JV', • C , A70-34, n `, i Business Phone
2. Name on Permit if Different than Above
3. Application for:
4. System to Serve
❑ Business
❑ General Evaluation
House
❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooms a'
No. of Bathrooms10
l
Dwelling Dimensions Sa ' %� 3 7•
F ' Septic Tank Installation Permit
❑ Mobile Home ❑ Place of Public Assembly
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures _
7. Type of water supply: ER4ublic ❑ Private
8. Property Dimensions 6L (C T - Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Unknown
Section Lot #
❑ Yes
❑ Basement/Plumbing
❑Basement/No Plumbing
10/Washing Machine
It1 dishwasher
❑ Garbage Disposal
❑ Community
*NOTE: Improvements Permits shall be valid - --.—.rom date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
1
R&D:
Tax Office PIN: # ,'5��9' 8.2 - D•S�/�'f'
PROPERTY ADDRESS, as follows:
Road Name: se'J lCdr.
city: Mnr—C tr.,Zlr
SUBMIT A PLAT WITH THIS APPLICATION.
Revisions effective October 1, 1995.
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
YJ
MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
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
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
/ 0�
DATESIGNATURE
DCHD (1193)
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