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896 Pine Ridge RdDavie Countv, NC Tax Parcel Report a 6 9 A Wednesdav, October 5, 2016 Zip Code: 27028-6756 Voluntary Ag. District: Legal Description: 1.174 AC PINE RIDGE RD Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 1.17 WARNING: THIS 1S 1VUT A SURVEY Middle School Zone: 006360202 Parcel Information Parcel Number: N50000001901A Township: Jerusalem NCPIN Number: 5745322442 Municipality: 18760.00 Account Number: 82516232 Census Tract: 37059-807 Listed Owner 1: PHELPS CHARLES BARNEY Voting Precinct: COOLEEMEE Mailing Address 1: 896 PINE RIDGE RD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27028-6756 Voluntary Ag. District: Legal Description: 1.174 AC PINE RIDGE RD Fire Response District: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 1.17 Elementary School Zone: 11/2005 Middle School Zone: 006360202 Soil Types: Flood Zone: Watershed Overlay: 200100.00 Outbuilding & Extra Freatures Value: 18760.00 Total Market Value: 242830.00 No COOLEEMEE COOLEEMEE SOUTH DAVIE Gn132 DAVIE COUNTY 23970.00 242830.00 9 hid 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 Davie, North Carolina, Its agents consultants, contractors or employees from any and all claims or causes of action due to �7 r'OC p'S� 1\ C or arising out of the use or inability to use the GIS data provided by this website. RECEIVED PAID 3�_ LLf Dom: I131A l- y � ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling ,/ Reconnection Name: �,�ewkg D PAe4te5 Phone Number 3�5ee- 14,03 0731 (Home) Mailing Address: < 9q& tj!h i?&Cf 2 /,?C/ 3 azo - L403-0131 �-; (Work) L/!`f'o NC 2_203 Fi Email Address: rY1l l L!S 6U -S -OrhS (ccs (�/C•%Co. C4. Detailed Directions To Site: %ake— deo S �v NI IQ�oI�tC �a�, GO.�/►1� %eS slo�krti /'�o - ��6 fiK� �.(, Property Address: nCp illne- i2iwrg act /V{ ocksw"Il-f luC �7OaZ /J Please Fill In The Following Information About The EXISTING Facility: J V �" 0`9 ' �� 'rl 0704& Name System Installed Under: H8 Type Of Facility: Date System Installed (Month/Date/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? Yes (No/��If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: (' Q j=ANumber Of Bedrooms:--c2—Number of Peopley Pool Size: Garage Size: 3 D 14 Other: Requested By: Date Requested:_ ignature) Or For Environmental Health Office Use Only A proved Disapproved Comments: Environmental Health Specialist Date: _ N —1 Y *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee CSP- 125` 7 D n &611 I G� p I l4e- Rlw�e, Rd P nnittee's '` �1� i i , fj ' ,' rDAVE COUNTY HEALTH DEPARTMENT Name: Environmental Health Section j P.O. Box 848 -Directions to property: ' 'j' = a Mocksville, NC 27028 Subdivision Name: ?' ?! Phone #: 336-751-8760 Section: AUTHORIZATION FOR WASTEWATER Tax Office PIN:#_ SYSTEM CONSTRUCTION PROPERTY INFORMATION Z �ti Lot: AUTHORIZATION NO: 002594 A Road Name: Zip: **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 RESIDENTIAL SPECIFICATION: BUILDING TYPE �' 1013EDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS ! INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)= tl'y NEW SITE REPAIR SITE p SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTHS ROCK DEPTH o LINEAR FT. �n/i REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 1 FOR FINAL INSPECTION OF THIS SYSTEM PLEA"SjjEXM E DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT 1/� IY: i�L�1v 77 14101P AUTHORIZATION NO. ` OPERATION PERMIT BY: DATE: 119 /0(0 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYST SC Ef; ABOVE HA 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. DCHD 02/02 (Revised) 7 f 'IP , / P�rmtte�'s•r _ 1 w - : DAVIE COUNTY HEALTH DEPARTMENT PROPERTY INFORMATION Z- 3v Name: �° �� Environmental Health Section P.O. Box 848 DirEcSioff9'fo property: Mocksville, NC 27028 Subdivision Name: = — Phone #: 336-751-8760 - Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION NO: 00259 4 A Road Name: Zip: _ **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) i ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 1-7b f 11;1, BEDROOMS 1:> # BATHS # OCCUPANTS r GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) •-/� �', NEW SITE REPAIR SITE f SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH f0 LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS IMPROVEMENT PERMIT LAYOUT FOR FINAL INSPECTION OF THIS SYSTEM PLEAA CALL BETWEEN 8:30 - 9:30 A.M. ON T1, E DAY OF INSTALLATION. TELEPHONE #'IS (336) 751-8760. OPERATION PERMIT HOc)x SYSI�EM INSTALLED B >^�✓� 11—��"� �O 77 D t �2' t;xtSTtrJL� �-- 1 AUTHORIZATION NO. \OPERATION PERMIT BY: / DATE:Le i ' "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTE v�1 )<SC IBED A13kEHA9ZEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 01102 (Revised) � _ / J / `�.: '1 `) �-~I 1 ,r DAVIE COUNTY HEALTH DEPARTMENT D �n 2 Environmental Health Section V E PO Box 848/210 Hospital Street 0 Mocksville, NC 27028 D EC - 7 �Uli Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWE LING �� oa iE COUNI HEALTH (Check One) REPLACEMENT ❑ REMODELING Z RECONNECT ❑ � Number: ��6 '// ��7D�vC - (Home) ` .?' 07.3/ (Work) Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under:I 4- D,,,, `J AA"i �1" Type Of Dwelling: Az h- l� Date System Installed(Month/Day/Year): Number Of Bedrooms: o Number Of People:_ Is The Dwelling Currently Vacant? Yes ❑ No � If Yes, For How Long? Any Known Problems? Yes ❑ No 2'*'- If Yes, Explain: Please Fill In The Following Information About The New Dwelling. I Type Of Dwelling: �� M*r Number f Bedrooms: Number Of People: 7 Requested By: (Signature) For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Comments: /1 i Requested: Environmental Health Specialist Date I"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 ❑ _Check 451Gloney Order ❑ # Do . •-0 Paid By: �-- - / J Received By: Cb" - Account #: 8!:z 0 Invoice #: S(Y" 0 SPS OUNTY HEALTH DEPARTMENT L (S tic Tank) Improve nts Permit and Certificate of Completion �' (Ground A orption Sewage Dispo al System - G.S. Chapter 130- rticle 13C) OWNER OR CONTRAC r t ,,� DATE .2 7�% PERMIT LOCATION P 1 �1 e k, ` ,r N? 13'7 5 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. ./ ,. HOUSE P MOBILE HOME 211 BUSINESS NO. BEDROOMS 2 NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE 4140 YES [3 NO ❑ SIZE OF TANK .gal. NITRIFICATION FIELD (#vOQ sq. ft. DEPTH OF STONE IN LINES: 4w,,Iave4 WATER SUPPLY: Individual ❑ Public ❑ IMPROVEMENTS PERMIT BY qb-f- � I House Trailer 800 Gal. Two Bedroom House 800 Gal. Three Bedroom House 900 Gal. Four Bedroom House 1000 Gal. '(:.n F To ?WA,4i1 INSTALLED BY AV aA h— - 400 Sq. Ft. 600 Sq. Ft. 900 Sq. Ft. 1200 Sq. Ft. CERTIFICATE OF COMPLETION By i p Date "Izwl%' (8/16/73) *Construction must c mply with all other applicable State and local regulations LOT AREA X01 'rU �•t X01 'rU