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187 Serenity DrDav !016 161 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 NC or arising out of the use or inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: J100000048 Township: Calahaln NCPIN Number: 4798818658 Municipality: Account Number: 8300195 Census Tract: 37059-801 Listed Owner 1: HOCHSTEDLER DALE Voting Precinct: SOUTH CALAHALN Mailing Address 1: 187 SERENITY DRIVE 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: 25.403 AC SERENITY DR Fire Response District: COUNTY LINE Assessed Acreage: 25.23 Elementary School Zone: COOLEEMEE Deed Date: 3/2011 Middle School Zone: SOUTH DAVIE Deed Book / Page: 008540741 Soil Types: PcC2,CeB2,WATER Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 26360.00 Outbuilding & Extra Freatures Value: 10120.00 Land Value: 121370.00 Total Market Value: 157850.00 Total Assessed Value: 157850.00 161 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 NC or arising out of the use or inability to use the GIS data provided by this website. Davie County Health Department � 18 t� F� onmental Health Section : - r. E C t P.O. Box 848 n JUN n 9 2011 210 Hospital Street O U 1A Courier #: 09-40-06 1911 L Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection Name: L it '6 No =� 5te_ 8 I Phone Number 3 Mailing Address: 1$7 Se r eh y Dr. 2\7- 8"VU -- 22 2 2 3 cell (Work) �1flodcsyJ)e %UC 2702 d Email Address: AAAaA3(.56'ctf'a.a-e.T" Detailed Directions To Site: Y hte CSrta �"e �Ci W� .54- "j'D -ex "(% b — �i .7 �� 9h 1- iso �4ci u �u S�r Cho 9w%k, IKhumeijWl bih R',Aj'. RA, �+bl G, ",f NAJe. 4V"h Le - `j- C rest o-,�- m.le , 4-u rr, 1e( -i- Safev6+y Dr. -- 90 5-+rzi,5h* -k- eJ, rF (4►ne, Property Address: 1g7 .Sereh.+y lir, ilocksv;lle A1C 2762S / Please Fill In The Following Information About The EXISTING Facility: `) Name System Installed Under: ;A6 aType Of Facility: 1��//� fldme ,DID Date System Installed (Month/Date/Year): bQN Number Of Bedrooms:_ Number Of People: ll Is The Facility Currently Vacant? Yes' No If Yes, For How Long? Any Known Problems? Yes ; No If Yes, Explain: Please Fill In The Following Information About The NEW Fa�;lity� FmJb�lj Type Of Facility: Cf Q f /f�/ Nu el Of Bedrooms: Number of People Pool Size: Garage Size: Other: )kequested By: - Abate Requested: q:: (j c R a D I (Signature) C:,,_,.�..._� For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist. Date: *The signing of this form by the Environmental Health Itaff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash (SLecV Money Order # ZQJ'0 Amount:$ /U U • U U Date: V.1 `%1/ / Paid By: , lloa 5fa.d l e I - Received By: J6 [0' &"e_ L Account #: f�(Q Q Invoice #: r I 1 8 3 %A DAVIE COUNTY HEALTH DEPARTMENT����� ry Environmental Health Section PROPERTY INFORMATION � P.O. Box 848 G1STZ; Mocksville, NC 27028 Subdivision Name: jftLO � ` Phone # 336-751-8760 l(�-1"Section: Lot: to propert' AUTHORIZATION FOR IVa', t— o� f e'? r WASTEWATER ��� tY�� YSTEM CONSTRUCTION Tax Offic^e-7PIN:# f7 _ Ti7f1, �J Dry .� t-iy+�F-� r y� u�D Road`Name: 1 'tY�Zip; L -%G%', *'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 Qavie County Building Inspections Office when applying for Building Permits. (Inco iaitcle 1�f C S �hapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER Z It D IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No / "Zo / LOT SIZE TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW (GPD) s TD NEW SITE REPAIR SITE - 7 N 1 SYSTEM SPECIFICATIONS: TANK SIZE �G_AL. PUMP TANK ^� GAL. TRENCH WIDTH 34' ROCK DEPTH Z LINEAR FT. c l_ t 1 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: LISTA L -L' d" IMPROVEMENT PERMIT LAYOUT *APPROVED, I I)PICA ISER(S) IF 6*' BELOW FINISHED ERADE* ExlSll^Ib —�,rs� `It 1,21 I.}�si; � c►.Vv3cx � Lk Z2- 1 iOl%1 �)3, ���pLtD VaQ� **CONTACT A REPRESENTATIVE OF THE DAVB?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) 634f WA(t X X X XX OPERATION PERMIT - SYSTEM INSTALLED BY. M1 i 4) J JI O 1 AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **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. DCHD 05/96 (Revised) _l n �o b ISER(S) IF 6*' BELOW FINISHED ERADE* ExlSll^Ib —�,rs� `It 1,21 I.}�si; � c►.Vv3cx � Lk Z2- 1 iOl%1 �)3, ���pLtD VaQ� **CONTACT A REPRESENTATIVE OF THE DAVB?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) 634f WA(t X X X XX OPERATION PERMIT - SYSTEM INSTALLED BY. M1 i 4) J JI O 1 AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **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. DCHD 05/96 (Revised) AUTHORIZATION No: i If I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee'sC4P.O. Box 848 Name,.* "C\N- 1 Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: uo -1c Section: Lot: AUTHORIZATION FOR L) 6.)WASTEWATER Tax Office PIN:# STEM CONSTRUCTION 'i0!.r Road Name:--Im, **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. (Incompl�iarice with Article 11 -G-S7Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems) I — / /.,, '57",.Qf ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED •_.__;,,; 1, /1- DAVIE COUNTY HEALTH DEPARTMENT ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION 7, '7.3 Permittee's2. t flame �~ (' (! ,t l ` 4 ` t Subdivision Name: Directions to property: k ) - i,..-� ¢ Section: Lot: r�,v IMPROVEMENT { �,.; Tax Office PIN:# P •�� i I... � '""'"`. PERMIT - - ( Road Name:, ame �. 4. �., r � � 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 TLIE SYSTEM. MAW RESIDENTIAL SPECIFICATION: BUILDING TYPE i 1 O tJ e # BEDROOMS # ELATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No �f 7 LOT SIZE TYPE WATER SUPPLY ELL- DESIGN WASTEWATER FLOW (GPD) 1 !D NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH J ROCK DEPTH LINEAR. ,�-'v (1Ti-1FR s=,.+ ��! rel 1 0,A %' 1, I l ..] �• J" l% '�f'LCJ REQUIRED SITE MODIFICATIONS/CONDITIONS: , t-\51-1% L_ L U -� C_e) r x1-o,)Q IMPROVEMENT PERMIT LAYOUT lr� Z i �17 .%APPROVED EFFLUS i rofcj� i Y I ;VII.fE_ ii ISE- R(S) IF 6" 13ELOr1 FIPJISHED GFAI3E.N K% I ,)b V, ab q 12-1 N **CONTACT A REPRESENTATIVE OF THE DAVIErCOUNTY 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) 634487150, X XXX X r-% St L-0 (336)751-8761 OPERATION PERMIT SYSTEM INSTALLED BY: � t ` A `A, � t52-tC�. 17 m H © oss S XA, ., 15b , g5, k �Z AUTHORIZATION NO. OPE ION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T E SCRIB OVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATME AND DISPOSALS STEMS", BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) !A 37 > AI�pp ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC,36�0-5 i ',----M lDavie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 -j (336) 751-8760 **IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. (Referto the INFORMATION BULLETIN for instructions. 1. Name to be Billed Da lI'� 1 e ®. O Ch s l'}'e A I e r /� contact Person ScLV ry Mailing Address '1626 3RD C(ZI:EK C1400i 2D Home Phone •76'-f - 02'/ 8 — 3 7`7 % city/state/zip CLEVEL AA/_D NC Q 7015 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC L9'Both 4. System to service: h" House ❑ Mobile Home ❑ Business ..��11❑ Industry ❑ Other 5. If Residence: # People _ # Bedrooms oL- # Bathrooms U Dishwasher ❑ Garbage Disposal L7 Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/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 k - Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? kIves O No If es, what 0 (11 ma h r Y h'Pe'• t�dd 3 new be�cooNns -� 1 bntlnc'oorn . � I a be�.rco�us co�yeri -b I• ,roovkt- h'o646I,% ,, A Add, dtskwasher . May putt basement knder Neta par+ l+ pessrble, ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: 126' x 831,?7 x 1877 x 5& Tax Office PIN: 14'7 C! :2 " � I - q (a S `� Property Address: Road Name 187 S FREIE iT Y D2, City/zip Mo C KS V ► LL F -176.287 If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: :L -Yo wr-s r -h eXrF 1 rvi-le -it R'Age Ka • 6o rlori K'41 delve -it Cre-sceni+ Dr. b!, S'frou� Su�Stgiiovl lura left Aev a-6 Cres�'ftT17f�' p �!� ►hite -fur,\ Jef a'-io SCreNl +% Dr t block A O to s��nall Jo 4 wh"Jz house Date Property Flagged: o;� old {ars^^ 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. I, 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 to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE U& 0, THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). It's Si.. r -1 q Revised DCHD (07/99) pi, laic, w4 I rl Site Revisit Charge LY Date(s): Client Notification Date: EHS: Account No. l .� Invoice No. 2 2, bid tih r � yLdeC —�O 3 Yes CO v-� V�P wj; h Yla`*A ,<7 TJ� f / .v �1 [ ic) I �G W —�O 3 Yes CO v-� V�P wj; h Yla`*A ,<7 TJ� S i-�2. P ��h Bale �oci, s�ed`er. I$7 Se-revx%-�, Dt- jy)ocksW',lle me g7oa,S-) N ?6�- `19.- -L-S`fo -1-6, W DCub1eW, �e