482 Will Boone RdDavie County, NC Tax Parcel Report Tuesdav, October 1 l. 2016
wAxlvuvc�: i�s is NOT' A SURVEY
Parcel Information
Parcel Number. K50000006901 Township:
NCPIN Number: 5747900828 Municipality:
Account Number: 8304465 Census Tract:
Listed Owner 1: KOKOSZKA LORY Voting Precinct:
Mailing Address 1: 482 WILL BOONE ROAD Planning Jurisdiction:
City: MOCKSVILLE Zoning Class:
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag. District:
Legal Descriptlon: 1.000 AC WILL BOONE RD Fire Response District:
Assessed Acreage: 0.95 Elementary School Zone
Deed Date: 12/2014 Middle School Zone:
Deed Book 1 Page: 009750654 Soil Types:
Plat Book: Flood Zone:
Plat Page: Watershed Overlay:
Building Value:
Land Value:
Total Assessed Value:
9A"'� F Davie County,
�o��,�� NC
128850.00 Outbuilding & Extra
Freatures Value:
14540.00 Total Market Value:
143870.00
Jerusalem
37059-807
JERUSALEM
Davie County
DAVIE COUNTY R-A
JERUSALEM
CORNATZER
WILLIAM ELLIS
Ce62
[J_1�11�KilIP.��'/
480.00
143870.00
No
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' ``, �._��%=� . DAVIE COUNTY HEALTH DEPARTMENT .�i
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� _ ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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*NOTE: Issued in Compiiance with G.S. of North Carolina Chapter 130 Article 13c
, " Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name�P�� ,��/�..i,• .�/'��c`'xr/�ST A1.�����Date � �/S,�� "���� �����
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Location �r/. � //'�''�f /�C. �i�a1...! ��' �%r .�i �i �/YJ /�'/. i .J.��/
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Subdivision Name Lot No. _ - - Sec. or Block No.
Lot Size� ��� House Mobile Home � / Business Speculation
No. Bedrooms � No. Baths�_ No. in Family � _
, Garbage Disposal YES �❑ NO p�
Specifications for System:
Auto Dish Washer YES ❑p NO ❑ � �O -�c�r
Auto Wash Machine YES [�j NO � �D���r`."�
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Type Water Supply � � _ ���x�^��
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� *This permit Void if sewage system des�ri ed�elow is not installed within 36 months from date of issue.
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Improvements permit by �`j'���
*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 � completion. Telephone Number: 704-634-5985.
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Final Installation Diagram: ` '"D System Installed by �� �°5��'r ��� � �a
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� Certificate of Completion - " ate �`f—y ��
'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.
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'� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
� Davie Count Health De artment
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,/� Environmental Health Section !�
P. 0. Box 665 GG��y`
Mocksville, N.C. 27028 �`
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit F
2. Address
3. Property Owner if Different than Above _
Address —��� �� ��' '�
4. Permit To: a) Install� Alter Repair
b) Privy Conventional Other Type
Ground Absorption
Home Phone � � / Z
Business Phone — -� "�
� %Q � r�'" �'X •'` a�0'�"
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home�Business
� Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions � L� X�� n
Bed Rooms� Bath Rooms_� Den w/Closetl�
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 urinals �
lavatory showers
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dishwasher sinks ?
garbage disposal
washing machine %
8. a) Type water supply: Public_� Private Community
b) Has the water supply systelntbeen approved? Yes� No
9. a) Property Dimensions
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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? f�
What type?
This is to certify that the information is correct to the best of my knowledge.
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Date Owner Signature
OWNER IS SOLE[.Y RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
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Address
1) Topography/Landscape Position
2) Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
3) Soil Structure (12-36 in.)
Clayey Soils
4) Soil Depth (inches)
5) Soil Drainage: Internal
External
6) Restrictive Horizons
7) Available Space
8) Other (Specify)
9) Site Classification
U—UNSUITABLE
Recommendations/Comments:
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Described by —����
SITE DIAGRAM
UCHD (6�82)
S
�
U
S
PS
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S—SUITABLE
EA 2
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
Date � �/ ��
Lot Size � �, ,��
EA 3
S
US
S
US
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
PS—Provisionally Suitable
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AREA 4
S
US
S
PS
U
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
S
PS
U
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� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME �G�%� i � //�/��'� PHONE NUMBER : �ci��'��� ����
ADDRESS ��� �/��i�����c�' SUBDIVISION NAME .
�/�%���/s��//� i'r/�-o2�0��
SUBDIVISION LOT #
DIRECTIONS TO SITE G� /S �•a�4d�l�n /'�!. O� L
l/(/��! �,��%l e %t�d . � � �iN/ `���//!< ��e i�- %� �i? .�,
I DATE SYSTEM INSTALLED.
I NAME SYSTEM INSTALLED UNDE
I SFECIFY PROBLEMS OCCURRING
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IDATE REQUESTED ������
NFORMATION TAKEN BY �i"/� I