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163 Windy TrailDavie County, NC ' Tax Parr.e.l R ennrt Tuesdav. October 11. 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: B30000001901 Township: NCPIN Number: 5813651037 Municipality: Account Number: 15110000 Census Tract: Listed Owner 1: CHILDRESS BOBBY GRAY Voting Precinct: Mailing Address 1: 163 V1/INDY TRAIL Planning Jurisdiction: City: MOCKSVILLE State: Zoning Class: NC Zoning Overlay: Zip Code: 2702&0000 Voluntary Ag. District: Legal Description: 1.012 AC OFF CHINQUAPIN RD Fire Response District: Assessed Acreage: 1.01 Elementary School Zone: Deed Date: Deed Book / Page: Plat Book: Plat Page: Buiiding Value: Land Value: Totat Assessed Value: ° �%'�' Davie County, ���N�� NC 10/1986 Middle School Zone: 001330620 Soil Types: Flood Zone: Watershed Overlay: 131260.00 Outbuilding & Extra Freatures Value: 10360.00 Total Market Value: 145740.00 Clarksville 37059-801 CLARKSVILLE Davie County DAVIE COUNTY R-A COURTNEY WILLIAM R DAVIE NORTH DAVIE MnC2,MnB2 DAVIE COUNN 4120.00 145740.00 No :; y�. -� +� , . , ' ,`' ';1;,�. • j'r1•``� ti.,%./'1�-- -. . ' ' . . ' - � _ �,.� • .; � , '• ; � :.�y �_ �4� ��l�:�s T:n � �. ;f �w,.��t� �� . ( '4'�y�,.r,�I�.r� s •• � �} � • �D�AVI!G• � • • • '- .�� . "�.,. _ ��_ _. . ... . _ � . CO:UNTY .H�EALTH: :D:E�PARTME�NT . _ r � �, ,wa . . • . . •/b u� - . .' .. . . •. _ . .. . . ���'�. „- :,�,: �i'IM;PR:OVE-M�ENTS P;ERM°IT. �AND� CE�RTIFICATE �OF �C:.OMPLE,TI.O;N ��- �. 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' . ,. � . . � . � , i • . . � � . - . • •.. :: I • • . • ' . . � , , , • , • . I . � �• • ' • .. ' . . ' ' . • • _ ' • • . � � �, . . :I ' � � . ' ,' . , . '�'` ' .. • . ' • + �r � � '. i ,� . , ... , . 1 . , .. , • ,' ' .. .'� .. - ,� • , .. . . . �• . '� , r ' � . i . ' , - . . . • • ' � , . . � . . . . . .I, ' � • + , ' • . � � � � � • . � . , .... i' . ' . -�. . . . • . . . ' • . . ' • . . '_ ' : . � . • : ' � � • � � •Cert�i.ficafe:of+Com�'I`etion � • �� Date���� I •��� � r •. � ' . - _._. _..----.. _.. ._ _..._,P_. �• -- - _.. _. ...._ _.. _.. . :- -•- . • . . '. - - - •� � • . . , . . . . . � ' "'The sign�ing;.gf't�h�'i.'s�,certi�fi`cate: sha�ll; indi.cate+t�hat�the-:s.ystern��d�es.c-,rib.e.d,�ab•.ove� has �be:en•;insta�lled:.in �c�omp�lian.c�e��with�. � � �� :t�h."e:,�stan.d`a�rds,:set:f�orth.in�the:�a`b:ove�'regufat�ion,;,;b.ut��shall�in..NQ wa,q�b�e;t�aken as;a g.uaranteTe'that�:the.s_y.stem��w;jl�f�unction, • ! s.at�isfa�cto:ri;l',y�•.f.o�r��a�n.y�;g:iven�:pe:ri:o:ci�of�timea.. . . •� . � �� � • � � - • • , � . •,• s . � . . � �I. . - . , . . � .. , � � . , . _ .� . � , . � . � : � . � . �.. •. . � . . ' � �..•��:���� . �. ' r . . , , APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ; Davie County Health Department �� ;� �i_A � � ; ` Environmental Health Section W°�����' +`a?3 f' ;�� ���t�� ', P. O. Box 665 � Mocksville; N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HA BE N ISSUED. q l `f� 4 Home �h ne � G a�� :S .� % 1. Permit Requested By % �j��2���� �� �� <��` .�"'e �� Business Phone ���`6 � �',�2y�? 2. Address %� � �� �'-� CZX ��� v ,�d. 7�' �-`� 3. Property Owner if Different than Above Address � 4. Permit To: a) Install� 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 '�s Industry Other 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) 1 dCj �� j 7. Number and type of water-using fixtures: commodes � urinals garbage disposal lavatory � showers �, washing machine � dishwasher sinks � ,j 8. a) Type water supply: Public Private� Community b) Has the water supply system been approved? Yes No� 9. a) Property Dimensions -'� ���`�� l b 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? �Li/'� What type? This is to certify that the information is correct to the best of my knowledge. � �� f �`� `� - �-� � i3 � �% . �. � �� � Date Owner Signature 1�� OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 0 1 �� �� ���, � � � _ , � � � �,,,� � �� � `�` �� � � � �<� �. �, � , � -e �C � � � �" � �-�-' ' � �' ' � �d� }�, .-a �`w�r-i�� �� Y ` 1,��- � � � � �. � `• 1,�,,� ,� 1 � � � 1 � ��'' � � � ���- � �?U �� � � �° -� - �- --_-_��-�--�-�- � F1U J � ��U� � �� ;�� �-�� �. _ _-----' � .� .�► �� � , �� DCHD (6-82) � S��s . '4 � . '� , Name � ��� 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) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION \ \ � '(� 'QS � � Y� 9) Site Classification U—UNSUITABLE Recommendations/Comments: Described by SITE DIAGRAM DCHD (6-82) PS �P � U .� U � U PS U �. U S PS U S—SUITABLE Title AREA 2 � U �P,SI U R�S� U �� U � U �/ U � S � S PS U Date /�_ � J� � v` �" Lot Size � �'��- P� PS � U � U �P.S� U � U ^ �I �� or Sr�J U S PS U PS—Provisional{y Suitable AREA 4 S PS U S PS U S PS U S US PS U S US PS U S PS U Date �� � + � .�N � � , , , .:�-,�-.4 � Mailing Address:. Directions To /'1. , �_1, . ProPerty VIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 C'�E � . �,�� � SeF� `�'�`� . L�SITE WASTEWA - R CERTIFICATION FOR DWELLING �) REPLACEMENT REMODELING o RECONNECTION o ,/r .ys, ,r �". �� r rG /'��S Phone Number: `7'1�� �"C!l / � � (Home) r r.. . f �'�d c _ I � �y� _� (�, i�� �i C�t �/ �ork) j �� ���`L Z 7 G' �? c�i :� �l �' • i , � � ���� < � ti �!3'1 � ��.1�� � � a � � .. _.�.- ✓1'1 / Please Fill I The Follo ing Information About The Existing Dwelling. Name System �lled�Un� . ��i.���i f��d r/L..� %-C� �.� T Of D llin •� �`��° f� . —� Date System Installed(Month/Day/Year) Is The Dwe}ling Currently Vacant? � �� YPe we g. Of Bedrooms:��Number Of People:,�_ No ❑ If Yes, For How Long?. Any Known Problems? Yes ❑ No If Yes, Explain: Please Fill In The Following Information About The New Dwelling: � � Type Of Dwelling: (�' ��� " Y Number Of Bedrooms: � Number Of People: ,� ,. ��' l� / �/ Requested By: For Environmental Health Office Use Only r'` Approved CY Disapproved ❑ , r,,..,.,,o,,,-c. � n �� � : . 1 Environmental Health � Requested: - � -�a%�- '"�The signing af this form by the Environmental Health Staff is in no way intended, nor should be taken as a �uarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash ❑ Check ❑ Money Order �# Amount: $ Date: Paid By: Received By: Account #:�� �'i Invoice #: � �• , ^ '� y��� ; � ; . (`�l � `� �� � �__ � �l l �. Account #: 990005069 Billed To: Bobby Childress Address: 163 Windy Trail City: Mocksville Reference Name: Voided Application no call back Proposed Facility: Residence 0 '� .� � �'V / 1 � � � � ;. ��� s..,�,�� ,���'�ic: _ i Tax PIN/EH #: 5813-54-8799 Subdivision Info: Location/Address: Windy Trail-27028 Property Size: 6.59 Acres � ���� `,�� f i� � s �, � _ _ �,