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134 Lakeside Drive Lot 2Davie County, NC ' Tax Parcel Report 254 Thursday, January 5, 2017 Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: WARNING: THIS IS NOT A SURVEY Parcel Information E8110B0011 Township: Shady Grove 5881045982 Municipality: 8301128 Census Tract: 37059-803 IVEY PHILIP ALLEN Voting Precinct: EAST SHADY GROVE 134 LAKESIDE DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R-20 NC Zoning Overlay: 27006 Voluntary Ag. District: LOT 2 GREENWOOD LAKE Fire Response District: 1.34 Elementary School Zone: 6/2012 Middle School Zone: 008930108 Soil Types: 0003 Flood Zone: 053 Watershed Overlay: Outbuilding & Extra Freatures Value: ADVANCE SHADY GROVE WILLIAM ELLIS GnB2 DAVIE COUNTY No Land Value: Total Market Value: Total Assessed Value: 91v I� 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 moo Tyra N`'�r or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department v Pts t� Environmental Health Section , "i P.O. Box 848 L 0 -L ,;�`;� 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 751-8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: p m 1 u= V F i Phone Number 9 4 4 g (Home) Mailing Address: i 3 Li L A k E 510 4— Q E. 5 n Z -$ 5 9 Z[$ E-5 [ )(Work) [40VAtu j. C. 2.?OUu Email Detailed Directions To Site: V tUa')'P-R- PR S S RO T O L A 1L E - S► Qk A R, © .v +r.H V40.4 s k- O iv R t Lx -H T Property Address: 39 L.Ak£S1Ori. / %} () VANCRc , tJ<<-_ 2_.? DOL Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: PA I -z V � I Type Of Facility: Date System Installed (Month/Date/Year): Number Of Bedrooms: 3 Number Of People: 3 Is The Facility Currently Vacant? Yes 10 If Yes, For How Long?. Any -Known Problems? Yes. 0 If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: QE.� �� � t Number Of Bedrooms: Number of People Requested By: Date Requested: (Signature) _ For Environmental Health Office Use Only Approved ` Disapproved Comments: Environmental Health Specialist %�dA )���L,�& Date: �-ZWZI*'7 *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 Money Order # Amount:$ Date: Paid By: Account #: Received By: Invoice #: DAVIE COUNTY ENVIRONMENTAL HEALTH 1 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR OPERATION PERMIT Account #: 990000693 Billed To: Philip Allen Ivey Reference Name: REPAIR PERMIT Proposed Facility: Residential Repair ATC Number: 5905 Tax PIN '/EH #: E8110B0011 Subdivision Into: Greenwood Lakes Lot # 2 LocationlAddress: 134 Lakeside Drive -27006 P(nperty Size: 1.340 Acres **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. Ir System Type: S.T. Manufacturer 6,4(Tank Date / Tank Size Pump Tank Size ,r Bedrooms 3 rj System Installed By::afif �1(6(1'1 �(Al1 ij Installer#: Date:-��d��� Environmental Health Specialist: Date:—��/���� DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990000693 Billed To: Philip Allen Ivey Tax PIN/EH #: E8110B0011 Subdivision Into: Greenwood Lakes Lot # 2 Reference Narne: REPAIR PERMIT Localion/Address 134 Lake ' Drive -27006 Proposed Facility: Residential Repair PropAFid i - OVs` 0`AN§ir ❑Expansion �,l**�Q Tom��,, ** Thi �horization to Construct (ATC) MUST BE ISSUED by the. Davie County Environmental eal�"Secfion pr9 or to -issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms 3 # Bathrooms ZL # People Basement asement plumbing2r Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size ? 4i�CoC�-�5 Type of Water Supply: County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)'(oOTank Size P �­ GAL. Pump Tank _A$GAL. r•e' 4 'Max.Trench Width ?U Trench Depth 3� Rock Depth Linear Ft. 3 2� ` An e.t<. ed h -i J_5A NCAC 18;x.1989(5"n � Site Modifications/Conditions/Other: , , : $ t t s;,".tt:na ; rw y also bo us a /� �Pd��e e/`� v Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. NO " �I pc cv�.•- Environmental Health Specialist Date: l� / DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR OPERATION PERMIT Account #: 990005847 Tax PIN/EH #: E8110B00l l Billed To: Johnny Dillon Subdivision Info: Greenwood Lakes Lot # 2 Reference Narne: REPAIR PERMIT LocationiAddress: 134 Lakeside Drive -27006 Proposed Facility: Residential Repair Property Size: 1.340 Acres ATC Number: 5905 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type: S.T. Manufacturer Tank Date Tank Size Pump Tank Size Bedrooms / System Installed By: Inspector#: Date: GPS Coordinate: Environmental Health Specialist: Date: DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH ` P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005847 Tax PIN.,EH #: E8110B0011 Billed To: Johnny Dillon Subdivision_ Info: Greenwood Lakes Lot # 2 Reference Name: REPAIR PERMIT LocationiAddress: 134 Lakeside Drive -27006 Proposed Facility: Residential Repair Propert..yy Size: 1.340 Acres Sife Type: ❑New XRepair ❑Expansion AT*1**%4q'ThiP9A'?Rhorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to.issuance of any building permit(s), (in compliance with Article I 1 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms 3> # Bathrooms # People Basementf4 Basement plumbingg Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 1.3 ho Type of Water Supply: fQCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD), (00 Tank Size K 'G'A?.Pump Tank GAL. Trench Width 3(p Max. Trench Depth 3 Rock DepthN/ff Linear Ft.3a a -7 i, st tc:3 in 1EF+ LI.0 1£3,1.190 5j"'' ���-!�,!!!''����"" a 5 e keC4 W_C_A - v Site Modifications/Conditions/Other: t 'ie vvL Contact the Davie County Environmental Hedlth Section for final inspection of this system 8:30 – 9:30a.m. on the day of installation. Telephone # (336)751-8760. Ne�s�5-tevr ay`�' �; r � �,�.d �xrs1•�� foc"l Environmental Health Specialist DCHD 11/06 (Revised) x241A i Date: '7' _h� —Ire _Uooice _(Ide)s Appraisal Card Page 1 of 1 HOLT BARRY WAYNE HOLT MARY KATHERINE Retum/Appeal Notes: E8-110-50-011 134 LAKESIDE DR UNIQ ID 7406 36607000 D144 -P17 ID NO: 5881045982 COUNTY TAX,FIRE TAX CARD NO. 1 of 1 Reval Year: 2009 Tax Year: 2012 LOT 2 GREENWOOD LAKE 1.000 LT SRC= Inspection Ap raised by 19 on 04/23/2008 03207 UNDERPASS TW -07 C- EX- AT- LAST ACTION 20100922 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE Foundation - 3 Eff. BASE Standard 10.22000 ontinuous Footing 5.0 USE MOD Area QUA RATE RCN EYB AYB CREDENCE TO MARKET ub Floor System - 4 01 01 3 159 113 177.9712SO80711987119721 N. GOOD 1 78.0 DEPR. BUILDING VALUE - CARD 195,630 -_ wood 8.00DEPR. TYPE: Single Family Residential Single Family Residential OB/XF VALUE - CARD 7,19 Exterior Walls - 21 MARKET LAND VALUE - CARD 47,50 Face Brick 34.0 STORIES: Ranch w/ basement OTAL MARKET VALUE - CARD 250,32 Roofing Structure - 03 Sable 8.0 TOTAL APPRAISED VALUE - CARD 250,32 Roofing Cover - 03 Asphalt or Composition Shingle 3.00 OTAL APPRAISED VALUE - PARCEL 250,32 Interior Wall Construction - 5 D wall/Sheetrock 20.0 Interior Floor Cover - 12 OTAL PRESENT USE VALUE - PARCEL Hardwood 10.00 OTAL VALUE DEFERRED - PARCEL Interior Floor Cover - 14 OTAL TAXABLE VALUE - PARCEL 250,32 aret 0.()(,+___24-_-_+__________60-------____+ PRIOR Heating Fuel - 04 1 U B M 1 U B M I BUILDING VALUE 187,32 OBXF VALUE Electric 1.0 1 1 I +---24----+ I Heating Type - 10 I I LAND VALUE 45,00 Heat Pump 4.00 I I PRESENT USE VALUE it Conditioning Type - 03 1 3 DEFERRED VALUE entral 4.0c 2 6 OTAL VALUE 232,320 Bedrooms/Bathrooms/Half-Bathrooms 5 I I I /3/0 16.00 I I Bedrooms I I BAS -3FUS -0 LL -1 +----------60-----------+ PERMIT Bathrooms CODE I DATE I NOTE I NUMBER AMOUNT BAS - 2 FUS - 0 LL - 1 OTAL POINT VALUE 1113.000 OUT: WTRSHD: BUILDING ADJUSTMENTS + 5 + SALES DATA ualit 3 AVG 1.000 +------40-------+FOP- -----39------+ ha a Desi n 4 FACTOR 4 1.050 i B A 5 = FF. INDICATE Size 3 Slze 0.950 RECORD DATE DEED SALES + - - - 2 4 - - I OTAL ADJUSTMENT FACTOR 1.00 1 F G D I I BOOK PAGE MO R TYPE /U / PRICE OTAL QUALITY INDEX 11 I I 3 0200 332 2199 WD U I 10900 1 I 6 0143 363 5 198 WD U I I 2 2 I 4 4 I I I I I I S +---24----+--21---+++++----30-----+ HEATED AREA 2,386 6PTO 6FOP4 +--21---+STP+ NOTES OWNER SUBAREA HUNIT UNIT PRICE I ORIG % COND BLDG#L/B AYB El ANN DEP RATE V % GOND OB/XF DEPR. VALUE GS ODE DESCRIPTIONLTH ON PAVING 5 2 1 32 1,20 512 4.0 37.4 30 _ _ L L 199 199 199 199 S 5 5 25 240 478 TYPE AREA % RPL CS 10 BAS 2 38 10 18603 8 POOL/VINYL FGD 576245 20194 TOTAL OB XF VALUE 7,187 FOP 35035 93 ,TO 126205 46 TP 53020 85 BM 2,424020 3781 FIREPLACE 5 4,500 SUBAREA OTALS 5,60 50,80 BUILDING DIMENSIONS BAS=W39FOP=N4WSS4E5$W45S11FGD=S24E24N24W24$E24S24PTO=S6E21N6W21$E21FOP=N2E553WSN1$STP=S5E9N4W2N3WSS2W2 E2N2ESS3E32N36$PTR=N20UBM=N36W60UBM=W24SIIE24N11$S36E60$S20$. LAND INFORMATION HIGHEST THER ADJUSTMENTS TOTAL NO BEST USE LOCAL FRON DEPTH / LND GOND AND NOTES ROA LAND UNIT LAND UNT TOTAL ADIUSTED LAND LAND SE CODE ZONING TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP A03ST UNIT PRICE VALUE NOTES FR RES 0100 1 0 0 1.0000 0 1 1.0000 47,500.00 1.000 IT 1.00 47,500.00 4750 1 1.00 OTAL MARKET LAND DATA 47,500 OTAL PRESENT USE DATA qq boo 6-�47 http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E81 I OB0011 W�W;5001 4/10/2012 -o DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME Hot+ OLJJAkl PHONE NUMBER Ll �h G k -P .S;J=e Q/ (y 61 DATE SYSTEM INSTALLED J-- NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING Ste, Q r`I"T DATE REQUESTED 4( ` Y- /.)- INFORMATION TAKEN BY V n6 1 Jc,'. 6 L This is to certify that the information provided is correct to the best of my knowledge, andjWl understand 1 am respo ole for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. if93 SSu 6J a�( LQC,v��Cvrj� VU 0t ��O✓\,a� �yOr�u�J. G O� GoMaps GIS Page 1 of 6 f http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=73662&CFTOKEN=10602933 4/9/2012 4 . 1 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed PML _T V,6,1 Contact Person �lhy1� Billing Address 319 6-06R C,ef.E,L 46 Home Phone 1750 498 -K9 19 City/State/ZIP Zg o o ce Business Phone Name on Permit/ATC if Different than Above, Address PKUPHKI'Y 1NP'UKMA'1'IUN *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name Phone Number Owner's Address /3 Y City/State/Zip Property Address /371 UP_ City d/JV.4Ne.,& Lot Size 1.31/0 Tax PIN# F 8 11 o 3 a o 1 t Subdivision Name(if applicable) 4,&k;Cs Section/Lot# 2 - Directions To Site: Rb / 70 VWAMPAss v N04�401)a51 7o 1 -Ake < end' If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes ❑No Does the site contain jurisdictional wetlands? ❑Yes ❑No Are there any easements or right-of-ways on the site? ❑Yes ❑No Is the site subject to approval by another public agency? ❑Yes ❑No Will wastewater other than domestic sewage be generated? OYes ❑No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:. ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: Q'County/City Water ❑ New Well 0Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C_lo If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the prover identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. r Site Revisit Charge Property owner's or owner's legal representative signature 1 0 tOL2 t 12 - Date Date(s): Client Notification Date: EHS: Sign given ❑Yes ❑No Account # O& ` 3 Revised 11/06 Invoice # r c ange. mile, _n 0 Fax TE WA ;), (in °.PERIOD OF FIVE YEARS.. edrooms " > # Ba' throoms Facility Type Ply: Pnj3 )-ital Street 7028;: 16)7531680 "- Taxa aalion PropE SUED plian( :EH f!.Infor idres�. SIZe. Type:. I the Davi vith Artie THL s subjec � People # People of Facility) :city/CityOWell Vol— Roc - Roc ;TRUCTION :811060011 3reenwood Lakes Lot # 2 , 34 Lakeside Drive -27006 1:340 Acres� New MRepair QExpansion " County Environmental 1I of 0,S. Chapter 130A AUTHORIZATION TO to revocation if site`plans, 'plat Environment 3 DCHD 11/06