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550 Danner Rd (2)Davie County, NC I Tax Parcel Report t'a o q V4 — ( Monday, October 3, 201 c WARNING: TH15 1S NUT A SURVEY - ---- --- - - - -- 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 �T County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to 1� �oUty c' C or arising out of the use or Inability to use the GIS data provided by this website. -11 Parcel Information Parcel Number: F400000006 Township: Clarksville NCPIN Number: 5820689073 Municipality: Account Number: •8300344 Census Tract: 37059-801 Listed Owner 1: GAGNIER JANE B TR REV LV TR'OF Voting Precinct: CLARKSVILLE Mailing Address 1: 550 DANNER ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-5727 Voluntary Ag. District: No Legal Description: 16.0 AC DANNER RD - Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 16.00 Elementary School Zone: WILLIAM R DAVIE Deed Date: 4/2011 Middle School Zone: NORTH DAVIE Deed Book / Page: 008570558 Soil Types: PcC2,RnD,ChA,CeB2 Plat Book: 10 Flood Zone: Plat Page: 327 Watershed Overlay: DAVIE COUNTY Building Value: 426870.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 119100.00 Total Market Value: 545970.00 Total Assessed Value: 448700.00 - ---- --- - - - -- 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 �T County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to 1� �oUty c' C or arising out of the use or Inability to use the GIS data provided by this website. -11 Phone: (336) - 753 - 6780 Davie County Health Department Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksvillc, NC 27028 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection a lN�rot., ?6A, L Wo - Name: !�/ tO 1V Phone Number & ' L�7 -7 - 7 66y ss (Ret e}- Mailing Ad ress: p' (� j�3 � �` e �. ( b 7 -101 RSw (Work) ^ Detailed Directions To Site: �. V 1 Voetlk Y, l Q vl OCLV% eA R-Cfc_�p1 VYl l I � i - Property Address: jam© Q vX n e(' M DG kg� tr' N L Please Fill In The Following Information About The EXISTING Facility: r Name System Installed Under: Jam' )4c-j�t N i E P Type Of Facility: IYV '!✓ Date System Installed (Month/Date/Year): Is The Facility Currently Vacant? Yes Any Known Problems? Yes No Number Of Bedrooms No If Yes, For How Long? If Yes, Explain: Number Of People: Please Fill In The Following Information About The NEW Facility: Type Of Facility: I t1J R r -n ti n nQ 'p eo L Number Of Bedrooms: ^ Number of People Pool Size: / ki� K : (o Garage Size: Other: Requested By: Date Requested: "d ^ I5 (Signatur Approved Disapproved For Environmental Health Office Use Only - /- Comments: ! Ji 11-e 9 `.A n [..' LJ - 20 1t I� !' XQ / / s•.-�. O(?v / Environmental Health Specialist Date: 7'— -2 ` i *The signing of this form by the Environmental Health Staff is in 6o 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 # Paid By:_ Account #: Received By: Invoice #: CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 120966-1 rte' Davie County Health Department County ID Number: F400000006 210 Hospital Street Evaluated For: NEW •��. P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 1/ 0 1/ 0 0 0 6 Applicant: Thomas T. Gagnier Address: 3556 Piedmont Rd. NE / Apt. 403 City: Atlanta State/Zip: GA 30305 Phone #: (813) 523-1165 �ddress/Road #: Subdivision: 550 Danner Rd Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: NEW WELL Property Owner: Thomas T. Gagnier Address: 3556 Piedmont Rd. NE / Apt. 403 City: Atlanta State/Zip: GA 30305 Phone #: (813) 523-1165 Phase: Lot: Directions 601 N Turn right on Danner Rd. 1 mile property on right at smail white house Minimum Trench Depth: 4 \ Site Classification: Ps Inches Saprolite System? O Yes X No Minimum Soil Cover: Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: a 7 5 Maximum Soil Cover: Inches *System Classification/Description: "Distribution Type: GRAVITY - SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)k, *Proposed System: 25.1. REDUCTION Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: Septic Tan . 1 0 0 0 Gallons 1 -Piece: O Yes ® No Pump Required: O Yes ® No Q May Be Required Sq. ft. Pump Tank: Gallons 1-Piece:OYes ONo 3 .1 8 ft GPM --vs-- ft. TDH 9 Q Inches O.C. O Feet O.C. Dosing Volume: _ Gallons 3 6 ® Inches O Feet Grease Trap: Gallons inches Pre -Treatment: O NSF OTS -1 OTS -11 / Septic Tank Installer Grade Level Required: 01 OII 0111 01V Page 1 of 3 CDP File Number 120966 - 1 I *Site Classification: Ps F400000006 County ID Number: Required: (&Yes ONO O No, but has Available Design Flaw: '� F pl Soil Application Rate: ) 5 *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Sq. ft. ❑ Open Pump System Sheet Trench Spacing: 9 O Inches O. ® Feet O.C. Trench Width:3 6 O Inches Feet Aggregate Depth: inches Minimum Trench Depth: Inches Minimum Soil Cover: a 4 Inches Maximum Trench Depth: Inches Maximum Soil Cover: 3 6 Inches *Distribution Type: GRAVITY - SERIAL Total Trench Length: 3 6 0 ft. Pump Required: OYes ®No OMay Be Required Pre -Treatment: O NSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be issued at the same time the Improvement Permit issued (NCGS 130A336(b)). If the Installation has not been completed during the period of validity of the Construction Permit, the Information submitted In the application for a permit or Construction Authorization is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2244 - Daywalt, Andrew Date of Issue: 0 4 / 1 8 / a 0 1 3 Authorized State Agent: Malfunction Log Oyes Hand Drawing O Import Drawing Total Time:(HH:MM) **Site Plan/Drawing attached.** 1 Hours 0 0 Minutes Page 2 of 3 S-8 - CA'S issued - new CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 120966 - 1 County File Number: F400000006 Date: 04/ 18 /,2013 Q Inch Scale: O Block Q N/A 110 a WT [ �QA ` 3 (ice —1 Page 3 of 3 P1 P2 k%\ CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 120966 - 1 County File Number: F400000006 Date: .0.4./ 18 / .2 0 13 Click below to import an image from an external location: Drawing Type: Construction Authorization Page 3 of 3 P1 P2 OPERATION PERMIT 10 Davie County Health Department �1 210 Hospital Street • P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Thomas T. Gagnier Address: 3556 Piedmont Rd. NE /Apt. City: Atlanta State/Zip: GA 30305 Phone #: (813) 523-1165 In Address/Road #: Subdivision: 550 Danner Rd Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: NEW WELL *IP Issued by: 2244 - Daywalt, Andrew *CA issued by: 2244 - Daywalt, Andrew Design Flow: Soil Application Rate: i I --or umce use umy *CDP File Number 120966 - 1 F400000006 County ID Number: Evaluated For: NEW Township: /"Property Owner: Thomas T. Gagnier Address: 3556 Piedmont Rd. NE / Apt. City: Atlanta State/Zip: GA 30305 hone #: (813) 523-1165 Phase: Lot: Directions 601 N Turn right on Danner Rd. 1 mile property on right at smail white house *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Saprolite System? O Yes (:K No *Distribution Type: GRAVITY -SERIAL Pump Required? OYes XNo *Pre -Treatment: lin field Nitrification Field Sq. ft. No. Drain Lines 4 Total Trench Length: 3 6 0 ft. Trench Spacing: 9 0Inches O.C. — ® Feet 0. C. Olnches Trench Width: — 3 ® Feet Aggregate Depth: inches Minimum Trench Depth: Inches Minimum Soil Cover: Inches Maximum Trench Depth: Inches Maximum Soil Cover: Inches Pagel of 4 *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Jaime Barnes Certification #: *EHS: 2325 - Mitchell, Brittany Date: A CDP File Number 120966 - 1 Manufacturer: Shoaf STB: Pump Tank Gallons: 1,000 Draw Down: Date: 0 6/ a 3/ a 0 1 3 *Filter Brand: Installer: ST Marker: ❑ Yes ❑ NO nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ NO F400000006 otic Tank County ID Number: Lat. Long: Installer: Barnes Certification #: *EHS: 2325 - Mitchell, Brittany Date: / / Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification #: *EHS: *Schedule: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Pump Type: Pump Tank - Draw Down: Manufacturer: *Chain: Installer: PT: ❑ Yes ❑ NO Certification #: ❑ Gallons: ❑ No Check -valve ❑ *EHS: ❑ Date: PVC Unions / Yes / Date: Vent Hole Riser Sealed ❑ Yes ❑ No ❑ Yes Riser Height: ❑ Yes ❑ No (Min. 6 in.) Approval Status. nforced Tank: ❑ Yes ❑ No ❑ ,Approved ❑ Disapproved 1 Piece Tank: ❑ Yes ❑ NO Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification #: *EHS: *Schedule: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Pump Type: Dosing Volume: - Draw Down: Inches *Chain: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ NO PVC Unions ❑ Yes ❑ No Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ NO Installer: Gal Certification #: *EHS: Page 2 of 4 Date: / / Approval Status Approved ❑ Disapproved CDP File Number 120966 - 1 County ID Number: F400000006 Electric Eauioment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ NO Certification #: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ NO *Activation Method: Date. Approval Status Alarm Audible ❑ Yes ❑ NO `❑ Approved ❑ , Disapproved Alarm Visible ❑ Yes ❑ No 2325 - Mitchell, Brittany *Operation Permit completed by: Authorized State Agent: Date of Issue: 1 0/ 3 0/ 2 0 1 3 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A. 1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE II A. sewage septic system. Rule .1961 requires that a Type TYPE II A. septic system meet the following criteria: Minimum System Review By The Local Health Department: NSA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator: NSA Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Activity Code: S-19 2Q4 - OP issued NEW Type II Quick 4 Page 3 of 4 Total Time:(HH:MM) a Hours 0 Minutes OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit �g Sg �I � r St lot R� r sL Q, -Pn Page 4 of 4 P1 P2 P3 CDP File Number: 120966 - 1 County File Number: F400000006 27028 Date: / / O Inch Scale: O Block n N/A POOL LAYOUT A CUSTOM POOL FOR: SHEET TITLE: REVISIONS COPYRIGHT THE ESI: THE THE DESIGN PROP ADI POOL AND SPA THE GAGNIER RESIDENCE PROPOSED POOL D7HERINSPA HE ARE THE PROPERTY OF ADI POOL AND BPA TY (AQUATIC DESIGNS, INC.) THE (AQUATIC DESIGNS, INC.) REPRODUCTION, COPYING, OR USE OF THIS DISTINCT POOL AND SPA CONSTRUCTION 550 DANNER ROAD LAYOUT DRAWING AND DESIGN WM40UT CONSENT OF ADI IS PROHIBITED AND ANY 6328 MONNETT RD, P.O. BOX 327 CLIMAX NC 27233 / NfOCKSVILLE, NC INFRINGEMENT WILL BE SUBJECT TO LEGAL (336) 674-7665 L- ACTION 70 THE FULL EXTENT OF THE LAW. WWWADIFOOLS.NEI N' J TRACT 1 PB 10 PG 327 TRACT 2 217' 44' POOL HOUSE J W I)ANNERRONo POOL LAYOUT A CUSTOM POOL FOR: SHEET TITLE: COPIRIGNT STATEMENT: REVISIONS THE DRAWINGS AND TE DESIGN TERN ADI POOL AND SPA ARE THE PROPERTY OF ADI POOL AND SPA THE GAGNIER RESIDENCE PROPOSED POOL (AQUATIC DESIGNS, INC.) THE (AQUATIC DESIGNS, INC.) B 1 REPRODUCTION, COPYING, OR USE Of THIS DISTINCT POOL AND SPA CONSTRUCTION - - 550 DANNER ROAD LAYOUT OF ADI µES DESIGN PPRIBNEEDOUf*0 ANY 6328 MONNETT RD, P.O. BOX 327 CLIMAX NC 27233 INFRINGEMENT WILL BE SUBJECT TO LEGAL (336) 674-7665 MOCKSVILLE, NC ACTION 70 THE FULL EXTENT OF THE LAW.-ADIPOOLS.NET