116 Guinevere DrOPERATION PERMIT
Davie County Health Department
t to 210 Hospital Street
` P.O. Box 848
r
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Frank Earnhardt
Address: 116 Guinevere Lane
City Mocksville
State2ip: NC
Phone #: (336) 284-2640
`CDP File Number 120714-1
M510OA0015
County ID Number:
Evaluated For: REPAIR
�ownship:
//Property Owner: Frank Earnhardt
Address: 2086 Junction Road
City: Mocksville
State/Zip: NC
Phone #: (336) 284-2640
Property Location & Site Information
r
Address/Road #: Subdivision: Phase: Lot:
116 Guinevere Drive
Mocksville NC 27028 Directions
Structure: OTHER Hwy 601 S. Right onto Hwy 801 Right on Guinevere
# of Bedrooms: 3 Lane, on corner
# of People: 4
'Water Supply: PUBLIC
'IP Issued by.
'CA issued by:
Design Flow: 3 6 0
Soil Application Rate: 0 3
Nitrification Field
No. Drain Lines
Total Trench Length
Trench Spacing:
Trench Width:
Aggregate Depth:
1 S A ft.
'System Classification/Description:
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? O Yes (2)No
'Distribution Type: GRAVITY - PARALLEL (eq. d -box) Pump Required?
OYes QNo
'Pre -Treatment:
Drain field
Sq. ft.
8 lnches O.C.
Feet O.C.
Olnches
()Feet
inches
Minimum Trench Depth:
Inches
Minimum Soil Cover.
Inches
Maximum Trench Depth:
Inches
Maximum Soil Cover:
I',— Inches
'System Type: INFILTRATOR QUICK 4 STANDARD
Installer: roge,t Spillman
Certification #:
'EH S: 2140 - Nations, Robert
Date: 0 8/ 0 8/.2 0 1 4
Approval Status
D Approved O Disapproved
CDP File Number 120714 - 1
Manufacturer.
STB:
Gallons:
Date:
*Filter Brand:
ST Marker: ❑ Yes ❑ No
Reinforced Tank: ❑ Yes ❑ No
,,.,,—Piece Tank: ❑ Yes ❑ NO
Manufacturer.
PT:
Gallons:
Date:
/
/
RiserSealed ❑
Yes
❑
No
Riser Height: ❑
Yes
❑
NO (Min.6 in.)
einforced Tank: ❑
Yes
❑
NO
`1 Piece Tank: ❑
Yes
❑
No
Pipe Size: inch diameter
Pipe Length: feet
*Schedule:
Pressure Rated ❑ Yes ❑ NO
,pproved fittings ❑ Yes ❑ NO
County ID Number: M510OA0015
c rants
Lat.
Long:
Installer:
Certification #:
*EHS:
Date: / /
Approval Status
❑ Approved ❑ Disapproved
Pump Tank
Installer:
Certification 0:
*EHS:
Date:
Approval Status
❑ Approved ❑ Disapproved
upply Line
Installer:
Certification #:
*EH S:
Date:
Approval Status
❑ Approved ❑ Disapproved
/ Pump Type: Installer:
Dosing Volume: — Gal Certification #:
Draw Down: Inches *EH S:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ NO
Flow Adjustment Valve ❑ Yes ❑ NO
Check -valve ❑ Yes ❑ NO Approval Status
PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved
Vent Hole ❑ Yes ❑ No
\ Anti -siphon Hole ❑ Yes ❑ NO
CDP File Number 120714 - 1
-!!41V9i11LM3!
OPERATION PERMIT 120714-1
Davie County Health Department CDP File Number:
210 Hospital Street
County File Number: M5100A0015
P.O. Box 848
Mocksville NC 27028 Date:
Q Inch
i +
CONSTRUCTION
For office use only `
'
AUTHORIZATION
*CDP File Number 120714-1
Davie County Health Department
tY P
County ID Number: M510OA0015
`
210 Hospital Street
Evaluated For: REPAIR
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:
Frank Earnhardt
Property Owner: Frank Earnhardt
Address:
116 Guinevere Lane
Address:
2086 Junction Road
City:
Mocksville
City:
Mocksville
State/Zip:
NC
State/Zip:
NC
Phone #:
(336) 284-2640
Phone #:
(336) 284-2640
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
116 Guinevere Drive
Mocksville NC 27028 Directions
Hwy 601 S. Right onto Hwy 801 Right on Guinevere Lane
Structure: OTHER on corner
# of Bedrooms: 3
# of People: 4
'Water Supply: PUBLIC
,"Site Classification: PS
Saprolite System? OYes ONo
Design Flow: 3 6 0
System Specifications
Minimum Trench Depth: 2 4
Inches
Minimum Soil Cover.
Inches
Maximum Trench Depth: 3 6
Inches
Soil Appwation Rate. 0 - 3 Maximum Soil Cover: Inches
'System Classification/Description: *Distribution Type: GRAVITY- PARALLEL (eq. d -box)
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Seis
t Tank'
'Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
.Aggregate Depth:
1 5 0 ft.
p
Gallons
1 -Piece: OYes 014o
Pump Required: ()Yes QNo OMay Be Required
Sq. ft. Pump Tank: Gallons
1 -Piece: OYes ONo
GPM—vs— ft. TDH
_8Inches O.C. Dosing Volume: Gallons
— Feet O.C. g —
8Inches
Feet Grease Trap: Gallons
inches Pre -Treatment: ONSF OTS -1 OTS -11
Septic Tank Installer Grade Level Required: OI OII 0111 OIV
�oqj Pagel of 3
CDP -Fite Number 120714-1
County ID Number: N1510OA0015
uirea:v r ub v Ivu vlvu, but nas Hvanable %1>
❑ Open Pump System Sheet
/Repair System
Trench Spacing:8Feet
Inches O.
*Site Classification: PS — O.C.
Trench Width: Q Inches
Design Flow: 3 6 0 — o Feet
Soil Application Rate: 0 - 3 Aggregate Depth: inches
Minimum Trench Depth: a 4
*System Classification/Description: Inches
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover.
Inches
'Proposed System: o Maximum Trench Depth: 3 6
Y 25 /a REDUCTION Inches
Maximum Soil Cover:
Nitrification Field Inches
Sq. ft.
No. Drain Lines 'Distribution Type: GRAVITY- PARALLEL (eq. d -box)
Total Trench Length: 1 5 0 fi Pump Required: Oyes ONo OMay Be Required
Pre -Treatment: ONSF OTS -I OTS -II
'Site Modifications
No grading or construction activity is allowed in areas designated for system and repairwithout approval of Health Department
'Permit Conditions
The issuance of this permit bythe Health Department in no wayguarantees 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 maybe Issued at the same time the Improvement Permit Issued (NCGS 130A -336(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, "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. ndrew Date of Issue: 0 3 / a 1 / a 0 1 3
Authorized State Agent: Malfunction Log Oyes
OHan Drawing 0Import Drawing Total Time:(HH:1.11J)
**Site Plan/Drawing attached.** 1
Hours Ll inutes
Page 2 of 3
Pane 3 of 3
W6)% `91/?
DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST
' APPLICATION IP/ATC OSWW REPAIR '
Name - .r '. ' ''/ - Telephone Number
Address
Mailing Address (if different from above)
Email Address: Y -1 DQ-A n -aI
Subdivision Name Lot # .,5ZO A/
Directions b o(:5 . 2--o r �� /{, - �f ��. �� � �' r� / I, o tJ C'.�
Date System Installed q Name System Installed Under
Type Facility ' w ai Number Bedrooms Number People Served
1
Type Water Supply Specific Problem Occurring
/Jot � r
Date Requested Info Taken By
THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE.BEST OF MY
KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS
Revisit Charge Date Reason
Revised 2-2011
Ve4u 6P?1� 397-11
0PXP-' / 207/`f
J,
'-Q f) W, z"'?f
DAVIE'COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST
APPLICATION IP/ATC OSWW REPAIR
Name
Telephone Number
Address or
Mailing Address (if different from above)
Email Address:
Subdivision Name
Lot #
Directions r
Date System Installed Name System Installed Under
';1) 1,;
Type Facility j-11 1
L, Number Bedrooms Number People Served
Type Water Supply Specific Problem Occurring
Date Requested Info Taken By
THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORREqlT"TO THE BEST OF MY
KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS
Revisit Charge - Date Reason
Revised 2-2011
Appraisal Card
Page 1 of 1
EARNHARDT SUES
Retum/Appeal Notes: MS -100 -AO -015
116 GUINEVERE LN
UNIQ ID 23198
2520122
D368 -P18 ID NO: 5745174443
COUNTY TAX (100), FIRE TAX (100)
CARD NO. 1 of 1
eval Year: 2013 Tax Year: 2013 .570
AC H WY 801
0.520 AC SRC= Inspection
,ppraised by 19 on 06/04/2008 05005 GLADSTONE
TW -05 C- EX- AT- LAST ACTION 20120926
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION CORRELATION OF VALUE
oun - 3
Eff.
BASE
Standard 0.2300
odation
ntinuous Footing8.0
US
MO
Area UA
RATE
RCN
EYB AYB
CREDENCE TO MARKET
ub Floor System - 4
02 02 1.5601100 43.00 808 199 199
% GOOD 77.0 EPR. BUILDING VALUE - CARD
52,42C
I ood
11.0 TYPE: Manufactured Home (Multi)
Manufactured Home DEPR. OB/XF VALUE - CARD
43
xterior Walls - 10
MARKET LAND VALUE - CARD
16,99
luminum in I Siding32.0
STORIES: 1 - 1.0 Story
OTAL MARKET VALUE - CARD
69,84
willing Structure - 03
able
9.0
OTAL APPRAISED VALUE - CARD
69,84
oofing Cover - 03
OTAL APPRAISED VALUE - PARCEL
69,84
s halt or Composition Shingle
5.0
nterior Wall Construction - 5
OTAL PRESENT USE VALUE -PARCEL
wall/Sheetrock
28.0
OTAL VALUE DEFERRED -PARCEL
nterior, Floor Cover - OB
OTAL TAXABLE VALUE - PARCEL
69,84
heel Vinyl/Laminate
7.0
nterior Floor Cover - 14
PRIOR
et
0.00
3UILDING VALUE
61,12
eating Fuel - 04
BXF VALUE
1,17
lectric
1.00
AND VALUE
16,99
eating Type - 30
RESENT USE VALUE
eat Pump
5.00
DEFERRED VALUE
Ir Conditioning Type - 03
OTAL VALUE
79,280
entral
5.0
Brooms/Bathrooms/Half-Bath rooms
2/0
0.000
PERMIT
3edrooms
CODE FDATE NOTE i NUMBER AMOUNT
AS-3FUS-OLL-0
throoms
ROUT: WTRSHD:
AS - 2 FUS - 0 LL - 0
SALES DATA
OTAL POINT VALUE
111.00
FF. INDICATE
BUILDING ADJUSTMENTS
ECORD ATE DEED
SALES
uallty 3 AVG
1.000
BOOK PAGE M R TYPE
PRICE
ha a Desi 3 1AF_R3
1.000 +------------------6S------------------♦ 0116 349 3 1996 WD Q I
2200
ize 3 Size
0.900C I BAS
I 117 D166 12 1990 WD Q V
1300
OTAL ADJUSTMENT FACTOR
0.90C 1
I 0115 189 12 1984 WD Q I
500
OTAL QUALITY INDEX
loc 1
I 0558 3233 6 2004 WD P I
4500
1
I 0531 3190 1 2004 WD I 1
3400
2
2
4
4
I
I
I
I
I
I HEATED AREA 1,560
I
1
+__________________65__________________+ NOTES
005 BOARD E&R 57500 VALU
.49 TO DAN U PRESNELL
SUBAREA
DESCRIPTIO T
UNIT
NIT PRICE
ORIG %
COND LDG7YL
B
AYB
EYB
ANN DEP
RATE V
%
GOND
OB/XF
DEPR.
VALUE
RPL
ODE
.41
301 20.001
1001
1 L
11982119821
SA
1 71
431
TYPE GS 02
AS I156 10 6708
OTAL OB/XF VALUE
431
2 - PreFabricated
REPLACE 1,00
UBAREA
1,56 68,08
OTALS
UILDING DIMENSIONS BAS=W65S24E65N24 .
NO INFORMATION
THER ADJUSTMENTS
LAND TOTAL
IGHEST AND
USE
LOCAL
FRON
DEPTH/
LND
COND
ND NOTES
ROA
UNIT LAND UNT
TOTAL
ADJUSTED LAND
LAND
EST USE
CODE
ZONING
TAGE
DEPTH
SIZE
MOD
FACT
RF AC LC TO
OT
TYPE
PRICE UNITS TYP
AD7ST
UNIT PRICE VALUE NOTES
OMMERCIAL
0700
158
0
1.0000
0
0.7500
PW
1.0 22651.200 SF
0.75
0.75 1698
OTAL MARKET LAND DATA
16,99
OTAL PRESENT USE DATA
qq
ffJ 1
,e' t
i J•
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=M510OA0015 2/25/2013
o:_
Mail r _ .• .t . ./ �`�' - �//fl�/7.f!�.?-/ /`i"Yy/T?.GEU• /rC�
WARRANTY DEED -Form WD -601 Printed and for sale by James Williams h Co., Inc., YadkidvWe, N. C.
STATE OF NORTH CAROLINA, Davie County.
THIS DEED Madethis 29th dayof March 1996 ,byandbetween Fred O. Ellis and rn
wifd, Marie C. Ellis p
of County
and staie of North Carolina, hereinafter called Grantor, and Chad Mitchell Thomas and wife.. Rebecca L. Thomas
o f
Davie County and State of North Carolina, hereinafter
called Cfantee, whose permanent mailing address is
Ten dollars and OVC--------------------
WITNESSETH: That the Grantor, for and in consideration of the sum of Dollars
and other good and valuable considerations to him in hand paid by the Grantee, the receipt whereof u hereby acknowledged, has given, granted, bargained, told
and conveyed, and by these presents does give, grant, bargain, sell convey and confirm unto the Grantee, his heirs and/or successors and assigns, premises in
Township, County, North Carolina, described as follows;
Lying and being in Jerusalem Township, Davie County, North Carolina and beginning at .o
a placed iron pin, said placed iron pin being located South 12 degrees 38 minutes 12
seconds West, 29.15 feet from a placed iron pin, said placed iron pin being the Southeast
corner of William R.Link, DB 82, page 370 and the Northeast corner of Robert D. Carter,
DB 118, page 376; thence from said beginning placed iron pin South 56 degrees 48 minutes
11 seconds East, 101.94 feet to a new iron pin, said new iron pin being located in the
Western line of Norman M. Kuhn, DB 64, page 249, DB 64, page 411 and Deed Book 71, page
524; thence with Kuhn line South 17 degrees 10 minutes 32 seconds West, 115.25 feet
to a point; thence South 24 degrees 23 minutes 35 seconds East, 53.81 feet to a point,
said point being located on the edge of the northern right of way of NCSR #801; thence
South 65 degrees 36 minutes 25 seconds West, 58.79 feet to a point; thence South 58
degrees 18 minutes 35 seconds West, 69.51 feet to a point; thence South 53 degrees 10
minutes 58 seconds West, 30.08 feet to a point; thence North 77 degrees 52 minutes 36
seconds West, 15.45 feet to an existing iron pin; thence North 02 degrees 46 minutes
23 seconds East, 13.37 feet to a tack in power pole; thence North 23 degrees 11 minutes
38 seconds East, 96:07 feet to a point located in easement; thence North 10 degrees
31 minutes 04 seconds East, 64.71 feet to an existing iron pin; thence North 64 degrees
03 minutes 18 seconds West, 31.55 feet to a point located in the Southern line of Robert
D. Carter, DB 118, page 376; thence with said Carter line North 21 degrees 46 minutes
26 seconds East 24.54 feet to a point; thence North 32 degrees 02 minutes 12 seconds
East, 80.71 feet to a point; thence North 12 degrees 38 minutes 12 seconds East, 20.71
feet to THE POINT AND PLACE OF BEGINNING and containing 0.575 acres as surveyed by Tutterow'
Surveying Company on December 120 1984, revised December 27, 1984 and October 22, 1990.
Grantor, personally appeared before me this day and acknowJSdg�d (hr, execution of the fore ing deed.
. Witness my hand and notarial seal i. the o/5 ql•! day of
Aly Commission Expires= v - AL)
DAVIE COUNTY 03-29-96 coin
MIR, NOTARY PUSUC
I,,,DAV ECOUNTY, NC
a Notary Public of said Coumfl�it>ttp�!es -
STATE OF $44-00
w+
RTN he execution of the foregoing deed
N 1,C)UNA � Is
Real Estate — day of 19—.
Gp Excise Tax N.P.ISEAL)
STATE OF NORTH CAROLINA, nn V i Pr•OUNTY.
The foregoing certificate(iq of Donna Stroud. Notary Public of Davie County, NC,
is (Xlq certified to be correct. This instrument was presented for registration tlils VQ da of March 19 96
2.53 Davie
at 3t�)Cf; P. M., and duly recorded in the office of kegbter of Deeds of County,
North Carolina, in Book 186 page 349
This the 29 day of March A. D„ 19 96 .
Henry L. Shore By
Reguser o Deeds TAQk" Deputy Register of Deeds
This Deed drawn by
IN
DEED TftA::SFC.R CuC"-:ED
DEED
0
Prepared by Wade H. Leonard,Jr.
DATE—��__•,_.tl'f..l'r�:
_
UPEn'v:� ii
No title search requested.
The above land was conveyed to Grantor by
. See Book No. , Page
TO HAVE AND TO HOLD The above described premises, with all the appurtenances thereunto belonging, or in any wise appertaining, unto the Grantee, his
heirs and/or successors and assigns forever.
And the Grantor covenants that he Is seized of mid premises in fee, and has the right to convey the same in fee simple; that said premises are free from en-
cumbrances (with the exceptions above stated, if any); and
that he will we r r a n t and defend the said title to the same against the lawful claims of all persons
whomsoever.
When reference is made to the Grantor or Grantee, the singular shill include the plural and the masculine shall include the feminine or the neuter.
IN WITN S W HOF, The gntor has hereunto act
his hand and seal, the day and year fust above written.
(SEAL) (SEAL)
(SEAL) (SEAL)
STATE OF NOR CAROLINA
COUNTY.
a N�glary Public of sai ty, do hereby certify that
Grantor, personally appeared before me this day and acknowJSdg�d (hr, execution of the fore ing deed.
. Witness my hand and notarial seal i. the o/5 ql•! day of
Aly Commission Expires= v - AL)
DAVIE COUNTY 03-29-96 coin
MIR, NOTARY PUSUC
I,,,DAV ECOUNTY, NC
a Notary Public of said Coumfl�it>ttp�!es -
STATE OF $44-00
w+
RTN he execution of the foregoing deed
N 1,C)UNA � Is
Real Estate — day of 19—.
Gp Excise Tax N.P.ISEAL)
STATE OF NORTH CAROLINA, nn V i Pr•OUNTY.
The foregoing certificate(iq of Donna Stroud. Notary Public of Davie County, NC,
is (Xlq certified to be correct. This instrument was presented for registration tlils VQ da of March 19 96
2.53 Davie
at 3t�)Cf; P. M., and duly recorded in the office of kegbter of Deeds of County,
North Carolina, in Book 186 page 349
This the 29 day of March A. D„ 19 96 .
Henry L. Shore By
Reguser o Deeds TAQk" Deputy Register of Deeds
This Deed drawn by
Davie County, NC - GoMaps Advanced Page 1 of 1
100 ft
http://maps2.roktech.net/davie_gomaps/index.html
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Latitude: 350 49' 19,30' Longitude; -800 32' 49.89'
531 1
221
3/21/2013