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157 Honeysuckle Ln Davie County,NC - _, Tax Parcel Report Wednesday, February 15, 2017 HONEYSUCKLE-LTJ 'l } I }I I, 157 I WARNING: THIS IS NOT A SURVEY „ _ . Parcel jnformation Parcel Number: M510000021 Township: Jerusalem NCPIN Number: 5745263754 Municipality: Account Number: 82531166 Census Tract: 37059-807 Listed Owner 1: LANCASTER SUSAN L PIERCE Voting Precinct: COOLEEMEE Mailing Address 1: P O BOX 242 Planning Jurisdiction: Davie County City: COOLEEMEE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27014-0000 Voluntary Ag.District: No Legal Description: 1.28 AC OFF LOOP ST Fire Response District: COOLEEMEE Assessed Acreage: 1.27 Elementary School Zone: COOLEEMEE Deed Date: 9/2009 Middle School Zone: SOUTH DAVIE Deed Book/Page: 008060233 Soil Types: EnB Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 77590.00 Outbuilding&Extra 860.00 Freatures Value: Land Value: 15750.00 Total Market Value: 94200.00 Total Assessed Value: 94200.00 161 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 NC or arising out of the use or Inability to use the GIS data provided by this website. GPE,RATJON PERMIT or ice se n Davie County Health Department *CDP File Number- 120971 -1 �- 210 Hospital Street M510000021 P.O.Box 848 County ID Number. Mocksville NC 27028 Evaluated For. EXISTING Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Susan Lancaster Property Owner: Susan Lancaster Address: 157 Honeysuckle Lane Address: 157 Honeysuckle Lane City: Mocksville City: Mocksville StatefLip: NC State/Zip: NC Phone 9: (336)284-6357 Phone#: (336)284-6357 Propertv Location & Site Information Address/Road#: Subdivision: Phase: Lot: 157 Honeysuckle Lane Mocksville NC 27028 Directions Structure: hwy 601 South right on Hwy 801, Loop St on right, SINGLE FAMILY Honeysuckle ane off of Loop. #of Bedrooms: 2 #of People: - *Water Supply: PUBLIC *IP Issued by. *System Classification/Description: TYPE 11 A CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? 0Yes oto Design Flow: 2 4 0 - *Distribution Type: GRAVITY-SERIAL Pump Required? 0Yes (7 No Soil Application Rate: 0 2 7 5 *Pre Treatment: Drain field rNtrnification Field 8 a 5 Sq•ft. *System Type: BIODIFFUSERARC36 rain Lines 4 Installer: Tim Abee Total Trench Length: 2 0 5 8• Certification#: 1011 Trench Spacing: 9 Oinches O.C. Feet O.C. *EHS�: 2140-Nations Robert Trench Width: 3Inches g(j)Feet Date: 0 6 / .1 4 / 2 0 1 - 6— Aggregate 6Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches . .. r , Minimum Soil Cover. .1 4 Inches ,Approval tatus. Maximum Trench Depth: 3 6 ® Approved Ca Disapproved; Inches r Maximum Soil Cover: 2 q Inches CDP File Number 120971 - 1 County ID Number: M5100co021 Septic Tank (4�2 Let, Long: Installer: Date: Certification#: *EHS: *Filter Brand: ST Marker: El Yes ❑ No Date: Reinforced Tank: ❑ Yes ❑ No Approval Status 1 Piece Tank: ❑ Yes ❑ No ❑ Approved 0' Disapproved, Pump Tank Manufacturer. Installer. PT: Certification#: Gallons: *EHS: Date: / / Date: Riser Sealed ❑ Yes ❑ No RiserHeght: ❑ Yes ❑ No (Min.6 in.) - Approval Statua us e Rinforced Tank: ❑ Yes ❑ No ❑ Approved❑ Disapproved 1 Piece Tank: ❑ Yes E3 No Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings [I Yes ElNo Approval Status Approved❑ Disapproved Pump u Pump Type: Installer: Dosing Volume: — Gal Certification#: Draw Down: Inches *EHS' *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 SDP File Number 120971 - 1 County ID Number: M51000O021 - Electric Equipment 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 2140-Nation.Robert *Operation Permit_completed by: Authorized State Men Date of Issue: 0 6 / a 4 / a 0 1 6 Owner/Applicant Signature: 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 It a sewage septic system. - Rule.1961 requires that a Type TYPE IIk septic system meet the following criteria: Minimum System Review ByThe Local Health Department: WA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator.N/A Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe 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 formaintenance 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 Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department CDP File N u tuber: 120971 --�__ 210 Hospital Street M510000021 P.O.Box 848 County File Number: Mocksville NC 27028 Date: J / Q Inch Drawin DrawingType: Operation Permit Scale: . OBk OvA ft. ` � I E I ! I 1 I -=- i ! a %F V . .......... x CONSTRUCTION -f=or,office Use only AUTHORIZATION *CDP File Number 120971 -11 °= Davie County Health Department County ID Number.M51000O021 210 Hospital Street Evaluated For , EXISTING P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336.753-6780 Fax:336-753-1680 0 6 / 1 4 / a 0 a 1 Applicant: Susan Lancaster Property Owner. Susan Lancaster Address: 157 Honeysuckle Lane Address: 157 Honeysuckle Lane City: Mocksville City: Mocksville StatefZip: NC State/Zip: NC Phone#: (336)284-6357 Phone#: (336)284-6357 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 157 Honeysuckle Lane Mocksville NC 27028 Directions - hwy 601 South right on Hwy 801, Loop St on right, Structure: SINGLE FAMILY Honeysuckle ane off of Loop. #of Bedrooms: 2 #of People: *Water Supply: PUBLIC - System Specifications Minimum Trench Depth: a 4 r ssification: Provisionally Suitable InchesMinimum Soil Cover. 1 a System? QYes ONo Inches ow: a 4 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate:` 0 - 3 Maximum Soil Cover. a 4 Inches *System Classification/Description: *Distribution Type: Septic Tank:_ Gallons *Proposed System: 1-Piece: QYes ONo Pump Required: QYes ONo OMay Be Required Nitrification Field 8 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines a 1-Piece: QYes ONo Total Trench Length: a 0 0 ft GPM vs— ft. TDH Trench Spacing: _ Feet O.C. 9 Onches O.C. Dosing Volume: _ Gallons Trench Width: Inches 3 . @Feet Grease Trap: Gallons P Aggregate Depth: inches Pre Treatment: ONSF OTS-I OTS-II Septic Tank Installer Grade Level Required: OI OII 0111 OIV Dona 1 ^f'A CDP File Number 120971 - 1 County ID Number. M510000021 Q• Open-Pump System Sheet Repair System Required:OYes ONo ONo, but has Available Space epair System Trench Spacing: 8Feet Inches 0. . *Site Classification: O.C. Trench Width: Q Inches Design Flow: — 0 Feet Soil Application Rate: Aggregate Depth: inches • Minimum Trench Depth: *System Classification/Description: Inches Minimum Soil Cover. Inches Maximum Trench Depth: *Proposed System: Inches Maximum Soil Cover. Nitrification Field Sq.ft. Inches No. Drain Lines *Distribution Type: Total Trench Length: Pump Required: 0Yes oNo 0May Be Required Pre Treatment: ONSF 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 forwastewater 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,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: 2140-Nations,Robert Date of Issue: . 0 6 / 1 4 / x 0 1 6 Authorized State Agent: Malfunction Log OYes ; @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 120971 - 1 Davie County Health Department CDP File Number: 210 Hospital Street M510000021 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 6 / 1 4 / 2 0 1 6 Q Inch Drawing Drawing Type: Construction Authorization Scale: , ONIABlock = ft. QN/ LL ................................. - --�-� 9' ,- G'u - c.� �C7 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street 1120971 - 1 CDP File Number: P.O.Sox 84$ M510000021 Mocksville NC 2702$ County File Number. Date: _© 6 / 1 4 / 2 0 1 6 Click below to Import an image from an extemal location: Drawing Type:Construction Authorization � S C' DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQ ST APPLICATION IP/ATC OSWW REPAIR J Name ! �s 16u Telephone Number Address 1157 aoj&ytte 16 Q Mailing Address(if different from Love) Email Address: Subdivision Name E Lot# Directions l Date System Installed 0 V S& Name System Installed Under lC Type Facility Number Bedrooms Number People Served Type Water Supply C�Q'(o( ►/�f(,,; Specific Problem Occurring M, IM —�, 1'j U a 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 DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST v�� APPLICATION IP/ATC OSWW REPAIR 1 Name �s 6U jLt( Telephone Number Address Mailing Address (if different from Love) Email Address: Subdivision Name Lot# '. Directions F Date System Installed 0 WIM 0 Name System Installed Under Type facility Number Bedrooms Number People Served Type Water Supply �(,( Specific Problem Occurring IMM 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 ChargeDate Reason Revised 2-2011'. . Davie COUNTY 210 Hiiispital Street �P:O` i3ox 848 Mocksville NC 27028 TEL: 336-753-6780 FAX: 336-753-1680 Request ID: 66403 REQUEST FOR SERVICE/COMPLAINT INVESTIGATION REPORT REQUEST DATE: 06/13/2016 TAKEN BY: SECTION: NIA TYPE: PROPERTY NUMBER: 120971 ASSIGNED TO: Nations, Robert ESTABLISHMENT NUMBER: PERSON OR PREMISES TO SEE: OWNER: Susan Lancaster Marshall Lancaster 157 Honeysuckle Lane 157 Honeysuckle Lane Mocksville , Mocksville NC, 27028 (336) 284-6357 REQUESTED BY: Marshall Lancaster HOME: WORK: Cell: Additional Information: CONDITION REPORTED:Need Septic Line replace he thinsk COMMENTS: RECORD OF INVESTIGATION DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: Next Inspection Date: Status of Complaint: OPEN Resolved Date: Complaintant Contacted: NO