191 Hillcrest Dr i
Davie County,NC Tax Parcel Report Thursday, February 23, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: F80000005303 Township: Shady Grove
NCPIN Number: 5870893294 Municipality:
Account Number: 8306106 Census Tract: 37059-803
Listed Owner 1: JONES JEFFREY Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 176 KNIGHT LANE Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006 Voluntary Ag.District: No
Legal Description: 0.777 AC HILLCREST DR Fire Response District: ADVANCE
Assessed Acreage: 0.77 Elementary School Zone: SHADY GROVE
Deed Date: 3/2016 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 010130029 Soil Types: GnB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 43730.00 Outbuilding 8r Extra 0.00
Freatures Value:
Land Value: 24230.00 Total Market Value: 67960.00
Total Assessed Value: 67960.00
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
County of Davis,North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to
�OUtyt NC or arising out of the use or Inability to use the GIs data provided by this website.
OPERATION PERMIT or ice se n v
eFo Davie County Health Department *CDP File Number 199685- 1
.r 210 Hospital Street I 1 15870892247
P.O. Box 848` County ID Number:
Mocksville NC 27028 Evaluated For: EXPANSION
Phone: 336-753-6780 Fax: 336-753-1680 Township:
Applicant: Jeffrey A. Jones Property Owner: Jeffrey A. Jones
Address: PO Box 2012 Address: PO Box 2012
City: Advance City: Advance
State/Zip: NC 27006 State/Zip: NC 27006
Phone#: (336)577-2494 Phone#: (336) 577-2494
Property Location & Site Information
Address/Road#: ,� Subdivision: Phase: Lot: 1
Hillcrest Drive
Advance NC 27028 Directions
Structure: SINGLE FAMILY Hwy 158 right on Hwy 801, Hillcrest on Left
#of Bedrooms: 3
#of People:
*Water Supply: N/A
*IP issued by:
*System Classification/Description:
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
*CA issued by: 2140-Nations,Robert
Saprolite System? O Yes ®No
Design Flow: 3 6 0 * GRAVITY-SERIAL Pump Re wired?
Distribution Type: Oyes �No
Soil Application Rate: 0 a 7 5 *Pre-Treatment:
Drain field
Nitrification Field 1 3 0 9 Sq.ft.' *System Type: INFILTRATOR QUICK 4 STANDARD
No. Drain Lines 3Installer: Jamie Barnes
Total Trench Length: a 0 0 ft. Certification#: 1018
Trench Spacing: Olnches O.C.
p g' — 9 ®Feet O.C. EHS: 2140-Nations,Robert
Trench Width: — 3 Olnches
®Feet Date: 0 3 / a 1 / a 0 1 6
Aggregate Depth: inches
Minimum Trench Depth: 3 6
Inches
Minimum Soil Cover: a 4 Approval Status
Inches
Maximum Trench Depth: 3 6 Inches REX roved❑ Disapproved
Maximum Soil Cover: a 4
Inches
Page 1 of 4
CDP File Number 199685 - 1 Septic Tank County ID Number: 587092247 e
Manufacturer: Lat.
STB: Long:
Gallons: Installer:
Date: Certification#:
*EHS:
*Filter Brand:
ST Marker: El Yes El No
Date:
Reinforced Tank: El Yes El No Approval Status
Piece Tank: El El ❑ Approved❑ Disapproved
1
Pump Tank
Manufacturer: Installer.
PT: Certification#:
Gallons: *EHS:
Date: Date:
Riser Sealed ❑ Yes ❑ No
Riser Height: ❑ YeS ❑ No (Min. 6 in.)
Approval Status
Reinforced Tank: El Yes ❑ No ❑ gpproved❑ Disapproved
'1 Piece Tank:..❑ Yes. _ _ ❑_NO_
Supply Line
Pipe Size: inch diameter 11 Installer.
Pipe Length: feet Certification#:
*Schedule: "EHS:
Pressure Rated ❑ Yes ❑ NO Date:
Approved fittings ❑ Yes ❑ NO Approval Status
y ❑ Approved El Disapprove
Pump Requirement
rPump Type: Installer:
sing 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
Page 2 of 4
` CDP File Number 199685 - 1 County ID Number: 5870892247
_ Electric E ui ment
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-Nations,Robert
*Operation Permit completed by:
Authorized State Age� . —r — Date of Issue: 0 3 a 1 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.1 900 et. Seq.,and all conditions of the Improvement Permit and
Construction Authorization.This property is served b a TYPE a 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: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator.
N/A
_ Reporting Frequency By Certified Operator: N/A
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.**
Page 3 of 4
OPERATION PERMIT 199685 - 1
Davie County Health Department CDP File Number.
210 Hospital Street County File Number: 5870892247
P.O.Box 848
Mocksville NC 27028 Date:
0 Inch
Scale: 0 Block
Drawing Drawing Type: Operation�Permit ON/A
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Page 4 of 4 Pi P2 P3
• CONSTRUCTION For Office Use Only
AUTHORIZATION *CDP File Number; 199685- 1
Davie Count Health Department 5870892247
''� Y P County ID Number:
210 Hospital Street Evaluated For: EXPANSION
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 3 / 1 1 / a 0 a 1
Applicant: Jeffrey A.Jones Property Owner: Jeffrey A.Jones
Address: PO Box 2012 Address: PO Box 2012
City: Advance City: Advance
State/Zip: NC 27006 State/Zip: NC 27006
Phone#: (336)577-2494 Phone#: (336)577-2494
Property Location & Site Information
Address/Road#: Subdivision: Phase: Lot: 1
Hillcrest Drive
_-Advance NC 27028 Directions
Structure: SINGLE FAMILY
Hwy 158 right on Hwy 801, Hillcrest on Left
#of Bedrooms: 3
#of People:
*Water Supply: NSA
_ System Specifications
Minimum Trench Depth: a 4
Site Classification Provisionally suitable Inches
Minimum Soil Cover:
Sp
rolite System? O Yes 9 No 1 a Inches
Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 a 7 5 Maximum Soil Cover: a 4 Inches
*System Classification/Description: *Distribution Type: GRAVITY-SERIAL
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
Septic Tank:
Gallons
*Proposed System: 25%REDUCTION 1-Piece: O Yes O No
Pump Required: O Yes O No O May Be Required
Nitrification Field 4 3 6
Sq.ft. Pump Tank: Gallons
No. Drain Lines 1 1-Piece: OYes ONo
Total Trench Length: 1 0 9 ft GPM--vs— ft. TDH
Trench Spacing: 9 ®_ O Inches O.C.
Feet O.C. Dosing Volume: Gallons
Trench Width: _ 3 O Inches
®Feet Grease Trap: Gallons
1Aggregate Depth: inches
Pre-Treatment: O NSF OTS-1 OTS-II
Septic Tank Installer Grade Level Required: 01011 O III O IV
Page 1 of 3
587089224y r
CDP File Number 199685 - 1 County ID Number:
❑ Open Pump System Sheet
Repair System Required:0 Yes O No ®No, but has Available Space
CDesign
System
Trench Spacing: Inches O. .
fication: — Feet O.C.
Trench Width: O Inches
w: — O Feet
Aggregate Depth:
Soil Application Rate: inches
. Minimum Trench Depth:
*System Classification/Description: Inches
Minimum Soil Cover: Inches
Maximum Trench Depth:
*Proposed System: Inches
Maximum Soil Cover:
Nitrification Field Sq. Inches
ft.
No. Drain Lines *Distribution Type:
-:Total;Trench Length: ft Pump Required: Oyes O No O May Be Required
- Pre-Treatment: O NSF OTS-I OTS-II
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rwai ng
750
*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. Rma ng
2000
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 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(8)).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? O Yes O No
Applicant/Legal Reps. Signature- Date:
*Issued By: 2140-Nations,Robert Date of Issue: 0 3 / 1 1 / a 0 1 6
Authorized State Agent: Malfunction Log Oyes
®Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number: 199685 - 1
210 Hospital Street County File Number: 5870892247
P.O.Box 848
Mocksville NC 27028 Date: 03 / 11 / ,2016
0 Inch
Bloc
:Drawing Drawing
0 Drawing Type: Construction Authorization 0 N/A k
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Page 3 of 3 Pi P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital street CDP File Number: 199685 - 1
P.O.Box 848 5870892247
Mocksville NC 27028 County File Number:
Date: A3./ 1 1 / a 0 16
Click below to import an image from an external location: Drawing Type:Construction Authorization
Page 3 of 3
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