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349 Blackwelder Rd Davie Coup'y,NC Tax Parcel Report Tuesday, January 10, 2017 w. �LACK � L��F�RD BLACK 01 IWO t. r't ..............._._.__.:....,1...:............ ......-........:...............:.::.:..'............................... a..-..............................................................................................................:....��`��: `` WARNING: THIS IS NOT A SURVEY ParcelInformation Parcel Number: F300000033 Township: Clarksville NCPIN Number:: 5810973102 Municipality: Account Number: - .82525432 Census Tract: 37059-801 Listed Owner 1 BLACKWELDER LARRY DALE Voting Precinct: CLARKSVILLE Mailing Address 1:-. 349 BLACKWELDER ROAD Planning Jurisdiction: Davie County City: = - MOCKSVILLE. Zoning Class: DAVIE COUNTY R-A State: ° NC Zoning Overlay: Zip Code: _ 27028-0000 Voluntary Ag.District: No Legal Description: _ 56.357 AC BLACKWELDER RD Fire Response District: WILLIAM R.DAVIE Assessed Acreage: 55.28' Elementary School Zone: WILLIAM R DAVIE Deed Date: 11/2005 Middle School Zone: NORTH DAVIE Deed Book/Page:. 006360602 Soil Types: PcC2,RnD,MdD,ChA,CeB2,WATER Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 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 SOU N� NC - or arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT or ice se ny Davie County Health Department ��� �'� *CDP File Number 217744-1 210 Hospital Street P.O. Box 848 l County ID Number. Mocksville NC 27028 Evaluated For REPAIR . Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Dale Blackwelder Property owner: Dale Blackwelder Address: 349 Blackwelder Road ;Address: 349 Blackwelder Road COY: Mocksville !COY Mocksville i, -Statef 'NC 27028' State2ip: NC 27028 Phone#: (336).655-9154. Phone#: (336)655-9154 Propertv Location & Site Information Address/Road #: Subdivision: Phase: Lot: 349 Blackwelder Road i Mocksville NC 27028 Directions Structure: SINGLE FAMILY h�'601� North, left on Blackwelder Rd ' #of Bedrooms: #of People: 2 *Water Supply: NiA = *System Classification/Description: *IP Issued by. 2146-Nabs,Robert 7. • !TYPE III G.OTHER NON-CONY.TRENCH SYSTEMS *CA issued by: 2140-Nations,Robert SaproliteSystem? OYes @No Design Flow; - a 4 0 GRAVITY-SERIAL Pump Required? Distribution Type: O Yes Q No Soil Application Rate: 0 a 7 5 *pre Treatment: - Drain field Nitrification Field 4 1 6 Sq. ft. *System Type: INFILTRATOR QUICK 4 STANDARD No. Drain Lines 1 Installer: Donnie Lakey Total Trench Length: 1 0 0 g• Certification#: 1108 Trench Spacing: 9 Inches O.C. 2Feet O.C. *EH S: 2140-Nations.Robert Trench Width: inches 3 Feet Date: 0 5 / 1 9 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Approvai Status Maximum Trench Depth: 3 6 ® Apprcived O Disapproved Inches Maximum Soil Cover: 2 4 Inches CDP File Number 217744 - 1 Septic Tank County ID Number: Manufacturer, Lat. Long: STB: Gallons: Installer. Date: Certification#: "EHS: 'Filter Brand: ST Marker. El Yes 11 No Date: Reinforced Tank: ❑ Yes ❑ No APl?rrnrat Status Piece Tank: ❑ Yes ❑ No F❑ Approved El,:Disapproved Pump Tank Manufacturer. installer. PT: Certification#: _Gallons: THS: -.Date: I Date: RiserSealed ❑ Yes ❑ No RiserHeight: Eles ❑ NO (Min.6 in. Approval StatusJr a Reinforced Tank: ❑ .Yes 0 N o O Approved❑ disapproved _ ❑ -Yes ❑ No _- 1Piece Tank: „ Supply Line Pipe Size: inch diameter installer: Pie Length: feet Certification 9: "Schedule: THS: Pressure Rated ❑ Yes ❑ No Date: f Approved fittings ❑ Yes - ❑ No Approval Status ❑ Approved❑ Disapproved enent Pump Type: Installer: Dosing Volume: — Cal Certification#: Draw Down: Inches THS: "Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No ,; Approvat Status'- PVC unions ❑ Yes ❑ No ❑ Approved❑ Disapproved El Na Vent Hole El Yes Anti-siphon Hole ❑ Yes ❑ No CDP Fite Number 217744- 1 County ID Number: Electric Equipment NEMA 4X Box or Equivalent 0 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 - O Approved❑ Disapproved Alarm Visible El Yes ❑ NO - 2140-Nations,Robert *Operation Permit completed by: 01 Authorized State Ag nt: - - Date of Issue: 0 3 / 1 9 / 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 :SewageTreatment and Disposal, 15A NCAC 18A .1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.-This property is served bye TYPE lu G. sewage septic system. Rule A 961--requires that a Type TYPE III G. septic system meet the following criteria: Minimum_System.Review.By The Local Health Department: NIA Management Entity: OWNER Minimum.System Inspection/Maintenance Frequency ByCertified Operator: N/A Reporting Frequency By Certified Operator: NIA _ Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract wrkh 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 fora 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. Q Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 217,744 - 1 Davie county Health Department CDP File Number: , 210 Hospital Street County File Number: P.O.Box 848 Mocksville NC 27028 Date: ! / Q Inch Scale: QBlock Drawing Drawing Type: Operation Permit ON/A 71 00�- I t 1 FT 1 e 4 CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 217744- 1 Davie County Health Department County ID Number: 210 Hospital Street Evaluated For: REPAIR P.O. Box 848 •.a..�• Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 4 / 1 9 a 0 a 1 Applicant: Dale Blackwelder Property Owner: Dale Blackwelder Address: 349 Blackwelder Road Address: 349 Blackwelder Road City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)655-9154 Phone#: (336)655-9154 Property Location & Site Information Address/Road M Subdivision: Phase: Lot: 349 Blackwelder Road Mocksville NC 27028 Directions - Structure: SINGLE FAMILY hwy 601 North, left on Blackwelder Rd #of Bedrooms: 1 #of People: 2 `Water Supply: NIA System Specifications Minimum Trench Depth: (Saprolite ite Classification: Provisionally suitable Inches Minimum Soil Cover: System? OYes No Inches esign Flow: Maximum Trench Depth: Inches Soil Application Rate: Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: Septic Tank: 1 0 0 Gallons *Proposed System: 1-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field Sq.ft. Pump Tank: Gallons No. Drain Lines 1-Piece: OYes ONo Total Trench Length: ft GPM--vs— ft. TDH Trench Spacing: _ Inches O.C. 8Volume: _ Gallons Feet O.C. Dosing Trench Width: _ Inches Aggregate Depth: Oeet Grease Trap: Gallons inches Pre-Treatment: ONSF OTS-1 O TS -II Septic Tank Installer Grade Level Required: O 1 Oil 0111 O N Page 1 of 3 CDP File Number 217744 - 1 County ID Number: ❑ Open Pump System Sheet Repair System Required:0 Yes O No O No, but has Available Space rDesignFlow: System Trench Spacing: Inches O. . fication: — Feet O.C. Trench Width: O Inches _ O 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 Inches Sq.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-11 *Site Modifications _ No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rem w 9 750 *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. Rmaini 9 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 4 / 1 9 / .2 0 1 6 Authorized State Agent: Malfunction Log Oyes ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 217744 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 04 / 19 / x016 O Inch Drawing Drawing Type:e: Construction Authorization Scale: , O Block N/A ............ . . .`__, - ................_ .... ...... j ! ............................_ ................... .. ....._ .. .. ... . ..........1............... . i.... .. ; .. .... i ................i 1 ...... 1 t t I.. ....... ..... ....... ................. !..... ...� .. .. .......................... ................1.................................. .................................. ............... 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I ... . ............i..............i i..........._...._...... ! .. . ... . .t ................., .._ ...; . . .l i..... ....... .................................................................................................................................................................................................................................................................................................................................::.._..... Page 3of3 P1 P2 CONSTRUCTION AUTHORIZATION . Davie County Health Department 210 Hospital Street CDP File Number: 217744- 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: A4./ 1 9. / .10 1 6 Click below to import an image from an external location: Drawing Type:Construction Authorization \ � tet-• I� 1 . 1 I t l Page 3 of 3 P1 P2