349 Blackwelder Rd Davie Coup'y,NC Tax Parcel Report Tuesday, January 10, 2017
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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
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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
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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
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