111 Stone Wood Rd Lot 2 Davie County,NC Tax Parcel Report Friday,December 30, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M4050B0002 Township: Jerusalem
NCPIN Number: 5736502452 Municipality:
Account Number: 82515801 Census Tract: 37059-807
Listed Owner 1: DONALDSON ROBERT PAUL Voting Precinct: COOLEEMEE
Mailing Address 1: 111 STONEWOOD DRIVE Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAME COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028-5503 Voluntary Ag.District: No
Legal Description: LOT 2 GLADSTONE WOODS Fire Response District: COOLEEMEE
Assessed Acreage: 0.68 Elementary School Zone: COOLEEMEE
Deed Date: 11/2000 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 003520691 Soil Types: GnB2,CeB2
Plat Book: 0007 Flood Zone:
Plat Page: 073 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
91 All data Is provided as Is without warranty or guarantee of any Idnd 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*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
�Obt344 NC or arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section '3;°`
P.O.Boa 848/210 Hospital Street /c °a
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000787 Tax PIN/EH#: 5736-50-6147.02
Billed To: Southern Showcase Subdivision Info: Gladstone Woods Lot#2
Reference Name: Keith Bolick Location/Address: Stonewood Road-27028
Proposed Facility: Residence Property Size: See Map
ATC Number: 2173
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with
Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type Im• "(DrAr #People 3 #Bedrooms 3 #Baths 2
Dishwasher: fff'� Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industriall Waste: 13Lot Size Type Water Supply WVord 17 E Design Wastewater Flow(GPD) Site: New Repair❑
System Specifications: Tank Size VCO GAL. Pump Tank GAL. Trench Width--2�d Rock Depth e' Linear Ft.300'
Other: .� S'f(Z�)ToQ
Required Site Modifications/Conditions: 't�LA— c),J 6'6f OTyoe P �' p�-F �. I�D►v1�
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6°°BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.****
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Environmental Health Specialist's Signature: Date: v!
DCHD 05/99(Revised)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028.
(336)751-8760
Account #: 990000787 Tax PIN/EH#: 5736-50-6147.02
Billed To: Southern Showcase Subdivision Info: Gladstone Woods Lot#2
Reference Name: Keith Bolick Location/Address: Stonewood Road-27028
Proposed Facility: Residence Property Size: See Map
ATC Number: 2173
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWA C TIO S VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature( Date: /J/27
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By: t.-4211
Environmental Health Specialist's Signature: Date:
DCHD 05/99(Revised)
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
Davie County Health Department $E� 5 I
Envimnmenhd Health Sectfon
P.O. Box 848/210 Hospital Street
Mooksviile, NC 21028
(336)751-8760
***Iwt7 vmv** %%Is "PLICATION mmm AB momm muss ALL %W MQM=
iNfOIt WION is PROVIDIM. Refer
to the n6Ol11MION BULLETIN for instrJ
dductionsl.
1. wave to be Willed L U i` e�n /S 11�w/,��G"/ Contact "coon �P.I 1
Nailing hrese Irl US )qk/L,��� �/ �/ som *lace.
City/state/a:' 1406kfy,*1/G IL ?02 susineas *riom.
�.�aJ351'?a. !lens as assn/M if Different than above rH G 60ts4,e ,6")GI,sG
Wiling hddeess City/state/sip
s. Application fort 0 Site ivaluation AImprovement Permit/ATC 0 Bath
s. cyst" to servioss 0 House KHabile Some 0 Business 0 Industry 0 Other
a. If Residenoe: i people 3 _ ! Bedrooms L e Bathrooms �-
)<Dishwsher O Garbage Disposal Xwashing Machine O easement/Plumbing O saaeaent/Ho Plumbing
i. tf ausiness/Industry/Others specify type I People I sinks
0 coaaodss 1 shouers I urinals water coolers
It NUMS&MCB: # Seats Istimated !tater Usage (gallons per day)
7. Type of water supply: XCounty/City 0 well 0 Community
s. Do you anticipate additions or expansions of the tacWty,this system Is Intended to serve? 0 Ya 0 No
If yes,what type?
***IMPORTANP**CGT6TMUWTCOMPLEMTHE REQUIRED PROPERTY INFORMATION REQUESTED
BELDW. Either a PIAT or SITE PLAN U11STBESt1BMiTrIED by the client with THIS APPWCATION.
Propa:rty Dlmewlonst D Z X Lis X 14, `'WRITE DIRECTIONS(from Moclerllle)to PROPERTY:
Tax C,g ase PINI N J ��(ri
7 �CiG��70`1 L �Q Q l�-
' Property Address: Road Name �S�o�G 1,✓oo�A 4 � ./t�11 Y eel
Citylzlp 100t4sto'i'L XJJeY &V o _KGf
If In a Subdivision provide information,as follows: Loi Z
Name: 1(-)GOls A126 C "'o d<
21 Section: Blockt Lott Date Property Maggedt
This Is to eerHtyr that the Information provided Is correct to the bat of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation,if the site pians or intended we change,or It the Information
submitted in this application is Melded or changed 1,abo,understand that 1 am responsible for aU charges incurred from
this applicadoa I,hereby,give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures a necessary to determine the site saltability.
DATE el !s /9� SIGNATURE
THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposal
property lines and dimensions, structures, setbacks, and septic locations)
site Revisit Charge
Date(s)t
Client NotiBaltion Date:
EHS:
Account No.
Revised DCHD(07199) Invoice Na 6
/
/ 22/ t!
/60 P�
/ 4�
NN /
`Y / I
i
�4.,r i
�93
/ SARAH NOLLEY i
D.B. 3B PG. 206
LOT 2v�e>3
. .E't:ENT •Op\ fir ' LOT 3
JT 1 \\ \\ OO
\ \ LOT 4 OO 21000 396.00
51,o z O 0
5600's.,
•-r� 54..' /34.36 `a't`"'1\ LOT 5 p
r fit• '�j. \ \ h
O:At. 'Ts ry LOT 6 0
LOT 22 p q� h LOT 7
\ N CP:/,) p
No cNa�
LOT B N 0
i
�p LOT 15 \0400\ s0 Jo 0.00—
LOT 23 n O
tD 100 DIT
.00— o0
Z: m195.00
p V ` ,2Q oo
A —g0 00 00
b. 0,
�65.00
� o LOT 9 N `
0 0�
- - - LOT 14 p 0
h 0 0 O p
v LOT 13LOT 12 N a
LOT 11 N LOT 10
I
255.00//.93 /20.00
��•N, /20.00
94-
09'Oq•• W /50.00
9/5.48 TOTAL 903.53 270.00
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APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT FONMENTAL
sDavie County Health DepartmentEnvironmental Health Section
P.O.Box 848 L - 2 1998Mocksville,NC 27028
(704)634-8760IOTY STH
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED
ALL THE REQUIRED INFORMATION IS PROVIDED. I�
1. Name to be Billed ��iv S W vee. C'�oQ') Contact Person floc
Mailing Address -` Home Phone 01 k 3 a a ?
City/StateMp o '_S \\\e L- c� Business Phone 7 5 La a a a K XT20?
2. Name on Permit/ATC if Different than Above
Mailing Address / City/State/Zip
3. Application For. M Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: a—House Mobile Home ❑ Business ❑ Industry O Other
5. If Residence: # People # Bedrooms # Bathrooms �-
ql-D-ishwasher ❑ Garbage Disposal a'Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other. Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
If Foodservice: # SeatsEstimated Water Usage(gallons per day)
7. i),pe of watee su �pply: 8 County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes EV-No
If yes,what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions:-700X 7331"o X 9105,S,)!( 4^OS,Q Y 92L 7, L� 1 WRITE DIRECTIONS(from
1 Mocksvtlle)TO PROPERTY:
Tax Office PIN: # � 7.3(0- - _5 O - _G k 4 '� 1
l 1 a •-�o
Property Address: Road Name A�e-\
1 -EoN
City/Zip C— 1
1
If in Subdivision provide information,as follows: 1
Name:
1
Section: _ 1\c.'RP Lot #: Z 1
1
1 '
This is to certify that the information provided is correct to the best of my knowledge.I understand that any permit(s)issued hereafter
are subject to suspension or revocaticn,if the site plans or intended use change,or if the information submitted in this application is
;alsified or changed.I,also,understand that I am responsible for all charges incurred from this application.I,hereby,give consent to
the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County
id owned by �e �J � ���� ie- d /"Ivy ezz t o conduct all testing procedures
necessary to determine the site suitability.
ATE /`�- SIGNATURE c
evised DCHD(06-96)
~� DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTIONLOT
Soil/Site Evaluation
APPLICANT'S NAME �Gt�? C�/MDQ � DATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION l ROAD NAME
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH �- O
Texture group .G
Consistence
Structure
Mineralogy
HORIZON 11 DEPTH
Texture group
Consistence
Structure r
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE <
SITE CLASSIFICATION: EVALUATION BY:
C
LONG-TERM ACCEPTANCE RATE: t OTHER(S)PRESENT:
REMARKS:
LEGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC.-Concave slope CV-Convex slope T—Terrace FP-Flood plain H-Head slope
Texture
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy.clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-Very friable . FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogy
1:1,2:1,Mixed
Notes
Horizon depth-In inches
Depth of fill-In inches
Restrictive horizon-Thickness and inches from land surface
Saprolite-S(suitable),U(unsuitable)
Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification-S(suitable),PS(provisionally suitable),U(unsuitable)
LTAR-Long-term acceptance rate-gal/day/ft2
DCHD(0I-90)