127 Stone Wood Rd Lot 3 Davie County,NC Tax Parcel Report Friday,December 30, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M4050B0003 Township: Jerusalem
NCPIN Number: 5736504303 Municipality:
Account Number: 82531540 Census Tract: 37059-807
Listed Owner 1: FOSTER ANGELA Voting Precinct: COOLEEMEE
Mailing Address 1: 127 STONE WOOD RD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: LOT 3 GLADSTONE WOODS Fire Response District: COOLEEMEE
Assessed Acreage: 0.72 Elementary School Zone: COOLEEMEE
Deed Date: 2/2010 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 008180492 Soil Types: Gn62
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:
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 Coun y's GIS website shall hold harmless the
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and ail claims or causes of action due to
N`''�v- or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT Pd //•/ 1
• Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990002040 Tax PIN/EH#: 5736-50-4303
Billed To: Schult Housing Advantage Subdivision Info: Gladstone Woods Lot#3
Reference Name: Location/Address: Stonewood Lane-27028
Pro osed Facility: Residnce Property Size: 150'x 180
ATC Number: 3008
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 WASTEW4TER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: JY Date:
CERTIFICATE OF COMPLETION
r
**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 tak g tee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By: j
Environmental Health Specialist's Signature: ll Date:
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section r4# 11—tv-41
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002040 Tax PIN/EH M 5736-50-4303
Billed To: Schult Housing Advantage Subdivision Info: Gladstone Woods Lot#3
Reference Name: Location/Address: Stonewood Lane-27028
Proposed Facility: Residnce Property Size: 150'x 180
ATC Number: 3008
**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 #People #Bedrooms #Baths
Dishwasher: Garbage Disposal: ❑ Washing Machine:21"" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply Design Wastewater Flow(GPD)� Site: NewerJRepair❑
System Specifications: Tank Size/Ni GAL. Pump Tank GAL. Trench Width Rock Depth 1 Linear Fts-71f1'
Other:
Required Site Modifications/Conditions:
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.****
Environmental Health Specialist's Signature: ADate:
DCHD 05/99(Revised)
AAPPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
. Davie County Health Department
NOv 6 501 Environmental Health Section
P.O. Box 848/210 Hospital Street
ENV► R"D ,��tITI�L.NEi�LTH Mocksville, NC 27028
DAVIE COUNTY (336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS •ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. I
1. Name to be Billed T / A S/,✓� Contact Person
.Mailing Address 1J`'Y It �j, /�,A/. Home Phone
City/State/ZIP '5 we6y"Ar ,C. c2&1477 7 Business Phone 7o 51- 771-67729
Or
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both
4. System to Service: ❑ House "o-bile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms # Bathrooms 2-
IJ Dishwasher U Garbage Disposal U Washing Machine ❑ Basement/Plumbing II Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: R- county/City ❑ Well U Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes E4-?tU—
If yes,what type?
***IAfPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
� p� 4
Property Dimensions: f sfl /6V WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Office PILI: # 5S7 3 6 J Q y'tl 6 3 ey
Property Address: Road Name c5/&4ft&bLy I,A/ • O N 4t�.s'%D.�fit /\ey
City/zip Cook r"ee
492rat ,
d2 riles o^-) /IJu///,� RJ,
If in a Subdivision provide information,as follows: W���p�ve Wd�J Dwj
Name: �1, - fJe W obj-r 407— J ZL-,/ O
Section: Block: Lot: _ Date Property Flagged:
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 revocation,if the site plans or intended use change,or if the information
submitted in this application is falsified or changed. I,also,understand that I ani 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 and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE �O-• •- SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
1' Client Notification Date:
EHS:
Account No.
Y�
Revised DCHD(07/99) Invoice No3 a
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.t-` t Mackie McDaniel
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} F'�f zt` r fib•r 3. ¢o-1� e a_��
z" Office: (336)751-9090
Mobile: (336)940-8649
Website:www. kiemcdaniel.com
��,q,�•s/oNE �DO�$
SWICEGOOD WALL&MCDANIEL !
REALTORS®
854 Valley Road Suite 100 '.
Mocksville,NC 27028
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IV
APPLICA'T'ION FOR SITE EVALUATIONAMPROVEMENT PERMIT&AlL
Davie County Health Department D
Environmental Health Section
P.O.Box 848 JUL - 2 hyo J
Mocksville,NC 27028
(704)634-8760 *Rsrt-�+.` lff HEA!]'H
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNL
ALLTHE REQUIRED INFORMATION IS PROVIDED.1. Name to be Billed k4� W SCP_ ('�aC) Contact Person
Mailing Address -` V o�� S� F� C� Home Phone k a
City/State/Zip 'K of SA\e. L'- Business Phone Z5 -a Ll a KX-rOy
2. Name on Permit/ATC if Different than Above
Mailing Address _ City/State/Zip
3. Application For: C3" Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: 3—House U�-Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms T� # Bathrooms
`lJ liishwasher ❑ 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: # Seats Estimated Water Usage(gallons per day)
7. Type of water supply: bounty/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Ek-No
If yes,what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions:.SDOX '733,5.� X' %5.s,� X -9a 7 f 3 1 WRITE DIRECTIONS(from
1 MocksvlUe)TO PROPERTY:
Tax office PIN: # �17 3 CO- - � - �L t-( '1 1 .
Property Address: Road Name �� 1
City/Zip 1N�o c'\�5.,�,��-P C_ 1
If in Subdivision provide information,as follows: 1
o-
Name: � � S t o 1
1
Section: IS t\c.R Lot #: 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
aro subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is
falsified or changed.1,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
and owned by ce mac/ �� �� �� c "� i o conduct all testing procedures
P-
as necessary to determine the site suitability.
DATESIGNATURE
c
evised DCHD(06-96)
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION--,/_LOT,!-
Soil/Site Evaluation
APPLICANT'S NAME 6� DATE EVALUATED f
PROPOSED FACILITY PROPERTY SIZE /f O
SUBDIVISION Co� Zy� fa-e ROAD NAMEA-_e"1/yI
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit t./ Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH 4,11
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture Eroup
Consistence _ r
Structure /C S
Mineralogyp
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
i
SITE CLASSIFICATION: EVALUATION BY-
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:
REMARKS: /' Pl✓1 2i1 if
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(01-90)