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139 Stone Wood Rd Lot 4 Davie County,NC Tax Parcel Report Friday, December 30, 2016 111 r F r f 127 j , 110 S' ,f ���✓�. 139 1 o f '1� O��D /rf 1511, 1591 � 169 f2 3 5 126 r ' — 140� it � , y -------- WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: M4050B0004 Township: Jerusalem NCPIN Number: 5736505226 Municipality: Account Number: 82518538 Census Tract: 37059-807 Listed Owner 1: AMMERMAN JEFFERY ALLEN Voting Precinct: COOLEEMEE Mailing Address 1: C/O HABITAT FOR HUMANITY 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 4 GLADSTONE WOODS Fire Response District: COOLEEMEE Assessed Acreage: 0.72 Elementary School Zone: COOLEEMEE Deed Date: 6/2010 Middle School Zone: SOUTH DAVIE Deed Book/Page: 008280938 Soil Types: GnB2 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: 101 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.Ail users of Davie County's 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 NCor arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 990005383 Tax P€N!EH#: 5736-50-5226 Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot#4 Reference Name: LocationlAddress: 139 Stone Wood Lane-27028 Proposed Facility: Residence Property Size: .724 Acres ATC Number: 5011 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. / System Type: -EKS.T.Manufacturer 62-1Z Tank Date(STank Size Pump Tank Size System Installed By: E.H.Specialist: Date: ( / .r f�- DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005383 Tax PINIEH#: 5736-50-5226 Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot#4 Reference Name: LocationrAddress: 139 Stone Wood Lane-27028 Proposed Facility: Residence Property Size: .724 Acres ATC Number: 5011 Site Type:OKew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms 3 #Bathrooms#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size CCCunty/Type of Water Supply: oCity ❑Well ❑Community Well 2 D System Specifications: Design Wastewater Flow(GPD) 3 �crank Size X GAL.Pump Tank GAL. ell r/ Trench Width Max.Trench Depth �i Rock Depth)=f�F Linear Ft.J �0 Site Modifications/Conditions/Other: As stated in 15A NCAC 181.1969(5) ceoeptud Systemsy also be use Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. UIo 0 � i ^�^ tads _ E ironm ntal Health Specialist Date: DCHD 11 6( evised) 4 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005383 Tax PiNIEH#: 5736-50-5226 Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot#4 Reference Name: LocationiAddress: 139 Stone Wood Lane-27028 Proposed Facility: Residence Property Size: .724 Acres ATC Number: 5011 Site Type: Rr<ew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms-3 #Bathrooms D,#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats ' Square Footage(or Dimensions of Facility) .Lot Size 11.7 "7 QCrt Type of Water Supply: ?'County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) 3&OTank Size GAL.Pump Tank GAL. Trench Width 3 L Max.Trench Depth 1 Rock Depth.0 Linear Ft.3(Do Site Modifications/Condi5A As stated in 1NCAC 18A.1969(5) tions/Other: ` ay also 56 used. Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. c _ O. o q► .� a C-N ZZ %A _ -imp Environme tal Health Specialist / Date: DCHD 11/06(Revised) Davie County Environmental Health P.O.Box 848%210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT a Account #: 990005383 Tax PIN/EH#: 5736-50-5226 Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot#4 Address: P.O. Box 1384 Location/Address: 139 Stone Wood Lane-27028 City: Mocksville, Property Size: .724 Acres Reference Name: Proposed Facility: Residence ' **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system.',,An v Authorization To Construct a wastewater system must be obtained from this office prior to the i! construction/installation of a wastewater system or the issuance of a building permit(in compliance with`fy Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change.:°w {i Permit Type: Aew ❑Repair ❑Expansion Permit Valid for: SP1 Years ❑No Expiration Residential Specifications: #Bedrooms 3 #Bathrooms__.2 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats 2// Square Footage(or Dimensions of Facility) Design Flow(GPD): JCQ� Type of Water Supply: 6County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As stated in 15A NCAC 18A.1�J69(5� asoer�trd Systems may bo us a -System Type LTAR Initial r .'O'n Repair � � ' ' d •7, Site Plan 1y J� SL Sv 5 �f 7 E vironmental Health Specialist Date i.p.11-06 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)75.1-8786 Application For: ❑ Site Evaluation/Improvement Permit Authorization To Construct(ATC) ❑ Both Type of Application: XNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORNATIOI�'IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Ha�r�a� {ar �u»Zgni ay' Contact Person Lnl7 e,L r�de,Phfm Billing Address PO Go)( 133 4 Home Phone City/State/ZIP a r,Jrsv;ll e.. /VC 27O2? Business Phone (336) 751-7515 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name "i -or v ni avie-G,, Phone Numbe 36 '751-75!5 Owner's Address M P City/State/Zip /JOSV/LLQ c 2702 Property Address 139 S}-one.wawd gvte, CityMods-v lle, Lot Size .79q-acres Tax PIN# 5Z5&-0-517Z(- Subdivision Z5&-0D5ZZ(- Subdivision Name(if applicable) C-1aas4one. Lyoods Section/Lot# Directions To Site: If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? . ❑Yes)kNo Does the site contain jurisdictional wetlands? ❑Yes XNo Are there any easements or right-of-ways on the site? ❑Yes o Is the site subject to approval by another public agency? ❑Yes No Will wastewater other than domestic sewage be generated? ❑Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms 3 #Bathrooms 2 Garden Tub/Whirlpool ❑Yes XNo Basement: ❑Yes )INo Basement Plumbing: ❑Yes NNo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:. Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ( County/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible_for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. /� a Site Revisit Charge Property owner's or owner's legal representative signature Date(s): /2Z ZQ 9 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# 3 Revised 11/06 Invoice# 116, W li. 151• ` , OOWC CU 1s SARAH NOLLEY C C6 p8 D.B.38 PG.206 C S 64�3Tp C #2 1SS4'4ST44) C 4 34 f \ C C - C ?a°' / 104 p0 0<'�F� C1. LOT #3 G,�o� C1 (0.720 AC.) 39 132,pp (396,0 14 oLOT #5 (0.748 AC.) LOT # o 6 (0.690 AC.) � 2 a LOT #7 .. N id (0.698 AC:) 1, `f/ 75 00 #15 I i �'pJ �/� 222.35 TOTAL) 135.00 - -- 53 AC.) i j �C11 ry 76-491S6, CS EA5EMIENT CIO` S 76'49,56. C4 n lj. -120.00_ 222.35 TJDrAI) _;/ •,�z'°�e LOT #14 i/ c. ca (1.29 a 9 AC.) � 4 LO 2 LOT #12 (0.762 AC.) 4J L 11 0.736 AC. o `� o zfu N o LOT #�. _ 8 a (0 944 AG� I _ i Z yk` 236.19 + 120.99 156.35 N 84.09104' Y NE BEARING DISTANCE (915.48 TOTAL) q. Ll S 04'19'21" W 84.93 ,+ L2 S 2508'44' W 180.37 0 S 0730'20* W 23.46 L4 S 07.3020 W 80.45 SHIRLEY JONES LS S 3322'31" W 31.61 e " D.B.66 PG.206 } ,trK� I, hereby certify that the subdivision plat shown a with the Davie 1' that we are the owners of hereon has been found to comply n of n and described hereon and County Subdivision Regulations with exceptio , 5• dopt this plan of subdivision such variances, if any, as•are noted in',the sent, establish minimum set— minutes of the Planning Board and it has been idicate all streets, alleys, walks, approved for recording in the Office of Deeds. sites and easements to public It is hereby noted that such approval for noted. Futhermore, we hereby recordation does not include approval for the ti q all sani sewer, storm sewer construction or occupancy of buildings or structures. `'�• &, � G �Y �t�ry k �4 to vie C unty(if app licable)• 1 lf4 DIRE OR ;' e " OWNER AVIE COUNTY PLANNING DEPARTMENT GC! M/ y. OWNER 1 A a 1 gat +4az moi,. / REVIEW OFFICER'S CERTIFICATE1 , I, John Gallimore, Revow 'atito whi hDavie thisCcertfication certify that the map P �xs OWNER is affixed meets all statutory requirements for recording. ` •z�' . Al 3 .w GG � -etDATE f� R OFFICER : t 4 QoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System +: LIR g'"r� a Glick Here To Start Over .'1 Quick Search:(County ID or Owner Ni r A. w; Active Layer. Use Ptap Tips U N M. �PARCELS(Map Tips Available) *r - ----- --- —-----– --.. Addre. 7.1 I Rp 121 1127 11.E �+' 23�yk �✓ p00 1 , 13 1 A 12-5 J �``� rf J/ 1 75, 2253 1}J � 5 , 1 0� 271# JgLt � t�zNi ��� 153 `.;,a� — — — — � `';• 42]1} 1.4JY G 3�5� / v 1.'.y 523 2 -4 4 U 5's �Oo156f1 http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=41... 10/27/2009 - .'PLICATION FOR SITE EVALUATION/IMPROVEMENTPERMIT&AT , • Davie County Health Department Environmental Health Section JUL 2 1998 P.O.Box 848 Mocksville,NC 27028 (704)634-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed �+ t' S W to P. C'no�J Contact Person Mailing Address _` U oR� S� fie, Home Phone 2 City/StateMip o S,J\U 'L d �� Business Phone 75 �a a a rev 2. Name on Permit/ATC if Different than Above Mailiag Address / City/State/Zip 3. ApplicE!ion For: O" Site Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: EI—House U-�Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms _ # Bathrooms 10 Dishwasher ❑ Garbage Disposal 01-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: El-'County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes U—No If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions:�O6' x ?33.5. X X105.S',)a( 67199.Sa X 7 1? 1 WRITE DIRECTIONS(frons 1 Mocksville)TO PROPERTY: Tax Office PIN: # .� 7 3(Q - '_� - _G k t-( f) 1 l 1 'F Property Address: Road Name 1 -Eo N City/Zip _1��c,��S.,���-P C_ 1 \ 1 AcJSWwG `� c 1 If in Subdivision ��provide information,as follows: 1 Name: 1 Section:�5 �C-Ry- 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 are subject to suspension or revocation,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 e Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County d owned by c ce o tpd. -Sr�We- d /"I i o conduct all testing procedures necessary to de/ttermine the site suitability. ATE /-�- SIGNATURE evised DCHD(06-96) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT Soil/Site Evaluation APPLICANT'S NAME 0d/ DATE EVALUATED 710`%zl�'601 PROPOSED FACILITY PROPERTY SIZE SUBDIVISION e!;�X7Z4C/0-11-/ ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit f/ u Cut FACTORS 1 e 7 Landscape position Sloe% HORIZON IDEPTH e• Texture group -5 G.L C Consistence D - Structure 5 r►S w x MineralogyJr- C HORIZON 11 DEPTH 'S/ vfl,L-�>l V-Zlfr Texture groupCIL C. Consistence i 4 Structure /( ,S Mineralogy = (0 HORIZON III DEPTH Texture group Consistence Structure 6% o.y gu Mineralogy D HORIZON IV DEPTH Texture group W as Consistence Structure bac Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1A 5 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 4 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: / OTHER(S)PRESENT: JV tz 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 I 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(O1-90)