159 Stone Wood Rd Lot 6 I
Davie County,NC Tax Parcel Report Friday,December 30, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M4050B0006 Township: Jerusalem
NCPIN Number: 5736507189 Municipality:
Account Number: 38001500 Census Tract: 37059-807
Listed Owner 1: HOWELL RANDY HUGH Voting Precinct: COOLEEMEE
Mailing Address 1: 159 STONEWOOD ROAD 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 6 GLADSTONE WOODS Fire Response District: COOLEEMEE
Assessed Acreage: 0.69 Elementary School Zone: COOLEEMEE
Deed Date: 10/1999 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 003170219 Soil Types: Gn132
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:
9AI�. 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'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
NC or arising out of the use or inability to use the GIS data provided by this webstte.
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
• + P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 890000787 Tax PIN/EH#: 5736-50-6147.06
Billed To: Southern Showcase Subdivision Info: Gladstone Woods Lot#6
Reference Name: Randy H. Howell Location/Address: Stonewood Road-27028
Proposed Facility: Residence Property Size: 135.00x225.03
ATC Number: 2174
**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 M• 001�kC #People 3 #Bedrooms 3 #Baths -2—
Dishwasher:
Dishwasher: Garbage Disposal: ❑ Washing Machine: 12"�e/.Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size USSI Type Water Supply 0WOW Design Wastewater Flow(GPD) O Site: New Repair❑
System Specifications: Tank Size L_ AL. Pump Tank GAL. Trench WidthRock Depth)2- Linear Ftp)
Other: 2 PS"(2A11110,3 � �=5 ,�STd U, r
1 L,.��S �
Required Site Modifications/Conditions: IrQE-> W� c0ihoop- S oR-- C'm - 1c; V
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6 11 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: q
—7
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account M 990000787 Tax PIN/EH M 5736-50-6147.06
Billed To: Southern Showcase Subdivision Info: Gladstone Woods Lot#6
Reference Name: Randy H. Howell Location/Address: Stonewood Road 27028
Proposed Facility: Residence Property Size: 135.00x225.03
ATC Number: 2174
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 WASTEWATER CO TION KYALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
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: r5 C7 a' 0C.
Environmental Health Specialist's Signature: Date: L/11019q
DCI-ED 05/99(Revised)
• - APPRICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC D
Davie County Health Department SEP 1 5 1999
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 `
***Mt7iRTAim" THIS 71PPLICATIOm CIMM BB PROCESM UNLESS 712.E TSS REQUIRED
INr0M=I0H IS PROVIDED. Rater to the IMa'ORMILTION BULLETIN for instructions.
1. Mase Yo be Gilled Sa t4 f`J1 crn �h o wt G S G Contact person ez 1
Nei linq address )r10� U.S l�1✓Y • 40) Al Rome Phanfsoo-670— 7 612 9
city/state/sIp Ao&ksydle, 4f6 2,70.2<-- &,sines ",ons 3).2
Z. Maas on Ressit/ATC ))i! Different than Above el w� 1
Nailing address I ) �Ct -,' La-Z , City/state/alp / 1 O6l4sy'llf /1/G
3. 4VILcation tor: O Site Evaluation XImprovement Permit/71TC O Both
4. system to service: O House A Mobile Home O Business O Industry O Other
s. If Residence: i People _ f Bedrooms f Bathrooms _
ADishvasher O garbage Disposal X""Ung MOM O aaseaent/pluebinq O sasaaant/Mo pivabinq
6. It susiness/Industry/other: specify type # people i sinks
t commodes I showers I Urinate i water Coolers
If 11=8ERVICi: # Seats Estimated hater Usage tt:ulons per dart)
7. Type of water supply: County/City 17 Well O Community
a. Do you anticipate additions or expansions of the fscWty this system Is Intended to serve? O Yes ANO
If yes,what type?
***IMPORTANT"**CLIENTS 1NfilST CiOMPIETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESVBMI7TED by the client with THIS APPLICATION.
Property Dimensions: ! 3.S.O,D X 21,2A. 03 WRITE DIRECFIONS(from MocWt1e)to PROPERTY:
Tax OfidcePIN: # .5'�;I3C'' 6-0- C/1;� LO) .»ut '-'o Oadyla,,�- Rrrt
Property Address: Road Name S--Oh e. WooG+ Rif 6 iG olS f on c i-o Al))e d /ti
.01
Cityalp Ala ))r o to 5�V n r- 410 �G1
Ufa a Subdivision provide Information,as follows:
Name: Cr ki Lf Ho o r, Waofit
Section: Blocks Lot: b Date Property Flagged: l0 9
This 1s to certify that the infbrmtion provided Is correct to the bat of my knowledge. I understand that any permil(s)
Issued hereafter are subject to suspension or revocation,It the site plans or intended use change,or If the information
submitted in this application Is falsified or changed. 1,also,undemand that I ant responsible for all cia:ga Incurredporn
this appUcadom I,hereby,give consent to the Authorised Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct aU testing procedures as necessary to determine the site suitability.
DATE q 1 SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(include all of the following: Existing and proposed
property Una and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
laientl4odfleation Date:
EHS:
Account No. �U
Revised DCHD(07/99) Invoice No. o
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SARAH NOLLEY
38 PG. 006
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\ "OT 2
SYS is43�9<
0p 0 v
� 0 e
J f 70 \SF'y/<i /�3•g
LOT 3 t
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OT I \ \ .
/3000.:.S_75•�53.0
\ \ LOT 4 00 21000 39600
\ P 56.
`jd.54•• µ•l34.36 �S�r'Fti'1\ �� ti LOT 5 0 oo .
r�•at r \� STs N LOT 6 0
LOT 22 v �� h LOT 7
obi \ \ ti 00 O
0' N
oo�
LOT 8, N O
�P LOT l53p`'o 80.00- Qui
LOT 23 h
1+b1 O O
m 0 195.00
l20 00_ —
�M nto. 0
7
V. p°0 •65.00) 3
N
O LOT 9 N �
_ 0
LOT 14 o O N
h O i
ti 0
LOT l3LOT 12 N v
m LOT 11 N LOT 10 \
255.Op
. 111.95 120.00
• � � N 84'09'04•• 1,y/20.00 /50.00 -
9/5.48 TOTAL 90353 27p 00
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DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME DATE EVALUATED
PROPOSED FACILITY �r y� PROPERTY SIZE
SUBDIVISION ROAD NAME V
Water Supply: On-Site Well Community Public L�
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope% (�
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence i
Structure S.3-F
Mineralogy A
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: A EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: 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-Finn 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)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT 188—
Davie County Health Department Environmental Health Section
P.O.Box 848 JUL - 2 1998Mocksville,NC 27028
(704)634-8760ENVIRONMENTAL HEALTH****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEDDAVIE COUNTY
ALL THE REQUIRED INFORMATION IS PROVIDED. I�
1. Name to be Billed Contact Person
Mailing Address -L V o�� Sv fie. Home Phone 01 IK 3)o ?
City/State0p o S��\\e C D Business Phone 7 5 (-a a a a
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: 3---Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: D—House Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms _ # Bathrooms
q3l&shwasher ❑ Garbage Disposal O'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: 8--c'-Ounty/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes EI—No
If yes,what type? _
PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: X FIDS,s..I j( SD�i.Q V 927 ? 1 WRITE DIRECTIONS(from
1 Mocksville)TO PROPERTY:
Tax Office PIN: # ,��7 3 Ce_ -
Property Address: Road Name
1 -Eos
City/Zip 1ko cNL--i-AVe N 1
1
If in Subdivision provide information,as follows: 1
Name: ey
� � Sto►�� 1 _
1
Section: IS Nc e a Lot #: 4� 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
e 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 ov.rned by ae oz:'). '�u I,-Sr�xr('- ) /I l to conduct all testing procedures
necessary to determine the site suitability.
ATE `ol- SIGNATURE c
evised DCHD(06-96)