164 Stone Wood Rd Lot 11 Davie County,NC Tax Parcel Report Friday, December 30, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M4050B0011 Township: Jerusalem
NCPIN Number: 5735597898 Municipality:
Account Number: 82532988 Census Tract: 37059-807
Listed Owner 1: KOON JAMIE F Voting Precinct: COOLEEMEE
Mailing Address 1: PO BOX 1384 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 11 GLADSTONE WOODS Fire Response District: COOLEEMEE
Assessed Acreage: 0.75 Elementary School Zone: COOLEEMEE
Deed Date: 10/2011 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 008720155 Soil Types: GnB2,GnC2
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:
9ht�, 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 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 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 PIN'/EH#: 5735-59-7898
Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot#11
Reference Name: Location/Address: 16q Stone Wood Lane-27028
Proposed Facility: Residence Property Size: .736
ATC Number: 5010
**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.
000 YTa.0
System Type: S.T.Manufacturer Tank Date3k?�v Tank Size lova
Pump Tank Size_,V/A
System Installed By: E.H.Specialist: Date: I ZI Zot a
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 PI[rl,EH#: 5735-59-7898
Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot#11
Reference Fume: LocationiAddress: 16N Stone Wood Lane-27028
Proposed Facility: Residence Property Size: .736
,STC Number: 5010 Site Type: 2New ❑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 #Bathrooms #People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lot Size a136CLC. Type of Water Supply: PCounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD)n(d)Tank Size_GAL.Pump Tank GAL.
i
Trench Width Max.Trench Depth Rock Depth Linear Ft. OD
Site Modifications/Conditions/Other: p ®lt
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.
I�
1 '
Environmental Health Specialist Dated 1
DCHD 11/06(Revised)
r
Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax(336)753-1680
IMPROVEMENT PERMIT
Account #: 990005383 Tax PIN/EH#: 5735-59-7898
Billed To: Habitat for Humanity of Davie County Subdivision Info: Gladstone Woods Lot# 11
Address: P.O. Box 1384 Location/Address: 16q Stone Wood Lane-27028
City: Mocksville, Property Size: .736
Reference Name:
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
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.
Permit Type: 2rNew ❑Repair ❑Expansion Permit Valid for: e5 Years ❑No Expiration V
Residential Specifications: #Bedrooms #Bathrooms 2 #People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): �� Type of Water Supply: RCounty/City ❑Well ❑Community Well
Site Modifications/Permit Conditions:
S stem Type LTAR
Initial
Repair
Site Plan
f lv 0,
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s
Environmental Health Specialist Date
i.p.l l-O6
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http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=41... 10/27/2009
• - 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)75.1-8.786 '71 ;
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
INFORN4ATIOI,`IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions
APPLICANT INFORMATION
Name to be Billed Pa6t+a -tar �gnily off' ,tyle_(Iun��._Contact Person Lnt2 e.,C�c,�Hr�j�m
Bilrmg Address_PO eoK 1384 Home Phone
City/State/ZIP a,)Js v;ll e. AJCC 270Z? Business Phone L336) 75/-75/5
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 Ian,no expiration with complete plat.)
,�-
Owner's Name Na -Ar Nynlayi4i oy payr2, urd y Phone Number('
Owner's Address PO B-o , 138 - City/State/Zip N(ockrw&. NC 27029
PropertyAddress 164- ,S-fonewood lane. City, 14ocksyi'lle—
Lot Size .736 ctcrer Tax PIN# ,5 iff
Subdivision Name(if applicable) 1Qds-l-one Wks 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 XNo
Does the site contain jurisdictional wetlands? ❑YesANo
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 ANo 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:. )iconventional ❑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 bJ 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,tG 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.
Site Revisit Charge
Property owner's or owner's legal representative signature
Date(s):
1Z� Q� Client Notification Date:
Date—' --^ EHS:
Sign given []Yes ❑No Account# �a
Revised 11/06 Invoice#
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53 AC.) i 11 N 76'49'56, i✓ C5
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(1.299 AC-) LO
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236.19
120.00 120.99
N 84.09'04' W 156.35
INE BEARING DISTANCE (915.48 TOTAL)
7s1'
l S 04'19'21" W 84.93
S 23'08'44" W 180.37
} S 07'30'20" W 23.46
L5 5 0730''2 0 W 80 61 SHIRLEY JONES
D.8,66 PG.206
-s �I
i, hereby certify that the subdivision plat
shown
that we are the owners of hereon has been found to comply with the Davie
n and described hereon and County Subdivision Regulations with exception of '
dopt this plan of subdivisionsuch variances, if any, as are noted in the
sent, establish minimum set— minutes of the Planning Board and it has been
Deeds.
ttdicate all streets, alleys, Walks, approved for recording in the Office of
sites and easements to public It is hereby noted that such approval for
noted. Futhermore, we hereby recordation does not include approval for the �. ?
G ll sani sewer, storm sewer construction or occupancy of buildings or structures.
y ).
la vie C unt (if applicable).
� ,i
fig G DIREC OR
pWNER \ AVIE COUNTY PLANNING DEPARTMENT
GG! I f
t,
OWNER
REVIEW OFFICER'S CERTIFICATE I
I, John Gallimore, Review officer of Davie County,
�. pJ 1 III �I
f' certify that the map or plat to which this certification
OWNER is affixed meets oil statutory requirements for recording.
i'
DATE
R OFFICER i1
31
i
APPILICATION FOR SITE EVALUATIONAWROVEMENT PERMIT&AT
Davie County Health Department O U is
Environmental Health Section
• P.O.Box 848 JUL — 2 1998
Mocksville,NC 27028
(704)634-8760
ENVIRONMENTAL HEALTH
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNIIESS DAVIE COUNTY
ALL THE REQUIRED INFORMATION IS PROVIDED. '(
1. "ame to be Billed L, A \ OCDCZ) J Contact Person1.
`
Railing Address �`J � U �r \P� �o� �utfe-I h C� Home Phone
Cir;;StateJZip oL�c S \ \C� C- Business Phone 7 5 L a a X K-KT@
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For. U--Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: O—House Mobile Home ❑ Business ❑ Industry D Other
S. If Residence: # People # Bedrooms T� # Bathrooms
6 D shwasher ❑ Garbage Disposal O-Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
.'ci Business/Other. Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated
Estimated Water Usage(gallons per day)
''. Type of water supply: a County/City D Well D Community
i;. 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:-700x ?3 3,5-� X 905,5,d SO�r,S-a Y 9�L7 3 1 WRITE DIRECTIONS(from
1 Mocksville)TO PROPERTY:
Tax Office PIN: # ,0 3(.,e_ - 0 - L( '� 1
Property Address: Road Name _ \`e�\
-Eo N
City(Lip 1� o c��5.,����e �l C_ 1
1
If in Subdivision provide information,as follows: 1
1 e P.J �o
Name: t ►.�e_ 1
- 1
Secron: 1 S N c..e e- Lot #: /� 1
1
1 .
its 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 owned by r-0- L,J eu I-S\rr_ d A ei'-Z A 6&1 o conduct all testing procedures
necessary
to determine the site suitability.
.ATE /-ol- 7 o SIGNATURE c
wised DCHD(06-96)
i
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT—//
Soil/Site Evaluation
APPLICANT'S NAME DATE l'2Q OC.C' DATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE /�f)440
SUBDIVISION [a//�L�SdFIAP tet/ ROAD NAMEC 19
Water Supply: On-Site Well Community`/ Public
Evaluation By: Auger Boring Pit ✓ Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope% ,(
HORIZON I DEPTH 07
Texture group C,4,
Consistence '
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure /C S
Mineralogyi
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:
LONG-TERM ACCEPTANCE RATE: I IV 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(01-90)