3038 Hwy 64E Davie County,NC' Tax Parcel Report Wednesday, December 7, 2016
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_ = WARNING: THIS IS NOT A SURVEY
Parcel Information ___
Parcel Number: J70000008401 Township: Fulton
NCPIN Number: 5777084344 Municipality:
Account Number: ""=8303595 Census Tract: 37059-804
Listed Owner 1: HAWKS BRENDAIGARY - Voting Precinct: FULTON
Mailing Address.1: - 3038 US HWY 64 EAST Planning Jurisdiction: Davie County
City: MOCKSVILLE - Zoning Class: DAVIE COUNTY R-A,R-20
Stater NC Zoning Overlay:
Zip Code:- : 27028 Voluntary Ag.District: No
Legal Description: 3.433 AC US HWY 64 Fire Response District: FORK
Assessed Acreage: 3.43 Elementary School Zone: CORNATZER
.-Deed-Date: 6/2014 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 009590989 Soil Types: PaD,PcB2,WATER
Plat Book: 11 Flood Zone:
Plat Page: 314 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 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.
OPERATION PERMIT o
rice use only
Davie County Health Department Number 124940-1
�- 210 Hospital Street %17-00(o b 0-8�,.;
P.D. Box 848 umber.
Mocksville; NC. 27028; r: NEW
Phone:336-753-6780 Fax:336-753-1680
Applicant: Gary W. Hawks Property Owner. Brenda Wyatt Hawks/ExEstate
Applicant:
194 No Creek'Road Address: 3050 US Hwy 64 East
City: Mocksville Cay: Mocksville
SWOOP: NC 27028 Statetzip: NC 27028
Phone#: (336)909-3044 Phone#: (336)909-3044
Property Location & Site Information
Address/Road#: 2 O�� Subdivision: Phase: Lot:
US Hwy 64 E J
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 64 east, past TR's Convience Store, property
3
behind 3050 US hwy 64 E on right.
#of Bedrooms
#of People:
*Water Supply: PUBLIC
'IP Issued by. 2sao-Nations,Roben 'System Classification/Description:
TYPE It A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
'CA issued by: 2140.NaUons,Robert
SaprotiteSystem? QYes @No
Design Flow: 3 6 0Distribution Type: GRAVITY-SERIAL Pump Required?
QYes QNo
Soil Application Rate: 0 - a a 5 *Pre Treatment:
Drain field
Nitrification Field 1 6 0 0 Sq.ft, *System Type: INFILTRATOR OUICK 4 STANDARD
No.Drain Lines 5 Installer: Randy Miller and Sons
Total Trench Length: 4 0 0 g• Certification#:
Trench Spacing: — 9 Olnches O.C.
s Feet O.C. EH S: 2140-Nations,Robert
Trench Width: — 3 Oin tes
Date: 0 7 / 1 5 / 2 0 1 5
Aggregate Depth: inches
Minimum Trench Depth: a 4
Inches
Minimum Soil Cover. 1 aaApproval Status
Inches
MaxirnumTtonch'Depth:
'a 4 ® ApproyedCJ Disapproved
Inches
Maximum Soil Cover.
1 2 Inches
CDP File Number 124940 ` 1 County ID Number: J7�00'000•84, •
Se tic Tank
Manufacturer. Shoaf Lat.
,
STB: 760 Long: - - - - -
Gallons:
1000 Installer: •Randy Miller and Sons
Date: 0 4 / 1 5 / 2 0 1 5 Certification#:
*EH S: 2140-Nations.Robert
*Filter Brand: POLYLOKPL-122 With Pipe Adapter
ST Marker. El Yes B No
Date: 0 / 1 5 / a 0 1 5
Approval Status
Reinforced Tank: ❑ Yes C] No : ''® 'Approved❑' 13isappraved
� Piece Tank: ❑ Yes C] No
Pump Tank
Manufacturer. Installer:
PT: Certification#:
Gallons: THS:
Date: / Date:
RiserSealed ❑ Yes ❑ NO
RiserHeight: ❑ Yes ❑ No (Min.6 in.) °Approval Status
Reinforced Tank: ❑ Yes ❑ No JO A°pprov6d❑�,Disapp'roved .
1 Piece Tank: ❑ Yes ❑ No -
Supply Line
Pipe Size: inch diameter Installer:
Pipe Length: feet Certification#:
THS:
*Schedule:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings ❑ Yes ElNo > Approval Status
❑ i pprove i❑ Disapproved:
e
Pump Type: Installer.
Dosing Volume: — Gal Certification#:
Draw Down: Inches *EH S:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ElYes ❑ No Approval statusn
PVC,unions_ ElYes ElNo ❑ jApproed❑ Dlsappr4ued
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole El Yes ❑ No
CDP Fi1$,Number 124940- 1 J7-000-000-84County ID Number:
Electric Equipment
NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ No Certification#:
Box Adj. Pump Tank ❑ Yes ❑ No
Conduit Sealed ❑ Yes ❑ No *EHS:
Pump Manually Operable ❑ Yes ❑ No
*Activation Method: Date;
Approval Status
Alarm Audible D Yes D No ❑ Approved ,!saipproved
Alarm Visible ❑ Yes ❑ No
2140-Nations,Robert
*Operation Permit completed by:
Authorized State A Date of Issue: 0 7 1 5 .1 0 1 5
Owner/Applicant Signature;
This system has been installed in compliance with applicable NC General Statutes:Article 11,Chapter 130A, Rules for
SewageTreatment and oisposa1,16A'NCAC.18A.1900 et. Seq.,and all conditions of the Improvement,Permit and
Construction Authorization.This property is served by a TYPE it A. sewage septic system.
Rule.1961 requires that a Type T'E II A septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: NA
Management Entity: OWNER
Minimum System InspectionlMaintenance Frequency ByCedifred Operator:
NIA
Reporting Frequency By Certified Operator:NIA
Rule.1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract
with a public management entitywth a certified operatorora private certified operator forthe life of the septic system.
Rule.1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule.1961 (2)(e)requires a contract shall be executed between the system owner and a management entity priorto the
issuance of an Operation Permit for a system,required to be maintained bya public or private management`entity,unless the
system ownerand certified opIoratoraare the same. `The contract shall require specific requirements form'aintenance and
operation,`responsibilities of the owner systems operator,provisions that the contract shall be in effect for as long as the
S ystem is in use,andotherrequirements forthe,continued proper performance ofthe'system. It shall also- be a condition'of'
the Operation Permit that`subsequent owners'of the systems execute such a contract.
®Hand Drawing Ulmport Drawing
**Site Plan/Drawing attached.** :
OPERATION PERMIT
12' 940
Davie County Health Department CDP File Number:
210 Hospital Street J7-000-000-84
P.O.Box 848 County File Number:
Mocksville NC 27028 Date:
Q Inch
locDrawin Drawing Type: Operation Permit Scale: ON A k
1
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CONSTRUCTION For office Use only
` AUTHORIZATION "CDP File Number 124940-1
Davie County Health Department J7-000-000-84
tY p County ID Number:
210 Hospital Street Evaluated For: NEW
P.O.Box 848 Township:
Mocksville NC 27028 PERLtIT VAL1D UNTIL:
Phone:336-753-6780 Fax:336-753-1680 0 3 / 1 1 / 2 0 1 9
Applicant: Gary W.Hawks Property Owner: Brenda Wyatt Hawks/ExEstate
Address: 194 No Creek Road Address: 3050 US Hwy 64 East
City: Mocksville City: Mocksville
State/Zip: NC 27028 State2ip: NC 27028
Phone#: (336)909-3044 Phone#: (336)909-3044
Property Location & Site Information
rAddress/Road #: Subdivision: Phase: Lot:
S Hwy 64 E
ocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 64 east, past TR's Convience Store, property behind
#of Bedrooms: CJ
6/2�I�5 /,itAkA 3050 US hwy 64 E on right.
/
#of People:
'Water Supply: PUBLIC
System Specifications
Minimum Trench Depth:
Site Classification: Provisionally suitable a 4 Inches
Minimum Soil Cover.
Saprolite System? OYes QNo 1 a Inches
Design Flow: 4 8 0 Maximum Trench Depth: a 4 Inches
Soil Application Rate: 0 a a 5 Maximum Soil Cover: 1 a Inches
'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
1 0 0 0 Gallons
'Proposed System: 25%REDUCTION 1-Piece: OYes QNo
Pump Required: OYes QNo OMay Be Required
Nitrification Field 2 1 3 3
Sq. ft. Pump Tank: Gallons
No. Drain Lines 1-Piece: QYes ONo
Total Trench Length: 5 3 3 g, GPM—vs— ft. TDH
Trench Spacing: — 9 Onches O.C.
Feet O.C. DosingVolume: Gallons
Trench Width: Inches
3 . gFeet Grease Trap: Gallons
Aggregate Depth: inches
Pre Treatment: ONSF OTS-1 OTS-II
Septic Tank Installer Grade Level Required: 01 011 0111 01V
Pagel of 3
CDP Fite Number 1'2494U- 1 County ID Number: J7-000-000-84
❑ Open Pump System Sheet
Repair System Required:OYes ONo ONo, but has Available Space
rDesign
System
Trench Spacing: 81�
Inches 0. .
Classification: Provisionally suitable — 9 Feet O.C.
Trench Width: Inches
w: 4 5 3 3 1 — 3 Feet
Soil Application Rate: Aggregate Depth:
0 a a 5 inches
1 a
*System Classification/Description: Minimum Trench Depth: Inches
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. 1 a
Inches
Maximum Trench Depth: a 4 Inches
'Proposed System: 25%REDUCTION
Nitrification Field 2 1 3 3 Sq. ft. Maximum Soil Cover: 1 a Inches
No. Drain Lines *Distribution Type: GRAVITY-SERIAL
Total Trench Length: 5 3 3 g Pump Required: Oyes ONo OMay Be Required
PreTreatment: ONSF OTS-1 OTS-11
*Site Modifications
No grading or constriction activity is allowed in areas designated for system and repair without approval of Health Department.
7;
'Permit Conditions
The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. `''
2(
This Authorization for Wastewater system Construction shall be valid fora person equal to the period of validity of the Improvement Permit not
to exceed five years,and may be issued at the same time the Improvement Permit Issued(NCGS 130A-336(b)).If the installation has not been
completed during the period of validity of the Construction Permit,the Information submitted in the application for a permit or Construction
Authorization is found to have been incorrect,falsified or changed,or the site Is altered,the permit or Construction Authorization shall became
invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible for assuring compliance
with the laws,rules,and permit conditions regarding system location,installation,operation,maintenances monitoring,reporting and repair
(1938(b)).
Applicant/Legal Reps.Signature Required? Oyes ONO
Applicant/Legal Reps. Signature: Date:
*Issued By: 2140-Nations,Robert Date of Issue: 0 3 / 1 1 / a 0 •1 4
Authorized State Agent: Malfunction Log OYes
OHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 124940 - 1
Davie County Health Department CDP File Number.
210 Hospital Street
County File Number: J7-000-000-84
P.O.Box 848
Mocksville NC 27028 Date: 03 / 1 1 / 2 0 1 4
Olnch
Drawing Drawing Type: Construction Authorization Scale: , OBlock = ft.
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�..__ Davie County Environmental Health
r' P.O.Box 848/210.Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax(336)753-1680
IMPROVEMENT PERMIT
Account #: 990004203 Tax PIN/EH#: J7-000-000-84
Billed To; Gary Hawks Subdivision Info:
Address: 194 No Creek Road Location/Address: US Hgihway 64 E-27028
City: Mocksville Property Size: 18.850 Ac
Reference Name:
Propoh—dAFF I't r Residence
1KIR 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: ew ❑Repair ❑Expansion Permit Valid for.—C 6 Years ❑No Expiration
Residential Specifications: #Bedrooms #Bathrooms 3 #People o2. Basement❑ Basement plumbing!]
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lr
Design Flow(GPD): L 8V Type of Water Supply: CxCounty/City ❑Well ❑Community Well
As stated in 15Arv_,�e C 18a r
a
Site Modifications/Permit Conditions: ``ccePtod Sy�,tr tTI S rn'r�� "I" ���.3®r('3) '
System Type LTAR t
Initial «•t d CY
Repair O
'
Site Plan
-' VA.
� � t
,LY
EnvironmentalHealthSpecialist Date
i.p.11-06 /
w DEC/27/2013/FRI 12: 17 PM FAX No. P. 001
OWPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
C� Davie County Environmental Realth
P.O.Boz$48/210 Hospital Street
Mocksville,IVC 27028
(3367753-67301 Fax(336)753-1680
9�¢• Application For: -15ite Evaluation/Improvement Permit VAuthorization To Construct(ATC) Both
Type of Application:ZNew System i7Repair to Existing System 1•Expension/Modiffication of Existing System or Facility
••'r1d9 0RTAVT't'THIS APPLICATION CANNOT BE PROCEBSEA UNLESS ALL OF THE REQUIRED
INFORMATION 13 PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed QY f g fi1A W kS Contact Person 6YCT'\& OrAW k5
Billing Address Home Phone_ce II G o q-,;_3 0 tic(
City/State)ZIPg�1 5yiI!e. NC— V70729 Business Phone *arI& -tzto-2-1994
Name on Permit/ATC if.Different than Above Sd 1ME
Mailing Address City/State/Zi
PROPERTY INFORMATION *Date House/FaciRty Corners Fla ed -r1M
NOTE: A survey plat or site plan must accompany this application. Included:I Site Plan ❑Plat(to scale)
(Permit is valid for 69 months with site plan,no expiration with complete plat.)
Owner's Name -5Y da Nva Vs PboneNumber 9_0q,5044
Owner's Address r e City/State/Zip MoLksg
Property Address3oSa { wCity Aocic5-V%\\e.
�
Lot Size Tax PIN#
Subdivision Name(if applicable) N A, Section/Lot#
Directions To Site: litv ori\ Moe 25-y 11 P.. OmEl to 4 ` t 30 S5 �b 4 Cern
If th answer to.any of the following questions is" supporting doctunentapgqn must be attached.
Are there any existing itastewater systems on the site? `'yes 7No �[
Does the site contain jurisdictional wetlands? -iYes'VNo J-?,U U Q—06 Q-g 7
Are there any easements or right-o1 hays on.the site? - UYes 5fNo c,
Is the site subject to approval by another public agency? CYes 18No () •b 5o A,
Will wastewater other than domestic sewage be generated? CYes ONO O
IF RESIDENCE FILL OUT TIM BOX BELOW
[#People Z #Bedrooms L #Bathrooms�_ Garden Tub/Whiripooi Wes i,No
Basement: []Yes LYNo BasementPiumbing: CYes Vo
IF NON-RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Tota Squ a Footage of Building. #People
#
$W4 #Commodes # h vers #Urinals
Estimated Water Usage(gallons per day) (Att ch entation of similar facility water consumption)
FOODSERVICE ONLY: #Seats
Type system requested: Ctonventional •nAccepted OInnovative 7Alternative (?Other
Water Supply Type:r,)'ounty/City Water Z New Well :Existing Well C Community Well
Do you anticipate additions or expansions of the%cility this system is intended to serve?0 Yes ,KNo
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 comers and
loc 'ng and flagging or staking he hou a/facility location,proposed well location and the location of any other amenities.
iu d�oy
14).
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Property owners or owner's legal representative signature Site Revisit Charge
Client Notification Date: q,(1
Date ��., EHS: (�
Sign given =Yes[]No Account t
Revised 11106 Invoice#
U I .+v.B.
NEW 1
1RONI
ct
•� nnn w 9B'15'38• t —�.. NEW EXEsrM
s)B'i538' E — IRON
r - 179 fit
(23UI #stat) 6
AREA = 3.333 AC S�
pond AREA -
H IW36t4V• . S 4151.575. v
gg'25'Sfl' U1 _ u�•��p�� 35.11 F
iEt. y118'fi9 04MING aT�', S 5545-W K
IRON
¢ �44•641V V 't
N 01•�• E
+ HOUSE VU87.44total)
� ' g—� BUILDING S,�Ty HAAS— -------- . 4 <
NEW IRON
—t 1 F �13A1Z—�—T � REBARf
IRON �
1 AREA = -`ACRES !
pond '`cp
862 eti —S o2"03'4V W R£BAR H OX35,1w E
rj— Sg' LF AXLE ~`.� 53.01
` LTID
LEN'S M WYATT
D.B. 174, PC. 179
L. ,STEIVART
OD, PG. .371 GEORGE W. HOWARD-
17 D.B. 137, .PG. 186
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R' • . DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
I Soil/Site Evaluation.
APPLICANT INFORMATION PROPERTY I
Alit=mItW, 990004203 TPM ERW: J7-000-000-84
®Ilh fft: Gary Hawks � mamitifbo:
11 madfim AEkoess: US Hgihway 64 E-27028 /
FRo F imft: Residence R4agq�t 3kw: 18.850 Ac �te ,
ted: '�-r" ± `7`'
Water Supply: On-Site Well Community Public
Evaluation By: ! Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 1 7
Landscape position L `. I
31
°:HORIZON I DEPTH ., R-7
Texture group C G i
j Consistence
(4',r S Vki, +
Structure i B k igE Mineralo HORIZON II DEPTH, 2Texture rou I
Consistence
Structure I
Mineralogyi
HORIZON III DEPTH I
Texture groupI
Consistence
Structure I
Mineralogy1
HORIZON IV DEPTH i
Texture groupI
Consistence I
Structure I
Mineralogy. I
SOIL WETNESS
RESTRICTIVE HORIZON 7 Z 1 r I
SAPROLITE 1•.
CLASSIFICATION 173
LONG-TERM ACCEPTANCE RATE 7 I '
-"`SITE CLASSIFICATION: 19 5
S�cR-&dLc/ EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: d '�' OTHER(S)PRESENT: 4
REMARKS: c) l J c✓( at
LEGE
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
NS -Non sticky SS-Slightly sticky S -Sticky VS -Very Sticky
NP-Non plastic I SP-Slightly plastic P-Plastic VP-Very plastic
S
Structure
Single grain! M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangulai blocky PL-Platy PR-Prismatic da
Mineralogy j
1:1,2:1,Mixed
lYQtr� �• '���• _
Horizon depth-In incl
Depth of fill-In inches
Restrictive horizon-Thickness and inches from land surface
Saprolite'- (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- ual/davM2 ru•un nvnr%PD—A.-A's
1