173 Kodiak Trl i
Davie County,NC Tax Parcel Report Wednesday, February 15, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: F400000052 Township: Mocksville
NCPIN Number: 5831606318 Municipality:
Account Number: 8301677 Census Tract: 37059-806
Listed Owner 1: SERGE RICHARD Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 173 KODIAK TRL Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028 Voluntary Ag.District: No
Legal Description: 8.598 AC BEAR CREEK EST.LT1 Fire Response District: WILLIAM R.DAVIE
Assessed Acreage: 8.60 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 3/2004 Middle School Zone: NORTH DAVIE
Deed Book/Page: 2004EO076 Soil Types: EnB,MsC,MsD
Plat Book: 11 Flood Zone:
Plat Page: 64 Watershed Overlay: DAVIE COUNTY
Building Value: 310980.00 Outbuilding&Extra 14630.00
Freatures Value:
Land Value: 64230.00 Total Market Value: 389840.00
Total Assessed Value: 389840.00
161 All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not Ilmited to the
Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS websiteshall 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.
OPERATION PERMIT
or fice use UnIV
,..swr.
Davie County Health Department *CDP Fite Number 188213-1
210 Hospital Street F4-000-00-052
P.O.Box 848
County ID Number.
Mocksville NC 27028 Evaluated For. NEW
Phone:336-753-6780 Fax:336-753-1680 Township:
Applicant: Bear Creek Log Homes Property owner. Richard and Marcy Serge
Address: 371 Valley Rd Address: 123 S Claybon Drive
CRY: Mocksville City: Advance
State2ip: NC 27028 State/Zip: NC 27006
Phone#: (336)751-6180 Phone#:
Property Location S Site Information
CAddress/Road;g: Subdivision: Bear Creek Estates Phase: Lot: 1
Kodiak Trail
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 601 North Right on Cana Rd, right on Angell on
the right
#of Bedrooms: 4
#of People:
*Water Supply: EXISTING WELL
*IP Issued by. 2140-Nat�ns,Robert *System Classification/Description:
TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP
*CA issued by: 2140.Nations,Robert Saprolite System? 0Yes QNo
Design Flow: 4 8 0 * PUMP TO GRAVITY Pump Required?
Distribution Type: 4Yes QNo
Soil Application Rate: 0 . 3 *Pre Treatment:
Drain field
N1rificationField 1 6 0 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD
No. Drain Lines 5 Installer: Randy Miller
Total Trench Length: 4 0 0 ft. Certification#: 1128
Trench Spacing: 9 Inches O.C.
• Feet O.C. *EHS: 2140-Nations,Robert
Trench Width: — 3inches
gFeet Date: 0 5 / 0 8 2 0 1 5
Aggregate Depth: inches
Minimum Trench Depth: 3 6
Inches
Minimum Soil Cover. a 4inches Approval Status
,,",Maximum Trench Depth: 3 6 ® Approved❑ Disapproved
Maximum Inchesak
Soil Cover. a 4
Inches
CDP File Number 188213 - 1 Septic Tank County ID Number: F4.000-00-0F2
Manufacturer. Shoaf Lat.
STB; 760 Long:
Randy Miller
Gallons:
1000 Installer:
Date: 0 1 / 0 8 / x 0 1 5 Certification#: 1128
*EH S: 2140-Nations,Robert
*Filter Brand: POLYLOK PLA 22 With Pipe Adapter
ST Marker. El Yes 0 No
Date: 0 5 / 0 8 / x 0 1 5
; Approval Status
Reinforced Tank:
El Yes ® No - - t
� Piece Tank: ❑ Yes ® No d Approved❑ Otsapproved
Pump Tank
Manufacturer. Shoaf Installer Randy Miller
PT: 42 Certification#: 1128
Gallons: 1250 *BHS. 2140-Nations,Robert
Date: 1 x / 1 3 / 2 0 1 4 Date: 0 5 / 0 8 / 2 0 1 5
RiserSealed S Yes ❑ No
RiserHeight: ® Yes El No (Min.6 in.) '
Appit at Status
AN
Reinforced Tank: ❑ Yes ® No
I Approved❑ Disapproved
1 Piece Tank: p Yes ❑ No
Supply Line
Pipe Size: a inch diameter Installer Randy Miller
Pipe Length: 4 0 0 feet Certification#: 1128
THS.
*Schedule: 402140-Nations,Robert
Pressure Rated O Yes ❑ No Date: 0 5 / 0 8 / _ 2 0 1 5
Approved fittings ® Yes ❑ NO ;Approval Status
® Approved❑ Disapproved
e u
Pump Type: ZoellerInstaller. Randy Miller
Dosing Volume: — Gal Certification#: 1128
Draw Down: Inches *EHS: 2140-Nations,Robert
*Chain: STAINLESS Date: 0 5 / 0 8 / .1 0 1 5
Valves Accessible p Yes ❑ No
Flow Adjustment Valve El Yes ❑ N o
Check-valve [� Yes ❑ No Approval Status:
PVC unions p Yes ❑ No ® Approvetl❑ Disapproved
Vent Hole p Yes ❑ NO
�Atihon Hole YeS 0 No
COP File Number 1$821$ - 1 County ID Number: F4-000'00'052
Electric Equipment
NEMA 4X Box or Equivalent p Yes ❑ No Installer: randy Miller
Box 12 inches Above Grade ® Yes ❑ No 1128
Certification#:
Box Adj.To Pump Tank ® Yes ❑ No
Conduit Sealed p Yes ❑ No *EHS:
Pump M an ually 0 perable ® Yes ❑ NO
Date: •0 5 8 a 0 1 5
*Activation Method:PIGGYBACK
_ / a /
Approval Status
Alarm Audible Yes ❑ NO ® Approved❑ Disapproved
Alarm Visible ® Yes ❑ No
2140-Nations,Robert
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 0 5 / a 8 / a 0 1 5
Owner/Applicant Signature:
This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A .1900 of. Seq.,and all conditions of the Improvement Permit and
Construction Authorization.This property is served by a TYPE III B. sewage septic system.
Rule.1961 requires that a Type TYPE III B. septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: 5YRS.
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency ByCertified Operator:
N/A
Reporting Frequency By Certified Operator: NIA
Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract
with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system.
Rule.1961 requires that Type VI septic systems designed for a homelbusiness owner must maintain a valid contract with a
public management entitywith 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 prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and
operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the
system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT 1 #. . = 1
Davie County Health Department CDP File Number:
210 Hospital Street F4-000-00.052
P.O. Box 848 County File Number:
Mocksville NC 27028 Date:
Qlnch
Drawing Drawing Type• Operation Permit cafe Q81ock
QN/A
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• CONSTRUCTION
For Office Use Only \
AUTHORIZATION *CDP File Number 188213- 1
Davie County Health Department County ID Number: F4-000-00-052
J 210 Hospital Street Evaluated For: NEW
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 1 / 3 0 a 0 a 0
Applicant: Bear Creek Log HomesProperty Owner: Richard and Marcy Serge
Address: 371 Valley Rd Address: 123 S Claybon Drive
City: Mocksville 7 City: Advance
State/Zip: NC 27028 State/Zip: NC 27006
Phone#: (336)751-6180 Phone#:
Property Location & Site Information
Address/Road#: Subdivision: Bear Creek Estates Phase: Lot: 1
Kodiak Trail
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 601 North Right on Cana Rd, right on Angell on the
right
#of Bedrooms: 4
#of People:
Water Supply: EXISTING WELL
System Specifications
Minimum Trench Depth: a 4
rDesign
ssification: Provisionally suitable Inches
System? Minimum Soil Cover: 1 a
y OYes (lNo Inches
low: 4 8 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 3 Maximum Soil Cover: a 4
Inches
*System Classification/Description: *Distribution Type: PUMP To GRAVITY
TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 0 0 0 Gallons
*Proposed System: 25%REDUCTION 1-Piece: O Yes ®No
Pump Required: ®Yes ONo O May Be Required
Nitrification Field 1 6 0 0
Sq.ft. Pump Tank: 1 0 0 0 Gallons
No. Drain Lines 3 1-Piece: OYes ®No
Total Trench Length: 4 0 0 ft GPM--vs— ft. TDH
Trench Spacing: Inches O.C.
— 9 Feet O.C. Dosing Volume: Gallons
Trench Width: — 3 Olnches
ADepth:
®Feet Grease Trap: Gallons
inches Pre-Treatment: O NSF OTS-1 OTS-11
Aggregate
Septic Tank Installer Grade Level Required: 01011 O III 01V
Page 1 of 3
CDP File Number 188213 - 1 County ID Number: F4-000-00-052 y
❑ Open Pump System Sheet
Repair System Required:®Yes O No O No, but has Available Space
rDesignFlow:
System
Trench Spacing: g O Inches O. .
ification: Provisionally Suitable — ®Feet O.C.
4 $ Trench Width: _ 3 Fe aIncht
Soil Application Rate: 0 3 Aggregate Depth: inches
*System Classification/Description: Minimum Trench Depth: a 4Inches
TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Minimum Soil Cover: 1 a
Inches
*Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches
Maximum Soil Cover: a 4
Nitrification Field 1 6 0 Inches
Sq. ft.
No. Drain Lines 3 *Distribution Type: PUMP TO GRAVITY
Total Trench Length: 4 0 0 ft. Pump Required: ®Yes O No O May Be Required
Pre-Treatment: O NSF OTS-I OTS-II
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rema��g
750
*Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. Chara��g
2000
This Authorization for Wastewater System Construction shall be valid for a 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 become
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,maintenance,monitoring,reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? O Yes ONO
Applicant/Legal Reps. Signature- Date:
*Issued By: 2140-Nations,Robert Date of Issue: 0 1 / 3 0 / a 0 1 5
Authorized State Agen . Malfunction Log OYeS
®Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 188213 - 1
' Davie County Health Department CDP File Number:
210 Hospital Street F4-000-00-052
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 01 / 30 / a015
O Inch
Drawing Drawing Type: Construction Authorization Scale: . O Block
O N/A
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CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street CDP File Number: 188213 - 1
P.O.Box 848
County File Number: F4-000-00-052
Mocksville NC 27028
Date: Al ./ 3 0 / 2 0 15
Click below to import an image from an external locatio►- Drawing Type: C Struction Authorization
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