114 Elberon Ct Lot 2 (2) Davie County,NC Tax Parcel Report Tuesday, December 20, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: J517OA0002 Township: Mocksville
NCPIN Number: 5758027859 Municipality:
.Account Number: 8307153 Census Tract: 37059-805
Listed Owner 1: -RICHARDSON ROBERT K Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 2970 KECOUGHTAN ROADPlanning Jurisdiction: Davie County
City:_ . PFAFFTOWN Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27040 Voluntary Ag.District: No
Legal Description: LOT 2 MARBROOK Fire Response District: MOCKSVILLE
Assessed Acreage: 0.69 Elementary School Zone: CORNATZER
Deed Date: 11/2016 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 010341185 Soil Types: CeB2
Plat Book: 0009 Flood Zone:
Plat Page: 152 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.aI 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.
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CONSTRUCTION For Office Use Only. I
AUTHORIZATION
'CDP File Number 231889-1 t
Davie County Health Department County ID Number.5758027859 t
210 Hospital Street Evaluated For.- NEW
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT vALlo UNTIL:
Phone:336-753-6780 Fax:336-753-1680 1 1 / 1 5 / 2 0 .2 1
Applicant: Robert K. Richardson Sr Property Owner: Land First Development
Address: 2970 Kecoughtan Road Address: PO Box 712
City: Pfafftown City: Yadkinville
State/Zip: NC 27040 StatefZip: NC 27055
Phone#: (336)992-6220 Phone#: (336)992-6220
Property Location & Site Information
C.Address/Road#: Subdivision: Marbrook Phase: Lot: 2
4 Elberon Court
ocksville NC 27028 Directions
- Hwy 64 East left on John Crotts Rd. left in Marbrook
Stricture: SINGLE FAMILY
#of Bedrooms: 3
#of People: 2
"Water Supply: NIA
System Specifications
Minimum Trench Depth: 3 6
Site Classification: Provisionally suitable Inches
Saprolite System? Minimum Soil Cover. a 4
y OYes &No Inches
Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: Maximum Soil Cover: a 4
0 , 1 7 5 Inches
'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL
TYPE III G.OTHER NON-CONY.TRENCH SYSTEMS Septic Tank:
1 0 0 0 _ Gallons
'Proposed System: 25%REDUCTION 1-Piece: OYes ®No
Pump Required: OYes ONo @May Be Required
Nitrification Field 1 3 0 9
Sq. ft. Pump Tank: 1 0 0 0 Gallons
No. Drain Lines 3 1-Piece: OYes @No
Total Trench Length: 3 a ft GPM—vs— ft. TDH
Trench Spacing: _ 9 Onches
Feet 0 C.0 Dosing Volume: _ Gallons
Trench Width: _ 3 @Inches
Feet Grease Trap: Gallons
Aggregate Depth: inches
Pre Treatment: ONSF OTS-1 OTS-II
Septic Tank Installer Grade Level Required: 01 011 0111 OIV
Donn 1 of Z
CDP File Number 231889 - 1 County ID Number: 5758027859
❑ Open Pump System Sheet
rDesign
Repair System Required:@Yes ONO ONO, but has Available Space
SystemTrench Spacing: � Inches O.ification: Provisionally Suitable — E3 Feet O.C.Trench Width: Inches
w:. 3 6 0 ,�,�, - 3@ Feet
Soil Application Rate: 0 _ a 7 5 Aggregate Depth: inches
`r Minimum Trench Depth: 3 6
'System Classification/Description: Inches
_�;TYPEJII 0:;OTHER NON-CONN.TRENCH SYSTEMS Minimum Soil Cover. a 4
Inches
_ ..._ Maximum Trench Depth: 3 6
'Proposed System: 2'5%REDUCTION -- Inches
Maximum Soil Cover: a 4
Nitrification Field 1 3 0 9 Sq.ftInches
.
No. Drain`Lines - _ *Distribution Type: GRAVITY-SERIAL
3'
Total Trench Length: 3, a :ft. - Pump Required: @Yes ONo OMay Be Required
_ = Pre Treatment: ONSF OTS-1 OTS-II
"Site Modifications
No grading or construction activity is allowed in areas'designated for system and repair without approval of Health Department.
"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. ;
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? Oyes ONO
Applicant/Legal Reps. Signature- Date:_
*Issued By: 2140-Nations,Robert Date of Issue: 1 1 / 1 5 / x 0 1 6
Authorized State Agent: Malfunction Log QYeS
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number: 231889 -1
210 Hospital Street 5758027859
P.O.Box 848 County File Number:
- Mocksville NC 27028 Date: 1 1 / 1 5 / 2 0 1 6
Olnch
- Drawing Drawing Type: Construction Authorization Scale: . OON/A k ft.
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CONSTRUCTION AUTHORIZATION '
Davie County Health Department
210 Hospital street CDP File Number: 231889 - 1
P.O.Box$48 5758027$59
Mocksville - NC 27028 County File Number:
Date: .1 1 / 1 5 / 2 0 1 6
Click below to import an image from an external location: Drawing Type:Construction Authorization
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APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC r
Davie County Environmental Health
P.O.Box 848/210 Hospital Street
�jI
. Mocksville,NC 27028
(336)753-6780/Zuthorization
36)753-1680
Date' , ti For: 7 Site Evaluation/Improvement Permit To Construct(ATC) ❑Both
Type of Application: ❑New System ❑Repair to Existing System :]Expansion/Modification of Existing System or Facility
••*1AfP0RTAN7***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name 0 02 Sa N Contact Person
Address at,) Home Phone
City/StatZIP - Business Phone
Email T Go 02 Email:
Name on Permit/A C if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Comers Flagged (J
NOTE: A survey plat or site plan must accompany this application. Included:U Site Plan UPlat(to scale)
(Permit is valid for 60 montlhs with si plan,no expiration with co plete plat.)
Owner's Name L rub nJ Phone N1 ber
Owner's Address City/State/Zi �.r/ -e
Property Address ity a 7
Lot Size Tax PIN#
Subdivision Nam (if applicable) 6 k= Section/Lot#�_
Directions To Site:
If the answer to any of the following questions is"Yes",supporting doctuJr entation must be attached:
Are there any existing wastewater systems on the site? _Yes No
Does the site contain jurisdictional wetlands? _Yes --No
Are there any easements or right-of-ways on the site?' " -Yes No
Is the site subject to approval by another public agency? Yes
Will wastewater other than domestic sewage be generated? Yes L-N o
t
IF RESIDENCE FILL OUT THE BOX BELOW
#People #Bedrooms #Bathrooms Garden Tub/Whirlpool I]Yes o
Basement: :]Yes &o Basement Plumbing: :]Yes&o
IF NON-RESIDENCE FILL OUT THE BOX BELOW IISI
Type of Facility/Business Total Square Footage of Building #People
#Sinks #Commodes #Showers #Urinals
j� 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:C County/City Water ❑New Well ❑Existing Well 7 Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve?C 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 j
of the Davie County Healt epart nt to conduct necessary inspections to determine compliance with applicable laws and rules. JI
I un n that I am re sible f the p er fdentifi 4n and labeling of property lines and comers and locating and flagging
or I us/f ttSL'ati ,prop se ell loca'on and the location of any other amenities. y
Property owners or owner's legal representative signature ^ Site Revisit Charge
Date(s):
Client Notification Date:
Date EHS:
Sign given I Yes❑No Account# ✓YI F7
Revised 11/06 Invoice#
00 3 M
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25'
146-10'
2,0' 2,0'
HOUSE
32'-6' 48-2' -32'-6-
60'
4 2 4'
DRIVEWAY
25'
PIN/PID 5758027859
114 CLOT 2) ELBER❑N COURT