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1036 Point Rd a Davie County,NC Tax Parcel Report Thursday, February 23, 2017 1 y�. 6 � � ,-ter• J Y1 Ye POINT E t 1 FARM LN II WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: 070000000205 Township: Jerusalem NCPIN Number: 5764203676 Municipality: Account Number: 8307267 Census Tract: 37059-807 Listed Owner 1: LAUDY ROGER KIM Voting Precinct: JERUSALEM Mailing Address 1: 1036 POINT ROAD 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: 32.85 AC POINT RD Fire Response District: JERUSALEM Assessed Acreage: 32.45 Elementary School Zone: COOLEEMEE Deed Date: 9/2016 Middle School Zone: SOUTH DAVIE Deed Book/Page: 010300253 Soil Types: PaD,PcB2,PcC2,ChA,WATER Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 280220.00 Outbuilding&Extra 9560.00 Freatures Value: Land Value: 121540.00 Total Market Value: 411320.00 Total Assessed Value: 411320.00 O ux�AAll 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 merchantabillty or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the /'r County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to SOU tyc NC or arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT or fice use UnIV ,•sti"f. Davie County Health Department *CDP File Number 192640-2, ~- 210 Hospital Street P.O. Box 848 County ID Number Mocksville NC 27028 Evaluated For: NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Roger Laudy Property Owner. Roger Laudy Address: 1036 Point Rd Address: 1036 Point Rd City Mocksville City: Mocksville State2ip: NC 27028 State/Zip: NC 27028 _Phone#: (336)918-0151 Phone#: (336)918-0151 Property Location & Site Information Address/Road#: - Subdivision: Phase: Lot: 1036 Point Road Mocksville NC 27028 Directions a_ 1 structure. MULTIFAMILY- Hwy;601 South, left on Cherry Hill Rd. right onPoint Rd1 #of Bedrooms: #of People: *Water Supply: N/A *Ip issued by. 2140-Nations Robert *System Classification/Description: _ :,.. TYPE III G.OTHER NON-CONV."TRENCH SYSTEMS *CA issued by: 2140.Nations,Robert - - Saprolite System? OYes ONo Design Flow: 1. 0 0 -*Dist ribution Type: GRAVITY-SERIAL Pump Required? OYes CNo Soil Application Rate: 0 - 4 *pre Treatment: Drain field rNo. cation Field 5 0 .S4 ft. *System Type: INFILTRATOR QUICK 4 STANDARD rain Lines 1 Installer: Rusty Miller Total Trench Length: 6 3 ft. Certification#: 1129 Trench Spacing: 9 OFeet nches O.C. O.C. *EH S: 2140-Nations,Robert Trench Width: — 3 Olnches (4)Feet Date: 1 2 / 1 6 / 2 0 1 6 Aggregate Depth: inches 1 Minimum Trench Depth: 3 6 _ Inches Minimum Soil Cover, a 4Inches App rovalStatus' Maximum Trench Depth: 3 6 ® approved 0,i Drsappraved Inches Maximum Soil Cover: a 4 �� Inches CDP File Number 192640 - 2 Septic Tank County ID Number: Manufacturer Lat. r. - STB: 760 Long: _ - Gallons: 1000 Installer: Rusty Miller Date:- 0 9 / x 0 / x 6 1 6 Certification#: 1129 *EHS: 2140-Nations,Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker: ❑ Yes No Date: 1 2 / 1 6 / 2 0 1 6 Reinforced Tank: E] 'Yes ® N No Approval Status y 1 Piece Tank. ElYe"s CO No" ® Approved❑ Disapproved Pump Tank Manufacturer. Installer: - - PT: Certification#: - Gallons: *EHS: Date: Date: Riser Sealed ❑ Yes ❑ No Riser Heght D Yes ❑ Np (Min.6 in.) y APPaI Status =� Reinforced Tank: ❑ Yes El No - Approved❑ Disapproved 1 Piece Tank: _ ❑_ Yes.�_ - ❑__N o� Supply Line Pipe Size: inch diameter Installer: - Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ NO Date: / 1 Approved fittings ❑ Yes ❑ NO Approval Status ❑ Approved❑ Disapproved Pump Requir-ement Pump Type: Installer. Dosing Volume: - Gal Certification#: Draw Down: Inches *EHS' *Cham: / Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ NO Approval Status PVC unions ❑ Yes ElNo ❑ Approved in Disapproved Vent Hole ❑ Yes ❑ No � Anti-siphon Hole El Yes 0 No CIDP File Number 192640 - 2 County ID Number: - Electric Equipment NEMA4XBox orEquivalent EJ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes 13No 'EHs: Pump Manually Operable ❑ Yes ❑ N0 "Activation Method: Date: Approval Status Alarm Audible .❑ Yes. ❑ No Approved O Disapproved Alarm-Visible ❑ `Yes � ❑ NO' - ... __ 2140•Nations,Robert *Operation Permit.completed by: _Authorized State Agent: Date of Issue: 1 a / 1 6 a 6 1 6 Owner/Applicant Signature: This system has been installed in-compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rulesifor tiSewage 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 G. sewage septic system. - ,. _ Rule:1961 requires that a Type TYPE III G. septic system meet the following criteria: _ Minimum System.Review By The Local Health Department: WA `+ _ Management Entity; OWNER M nimum System Inspection/Maintenance Frequency By Certified 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 entity with a certified operator or a private certified operator for the life of the septic system. - Rule.1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operatorforthe 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 tong 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 192640 :2 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Scale: , puck Drawing Drawing-Type: Operation Permit pNiA ei� _ I e-o - .. 1 -- I " 'CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 192640-2 Davie County Health Department County ID Number. t+` 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 9 / a 6 / a 0 a 1 Applicant: Roger Laudy Property Owner: Roger Laudy Address: 1036 Point Rd Address: 1036 Point Rd City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)918-0151 Phone#: (336)918-0151 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 1036 Point Road Mocksville NC 27028 Directions Structure: MULTI FAMILY Hwy 601 South, left on Cherry Hill Rd. right onPoint Rd\ #of Bedrooms: #of People: *Water Supply: N/A System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally suitable Inches Minimum Soil Cover: Saprolite System? Q Yes 9No 1 a Inches Design Flow: 1 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 4 Maximum Soil Cover: a 4Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field a 5 Sq.ft. Pump Tank: Gallons No. Drain Lines 1 1-Piece: OYes ONo Total Trench Length: 6 3 ft GPM--vs— ft. TDH Trench Spacing: O Inches O.C. _ 9 ®Feet O.C. Dosing Volume: _ Gallons Trench Width: _ 3 O Inches ®Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: O NSF OTS-1 O TS-11 Septic Tank Installer Grade Level Required: 01011 O III 01V Page 1 of 3 e- z CDP File Number 192640 - 2 County ID Number: - ❑ Open Pump System Sheet Repair System Required:®Yes ONO O No, but has Available Space CDesign System Trench Spacing: Q he O. . ification: Provisionally suitable — g ®Feet O.C. Trench Width: Inches w: 1 0 0 — 3 Feet Soil Application Rate: 0 Aggregate Depth:4 inches Minimum Trench Depth: 02 4 *System Classification/Description: Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: 1 a LESS) Inches Maximum Trench Depth: 3 6 *Proposed System: 25%REDUCTION Inches Maximum Soil Cover: a 4 Inches Nitrification Field a 5 0 Sq.ft. No. Drain Lines 1 *Distribution Type: GRAVITY-SERIAL Total Trench Length: 6 3- ft Pump Required: OYes QNo QMay 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. R. 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. Rmai 9 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(8)).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 O No Applicant/Legal Reps. Signature- Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 9 / 2 6 / .2 0 1 6 Authorized State Agent: Malfunction Log OYes f ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 • CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box$aa County File Number: Mocksville NC 27028 Date: 09 / a6 / a016 Q Inch Drawing Drawing Type: Construction Authorization Scale: , O Block O N/A ......................................................................,.................,................................_......................................................,.................................._..............._............_..,..............:..;..................._............,..................................,............._................... . .. ................. ....................! ..........�............... .. ........._i.............. .. ! ....... i j I ;_........ . ... ............ ........................ 1. I ..... . . .._ .. ... ....._ . . .........._............. ' .. . ...... ...... ....... .l.... ... ... ........ I......_ ..........._ . ..I . I .........�....._......_ . .. .........._.... ,....... I I ' i � 1. I �.............................. i ....._ I ........._L............ i.........._.... .. ;....__ I ... ........ ... .... ._� ... ._+................................. I I , I I � L............ ...I........................... ........_i.... ......................I.. . ........... .. ....; a i. .. ...._ ....... .... .................. ..... ............. .. .......E.. ... ._.... ... I f ,. ....................... ................... 1 � . ....................... ........ ......._ i I . ............... . . .. ..; .... .... ...... ......... .............. .. ...........: 1..._..... ......... .....i .............i.... . 1. .. .... ........ .........L. _... -I ..... ......... - I I I i' I i I I . i , ' I I i... I i i l ....... 1........ . .... ................................................... ............._ ............ f � . I i i s. ..... .. j....... ... .....{.. .. __.,... ...- . ....................................... . ...._ ............................ .G ............ ............... i i r I i............._'......... I ........ .... .. .._.........- I . . 1 ........_................. ...... .. .. . _. f 1I I I � I .... i � � _ � . { ........ S .. . G ......... . C ....... L i .. . ... j .......; . C . . ...... I 1 ...... .. I I I I l.. N ........_ - c --� ...... . . L i .. .... . . . ........ II 111 a it I , I ........... ......_. .. _....... .. I f I , . .............. .... ...... : . .. Page 3 of 3 P1 P2 t 1 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: P.O.Box 848 Mocksville NC 27028 County File Number: Date: A9./.a.6. /.a.0.1.6. Click below to import an image from an external location: Drawing Type: Construction Authorization I s t f J h IN t {{ a s L , r r Page 3of3 P1 P2 CONSTRUCTION For Office`Use only • AUTHORIZATION *CDP File Number 192630`-2 °= Davie County Health Department County ID Number. f 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 9 / a 6 / a 0 a 1 Applicant: Roger Laudy Property Owner: Roger Laudy Address: 1036 Point Rd Address: 1036 Point Rd Cay: Mocksville City: Mocksville StatefZip: NC 27028 StatefZip: NC 27028 Phone#: (336)918-0151 Phone#: (336)918-0151 Property Location & Site Information rAddress/Road #: Subdivision: Phase: Lot: int Road lle NC 27028 Directions Structure: MULTI FAMILY Hwy 601 South, left on Cherry Hill Rd. right onPoint Rd\ #of Bedrooms: #of People: *Water Supply: N/A System Specifications Minimum Trench Depth: a 4 rDesign ssification: Provisionally Suitable Inches System? QYes Minimum Soil Cover. 1 a (j)No Inches ow: 1 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 4 Maximum Soil Cover: a 4 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: O Yes ®No Pump Required: QYes @No OMay Be Required Nitrification Field a 5 0 Sq ft Pump Tank: Gallons No. Drain Lines 1 1-Piece: QYes ONo Total Trench Length: 6 3 ft GPM—vs— ft. TDH Trench Spacing: _ 9 Inches 2 t O.C.O.C. C.0 Dosing Volume: _ Gallons Trench Width: — 3 2Feet Inches Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: OI OII OIII OIV Dann I of Z r , CDP File Number 192640 -2 County ID Number s ❑ Open Pump System Sheet Repair System Required:@Yes ONO ONO, but has Available Space epair System Trench Spacing: 9 (�Inches O.C. *Site Classification: Provisionally Suitable — Feet O.C. Trench Width: Inches Design Flow: 1 0 0 — 3 ( Feet Soil Application Rate: Aggregate Depth: 0 - 4 inches Minimum Trench Depth: a 4 Inches *System Classification/Description: TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover 1 a Inches - • *Proposed System. 25 REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field Inches a 5 -0 Sq.ft. • - *Distribution Type: GRAVITY•SERIAL No. Drain Lines 1 Total Trench Length: _ ,6 3 ft. `- Pump Required: QYes QNo QMay Be Required - - - � - Pre Treatment: ONSF OTS-I OTS-11 *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 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. ; This Authorization for wastewater System Construction shall bevalld 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 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? QYes ONO Applicant/Legal Reps. Signature* Date:_ *Issued By: 2140-Nations,Robert Date of Issue: 0 9 / a 6 / a 0 1 6 Authorized State Agent: Malfunction Log QYes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 t CONSTRUCTION AUTHORIZATION Davie county Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 9 / a 6 / a 0 1 6 Olnch Drawing Drawing Type: Construction Authorization Scale: , . OBlock O N/A 7-7, '1 LL --------- ------- 11r -LLC 3 • CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: P.O.Box 848 Mocksville NC 27028 County File Number: Date: _09 / a6 / 2076 Click below to Import an image from an external location: Drawing Type:Construction Authorization - IMPROVEMENT PERMIT For office use only "CDP File Number 192640-2 Davie County Health Department 210 Hospital Street County ID Number. P.O. Box 848 Evaluated For. NEW Mocksville NC 27028 Township: _ Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 9/2612021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Roger Laudy Property Owner: Roger Laudy Address: 1036 Point Rd Address: 1036 Point Rd City: Mocksville CRY: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)918-0151 Phone#: (336)918-0151 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 1036 Point Road Mocksville NC 27028 Directions Structure:,. MULTI FAMILY Hwy;601 South, left on Cherry Hill Rd. right onPoint #of Bedrooms: Rd1 #of People: *Water Supply: NIA _ System Specifications nitial System rpsat Classification: Provisionally suitable - Minimum Trench Depth: 2 4 Inches olite System? (QYes QNo Maximum Trench Depth: 3 6 Inches Design Flow: 1 0 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 4 1-Piece: QYes QNo *System Class ificatan/Description: Pump Required: QYes (QNo OMay Be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 25%REDUCTION 1-Piece: Q Yes QNo Repair System Required:QYes ONO ONO, but has Available Space Repair System *Site Classification: Provisionally suitable Minimum Trench Depth: *1 4 Inches Soil Application Rate: 0 4 Maximum Trench Depth: 3 6 Inches "System Classification/Description: Pump Required: QYes Q No O May be Required TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 192640 - 2 County ID Number: *Site Modifications ❑ open Fill Sheet 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. Site Plan The improvement Permit shag be valid for 6 years from date of issue with a site plan(means a drawing not necessarily drawn to O scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the site for the proposed wastewater system,and the location of water supplies and surface waters). Plat The knprovement Permit shag be valid without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drawn to a scale of one inch equals no more than eo feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit is subject to revocation if the site plan,plat,or intended use changes(NCOS 130A-335(f)).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: 0 9 / a 6 / a 0 1 6 Authorized State Agent: OValid without Expiration? 0Create CA. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.`* Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department CDP File Number: 192640 -2 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: QB,A k ft. f ..........T f f � f f �1 ►T" V� JJ "V IMPROVEMENT PERMIT L Davie County Health Department ` 210 Hospital Street192640 -2 CDP File Number: P.O.Box$48 Mocksville NC 2702$ County File Number: Date: 09 / 26 / 2016 Click below to import an image from an external location:Drawing Type: Improvement Permit NCDENR Division-of Environmental Heal On-Site Wastewater Section *Date: o g l 3 l a o 1 6 Soil/Site Evaluation *File#: 1 9 2 6 4 0 For On-Site Wastewater System Plat #: *Owner Roper Laudy Proposed Facility MULTI FAMILY Proposed Design'Flow(.1949) Location of Site 1036 Point Road Property Size WaterSupply N/A Evaluation Method n1a 1940 Horizon SOIL MORPHOLOGY Profile# Lan*escape Depth .1941 Other Profile POS o -. lN Mineralogy Matrix Mottle Factors to Slope -(IN) Texture Structure Consistence Color Color 1 L 0-48 SCL 3-Stng or fr ss sp .1942 Wet. 3 °lo .1943 Depth GPS Saprofite:(in) .1944 Rest. Horizon ENS .1947 Class PS Nations,Rabe Profile LTAR 0 . 4 L 0-48 SCL 3-Stng gr fr SS Sp .1942 Wet. 3 % .1943 Depth GPS Saprolitcon) .1944 Rest. Horizon EHS 1947 Class PS Cop oriie Nations,Robe PTAR rofile,_.0 4 L .1942 Wet. �o .1943 Depth GPS Saprolite:(in) .1944 Rest. Horizon EHS 1947 Class Cop)LEroflle Profile LTAR._ .1942 Wet. °la .1943 Depth GPS Saprotite:(in) .1944 Rest. Horton EHS .1947 Class Copy Profile Profile LTAR 1942 Wet. % .1943 Depth GPS Saprolde:00 .1944 Rest. Horizon EHS .1947 Class Copy ofile Profile LTAR Available Space(.1945) S f Other Factors(.1946) Site Classification (.1948)Ps Initial LTAR: o . 4 Repair LTAR: o . 4 Others Present: Comments: Evaluated By. Nations,Robert NCDENR Division of Environmental Health On-Site Wastewater Section Date: 0 9 t h �' 6 Soil/Site Evaluation Fie#: 1 9 2 6 4 0 For on-Site Wastewater System PIN #: 11940 Horizon SOIL MORPHOLOGY Landscape .1941 Other Profile Profile# Depth Sipe Ria {IN) Mineralogy Matrix Mottle Factors Texture Structure Consistence Color Color .1942 Wet. % .1943 Depth GPS Saprolite:pn) 1944 Rest. I. Horizon EHS .1947 Class COPLErafil Pronle LJ LTAR,_, • . 1942 Wet. % 1943 Depth GPS Saprobe:Cn) 1944 Rest Hori`on EHS .1947 Class Copg.P,rofil Profile LTAR..... . .1942 Wet. 0,6 _ .1943 Depth GPS Saprolde:00 .1944 Rest. Horizon EHS �... .1947 Class Capt rafil Profile LTAR .1942 Wet. % .1943 Depth GPS Saprolite:Qn) .1944 Rest. HorLzon EHS .1947 Class Copy�rofil Profile PAR .1942 Wet. % .1933 Depth GPS Saprollte:(n) 1144zRanst' EHS 1947 Class Copyrp4ofil Profile L,J PAR Comments: Attach Image The "Open Drawing Form"button, opens the the drawing form. = The "Import"button,attaches the drawing, or other image Into the space below. Open Drawing Form t�-Z -/4 Profile: 1 X Y Z Profile2 X Y Z Profile: X Y Z Profile: X y Z Profile: X y Z Profile: X y Z Profile: X • ` - y Z . Profile: X Y Z Profile: j@ X y Z Profile: I@ X- - Y Z - APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: 7 Site Evaluation/Improvement Permit C Authorization To Construct(ATC) ❑Both Type of Application: ❑New System ❑Repair to Existing System :]Expansion/Modification of Existing System or Facility ***IMPORTANT"**THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name { V Contact Person Address Home Phone\�— City/Statel, y Business Phone Email_ L ® In\ { / Email: Name on�C if Dii ferentihan Above .Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included:LJ Site Plan LJPlat(to scale) (Permit is v for 60 mo the w'h site pl n,no expiration with complete plat.) Owner's Name � { G 4✓ Phone Number Owner's Address City/State/Zip Property Ad Ss City Lot Size Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is"Yes",supporting do umentation 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 _VNo Is the site subject to approval by another public agency? _Yes`j(No Will wastewater other than domestic sewage be generated? Yes k. Y`. IF RESIDENCE FILL OUT THE BOX BELOW #People - #Bedrooms #Bathrooms Garden Tub/Whirlpool I IYes Basement: IYes o Basement Plumbing: :]Yes o 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: Conventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type:C County/City Water ❑New Well kxisting Well J Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?C Yes 00 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 pennit(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 Da ' unty He lth Depart nt to conduct necessary inspections to determine compliance with applicable laws and rules. I under LhotuIsN/faflA ponsible f the per identification and labeling of property lines and comers and locating and flagging or stak g t locatio prop a well location and the location of any other amenities. Prope own is owner's I epres to ve signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: Sign given I Yes❑No Account# Revised 11/06 Invoice# ' HEALTH DEPARTMENT RELEASE For Office UseOnly *CDP File Number 192640-1 Davie County Health Department 210 Hospital street - r.County ID Numbe P.O. Box 848 HDRMIWC � Evaluated Fora.. Mocksville NC 27028 Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID 0 4 / 0 1 / 2 0 2 0 UNTIL: Applicant: Robert K. Laudy Property Owner: Robert K. Laudy Address: 1036 Point Rd Address: 1036 Point Rd City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)918-0151 Phone#: (336)918-0151 Property Location&Site Information Address 1036 Point Road Subdivision: Phase: Lot Road# Mocksville NC 27028 SINGLE FAMILY Township: Structure: Directions #of Bedrooms: 2 #of People: Hwy 601 South,left on Cherry Hill Rd.right onPoint Rd\ "Water Supply: NIA Basement: F]Yes n No Type of Business: Total sq"Footage: No. Of Employees: 'Proposed Improvement: Sunroom 'Release Conditions Proposed sunroom to be metal&glass.Must be 5'minimum from septic.Well must be 25'minimum from any treated wood. This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps.Signature Required? QYes @)No Applicant/Legal Reps.Signature: *Date: *Issued By: 2325-Mitchell,Brittany *Date of Issue:. 0 4 0 1 2 0 1 5 Authorized State Agent: " Site Plan/Drawing attached." ; ? °`� *Hand Drawing OlmportDrawing Davie County Health Department .40 NV j ' Environmental Health Section P.O. Box 848 210 Hospital Street Courier# : 09-40-06 1 Mocksville,NC 27028 Phone:(336)-753-6780 Fax:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: IL L4 Phone Number 33 CJ c ' (Home) Mailing Address: ' I L( (Work) Email Address: L Detailed Directions To Site: Z 1 }V Property Address: Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Type Of Facility: S�- Date System Installed(Month/Date/Year): / Number Of Bedrooms:_,�, Number Of People: Is The Facility Currently Vacant? Yes To If Yes,For How Long? Any Known Problems? Yes �oo If Yes,Explain: Please Fill In The Following Information About The EW Facility: Type Of Facility: ,90/JU 0M /6 X L& ld 10 Number Of Bedrooms: Number of People Pool Size: — Garage Size: Other: / -Requested By: Date Requested: / tune) For Environmental Health Office Use Only Approved Disapproved Comments: Prbpo5cd .5 cn i, h be m efa.l alcss. Mgs-L be 96'm in w Sedir. W.e l a2w&k be 25' miri-imum an -h104cd r Environmental Health Specialist Date: / *The signing of this form by the Environmental gbalth Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order # Amount:$ Date: Paid By: //-- Received By: Account Invoice#: b/b:3 "ra f Mj aQ ' j 1I i 0107 U_ lit IN o e%rF All data is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Implied IE 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 or arising out Pri nted:M ar 19, 2015 CV of the use or Inability to use the GIS data provided by this website. /'p v � ` DAVIE COUNTY HEALTH DEPARTMENT • "� (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130-Article 13CY OWNER OR CONTRACTOR t` sf " ,� v' DATE f� ,,+•t, F "` PERMIT '� "�f ' fS� i� LOCATION + '� •'� ` /,�."�{� ..tii��f ,.�r� �, 4y '" ,h-'`' !� �ft3`� Ar3 •'J>1 .sem 1699. S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE MOBILE HOME 0 BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO Q Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES goo.-INNO 0 [�] Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES ❑ ,y. y SITE .SUITABLE �r`i YES E3-'NO ❑ SIZE OF .TANK gal. NITRIFICATION FIELD sq. ft. ��: DEPTH OF STONE IN LINES: WATER SUPPLY: Individual Publ1 13 IMPROVEMENTS PERMIT BY „� ` INSTALLED BY =91 92 Vda CERTIFICATE OF COMPLETION * B Date (8/16/73) *Construction must comply wit all other applicable State and toO/Ovrtions LOT AREA } ; _ l C DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C . 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site E aluations J� / rOle NAME ��1/►i "Ld' /'1tak6 DATE ISSUED � /P< ADDRESS OV PERMIT NO. Explanation of charge 57 44:f ell AMOUNT DUE SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT. cam' 9/19/2016 '• ' . F GoM aps 4.0 j 1 954 994 Parcels • a LEI I I l "" I �� X FnI h F9_ _J f FrC j1 1 y I 1 Results �. F Property Find Deed a. ccountNumber Zoom Buffer Report CO JNTYID .€ NC IN 3 Card Adjoiners Reference Property Create Find Deed - Zoom Buffer 070000000202 'j576420484682514728 s 1ogmrd Report Adjoiners Reference http://maps2.roktech.netIDavienc_gm4/ 1/2