178 Stanley Trail Davie County,NC . . Tax Parcel Report Monday, January 30, 2017
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THIS IS NOT A SURVEY
Parcel Number: E300000073 Township: Clarksville
NCPONNumhec 5821253851 Municipality:
Account Number: 70694000 Census Tract: 37059-801
Listed Owner 1: STANLEY PAUL DOUGLAS Voting Precinct: CLARK8V|LLE
Mailing Address 1/ 178STANLEY TRAIL Planning Jurisdiction: Davie County
City: /NOCKGV|LLE Zoning Class: DAV|ECOUNTY R' U
State: NC Zoning Overlay:
Zip Code: 270284808 Voluntary Ag.District: No
Legal Description: 38.83OACOFF ANGELLRD Fire Response District: WILLIAM R.DAV|E
Assessed Acreage: 38.66 Elementary School Zone: WILLIAM RDAV|E
Deed Date: 11/1987 Middle School Zone: NORTHD/YV|E
Deed Book/Page: 001400838 Soil Types: W1nC2.W1nB2.K4dD.MdE
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: D/vNECOUNTY
Outbuilding�Gxtra
Building Value: =�
FreaturasVa|ua:
Land Value: Total Market Value:
Total Assessed Value
All data Is pr vided 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 websits 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
161 NC or arlsIng out of the use or Inability to use the GIS data provided by this website.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT -.001
'-'IMPROVEMENT
**NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article it of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME Av� J�AN'qPROPERTY ADDRESS — ��^ DATE
LOCATION (n� 1 ly 1�` `�
SUBDIVISION NAME �/ 1� �7���e�� Trail LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE H TIN.-. # BEDROOMS 3 # BATHS # OCCUPANTS 4 GARBAGE DISPOSAL.: Ye No
COMMERCIAL SPECIFICATIIXVo FACILITYJYPE F # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL. WASTE: Vos/No
LOT SIZE 0��-,.,7PE WATER SUPPLY W s�_ DESIGN.WASTEWATERFLOW (GPD)._ NEW,SITE REPAIR SITE
ti'
SYSTEM SPECIFICATIONS: TANK.SIZE1000 GAL. PUMP TANK GAL. TRENCH WIDTH 3 ROCK DEPTH LINEAR FT 3'06'
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOURIWASTERWATER SYSTEM-CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
.Y4
Lpr
.A
MPROV T , RMIT BY
**CONTACT A REPRESENTATIVE OF THEIECOLIN DEPARTMENT FOR FINAL INSPECTION EF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1: -1:30 P.M. ON INSTAL 1
I/M. TELEPHONE # I5 (704) 634-8760.
OPERATION PERMIT A D ► SYSTEM ALLE BY - -
G� S o e-lt�
o b
AUTHORIZATION NO. t ? OPERATION PERMIT BY DATE 2G - s
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPL.IANCE WITH
ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 -SEWS 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.
DCHD JO/95
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Davie County Health Department
ENVIRONMENTAL HEALTH SECTION
P.D. Box 665rt)��-�s D'Ct C'I)
�
Mocksville, N.C. 27028
`) AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 11 of r
S.S. Chapter 130A, Wastewater Systems)
j ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to
y issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County BuildingInspections
—r Office when applying for Building Permits.***
q AUTHORIZATION NUMBER
NAME AV ' /9 vg\1 DATE a) {� '7 6
4
NAME ON IMPROVEMENT PERMIT (If different than above)
SITE LOCATION a L�
COM WS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
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�} • ...'by k �',! •t • t� • \T - ,
*HNOTICE*H THIS AUTHORIZATION FOR WASTEWATERSYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE
DCHD 10/95
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS OWIE
Davie County Health Department 1
Environmental Health SectionNOV Z Q 19%
P. O. Box 665
Mocksville, NC 27028 IrL
lyt B
1. Application/Permit Requested y
Mailing Address ( Home Phone Y V 2 8 q.5 Business Phone 4/
2. Name on Permit if Different than Above
3. Application for: ❑General Evaluation eptic Tank Installation Permit
4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly
1
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
2-1 l:
asement/Plumbing
No. of People ❑❑ Basement/No Plumbing
No. of Bedrooms ._! ,3"9ashing Machine
No. of Bathrooms jfd'5ishwasher
Dwelling Dimensions �3 (`�7� o ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type I
No. of People Served No. of Sinks
G..
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers a:
is
No. of Showers Water Usage Figures t:
7. Type of water supply: ❑ Public rivate ❑ Community r
8. Property Dimensions y J Sewage Disposal Contractor I_
i,
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No i.
If yes, what type? f
_ t.
i.
( i
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989. i
PROPERTY INFORivATION REQUIRED:
Directions to Property: Tax Office PIN ifs
0/IA/ Road Name LCL q 2 //
/ Box // (if available)
G.tGT in `iby,7` cvel ,BoOSCity i.
t
i
i
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this app1.
/ Z-?0/, ation. .
I
DATE SIGNATU
h`
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: 421*1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. j
If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by.the owner:
I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described
property located in Davie County and owned by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disp sal system.
DATE SIGNAT
S
n
DCHD(1193)
4
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name t5ly� Date ---�" 1� 9 NO
Location c�'C '# owl. Ae
Subdivision Name Lot No. Sec. or Block No.
Lot Size 5 � House V Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ 0 J O
Auto Wash Machine YES VO ❑ d \ 1i
3
Type Water Supply �`� 0�
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
loot <
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Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
Davie County,NC Tax Parcel Report Wednesday, October 12, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: E300000073 Township: Clarksville
NCPIN Number: 5821253651 Municipality:
Account Number: 70694000 Census Tract: 37059-801
Listed Owner 1: STANLEY PAUL DOUGLAS Voting Precinct: CLARKSVILLE
Mailing Address 1: 178 STANLEY TRAIL Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAME COUNTY R-20
State: NC Zoning Overlay:
Zip Code: 27028-4608 Voluntary Ag.District: No
Legal Description: 38.830AC OFF ANGELL RD Fire Response District: WILLIAM R.DAVIE
Assessed Acreage: 38.66 Elementary School Zone: WILLIAM R DAVIE
Deed Date: 11/1987 Middle School Zone: NORTH DAVIE
Deed Book/Page: 001400838 Soil Types: MnC2,MnB2,MdD,MdE
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 111410.00 Outbuilding&Extra 4500.00
Freatures Value:
Land Value: 162600.00 Total Market Value: 278510.00
Total Assessed Value: 278510.00
161
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or implied Including but not limited to the
Davie County, Implied warranties of merchantabllHy 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 webske.
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- f o , DAVIE dOlONTY HEALTH DEPARTMENT H
IMPROVEMENT AND.'OPERATION.PERMITS PROPERTY INFORMATI04-
Permitt`ee�s...-•-- ,.� J ,` �8�
Name: ' t -' /! f> Subdivision Name:
Directions-to property:,, <:'!' ''f s( Section: Lot:'
Ar IMPROVEMENT
PERMIT' Tax Office PIN: -
' Road Nairie Zip:
**NOTE**This Improvement Permit DOES NOT authorize the construction "or installation of a septic tank system or any,wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the ;
constniction/installation of a system or the issuance of a building permit. _
i (In compliance with Article,I l of G.S.Chapter 130A',Wastewater Sy stems,,Section.1900 Sewage Treatment and Disposal Systems) "
r i w r.
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE', '
✓'` ,' rr °'r"' PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE,
INSTALLING THE SYSTEM. p +
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT' #SEATS INDUSTRIAL WASTE`.Yes or No
LOT SIZE- • TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD2�—, 'NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZEalts GAL. PUMP TANK. GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. �
i
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
r
'r.
i
"*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPAR E FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR I:00 1:30 P.M.ON THE DAY OF INST LATI N.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLE BY: 40A o-A
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AUTHORIZATION NO.j OPERATION PERMIT BY:----7 % �% DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 05/96(Revised)
.N,.
DAVIE .COUNTY HEALTH DEPARTMENT 73:N
s M -
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION/~ �
Permittees too
Name: f % .►' ; '%., f f,
Subdivision Name:
Directions to property:.;, 'f - '' Section: Lot:
IMPROVEMENT
PERMITr
Tax Office PIN:#...)
Road Name:f7 E"!J ,�� Zip;
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article'I I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal System's)
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE;
�•: PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS c r'#BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE-.:7A'4 410 TYPE WATER SUPPLY / r i DESIGN WASTEWATER FLOW(GPD) (- NEW SITE__L,--' REPAIR SITE
SYSTEM SPECIFICATIONS: TANK,SIZ.E,Z,j GAL. PUMP TANK ^i G�L. TRENCH WIDTH _ ROCK DEPTH_Z/ LINEAR FT. 04;
z
OTHER X/
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMEkT PERMIT LAYOUT
i -
}
r1
.`r
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPAR MEN' FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INST LATI N.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLE BY:
AUTHORIZATION NO. >�d�OPERATION PERMIT BY: DATE: "
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96(Revised)
.,t
APPUCAHON FOR SITE EVALUATION/IMPROVEMENT PERMIT& -----"' 2
Davie County Health Department [ Q [ Q t5
Environmental Kealffi Section a
t P.O. Box 848/210 Hospital Street NOV 2 3 1
Mockaville, NC 27028
(336)751-8760
ENVIRONMENTAL HEALTH . 1
***IIWORTANT*** THIS APPLICATION CANNOT 8E PROCESSED UNLESS ALL
M"ORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed _j at'6 n �(�U�„ CAS G ILL Contact Person �YP(In `j/�Ly7
Mailing Address .2,L/01-( Rome Phone Qq0_ /y /vim/
City/State/ZIP _ MikU V 1 9 Business Phone r-
2. Name cn,?ermit/ATC if Different than Above )a5bn ar\c� , e Sinle l
Mailing Address '�L(UL ,/
1 i)nQe 1) Q-A. eity/state/Zip �(`�[S ���� Q �M 1c . ,)/�!1
3. Application For: 0 Site Evaluation 0 Improvement Permit/ATC qd Both
4. system to Service: ^ House [lY Y 06ile Home ❑ Business 0 Industry 0 Other
a. IfResidence: # People ac # Bedrooms # Bathrooms
[//Dishwasher 0 Garbage Disposal Wl ashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/other: specify type # People # sinks
4 Commodes # showers # Urinals # Nater Coolers
IF FOODSERVICE: # Seats Estimated !later Usage (gallons per day)
7. Type of water supply: u/county/City 0 hell ❑ Co=mMity
e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes w6w.
If yes,what type?
***IMPORTANT'**CLIENTSMUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: c? WRITE DIRECTIONS(from Mocluville)to PROPERTY:
Tax OMcePIN: # � ,�1 -3j� �lT 0� '� _j�U�
Property Address: Road Name IVY,- Q
City/Zip j e '�•
If in a Subdivision provide information,as follows: ', L
Name:
Section: Block: Lot: Date Property Flagged: �'��
This Is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation,If the site plans or Intended use change,or If the information
submitted in this application Is falsified or change(L I,also,understand that 1 am rmponslblefor all charges Incurred from
this appU cation. I,hereby,give consent to the Authorized Representative of the Davie County a ith Dg artment
to enter upon above described property located in Davie County and owned b)
to conduct all testing procedures as necessary to determine the site sultabilih.
DATE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(include all of the follow! g: Existing and proposed
property lines and dimension structures, setbacks, and septic locations).'
a
G Account No.
Revised DCHD(07/98) Invoice No. 3"T
i.
A
t ' ' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME ��/ DATE EVALUATED /02- - 9T
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION ROAD NAME �-C//� ;&
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position J_ ,Z
Sloe%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group /17 C
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION T
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:_ EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: i 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
Moi t
VFR-Very friable FR Friable FI-Firm VFI-Very firm EFI-Extremely firm
et
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)
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