252 Country Circle Lot 21Davie County, NC - . Tax Parcel Report Tuesday, November 29, 2016
& Extra
Building Value: FO eatur s Va Value:
Land Value: Total Market Value:
Total Assessed Value:
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 merchardalilitty or fitness for a particular use. All users of Davie Cowdys 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.
WARNING: "IMS IS NOTA SURVEY
Parcel Information
Parcel Number:
E8140A0021
Township:
Shady Grove
NCPIN Number:
5881127633
Municipality:
Account Number.
82525066
Census Tract:
37059-803
Listed Owner 1:
MEADWELL KIMBERLY D
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
252 COUNTRY CIRCLE
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAME COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006-0000
Voluntary Ag. District:
No
Legal Description:
LOT 21 COUNTRYSIDE SECTION 2
Fire Response District:
ADVANCE
Assessed Acreage:
1.71
Elementary School Zone: SHADY GROVE
Deed Date:
8/2005
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
006230806
Soil Types:
GnB2
Plat Book:
0006
Flood Zone:
Plat Page:
014
Watershed Overlay:
DAVIE COUNTY
& Extra
Building Value: FO eatur s Va Value:
Land Value: Total Market Value:
Total Assessed Value:
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 merchardalilitty or fitness for a particular use. All users of Davie Cowdys 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.
/Address/Road M
252 Country Circle
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
*Water Supply: PUBLIC
Subdivision: Country Side
Phase: Lot: 21
Directions
Hwy 158 East, right on Hwy 801, Left on Underpass Rd.
Country Circle on right
CONSTRUCTION
a
For Office use only
Site Classification: Provisionally suitable
AUTHORIZATION
*CDP File Number 218608-1
Saprolite System? OYes @No
Davie County Health Department
1a
County ID Number.
Design Flow: 3 6 0
210 Hospital Street
3
Evaluated For. HDR/WWC
.�,,.
P.O. Box 848
a
Township:
"System Classification/Description:
Mocksville NC 27028
PERMIT VALID UNTIL:
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Phone: 336-753-6780 Fax: 336-753-1680
0 5/ 0 6/ a 0 a 1
Applicant:
Andrew Meadwell
roperty Owner: Andrew Meadwell
Address:
252 Country Circle
rAddress:
252 Country Circle
City:
Mocksville
City:
Mocksville
State2ip:
NC 27028
StatefZip:
NC 27028
Phone #:
(336) 477-5346
Phone #:
(336) 477-5346
/Address/Road M
252 Country Circle
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
*Water Supply: PUBLIC
Subdivision: Country Side
Phase: Lot: 21
Directions
Hwy 158 East, right on Hwy 801, Left on Underpass Rd.
Country Circle on right
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
p 1 0 0 0_ Gallons
1 -Piece: OYes @No
Pump Required: OYes @No O May Be Required
1 a 0 0 Sq. ft. Pump Tank: Gallons
3 1-Piece:OYes ONo
3 0 0 ft GPM—vs— ft. TDH
_ 9 Onches O.C. Feet O.C. Dosing Volume: _ Gallons
3 , 2Inches
Feet Grease Trap: Gallons
inches Pre -Treatment: ONSF OTS -1 OTS -II
Septic Tank Installer Grade Level Required: 01011 O 111 ON
Dunn 1 ^f'A
Minimum Trench Depth:
a
\
4 Inches
Site Classification: Provisionally suitable
\
Saprolite System? OYes @No
Minimum Soil Cover.
1a
Inches
Design Flow: 3 6 0
Maximum Trench Depth:
3
6 Inches
Soil Application Rate: 0 3
Maximum Soil Cover:
a
4 Inches
"System Classification/Description:
*Distribution Type:
GRAVITY -SERIAL
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Se tic Tank'
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
p 1 0 0 0_ Gallons
1 -Piece: OYes @No
Pump Required: OYes @No O May Be Required
1 a 0 0 Sq. ft. Pump Tank: Gallons
3 1-Piece:OYes ONo
3 0 0 ft GPM—vs— ft. TDH
_ 9 Onches O.C. Feet O.C. Dosing Volume: _ Gallons
3 , 2Inches
Feet Grease Trap: Gallons
inches Pre -Treatment: ONSF OTS -1 OTS -II
Septic Tank Installer Grade Level Required: 01011 O 111 ON
Dunn 1 ^f'A
CDP File Number 218608-1 County ID Number:
❑ Open Pump System Sheet
Repair System Required:@Yes ONO ONO, but has Available Space
epair SVstem Trench Spacing: 9 O Inches O.0
*Site Classification: Provisionary Suitable — Feet O.C.
Trench Width: Inches
Design Flow: R _ , 3 Feet
3
Total Trench Length: 3 0 0 Pump Required: OYes ®No OMay Be Required
\ Pre Treatment: ONSF OTS -1 OTS -ll
*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 noway 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 sametime the Improvement Permit issued (NCGS 130A-336(10)} 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: 0 5/ 0 6/ 2 0 1 6
Authorized State Agent: �L�...--�--- Malfunction Log OYes
CHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
Aggregate Depth:
Soil Application Rate: 0 3
inches
._
Minimum Trench Depth:
a
4
*System Class i%cation/Description:
Inches
TYPE 11 A CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover.
1
a
Inches
Maximum Trench Depth:
3
6
*Proposed System: 25% REDUCTION
Inches
Maximum Soil Cover:
a
4
Nitrification Field 1
0 0
Inches
-2 Sq. ft.
No. Drain Lines
*Distribution Type:
GRAVITY -SERIAL
3
Total Trench Length: 3 0 0 Pump Required: OYes ®No OMay Be Required
\ Pre Treatment: ONSF OTS -1 OTS -ll
*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 noway 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 sametime the Improvement Permit issued (NCGS 130A-336(10)} 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: 0 5/ 0 6/ 2 0 1 6
Authorized State Agent: �L�...--�--- Malfunction Log OYes
CHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
• Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Drawing Type: Construction Authorization
CDP File Number: 218608 -1
County File Number:
Date: 05/06/.1016
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CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 218608 -1
County File Number:
Date: .0.8 / 0 6/ 2 0 1 6
Click below to Import an image from an external location: Drawing Type: Construction Authorization
� l
Davie County Health Department _
-41st Environmental Health Section
r P.O. Box 848
.0 , 210 Hospital Street IJ
0 U� Courier # : 09-40-06 n� 1
Mocksville, NC 27028 }
Phone: (336) - 753 - 6780 Fax: (336) - 753-1680
ON-SITE WASTEWAT ICATION
(Check One) Replacement Remodeli Reconnection
Name: lT?'bWGc! Phone Number 5 3�O (Home)
Mailing Address:�Ve�'
3 v -7-r3[�c' S (Work)
A/C a ?Gd Email AddressA) G✓rt dw h �� W , 9GJ
Detailed Directions To
A r r
Property
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: Type Of Facility: Azszi
Date
System Installed (Month/Date/Year): Number Of Bedrooms -._3 _Number Of People:_
Is The Facility Currently Vacant?
YesNo If Yes, For How Long?.
Any Known Problems? Yes 0 If Yes, Explain:
Please Fill In The Ulowing Information About The NEW Facility:
Type Of Facility: r �0/ Number Of Bedrooms: Number of People
Pool Size:Gara a Other:
F,equested By: Date Requested: 02
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health 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 #: I X & 0 di Invoice #:
lc�
cJ
N
Lei. y
+ DAVIE COUNTY HEALTH DEPARTMENT �+ J
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued In Compliance With Article II of G.S Chapter 130a
sari yr 3e�v`eee S rr�s r i J 3 Perm[ u�j f;er
'K V\, Date v ( t NO �t V
Location
Subdivision N me„ i� Lot No. Sec. or Block No.
Lot Size � House Mobile Home Business Speculation
No. Bedrooms --j
No. Baths �— No. in Family
Garbage Disposal YES NO ❑ ioI
Auto Dish Washer YES NO ❑
Auto Wash Ma:hine YES ] NO 0 A 2 �d�L
Type Water Supply _—
*This permit VoiAf sewage system described below is not installed within 5 years from date of issue.
This permit�0 subfgct to relocation if site plans or the intended use change.
. \ \\�
F
'Contact a representative of the
9:30 A.M. or 1:00-1:30 P.M. on
Final Installation Diagram: �M
Improvements permit by
Health Department for final inspection of this system between 8:30-
letion. Telephone Number 704-634-5985.
System Installed by
Certificate of Completion Date e ,AAA, f
`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.
o :• � �.:.. .,;.. r; ..,. { r y ...s�Y �` �,. a,:..�r I.�-...h. _ fr.R..y w..' .: a.c� _ ,.w- - .
r a.N i 'k y=, ye • i i :: 'r r,� _ . ,F -S`'` �'� `'may t ,fie. 'T`' `l' p F. �"�"'i`: >-',. , , s 't '';.y/� '..
f Xo
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sa ita Swage Sys emsPerms#,,,, umker
Date N `I
Name — � o
Location
{ %-= �1 : - 1-'� � U 1 _ � �' to �1..� .. '�_-t;.'•.:t . ;,�:.`.:. `� `,',i ` �-�.� -. �'.. � (<'.• ci
Subdivision Name Lot No. Sec. or Block No.
Lot Size -
House .— Mobile. Home
Business --
Speculation _
No. Bedrooms
No. Baths_— No. in Family
_
Garbage Disposal
YES
NO ❑
S ations oS
N r stem.
Auto Dish Washer '
YES
r NO ❑
t;`
Auto Wash Ma.hine
YES
NO
Lo��-�
Type Water Supply
*This perms voijN sewag
This permit •s subject to n
t. � 1.
system described below is not installed within 5 years from date of issue.
ocation if site plans or the intended use change.
Improvements permit by
*Contact a representative of the Da(iie �Cour�ty Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on GCllay f c pletion. Telephone Number 704-634-5985.
Final Installation Diagram:
System Installed by
F
—
�.
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.
ICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
D _ Davie County Health Department
Environmental Health Section
O. Box2 J
Mocksville, NC 27028 �� Zp
ca )on/Permit Requested By M lP Ern ar--
Mailing Address —1506 711, lee -T-,a.i l Kerr%ers vA N G aZa.85
Home Phone ( 91a1 -Tgq - 0go a, Business Phone (qiA b7R-- eg 7 -7
2. Name on Permit if Different than Above
3. Application/Permit for: �El General Evaluation 2(Septic Tank Installation
4. System to Serve: L// House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
O'Basement/Piumbing
No. of People
y
No. of Bedrooms J
No. of Bathrooms a '/2-
Dwelling
/2Dwelling Dimensions 60;X 20
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
7. Type of water supply: Public
8. Property Dimensions
No. of Sinks
No. of Urinals
No. of Water Coolers _
Water Usage Figures _
❑ Private
Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Yes
❑ Basement/No Plumbing
ff Washing Machine
E� Dishwasher
❑ Garbage Disposal
O No
❑ Community
*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.
Directions to Property: D 0f\ UnAerp-Ss 904
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 application.
g116�Q3 `T'+k
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. �2. I DO NOT OWN the property.
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 disposal system.
DATE SIGNATURE
DCHD (12-90)