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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 Q Inch Scale: QBlock Q N!A j• I ...._ _.. _......._ _._. _ 0 G- - ------ - ----- r--F- i �. _ J� S - t -- _ I a �.��._�......��'}..��_w..,..,----«-•-� 'SII # �,_.�� I 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)