239 Pine Valley Road Section 1 Lot 23 P/O 24Davie County, NC Tax Parcel Report Tuesday, January 24, 2017
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WARNING: THIS IS NOT A SURVEY
All data Is provided as is without warranty or guarantee of any Idnd either expressed or implied including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shag 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 of the use or Inability to use the GIS data provided by this website.
Parcel Information
Parcel Number:
J605000016
Township:
Fulton
NCPIN Number:
5758817141
Municipality:
Account Number:
1297000
Census Tract:
37059-804
Listed Owner 1:
ALLERTON GIRTEN O
Voting Precinct:
FULTON
Mailing Address 1:
239 PINE VALLEY ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE
COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 23+P/024 HICKORY HILLSECTION 1
Fire Response District:
FORK
Assessed Acreage:
1.07
Elementary School Zone:
CORNATZER
Deed Date:
2/1996
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
001850414
Soil Types: GnC2,GaD,WATER,MsD
Plat Book:
0004
Flood Zone:
Plat Page:
107
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
�o� lyS'L
Davie County,
N`"r
All data Is provided as is without warranty or guarantee of any Idnd either expressed or implied including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shag 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 of the use or Inability to use the GIS data provided by this website.
ONSTRUCTION
AUTHORIZATION
5=°t' Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Girten Allerton
Address: 239 Pine Valley Road
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 998-7095
/ For Office Use Only
*CDP File Number 202356 -1
County ID Number: 5758817141
Evaluated For: EXPANSION
Township:
0 4/ 0 4/ a 0 a 1
Property Owner: Girten Allerton
Address: 239 Pine Valley Road
City: Mocksville
State/Zip: NC
Phone #: (336) 998-7095
Property Location & Site Information
Subdivision: Hickory Hill
27028
Phase: 1 Lot: 23/24
Directions
Hwy 34 W to Hickory Hill turn left onto Pine Valley to 239
on left.
cations
Address/Road #:
Minimum Trench Depth:
239 Pine Valley
Road
Mocksville
NC 27028
Structure:
SINGLE FAMILY
# of Bedrooms:
4
# of People:
2
*Water Supply:
PUBLIC
Subdivision: Hickory Hill
27028
Phase: 1 Lot: 23/24
Directions
Hwy 34 W to Hickory Hill turn left onto Pine Valley to 239
on left.
cations
Page 1 of 3
Minimum Trench Depth:
a \
4 Inches
Site Classification: Provisionally suitable
Saprolite System? O Yes (9 No
Minimum Soil Cover:
1 a Inches
Design Flow: 4 8 0
Maximum Trench Depth:
3 6 Inches
Soil Application Rate: 0 ) 7
5
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:
Gallons
*Proposed System: 25% REDUCTION
1 -Piece:
O Yes O No
Pump Required: O Yes
(& No O May Be Required
Nitrification Field 4
3
9
Sq. ft. Pump Tank:
Gallons
No. Drain Lines 1
1 -Piece:
OYes 0 N
Total Trench Length: 1 0 9
GPM
--vs— ft. TDH
ft
Trench Spacing:O
_
9
®
Inches O.C.
Feet O.C. Dosing Volume:
Gallons
Trench Width:
3
O
®
Inches
Feet
_
Grease Trap:
Gallons
Aggregate Depth:
inches
Pre -Treatment: O NSF OTS -I O TS -II
Septic Tank Installer Grade Level Required: 01011
O 111 O IV /
Page 1 of 3
CDP File Number 202356 - 1
Repair Systel
*Site Classification
Design Flow:
m
Provisionally Suitable
County ID Number: 5758817141
❑ Open Pump System Sheet
ired:OYes O No ®No, but has Available Space
Soil Application Rate: 0 a 7 5
*System Classification/Description:
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR
LESS)
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
1 7 4 5 Sq. ft.
4
4
3
6 ft.
Trench Spacing: 90 Inches O.
® Feet O.C.
Trench Width: 3 Inches
Feet
Aggregate Depth:
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover:
1
a
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover:
a
4
Inches
*Distribution Type: GRAVITY - SERIAL
Pump Required: Oyes ®No O May Be Required
Pre -Treatment: O NSF OTS -1 OTS -11
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Ramer
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. Rm�re
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(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? O Yes ONO
Applicant/Legal Reps. Signature: Date:
*Issued By: 2140 - Nations, Robert Date of Issue: 0 4 / 0 4 / a 0 1 6
Authorized State Agent: Malfunction Log OYes
® Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 202356-1
Davie County Health Department CDP File Number:
210 Hospital Street 5758817141
P.O. Box 848 County File Number:
Mocksville NC 27028 Date: 04/04 / x 0 1 6
0 Inch
Drawing Drawing Type: Construction Authorization Scale: , 0 Block = ft.
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
M91;»1CaMUM
County File Number:
202356-1
5758817141
Date:.0.4./ 0 4/. 0 16
Click below to import an image from an external location: Drawing Type: Construction Authorization
Page 3 of 3
P1 P2
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
A icatton For: 7 Site Evaluation/Improvement Permit C Authorization To Construct (ATC) ❑ Both
Type of Application: ❑New System ❑Repair to Existing System rxpansion/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 ' LlY L f.."FA ra Contact Person G/fZ irC`ll/
Address .✓E G 2 G V &J Home Phone 336 — 5� Pte- pis
City/State/ZIP C OZ�tusiness Phone
Email &4A g -RL LQ- 4, o L. , G� �-1° Email:
Name on Permit/ATC if Different than 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: U Site Plan UPlat(to scale)
(Permit is valid for 60 months with site plan, no expira ion with mpleteplat.)
Owner's Namei/f L 4--ite-2 Phone Ntunber -q',
Owner's Address ,:Z � P �t )/4 _- 1-47 City/State/Zipr' � !
' -
Property Address 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 documentation 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 2
Is the site subject to approval by another public agency? _Yes No t(J
Will wastewater other than domestic sewage be generated? _ Yes No C)
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms � # BatI ours Garden Tub/Whirlpool I IYes INo
Basement: ❑ es o Basement Plum ing: IYes o
IF NON-RF.SmF.NCF, 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: DConventional ❑Accepted ❑Innovative ❑Altemative ❑Other
Water Supply Typet County/City Water ❑ New Well ❑Existing Well D 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
of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules.
I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging
or stakin he hou /f cilityI ation, po well I nd the location of any other amenities.
Site Revisit Charge
p owroer's owner's legal epresentative si ture
>Date(s):
Ll Client Notification Date:
ate EHS:
Sign given I Yes ❑No Account #
Revised 11/06 Invoice #
"].GRADY L.TUTTE'ROW certify that on OCTOBER 15 19 87 . I surveyed the property 7010,wn on this',
that the property lines and location of all structures are accurately shown hereon; that no structure located on this property
encroaches on any adjacent street or 'property, and that no structure on adjacent properly encroaches on the premises
surveyed "
4 GNF roc
LAKE HICKORY HILL
22
jODt�
EIP c EXISTING IRON PIN
PIP = PLACED IRON PIN
NIP =NEW IRON PIN
+ = UNMARKED POINT
unmarked point
in lake unmarked point
�+ N it 12' 48" W —y in take
W
GE
0 8700 _tea{ -----J` ED
N O
NIP
NIP x "
„O
SURVEY FOR:
24
C` \R
Ory
�A
20' UTILITY EASEMENT
Pip -0 t
13ENT EIP
2p pAV E D
o* mprFru n M I FRTON & w/
power
pole.
• .F"jr DAVIE COUNTY HEALTH DEPARTMENT
► (Septic Tank) Improvements Permit. and Certificate of Completion zi3 �j
o`u d,Absor ioli-twage pis osal System - G.S. Chapter 1 0 -Article 13C)
* �� vR CONTRACTOR *J`'C /`c] t y •.=`! (,1 ( DATE -" ` r PERMIT
LOCATIONji• 1129
s•—
SUBDIVISION NAME
HOUSE [21
OME BUSINESS
NO. BATHROOMS
:R. NO.
LOT NO. c2 3 SECTION OR BLOCK N0. C
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER. YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO Q
SIZE OF TANK Q gal. J
NITRIFICATION FIELD (! S' + 3 ssqgq. ft.
DEPTH OF STONE IN LINES: O
WATER SUPPLY: Individual ,,Q Public be
IMPROVEMENTS PERMIT BYJ;=' P
House Trailer
800 Gal.
400
Sq.
Ft.
Two Bedroom House
800 Gal.
600
Sq.
Ft.
Three Bedroom,House
900 -Gal.
900
Sq.
Ft.
Four Bedroom House
1000 Gal.
1200
Sq.
Ft.
INSTALLED BY �•= 'fr��`a
CERTIFICATE OF COMPLETION �J t
` fP,,,,. !
BY Date
(8/16/73) *Construction must COMPW with all other applicable State and local regulations
LOT AREA A.C.lCY�%'0.�...
/S�ot4X-3'�(
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion ��.+� %i f'� n'
I
(Ground Abso$ion Sewage Disnosal System- G.S. Chaptrer 30 -Article 13C)
1i � DATE OR CONTRACTOR
PERMIT
LOCATION i n , ��: •- �. : 4� �.:� �.' �..'.�'u►g �,- ~ !�' i/ 1\ 9. 1129
613 9 %Alf- S:R. NO.
SUBDIVISION NAME �-�Ii c -X -Cs y i % LOT NO. C1 .5 SECTION OR BLOCK NO. +.
SE R MOBILE HOME ❑ BUSINESS
BE ROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER,. YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ No El
SIZE OF TANK gal.
�
NITRIFICATION FIELD:- -o sq. ft.
DEPTH OF STONE IN LINES:
ra
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY
J l
CF.RTTFTCATE OF COMPLETION
(8/16/73)
LOT AREA
e
By—L�
*Construction must comp
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom,House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
,; , - _ "`""""'�Date i
with all other applicable State and local regulations
r
,{ er
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorion Sewage pis osal System G.S. Chapter 130 -Article 13C)
OR CONTRACTOR r C 2i ts� f i DATE PERMIT
NO.
SUBDIVISION NAME&C-k6 T %�i ,/f LOT NO. �( SECTION OR BLOCK NO.
SE [Z MOBILE HOME 0 BUSINESS
NCrrBEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ N
SIZE OF TANK �1 gal.
NITRIFICATION FIELD �,;sq. ft.
DEPTH OF STONE IN LINES: cR �*
WATER SUPPLY: Individual Public
IMPROVEMENTS PERMIT BY } (
CERTIFICATE OF COMPLETION By
(8/16/73) *Construction must comp
LOT AREA
1129
House Trailer
800
Gal.
400
Sq.
Ft.
Two Bedroom House
800
Gal.
600
Sq.
Ft.
Three Bedroom,House
900
Gal.
900
Sq.
Ft.
Four Bedroom House
1000
Gal.
1200
Sq.
Ft.
INSTALLED BY
''Date r
,17
with all other applicable State and local regulations
AL�
'7e�, L,4
r F
y DA_VIE COUNTY HEALTH DEPARTMENT
^ IMPROVEEN3S 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—Date
Location
Subdivision Name
Lot No. Sec. or Block No. li
Lot Size
House
— �'f
Mobile Home _ Business __ Speculation
No. Bedrooms 3 — No.
Baths —
2
_ No. in Family �—
Garbage Disposal YES
❑' NO
Ej
.J „-"
Specifications for System:'-,/
Auto Dish Washer YES
Q' NO
❑
- =
Auto Wash Machine YES
Q' NO
❑
_
; ,.i 4 • , , r. _; ; - ; �;'
Type Water Supply
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 �' f� f Date
signing of this certificate shall indicate that the system described above has been installed in compliance with
\tandards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
torily for any given period of time.