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116 Guinevere DrOPERATION PERMIT Davie County Health Department t to 210 Hospital Street ` P.O. Box 848 r Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Frank Earnhardt Address: 116 Guinevere Lane City Mocksville State2ip: NC Phone #: (336) 284-2640 `CDP File Number 120714-1 M510OA0015 County ID Number: Evaluated For: REPAIR �ownship: //Property Owner: Frank Earnhardt Address: 2086 Junction Road City: Mocksville State/Zip: NC Phone #: (336) 284-2640 Property Location & Site Information r Address/Road #: Subdivision: Phase: Lot: 116 Guinevere Drive Mocksville NC 27028 Directions Structure: OTHER Hwy 601 S. Right onto Hwy 801 Right on Guinevere # of Bedrooms: 3 Lane, on corner # of People: 4 'Water Supply: PUBLIC 'IP Issued by. 'CA issued by: Design Flow: 3 6 0 Soil Application Rate: 0 3 Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: 1 S A ft. 'System Classification/Description: TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Saprolite System? O Yes (2)No 'Distribution Type: GRAVITY - PARALLEL (eq. d -box) Pump Required? OYes QNo 'Pre -Treatment: Drain field Sq. ft. 8 lnches O.C. Feet O.C. Olnches ()Feet inches Minimum Trench Depth: Inches Minimum Soil Cover. Inches Maximum Trench Depth: Inches Maximum Soil Cover: I',— Inches 'System Type: INFILTRATOR QUICK 4 STANDARD Installer: roge,t Spillman Certification #: 'EH S: 2140 - Nations, Robert Date: 0 8/ 0 8/.2 0 1 4 Approval Status D Approved O Disapproved CDP File Number 120714 - 1 Manufacturer. STB: Gallons: Date: *Filter Brand: ST Marker: ❑ Yes ❑ No Reinforced Tank: ❑ Yes ❑ No ,,.,,—Piece Tank: ❑ Yes ❑ NO Manufacturer. PT: Gallons: Date: / / RiserSealed ❑ Yes ❑ No Riser Height: ❑ Yes ❑ NO (Min.6 in.) einforced Tank: ❑ Yes ❑ NO `1 Piece Tank: ❑ Yes ❑ No Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ NO ,pproved fittings ❑ Yes ❑ NO County ID Number: M510OA0015 c rants Lat. Long: Installer: Certification #: *EHS: Date: / / Approval Status ❑ Approved ❑ Disapproved Pump Tank Installer: Certification 0: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved upply Line Installer: Certification #: *EH S: Date: Approval Status ❑ Approved ❑ Disapproved / Pump Type: Installer: Dosing Volume: — Gal Certification #: Draw Down: Inches *EH S: *Chain: Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ NO Check -valve ❑ Yes ❑ NO Approval Status PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No \ Anti -siphon Hole ❑ Yes ❑ NO CDP File Number 120714 - 1 -!!41V9i11LM3! OPERATION PERMIT 120714-1 Davie County Health Department CDP File Number: 210 Hospital Street County File Number: M5100A0015 P.O. Box 848 Mocksville NC 27028 Date: Q Inch i + CONSTRUCTION For office use only ` ' AUTHORIZATION *CDP File Number 120714-1 Davie County Health Department tY P County ID Number: M510OA0015 ` 210 Hospital Street Evaluated For: REPAIR P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 1/ 0 1/ 0 0 0 6 Applicant: Frank Earnhardt Property Owner: Frank Earnhardt Address: 116 Guinevere Lane Address: 2086 Junction Road City: Mocksville City: Mocksville State/Zip: NC State/Zip: NC Phone #: (336) 284-2640 Phone #: (336) 284-2640 Property Location & Site Information Address/Road #: Subdivision: Phase: Lot: 116 Guinevere Drive Mocksville NC 27028 Directions Hwy 601 S. Right onto Hwy 801 Right on Guinevere Lane Structure: OTHER on corner # of Bedrooms: 3 # of People: 4 'Water Supply: PUBLIC ,"Site Classification: PS Saprolite System? OYes ONo Design Flow: 3 6 0 System Specifications Minimum Trench Depth: 2 4 Inches Minimum Soil Cover. Inches Maximum Trench Depth: 3 6 Inches Soil Appwation Rate. 0 - 3 Maximum Soil Cover: Inches 'System Classification/Description: *Distribution Type: GRAVITY- PARALLEL (eq. d -box) TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Seis t Tank' 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: .Aggregate Depth: 1 5 0 ft. p Gallons 1 -Piece: OYes 014o Pump Required: ()Yes QNo OMay Be Required Sq. ft. Pump Tank: Gallons 1 -Piece: OYes ONo GPM—vs— ft. TDH _8Inches O.C. Dosing Volume: Gallons — Feet O.C. g — 8Inches Feet Grease Trap: Gallons inches Pre -Treatment: ONSF OTS -1 OTS -11 Septic Tank Installer Grade Level Required: OI OII 0111 OIV �oqj Pagel of 3 CDP -Fite Number 120714-1 County ID Number: N1510OA0015 uirea:v r ub v Ivu vlvu, but nas Hvanable %1> ❑ Open Pump System Sheet /Repair System Trench Spacing:8Feet Inches O. *Site Classification: PS — O.C. Trench Width: Q Inches Design Flow: 3 6 0 — o Feet Soil Application Rate: 0 - 3 Aggregate Depth: inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. Inches 'Proposed System: o Maximum Trench Depth: 3 6 Y 25 /a REDUCTION Inches Maximum Soil Cover: Nitrification Field Inches Sq. ft. No. Drain Lines 'Distribution Type: GRAVITY- PARALLEL (eq. d -box) Total Trench Length: 1 5 0 fi Pump Required: Oyes ONo OMay Be Required Pre -Treatment: ONSF OTS -I OTS -II 'Site Modifications No grading or construction activity is allowed in areas designated for system and repairwithout 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 be valid for a person equal to the period of validity of the Improvement Permit not to exceed five years, and maybe 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, "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: 2244 - Daywalt. ndrew Date of Issue: 0 3 / a 1 / a 0 1 3 Authorized State Agent: Malfunction Log Oyes OHan Drawing 0Import Drawing Total Time:(HH:1.11J) **Site Plan/Drawing attached.** 1 Hours Ll inutes Page 2 of 3 Pane 3 of 3 W6)% `91/? DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST ' APPLICATION IP/ATC OSWW REPAIR ' Name - .r '. ' ''/ - Telephone Number Address Mailing Address (if different from above) Email Address: Y -1 DQ-A n -aI Subdivision Name Lot # .,5ZO A/ Directions b o(:5 . 2--o r �� /{, - �f ��. �� � �' r� / I, o tJ C'.� Date System Installed q Name System Installed Under Type Facility ' w ai Number Bedrooms Number People Served 1 Type Water Supply Specific Problem Occurring /Jot � r Date Requested Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE.BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason Revised 2-2011 Ve4u 6P?1� 397-11 0PXP-' / 207/`f J, '-Q f) W, z"'?f DAVIE'COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR Name Telephone Number Address or Mailing Address (if different from above) Email Address: Subdivision Name Lot # Directions r Date System Installed Name System Installed Under ';1) 1,; Type Facility j-11 1 L, Number Bedrooms Number People Served Type Water Supply Specific Problem Occurring Date Requested Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORREqlT"TO THE BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge - Date Reason Revised 2-2011 Appraisal Card Page 1 of 1 EARNHARDT SUES Retum/Appeal Notes: MS -100 -AO -015 116 GUINEVERE LN UNIQ ID 23198 2520122 D368 -P18 ID NO: 5745174443 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 .570 AC H WY 801 0.520 AC SRC= Inspection ,ppraised by 19 on 06/04/2008 05005 GLADSTONE TW -05 C- EX- AT- LAST ACTION 20120926 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oun - 3 Eff. BASE Standard 0.2300 odation ntinuous Footing8.0 US MO Area UA RATE RCN EYB AYB CREDENCE TO MARKET ub Floor System - 4 02 02 1.5601100 43.00 808 199 199 % GOOD 77.0 EPR. BUILDING VALUE - CARD 52,42C I ood 11.0 TYPE: Manufactured Home (Multi) Manufactured Home DEPR. OB/XF VALUE - CARD 43 xterior Walls - 10 MARKET LAND VALUE - CARD 16,99 luminum in I Siding32.0 STORIES: 1 - 1.0 Story OTAL MARKET VALUE - CARD 69,84 willing Structure - 03 able 9.0 OTAL APPRAISED VALUE - CARD 69,84 oofing Cover - 03 OTAL APPRAISED VALUE - PARCEL 69,84 s halt or Composition Shingle 5.0 nterior Wall Construction - 5 OTAL PRESENT USE VALUE -PARCEL wall/Sheetrock 28.0 OTAL VALUE DEFERRED -PARCEL nterior, Floor Cover - OB OTAL TAXABLE VALUE - PARCEL 69,84 heel Vinyl/Laminate 7.0 nterior Floor Cover - 14 PRIOR et 0.00 3UILDING VALUE 61,12 eating Fuel - 04 BXF VALUE 1,17 lectric 1.00 AND VALUE 16,99 eating Type - 30 RESENT USE VALUE eat Pump 5.00 DEFERRED VALUE Ir Conditioning Type - 03 OTAL VALUE 79,280 entral 5.0 Brooms/Bathrooms/Half-Bath rooms 2/0 0.000 PERMIT 3edrooms CODE FDATE NOTE i NUMBER AMOUNT AS-3FUS-OLL-0 throoms ROUT: WTRSHD: AS - 2 FUS - 0 LL - 0 SALES DATA OTAL POINT VALUE 111.00 FF. INDICATE BUILDING ADJUSTMENTS ECORD ATE DEED SALES uallty 3 AVG 1.000 BOOK PAGE M R TYPE PRICE ha a Desi 3 1AF_R3 1.000 +------------------6S------------------♦ 0116 349 3 1996 WD Q I 2200 ize 3 Size 0.900C I BAS I 117 D166 12 1990 WD Q V 1300 OTAL ADJUSTMENT FACTOR 0.90C 1 I 0115 189 12 1984 WD Q I 500 OTAL QUALITY INDEX loc 1 I 0558 3233 6 2004 WD P I 4500 1 I 0531 3190 1 2004 WD I 1 3400 2 2 4 4 I I I I I I HEATED AREA 1,560 I 1 +__________________65__________________+ NOTES 005 BOARD E&R 57500 VALU .49 TO DAN U PRESNELL SUBAREA DESCRIPTIO T UNIT NIT PRICE ORIG % COND LDG7YL B AYB EYB ANN DEP RATE V % GOND OB/XF DEPR. VALUE RPL ODE .41 301 20.001 1001 1 L 11982119821 SA 1 71 431 TYPE GS 02 AS I156 10 6708 OTAL OB/XF VALUE 431 2 - PreFabricated REPLACE 1,00 UBAREA 1,56 68,08 OTALS UILDING DIMENSIONS BAS=W65S24E65N24 . NO INFORMATION THER ADJUSTMENTS LAND TOTAL IGHEST AND USE LOCAL FRON DEPTH/ LND COND ND NOTES ROA UNIT LAND UNT TOTAL ADJUSTED LAND LAND EST USE CODE ZONING TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP AD7ST UNIT PRICE VALUE NOTES OMMERCIAL 0700 158 0 1.0000 0 0.7500 PW 1.0 22651.200 SF 0.75 0.75 1698 OTAL MARKET LAND DATA 16,99 OTAL PRESENT USE DATA qq ffJ 1 ,e' t i J• http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=M510OA0015 2/25/2013 o:_ Mail r _ .• .t . ./ �`�' - �//fl�/7.f!�.?-/ /`i"Yy/T?.GEU• /rC� WARRANTY DEED -Form WD -601 Printed and for sale by James Williams h Co., Inc., YadkidvWe, N. C. STATE OF NORTH CAROLINA, Davie County. THIS DEED Madethis 29th dayof March 1996 ,byandbetween Fred O. Ellis and rn wifd, Marie C. Ellis p of County and staie of North Carolina, hereinafter called Grantor, and Chad Mitchell Thomas and wife.. Rebecca L. Thomas o f Davie County and State of North Carolina, hereinafter called Cfantee, whose permanent mailing address is Ten dollars and OVC-------------------- WITNESSETH: That the Grantor, for and in consideration of the sum of Dollars and other good and valuable considerations to him in hand paid by the Grantee, the receipt whereof u hereby acknowledged, has given, granted, bargained, told and conveyed, and by these presents does give, grant, bargain, sell convey and confirm unto the Grantee, his heirs and/or successors and assigns, premises in Township, County, North Carolina, described as follows; Lying and being in Jerusalem Township, Davie County, North Carolina and beginning at .o a placed iron pin, said placed iron pin being located South 12 degrees 38 minutes 12 seconds West, 29.15 feet from a placed iron pin, said placed iron pin being the Southeast corner of William R.Link, DB 82, page 370 and the Northeast corner of Robert D. Carter, DB 118, page 376; thence from said beginning placed iron pin South 56 degrees 48 minutes 11 seconds East, 101.94 feet to a new iron pin, said new iron pin being located in the Western line of Norman M. Kuhn, DB 64, page 249, DB 64, page 411 and Deed Book 71, page 524; thence with Kuhn line South 17 degrees 10 minutes 32 seconds West, 115.25 feet to a point; thence South 24 degrees 23 minutes 35 seconds East, 53.81 feet to a point, said point being located on the edge of the northern right of way of NCSR #801; thence South 65 degrees 36 minutes 25 seconds West, 58.79 feet to a point; thence South 58 degrees 18 minutes 35 seconds West, 69.51 feet to a point; thence South 53 degrees 10 minutes 58 seconds West, 30.08 feet to a point; thence North 77 degrees 52 minutes 36 seconds West, 15.45 feet to an existing iron pin; thence North 02 degrees 46 minutes 23 seconds East, 13.37 feet to a tack in power pole; thence North 23 degrees 11 minutes 38 seconds East, 96:07 feet to a point located in easement; thence North 10 degrees 31 minutes 04 seconds East, 64.71 feet to an existing iron pin; thence North 64 degrees 03 minutes 18 seconds West, 31.55 feet to a point located in the Southern line of Robert D. Carter, DB 118, page 376; thence with said Carter line North 21 degrees 46 minutes 26 seconds East 24.54 feet to a point; thence North 32 degrees 02 minutes 12 seconds East, 80.71 feet to a point; thence North 12 degrees 38 minutes 12 seconds East, 20.71 feet to THE POINT AND PLACE OF BEGINNING and containing 0.575 acres as surveyed by Tutterow' Surveying Company on December 120 1984, revised December 27, 1984 and October 22, 1990. Grantor, personally appeared before me this day and acknowJSdg�d (hr, execution of the fore ing deed. . Witness my hand and notarial seal i. the o/5 ql•! day of Aly Commission Expires= v - AL) DAVIE COUNTY 03-29-96 coin MIR, NOTARY PUSUC I,,,DAV ECOUNTY, NC a Notary Public of said Coumfl�it>ttp�!es - STATE OF $44-00 w+ RTN he execution of the foregoing deed N 1,C)UNA � Is Real Estate — day of 19—. Gp Excise Tax N.P.ISEAL) STATE OF NORTH CAROLINA, nn V i Pr•OUNTY. The foregoing certificate(iq of Donna Stroud. Notary Public of Davie County, NC, is (Xlq certified to be correct. This instrument was presented for registration tlils VQ da of March 19 96 2.53 Davie at 3t�)Cf; P. M., and duly recorded in the office of kegbter of Deeds of County, North Carolina, in Book 186 page 349 This the 29 day of March A. D„ 19 96 . Henry L. Shore By Reguser o Deeds TAQk" Deputy Register of Deeds This Deed drawn by IN DEED TftA::SFC.R CuC"-:ED DEED 0 Prepared by Wade H. Leonard,Jr. DATE—��__•,_.tl'f..l'r�: _ UPEn'v:� ii No title search requested. The above land was conveyed to Grantor by . See Book No. , Page TO HAVE AND TO HOLD The above described premises, with all the appurtenances thereunto belonging, or in any wise appertaining, unto the Grantee, his heirs and/or successors and assigns forever. And the Grantor covenants that he Is seized of mid premises in fee, and has the right to convey the same in fee simple; that said premises are free from en- cumbrances (with the exceptions above stated, if any); and that he will we r r a n t and defend the said title to the same against the lawful claims of all persons whomsoever. When reference is made to the Grantor or Grantee, the singular shill include the plural and the masculine shall include the feminine or the neuter. IN WITN S W HOF, The gntor has hereunto act his hand and seal, the day and year fust above written. (SEAL) (SEAL) (SEAL) (SEAL) STATE OF NOR CAROLINA COUNTY. a N�glary Public of sai ty, do hereby certify that Grantor, personally appeared before me this day and acknowJSdg�d (hr, execution of the fore ing deed. . Witness my hand and notarial seal i. the o/5 ql•! day of Aly Commission Expires= v - AL) DAVIE COUNTY 03-29-96 coin MIR, NOTARY PUSUC I,,,DAV ECOUNTY, NC a Notary Public of said Coumfl�it>ttp�!es - STATE OF $44-00 w+ RTN he execution of the foregoing deed N 1,C)UNA � Is Real Estate — day of 19—. Gp Excise Tax N.P.ISEAL) STATE OF NORTH CAROLINA, nn V i Pr•OUNTY. The foregoing certificate(iq of Donna Stroud. Notary Public of Davie County, NC, is (Xlq certified to be correct. This instrument was presented for registration tlils VQ da of March 19 96 2.53 Davie at 3t�)Cf; P. M., and duly recorded in the office of kegbter of Deeds of County, North Carolina, in Book 186 page 349 This the 29 day of March A. D„ 19 96 . Henry L. Shore By Reguser o Deeds TAQk" Deputy Register of Deeds This Deed drawn by Davie County, NC - GoMaps Advanced Page 1 of 1 100 ft http://maps2.roktech.net/davie_gomaps/index.html N .0- ' 0 i[jIF& � VMV Latitude: 350 49' 19,30' Longitude; -800 32' 49.89' 531 1 221 3/21/2013