143 Deer Hollow Ln Davie County,NC Tax Parcel Report Friday,November 18, 2016
DEER MbLLOWN N�
143 127-------.-_�
r,r
�r
{
1,
WARNING: THIS IS NOT A SURVEY
Parcel Information .,Fw_ ry ��
Parcel Number: G813OA000301 Township: Shady Grove
NCPIN Number: 5789272501 Municipality:
Account Number:,:: : '82528363 Census Tract: 37059-804
Listed Owner 1: MYERS CAROLINE Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 109 RIVERVIEW TOWNHOUSE DRIVE Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27006-0000 Voluntary Ag.District: No
Legal Description: 1.00 AC OFF HWY 801 LT 1 GOLDS/MY Fire Response District: ADVANCE
Assessed Acreage: 1.09 Elementary School Zone: SHADY GROVE
Deed Date: 5/2016 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 010180375 Soil Types: PaD,WeC,PcB2
Plat Book: 0009 Flood Zone:
Plat Page: 139 Watershed Overlay: DAVIE COUNTY
Building Value: 146890.00 Outbuilding&Extra 1130.00
Freatures Value:
Land Value: 14850.00 Total Market Value: 162870.00
Total Assessed Value: 162870.00
o DI�p All data Is provided 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 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
�ODp4 NC or arising out of the use or Inability to use the GIS data provided by this website.
OPERATION PERMIT F*CDPFileNumber
ice use Only
_ Davie County Health Department 229984-1
210 Hospital Street 5789272501
P:0.13ox 848umber:
MocksvilleNC 27028 Evaluated For. NEW
Phone:336-753-6780 Fax:336-753-1680 Township:
Applicant: Aaron Moore rAddrerss--O'
ropety ner: Dale Gold
Address: 2608-Lafayette Ave v;: 109 Riverview Townhouse Dr.
City: Greensboro City: Advance
State)Zip: NC 27408 State/Zip: NC 27006
Phone#: (336)301-4177Phone#:
Pro a Location & Site Information
Address/Road #: - = Subdivision: Phase: Lot:
143 Deer Hollow Lane
Advance NC 27006 Directions
cture
Stru
Hwy,64 East, left on Hwy 801 approximately 5 miles
SINGLE FAMILY
_
Deer Hollow on left past William Ellis
#of Bedrooms: 4'
#of People:
*Water Supply: PUBLIC
*IP Issued by. "2140-NaGons;R�ert *System Classification/Description:
- ;TYPE 111 G.OTHER NON-CONV.TRENCH SYSTEMS
*CA issued by: 2140-Nations,Robert
SeproliteSystem? QYes ONo
Design Flow: 4 . 8 0 *Distribution Type: GRAVITY-SERIAL Pump Required?
QYes,, No
Soil Application Rate: 0 3 2 5 *Pre Treatment:
Drain field
NKrification Field 3 6 . 9 Sq.ft. *System Type: INFILTRATOR QUICK STANDARD
No. Drain Lines 1 Installer: Paul daniel Davis
Total Trench Length: 1 0 0 ft. Certification#: 1060
Trench Spacing: 9 Inches O.C.
()Inches
O.C. 'EH S: 2140-Nations.Robert
Trench Width: _ 3 inches
Feet Date: 1 1 / 0 2 / 2 0 1 6
Aggregate Depth: inches
Minimum Trench Depth: 3 6
Inches
Minimum Soil Covera 4 App
Inches rovat�Status�
Maximum Trench Depth: 3 6 Pp, `Pp
inches A roved O Disa roved
Maximum Soil Cover: 2 4 Inches
f
229984 - 1 . ,,57$9272501
CDP File Number County ID Number:
Septic Tank
Manufacturer. Lat.
Long;
STB:
Gallons: Installer:
Date: Certification#:
*EHS:
*Filter Brand:
ST Marker. ❑ Yes ❑ No
Date:
Approval Status
Reinforced Tank: El Yes' El No
Approved❑,�Dlsapproved
1Piece Tank: ❑ Yes _ ❑ No
Pump Tank
Manufacturer. Installer
PT: Certification#:
Gallons: *EHS:
Date: Date.
RiserSealed ❑ Yes ❑ No
Riser Height: ❑ Yes -_ - ❑ No (Min.6 in.)
Approval Status
Reinforced Tank: ❑ Yes D- No
❑ Approved❑ Disapproved ;
1 Piece Tank; _❑ Yes - — ..❑.-No_.
;. Suppiy Line
=Pipe Size: inch diameter Installer:
Poe t.ength: feet Certification#:
*Schedule: 'EHS.
Pressure Rated-El -Yes. .. ❑ No Date: I 1
Approved fittings ❑ Yes ❑ No Approval Status
`CI ApprovDlsapproved
_ _. .-..
Pump Requir—erDent
Pump Type: Installer:
Dosing Volume: — Gal Certification>r:
Draw Down: Inches *EHS:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ NO
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ❑ Yes ❑ No AppravhStatus
PVC unions ❑ Yes ❑ No ❑ Approved El Disapproved
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole ❑ Yes ❑ No
229984 . 1 5789272501
,P,PP I-ti,e Number County ID Number:
Electric Equipment
NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ No
Certification#:
Box Adj. Pump Tank ❑ Yes ❑ No
_ 'Conduit Sealed ❑ Yes ❑ No 'EHS:
Pump Manually Operable ❑ Yes ❑ No
*Activation Method: Date:
- � Approval Status
Alarm Audible ❑ Yes O No ❑ Approved❑ Disapproved'
Alarm Visible
❑ Yes ❑ No =
2140•Nations,Robert
*Operation Permit completed by: -.
Authorized.State Agent: - Date of Issue: 1 1 / 0 2 / 2 0 1 6
Owner/Applicant Signature:
This system has been installed in.compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal-15A NCAC 18A .1900 et. Seq.,and all conditions of the Improvement Permit and
Construction Authorization.This property is served by a TYPE to G. sewage septic system.
Rule .1961 requires that a Type TYPE 111 G. septic system meet the following criteria:
..Minimum_System Review By The Local Health Department: NIA
Management Entity;, OWNER
Minimum�System Inspection/Maintenance Frequency ByCertified Operator:
N/A
Reporting Frequency By Certified Operator:NIA
Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract
with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system.
- Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements formaintenance and
operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the
system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT +
Davie County Health Department CDP File Number: 229904-1-
210 Hospital Street 5789272501
P.O.Box 848 County File Number:
Mocksville NC 27028 Date:
- 1 V J 7 J
Q Inch
Scale; . QBlock
Drawing Drawing Type: Operation Permit pN/A
—71
► _ � �"�
I ,
! t
� }...._—��..,.«.....,.y..............»-........«. _ 1- --� .- ....mom....}, ».. «... ,. .- r .,—
3
i
I I