209 Gordon Dr Davie County,NC Tax Parcel Report Thursday, February 23, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: D700000017 Township: Farmington
NCPIN Number: 5862445840 Municipality:
Account Number: 82532378 Census Tract: 37059-802
Listed Owner 1: STONE JORDAN L Voting Precinct: SMITH GROVE
Mailing Address 1: 212 BRACKEN ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 5.79 AC GORDON DR Fire Response District: SMITH GROVE
Assessed Acreage: 5.59 Elementary School Zone: PINEBROOK
Deed Date: 9/2001 Middle School Zone: NORTH DAVIE
Deed Book/Page: 2001 E0270 Soil Types: GnB2,GnC2
Plat Book: 0004 Flood Zone:
Plat Page: 163 Watershed Overlay: DAVIE COUNTY
Building Value: 138800.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 64040.00 Total Market Value: 202840.00
Total Assessed Value: 202840.00
O bylE 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
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County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�ObN� NC or arising out of the use or Inability to use the GIS data provided by this website.
OPERATION PERMIT F*CDPFileNumber
ice se v
* Davie County Health'Department 200325-1
210 Hospital Street 5862445840P.O. Box 848 umber.
=� Mocksville NC 27028 Evaluated For. NEW
Phone:336-753.6780 Fax:336-753-1680 Township:
-
C7Address:
Applicant: Jprdan Stone Property owner Jordan Stone
212 Bracken Road ,Address: 212 Bracken Road
CRY: Mocksville !Cay: Mocksville
State/Zip: NC: 27028 State/Zip: NC 27028
Phone#: (336).492-2850 Phone#: (336)492-2850
Pro a Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
209 Gordon Drive
_ -;Advance NC 27006 Directions
_ 1-40 'East exit#180 turn left going North . Turn L
_Stricture SINGLE FAMILY
Redland then Left Gordon Property on Left past
of Bedrooms: 4 V = idleVilild Dev.
of People:
"`Water Supply: PUBLIC
`
*System Classification/Description:
*IP Issued by.
..._- TYPE ill G.OTHER NON-CONN.TRENCH SYSTEMS
*CA issued by: 2140.Nations,Robert
SaproliteSystem? OYes QNo
Design Flow: 4 8 0 *Distribution Type: GRAVITY-SERIAL Pump Required?
OYes ONo
Soil Application Rate: 0 - 2 7 5 *Pre Treatment:
Drain field
N kriiftcation Field - 1 7 4 5 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD
No. Drain Lines 4 Installer: Jamie Barnes
Total Trench Length: 4 3 a 8• Certification#: 1108
Trench Spacing: _ 9 Inches O.C.
Feet O.C. *EH S: 2140-Nation.Robert
Trench Width: _ 3 ()Inches
Feet Date: 1 1 / 0 1 / 2 0 1 6
Aggregate Depth: inches
Minimum Trench Depth: 3 6 Inches
Minimum Soil Cover. 2 4 Inches Approval Status,\,, '
Maximum Trench Depth: 3 6 ® Approvetl 0 Disapproved
Inches
Maximum Soil Cover.
2 4 Inches
CDP File Number 200325. 1 Septic Tank County ID Number: 5862445840
Manufacturer Sheaf Lat. -
STB: 760 Long:
Gallons: 1000 installer. Jamie Bames
Certification#: 1108
Date: 8 8 / 1 3 / x 0 1 6
*EHS: 2140-Nations,Robert
*Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter
ST Marker. El Yes ® No Date: 1 1 / 0 1 / x 0 1 6
pproval Status-'.
Reinforced Tank: ❑ Yes B No A
pp Disapproved
1 Piece Tank: ❑ Yes ® NO ` � _
Pump Tank
Manufacturer. Installer:
- PT: Certification#:
Gallons: *EHS:
Date:
Date: /
RiserSealed ❑ Yes ❑ No
Riser Height: ❑ Yes ❑ No (Min.6 in.)
Apprrnral Status
'ei forc ed Tank: ❑ _Yes ❑ .No ..._
_ t ❑ Approved Disapproved
1 Piece Tank; ❑.YeS_,-__ ❑ .NO—
Supply Line
Pipe Size: inch diameter Installer:
Pipe Length: feet Certification :
*Schedule: *EHS:
Pressure Rated ❑ Yes ❑ No Date, /
Approved fittings 0-Yes = ❑ No Approval Status
_ C] Approved❑ Disapproved
Pump eu e
Pump Type: Installer:
Dosing Volume: — Gal Certification#:
Draw Down: Inches *EHS:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ NO
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ❑ Yes ❑ NoApproval Status
PVC unions ❑ Yes ❑ No ❑"Approved❑ Disapproved
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole ❑ Yes 0 NO
CDP+ile Number 200325 - '1 County ID Number: 5862445840
Electric Equipment
N E�4X or Equivalent ❑ Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ No
Certification#:
Box Adj. Pump Tank ❑ Yes ❑ No
Conduit Sealed ❑ Yes ❑ NO 'EMS:
Pump Manually Operable ❑ Yes ❑ NO
'Activation Method: Date:
Approval Stafus
Alarm Audible ❑ Yes ❑ N0
❑ Approved❑ Disapproved
Alarm Visible ❑ Yes ❑ NO
2140-Nation.Robert
"Operation Permit completed by: 49
Authorized:State Ag - Date of Issue: 1 1 0 1 2 0 1 .6
_.Owner/ApplicantSignatGre:
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 seryed by a TYPE Iu G. sewage septic system.
Rule-:1961 requires that a Type -TYPE III G septic system meet the following criteria:
Mimum.System Review-ByThe Local Health Department: N/A
_._—M-anagement.Entity: OWNER
Minimum System InspectionMlaintenence Frequency ByCertified Operator:
NIA
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 entity with a certified operator or a private certified operator for the life of the septic system.
Rule.1961 requires that Type VI septic systems designed for a homelbusiness 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 for maintenance 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.
OHand Drawing OlmportDrawing
**Site Plan/Drawing attached.**
OPERATION PERMIT
Davie County Health Department CDP File Number: 20031 '
210 Hospital Street 5862445840
P.O.Box 848 County File Number:
Mocksville NC 27028 Date:
Olnch
Scale: . . . OBock
Drawing Drawing Type:-Operation Permit _ - ON/A
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' CONSTRUCTION For Office Use Only
.
AUTHORIZATION *CDP File Number 2100325.1
Davie County Health Department ( 5862445840
tY P � - � County ID Number
210 Hospital Street �� Evaluated For. NEW
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone:336-753-6780 Fax:336-753-1680 0 3 / 1 7 / a 0 a 1
Applicant: Jordan Stone Property Owner: Jordan Stone
Address: 212 Bracken Road Address: 212 Bracken Road
City: Mocksville City: Mocksville
State2ip: NC 27028 State/Lip: NC 27028
Phone#: (336)492-2850 Phone#: (336)492-2850
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
Advance NC 27006 Directions
Structure: SINGLE FAMILY 140 East exit#180 turn left going North . Turn L Redland
-- then Left Gordon Property on Left past Idlewild Dev.
#of Bedrooms: 4
#of People:
'Water Supply: PUBLIC
- System Specifications
Minimum Trench Depth: a 4
(Design
e Classification: Provisionally Suitable Inches
prolite System? OYes QNo Minimum Soil Cover. 1 a Inches
Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 , a 7 5 Maximum Soil Cover: a 4 Inches
'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL
TYPE 11 A CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0
Gallons
'Proposed System: 25%REDUCTION 1-Piece: OYes QNo
Pump Required: OYes QNo OMay Be Required
Nitrification Field 1 7 4 5
Sq. ft. Pump Tank: Gallons
No. Drain Lines 4 1-Piece: OYes ONo
Total Trench Length: 4 3 6 ft. GPM—vs— ft. TDH
Trench Spacing: — 9 Inches @ t O C.0 Dosing Volume: Gallons
Trench Width: — 3 ()Inches
Feet Grease Trap: Gallons
Aggregate Depth: inches
Pre Treatment: ONSF OTS-1 OTS-II
17
Septic Tank Installer Grade Level Required: OI 011 0111 OIV
Danes I of Z
CDP File Number 200325- 1 County ID Number: 5862445840
❑ Open Pump System Sheet
Repair System Required:Wes ONO ONo, but has Available Space
rDesign
System
Trench Spacing: 9 Inches O.C.
ification: Provisionally Suitable — Feet O.C.
Trench Width: Inches
w: 4 $ 0 _ 3 Feet
SoilAggregate Depth:
Application Rate: 0 - a 3 5 inches
*System Classification/Description: Minimum Trench Depth: 4 Inches
TYPE 11A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover 1 2 Inches
'Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches
Nitrification Field 1 7 4 6 Sq Maximum Soil Cover: a 4 Inches
No. Drain Lines 4 *Distribution Type: GRAVITY-SERIAL
Total Trench Length: 4 3 6 ft. Pump Required: C7Yes @No OMay Be Required
Pre-Treatment: ONSF OTS-1 OTS-II
"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 no way 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 or 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 ofthe 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 we Date of Issue: . 0 3 / 1 7 / x 0 1 6
Authorized State A Malfunction Log OYes
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Dav1Q County Health Department CDP File Number: 200325 - 1
210 Hospital Street 5862445840
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 0 3 / 1 7 / 0 1 6
Q Inch
Drawing Drawing Type: Construction Authorization Scale: . QBlock
O N/A
I �
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CONSTRUCTION AUTHORIZATION
L Davie County Health Department + _
210 Hospital Street' '' CDP File Number: 200325- 1
P.O.Box 848 5862445840
Count File Number:
ko / ('0 p O cr d Mocksville NC l 27028 a� y
Date: .0 .3 / 1 7 / 2 0 1 6
Click below to Import an Image from an external location: Drawing Type:Construction Authorization
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16
L D
1K aid (Uc)
1U
j F,I N FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC
_
D *` Davie County Environmental Health
P.O.Boz 848/210 Hospital Street
J
' Mocksville,NC 27028
7 2010
SEP 2 (336)753-6780/FZuthm.W. 70sy.ristruct(ATC)
65
Applicati rte Eval 'on/Improvement Permit
❑Both
�gfion: ONew ystem DRepair to Existing System CExpansion/Modification of Existing System or Facilitty
E1vVlR0 � �,
+' ss THIS APPLICATION CoMNOT BB PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed Contact Person JO fctq,,, S f at),—
Billing Address'- I a, Rrack%z NA Home Phone '316-y 9 a- P.5 PO
City/State2IP Moc SUillr; N C 9,7 )L X Business Phone 336- 9721-/930
Name on Permit/ATC if Different than Above
Mailing Address City/State,7ip
PROPERTY INFORMATION *Date House/Facility Comers Flagged
NOTE: A survey plat or site plan must accompany this application. Included:O Site Plan OPlat(to scale)
(Permit is valid for 60 months site Ian no on with complete plat.) Q
Owner's Name v (I Phone Number 19g-30S�
Owner's Address I a n City/Stateaip (I/o c KS vT�7 09-
Property Address ry city Ad✓a L a e--,Lot Size Tax PIN# �D
Subdivision Name(if le Section/Lotff
ns To ite 61
'
If the answer to arty of the fol owin questions s e<supporting documcptafion must 6e attached
Are there any existing wastewater systems on the site? ffy 18No
Does the site contain jurisdictional wetlands? ANo
Are there any easements or right-of-ways on the site? ��X.es 5INo
Is the site subject to approval by another public agency? Yd�s 9INo
Will wastewater other than domestic sewage be generated? t Yes$No
IF RESIDE FILL OUT THE BOX-IJELOW
#People #Bedrooms #Bathrooms Gardcn Tub/Whirlpool Dyes o
Basement: s DNo Basement Pl bin : ❑Yes DTI;
0-05s
NON-RESIDENCE FILL OUT THE BOX BELOW
Type of FacffltyBusiness Total Square Footage of Building. #People
#Sinks #Commodes #Showers #Urinals
Fstimated Water Usage(gallons per day) (Attach documentation of similar facility water cousumpemnon)
FOODSERVICE ONLY: #Seats
Type system requested: W.nventional ❑Accepted ❑Innovative ❑Alternative DOther
Water Supply Type:�(County/City Water 0 New Well OExisting Well D Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve?0 Yes 04No
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 understwi d
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 Authoriked
Representative of the Davie County Health Department to conduct necessary inspections to detennine compliance with appliatmable
laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and.
1 g and flaggin� taking the house/fac'i location,proposed well location and the location of any other amenities.
�� /2.,
Property owner's or owner's 1 gal entative signature Site Revisit Charge
Date(s):
�Q Client Notification Date:
Date ERS:
Sign given DYes ONo Account# V
Revised 11/06 Invoice#
nA
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MB C"bwnty; NC
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dMARNING:THIS IS NOT A=t SURVEY!* Tuesday, 1/19/2010 rParcel Number: 700000017
s map is prepared for thea inventory of umber: 5862445840
real property found within this O�` sIF nt Number: 00082521922
jurisdiction,and is compl5led from carded deeds,plats,acrd e:11x r public OU ISON BOBSI
cords and data.Users of this map are p . Owner�€1: OU
reby notified that the aforvementioned lusted Owner#2:
Aic primary information soumrces should Mailin Address 1 155 ROLAND ROAD
be consulted for verificatitaan of the
formation contained on thiels map.The Mailin Address 2:
mty and mapping compangtyi assume no CI : MOCKSVILLE
:gal responsibility for the innformation State: NC
contained on this maap. Zi Code: 1127028
Notes: Legal Description: 5.79 AC GORDON
EX-c� O DR
Acrea e: 115.30100000
eed Date: 020010907
N v rel, B o u r,d., L-. .-C�- o n'roOeed Book and OOIED270
Plat Book:
1 0004
�,al a�a fZa , �-..J, r 0r%+0 Piat Pa e: 163
Building Value: 0
Outbuilding and Extra Features 0
Vaiue:
�.T J us� POSE ..Ld t2V.J d Land Value: 64040
otal Market Value: 64040
D��.lopr�en�, otal Assessed Value: 64040
// • • /� � � / /. A/�Tin rr/A1 A /�TTI�T/T1T /1AnA•Atn 1 /1 AlAA1l1
Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028 "
Billed To: Jordan Stone Subdivision Info:
Address: 212 Bracken Road Location/Address: Gordon Drive-27006
City: Mocksville Property Size: 5.79 Acres
Reference Name:
Proposed Facility: Residential
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permitis subject to
revocation if site plans,plat or the intended use change.
Permit Type: ItNew ❑Repair ❑Expansion Permit Valid for: Xf5 Years ❑No Expiration
Residential Specifications: #Bedrooms—q--#Bathrooms 3 #People—!k—BasemeAt Basement plumbing(
Non-Residential Specifications: Facility Type #People—#Seats
/I Square Footage(or Dimensions of Facility)
Design Flow(GPD):'1 RO Type of Water Supply: KCounty/City ❑Well ❑Community Well
Site Modifications/Pcrmit Conditions:
System Type LTAR
Initial
Repair
Site Plan
1Z
P v "
Environmental Health Specialist Date
i.p.11-06
a00 3Z6000*
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990005581 Tax PIN/EH#: 5862-44-5840
Billed To: Jordan Stone Subdivision Info:
Reference Name: Location/Address: Gordon Drive-27006
Proposed Facility: Residential Property Size: 5.79 Acres Date Evaluated: /��
Water Supply: On-Site Well Community Public `
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 .3 4 5 6 7
Landscape position
Slope % o
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy t,' 1;
HORIZON H DEPTH
Texture group
Consistence
Structure W
Mineralogy "
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY-
LONG-TERM ACCEPTANCE RATE: - cJ OTHER(S)PRESENT:
REMARKS:
LEGEND
Landscape Position
R Ridge S -Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC -Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
Tgxture.
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty clay loam SIL-Silty loam. CL-Clay loam SCL Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay .
CONSISTENCE
Moist
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
NS-Non sticky SS-Slightly sticky S-Sticky VS -Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP.-Very plastic
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogy
1:1,2:1,Mixed
lY9tgS
Horizon depth-In inches
Depth of fill-In inches
Restrictive horizon-Thickness and inches from land surface
f Saprolite-S(suitable);U(unsuitable)
1`1 Soil wetness-Inches from land surface'to free water or inches from land surface to soil colors with chroma 2 or less
Yy, .;
Classification-S(suitable),PS(provisionally suitable),U(unsuitable)
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