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531 Bailey's Chapel Rd Davie County,NC Tax Parcel Report Friday,November 18, 2016 RD k�qA/ ~ Rp fv1AF�KLAND.RD ILU n El r gAILEyS Co _..-_...-_..............__................- .......... _......._ __ -------......................_.. -- ............. - ' __.....................__.......................................-._...._.....__._..._.............................................._...._.__...:..._......._...__._._.. -- WARNING: THIS IS NOT A SURVEY -. � �� Parcel Inforbiation,� Parcel Number: H80000005314 Township: Shady Grove NCPIN Number: 5779651471 Municipality: r Account Number: Census Tract: 37059-804 _ Listed Owner 1: : Voting Precinct: WEST SHADY GROVE Mailing Address 1: Planning Jurisdiction: Davie County - City:. Zoning Class: DAVIE COUNTY R-A State: Zoning Overlay: Zip Code: Voluntary Ag.District: No Legal Description: Fire Response District: ADVANCE Assessed Acreage: 48.87 Elementary School Zone: SHADY GROVE Deed Date: / Middle School Zone: WILLIAM ELLIS Deed Book/Page: Soil Types: PaD,WeC,PcB2,PcC2,ChA Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 9 hiA 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 �r County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �O�p� NC or arising out of the use or inability to use the GIS data provided by this website. ` or fice use Only , OPERATION PERMIT s r�i Davie County Health Department *CDP File Number. 175698-1 210 Hospital Street P.a.Box 848 County ID Number. Mocksville NC 27028 Evaluated For,NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant:- Christopher and Aletha Property Owner Edith Bailey Slayle Estate Address: 560 N.Hiddenbrooke Drive Address: 613 Webster Drive City: _Advance City: Decatur - _State2ip: NC_ 27096 State/Zip: GA 30033 Phone#: (336)331-5132 Phone#: Property Location & Site Information \ Address/Road#: Subdivision: Phase: Lot: Galley's Chapel Road ' Advance NC 27006 Directions SINGLE FAMILY Hwy 64 East Left On Fork Bixby Rd. Right on Baileys `Structure Chapel Property on left - of Bedrooms: 5 #of People: - "Water Supply: PuaLlc *IP Issued by. 214Q-NatioiisRobert 'System Classification/Description: _ TYPE 111 G.OTHER PION-CONN.TRENCH SYSTEMS —.- `CA Issued by: 2140•Nations,Robert SaproliteSystem? OYes QNo Design Flow: 6_ 0 0 *Distribution Type: GRAVITY-SERIAL Pump Required? QYes (DNo Soil Application Rate: 0 3 *Pre Treatment; Drain field ('Nitrification Field 2 0 0 0 Sq. ft. *System Type: No. Drain LinesInstaller: William Rueben Clayton III Total Trench Length: 5 0 a ft. Certification#.* 2694 Trench Spacing: 9 Inches O.C. Feet O.C. 'EH S: 2140-Nations,Robert Trench Width: 3 ()Inches es Feet Date: 1 1 / 0 3 / 2 0 1 6 Aggregate Depth: inches _ Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. *1 4 Inches Approval Status Maximum Trench Depth: 3 6 Inches a © Approved© Disapproved Maximum Soil Cover: � �, Inches 4CDP File Number 175698 - 1 Septic Tank County Id Number: ► Manufacturer. Shoat Lat. Long: STB: 964 , Gallons: 1500 Installer William Rueben Clayton ilt Certification#: 2694 Date: 0 9 1 7 / 2 0 1 6 "`EHS: 2140-Nations,Robert 'Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter ST Marker © Yes a No Date: 1 1 D 3 2 D 1 6 Reinforced Tank: ❑ Yes d No Approval Status _ ❑-Approved❑ Disapproved 1 Piece Tank: ❑ Yes O Na - Pump Tank Manufacturer Installer: PT: Certifiication#: Gallons: *EHS: - Date: / Date: RiserSealed ❑ Yes ❑ No Riser Height: ElY8S ❑ NO (Min.6 in.) ApP rovatS#atus Reinforced Tank: ❑ Yes Cl No ❑ pProved❑�Qisapptzr+teci 1 Piece Tank; ❑ :Yes C1. No Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: *EHS: "Schedule: Pressure Rated- ❑ Yes ❑ No Date: 1 Approved fittings ❑ Yes ❑ No Approval Status CI Approved❑ Disap�rove U e u e en Pump Type; Installer: Dosing Volume: - Gal Certification 4: Draw Down: Inches *EHS: 'Chain: Date; Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval status PVC Unions ❑ Yes ❑ No ❑ Approvetl Q Disapproved / Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No 4DF.ile Number 175698'- 1 County ID Number: Electric Equipment N EMA 4X Box or Equivalent ElYes ElNo Installer: Box 12 inches Above Grade [:1 Yes (3 No Certification Box Adj. Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'ENS: Pump Manually Operable ❑ Yes ❑ NO _ 'Activation Method: Date: Approval StafuS , Alarm Audible ❑ Yes 0 No Approved❑ Disapproved Alarm Visible ❑ Yes ❑ NO *Operation Permit completed by: Authorized State Agent: Date of Issue: _.T ._Owner/Applicant Signature: This system has been installed in 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 III G. sewage septic system. Rule A 961 requires.that a Type TYPE Ili G. septic system meet the following criteria: M imum_System,Re-view By The Local Health Department: WA Management Entity; OWNER Minimum System Inspection/Maintenance Frequency By Certified 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 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. GHand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 17560 84W Davie County Health Department CDP File Number: 210Hospital Street P.o.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Scale: . _ a OBbck Drawing Drawing Type:-Operatioh Permit - - ON/A I I - __�------� _:.__► � Sao --�---;--�.� � � � I p..,...».--gym_...---•--. ._ ---,.�,....�.»-.--.... �..•m.r..---� __.._--��-�-».�...--,...d...,q...,.._..-T- -,,,._ ....-...m..-.�.....-.__ .,..C,,,, -.�.._.....� I I CONSTRUCTION For office Use only s -AUTHORIZATION *CDP File Number 175698-1 Davie County Health Department 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 4 / 0 4 / a 0 a 1 Applicant: Christopher and Aletha Thompson Property Owner: Edith Bailey Slayle Estate Address: 560 N. Hiddenbrooke Drive Address: 613 Webster Drive City: Advance City: Decatur StatetZip: NC 27006 State/Zip: GA 30033 Phone#: (336)331-5132 Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Bailey's Chapel Road Advance NC 27006 Directions Hwy 64 East Left On Fork Bixby Rd. Right on Baileys Structure: SINGLE FAMILY Chapel Property on left #of Bedrooms: 5 #of People: *V1later Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign sification: Provisionally Suitable Inches Minimum Soil Cover. 1 a System? OYes ONo Inches ow: 6 0 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 III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Septic Tank: 1 a 5 0 Gallons *Proposed System: 25%n REDUCTION 1-Piece: OYes @No Pump Required: OYes @No OMay Be Required Nitrification Field a 0 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 5 1-Piece: OYes ONo Total Trench Length: 5 0 0 ft GPM—vs— ft. TDH Trench Spacing: _ 9 Inches D.C.Feet O.C. Dosing Volume; _ Gallons Trench Width: _ g Inches 3 Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01 OII 0111 01V Mann 9 M1 CDP File Number 175698 - 1 County ID Number: • a ❑ Open Pump System Sheet Repair System Required:@Yes ONO ONO, but has Available Space epair System Trench Spacing: 9 Q Inches O.C. *Site Classification: Provisionally Suitable ()Feet O.C. Trench Width: Inches Design Flow: 6 0 0 — . 3.. @ Feet Soil Application Rate: 0 Aggregate Depth:- 3 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Minimum Soil Cover. 1 a Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Covera 4 Nitrification Field a 0 0 Inches Sq.ft. No. Drain Lines 5 *Distribution Type: GRAVITY-SERIAL Total Trench Length: 5 � � � Pump Required: (' Yes QNo 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 repair without approval of Health Department. i *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 of validity of the Improvement Permit,not to exceed five years,and may be Issued at the sanetime the Improvernent 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"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 4 / 0 4 1 .2 0 1 6 Authorized State Agent: Malfunction Log Oyes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 175698 - 1 ' Davie County Health Department CDP File Number: 210 Hospital Street P.O.sox 848 County File Number: Mocksville NC 27028 Date: 0 4 / 0 4 / 2 0 1 6 Q Inch Drawin Drawing Type: Construction Authorization Scale: , Qslock Q N/A tI ,�... a .� t I° A_ CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 175698 - 'I P.O.Box 848 Mocksville NC 27028 County File Number: Date: .04 / 04 / 2016 Click below to Import an Image from an extemal location: Drawing Type:Construction Authorization Q,,I k—e t;- Oy � IMPROVEMENT PERMIT For.OfticeUse only *CDP File Number 175698- 1 Davie County Health Department County ID Number 210 Hospital Street s 0� P.O.Box 848 �Y1UrykP Evaluated.For: NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL' 12!'11/2019 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: �C�hrdistopher and Aletha Property Owner. Edith Bailey Slayle Estate om D5o7v Address: N. Hiddenbrooke Drive Address: 693 Webster Drive CRY: Advance CRY: Decatur State/ZIP: NC 27006 State/Zip: GA 30033 Phone#: (336)331-5132 1 Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Bailey's Chapel Road Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 East Left On Fork Bixby Rd. Right on Baileys *of Bedrooms: 5 Chapel Property on left #of People: *Water Supply: PUBLIC S stem Specifications nidal S stem r-S iteClassification:` Provisionally Suitable Minimum Trench Depth: 2 4 Inches prolite System? OYes @No Maximum Trench Depth: 3 6 Inches ' esign Flaw: 6 0 0 Septic Tank: 1 a 5 0 Gallons Soil Application Rate: 0 - 3 1-Piece: OYes *No "System Classification/Description: Pump Required: ()Yes QNo OMay Be Required TYPE III A.CONY SYSTEM:>480 GPD(EXCLUDING SFD) Pump Tank: Gallons *Proposed System: 25°Jo REDUCTION 1-Piece: ()Yes ONo Repair System Required:*Yes ONo ONO, but has Available Space Repair System *Site Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches Soil Application Rate: 0 3 Maximum Trench Depth:` 3 6,, inches *System Classification/Description: Pump Required: OYes ®No OMaybe Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION / OA VNO -J Page 1 of 3 IMPROVEMENT PERMIT 175698- 1 y ► Davie County Health Department CDP File Number: 210 Hospital Street . County File Number: P.O.Box 848 Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: _ QBiock ON/A ft. �T 1;47 � � f ' � ti 3o� 1�b tor 1 5 cG C l � 17 (e l � � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health bate;.. AA SO P.O.Box 848/210 Hospital Street Rel . t� Mocksville,NC 27028 ce fib'; 1 w�1 i Z�r (336)753-6780/Fax(336)7 - 0 pt+�' anon For: Site Evaluation/Improvement Permit uthoriza i To(onstruct(ATC) ❑Both Type of Application: 14New System ❑Repair to Existing System ❑Expan ion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOTBEPROCESSEDUNLESS ALL OF THE REQUIRED ^ ] INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. t V APPLICANT INFORMATION Name to be BilledCV12\S-► g AN,et4 N 0'."Contact Person 3)c.v Ll 91 Billing Address -�(00 b, ��aen,ln2ook Home Phone 3 3(n- 3 3( -$ 13 DL- City/State/ZIP N3 U A"t P WC. -)o0(. Business Phone 3 3 G S 1'7- 17 7 7 Name on Pemiit/ATC if Different than Above S A -r— Mailing Address A S City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged -� NOTE: A survey plat or site plan must accompany this application. Included: ❑Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name (�ri ��e s Phone Number O Owner's Address City/State/Zip -eC4tvrC rb 3 P033 Property Address qCity 41 %.�A a1C P Lot Size L} $ -4 viZ— Tax PIN#_,� Subdivision Name(if applicable) Section/Lot# Directions To Site:64-1,.>- l,e�;Zf oti Qr -vN 6'Ntlz 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? Dyes No Does the site contain jurisdictional wetlands? Dyes No Are there any easements or right-of-ways on the site? Dyes o Is the site subject to approval by another public agency? Dyes o Will wastewater other than domestic sewage be generated? Dyes No IF RESIDENCE FILL OUT THE BOX BELOW #People H #Bedrooms .T #Bathrooms Garden Tub/Whirlpool KYes ❑No Basement:$Yes ❑No Basement Plumbing: Wes ❑No IF NON-RESIDENCE 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: Ptonventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ounty/City Water ❑New Well ❑Existing Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes JC 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 applt • n is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie Coun ealth D went to conduct necessary inspections to determine compliance with applicable laws and rules. I unde stand tha am resp o ible forth proper identification and labeling of property lines and comers and I flagging o staking he hou a ity to ion,propos ell location and the location of any other amenities. TM Proper--ty owner's or owner's legal eke ntative i e Site Revisit Charge O[ Client Notification Date: Date - EHS: Sign given Oyes❑No Account# Revised 11/06 Invoice# - `.ry •rry s - Apra 1189' Ap s Aprx 4R +;- Acro♦ 399 A '41' ...,..... O ` ,�.^.� [`µ a r • R i Aprx 1189' Aprx 7 tea Aprx 48 +r- Acres ` z �Y site 559 j ff 7-: � 4 Q� L � � cgs r sG S � i i DAVIE COUNTY HEALTH DEPARTMENT y Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION lei op? :. P kj kaf e_.5 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5., 6. . .7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure' 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: 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 Texture 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 MineraloQv 1:1,2:1,Mixed Horizon depth 7 In inches Depth of fill-In inches " Restrictive horizon Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-LonQ-term accemance rate-eal/dav/ft2 nrwn nvnc M.....-A.