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243 Gibson Way (3) Davie County,NC, Tax Parcel Report Wednesday, February 15, 2017 o ti BEAN RD � ' Jf, 1 1 .= MIS J tl ICER +t r , 1-- +'`��- F ' Jfryfj,� C z��F C z 10 G ............................... ................ ........................................................._._.............................. WARNING: THIS IS NOT A SURVEY Y -° '; Parcel Information= _ Parcel Number: N50000004401 Township: Jerusalem NCPIN Number: 5745516640 Municipality: Account Number: 12421750 Census Tract: 37059-807 Listed Owner 1: CAMP MANNA MINISTRIES INC Voting Precinct: JERUSALEM Mailing Address 1: PO BOX 795 Planning Jurisdiction: Davie County City: COOLEEMEE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27014-0000 Voluntary Ag.District: No Legal Description: 39.049 AC OFF PINE RIDGE Fire Response District: JERUSALEM Assessed Acreage: 38.87 Elementary School Zone: COOLEEMEE Deed Date: 3/1995 Middle School Zone: SOUTH DAVIE Deed Book/Page: 001790756 Soil Types: SeB,PcB2,RnC,PcC2,EnB,RnD,EnC,ChA Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 577940.00Outbuilding 8r Extra 42560.00 Freatures Value: Land Value: 250820.00 Total Market Value: 871320.00 Total Assessed Value: 871320.00 AV All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the °1 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 Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �OUN'�l NC or arising out of the use or Inability to use the GIS data provided by this website. .......... 'OPERATION PERMIT or I tee use Only Davie County Health Department *CDP File Number .192750-.1 210 Hospital Street P.O.Box 848 Counfy ID Number. Mocksville NC 27028 Evaluated For: NEW Phone:336-753.6780 Fax:336-753-1680 Township: FApplicant Camp Manna Ministries/Stan Property owner: Camp Manna Ministries/Stan Address: 243 Gibson Way Address: 243 Gibson Way CRY: Mocksville CRY: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone : (336)284-2709 Phone#: (336)284-2709 PropeLty Location & Site information Address/Road#: Subdivision: Phase: Lot: 243 Glbson Way Mocksville NC 27028 Directions Structure: CHURCH Gibson Way #of Bedrooms: #of People: *Water Supply: EXISTING WELL *IP issued by. 2140-Nations,Robert *System Class ificationtDescription: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? { Yes @No Design Flow: a 0 0 *Distribution Type: GRAVITY-SERIAL Pump Required? QYes ONo Sol!Application Rate: 0 a 5 *Pre Treatment: Drain field Nitrification Field 8 0 0 Sq. ft. *System Type: INFILTRATOROUICK4STAND ARD No. Drain Lines Brian McDaniel i Installer: Total Trench Length: a 0 0 ft. Certification#: 1118 Trench Spacing: — 9 FeetO.C.4 *EH S: 2140•Nations,Robert Trench Width: 3 inches Feet Date: 0 9 / 1 5 / .2 0 1 5 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 inches AporovaM Status Maximum Trench Depth: 3 6 Q Approvetl Q Disapproved Inches j Maximum Soil Cover. a 4 ` Inches CDP File Number 192750 - 1 Septic Tank County ID Number: Manufacturer. Shoal Lat. STB: 760 Lang: Gallons: 1000 Installer'. Brian McDaniel Certification#: 1118 Date: 0 7 / 1 1 12 0 1 5 *EH S: 2140-Nations,Robert "Filter Brand: POLYLOKPL-122 With Pipe Adapter 1 5 ST Marker. C] Yes No Date: .0 9 1 1 5 / a f3 Reinforced Tank: ❑ Yes ❑ NO ApprovatSttus ; �' r❑ Approved❑��Isapproved�,' 1 Piece Tank: ❑ Yes ® NO � Pump Tank Manufacturer; Installer: PT: Certification#: Gallons: "EH S: Date: I I Date: RiserSealed ❑ Yes ❑ No RiserHegtjt:.❑ Yes ❑ No (Mln.6 in.) �� Apprcnral status - ��'� Reinforced Tank: ❑ Yes ❑ No ._ ;�,� Approved CI d�sappro�ed ,; ❑ .Yes __- ❑ No 1 Piece Tank: f��. f�%, ✓{ �.��,.,��. Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: "Schedule: 'ENS: Pressure Rated ❑ Yes ❑ No Date: / Approved fittings ❑ Yes ❑ No Approval Status f ❑ Approved❑ Disapproved Pu13eq!jlreMent Pump Type: Installer. Dosing Volume: - Gal Certification#: Draw Down: Inches 'ENS: 'Chain: I I Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Matas, PVC Unions ❑ Yes ❑ No ❑ Approved❑ Disappraued Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No CDP File Number 192750 - 1 County ID Number: Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'ENS: Pump Manually Operable ❑ Yes ❑ NO *Activation Method: Date: Approval Status,: Alarm Audible ❑ Yes ❑ N o ❑ Approved❑ Disapproves Alarm Visible ❑ Yes ❑ No 2140-Nations,Robed 'Operation Permit completed by, Authorized State Agent: Date of Issue: 0 9 / 1 5 / 2 0 1 5 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 It A. sewage septic system. Rule.1961 requires that a Type -TYPE It A- septic system meet the following criteria: Minimum System Review ByThe Local Health Department: N/A 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 homelbusiness 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 operatorforthe life of the septic system. Rule.1961 (2)(e)requires a contract shall be executed between the system owner and a management ently prior to the issuance of an Operation Permit for a system required to be maintained bya public or private management entity, unless the system ownerand 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 Davie County Health Department CDP File Number: 192750 - 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch OBloDrawing Drawing Type: Operation Permit Scale: , ON/A = ft. QNI I � �' OXA 1 I CONSTRUCTION For office use only 'AUTHORIZATION r*CDPFife Number 192750- 1 Davie County Health Department y ID Number: 210 Hospital Street Evaluated For NEW .off. P.O.Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 4 / 1 6 / a 0 a 0 Applicant: Camp Manna Ministries/Stan Riddle Property Owner: Camp Manna Ministries/Stan Riddle Address: 243 Gibson Way Address: 243 Gibson Way City: Mocksville City: Mocksville Stategip: NC 27028 State/Zip: NC 27028 Phone# (336)284-2709 Phone#: (336)284-2709 Property Location & Site Information FAddress/Road#: Subdivision: Phase: Lot: on Way e NC 27028 Directions Structure: CHURCH Gibson Way #of Bedrooms: #of People: "Water Supply: EXISTING WELL System Specifications Minimum Trench Depth: a 4 rDesigan ssification: Provisionally Suitable Inches System? Minimum Soil Cover y OYes @No 1 a Inches low: a 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a 5 Maximum Soil Cover: a 4 Inches "System Classification/Description: "Distribution Type: TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons 'Proposed System: 25%REDUCTION 1-Piece: OYes @No Pump Required: OYes @No 0May Be Required Nitrification Field 8 0 0 Sq.ft. Pump Tank: Gallons No.Drain Lines a 1-Piece: OYes ONo Total Trench Length: a 0 0 GPM—vs— ft. TDH Trench Spacing: — Inches O.C. 9 . Feet O.C. Dosing Volume: Gallons Trench Width: inches 3 @Feet Grease Trap: LGallons Aggregate Depth: p inches Pre-Treatment: ONSF OTS-1TS-11 Septic Tank Installer Grade Level;Required: 01 011 0111 Dana I of Z CDP File Number 192750- 1 County ID Number. 9 , ❑ Open Pump System Sheet Repair System Required:Wes ONo ONo, but has Available Space rDesign System Trench Spacing: Inches 0. . ification: Provisionally Suitable E*03 9Feet O.C. Trench Width: 0Inches w: a 0 0 _ 3 . Feet Soil Application Rate: 0 - a 2 5 Aggregate Depth: inches *System Classification/Description:/Description: Minimum Trench Depth: a 4 Inches TYPE it A.CONV,SYSTEM(SINGLE-FAMILY OR480,GPD OR LESS) Minimum Soil Cover. '1 2 Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches 0 � Sq.ft. Maximum Soil Cover: a 4 Nitrification Field Inches t3 No. Drain Lines "Distribution Type: ;GRAVITY-PARALLEL(eq.d-box) a TotalTrench Length: 0 0 ft. Pump Required: OYes ONo OMay Be Required PreTreatment: ONSF OTS-1 OTS-ll "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 by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate goveming 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 Permi%not to exceed five years,and may be issued atthe sametime 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 theapplication for a permit or Constriction 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(8)).The person owning or controlling the system shall be msponsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1s38(b)). Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps.Signature: Date:, 'Issued By: 2140-Nations,Robert Date of Issue: . 0 4 / 1 6 / 2 0 1 5 Authorized State Agent: Malfunction Log OYes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street P.O. Box 848 County File Number: Mocksville NC 27028 Date: 0 4 / 1 6 / a 0 1 5 Q Inch Drawing Drawing Type: Construction Authorization Scale: . . QOM Block = ft. 7 ............ ------- r16 it , _ ____�__.. a '®.�.----.. ----•'__ K•-4�.. ,�,,.�... r�-�.. I I ' -IMPROVEMENT PERMIT Forofflct#Use only. "CDP File Number 192750-1 Davie County Health Department 210 Hospital Street County ID Number ., P.O.Box 848 Evaluated For: NEW ..mow,. Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PER I,IIT VALID UNTIL 4/16/2020 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Camp Manna Ministries/Stan Property owner: Camp Manna Ministries/Stan Address: 243 Gibson Way Address: 243 Gibson Way CRY Mocksville City: Mocksville StatetZip: NC 27028 State)Zip: NC 27028 Phone#:, (336)284-2709 Phone#: (338)284-2709, Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 243 Gibson Way Mocksville NC 27028 Directions Structure: CHURCH Gibson Way #of Bedrooms: #of People: "Water Suppty: EXISTING WELL System Specifications nitial S sy tem *SIteZTassii'ica�ion—Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprotite System? QYes @No Maximum Trench Depth: 3 6 Inches Design Flow: a 0 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 . a 5 1-Piece: QYes QNo *System Class ificationlDescription: Pump Required: QYes 0N 0May,Be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) "Proposed System: 1-Piece: QYes QNo 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: - a a Maximum Trench Depth: 3 6 Inches7 s "System Classification/Description: Required: Yes n/Description: O Q No Q May be Required TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) 'Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 192750 - 1 County ID Number. *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of thispermit bythe Health Department in noway guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for o years from date of issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions,the location ofthefaciitty and appurtenances,the site forttme proposed Wastewatersystem,and the location of water supplies and surfacewaters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land q surveyor,drawn to a scale of oneinch equals no morethan so fee%that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed,Wastewater system,land the location of water supplies and surface waters. Plat also means,forsubdivision'lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may impose conditions an the Issuance and may revoke the permlts for failure of the system to satisfy the conditions,the rules,or this article:This permit is subject to revocation If the site pian,plat,or Intended use changes(NCGS 130A-335(1)).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(.1838(b)) Applicant/Legal Reps.Signature Required? Oyes ONO Applicant/Legal Reps_Signature: Date: / *Issued By_ 2140-Nations,Robert Date of Issue: 0 4 / 1 6 / .2 0 1 5 Authorized State A ent: tOValid without Expiration? (i�Create CA? @Hand Drawing Olmport Drawing **Site ;Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 192750 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.sox 848 County File Number: Mocksville NC 27028 Date: J J Q Inch DraWjnjjL Drawing Type: Improvement Permit Scale: . , 0810 k O - r- ------------ i �ATION FR-SITE VALUATION/ITAPROVEMENT PERMIT &ATC �'"�Lj vie ounty Environmental Health Box 848/210 Hospital Street Mocksville,NC 27028 WWI 0i- Al 9a�0' (336)753-6780/Fax(336)753-1680 qy. cc Application For: ❑ Site uation/Improvement Permit ❑Authorization To Construct(ATC) Both Type of Application: gNewSystem ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility V ***IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name (1,0 M 0 1a VI no- R-(S-(J�Ps Contact Person r 7P t c(j le Address 1,\ 1,1 6.0 Home Phone 3 3 6 - 2 8 —a70"l City/State/ZIP _ ac,kS v i Iln CJ Business Phone 33h —�2 q-- 2a 7 Email n-�6 Name on Permit/ATC if Di erent than Above Mailing Address 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 Phone Number Owner's Address City/State/Zip PropertyAddress ZL15 C11 bsw W aM City Lot Size_qZ OWe S Ta PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: Specify Problem Occurring: IF RESIDENCE FILL OUT THE BOX BELOW FI eople #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business ft embl u Total Square Footage of Building 5"oo o #People 2-2 5— # #Sinks -'� _ #Commodes I # Showers_0 #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: B6onventional 21 ccepted .❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑New Well O&ting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? /Yes ❑ o Ifyes,whattype? o55'bIe- Yi+c -e, 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 comers and locating and flagging or ial' the ho a/fac' 'ty location,proposed well location and the location of any other amenities. Property owner's or owner's legal representative signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: I . i Sign given ❑Yes ❑No Account# a v Revised 11106 Invoice# • o 3 i 6 c , � 1 - i '� - Irl• ,r _ f 1L� ' D ft = 7 , - l ti + � 1 Y LILY i S_ An DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION S1 & eiddk 61',65i4i t0n 00-M r A0,0 v16L 42 Aeras 33& 2gLl- .ZED1 i-f 1.� _ , 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 groupL� GL Consistence Structure Mineralogy HORIZON II DEPTH Texture group 3 C_ Consistence S Structure S Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH • Texture group Consistence Structure Mineralogy SOIL WETNESS r RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE A/ ,SITE CLASSIFICATION: EVALUATION BY: ✓v��5 LONG-TERM ACCEPTANCE RATE: 6.a Q.'a- OTHER(S)PRESENT: t r!4K • .��. �i cS�CI n �'i t 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 ' �Q15� VFR-Very friable FR-Friable F1-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 LYQt� Horizon depth-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-Long-term acceptance rate-gal/day/ft2 DCHD 05105(Revised)