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459 Bell Branch Rd Davie County,NC Tax Parcel Report Thursday, February 23, 2017 J I //f 1 f/ 1 f j J I 7 i t fJ 7 r-------------------------- 4 --- t I pp -- II 4457 5 5 5 lY �� 5 Ix f %...._......__-_.....................______-_..............-....--.-..................................................................................................................................1............. ................ WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: B20000002403 Township: Clarksville NCPIN Number: 5813194130 Municipality: Account Number: 8305596 Census Tract: 37059-801 Listed Owner 1: STANTON TIFFANY A Voting Precinct: CLARKSVILLE Mailing Address 1: 445 BELL BRANCH ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag.District: No Legal Description: 1.144 AC BELL BRANCH RD Fire Response District: COURTNEY Assessed Acreage: 1.03 Elementary School Zone: WILLIAM R DAVIE Deed Date: 10/2015 Middle School Zone: NORTH DAVIE Deed Book/Page: 010011122 Soil Types: MnC2,MnB2 Plat Book: 11 Flood Zone: Plat Page: 385 Watershed Overlay: DAVIE COUNTY Building Value: 350.00 Outbuilding&Extra 0.00 Freatures Value: Land Value: 12520.00 Total Market Value: 12870.00 Total Assessed Value: 12870.00 O uu�AAll data is provided as 13 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 Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �oCN4 NC or arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT or ficeluse UnIV Davie County Health Department *CDP File Number 199146-1 r 210 Hospital Street B00000024 P.O. Box 848 County ID Number. Mocksville NC 27028 Evaluated For. NEW . Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Tiffany StantonProperty Owner: Tiffany Stanton Address:: 445 Bell Branch Road Address: 445 Bell Branch Road City: Mocksville City: Mocksville _. State/Zip: NC 27028 StatefZip: NC 27028 Phone#: (732),674-0699: Phone#: (732)674-0699 PropeLocation & Site Information Address/Road#: Subdivision: Phase: Lot: Bell Branch Rd Mocksville NC 27028 Directions Structure FAMILY—— H 601 N. left on LibertyChurch Road, to bell - -r SINGLE. Branch Property is just past 445 Driveway. of Bedrooms`: 3 #of People: "Water Supply: EXISTING WELL "IP Issued by 2tao-Nations,Robert 'System Classification/Description: TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS *CA issued by: 2140-Nations,Robert Saprolite System? OYes ONo Design Flow: 3 6 0 _ 'Distribution GRAVITY-SERIAL Pump Required? Dist QYes QNo Soil Application Rate: 0 - a *Pre Treatment: Drain field ('*'N rtritIcation Field 1 8- 0 -0 Sq. ft. *System Type: INFILTRATOR t2UIGK 4 STANDARD No. Grain tines 6Installer: Brian McDaniel Total Trench Length: 4 5 0 ft. Certification#: 1118 Trench Spacing: — a Olnches O.C. Feet O.C. EH S: 2140-Nations,Robert Trench Width: 3 Inches Feet Date: 1 2 / 2 0 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches ApprovaI lls" Maximum Trench Depth: 3 6 Inches ®:Approved CI� Disapproved Maximum Soil Cover. 2 4 Inches CDP File Number 199146 - 1 County ID Number: g00000024 ` Septic Tank Manufacturer. Shoa# Lat. STB: 760 Lang: . Gallons: 1000 Installer: Shan McDaniel Certification#: 1118 Date: 0 8 / 3 0 / .2 0 1 6 `—'"--"" *EH S: 2140-Nations,Robert *Filter Brand: POLYLOKPL-122 With Pipe Adapter ST Marker: ❑ Yes L7 No Date: 1a / a0 / a � 16 Reinforced Tank: E3Yes ® N Approval Status D Approved❑:Disapproved ; 1 PieceTank: ❑ Yes � No � Pump Tank Manufacturer. '-,,,,,Installer PT: Certification#: -Gallons: *EH S: Date: / Date: Risersealed ❑ Yes ❑ Na RiserHeiht: ❑ .Yes ❑ No (Min.6 in. Approval Status Reinforced Tank: 0..Yes ❑ -No ❑ Approve,d❑ Disapproved 1 Piece Tank: .❑ Yes ___❑ No _ Suppiy Line -- Pipe Size: inch diameter Installer: Pipe Length: feet Certification : *EH S: *Schedule: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status Approved❑ Disapproved u equirement Pump Type: Installer: Dosing Volume: - Gal Certification#; Draw Down: Inches *EHS: *Chair: Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ NO Check-valve ❑ Yes ❑ No ApprovalStatus` PVC Unions ❑ Yes ❑ No ❑ approved[� Disapproved Vent Hole ❑ Yes ❑ No e Anti-siphon Hole ❑ YeS ❑ No CDP Fite Number 199146,- County ID Number: 1 B00oa0024 Electric Equipment NEMA 4X Box or Equivalent El 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 j *Activation Method: Date: �Apprwal Status Alarm Audible ❑ Yes ❑ N0� O Approved❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140-Nation,Robert *Operation permit completed by: Authorized:State Agent: - - Date of Issue: 1 a / a 0 / a 0 1 6 Owner/Applicant Signat This system has beeninstalled in compliance-with applicable NC General Statutes:Article 11, Chapter 130A, Rules for Sewage Treatment:and Disposal;15A NCAC:I8A..1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.-This property is served by a TYPE Ill G. sewage septic system. TYPE I I I G. Rules.1.96.1 requires hat aType_.�: septic system meet the following criteria: Minimum System Review By The Local Health Department: N/A Management Entity;. OWNER :Minimtam=System Inspection/Maintenance Frequency By Certified Operator: NSA _ 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 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 tong 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 199146- 1 Davie County Health Department CDP File Number: 210 Hospital Street800000024 P.O.Box 848 County File Number: Mocksville NC 27028 Date: l Q Inch Scale: . pslock Drawing Drawing Type: Operatiol Permit ON/A 1 I Le LL .......... 7 1 � _7 I J__ rS- I 1— t _ l CONSTRUCTION For office Use only -- "AUTHORIZATION *CDP File Number 199146-1 Davie County Health De ED l)0000024 P��'' County ID Number.B 210 Hospital Street ��' Evaluated For: NEW nate: ,�..+•� P.O. Box 848 -~"� Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 4 / 0 6 / a 0 a 1 Applicant: Tiffany Stanton Property Owner: Tiffany Stanton Address: 445 Bell Branch Road Address: 445 Bell Branch Road City: Mocksville City: Mocksville State2ip: NC 27028 State2ip: NC 27028 Phone#: (732)674-0699 Phone#: (732)674-0699 Property Location & Site Information rAddress/Road#: Subdivision: Phase: Lot: ch Road e NC 27028 Directions Structure: SINGLE FAMILY Hwy 601 N. left on Liberty Church Road, to bell Branch - Property is just past 445 Driveway. #of Bedrooms: 3 #of People: *Water Supply: EXISTING WELL System Specifications "�) Site Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? QYes (j)No Soil Cover. 1 a No Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE IIA.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes ®No Pump Required: QYes ONo OMay Be Required Nitrification Field 1 8 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 4 14Piece: QYes QNo Total Trench Length: 4 5 0 ft. GPM—vs— ft. TDH Trench Spacing: 9 @Feet O.C.Inches O.C. — Dosing Volume: Gallons Trench Width: 3 Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: 01011 O 111 01V Dann i of Z CDP File Number 199146 - 1 County ID Number: 800000024 ❑ Open Pump System Sheet Repair System Required:@Yes ONO ONO, but has Available Space rDesign System Trench Spacing: 9 Q Inches 0. . ification: Provisionally Suitable — Feet O.C. Trench Width: Inches w: 3 6 _ , 3 Feet Soil Application Rate: 0 - a Aggregate Depth: inches "System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover. 1 a Inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 1 8 0 Inches Sq.ft. No. Drain Lines 4 "Distribution Type: GRAVITY-SERIAL Total Trench Length:- 4 5 0 ft Pump Required: OYes ONo eMay Be Required Pre Treatment: ONSF OTS-1 OTS-11 "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 bevalid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and maybe issued at the 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 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 Date of Issue: 0 4 0 6 2 0 1 6 Authorized State Agent: Malfunction Log OYes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 199146 - 1 Davie County Hgaith Department CDP File Number: . 210 Hospital Street County File Number: saoa000za P.O.sox 848 Mocksville NC 27028 Date: 0 4 / 0 6 / 2 0 1 6 Q Inch Drawing D,cawing Type: Construction Authorization Scale: . OBlock Q N/A ,dl c --7,4PI, z Y r I i I I CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 199146 - 1 P.O.Box 848 800000024 Mocksville NC 27028 County File Number: Date: .0 `t / 06 /2016 Click below to Import an Image from an external location: Drawing Type:Construction Authorization V �G 1 16Z, r 4 q u . . , . IMPROVEMENT PERMIT e For office use only *CDP File Number 199146- 1 OF W- -.NrDavie County Health Department 210 Hospital�Street. lea AL County ID Number:soo0oo024 P.O.Box 848 Evaluated for. NEW Mocksville NC 27028 Township: Phone: 336-753-6780 Fax:336-753-1680 pERMITVALiD UNTIL 1/7/2021 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit Applicant: Tiffany Stanton Property Owner. Tiffany Stanton Address: 445 Bell Branch Road Address: 445 Bell Branch Road City: Mocksville CRY: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#:, (732)6740699, Phone#: (732)674-0699 Prol2erty Location & Site Information Address/Road#: Subdivision: Phase: Lot: Bell Branch Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 601 N. left on Liberty Church Road, to bell #of Bedrooms: 3 Branch Property is just past 445 Driveway.., #of People: *Water Supply: EXISTING WELL System S ecifiications nitiai System Site ,asst Ica Ion: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? OYes @No Maximum Trench Depth: 3 6 . Inches Design Flow: 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 • a 1-Piece: OYes ONo Pump Required: OYes QNo OMay Be Required `SystemClassification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 25%REDUCTION 1-Piece: OYes 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: a Maximum Trench Depth: 3 6 inches d i Requre : 'System Classification/Description: Pump OYes ONo OMaybe Required TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Proposed Pagel of 3 CDP File Number 199146 - 1 -County ID Number: e0000. . I .+ *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 this perm it by the 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 tnprovement Permit shad be valid for 5 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 of thefacility and appurtenances,the site forthe proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale of one inch equals no morethan 60 feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and 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 on the Issuance and may revoke the permits 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,orintended use changes(NCGS 130Ae435(f)).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 1 J 0 ? / a 0 1 6 Authorized State OValid without Expiration? 0Cre:ate CA? @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 199146 - 1 •- Davie County Health Department CDP File Number: 210 Hospital Street 800000024P.O.Box 848 County File Number: Mocksvine NC 27028 Date: J i Qinch Drawing: Drawing Type: Improvement Permit Scale: . QBlock QN/A ft - ' 7-1 ... ...... ......... .. : .. ... .. :... _ _� IMPROVEMENT PERMIT , Davie County Health Department .y 210 Hospital Street CDP File Number: 999146 . 1 P.O.BOX 848 800000024 Mocksville NC 27028 County File Number: Date: 0 1 / L02-0/ 2 0 1 6 Click below to import an image from an external location:Drawing Type: Improvement Permit APPLICATION FOR SITE EVALUATION/INIl'ROVEMENT PERMIT & ATC Davie County Environmental Health PAm P.O.Box 848/210 Hospital Street Mocksville,NC 27028 Dart' Oct, OA4 (336)753-6780/Fa (336)753-1680 Application For: uation/ImC�provement Permit Ar 21Jza�fTo Construct(ATC)ATC ❑ Both Typeion: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name \ Contact Person Address Home Phone -732-6oQL4:Q2g, City/State/ZIP 1' OC SVi Ile , A, '-, �- 4z Business Phone Email S �' Email:WKW lcb2 Q r Q'Ct'. (u Name on Pe it/ATC if Different than Above Mailing Address qQ7 (;6b(GAte ) qJ City/State/Zip I 27U PROPERTY INFORMATION *Date House/Facility Corners Fla edpollowtc-S1rIJ NOTE: A survey plat or site plan must accompany this application. Included: WSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name S Phone Number ^7 7-- Owner's Address 1 City/State/Zip_I "�C�I Property Address E211 City I Lot Size (• Tax PIN# O 2 N20- / Subdivision Name(if applicable) Section/Lot# Directions To Site: L&N C S LN566& If the answer to any of the following questions is"Yes",supportinp dbcumentation must be attached: Are there any existing wastewater systems on the site? I Yes No V E IZY b i G Does the site contain jurisdictional wetlands? Yes o Are there any easements or right-of-ways on the site? _Yes _LfTo Is the site subject to approval by another public agency? _Yes ✓No Will wastewater other than domestic sewage be generated? Yes IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ANo Basement: Ves ❑No Basement Plumbing: XYes ❑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: U&ventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: ❑ County/City Water ❑New Well Axisting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 Yes KNo If yes,what type? This is to certify that the information provided on tlns 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 charges,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 corners and locating and flagging or st e h)mViacililty location,proposed well location and the location of any other amenities. Prop or owner's legal representative signature Site Revisit Charge Ib 15 Date(s): Client Notification Date: Dat EHS: Sign given ❑Yes ❑No Account# I Revised 11106 Invoice# t t t t � 374 VV t i p�'7 ell mL qP�r� All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Implied warrantfes 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 or arising out Printed:Dec 10 2015 QV of the use or inability to use the GIS data provided by this website. r _f . "♦ . ' . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Tiffany Stanton'. . — Bell Branch Road M 674-0699 B00000024 1.144 Acres Water Supply: On-Site Well Community Public Evaluation By: Auger Boring _ — Pit Cut FACTORS 1 2 3 4 5 6 .7 Landscape position Slope% Ll HORIZON I DEPTH J— Texture group Consistence r Structure S /CSAILIClu Mineralogy HORIZON II DEPTH - Texture group Consistence , } Structure ! _15 A/L, 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: -J EVALUATION BY: LONG-TERM ACCEPTANCE RATE: O + OTHERS)PRESENT: REMARKS: LEGEND La_ndscane 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 1�415� 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 Notes 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-LonQ-term acceptance rate- eal/dav/ft2 arum n vnc M—A..-AN