170 Stone Wood Rd Lot 10 Davie County,NC Tax Parcel Report Friday,December 30, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: M4050B0010 Township: Jerusalem
NCPIN Number: 5735599836 Municipality:
Account Number: 82514439 Census Tract: 37059-807
Listed Owner 1: SMITH RICHARD J Voting Precinct: COOLEEMEE
Mailing Address 1: PO BOX 1012 Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: 27028-1012 Voluntary Ag.District: No
Legal Description: LOT 10 GLADSTONE WOODS Fire Response District: COOLEEMEE
Assessed Acreage: 0.92 Elementary School Zone: COOLEEMEE
Deed Date: 10/1999 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 003170659 Soil Types: GnB2,GnC2
Plat Book: 0007 Flood Zone:
Plat Page: 073 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
9l 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
�OUtyS� NC or arising out of the use or inability to use the GIS data provided by this website.
• DAME COUNTY HEALTH DEPARTMENT
j Environmental Health Section
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000787 Tax PIN/EH#: 5736-50-6147.10
Billed To: Southern Showcase Subdivision Info: Gladstone Woods Lot#10
Reference Name: Richard Smith Location/Address: Stonewood Road-27028
Proposed Facility: Residence Property Size: 0.944 Acre
ATC Number: 2188
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with
Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type I'1.�'(�W�1� #People #Bedrooms 3 #Baths --
Dishwasher: Garbage Disposal: ❑ Washing Machine: 0r- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size 0.CWAq%Q-5'ype Water Supply(260-P.-W Design Wastewater Flow(GPD) Site: New Repair❑
System Specifications: Tank Size)CIDOGAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.:;:_C�
Other: 6L-g'a's, i lt\1S;Mu, ur-jes ! �.C.
Required Site Modifications/Conditions: 1-EDE ` vv i., V0ep Ick or-p
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m.to 9.30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.****
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Environmental Health Specialist's Signature:
DCHD 05/99(Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Bog 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 990000787 Tax PIN/EH#: 5736-50-6147.10
Billed To: Southern Showcase Subdivision Info: Gladstone Woods Lot#10
Reference Name: Richard Smith Location/Address: Stonewood Road-27028
Proposed Facility: Residence Property Size: 0.944 Acre
ATC Number: 2188
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article I 1 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWAT ON IS ALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signa e: Date: h?
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By: uJ —NSC-7
Environmental.Health Specialist's Signature: Date: 99
DCHD 05/99(Revised)
APPUCATION FOR SITE EVAUTATION/IMPROVEMEM PERMIT&Al
Davie County Health Department
Environmental Health Se+cdion
P.O. Box 868/210 Hospital Street SEP 2 21999 ;
Mocksville, NC 27028
(336)751-8760 - ENVIRONMENTAL HEALTH
pAvir mmiTy
***A�ORTAZfV** THIS APPLICATION CANNOT BZ PROCBSBND VNLESS AL
INFORMATION IS PROVIDED. ReMAT
Refer to the IMM ION BULLETIN for instructions.
7,
1. Nass to be Billed � L44 '/1 -a0We;Se- Contact parson �
Mailing Address 1'70,4 US //wY of , �f/ Nose phone /-0040- 9(/ - 7V`r
city/state/asp v L 2-70 <-- Business phone kap)Z2
s. Name on Permit/ATC if Different then above
Nailing address 1-10'2 2 city/state/zip /"1 ot�s v�I1c
9. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both
a. system, to service: ❑ HouseMobile Home ❑ Business ❑ Industry ❑ other
5. If Residence: # People J # Bedrooms �, � # Bathrooms
XDishwasher O Garbage Disposal )(washing (Machine 0 Basement/plumbing ❑ Basesant/No plumbing
6. if Business/industry/other: spaatry type # people # sinks
# Commodes # Showers # urinals # hater Coolers
IF 1=SE1k\1ICE: # Seats Estimated Nater Usage (gallons per day)
7. Type of water supply: X County/City ❑ Nell ❑ Community
a. Do you anticipate additions or expansions of the facWty this system is Intended to serve? ❑Yes ❑No
If yes,what type?
***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMHTTED by the client with THIS APPUCATION.
Property Dimensions: 0,ul1 L( dc/.-s WRITE DIRECTIONS(from Mockav/iile)/to PROPERTY:
Tax Office PIN: # ,-�3� -- .5—a �/V-7 l��J u f •fo 64ed!4 i e-
Property Address: Road Name If,o/le v KZ
City/Zip o e l� v-s
If in a Subdivision provide information,as follows: J��ohG 1 Z-o� '/'o
Name: Gl Am e, ���s Lit 41,:7 la
Section: Bloch: Lot: _ Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation,U the site plans or intended we change,or if the information
submitted in this application is falsifled or changed. 1,also,understand that I ani responsible for all charges Incurred frons
this application. 1,hereby,give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located In Davie County and owned by
to conduct all testing rocedures as necessary to determine the site sultabill .
DATE �aZ SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed
property tines and dimensions, structures, setbacks, and septic locstions).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. �o
Revised DCHD(07/99) Invoice No. D
9L Nlk
N 372.77 4, E iS' /I}1REC( OF
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BS ` ti d PWINWC
N 44.46.46• E
28.45 C n
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N 4460.006- E y •'moo }� {0,yl�R\ n
s 24• op \ LOT rho SARAH NOLLEY
.89 M • ai #2 6r. 3 J D.EI.JB PC-206 CURVE DELTA RADIU
o�� S�� (0.778 AC.) 4. ISrr 4ST1CJ 2'52'44• 497
cZ .
I T55'08' 497.7
;?0, \ �s S. \ c1 02 C3 10'56'08• 497.7
pa. 4 \ a^i 09' '� C4 42'50'00• 25.
CS 70'53'34' 50.
LOT 3 ;. ,' o C6 4504'26• 50.0
NCGi \`^ \ # .i.. .,G, r,p 53'22'07' 50.
ra (0.720 AC.) �, p ,. C8 93'19'54• 50.0
ACCESS EASEMErrt \ C 2� PY l�-4,; CIO 42'50'00• 25.p.
B�•�3'4B' �'=x. \ J.
r� a2 pl�.�2101 7pS Q,•"n C11 ,Q�6.2� 557.7
1.22 LOT # r \ ,sa ,J?'; 2�2 39 ..F'��,t'`� C,z ,Szo',8• 55�:��
IBJ., (0.960 AC.) J` °Sg`H ��,� 22g.
N42'34• 8 #Q G. 1j2.00
134.3 ^ Vc' ps L i (0.724 AC.) &j [39600.
. / N °0.42' V eJySJ f '�� a a2�1
54• S 6* J•p2r4o
LOT #5 W 19900 E _`.
10' Mr1Un
1 CASEMENT (0.748 AC.)
l .�` Z \ LOT #g W 6$'00
SUBDIVISION L_ LOT 22 a * (0.690 AC.) n rt
L PGA / ° ; I i �'a %s 6p i y. LOT #7
l `:+ LOT (0.698 AC.) Sao
# 15
21 / J^ (1.133 AC.)
Lor � 2X235 `
_ 23 a T cJ LOT #a ^ N
1:;ury:r, Oro 13s.00 _ �2.
C, S N >6. !/ �5- (0.730 AC.
0 76.49 49.56, ) ,n
c J W ��'�,• 2qa Pv
2>35 56• f Y C4 CS
LOT 24 Kr•-., 2o.00 `222 )3
r
Jr-?, `6 2yb LOT # 1425.
°7qC, N 99'18'04' F.
n CK , 2 a. 7 5.00.. C9 195.R8
. ;. �;• ,ya (1.299 ACJ
W LOT # 13
- - - � z
(0.758 AC. W
R I y ) , LUT # 12
o S� (0.762 AC.) W LOT LUT #g
vi
it J !
' 5 AC.
LOT 25 (0.7[6 #4r i (0.94 )
_
tor
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_ _ 11.93, -> 1�J.�•,•) [C 1 t> -
' E vnNF 236.19 t n
OT 26 i 120.00 3
.alf:Lli•nl!. Sru,rF v-� 120.99 I
El
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' APPLIC41I0N FOR SITE EVALUATIONAMPROVEMENT PERMIT&A Q
Davie County Health Department
Environmental Health Section 1998
P.O.Box 848 juL — 2
Mocksville,NC 27028
(704)634-8760
ENVIRONMENTAL HEALTH
DAVIE COUNTY
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNL S
ALL THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Biller u t' W\C P. Q) Contact Person
Mailing Address R 22 V v P<� V Ee, (� Home Phone ^3 a a
City/StateMp oC S0\\\eC— c� a Business Phone 75
2. Name on Permit/ATC if Different than Above
Mailing Address CCity/State/Zip3. Application For. O"/Site Evaluation ❑ Improvement Permit&ATC ❑ Both
4. System to Serve: B—House U--Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms _ # Bathrooms
dishwasher ❑ Garbage Disposal U-VVashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
If Foodservice:. # Seats Estimated Water Usage(gallons per day)
7. Type of water supply: County/City ❑ Well ❑ Community
8. Do yos anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes EI—No
If yes,what type?
PROPERTY IaN'FORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimer Bions:MOX ?33,S0 X 9705,Q SO�i,Sd �( �l 7 1 WRITE DIRECTIONS(from
1 Mocksville)TO PROPERTY:
Tax Offict-PIN: # � 7.3(� - '� � - _(,D<<-( '� 1
Property Address: Road Name
Citymp We \�1 C_ 1
1
1
If in Subdivision provide information,as follows: 1
Named
i
Section: 15 I\c.e v Lot #: �� 1
1
1
us is to certify that the information provided is correct to the best of my knowledge.I understand that any permit(s)issued hereafter
e subject.¢o suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is
alsified or changed.I,also,understand that I am responsible for all charges incurred from this application.I,hereby,give consent to
e Autlorized Representat-ve of the Davie County Health Department to enter upon above described property located in Davie County
d owned by e0- ad '�u �Wr—1 '� d /"I�f, 1 o conduct all testing procedures
necessary to determine the site suitability.
ATE oD
SIGNATURE Zu
evised DCHD(06-96)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION_.LOT
Soil/Site Evaluation
APPLICANT'S NAME J;�Xe We DATE EVALUATED 71 �/%6
PROPOSED FACILITY J PROPERTY SIZE
SUBDIVISION ROAD y< � G('Bd -� ROAD NAME
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS1 2 3 4 5 6 7
Landscape position
Sloe%
HORIZON I DEPTH
Texture aroupL
Consistence
Structure
Mineralogy
HORIZON II DEPTH (j f,i <Ief
Texture group
Consistence r i
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION 75
LONG-TERM ACCEPTANCE RATE J
SITE CLASSIFICATION: EVALUATION BY: �t �-l�
LONG-TERM ACCEPTANCE RATE: T 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
Wet
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-Long-term acceptance rate-gal/day/ft2
DCHD(01.90)