950 Hwy 64 W z
Davie County,NC Tax Parcel Report Wednesday, February 15, 2017
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WARNING: THIS IS NOT A SURVEY
- "` - - Parcel Information ' `
Parcel Number: 1400000057 Township: Mocksville
NCPIN Number: 5738078128 Municipality:
Account Number: 11968620 Census Tract: 37059-806
Listed Owner 1: BYERLY LYNNE HICKS Voting Precinct: NORTH MOCKSVILLE COUNTY
Mailing Address 1: 124 WEST DEPOT STREET Planning Jurisdiction: MOCKSVILLE
City: MOCKSVILLE Zoning Class: MOCKSVILLE OSR
State: NC Zoning Overlay:
Zip Code: 27028-2328 Voluntary Ag.District: No
Legal Description: 1.12 AC HWY 64 Fire Response District: MOCKSVILLE
Assessed Acreage: 1.13 Elementary School Zone: MOCKSVILLE
Deed Date: 8/2012 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 2012EO252 Soil Types: GnB2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: MOCKSVILLE
Building Value: 43000.00 Outbuilding&Extra 510.00
Freatures Value:
Land Value: 19560.00 Total Market Value: 63070.00
Total Assessed Value: 63070.00
0�a IE 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
�OUKf NC or arising out of the use or Inability to use the GIS data provided by this website.
OPERATION PERMIT or ice use unly
' Davie County Health Department *CDP,File Number 194642.1
+w-` 210 Hospital Street 14-000="57
P.O. box'848 ;County.ID Number,:
Mocksville NC; 27028, Evaluated For: REPAIR
Phone:336-753-6780 Fax:336.753-1680 Township;
Applicant: Lynn Hicks Byerly Property Owner. Lynn Hicks Byerly
Address: 124 West Depot Street Address: 124 West Depot Street
City: Mocksville Cly: Mocksville
State/Zip: NC 27028 state/zip: NC 27028
Phone#: (888)751-3312 Phone#: (388)751-3312
Property Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
950 US Hwy 64 West
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 64 West on the right
#of Bedrooms: 2
#of People:
*Water Supply: NIA
'System Cie ssification/Description:
'IP IsStaed by. TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
*CA issued by: 2140-Nations,Robert SeproliteSystem? 0Yes (J)No
Design Flow: a 4 0 *Distribution Type: GRAVITY-PARALLEL(eq.d-box) PumpReQ ?
OYesNo
Soil Application Rate: 0 - 3 *Pre Treatment:
Drain field
Nitrification Field 8 . 0_._0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD
No.Drain Lines 4 Installer: Donnie Lakey
Total Trench Length: a a a g• Certification#:
Trench Spacing: _ Inches O.C.
Feet O.C. *EH S: 2140-Nations,Robert
Trench Width: _ 3 Inches
Feet Date: 0 _ 8 f 1 1 / a 0 1 5
Aggregate Depth: inches
Minimum Trench Depth: 3 6
_ Inches
Minimum Soil Cover. a 4Inches Approvalkfatu§�°,
MaximumTrench Depth:'3 6Inches °I Approved 0 DJsaPDr ved
_
Maximum Soil Cover: 4
Inches
CDP File Number 194642 - 1 Septic Tank County ID Number: 114-000-00-057
Manufacturer. shoaf Lat. -
STB: 760
Long:
Gallons: 10D0
Installer. Donnie Lakey
Date: 0 6 / 1 6 .2 0 1 5 Certification#:
*EHS: 2140-Nations,Robert
*Filter Brand: POL'YLOKPL-122 With Pipe Adapter
ST Marker: El Yes 59 No
Date: . 0 _ 8 i! 1 1 / a 0 1 5
Reinforced Tank: 11Yes R No APpravalStetus _
y'.x a .�tii
KI
Piece Tank: El Yes No ® Approved❑ .Disapproved
Pump Tank
Manufacturer. Installer.
PT: Certification#:
Gallons: THS:
Date: Date:
RiserSealed ❑ Yes ❑ No
RiserHeight: ❑ Yes ❑ No (Min.6 in.) LL
T a � Approval Sfatus
Reinforced Tank: ❑ Yes ❑ NopAppi"ovedL7 Disapproved«
1 Piece Tank: ❑ Yes ❑ No r
Supply Line
Pipe Size: inch diameter Installer
Pipe Length: feet Certification#:
THS:
*Schedule:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings ElYes 11 No y s Approval Statusy
Approved Cl pisappraued
u
Pump Type: Installer.
Dosing Volume: — ,Sal Certification#:
Draw Down: Inches *EHS'
*Chain:
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve El Yes 13No {AppiiovaiStetus
PVC unions ❑ Yes ❑ No ❑ Approved❑ Disapproved r
Vent Hole ❑ Yes ❑ No _
Anti-siphon Hole ❑ Yes ❑ No
CDP Fite Number X94 - 1County ID Number: 14-000-00-057
Electric E ui ment
NEMATes
or Equivalent ❑ Yes ❑ No Installer:
Box 1Above Grade C1 Yes D NO 1
Certification#:
Bo Pump Tank ❑ Yes ❑ No
Conduit Sealed ❑ Yes D No *EH S:
Pump Manually Operable ❑ Yes ❑ NO
'Activation Method: Date:
Alarm Audible ❑ Yes, D No Approval Status' {
D A�pproV6 D I isapproved y
Alarm Visible ❑ Yes D No
214 -Nations.Robert
"Operation Permit completed by
Authorized State Agent: Date of Issue: 0 8 1 1 / 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, l5A 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 IIIA. septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: N/A
Management Entity: OWNER
Minimum System InspectionlMaintenance Frequency ByCertified Operator:
WA
Reporting Frequency By Certified Operator.N/A
Rule.1,961 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 operatoror a private certified operator forthe life of the septic system.
Rule.1961 requires that Type VI septic systems designed for a 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 aril Operation Permit for a system required to be maintained by a public.or private management entity,unless the
system.ownerand certified operator are,the some. The contract shall require specific requirements formaintenance and
operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effectfor as long as the
system is in use,and otherrequirem'nts forthe,continued proper performance of the system. It shall also be a condition of
theOperation Permit that subsequent owneisof the systems execute such a contract.
@Hand Drawing 01mport Drawing n.
**Site Flan/Drawing attached.** '
OPERATION PERMIT
Davie County Health Department CDP File Number: 194642 1
210 Hospital Street I4-000-00-057 ,
P.O.Box 848 County File Number:
Mocksville NC 27028 Date:
A
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Dra�vin Drawing Type: Operation Permit Scale: . O = ft.
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CONSTRUCTION For office Use only
AUTHORIZATION
*CDP Fife Number 194642- 1
N Davie County Health Department County ID Number 14-000-oao57
210 Hospital Street Evaluated For. REPAIR
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone:336-753-6780 Fax:336-753-1680 0 6 / 1 6 / a 0 a 0
Applicant: Lynn Hicks Byeriy Property Owner: Lynn Hicks Byerly
Address: 124 West Depot Street Address: 124 West Depot Street
City: Mocksville City: Mocksville
State/Zip: NC 27028 State/Zip: NC 27028
Phone#: Phone
(336)751-3312 (336)751-3312
#:
Property Location & Site Information
rAddressIRoad#: Subdivision: Phase: Lot:
wy 64 West
e NC 27028 Directions
Structure: SINGLE FAMILY Hwy 64 West on the right
#of Bedrooms: 2
#of People:
"Water Supply: NIA
System Specifications
Minimum Trench Depth:
rDesigan
Classification: Provisionally Suitable a 4 Inches
e S stem? Minimum Soil Cover.
y OYes QNo 1 a inches
low: a 4 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 . 3 Maximum Soil Cover: a 4 Inches
*System Classification/Description: *Distribution Type: GRAVITY-PARALLEL(eq.d•box)
TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
*Proposed System: 250%REDUCTION 1-Piece: Oyes ONo
Pump Required: OYes ®No OMay Be Required
Nitrification Field 8 0 0 Sq ft Pump Tank: Gallons
No.Drain Lines a 1-Piece: OYes ONo
Total Trench Length: a 6 $ ft GPM vs— ft. TDH
Trench Spacing: _ (finches O.C.
9 . @Feet O.C, Dosing Volume: Gallons
Trench Width: Q inches
3 2 Feet Grease Trap: Gallons
Aggregate Depth: _ inches - -
Pre-Treatment: ONSF OTS-I OTS-11
Septic Tank Installer Grade,Level Required: 01011 OUI OIV
Dana I of Z
CDP Fite Number 194642 - 1 County iD Number. 14-000-00-057
❑ Open Pump System Sheet
Repair System Required:OYes ONO ONO, but has Available Space
rDesign
System Trench Spacing: Q Inches 0. .
ification: Provisionally Suitable — 9 e Feet O.C.
Trench Width: Inches
w: a 4 0 _ 3 . Feet
Soil Application Rate: 0 Aggregate Depth:- 3 inches
� 4
"System Classification/Description: Minimum Trench Depth: Inches
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR480 GPD OR LESS) Minimum Soil Covera 1 a Inches
Maximum Trench Depth: 3 6 Inches
'Proposed System: 25%REDUCTION
Nitrification Field 8 0 0 Sq. -
Maximum Soil Cover: a 4
Inches
ft, '
No. Drain Lines a "Distribution Type: GRAVITY-PARALLEL(eq.d-box)
1�77
h Length: a 3 3 f. Pump Required: Oyes @No OMay Be Required
Pre Treatment: O NSF 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 wayguarantees 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 valldity of the Improvement Permit,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 the application fora permit or Construction
Authorization is farad to have been incorrect,falsified or changed,or the site Is altered,the permit or Construction Authorization shall become
In,alld,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:_
2140-Nations,Robert 0 6 1 6 / .2 0 1 5
Issued By: Date of Issue:
Authorized State Agent: 4., alfunction Log Oyes
@Hand Drawing 01mport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health.Department CDP File'Number: 194642- 1
210 Hospital Street
County File Number: 14-000-00-057P.O.Box 848
Mocksville NC 27028 Date: 06 / 1 6 / 2 0 1 5
Q Inch
Drawing Drawing Type: .Construction Authorization Scale: , pBlock
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CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street CDP File Number: 194642 - 1
P.O.Box 848 14.000.00.057
Mocksville NC 27028 County File Number:
Date: .0 .6./ 1 6 / 2 0 1 5
Click below to Import an image from an external location: Drawing Type:Construction 4orizatlop
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+. . DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST
APP KATION IP/ATC OSWW REPAIR
Name :; I �e Telephone Number '33
Address
Mailing Address (if different from above)
Email Address:
Subdivision N me Lot#
Directions I W N - 0`
Date System Installed 40 ' 7 Name System Installed Under
Type Facility 0 wNumber Bedrooms Number People Served
T Water Supply'701 Specific Problem Occurring b
Date Requested J Info Taken By
THIS IS TO CERTIFY T T HE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY
KNOWLEDGE,AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS t q qv
Revisit Charge Date Reason f `7
Revised 2-2011
-DA VIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST.
APP KATION IP/ATC OSWW REPAIR
Name -� l' L� . Telephone Number
Ad4ress
Mailing Address (if'different from above) .
Email Address: �l V i t r� r -00
Subdivision IBJ me %'; ''., v { - Lot#
Directions"ffbUL1, VW
Date System Installed L O - 070 Name System Installed Under
Type Facility, r" 0 Number Bedrooms Number People Served
' T Water Supply? j'�G1 Glut o Specific Problem Occurring
Date Requested Info Taken By (/1' � -
THIS IS TO CERTIFY T T THE INFORMATION PROVIDED IS CORRECT TO THE BEStOF 1VIY
KNOWLEDGE,AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS
Revisit Charge Date Reason
Revised 2-2011