1719 Hwy 801S Davie County,NC` Tax Parcel Report Wednesday, February 15, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: K510OA0031 Township: Jerusalem
NCPIN Number: 5747110192 Municipality:
Account Number: 66530000 Census Tract: 37059-807
Listed Owner 1: SLEDGE LOUDETTA B HEIRS Voting Precinct: JERUSALEM
Mailing Address 1: C/O JUDY HOSKINS Planning Jurisdiction: Davie County
City: KERNERSVILLE Zoning Class: DAVIE COUNTY H-B,R-20
State: NC Zoning Overlay:
Zip Code: 27284-0000 Voluntary Ag.District: No
Legal Description: LOTS 18-20 R P ANDERSON Fire Response District: JERUSALEM
Assessed Acreage: 0.87 Elementary School Zone: COOLEEMEE
Deed Date: 6/1979 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 001080024 Soil Types: Gn62
Plat Book: 0001 Flood Zone:
Plat Page: 097 Watershed Overlay: DAVIE COUNTY
Building Value: 31550.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 16000.00 Total Market Value: 47550.00
Total Assessed Value: 47550.00
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 Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�OUN� NC or arising out of the use or inability to use the GIS data provided by this website.
01PERATION PERMIT or ice use Only
Davie County Health Department *CDP File Number 138440-1
210 Hospital Street K5.100-Ao-031
n P.O.Box 848 County ID Number ,
Mocksville NC 27028 Evaluated For. REPAIR
Phone:336-753-6780 Fax:336-753-1680 Township.
Applicant: Property Owner. Sledge Heirs C/O Judy Hoskins
Address Address: 7318 Horseman's Cove
City: City: Kemersville
State2ip: NC State2ip: NC 27284
Phone#: Phone#.
Property Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
1719 US Hwy 601 South
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY US Hwy 601 South on Left past McCullough Rd on
#of Bedrooms: Right
#of People:
*Water Supply: NIA
*IP Issued by. *System Classification/Description:
TYPE Il A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
*CA issued by: 2140.Nations,Robert
5aprolite System? QYes RNo
Design Flow: .1 4 0 *Distribution Type: GRAVITY-SERIAL Pump Required?
QYes ONo
Soil Application Rate: 0 - a 7 5 *Pre Treatment:
Drain field
(No.
0rification Field $ 7 a Sq. *System Type: INFILTRATOROUICK4 STANDARD
Drain Lines a Installer: Brian Mcdaniel
Total Trench Length: :1 1 8 8• Certification#: 1118
Trench Spacing: — 9 Inches O.C.
Feet O.C. *EH S: 2140-Nations,Robert
Trench Width: 3Inches
QFeet Date: 0 6 / 1 7 1 .2 0 1 5
Aggregate Depth: inches
Minimum Trench Depth: Inches
Minimum Soil Cover. Inches Approval Status
Maximum Trench Depth: p Appeaved® Disapproved
Inches
Maximum Soil Cover. Inches
CDP File Number 138440 - 1 Septic Tank County ID Number".-
K5-100-AO031
Manufacturer. Lat.
Lang:
STB:
Installer:
Date: / / Certification#:
`.....'_' *EHS:
*Filter Brand:
ST Marker. El Yes 11 No
Date:
Reinforced Tank: ❑ Yes ❑ No Approval Status
1 Piece Tank: O Yes ❑ No �❑ Approved O-: Disapproved
Pump Tank
Manufacturer, Installer.
PT: Certification#:
Gallons: *EHS:
Date: / / Date:
RiserSealed ❑ Yes ❑ No
RiserHeight: ❑ Yes ❑ No (Min.6 in.) �� gpprovalStatus �
Reinforced Tank: ❑ Yes ❑ No
�❑ Approved❑ .Disapproved=
1 Piece Tank: ❑ Yes ❑ No
Supply Line
Pipe Size: inch diameter Installer.
Pipe Length: feet Certification#:
*Schedule: *EHS:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings [I Yes El No Approval Status
❑ Approved❑ Disapproved
Pump e e
Pump Type: Installer.
Dosing Volume: — Gal Certification#:
Draw Down: Inches *EHS:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ❑ Yes ❑ NO Approval„Status
PVC unions ElYes ElNo ❑ AProved❑ Disapproved
Vent Hole ❑ Yes ❑ NO'..”
Anti-siphon Hole ❑ Yes ❑ NO
'138440 - 1 KS-100-AO-031
CDP File Number County ID Number:
Electric Equipment
NEMA4XBoxorEquivalent 0 Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ No
Box Adj.To Pump Tank Certification#:
❑ Yes ❑ N o
Conduit Sealed ❑ Yes ❑ No *EHS:
Pump Manually Operable ❑ Yes ❑ No /
*Activation Method: Date:
Approvat Status
Alarm Audible E3 Yes ❑ Na ❑ Approved❑ ,Disapproved`
Alamt Visible ❑ Yes ❑ No
2140-Nations,Robert
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 0 6 / 1 7 / .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 11 A sewage septic system.
Rule.1961 requires that a Type TYPE 11 A septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: NIA
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator:N/A
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 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 entitywith 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 entry, 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.
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT 13$440- 1
Davie County Health Department CDP File Number:
210 Hospital Street K5-100-AO-031
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: %/ /
---
0 Inch
Drawing Drawing Type: Operation Permit Scale: OBlo
QN/A ft.
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CONSTRUCTION For Office Use Only
AUTHORIZATION *CDP File Number 138440- 1
Davie County Health Department County�ID Number:
210 Hospital Street EvldFREPAIR
•� �. P.O. Box 848 �T�ownshi�p: �
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 6 / 1 1 / a 0 1 9
Applicant: Property Owner: Sledge Heirs C/O Judy Hoskins
Address: Address: 7318 Horseman's Cove
City: City: Kernersville
State/Zip: NC State/Zip: NC 27284
Phone#: Phone#:
Property Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
1719 US Hwy 601 South
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY US Hwy 601 South on Left past McCullough Rd on Right
#of Bedrooms:
#of People:
*Water Supply: NSA
System Specifications
Minimum Trench Depth: � 4
rDesign
ssification: Provisionally suitable Inches
Minimum Soil Cover:
System? O Yes (&No 1 a Inches
low: a 4 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 a 7 5 Maximum Soil Cover: a 4
Inches
*System Classification/Description: *Distribution Type:
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
*Proposed System: 25%REDUCTION 1-Piece: O Yes O No
Pump Required: O Yes O No O May Be Required
Nitrification Field 8 7 a Sq.ft. Pump Tank: Gallons
No. Drain Lines 3 1-Piece: OYes ONo
Total Trench Length: a 1 8 ft GPM--vs— ft. TDH
Trench Spacing: Inches O.C.
— 9 Feet O.C. Dosing Volume: Gallons
Trench Width: — 3 OInches
®Feet Grease Trap: Gallons
Aggregate Depth: inches Pre-Treatment: O NSF OTS-I OTS-11
Septic Tank Installer Grade Level Required: 01011 O III ON
Page 1 of 3
M • ti
CDP File Number 138440 - 1 County ID Number: K5-100-AO-031 ,
❑ Open Pump System Sheet
Repair System Required:0 Yes O No O No, but has Available Space
rDesignFlow:
System
Trench Spacing: O Inches O. .
ification: — O Feet O.C.
Trench Width: _ O Fe tInches
Soil Application Rate: Aggregate Depth: inches
*System Classification/Description: Minimum Trench Depth: Inches
Minimum Soil Cover:
Inches
Maximum Trench Depth:
*Proposed System: Inches
Maximum Soil Cover:
Nitrification Field Inches
Sq. ft.
No. Drain Lines *Distribution Type:
TotalTrench Length: Pump Required: OYes O No O May Be Required
ft.
Pre-Treatment: O NSF 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. Characters
750
*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 governing bodies in meeting their requirements. Characters
Tie in drains from the house that currently do no go into the septic tank.If the current system can not hold the additional flow,add septic as described 1728
above and in the drawing below.House drain from either the washing macine,sinks,or tubs are running down driveway.
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 same time 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(8)).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 O No
Applicant/Legal Reps. Signature: Date:
*Issued By: 2140-Nations,Robert Date of Issue: 0 6 / 1 1 / 2 0 1 4
Authorized State Agent: ` roc �'� �f=— Malfunction Log Oyes
®Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 138440 - 1
Davie County Health Department CDP File Number:
210 Hospital Street County File Number: K5-100-AO-031
P.O.Box 848
Mocksville NC 27028 Date: 06 / 11 / .2014
0 Inch
Drawing Drawing Type: Construction Authorization Scale: 0BIock - -
0 N/A
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Page 3 of 3 Pi P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street CDP File Number: 138440 - 1
P.O.Box 848
Count File Number: K5-1 00-AO-031
County Mocksville NC 27028
Date: .0.6./ .1,1, /..2 0.1.4,
Click below to import an image from an external location: Drawing Type: Construction Authorization `J
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Page 3 of 3
P1 P2
CONSTRUCTION For Office Use Only
AUTHORIZATION *CDP File Number 138440-1
Davie Count Health
Department K5-100-AO-031
y P County ID Number:
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 1 a 0 1 9
Applicant: Property Owner: Sledge Heirs C/O Judy Hoskins
Address: Address: 7318 Horseman's Cove
City: City: Kernersville
State/Zip: NC State/Zip: NC 27284
Phone#: Phone#:
Property Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
1719 US Hwy 601 South
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY US Hwy 601 South on Left past McCullough Rd on Right
#of Bedrooms:
#of People:
`Water Supply: NSA
System Specifications
Minimum Trench Depth: a 4
(Design
assification: Provisionally suitable Inches
Minimum Soil Cover:
e System? OYes XNo 1 Inches
Flow: 01 4 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 .2 7 5 Maximum Soil Cover: a 4 Inches
*System Classification/Description: *Distribution Type:
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
*Proposed System: 25%REDUCTION 1-Piece: O Yes O No
Pump Required: OYes 0 N O May Be Required
Nitrification Field 8 7 a
Sq.ft. Pump Tank: Gallons
No. Drain Lines 3 1-Piece: OYes ONo
Total Trench Length: .2 1 8 ft GPM--vs-- ft. TDH
Trench Spacing: 0Inches O.C.
— 9 O Feet O.C. Dosing Volume: _ Gallons
Trench Width: 3 0Inches
AgDepth:
(9 Feet Grease Trap: Gallons
Aggregate
inches Pre-Treatment: ONSF OTS-1 OTS-II
Septic Tank Installer Grade Level Required: 01011 O III ON
Page 1 of 3
CDP File Number 138440 - 1 County ID Number: K5-X00-AO-031
❑ Open Pump System Sheet
Repair System Required:0 Yes O No O No, but has Available Space
Repair System
Trench Spacing: O Inches O.C.
(Design
Site Classification: — O Feet O.C.
Trench Width: Inches
Flow: _ Feet
Soil Application Rate: Aggregate Depth: inches
Minimum Trench Depth:
*System Classification/Description: Inches
Minimum Soil Cover:
Inches
Maximum Trench Depth:
*Proposed System: Inches
Maximum Soil Cover:
Nitrification Field Sq.ft. Inches
No.Drain Lines *Distribution Type:
Total Trench Length: ft Pump Required: OYes O No O May Be Required
Pre-Treatment: O NSF OTS-1 OTS-II
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rem`�9
750
*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 governing bodies in meeting their requirements. Rag
Tie in drains from the house that currently do no go into the septic tank.If the current system can not hold the additional flow,add septic as described 1728
above and in the drawing below.House drain from either the washing macine,sinks,or tubs are running down driveway.
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 same time the Improvement Permit issued(NCGS 130A336(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 6 / 1 1 / 0 1 4
Authorized State Agent: dc '-w-re - Malfunction Log OYes
Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3