256 Lat Whitaker Rd Davie County,NC Tax Parcel Report Wednesday, February 15, 2017
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WARNING: THIS IS NOT A SURVEY
Parcel Number: C200000016 Township: Clarksville
NCPIN Number: 5803639439 Municipality:
Account Number: 18468000 Census Tract: 37059-801
Listed Owner 1: CRANFILL FRED G Voting Precinct: CLARKSVILLE
Mailing Address 1: 256 LAT WHITAKER ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 9.11 AC LAT WHITAKER RD Fire Response District: LONE HICKORY
Assessed Acreage: 9.18 Elementary School Zone: WILLIAM R DAVIE
Deed Date: / Middle School Zone: NORTH DAVIE
Deed Book/Page: Soil Types: MnB2,MdB,ChA,MdC
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 72820.00 Outbuilding&Extra 6110.00
Freatures Value:
Land Value: 54790.00 Total Market Value: 133720.00
Total Assessed Value: 133720.00
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 Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�O�p C NC or arising out of the use or Inability to use the GIS data provided by this website.
OPERATION PERMIT or trice use univ
Davie County Health. Department 'RCDP File Number, 199461 -1
210 Hospital Street cz=000-04016
P.O.Box 848 County ID+Number,
•'`°•^''• Mocksville NC 27028 Evaluated For. REPAIR
Phone:336-753-6780 Fax:336-753-1680 Township:
Applicant: Ida Cranfiil Property Owner. Ida Cranfill
Address: 266 Lat Whitaker Rd Address: 266 Lat Whitaker Rd
Cky: Mocksville City: Mocksville
State/zip: NC 27026 State2ip: NC 27028
Phone#: Phone#:
Property Location & Site information
Address/Road#: Subdivision: Phase: Lot:
256 Lat Whitaker Road 7
Mocksville NC 27028 Directions
Address/Road
Structure: SINGLE FAMILY Hwy 601 North, Left on Liberty Church Rd then Left
on Lat Whitaker Rd.
#of Bedrooms: 3
#of People:
*Water Supply: EXISTINGWELL
*System Classification/Description:
'1P ISSued by. TYPE II A COW SYSTEM{SINGLE-FAMILY OR 480 GPD OR LESS)
*CA issued by: 2140-Nations,Robert Saprolite System? 0Yes QNo
Design Flow: 3 6 0 * GRAVITY.PARALLEL d-box Pump Required?
Distribution Type: tom` ) OYes MNo
Soil Application Rate: 0 -
*Pre Treatment:
Drain field
rNo.
cation Field 1 8 Sq.ft. ISystem Type: INFILTRATOR QUICK 4 STANDARD
rain Lines 3 Installer: Shannon henderson
oaTrench Length: 4 5 0 ft. Certification#: 1091
Trench Spacing: — 9 Inches O.C.
Feet O.C. *EHS: 2140-Nations.Robert
Trench Width: 3Inches
— ()Feet Date: 0 2 ! 1 8 ! 2 0 1 6
Aggregate Depth: inches
Minimum Trench Depth: 3 0
_ Inches
Minimum Soil Covet 1 8
Inches ApprovalStatus`
Maximum Trench Depth: $ Inches Approved Ci Disapproved
Maximum Soil Cover. 2 8 Inches
CDP Fite Number 199461 - 1 Septic Tank County ID Number: c24000.00.016 ,
Manufacturer. $hoar Let.
STB: 760
Long:
Gallons: 1000
Installer: Shannon Henderson
Certification#: 1091
Date: g g / l7 / a 6 1 5
*EH S: 2140-Nations,Robert
*Filter Brand: POLYLOKPL-122 With Pipe Adapter
ST Marker: El Yes O No
Date: Oat is / alazs
Reinforced Tank: El Yes
® NO Approval Status "
1 Piece Tank: ❑ Yes [� Na [� Approved�:Dlsapprowed
Pump Tank
Manufacturer, Installer
PT: Certification#:
Gallons: THS:
Date: Date: r
RiserSeeled ❑ Yes ❑ No
RlserHeight: ❑ Yes ❑ No (Min.6 in.) Appmval Status
einforced Tank: ❑ Yes ❑ Na Q ApprovedCl Dlsapproviti
1 Piece Tank:
❑ Yes ❑ No
Supply Line
Pipe Size: inch diameter Installer
Pipe Length: feet Certification#:
*Schedule: THS:
Pressure Rated ❑ Yes ❑ No Date: /
Approved fittings ❑ Yes ❑ No � ' ApprovalStatus
"-
G7;Approved❑r Di sap
Pump RequIrement
Pump Type: Installer.
Dosing Volume: - Gal Certification#:
Draw Down: Inches THS:
*Chain: j
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ❑ Yes ❑ No Approval Status
PVC Unions ❑ Yes ❑ Na ❑ Approved,Cl, DlsapprovedA
Vent Hole:[:] Yes ❑ No
",.,",Anti-s1phon Hole ❑ Yes ❑ No
CDP File Number '199461 - 1 County ID Number: c2.000-00.016
Electric Equipment
NEMA 4X Box or Equivalent ❑ Yes ❑ No installer.
Box 12 in
Above Grade ❑ Yes ❑ No
Certification#: f
Box Adj. Pump Tank ❑ Yes ❑ No
Conduit Sealed ❑ Yes ❑ No *EHS:
Pump Manually Operable ❑ Yes ❑ No /
*Activation Method: Date;
Approval Stitus t
Alarm Audible
.13 Yes ❑ No ._
Approved l Disapproved
Alarm Visible El Yes ❑ No
2140-Nations,Robert
*Operation Permit completed by'
Authorized State Agent: Date of Issue: 0 x 1 8 6
Owner/Applicant Sign atur .
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.Se,q.,and an conditions of the Improvement Permit and
Construction Authorization.This property is served by a�E Ir A Sewage septic system..,
Rule,1961 requires that a Type TYPE111A.
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.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 putslie management entitywith 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 an;Dpecation Permit fora system required#o be maintained by a public or private management entity,unless the
system ownerand certified operatorarethe same, The contractshall require specific requirements formaintenance and
operation,responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long es the
system iS`in use,and other requirements for'the;continued proper performance ofthe'system.' it Shalt also be a condition of
theOperation Permit thatsubsequentowners"of the systems execute such a contract.
@Hand Drawing 01mportDrawing
**Site Plan/Drawing attached.** �:
OPERATION PERMIT 199461 - 1
Davie County Health Department CDP File Number:
210 Hospital Street c2-000-00-016
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: / !
O Inch
Dm,vvin� Drawing Type: Operation Permit Scale: . OOBlock= ft.
4F{4
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CONSTRUCTION For Office Use Only
AUTHORIZA1I0N
"CDP Fite Number 199461 -1
Davie County Health Department county ID Number.
c2-000-00-016 `
210 Hospital StreetEvaluated For. REPAIR
•o«...►• P.A.Box 848 Township: '
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone:336-753-6780 Fax:336-753-1680 0 1 / 1 9 / a 0 a 1
Applicant: Ida Cranfill Property Owner Ida Cranfili
Address: 256 Lat Whitaker Rd Address: 256 Lat Whitaker Rd
City: Mocksville City: Mocksville
State0p: NC 27028 StatefLip: NC 27028
Phone#: one#:
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
256 Lat Whitaker Road
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY Hwy 601 North, Left on Liberty Church Rd then Left on Lai
Whitaker Rd.
#of Bedrooms: 3
#of People:
"Water Supply: EXISTING WELL
System Specifications
Minimum Trench Depth: a 4
Site Classification: Provisionally Suitable Inches
Minimum Soil Cover. 1 a
Seprolite System? OYes @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-PARALLEL(eq.d-box)
TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
1 10 0 0 Gallons
*Proposed System: 25%REDUCTION 1-Piece: OYes QNo
Pump Required: OYes OQ No OMay Be Required
Nitrification Field 1 8 0 0
Sq.ft. PumpTank: Gallons
No.Drain Lines 3 1-Piece:OYes ONo
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: Inches
3 . Feet Grease Trap: Gallons
Aggregate Depth:
inches Pre Treatment: ONSF OTS-1 O:TS-11
SepticTank InstailerGrade Level Required: OI Oil 0111 OIV
Donn � �f 4
CDP File Number 199461 - 1 County ID Number.U-000-00-016
❑ Open Pump System Sheet
Repair System Required:OYes @No ONO, but has Available Space
rnesign
System Trench Spacing: Inches 0. .
ification: — Feet O.C.
Inchew**** 15A N 18r/&—%h.wl945 8Feet s
SoilAggregate Depth:
Application Rate: inches
Minimum Trench Depth:
*System,Classification/DescriInches
`repair Area Exen Nat—
inches
Maximum Trench Depth:*Proposed System: Inches
Maximum Soil Cover:
Ntrification Field Sq. Inches
ft.
No. Drain Lines *Distribution Type:
Total Trench.Length: �. Pump Required: Oyes �No OMay Be Required
Pre-Tree#mart: ONSF 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,
"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. ;
Check to see 9 old lines are serviceable.If not add all of the line length with the new tank.Tie all plumbing to new system.
This Authorization forWastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not
to exceed five years,and maybe issued atthe sametime the Improvement Permit issued(NCGS 13t1A-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
invallck and may be suspended or revoked(.193T(g)).The person owning or controuing the system shall be responsible forassuring+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: Date of Issue:,
2140-Nations,Robert 0 1 / 1 9 / 4 0 1 6
Authorized State Age Malfunction Log QYeg :
®Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 1994611
: Davie county Health Department CDP File Number:
210 Hospital Street
P.O.Box 848
County File Number: c2'°oa00-0
Mocksvitle NC 27028 Date: 0 1 / 1 9 / 2 0 16
Q Inch
Drawing Drawing Ty e: Construction Authorization, Scale: . , ON/AOBlot< = ft.
Q N!A
.001
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CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street CDP File Number: 199461 - 1
P.O.Box 848 c2.000-00-016
Mocksville NC 27028 County File Number:
Date: .0 .1 / 19 / 2016
Click below to import an image from an xtemal location: Drawing Type:Construction Authorization
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Davie County Health Department
.1836 � Environmental Health Section ..
P.O. Box 848
210 Hospital Street
Courier#: 09-40-06 n
. Mocksville, NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATE FICATION
(Check One) Replacementtemodeling Reconnection
IDName: RIGKgp %,jM-Cot 77ft KE owhone Number (Home)
Mailing Address: P610 Uri %,,t4tT-n1' C fz7�> 6ow1g,'C-00-1fl�I-9aD-'5436 (Work)
10CKS\II LL FE NC Email Address:r'i(,Ul of v i vecol a hoo'C 0M
Detailed Directions To Site: -r K C (o l -r0%-AAIZDS �R-0611w)Lc a, r F}K E A tk-�"i' O t, t
U 13 6-RT1' r tla eCc-1 TLS �R iu l? 3-5- M I I CS AND ' }KE !4 C,Er 1 a/.r7t� (.fl i 1-J/4(71)K�"�f2�D,
?fR O O? Ty k111 L Be O+j TNS V21&t-/T-
PropertyAddress: 9S4o (_A-I \-j4r-AKG7Z 2� µoCKSAM C-C
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under: /JA Type Of Facility: d-oft Z 16-5 ID tyu C6
Date System Installed(Month/Date/Year): dA Number Of Bedrooms: 3 Number Of People:
Is The Facility Currently Vacant? Yes 9) If Yes,For How Long?
Any Known Problems? Yes to If Yes,Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: Number Of Bedrooms: 3 Number of People
'Pool Size: Garage Size: Other:
Requested By: Z� _ Date Requested:
( 1gna e)
For Environmental Health Office Use Only
Approved Disapproved r
Comments: t' LL `4,, V
beina 0,(A&A .. -TS 5 L -P ArglaXi /J2d2-0*1✓Z� Y12 f . (AI 04
—7''
Environmental Health Specialist Date: nj
*The signing of this form by the Environm ntal H alth Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order # Amount:$ Date:
Paid By: Received By:
Account#: Invoice#:
_ _ C