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2496 Liberty Church Rd 3avie County, NC Tax Parcel Report Tuesday, September 27, 201 f r ! i 19 5-//// 1775\ 2566 j X 2544 2573 2496 - - —` 249}3 2479 2471 J 2468 2462 - ....._... . . .:.. .~...............--------.-----------------------.........._..............-.......-:._... ..............................-...... WARNING: THIS IS NOT A SURVEY sInforination Parcel Number: B20000000408 Township: Clarksville - NCPIN Number: 5803694567 Municipality: Account Number: = Census Tract: 37059-801 Listed Owner 1: Voting Precinct: CLARKSVILLE Mailing Address 1: Planning Jurisdiction: Davie County City: Zoning Class: DAVIE COUNTY R-A,R-20 State: Zoning Overlay: Zip Code: Voluntary Ag.District: No Legal Description: Fire Response District: LONE HICKORY Assessed Acreage: 10.83 Elementary School Zone: WILLIAM R DAVIE Deed Date: / Middle School Zone: NORTH DAVIE Deed Book/Page: Soil Types: MnC2,MnB2,MdE Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 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 �DUN�� NC or arising out of the use or inability to use the GIs data provided by this website. For Office Use Only HEALTH DEPARTMENT RELEASE *CDP File Number 230481 - 1, Davie County Health Department 1f 210 Hospital Street County ID Number: Box 848 P.O. HDRMWC Evaluated For. Mocksville NC 27028 Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID 0 9 / a 6 / a 0 a 1 UNTIL Applicant: Chasity Robertson Property Owner: Chasity Robertson Address: 2496 Liberty Church Rd Address: 2496 Liberty Church Rd City: Mocksville City: Mocksville State2ip: NC 27028 State0p: NC 27028 Phone#: (704)746-6133 Phone#: (704)746-6133 Property Location&Site Information Address2496 Liberty Church Road _ Subdivision: Phase: Lot - - Road# Yadkinville NC 27055 - SINGLE FAMILY Township: 'Structure: Directions #of Bedrooms: 3 #of People: Hwy 601 North Left on Liberty Church Road.house on left 'Water Supply: PUBLIC Type of Business: Basement: n Yes�No Total sq.Footage: No.Of Employees: "Proposed Improvement: Remodeling Home *Release Conditions ` Maintain 5 foot setback to any poertion of the septic system. I This release in'no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps.Signature; *Dated *Issued By: 2140-Nations,Robert *Date of Issue: 0 9 / 2 6 2 0 1 6 Authorized State Agent: **Site Plan/Drawing attached.** U Hand Drawing Olmport Drawing HEALTH DEPARTMENT RELEASE sra Davie County Health Department CDP' File Number: 230481 - 1 210 Hospital Street P.O.sox 848 County File Number: J Mocksville NC 27028 Date: 09 / 2 6 / 2 0 1 6 QWA Olnch Scale: OBlock = .ft. Drawing Type: Health Department Release ON/A I � 4 x v '( . i._/1` � � I Page 2 &Y CONSTRUCTION For Office use Only AUTHORIZATION *CDP File Number, 230481 -1 Davie County Health Department County ID Number: 210 Hospital Street Evaluated For HDRMWC P.O. Box 848 Township:: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 9 / a 6 / a 0 a 1 Applicant: Chasity Robertson rAdd roperty Owner: Chasity Robertson Address: 2496 Liberty Church Rd ress: 2496 Liberty Church Rd City: Mocksville City: Mocksville State2ip: NC 27028 StatefZip: NC 27028 Phone#: (704)746-6133 Phone#: (704)746-6133 Property Location & Site Information CYaAddress/Road#: Subdivision: Phase: Lot: 96 Liberty Church Road dkinville NC 27055 Directions Structure: SINGLE FAMILY Hwy 601 North Left on Liberty Church Road. house on left #of Bedrooms: 3 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a � rSitessification: Provisionally Suitable Inches Minimum Soil Cover. 1 a System? OYes ONo Inches Design Flow: 3 6 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: GRAVITY-SERIAL TYPE II A CONI SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: �. Gallons *Proposed System: 25%REDUCTION 1-Piece: Oyes ONo Pump Required: OYes ONo OMay Be Required Nitrification Field Sq. ft. Pump Tank: Gallons No. Drain Lines 1-Piece: OYes ONo Total Trench Length: a 0 0 ft GPM—vs— ft. TDH Trench Spacing: _ 9 Onches Fe t O.C.O.C. Dosing Volume: _ Gallons Trench Width: Inches 3 Feet Grease Trap: Gallons Aggregate Depth: - - inches Pre Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: 01 011 0111 OIV D,m~% 4 ^f'A CDP File Number 230481 - 1 County ID Number. , ❑ Open Pump System Sheet Repair System Required:OYes ONo ONo, but has Available Space rDesign system Trench Spacing: Q Inches 0. ification: Q Feet O.C. Trench Width: Inches w: — Feet 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: Total Trench Length: - ft Pump Required: QYes ONo OMay 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 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. ; This Authorization for Wastewater System Construction shall be valid fora 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(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? QYes ONO Applicant/Legal Reps. Signature• Date: *Issued By: 2140-Nations,Robert Date of Issue: . 0 9 / a 6 / a 0 1 6 Authorized State Agent: Malfunction Log OYes .' @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 230481 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 9 / .2 6 / .1 0 1 6 Q Inch Drawing Drawing Type: Construction Authorization Scale: , 081ock ONIA ck s �.r CONSTRUCTION AUTHORIZATION . Davie County Health Department 210 Hospital street CDP File Number: 230481 - 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: 09 / 26 / 2016 Click below to Import an Image from an external location: Drawing Type:Construction Authorization A16 (wall Davie County Health Dep'c tnient 4'1; " Environmental Health Section .� 10 P.O.Box 848 k �. 210 Hospital Street 1 . Q ZT �'S Courier# : 09-40-06 Mocksville,NC 27028 . rw.. Phone:(336)-753-6780 F=(336)-753-1680 - ON-SITE WASTEWATER CERTIFICATION - (Check One) Replacement Remodeling Reconnection Name: Q�l Phone Number ��Y'" /�tlJ '&/! `(Home) Mailing Address: ��� (Work) ^_ 70 Detailed Directions To Site: / G_X_P (y Q/ A"Dr-&-1 'f O )2­4A�W/ [,/. - -< • r. __ Property Address: g l L.// Please Fill In The Following Information About The EXISTING Facility - a7G� S Name System Installed Under: Type Of Facility: Date System Installed(Month/Date/Year): Number Of Bedrooms: Number Of People:p _. Is The Facility Currently Vacant Yes No If Yes,For How Long?_ Any Known Problems? Yes No If Yes,Explain: j? 2 C o /? - no Please Fill In The Following InformLatio�n�About The NEIV Facility: Type Of Facility: 92,QZ cemZIC.0(� / 0/np Number Of Bedrooms: Number of People_ Pool Size •// Q Garage Size:_ /�-� Q Other:. Requested By: (' Date Requested: -5z l(o (Signature) For Environmental Health Office Use Only Approv d Disapproved Comments: ✓ �� �� �l� S s Environmental Health Specialist Date: q `� *The signing of this form by the Environmental Health 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: CashChec Money Order # 0 3 Amount:$ /00-0 Date: Paid By: 2,�(' Received By: Account#: oq 367 V Invoice#: �, yad/Lam �riC00' 0�'1' �� 7o�• 7s��o• ��33 l4 o� Z v a Tq CHU &�[-f ���-�