158 Odell Myers RdDavie County, NC Tax Parcel Report I ay ��� �� Tuesday, September 27, 2016
4 31
126
WARNING: THIS IS NOT A SURVEY
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causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
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Parcel Number:
H800000031
Township:
Shady Grove
' •�` 7835""
5789443376
Municipality:
9814
Account Number:
2811
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157
COCKERHAM WILLIAM C
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
PO BOX 202
Planning Jurisdiction:
Davie County
City:
ADVANCE
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106 W
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Zoning Overlay:
.............._
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2
No
Legal Description:
1 E6�-•
_ a
ADVANCE
'112 \ �.,\. i r :•.
2h2
Elementary School Zone:
SHADY GROVE
200
'210
Middle School Zone:
WILLIAM ELLIS
Deed Book f Page:
009480731
Soil Types:
PcB2,PcC2
\
120A
Flood Zone:
X
0424
Watershed Overlay:
WS -IV -P
Building Value:
329110.00
�0
3640.00
Freatures Value:
2318
1 r t 84
3376
110610.00
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443360.00
Total Assessed Value:
443360.00
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Davie County, NC
WARNING: THIS IS NOT A SURVEY
°r
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
Parcel Number:
H800000031
Township:
Shady Grove
NCPIN Number:
5789443376
Municipality:
Account Number:
8303088
Census Tract:
37059-804
Listed Owner 1:
COCKERHAM WILLIAM C
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
PO BOX 202
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class:
DAVIE COUNTY R-A,R-20
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
No
Legal Description:
7.37 AC HWY 801 LOT 3 HARTMAN
Fire Response District:
ADVANCE
Assessed Acreage:
7.57
Elementary School Zone:
SHADY GROVE
Deed Date:
1/2014
Middle School Zone:
WILLIAM ELLIS
Deed Book f Page:
009480731
Soil Types:
PcB2,PcC2
Plat Book:
Flood Zone:
X
Plat Page:
Watershed Overlay:
WS -IV -P
Building Value:
329110.00
Outbuilding & Extra
3640.00
Freatures Value:
Land Value:
110610.00
Total Market Value:
443360.00
Total Assessed Value:
443360.00
Davie County, NC
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the
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
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causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
OPERATION PERMIT
Davie County Health Department
r 210 Hospital Street
1i
r P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: William c. Cockerham Jr
Address: 4308 Walnut Hollow Dr
City: Winston-Salem
State0l): NC 27127
Phone #: (336) 784-5222
Pro
Address/Road #: Subdivision:
Hwy 801 S.
l Advance NC 27006
cture:
SINGLE FAMILY
# of Bed -oms:
4
# of People:
5
'Water Supply:
PUBLIC
*IP Issued by: 2140 -Nations, Robert
*CA issued by: 2140 - Nations, Robert
Design Flow: 4 8 0
Soil Application Rate: 0 a 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
*CDP File Number 124664-1
H8-000-00-031
County ID Number:
Evaluated For: NEW
l Township:
/ Property Owner: William c. Cockerham Jr
Address: 4308 Walnut Hollow Dr
CRY: Winston-Salem
State/Zip: NC 27127
Phone #: (336) 784-5222
Phase: Lot:
Directions
Hwy 64 E. left on Hwy 801 going norh. Property on
right at the corner of Odell Myers Rd and Hwy 801 on
right.
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
Saprolite System? O Yes Q No
*Distribution Type: WA Pump Required?
QYes ONo
*Pre -Treatment:
Drain field
1 9 a 0 Sq. ft.
ii#
Inches O.C.
Feet O.C.
Inches
— OFeet
inches
Minimum Trench Depth:
Inches
*System Type: INFILTRATOR QUICK 4 STANDARD
Installer: Frank Transou
Certification #:
*EH S: 2140 - Nations, Robert
Date: 1 1/ 2 0 / a 0 1 4
Minimum Soil Cover. Inches Approval Status
Maximum Trench Depth: Inches 0 Approved E3Disapproved
\ximum Soil Cover: Inches
CDP he Number 124664 -1
Manufacturer. shoaf
STB: 760
G allons: 1000
Countv ID Number: H8-000-00.031
nK
Let.
Long:
Installer: Frank transou
Date:
06/
j
08
j a 0 1 4
Certification #:
1' 1 j a 0 j a 0 1 4
RiserSealed
Q
Yes
❑
*EH S: 21140 -Nations, Robert
'Filter Brand:
Riser Height:
[]
Yes
❑
ST Marker:
❑
Yes
El
No
Date: 1 1 j a 0% 2 0 1 4
-
Reinforced Tank:
❑
Yes
El
No
Approval Status
1\1,,Piece Tank:
❑
Yes
D
No
l Approved ❑ Disapproved
Manufacturer. shoat
PT: 363
Gallons: 1000
Pump Tank
Installer: frankt-transou
Certification #:
'EH S: 2140 -Nations. Robert
Date:
j
j
Date:
1' 1 j a 0 j a 0 1 4
RiserSealed
Q
Yes
❑
No
Riser Height:
[]
Yes
❑
No
(Min.6 in.)
Approval Status
einforced Tank:
El
Yes
B
No
p
Approved O Disapproved
11 Piece Tank:
❑
Yes
O
No
Supply Line
Pipe Size:
a
inch diameter Installer:
frank transou
Pipe Length:
feet
Certification #:
'EH S:
2140 - Nations, Robert
'Schedule:
Pressure Rated
0
Yes
❑
No
Date:
1 1 j a 0 j a 0 1 4
approved fittings
El
Yes
❑
No
Approval Status
D
Approved ❑ Disapproved
/ 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 ❑ Yes ❑ No ❑ Approved ❑ Disapproved
Vent Hole ❑ Yes ❑ No
Anti -siphon Hole ❑ Yes ❑ No
CDP File Number. 124664 -1
NEMA4X Box or Equivalent ❑ Yes
Box 12 inches Above Grade ❑ Yes
Box Adj. To Pump Tank ❑ Yes
Conduit Sealed ❑ Yes
Pump Manually Operable ❑ Yes
*Activation Method:
County ID Number: H8-000-00-031
Electric Eauioment
❑ No Installer:
❑ No Certification #:
❑ No
❑ No *EHS:
❑ No
Date:
Alarm Audible ❑ Yes ❑ No
Alarm Visible ❑ Yes ❑ No
2140 - Nations, Robert
*Operation Permit completed by: y
Authorized State Agent:
Approval Status
Approved ❑ Disapproved
Date of Issue: 1 1/.2 0 / a 0 1 4
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 III B. sewage septic system.
Rule .1961 requires that a Type TYPE III B. septic system meet the following criteria:
Minimum System Review By The Local Health Department: 5YRs.
Management Entity: OWNER
Minimum System InspectionlMaintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: NIA
Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract
with a public management entitywith a certified operator or 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 entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements for maintenance 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.
01 -land Drawing Olmport Drawing
'Site Plan/Drawing attached:
OPERATION PERMIT
Davie County Health Department
290 H 'tal of t
CDP File Number: 124664 -1
ospree H8-000.00.031
P.O. Box 848 County File Number:
Mocksville NC 27028 Date:
Q Inch
Drawing Drawing Type: Operation Permit Scale: , QBlock ft.
Q N!A
Prof
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I
• CONSTRUCTION
AUNORIZATION
Davie County Health Department
t 210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
For Office Use Only
*CDP File Number 124664 -1
County ID Number. H8-000-00-031
Evaluated For: NEW
� Township:
PERMIT VALID UNTIL:
0 7/ 0 7/ a 0 1 9
Applicant:
William c. Cockerham Jr
Property Owner.
Marsha H. Palanis
Address:
4308 Walnut Hollow Dr
a
Address:
1673 Village Place
City:
Winston-Salem
Inches
City:
Winston-Salem
State2ip:
NC 27127
State/Zip:
NC 27127
Phone #:
(336) 784-5222
Phone #:
(366) 755-1259
Address/Road #: Subdivision:
Hwy 801 S.
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People: 5
*Water Supply: PUBLIC
'Site Classification: Provisionally suitable
SaproliteSystem? OYes XNo
Design Flow: 4 8 0
Soil Application Rate: 0 a 5
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length
1 9 a 0 Sq. ft.
Phase: Lot:
Directions
Hwy 64 E. left on Hwy 801 going norh. Property on right
at the corner of Odell Myers Rd and Hwy 801 on right.
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover.
1
a
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover.
a
4
Inches
*Distribution Type:
Septic Tank: 1 0 0 0
Gallons
1 -Piece: O Yes ® No
Pump Required: (& Yes O No O May Be Required
Pump Tank: 1 0 0 0 Gallons
4 1-Piece:OYes I&No
4 8 0" ft GPM—vs— ft. TDH
Trench Spacing: Inches O.C.
9 R Feet O.C. Dosing Volume: _ Gallons
Trench Width: 3 Inches
Feet Grease Trap: Gallons
Aggregate Depth:
inches Pre -Treatment: O NSF OTS -1 OTS -II
Septic Tank Installer Grade Level Required: 01011 OIII 01V
Page 1 of 3
CDP File Number -1 24J36,4 - 1
r
/Repair System
*Site Classification: Provisionally Suitable
County ID Number: 1-18-000-00-031
(&Yes O No O No. but has Available
Design Flow: 4 8 0
Soil Application Rate: 0 _ a 5
*System Classification/Description:
TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP
*Proposed System: 25% REDUCTION
Nitrification Field 1 9 a 0
Sq. ft.
No. Drain Lines 4
Total Trench Length: 4 8 0
ft.
Trench Spacing:
Trench Width:
Aggregate Depth:
Minimum Trench Depth:
a
4
Minimum Soil Cover.
1
a
Maximum Trench Depth:
3
6
Maximum Soil Cover
❑ Open Pump System Sheet
ace
9 O Inches O. .
® Feet O.C.
3 Inches
Feet
inches
Inches
Inches
Inches
C4 4 Inches
*Distribution Type: PUMP TO GRAVITY
Pump Required: ®Yes 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. a maw
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. R �;re9
2000
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(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 ONO
Applicant/Legal Reps. Signatu
*Issued By: 2140 - Nations, Robert
Authorized State Agent:
Date: / /
Date of Issue: 0 7 / 0 7/ 2 0 1 4.
Malfunction Log OYes
0 Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION 124664-1
Davie County Health Department CDP File Number:
210 Hospital Street H8-000-00-031
P.O. Box Bas County File Number:
Mocksville NC 27028 Date: 07 /07/.2014
O Inch
Drawing Drawing Type: Construction Authorization Scale' . 00 Block ft.
16 �dt o