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239 Pine Valley Road Section 1 Lot 23 P/O 24Davie County, NC Tax Parcel Report Tuesday, January 24, 2017 r` 261 253 / _ ,! 230 f `� f -p /226 218 �E ,0 181 C� r IT 186 �o� lyS'L WARNING: THIS IS NOT A SURVEY All data Is provided as is without warranty or guarantee of any Idnd 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 shag 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 or arising out of the use or Inability to use the GIS data provided by this website. Parcel Information Parcel Number: J605000016 Township: Fulton NCPIN Number: 5758817141 Municipality: Account Number: 1297000 Census Tract: 37059-804 Listed Owner 1: ALLERTON GIRTEN O Voting Precinct: FULTON Mailing Address 1: 239 PINE VALLEY ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 23+P/024 HICKORY HILLSECTION 1 Fire Response District: FORK Assessed Acreage: 1.07 Elementary School Zone: CORNATZER Deed Date: 2/1996 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 001850414 Soil Types: GnC2,GaD,WATER,MsD Plat Book: 0004 Flood Zone: Plat Page: 107 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: �o� lyS'L Davie County, N`"r All data Is provided as is without warranty or guarantee of any Idnd 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 shag 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 or arising out of the use or Inability to use the GIS data provided by this website. ONSTRUCTION AUTHORIZATION 5=°t' Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Girten Allerton Address: 239 Pine Valley Road City: Mocksville State/Zip: NC 27028 Phone #: (336) 998-7095 / For Office Use Only *CDP File Number 202356 -1 County ID Number: 5758817141 Evaluated For: EXPANSION Township: 0 4/ 0 4/ a 0 a 1 Property Owner: Girten Allerton Address: 239 Pine Valley Road City: Mocksville State/Zip: NC Phone #: (336) 998-7095 Property Location & Site Information Subdivision: Hickory Hill 27028 Phase: 1 Lot: 23/24 Directions Hwy 34 W to Hickory Hill turn left onto Pine Valley to 239 on left. cations Address/Road #: Minimum Trench Depth: 239 Pine Valley Road Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: 2 *Water Supply: PUBLIC Subdivision: Hickory Hill 27028 Phase: 1 Lot: 23/24 Directions Hwy 34 W to Hickory Hill turn left onto Pine Valley to 239 on left. cations Page 1 of 3 Minimum Trench Depth: a \ 4 Inches Site Classification: Provisionally suitable Saprolite System? O Yes (9 No Minimum Soil Cover: 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 ) 7 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY - SERIAL 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 (& No O May Be Required Nitrification Field 4 3 9 Sq. ft. Pump Tank: Gallons No. Drain Lines 1 1 -Piece: OYes 0 N Total Trench Length: 1 0 9 GPM --vs— ft. TDH ft Trench Spacing:O _ 9 ® Inches O.C. Feet O.C. Dosing Volume: Gallons Trench Width: 3 O ® Inches Feet _ Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: O NSF OTS -I O TS -II Septic Tank Installer Grade Level Required: 01011 O 111 O IV / Page 1 of 3 CDP File Number 202356 - 1 Repair Systel *Site Classification Design Flow: m Provisionally Suitable County ID Number: 5758817141 ❑ Open Pump System Sheet ired:OYes O No ®No, but has Available Space Soil Application Rate: 0 a 7 5 *System Classification/Description: TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: 1 7 4 5 Sq. ft. 4 4 3 6 ft. Trench Spacing: 90 Inches O. ® Feet O.C. Trench Width: 3 Inches Feet Aggregate Depth: inches 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: GRAVITY - SERIAL Pump Required: Oyes ®No O May 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. Ramer 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. Rm�re 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 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? O Yes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140 - Nations, Robert Date of Issue: 0 4 / 0 4 / a 0 1 6 Authorized State Agent: Malfunction Log OYes ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 202356-1 Davie County Health Department CDP File Number: 210 Hospital Street 5758817141 P.O. Box 848 County File Number: Mocksville NC 27028 Date: 04/04 / x 0 1 6 0 Inch Drawing Drawing Type: Construction Authorization Scale: , 0 Block = ft. CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 M91;»1CaMUM County File Number: 202356-1 5758817141 Date:.0.4./ 0 4/. 0 16 Click below to import an image from an external location: Drawing Type: Construction Authorization Page 3 of 3 P1 P2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 A icatton For: 7 Site Evaluation/Improvement Permit C Authorization To Construct (ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System rxpansion/Modification of Existing System or Facility **'IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name ' LlY L f.."FA ra Contact Person G/fZ irC`ll/ Address .✓E G 2 G V &J Home Phone 336 — 5� Pte- pis City/State/ZIP C OZ�tusiness Phone Email &4A g -RL LQ- 4, o L. , G� �-1° Email: Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged_ NOTE: A survey plat or site plan must accompany this application. Included: U Site Plan UPlat(to scale) (Permit is valid for 60 months with site plan, no expira ion with mpleteplat.) Owner's Namei/f L 4--ite-2 Phone Ntunber -q', Owner's Address ,:Z � P �t )/4 _- 1-47 City/State/Zipr' � ! ' - Property Address City Lot Size Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is "Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes No Does the site contain jurisdictional wetlands? _Yes No Are there any easements or right-of-ways on the site? _Yes No 2 Is the site subject to approval by another public agency? _Yes No t(J Will wastewater other than domestic sewage be generated? _ Yes No C) IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms � # BatI ours Garden Tub/Whirlpool I IYes INo Basement: ❑ es o Basement Plum ing: IYes o IF NON-RF.SmF.NCF, FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: DConventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Typet County/City Water ❑ New Well ❑Existing Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes ❑ No If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or stakin he hou /f cilityI ation, po well I nd the location of any other amenities. Site Revisit Charge p owroer's owner's legal epresentative si ture >Date(s): Ll Client Notification Date: ate EHS: Sign given I Yes ❑No Account # Revised 11/06 Invoice # "].GRADY L.TUTTE'ROW certify that on OCTOBER 15 19 87 . I surveyed the property 7010,wn on this', that the property lines and location of all structures are accurately shown hereon; that no structure located on this property encroaches on any adjacent street or 'property, and that no structure on adjacent properly encroaches on the premises surveyed " 4 GNF roc LAKE HICKORY HILL 22 jODt� EIP c EXISTING IRON PIN PIP = PLACED IRON PIN NIP =NEW IRON PIN + = UNMARKED POINT unmarked point in lake unmarked point �+ N it 12' 48" W —y in take W GE 0 8700 _tea{ -----J` ED N O NIP NIP x " „O SURVEY FOR: 24 C` \R Ory �A 20' UTILITY EASEMENT Pip -0 t 13ENT EIP 2p pAV E D o* mprFru n M I FRTON & w/ power pole. • .F"jr DAVIE COUNTY HEALTH DEPARTMENT ► (Septic Tank) Improvements Permit. and Certificate of Completion zi3 �j o`u d,Absor ioli-twage pis osal System - G.S. Chapter 1 0 -Article 13C) * �� vR CONTRACTOR *J`'C /`c] t y •.=`! (,1 ( DATE -" ` r PERMIT LOCATIONji• 1129 s•— SUBDIVISION NAME HOUSE [21 OME BUSINESS NO. BATHROOMS :R. NO. LOT NO. c2 3 SECTION OR BLOCK N0. C GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER. YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑ NO Q SIZE OF TANK Q gal. J NITRIFICATION FIELD (! S' + 3 ssqgq. ft. DEPTH OF STONE IN LINES: O WATER SUPPLY: Individual ,,Q Public be IMPROVEMENTS PERMIT BYJ;=' P House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom,House 900 -Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY �•= 'fr��`a CERTIFICATE OF COMPLETION �J t ` fP,,,,. ! BY Date (8/16/73) *Construction must COMPW with all other applicable State and local regulations LOT AREA A.C.lCY�%'0.�... /S�ot4X-3'�( DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion ��.+� %i f'� n' I (Ground Abso$ion Sewage Disnosal System- G.S. Chaptrer 30 -Article 13C) 1i � DATE OR CONTRACTOR PERMIT LOCATION i n , ��: •- �. : 4� �.:� �.' �..'.�'u►g �,- ~ !�' i/ 1\ 9. 1129 613 9 %Alf- S:R. NO. SUBDIVISION NAME �-�Ii c -X -Cs y i % LOT NO. C1 .5 SECTION OR BLOCK NO. +. SE R MOBILE HOME ❑ BUSINESS BE ROOMS NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER,. YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑ No El SIZE OF TANK gal. � NITRIFICATION FIELD:- -o sq. ft. DEPTH OF STONE IN LINES: ra WATER SUPPLY: Individual Public IMPROVEMENTS PERMIT BY J l CF.RTTFTCATE OF COMPLETION (8/16/73) LOT AREA e By—L� *Construction must comp House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom,House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY ,; , - _ "`""""'�Date i with all other applicable State and local regulations r ,{ er DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorion Sewage pis osal System G.S. Chapter 130 -Article 13C) OR CONTRACTOR r C 2i ts� f i DATE PERMIT NO. SUBDIVISION NAME&C-k6 T %�i ,/f LOT NO. �( SECTION OR BLOCK NO. SE [Z MOBILE HOME 0 BUSINESS NCrrBEDROOMS NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑ AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑ N SIZE OF TANK �1 gal. NITRIFICATION FIELD �,;sq. ft. DEPTH OF STONE IN LINES: cR �* WATER SUPPLY: Individual Public IMPROVEMENTS PERMIT BY } ( CERTIFICATE OF COMPLETION By (8/16/73) *Construction must comp LOT AREA 1129 House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom,House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. INSTALLED BY ''Date r ,17 with all other applicable State and local regulations AL� '7e�, L,4 r F y DA_VIE COUNTY HEALTH DEPARTMENT ^ IMPROVEEN3S PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S.. of North Carolina Chapter 130 Article 13c - Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.'1968)' Permit Number Name—Date Location Subdivision Name Lot No. Sec. or Block No. li Lot Size House — �'f Mobile Home _ Business __ Speculation No. Bedrooms 3 — No. Baths — 2 _ No. in Family �— Garbage Disposal YES ❑' NO Ej .J „-" Specifications for System:'-,/ Auto Dish Washer YES Q' NO ❑ - = Auto Wash Machine YES Q' NO ❑ _ ; ,.i 4 • , , r. _; ; - ; �;' Type Water Supply 'This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by `Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion �' f� f Date signing of this certificate shall indicate that the system described above has been installed in compliance with \tandards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function torily for any given period of time.