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992 Ben Anderson Rd _J OPERATION PERMIT or ice use Davie County Health Department 'CDP Fite Number 120313-1 210 Hospital Street D30000005502 P.O.Box 848 County ID Number. .-: Mocksville NC 27028 Evaluated For: NEW Phone:336-753-6780 Fax:336-753-1680 Township: r plicant: Marty Anderson Property owner: Marty Anderson dress: 992 Ben Anderson Rd. Address: 992 Ben Anderson Rd. City: Mocksville, City: Mocksville, State/Zip: NC 27028 State2ip: NC 27028 Phone K: (704)546-5353 Phone;-: (704)546-5353 Property Location & Site Information Address/Road Subdivision: Phase: Lot: 992 Ben Anderson Rd. Mocksville NC 27028 Directions Structure: SINGLE FAMILY 601 N, right on Eaton's Ch Rd. beside #1081 of Bedrooms: 3 of People: 4 'Water Supply: PUBLIC 'IP Issued by. 2244-Daywalt.Andrew 'System Classification/Description: TYPE II A COW SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) 'CA issued by: 2244-Daywalt.Andrew Saprolite System? QYes QNo Design Flow: 3 6 0 'Distribution Type: GRAVITY-SERIAL Pump Required? QYes Qtlo Soil Application Rate: 0 2 5 'Pre-Treatment: Drain field Nitrification Field Sq. ft' 'System Type: INFILTRATOR QUICK 4 STANDARD No. Drain Lines shcrmandunn Installer: Total Trench Length: 3 6 0 ft. Certification Trench Spacing: — ()Inches O.C. Feet O.C. EH S: 2244-Daywalt,Andrew Trench Width: Inches Feet Date: 0 9 / 0 9 / 2 0 1 3 Aggregate Depth: inches Minimum Trench Depth: Inches Minimum Soil Cover. Inches Approval Status l:laximum Trench Depth: Inches ❑ Approved 1Disapproved I.�aximum Soil Cover: Inches CDP,File Plumber 120313 - 1 Septic Tank County ID Number: D30000005502 rlanufacturec snoat Lat. STB: Long: Gallons: 1000 Installer: Date: 0 4 / 1 2 / 2 0 1 3 Certification 9: 'EH S: 2244•DaywalL Andrew 'Filter Brand: ST ttarker. El Yes ❑ No Date: Reinforced Tank: El Yes ❑ NO Approval Status 1 Piece Tank: ❑ Yes ❑ No ❑ Approved❑ Disapproved Pump Tank Llanufacturer. Installer: PT: Certification-: Gallons: "EHS: Date: / / Date: Riser Sealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (I'Ain.6 in.) Approval Status 71 nforTank: ❑ Yes ❑ No Reinforced Tank: El Yes ❑ No ❑ Approved❑ Disapproved 1 Piece Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification TM: "Schedule: 'EH S: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status ❑ Approved ❑ Disapproved Pump e re 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 ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes 0 NO CDP'File Number 120313 - 1 County ID Number: 030000005502 Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ElNo Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification::: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'EHS: Pump Manually Operable ❑ Yes ❑ NO 'Activation Method: Date: Approval Status Alarm Audible ❑ Yes ❑ No Alarm Visible ❑ Yes ❑ No ❑ Approved❑ Disapproved 2244-Oayv.alt,Andrew 'Operation Permit completed by: Authorized State Agent: Date of Issue: 0 9 / 0 9 / 2 0 1 3 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 II 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: o'A'NER Minimum System Inspectiontl,taintenance Frequency By Certified Operator: N!A Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora homelbusiness owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed fora homWbusiness 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 Operation Permit for a system required to be maintained bya 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. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Total Time:(HH:ldl,t) Activity Code: S-19 204-OP issued NEW Type 11 Quick 4 0 1 Hours 0 0 r.t inutes OPERATION PERMIT 120313 - 1 Davie County Health Department CDP File Number: 210 Hospital Street County File Number: D30000005502 P.O.Box 848 Mocksville NC 27028 Date: 0 Inch ck Di-awiScale: ON ,no Drawing Type: Operation Permit ON/A --------------------- --- ------- F'9 /Z, OONSTRUCTION For office use Only AUTHORIZATION •CDP File Number 120313-1 Davie County Health Department D30ON005502 ty P County ID Number. f 210 Hospital Street Evaluated For. NEW P.O.Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 10 / 0 102 D f Applicant: Marty Anderson Property Owner. Marty Anderson Address: 992 Ben Anderson Rd. Address: 992 Ben Anderson Rd. City: Mocksville, City: Mocksville, State/Zip: NC 27028 State2ip: NC 27028 Phone#: (704)546-5353 Phone#: (704)546-5353 Property Location Site Information rAddress/Roadig: Subdivision: Phase: Lot: Anderson Rd. e NC 27028 Directions Structure: SINGLE FAMILY 601 N, right on Eaton's Ch Rd. beside#1081 #of Bedrooms: 3 #of People: 4 'Water Supply: PUBLIC System Specifications Minimum Trench Depth: 2 4 Site Classification: PS Inches Minimum Soil Cover. Saprolite System? QYes (j)No Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . 2 5 Maximum Soil Cover: Inches 'System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE 11 A CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 _ Gallons *Proposed System: 25%REDUCTION r 1-Piece: QYes QNo Pump Required: QYes QNo OMay Be Required Nitrification Field Sq.ft. Pump Tank: Gallons No. Drain Lines 1-Piece:QYes ONo Total Trench Length: 3 6 0 ftGPM vs— ft. TDH Trench Spacing: 9 Onches O.C. — Feet O.C. Dosing;Volume: _ Gallons Trench Width: Inches 3 6 8Feet Grease Trap: Gallons Aggregate Depth: inches Pre TrOatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: OI 011 0111 OIV Page 1 of 3 .; �� ,' _ � � .. �. ti; i ;. ,. - � �.�i /ZD, � - ,fa ,.. llZo' �' _ l I �� Q ICDP F+lp Number 120313 - 1 County ID Number: D30000005502 ❑ Open Pump System Sheet Repair System Required:OYeS ONO ONO, but has Available Space epair System Trench Spacing: Inches 0. *Site Classification: PS — 9 Feet O.C. Trench Width: Q Inches Design Flow: 3 6 0 — 3 6 o Feet Soil Application Rate: 0 - 2 5 Aggregate Depth: inches Minimum Trench Depth: *System Classification/Description: 2 4 Inches . TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. Inches Maximum Trench Depth: *Proposed System: 3 6 Inches Maximum Soil Cover: Nitrification Field Inches Sq.ft. No. Drain Lines *Distribution Type: GRAVITY-SERIAL Total Trench Lengih: 3 6 0 ft. Pump Required: QYes ONo OMay Be Required Pre Treatment: 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 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 Constriction shall bevalld for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued at the sametime 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? Oyes ONO Applicant/Legal Reps. Signature Date: 4 'Issued By: 2244-Da Andrew Date of Issue: 0 6 0 6 2 0 1 3 Authorized State Agent: A Malfunction Log OYes ED 11-104 Drawing OlmportDrawing TotalTime:(HH:MM) **Site Plan/Drawing attached.** Page 2 of 3 0 1 Hours 0 0 1.11nutes S-8-CA'S issued-new CONSTRUCTION AUTHORIZATION �,. Davie County Health Department CDP File Number: 120313 - 1 210 Hospital Street D30000005502 P.O.Box 848 County File Number: Mocksville NC 27028 Date 06 / 0 6 / 2 0 1 3 Q Inch Drawing Drawing Type: Construction Authorization Scale: QBlock QN/A I, �3�`l L—J. �_ L-JI, dBdjJ J L—L T-I Pane 3 of 3 IMPROVEMENT PERMIT For Office Use Only _ . 'CDP File Number 120313- 1 •�'�`"'�• Davie County Health Department f- County ID Number.D30000005502 210 Hospital Street . P.O.Box 848 Evaluated For: NEW •.,...•• Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UtJTII 2/20/2018 "NOTE TO INSPEC DIVISIO : ding Permits cannot be issued with this Improvement Permit. Apptica Marty Anderson Property Owner: Marty Anderson Address: 99 2 Ben Anderson Rd. Address: 992 Ben Anderson Rd. City: Mocksville, City: Mocksville, State/Zip: NC 27028 StatetZip: NC 27028 Phone#: (704)546-5353 Phone#: (704)546-5353 Pro a Location & Site Information Address/Road#: Subdivision: Phase: Lot: 992 Ben Anderson Rd. Mocksville NC 27028 Directions Structure: SINGLE FAMILY 601 N, right on Eaton's Ch Rd. beside#1081 #of Bedrooms: 3 #of People: 4 'Water Supply: PUBLIC System Specifications nitial system 'Site Classification: Minimum Trench Depth: 2 4 Inches Seprolite System? QYes ONo Maximum Trench Depth: 3 6 Inches Design Flow: 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 2 2 5 1-Piece: OYes QNo Pump Required: QYes (D No OMay Be Required 'System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) 'Proposed System: 25%REDUCTION 1-Piece: QYes ONo j Repair System Required:OYes ONo ONo, but has Available Space rsoiitle, epair System Classification: PS Minimum Trench Depth: a 4 Inches pplication Rate: Maximum Trench Depth: 3 6 Inches eaa5 'System Classification/Description: Pump Required: QYes (S)No O May be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) 'Proposed System: 25%REDUCTION Pagel of 3 CDP•File�Nurhbef 120313- 1 County ID Number D30MOOSS02 • 'Site Modifications ❑ Open Fill Sheet 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 perm it holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for 5 year:from date of Issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dllmensions,the location of the facility and appurtenances,the O G site for the proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale of one Inch equals no more than 60 feet,that Includes:the specific location of the proposed facility O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions platthat Is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article This permit Is subjectto revocation If the site plan,plat!or Intended use changes(NCGS 130A335(j).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)} ApplicantlLegal Reps.Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: 'Issued By: 2244'Daywalt,Andrew Date of Issue: 2 a 0 a 0 1 3 Authorized state Agent: OValid without Expiration? OCreate CA. 01-land Drawing Olmport Drawing **Site Plan/Drawing attached.** TotalTime:(HH:MM) 1 .Hours 0 Minutes Page 2 of 3 Activiv Code: IMPROVEMENT PERMIT 120313- 1 Davie County Health Department CDP File Number. • • 210 Hospital Street D30000005502 P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: 08lock ONia Gor ____ I LJ_ I I 1 1 1 1 I LJ 3 04 if -T-1- F C 011- -3,-7 LJ Page 3 of 3 APPLIC FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC r Davie County Environmental Health P X013 P.O.Boz 848/210 Hospital Street AJAN 2 1 p Mocksville,NC 27028 ® (336)753-6780/Fax(336)753-1680 BY: Application For: Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/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. APPTJCANT INFORMATION c Name /11 a1- 4-I44j4(56 Contact Person r,-4!i A,4%,Address 1 q11""50Home Phone 7U N , City/State/ZIP v,11 f /VL - Business Phone— �— 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: 2-Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name a„ r)ie� c Phone Number 7 Owner's Address Z ^ City/State/ZipT!'7�- 4f k J/L �C Property Address EOL-0.109 •-ity_ 1W5WWc Lot Size Tax PIN# Subdivision ame(ifppR ble) 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 .'114-o . Does the site contain jurisdictional wetlands? Yes o Are there any easements or right-of-ways on the site?. _Yes _ 99 Is the site subject to approval by another public agency? _Yes o Will wastewater other than domestic sewage be generated? Yes - io TF RFS>TDF,NCF FIT J,OT IT THF,BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes fro Basement: ❑ es BNNo Basement Plumbing: ❑Yes gNo 1F NON-RFSIDF,NCE FIT-J,OUT THF,BOX.BFJ..OW 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: 2/conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: /County/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Zd 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 staking the hb a/facility ocation,proposed ation and the location of any other amenities. Property o er's or owner's legal representative signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# b6I Revised 11/06 Invoice# ��3 A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section r Soil/Site Evaluation ; APPLICANT INFORMATION _ PROPERTY INFORMATION #' Account #: 990006011 Tax PINMH D30000005502 Billed To: MartyAnderson ; Subdivision Info: : Reference Nam; Location/Address: Eaton Church Road-27028 Proposed Faa"lity: Residence Property Size, 4.85 Ac. Date Evaluated: i Water Supply: On-Site Well Community Public Evaluation By Auger Boring Pit Cut -FACTORS—_--- -- - _ 1. -- -2 3 - - 4 - .5-._. __..6 - -7 Landscape position Slo qo x ... ;.. �,, r� HORIZON I DEPTH o_2 O Texture group 5(LG C Consistence 1-72 Structure V� Mineralogyi= 1 HORIZON II DEPTH Texture groupC C' Consistence Structure bl WaitA C Mineralogy ;1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy _....__ SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P5fJ2 S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ISS EVALUATION BY: -1 LONG-TERM ACCEPTANCE RATE: 2) OTHER(S)PRESENT: REMARKS: t 446Aclolltlu omJ ;ktd lel LEGE&D* " Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope - CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE MDEt VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI--Extremely firm 1 it -- NS-Non sticky SS-Slightly sticky S-Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-.Very plastic ,Structure SC-Single grain M-Massive . CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed shim Horizon depth-In inches Depth of fill-In inches Restrictive horizon Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD 05105(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■e■■■■■■■■■■■■■■■■■■e■■■■ee�■e■■■■■■■■■■■■e■■■■■ecce■■■ecce■ ■■■■■■■e■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■e■e■■■■■■eee■ ■■■■■■■■■■■■■■■■■■■■i,■■■�::�:�a■■■■■■■■■■■■■■■e■■e■■■eee■■■■■■a■e■ ■■■■■e■■■■■■■■■■■■■wI�■■■■�a■■�■■■■■■■■■■■■e■■■■■■■ee■w.�e■■■■eee■■e■ ■■■■■see■■■■■e■■■■■iwts■■■■i■�■►■■►�a ■■■■■■■■■■■■■■■■■■■■s■■■■■■■■e■■ ■■■■■■■a■■■e■■■■■■■■■■e■■I■■■I■■e►����■eee■■■e■■■■e■■ee■■■eee■■■■■e■■■ ■■■■■■■■■■■■■■■■■■u■■■■■■■■■■eerie■■■■■■■■■■■■■■■■■■w.■■■■■eee■■■■■■ ■■■■■■■■■■s■■■■■eee■■e■s■■■■■■■■■■■■■■■■■■e■■e■■ems■■■■■■■■■■■■■■■ iiiiiiMEMNONMEMNON iiiiiiMENNEN IMMMEMiiiiii■■ OEM■■■■■■■■■■■■■■■i■■■RM ■■■ ■Popp RIME■MESON■■■■■■■■ ■■■■■e■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■e■■■■■■■ee■■■e■e■■eee■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■a■■■■■■■■■�■■■■ea■e■■■e■■■■■eee■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■se■■e■■■■■■■■■■e■■■■e■■■■■■■■■■■■■■■eee■e■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■e■eee■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■e■■■■■ ■■■■■■■■■■■e■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ee■■■■e■e■■■ ■■■■■■■■■■■■■■■■■■e■■■■e■■■■e■■■ ■■■■■ecce■■■■■■■e■■■■e■■■■■■e■e■ ■■■■■■■■■c■■ee■ee■■■■e■■■■c■■■■■ce■■eee■■■■■■■■■■■ee■■■■■e■■■e■■■■ Appraisal'Card• Page 1 of 1 DAVIE COUNTY NC 2/112013 9:32:02 AM ANDERSON MARTY Retum/Appeal Notes: D3-000.00-055-02 1081 EATONS CHURCH RD UNIQ ID 3517 301597 ID NO:5822522019 COUNTY TAX(100),FIRE TAX(100) CARD NO.I of 1 `o eval Year:2013 Tax Year:2013 18.419 AC EATON CHURCH RD 17.960 AC SRC=Inspection Appraised by 02 on 04/21/2008 02003 EATON'S CHURCH TW-02 C- EX-AT- LAST ACTION 20121126 D CONSTRUCTION Z MARKET VALUE DEPRECIATION CORRELATION OF VALUE DETAIL m TOTAL POINT VALUE Eff. BASE - N BUILDING USE MOD Area UAL RATE RCN EYB AYB REDENCE TO C ADJUSTMENTS 97 1 00 1 %GOOD - " )EPR.BUILDING VALUE-CARD z TOTALADJUSTMENT TYPE:Vacant EPR.OB/XF VALUE-CARD 4,50 ACTOR 4ARKET LAND VALUE-CARD 111,28 rp TOTAL QUALITY INDEX STORIES: rOTAL MARKET VALUE-CARD 115,78C TOTAL APPRAISED VALUE-CARD 115,78 TOTAL APPRAISED VALUE-PARCEL 115,78C TOTAL PRESENT USE VALUE-PARCEL TOTAL VALUE DEFERRED-PARCEL TOTAL TAXABLE VALUE-PARCEL 115,78( PRIOR UILDING VALUE BXF VALUE 4,50 ND VALUE 107,95 RESENT USE VALUE DEFERRED VALUE OTAL VALUE - 112,450 PERMIT CODE I DATE NOTE I NUMBER AMOUNT OUT:WTRSHD: SALES DATA FF. ECORD DATE DEED INDICATE SALES OOK AGE M R TYPE PRICE 7 b 206 291 10 1998 WD Q V 5850 0908 274 11 2012 WD E V 006E 321 102006 EF E V 0C) HEATED AREA 0 NOTES o 0 SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR o GS RPL ODE ESCRIPTIO LTM NET PRICE GOND LDG B AYB EYB RATE V COND VALUEp TYPE AREA CS 4 HED 2 7 1,65 5.1 10 L 1199IREPLACE DB H SITE 4,500.0 10 L 19 199 S 10 450 c UBAREA 1 RAIN BIN 1 1 32 1.5 30 L 19 CN OTALS OTA L OB/XF VALUE 4,50 UILDING DIMENSIONS NO INFORMATION IGHEST ER ADJUSTMENTS LAND TOTAL NO BEST USE LOCAL FROM DEPTH/ I.N. CONDrTH NOTES OA UNIT' LAND UNT TOTAL ADJUSTED LAND JLANDSE CODE ZONING TAGE EPT SIZE MOD FACTRF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE URAL AC 0120 473 0 1.0170 4 0.9100 01+20+00-20-10 PW 6 700.0 17.95 AC 0.92 6 197.5 11127 OTAL MARKET LAND DATA 17.95 111,280 OTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=D30000005502 2/1/2013 X D m O rl "NO APPROVAL REQUIRED BY THE DAVIE COUNTY - FILED FOR REGISTRATION AT O'CLOCK M. 2007 AND RECORDED IN PLAT BOOK PAGE PLANNING DEPARTMENT." EATON'S CHURCH Rpgp PLANNING DIRECTOR DATE SITE__— m H REVIEW OFFICER' CERTIFICATEm I, REVIEW OFFICER OF DAVIE COUNTY m VICINITY MAP NTS CERTIFY THAT THE MAP OR PLAT TO WHICH THIS m CERTIFICATION IS ATTACHED MEETS OR EXCEEDS ALL Io STATUTORY REQUIREMENTS FOR RECORDING. FqT o �� s°. GiV Z:z 79 p�GyT (SRC '_ ` ROAD W M } q�0OF81 6 4YR01DEIP N N 8WEIP 148.74'15004EIREVIEW OFFICER DATE S \� R s UNE BEARING DISTANCE I - \ L1 S 03'09 58 W 36.80' \\ L2 S 0755'1 F W 49.86 S � L3 N 81'53 57 W 30.12 U0 O L4 N 03'09 58 E 41.14' L5 N 20'2302 E 278.71' 3 z r7 Go M ^ \ L6 S 62'07'39E 30.26 e O U,) u) W (L N cV W M \ \ iA 0 a) e \ � O o 'no N M a 211445.1 SQ. Fr. w^^z o 4.85 ACRES / INTERSECTION OF til o M �� EIPS \ EATON'S CHURCH ROAD Boaz o 6 � sg• p NO HOWELL ROAD I z o �� N� s2 F x•22\ f0 IP CV 26 69 F\/ • �--9.11' �3 3 nF �— EIP EIP 66 4 ' CLARENCE DRIVER o-- N 8373.09'" W --- EIP 100.4 BUILp�NG SITE Qj BRADLEY MEDFORD 9? EIP DB 483 PG 381 1p Vc� DB 495 PG 749 NCPIN# 5822526368 NCPIN# 5822525424 I OWNER STATEMENT ii W WE HEREBY CERTIFY THAT WE ARE THE OWNERS OF THE �� EIP ^ � J ,r, - W PROPERTY DESCRIBED HEREON, WHICH IS LOCATED IN THE IPS N 1�s 57• 'P to 00 SUBDIVISION JURISDICTION OF DAVIE COUNTY AND THAT WE 437.83' (roraLj PEGGY Y. CUNNINGHAM DB 852 PG 1091 HEREBY ADOPT THIS SUBDIVISION PLAN WITH OUR FREE CONSENT, •; IPS 17 ;,.1 ZI z M NCPIN# 5822527289 ESTABLISHED MINIMUM BUILDING SETBACK LINES AND ��° 0 F 477.94 I DEDICATE ALL STREETS (ROADS), ALLEYS, WALKS, PARKS, AND 6SILOS �ror OTHER SITES AND EASEMENTS TO PUBLIC AND PRIVATE USE AS 'EIP ss76I NOTED. DBMES 738APG 853 3 EIP NCPIN# 5822425186 Z o �0 0 MARTY ANDERSON DATE W 0 IPS L _ � o 0 w o 0 w z ,n 344008.3 SQ. Ff. o ^ EIP NOTES 7.90 ACRES z � � �� J H 0 1. AREA WAS COMPUTED BY COORDINATE GEOMETRY 246900.6 SQ. Fr. 2. AREA INCLUDES RIGHT OF WAY 5.67 ACRES t _ 3. THIS SURVEY IS SUBJECT TO ANY FACTS OR RECCR[7' �- THAT MAY BE DISCLOSED BY A FULL AND ACCURATE. 3 M PETER J. PAPPAS TITLE SEARCH, THAT WAS NOT FURNISHED AT Tr DB 795 PG 726 4. THIS PROPERTY IS ZONED RA o NCPIN# 5822611503 5. THIS PROPERTY MAY BE LOCATED IN A WATERSFiEP. 1 DEVELOPMENTAL RESTRICTIONS MAY APPLY EIP O 6. RIGHT OF WAY DIMENSIONS AS PER NCDOT RIGH N F6--0-1,03-•o1'o3" w cn 7. THE LOCATIONS OF ALL UNDERGROUND UTILITY I_!°508.62' EIP _ N 84 340 ' ' WTHIS MAP ARE APPROXIMATE. 8. THIS PROPERTY MAY BE SUBJECT TO EASEMENT- GUM 3~4.43 GUM TREE AND UNAPPARENT. JAMES A. EATON I, D. CLIFT BODENHAMER JR., PROFESSIONAL LAND SURVEYOR, DB 862 PG 943 WITNESS IRONS SET 9. THERE WERE NO NCGS SURVEY MONUMENTS AT 5' IN EACH LINE L-4388 CERTIFY THAT THIS PLAT IS OF A SURVEY THAT CREATES PB 10 PG 310 WITHIN 2000' OF THIS SURVEY. A SUBDIVISION OF LAND WITHIN THE AREA OFA COUNTY OR PB PG 311 NCPINN# 5822606525 10. OWNER ADDRESS LEGEND MUNICIPALITY THAT REGULATES PARCELS OF LAND. I MARTY ANDERSON ,� S 992 BEN ANDERSON ROAD These standard symbols and lines 1�t- —� �yMOCKSVILLE NC 27028 TIME may be found in the drawing. ® IRON PIN D. CLIFT BODENHAMER JR. ® RAILROAD SPIKE OR NAILPLS # I_-4388 •I};(;A • �/POINT (NOT SET) ,r` siss�se�� V�AY Y — — — — PROPERTY LINE R •s+�� SS�3 - r i EXISTING RIGHT OF WAY e TIE ONES I, D. CLIFT BODENHAMER JR.' CERTIFY THAT THIS PLAT WAS DRAWN UNDER MY SUPERVISION FROM AN = > SURVEY FOR: — — — — OLD TRACT LINES NOT SURVEYED ACTUAL SURVEY MADE UNDER MY SUPERVISION DEED DESCRIPTION RECORDED IN BOOK 2M PAGE(S)274. UNDERGROUND FIBER OPTIC MARTY ANR ' _ — a 9 �� ' THAT THE BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED AS DRAWN FROM INFORMATION FOUND IN {� ' r" '�JI9,` so � ® CABLE TELEVISION PEDESTAL BOOK N A PAGE N A THAT THE RATIO OF PRECISION IS AS CALCULATED 1:10000+; , 'r;�`.�, a®®•ttq"y�'{�� ✓ i'3Fot 0UTILITY POLE THAT THE PLAT WAS PREPARED IN ACCORDANCE WITH G. S. 47-30 AS AMMENDED. r r TO NUMBER: 5822522C IPS IRON PIN SET WITNESS MY ORIGINAL SIGNATURE, REGISTRATION NUMBER AND SEAL THIS 2ND DAY OF JANUARY, A.D. 2013 DRAWN DATE TOcLAR�w COUNTY: DAVIE EIP EXISTING IRON PIN DCB 0 1/01/13 STATE: NORTH CAROLINA NTS NOT TO SCALE OB DEED BOOK APPROVED DATE PG PAGE D. CLIFTON BODENHAMER, JR. ' SF SQUARE FEET 1332 JONESTOVM ROA.'c HTR HOUSE TRAILER PLS # L-4388 WINSTON-SALEM, NOR CARGi_'v - O WATER METER DCB 01/03/13 PHONE No. (336) 926-2065 �( FIRE HYDRANT WATER CONC. CONCRETELY 0' 150' 300' 450' U/G UNDERGROUND SCALE SHEET PROJECT N0. GIR GRAVEL ® TELEPHONE PEDESTAL 1 " _ 150' 1 OF 1 MANDERSON S SHED 11zl K I r AiwkRSON n .k� .�• .r" ?'� '�a:: ,2ta. �{;p+ �, fps' �, °•a. -y,. `'°r;Y.��'^a"d`.;r ,s`�5 .:�' ��. y' r s fl kN The Pear Z�� � '� f ffo i {�1530 V LL" 0 lw .Ii rami moots ® m a3 Bedroom R o i 2 Bath � rumor a waw root (�`ypa on orwr 28 x 60 +rr.+zr SAT k 04 I i OPT.34.a.26 OPT CORNER FIREPLACE_ Gl BLJC WIN. Bonn °"�° NA 1 738 sq O • Q GO KITCHEN DINING ROOM w•1•C' I O 3 Bedroom ^�} 2 Bath +ar.+rwr OFT L:.TY O r X bb BEDROOM a 0 BEDROOM 2 —.'_"_'—^ MASTER BEDROOM ve+-R+rr +rr a+rr 'FOYER awTN ii ii I ! i ` OPT.Fl1RCN