322 Blevins Rd (2) . , .•
, � .
, � ' ' � DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section 5.�. �2�N
r.o.Bog sasmo xo�p�tai st��t
Mocksville,NC 27028 $� �
(336)751-8760
Account #: 990000924 Tax PIN/EH#: 5823-29-1104.01 � 3�7-�'
Billed To: Texie West Subdivision Info:
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Reference Name: Angie West Location/Address: Blevins Road-27028
Proposed Facility: Residence Property Size: 5 Acres
ATC Number: 2296
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S:Chapter 130A,Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWAT C NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health SpecialisYs Signature: � (����1 � � Date: �—�g`�d
CERTIFICATE OF COMPLETION
**NOTE�'* The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation Permit
has been installed in compliance with Article 11 of G.S.Chapter 130A, Section.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By:
Environmental Health Specialist's Signature: Date: ��—O���v
DCHD OS/99(Revised)
„ • DAVIE COUNTY HEALTH DEPARTMENT ��`�2`��'a
' ' , Environmental Heaith Section
' ` � P.O.Boz 848/210 Hospital Street
� Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000924 Tax PIN/EH#: 5823-29-1104.01
Billed To: Texie West Subdivision Info:
Reference Name: Angie West Location/Address: Blevins Road-27028
Proposed Facility: Residence Property Size: 5 Acres
** ��*�I{�rtbgr: 2296
lV is mprovemendOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AiJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with
Article 1 l of G.S.Chapter 130A,Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type /� /7 #People_� #Bedrooms�_ #Baths_�
Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply `'1/I// Design Wastewater Flow(GPD)—s�,JU Site: New�Repair❑
System Specifications: Tank Size�Jj��GAL. Pump Tank GAL. Trench Width ��, ��Rock Depth� Linear Ft. 6D�
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6`�BELOW
FtNISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis
system between 830 a.m.to 9:30 a.m.or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(33G)751-87G0.****
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Environmental Health Specialist's Signature: Date:��� �'�9�
DCHD OS/99(Revised)
� �_
S �`”
.....�.���.0 ��v�untril f'tJlM11 !it All;
Davie County Health Deparhnent � [� (� [������
•� ' ' Environmenial He,ald't 5e�c�Ion �{
• ' � B.o. Box e�9/210 Hospitai strnet u
, �, � DEC 2 g 1999
, Moakaville, t1C 27028
�1 �336�781-8760
ENVIROid�s�EPJTAL HEALTN
**�ZtII�t7RTAIaT**• THI3 AQpLIG1TIG� C�! ffi PROCEBStD VNL88 S ALL QVZ .,,�
INl�ORMATIO:d IS PRiDVIDED. Itefcr •to the INFORblATZGN HOLLSTIN for inatruationa.
1. Ila�a to be Hsuea �,P.?C.1�. t�t • �,�,1P.S-r _ ccata� per.«i 1 `���'S�
C�/�
��� ,��� '� �r� � � ��� — '? �e�- 33?� .�,��
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CittY/8tate/EIO �3 ���., � �3to— � �jn- 138'g '�.-
Y � .
Z. 11a�n aa fyait/1►tC i! Dittarent thaa 11bws `�
1lailitq llddrass Mty/8tate/Zip
s. 1lppiiaition por: ❑ Site 8rralnation 0 Im�rovement Pesmit/!�'C �Both
�. �y�tm to sanvio.: 0 Honsa ��3ob�le Bo�e � Bnsiness 0 Indnatry ❑ Other
e. It Resideace: / People � i Hedrooms � • Bathrooms �_
�Dishxasher 0 Oubaqe Disposal �llashit�q Na�in� 0 8asa�t/Dlmbit�q U Sasemesit/Iio Pla�binq
s. sr Snsinass/snanatsr/ot2»r: spsaslp typa / reople t atnts
i Ca�mrades ' ! 8hoxers � Urinals • Natar Coolers
. ITi �'OODSERVICB: # Seata Estimatad Natar OsaQa �qaiiona par day) .
7. �pr o! Nates supplp: 0 Conaty/City � Aall 0 Co�nity
s. Oo yon anttcipite addltioo�or espan:loo�ot the�actllt�t6b�dem b iut�ended to arve! 0 Yes �I�o
U ya,w6at type'
"*'/MPOR7'ANT"••CI.IENTS AlAST C��llPLE7E TNE REQUIRED PROPL►RT'Y INFORMATION REQUESfLD
BELOW. Eitber a PI.AT or SITB PLAN MUST BESUBMIITED b t6e clknt wlt6 TH1S APPLICATION.
6`�"� a.c�.cp �
Froperty Dimeu�ion�: ��� '{� WRTI'S DIRECTIONS(trom Malcssvilie)to PROPERTY:
Ta:Oitice PIN: # �J�o`�"o��l— 11 D`C I F �� / ��-f. �d` N . "� �...-�-�-�t'
C--7 _
Property Addrar. Road Nam���2V i v�S Qc�, ��, V.'� `C -�
+c�b�.survc� 1 �,(��` ` .
� ! City/Zip I'Y�bL�Ui��[, rJC_��0�-� �f> 4.�Y�t` C`�V1 l��l�
s� 1 .
If ia a Subdivision providt Information,�u folfow�: � .� J��-YU 1 S �Y�
Name: � • �'�"` J � �� •
� sarne ees n b�. .
SeCtiou: Block: Lo� Datc P'�operty Ftl�gged: ,� o,n _��o �
This i�to certify t6at the iotormation provided i�corRct to t6e bat of m�kam►ledge. I anderriand t6at�ny permit(a)
isaed bere�cr are wbject to�aspwaioo or revocallon,if t6e�ite plans or tnteaded aae cbange,or i�t6e lnformatioa
submitied in t6b application i��alsitkd or e6anged I,a[w,�adentand that I afit tcsponsil►lejor oll cl�arga lrrcurr�d fram
tbls appilca�nEo�r. I,6er+eby,give coosent to the Aat6oriud Repraentative of t6e Davie County Beallh Department
to enler npon above desc�ibed property located in Davie County and owoed b���!'. e�C'v�C1CL�Cl �fJi.��h�.QY1
to condact all teriing procednra�neta�ry to ddermloe t6e dfe witabilih.
c
DATE . �- �i l�-��' SIGNATURE
THIS AREA MAY BL U3LD I�'OR DRAWINC YOUR SITL PL.AN(Wclade all of tbe folloRiog: Liisttng and proposed
property lina and dlmenslon=, drnctur�a, ietbacks, and teptk Iocations).-�l� ,Q r-O� �/�`� n �
� �e,' �Or a� !` t�-w� .e ��r,dc
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�, �a�e-u��d�.�. �n�C(.e ,h�.
� s:��u�� �P�� �� h�
� � �su�,rr�,-�.� -�r-�z��., .
Acconnt Na � �
Revbed DCHD(07/98) Invoice Na /�`5
' ' • ' �� � DAVIE COUNTY HEALTH DEPARTMENT
� � ' Environmental Health Section
� ' Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000924 Tax PIN/EH#: 5823-29-1104.01
Billed To: Texie West Subdivision info:
Reference Name: Angie West Location/Address: Blevins Road-27028 ��9
Proposed Facility: Residence Property Size: 5 Acres Date Evaluated: �'l�l/�
Water Supply: On-Site Well :/ Community Public
Evaluation By: Auger Boring �� Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition �i
$10 C�IO � •r
HORIZON I DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH ^ '` �
Texture rou
Consistence i- /
Structure S /
Mineralo , ,�
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE , � � `
SITE CLASSIFICATION: �� EVALUATION BY: /
LONG-TERM ACCEPTANCE RATE: �v OTHER(S)PRESENT:
REMARKS: �1�1s���� 1�'�Z)-�/,'�rJ `� �
LEGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foo[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
Moist
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
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
Mineralo�v
1:1,2:1,Mixed
Notes
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-gaUday/ft2
DCHD OS/99(Revised)
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This map is for PERC TEST
and BUILDING PERMIT purposes
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y TaxAdministrator's Office
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COUNTY-ID:B300000052
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' ' a°"' December 28,199912:00 PM
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5823-29-1104
�Appraisal Card Page 1 of 1
,� , . . ,
DAVIE COUNTY NC 5 7 2013 2:38:44 VM
EST BILLY G Retum/AppealNotes: 63-000-00-052-07
322 BLEVINS RD UNIQ ID 500
2527678 ID NO:5823099209
_ COUN7Y TAX(100),FIRE TAX(300) CARD N0.Y of 1 �
• eval Year:2013 Tax Year:2013 0.913 AC BLEVINS RD � 0.880 AC SRC=Inspedion
raised b 02 on 04/21/2008 02003 EATON'S CHURCH TW-02 C- EX-AT- lAST ACTION 20120919
CONSTRUCTION MARKET VALUE DEPRECIATION GORRELATION OF VALUE r"'
DETAIL `�
OTAL POINT VAWE Eff. BASE '
BUILDING USE MOD Area UAL RATE RCN EYB AYB REDENCETO
AD7USTMENTS 97 00 %GOOD DEPR.BUILDING VALUE-CARD
OTAL ADJUSTMENT TypE:Vacant DEPR.OB/XF VALUE-CARD 8,45 ��, �
ACTOR MARKET UND VALUE-CARD � 14,84
OTAL QUALITY INDEX STORIES: OTAL MARKET VALUE-CARD 23 29
O7AL AVPRAISED VALUE-GRD 23,29
OTALAPPRAISED VALUE-PARCEL 2329
OTAL VRESENT USE VAWE-PARCEL �
OTAL VALUE DEFERRED-PARCEL
OTAL TAXABLE VALUE-PARCEL 23 29
PRIOR
UILDING VALUE �
BXF VALUE 4,50
ND VALUE 14,40
� RESENT USE VALUE
DEFERRED VALUE
OTAL VALUE 18,90
PERMIT
CODE DATE NOTE NUMBER AMOUNT
ROUT:WTRSHD:
SALES DATA '
PF.
� RECORD ATE DEED INDICATE SALES
. BOOK PAGE M R TVPE� U PRICE �
006E 326 9 00 WL X V
' 0325 176 2 00 WD U V 3300 �
0325 176 2 00 WD � U V 3300
0325 176 2 00 WD U V 3300 c
HEATED AREA �
c
NOTES
� DDED MHHUP REVAL 2009 ��
12 LISTING:14X28 STG. �
+v
SUBAREA � UNIT ORIG% ANN DEP % OB/XF DEPR. .
GS RPL ODE ESCRIPTIONITH HUNIT �RICE COND BLDG#L B AVB EYB RATE V COND. VALU
. TYPE AREA CS D8 H SITE 1 4,500.0 _ l 00 00 5 30 450
IREPLACE 1 ORAGE 1 2 28 15.0 O11 O11 S 9 394
UBAREA OTAL OB XF VALUE 8 448
OTALS
BUILDING DIMENSIONS - �
LANDINFORMATION
MIGHEST THER AD)USTMENTS LAND TOTAL � .
ND BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES ROA UNIT LAND UNT TOTAL ADIUSTED LAND LAND
SE CODE 20NING TAGE DEPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES
' URAL AC 0120 20 0 2.5680 4 0.9800 02+00+00+00+00 RP 6 700.0 0.88 AC 2.51 16 863.9 1484
OTAL MARKET LAND DATA 0.88 14,64
OTAL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parce1=B30000005207 5/7/2013