217 Bracken Rd (2) DAVIE COUNTY ENVIRONMENTAL HEALTH
- P.O.Box 848/210 Hospital Street
• Mocksville,NC 27028
(336)753.-6780/Fax# (336)753-1680
REPAIR OPERATION PERMIT
Account #: 990006014 Tax PIN:EH#: F30000006801 '
Billed To: Duncan Real Estate Subdivision Info:
Reference Name: :Rt;VA Sh leAd 02., LocationiAddress: 217 Bracken Road-27028
Proposed Facility: Residential Repair Properly Size: 0.99 Ac
ATC*Ptt OMt*T8®2suance of this Operation Permit shall indicate the system described on the ATC 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.
41CtMS W.M nufacturer Tank Date Tank Size
System Type: ,
Pump Tank Size Bedrooms 2>
System Installed By: j?QVX&j Ng1eAS0Ajnstaller#:1F' Date: 0 2d
Met
GPS Coordinate:
c
QEnvironmental Health Specialist: " 1, Date:-TAt
DCHD 11/06(Revised)
jjjuoi ee W33
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990006014 Tax PIN/EH#: F30000006801
Billed To: Duncan Real Estate Subdivision Info:
Reference Nance: LocationiAddress: 217 Bracken Road-27028
Proposed Facility: Residential Repair Property Size: 0.99 Ac
Site Type: DNew XRepair DExpansion
ATC Number. 6025
**NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
Health Section prior to.issuance of any building permit(s),(incompliance with Article 11 of G.S.Chapter 130A
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specifications: #Bedrooms_#Bathrooms _4 People Basement❑Basement plumbing❑
Non-Residential Specifications: Facility Type # People #Seats
(� Square Footage(or Dimensions of Facility)
Lot Size . —I Type of Water Supply: DCounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) Tank SizAL.Pump Tank / GAL.
Trench Width. Max.•Trench Depth Rock Depth Linear Ft. , `o�Srlo
Site Modifications/Conditions/Other. ht CFS �'J
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the day of installation. Telephone# 336 751-8760.
J
Environmental Health Specialist Date:
DCHD 11/06(Revised)
� 3 C � uv� X33
J 'e, l ruin h dt a& '.ml
DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST
Vol APPLICATION IP/ATC OSWW REPAIR « �
Name &1ja buml4q� Telep one Number q171 "
Address 41ZN11106(Z- A101
Mailing Address (if different from above)
Email Address:-
Subdivision Name Lot# 6,9 Ma-
Directions oe-I-) -94�e 0 A
Date System Inst fled Name System Installed Under
Type Facility Number Bedrooms Number Pe' le Served
Type Water Supply Specific Pr blem Occurring U e
iG �/ d q <�
I6 to Requested Info Taken By
THIS IS TO CERTIFY HAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY
KNOWLEDGE,AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS
Revisit Charge Date Reason &26q
Revised 2-2011
DTAVIE COUNTY ENVIRONMENTAL;HEALTH SERVICE REQUEST
.. - APPLICATION IP/ATC OSWW REPAIR ��� MY#
'
i
Name ` /1�n �N Telep one Number 0171 "
Address klelux1d, (/
Mailing Address (if:,different from above)
Email Address: .• , 3, ,y
Subdivision Name Lot#
Directions -h d'ke"& e 4tZ PO-A.i LC
Date System Inst lled Name System Installed,Under Orl /L
Type Facility Number Bedrooms 1 Number Peo le Served
Type Water Supply Ujoff :� ��` Specific Pr blem Occurring
1QA AZO I'd �e�i lq'ltl��Iod --.5al'Z
D&Re uested `
• TakenBy , f :... ,
a THIS IS TO CERTIFY HATTHE INFORMATION;PROVIDED IS"CORRECT TO THE BEST OF MY
KNOWLEDGE,AND THAT I,UNDERSTAN*HAT I`A4.RESPONSIBLE FOR ALL;CHARGES INCURRED
FROM THIS APPLICATION.
`r
Signature of owner or Authorized Agent r r' `
Initial Fee Date REHS
Revisit Charge Date Reason ?Qq
Revised 2-2011
DAVIE COUNTY HEALTH DEPARTMENT
,(Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absor tion Sewage Disposal System G.S. Chapter 130-Agticle 13C)
OWNER OR CONTRACTOR i�r-,\�l -- .;,VJE?5 DATE 7� Yi r. PERMIT
LOCATION t"311A " f i N9 1895
Q"X-" . S.R. NO,
SUBDIVISION NAME ffi-a LOT NO. SECTION OR BLOCK NO.
HOUSE MOBILE HOME E3 BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS r, NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 0--' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES 99— NO ; ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO . ❑ , �"`"'
SITE SUITABLE YES NO ❑ i-Vi -.
SIZE OF TANK Cj ! gal. -
.
NITRIFICATION FIELD sq* ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Q" Public ❑ ` •�'�. �`Id41
IMPROVEMENTS PERMIT. BY C`a rCINSTALLED BY -
J i
c
CERTIFICATE OF COMPLETION By Date 107179
r_
(8/16/73) *Construction must comply with ala other applicable State and local 4egulfitions
LOT AREA
J
�r
DAV IE COUNTY HEALTH DEPARTMENT �
P . 0. BOX 57
MOCKSVILLE, N. C . 27028 /
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME N ' � Ic���S DATE ISSUED
�+a7 I t SA „.►
ADDRESS w�� ~ �- PERMIT NO.
(11ocVS�:11�
Explanation of charge
AMOUNT DUE SANITARIAN ' I ►�m�a
`, PLtASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT,
DAVIE COUP!TY HEALTH DEPT.
RERCOLITION TEST RESULTS
1
DATES O
Y 4 NAf�E' c'1%l. L. /vai��C2 d`7 Ql
t OCp -ION ��� :24
} j COWE NTS
t j � , , �: •HOLE NO. _ -j �rJ.� ��i ��'�-*-P�`�"`
ti FIFeMUGS: 1270 -
i
,
3 ,
4 wl ,
s f - �;•
Lot' 71
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Appraisal Card Page 1 of 1
DAVIE COUNTY NC 1/31/2013 8:04:00 AM
OHNSON DONALD S JR JOHNSON NANCY A Retum/Appeal Notes: F3-000-00-068-01
17 BRACKEN RD UNIQ ID 8779
2524395 20031-14 ID NO:5821206077
COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1
eval Year:2013 Tax Year:2013 1.000 AC BRACKEN RD 0.990 AC SRC-Inspection
Appraised by 28 on 02/23/2009 02003 EATON'S CHURCH TW-02 C- EX-AT- LAST ACTION 20120409
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE
Z
oundation-3Eff. BASE Standard 10.26000 'L
ontinuous Footing 5.0 N
US MO Area UA RATE RCN EYB AYB CREDENCE TO MARKET O
ub Floor System-4 01101 11,6681116 181.201135441119BA197 %GOOD 1 74.0 DEPR.BUILDING VALUE-CARD 100,23
'iywood 8.00
xterior Walls-21 TYPE:Single Family Residential Single Family Residential DEPR.OB/XF VALUE-CARD 2,70 D
ace Brick 34. MARKET LAND VALUE-CARD 18,30
STORIES:1-1.0 StoryOTAL MARKET VALUE-CARD 121,23
oofing Structure-03 t7
able 8.0cv
oofing Cover-03 TOTAL APPRAISED VALUE-CARD 121,23
ksphatt or Composition Shingle 3.DC TOTAL APPRAISED VALUE-PARCEL 121,23
nterior Wall Construction-5
)rywall/Sheetrock 20.00 TOTAL PRESENT USE VALUE-PARCEL
nterlor Floor Cover-12 TOTAL VALUE DEFERRED-PARCEL
ardwood 10.0c TOTAL TAXABLE VALUE-PARCEL 121,23
nterlor Floor Cover-14
0.0c PRIOR
eating Fuel-04 BUILDING VALUE 101,44
lectric 1.0c BXF VALUE 93
eating Type-SO ND VALUE 17,75
' eat Pump 4.0 RESENT USE VALUE
Ur Conditioning Type-03 EFERRED VALUE
OTAL VALUE 120,120
ntral 4 0
3edrooffis/Sathrooms/Half-Bathrooms
/1/1 11.00
rooms PERMIT
-3 FUS-0 LL-0 CODE I DATE I NOTE I NUMBER AMOUNT
throoms +--1 6•--+
-IFUS-OLL-O IWDD +---20----+ 9
atf-Bathrooms I IPTG I OUT:WTRSHD: a
1 1 1 SALES DATA
-1 FUS-O LL-0 4 2 2 FF. INDICATE ••
DIAL POINT VALUE 108.00 1 1 1 RECORD ATE DEED SALES '^
BUILDING ADJUSTMENTS IBA----29 +--16---+-B-+FGD +-13 I BOOKPAGEM R TYPE / PRICE w
ize 3
Size 1.020 I I I 0606 592 5 00 WD Q I 12300
uall 3 AVG 1.000 I I I 0359 678 2 001 WD Q 1 10100
ha a Desi 4 FACTOR 4 1.050 I I I 0163 541 4 199 WD Q I 5600 0
TOTAL ADJUSTMENT FACTOR 1.07 2 2 2 0177 937 12199 NW U 1 00
TOTAL QUALITY INDEX 11 I I I m
I I I r
I I I
+-----25-----+5+----23-----+----25---•-+ HEATED AREA 1,325
-STP
+5+ NOTES
SUBAREA UNIT ORIG% - ANN DEP % OB/XF DEPR,
GS ODEEORAGE
SCRIPTIO T NIT PRICE COND LDG /B AYB EYB RATE V GOND VALUE
TYPE AREA %RPL CS 1 ORAGE 1 1 1 15.0 10 _ L 1981199 5 31 67
1 32 10 10759 1 1 1 1 15.0 011 011 S 9 203
GD 62504d 22817 TOTAL OB XF VALUE 2,70C
O 24C 30 97
P 2 2 40
OD 22 2 3654
IREPLACE 1-None
UBAREA 2,43 135,44
.LS
UILDING DIMENSIONS PTO-W20 WDD-N2W16S14E16N12 S12 BAS=W45S25E25 STP=SSESN5W5S E28 FGD=E25N25W25525$N25W8 E20N12$.
ND INFORMATION
IGHEST THER ADJUSTMENTS LAND TOTAL
D BESTALOCAL FRO DEPTH/ LND CO.. ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND
SE ZONING TAGS EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES
URAL AC 179 0 2.5050 4 1.10001+1 +00+00+00+00 RP 6,700.0 0.991 AC 2.75 18 465.2 1829
OTAL MARKET LAND DATA 0.991 18,30
OTAL PRESENT USE DATA
http://rraps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=F30000006801 1/31/2013