117 Camellia Ln HEALTH DEPARTMENT RELEASE Forot;Flceuse only
• t *CDP File Number 121851 -1
Davie County Health Department
F3-000-00-098
d�. 210 Hospital Street County ID Number.
. .� V P.O. Box 848 Evaluated For. HDRhVWC
Mocksville NC 27028
Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID 0 6 1 1 1 / 2 0 1 8
UNTIL
Applicant: Chris Buffone Property Owner: Chris Buffone
Address: 117 Camellia Lane Address: 117 Camellia Lane
City: Mocksville City: Mocksville
State0l): NC 27028 State0p: NC 27028
Phone#: (336)588-7374 Phone M (336)588-7374
Property Location&Site Info enation
rl:�A-ddressL'17camelliaLane Subdivision: Phase: Lot
Road# Mocksville NC 27028SINGLE FAMILYTownship-.
Structure: Directions
#of Bedrooms: #of People: Hwy 601 n,right on Danner,Hou on comer of Danner and camelilia
Lane Driveway is in back of house and entered from Danner Road side
*Water Supply: N/A
Basement: n Yes❑No Type of Business:
Total sq_Footage: No.Of Employees:
*Proposed Improvement:
Bann
`Release Conditions
It Is the responsibility of the owner to maintain a 5'minimum setback between the wastewater system and any part of the structure
foundation,including porches;decks,and any other appurtenances. If you are unsure as to the exact location of the septic system,please
have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the
proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this
property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed.
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps.Signature Required? QYes 0 N
Applicant/Legal Reps.Signature: *Date:
*Issued By: 2244-Daywalt,Andrew *Date of Issue: 0 6 1 1 2 0 1 3
Authorized State Agent:
**Site Plan/Drawing attached.** TotalTime:(HH:MM)
0 1 Hours O O Minutes
E)Hand Drawing OImport Drawing
N Nd f Fid d UP 61-1,Y14
Davie County Health Department
X18 t� Environmental Health Section ,
P.O. Box 848 1
. S0 , � 210 Hospital Street ��� I�o1
O �'S Courier# : 09-40-06 (",
Mocksville, NC 27028 .11��`�3
Phone:(336)-753-6780 ' ' Fax:(336)-751-8786
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
Name: NA"'13 Phone Number �31p"�S8'737� Home
Mailing Address:/ 7 a?Gf�/Gt Lcc-r!e (Work)
l WkoU/lk Nc- x7028 Email //Vase
Detailed Directions To Site: !�01 A , f�i6j k-,4o;;7 /`7`�uSe O>'f e'.'02d/ex
Property Address: //,7 e!?ot7e-4!A lle� /K.0y/Ile Al C- v?76 Z f
Please Fill In The Following Information.About The EXISTING Facility: F3-y)o0_0o--0`n
V
Name System Installed Under: /C.aSS6� Type Of Facility: A Ve14es/cls e-e-
Date System Installed(Month/Date/Year): H73�_ Number Of Bedrooms: Number Of People: Z
Is The Facility Currently Vacant? Yes No If Yes,For How Long?
Any-Known Problems? Yes If Yes,Explain:
Please Fill In The Following Information About The NEW Facility:
Type Of Facility: C(X A) Number Of Bedrooms: Number of People O
Requested By: Date Requested: J`—/Z�A 3
(Signature)
For Environmental Health Office Use Only
Approved Disapproved,
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee
(extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Check Money Order Amount:$_JAJ:>� Date: 1
Paid By: [iClri 5 �- Received By V
Account#: ON Invoice#:
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Appraisal Card Page 1 of 1
DAVIE COUNTY NC 5/31/2013 9:47:01 AM
ARSDEN GWENDOLYN Z Retum/Appeal Notes: F3-000-00-098
117 CAMELLIA IN UNIQ ID 8844
2532075 D34-P27 ID NO:5820566061
COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1
eval Year:2013 Tax Year:2013 9.94 AC DANNER RD 9.850 AC SRC-Inspection
Appraised by 02 on 04/21/2008 02003 EATON'S CHURCH TW-02 C- EX-AT- LAST ACTION 20130306
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE 7
oundation-3 EfY BASE Standard 0.2800 G
ontinuous Footing5.0 USE MO Area QUA RATE RCN EYB AYB CREDENCE TO MARKET
ub Floor System-4 m
Z
)lywood 8.00 01 0112,26411 6 74.20 17024 198 197 %GOOD 1 72.0 DEPR.BUILDING VALUE-CARD 122,57(
Exterior Walls-21 TYPE:Single Family Residential Single Family Residential DEPR.OB/XF VALUE-CARD 7,58 m
ace Brick 34.00 MARKET LAND VALUE-CARD 75,23 Z
STORIES:5-Ranch w/basement TOTAL MARKET VALUE-CARD 205,38
Doting Structure-03 p
able 8.0c r-
{
oo0ng Cover-03 Z
haft or Composition Shingle 3.0 OTAL APPRAISED VALUE-CARD 205,38
N
OTAL APPRAISED VALUE-PARCEL 205,36
nterlor Wall Construction-5
)rywall/Sheetrock 20.0 -
nterior Floor Cover-08 OTAL PRESENT USE VALUE-PARCEL
heet Vinyl/Laminate 6.00 OTAL VALUE DEFERRED-PARCEL
nterior Floor Cover-14 OTAL TAXABLE VALUE-PARCEL 205,38
met 0.0 --------------62--------------+ PRIOR
eating Fuel-04 I U B M I WILDING VALUE 128,75
lectric 1.0o I I BXF VALUE 9,35
eating Type-02 1 1
seboard Heat 3.0 2 2 ND VALUE 78,17
4 4 RESENT USE VALUE
r Conditioning Type-03 1 I EFERRED VALUE
ntral 4.00 1 I TOTAL VALUE 216,270
rooms/Sathrooms/Half-Bathrooms 1 1
/2/1 13.00 +-------------62--------------+
r00ms
-3 FUS-0 LL-0 PERMIT
throoms CODE I DATE I NOTE i NUMBER AMOUNT
-2 FUS-0LL-O
alf-Bathrooms +---2 0----+-12--+
-I FUS-0 LL-0 I W D D I F E P I OUT:WTRSHD:
1 1 1 SALES DATA
ce 0 0 0 FF. INDICATE m
+-----30------+---20----+-12--+ ECORD ATE DEED SALES n
OTAL POINT VALUE 105.00 I B A S I OOK PAGE M R TYPE PRICE
BUILDING ADJUSTMENTS
Uallty 1 3 AVG 1.000C I I 0915 134 1�01 WD U I 18500 2 2 0830 560 7O1 WD U I 17800ha Desi 4 FACTOR 4 1.050 4 4 0167 32 3 99 WD U V 8500 0
lze 3 Size 0.9600 I I o
OTAL ADJUSTMENT FACTOR 1.01C I I o
OTAL QUALITY INDEX1 06 I I
+----25-----+-12--+----25-----+ ea
I F O P I HEATED AREA 1,928
8 8
+-12--+ NOTES
SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR.
TYPE GS AREA % RPL CS ODE DESCRIPTIO LT N PRICE GOND BLDG B AYB EYB RATE V GOND VALUE
AS 1 80 10 13415 5 RN 3 3 9 15.0 10 _ L 197 198 5 1 256
P 12 07 623 D8 H SITE 1 4,500.0 1 _ L 19 19 S 10 450
OP 9 03 252 1 ORAGE 1 8 15.0 10 _ L 199 19 S 4 51
BM 1,48102 2211 5 ODD FENCE 24 15.9 198 198 S5 0
DD 2 02 296 a OB XF VALUE 7,581
[REPLACE 3-1 Story 2,25Sin le
AREA 3,71 170,24ALS
LDING DIMENSIONS FEP-W12SIOEI2NIO$BAS=W12 WDD=W20SIOE20NIO$W20S10W30S24E25 FOP=S8El2N8W12 E37N34 PTR=N40 UBM=W62S24E62N24 S40$.
D INFORMATION
HEST THER ADJUSTMENTS LAND TOTAL
BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND
CODE ZONING TAGE EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNITPRICE VALUE NOTES
AL AC 0120 402 0 1.1520 4 0.9900 O1+00+00+00+00 RP 6,700.0 9.84 AC 1.14 7,638.0 7522AL MARKET LAND DATA 9.84 75 23AL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=F300000098 5/31/2013