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1198 Cana Rd 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 #: 990005852 Tax PIN:EH#: E400000029 Billed To: Carolyn Hines SubdivisionInfo: Reference Name: REPAIR PERMIT Location/Address: 1198 Cana Road-27028 Proposed Facility: Residence Property-Size: 3.35 Acres ATC Number: 5925 **NOTE**The issuance 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. System Type:_S.T.Manufacturer 5 IPA- Tank Date Tank Size �(�b Pump Tank Size Bedrooms System Installed By: uyLN Inspector#: Date: GPS Coordinate: N- Environmental Health Specialist: Date: V 12 iD 1 DCHD 11/06(Revised) 1 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AU'I:HORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005852 Tax PIN/EH#: E400000029 Billed To: Carolyn Hines Subdivision Info: Reference Name: REPAIR PERMIT Location/Address:: .1198 Cana Road-27028 Proposed Facility: Residence Property Size: 3.35 A res Site Type: ONew Repair OExpansion A I�WrT00horization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to.issuance of any building permit(s),(in compliance 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 _#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type # People #Seats Square Footage(or Dimensions of Facility) Lot Size 35 o,(— Type of Water Supply: OCounty/City ❑Well DCommunity Well System Specifications: Design Wastewater Flow(GPD) LW Tank Size ffiocb'AL.Pump Tank ./ GAL. Trench Width ?jEL Max. Trench Depth_ Rock Depths Linear Ft. Gp' ZS�ib Site Modifications/Conditions/Other: 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. I J Environmental Health SpecialistDate: 2 DCHD 11/06(Revised) 7" • Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005852 Tax PIN/EH#: E400000029 Billed To: Carolyn Hines Subdivision Info: Address: 708 Nottingham Road Location/Address: 1198 Cana Road-27028 City: Greensboro Property Size: 3.35 Acres Reference Name: Prop"(STV(STVi Wib§19d?Xrgment Permit DOES NOT authorize the construction of a wastewater systema An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ❑New XRepair ❑Expansion Permit Valid for: X5 Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms #People Basement Basement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): �_ Type of Water Supply: ❑County/City WVell ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial 0 n .225 Repair • Z Z� Site Plan Environmental Health Specialist Date111"n1"?-_ _ i.p.11-06 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC �� Davie County Environmental Health c e P.O.Box 848/210 Hospital Street Mocksville,NC 27028 APR sl 202 (336)753-6780/Fax(336)753-1680 plica ' e ation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both pe of Application: ew 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. APPLICANT INFORMATION Name lafif A�(,�J%� Contact Person Address Q Home Phone c City/State/ZIP L 0( Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is Xalid for 60 months with site plan;no expiration with complete plat.) Owner's Name /d e—S Phone Number o275�0� Owner's Address City/State/Zip6nwmbpre We- 24oq • Property Address / QN City Noe tSyai l 0270 Lot Size .3 3 5 re-1— Tax PIN# - 0000� 9 Subdivision Name(if a plicable) Section/Lot# Dir ns To Site: �Q/ Al - ,v 0 ,SSS -Ifthe answer to any of the following questions is•"Yes",supporting documentation must be attached: ' Are there any existing wastewater systems on the site? P—Yes _No Does the site contain jurisdictional wetlands? _Yes _No Are there any easements or right-of-ways on the site? 'Yes No N Is the site subject to approval by another public agency? Yes o Will wastewater other than domestic sewage be generated? Yes No IF RESID NCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plu Bing: ❑Yes ❑No IF NON-RESIDENCE 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: onventional ❑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 ❑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 locati g nd flagging or s ing the house/facility location,proposed well location and the location of any other amenities. �on ''"'^ a Site Revisit Charge T° = Property owner's or owner's legal representative signature Date(s): �Ap,^ / Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# - v Revised 11/06 Invoice# DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION t APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME �OI I 9 PHONE NUMBER ADDRESS "l b &nft- 1j• SUBDIVISION NAME /� ^/ LOT # DIRECTIONS TO SITE &of /v- �JI/ v / E�e000 �q �l-f OAJ 7 DATE SYSTEM INSTALLED �J�Z NAME SYSTEM INSTALLED UNDER TYPE FACILITY �5� NUMBER BEDROOMS NUMBER PEOPLE SERVED TYP WATER SUPPLY SPECIFY PROBLEM OCCURRING cS EI-40res DATE REQUESTED. Io , INFORMATION TAKEN BY ZA&e� This is to certify that the information provided is correct to the best of my knowledge.and that I understand I a responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT tirt„� Rev.1193 Appraisal Card Page 1 of 1 y View All Cards Next Card DAVIE COUNTY NC 4/10/2012 10:18:42 AM Q HINES CAROLYN RICH GODWIN MARGARET RICH Retum/Appeal Notes: E4-000-00-029 2 1198 CANA RD UNIQ ID 6168 •• 2529956 D122-PS ID NO:5831334171 = COUNTY TAX,FIRE TAX CARD NO.1 of 2 Z eval Year:2009 Tax Year:2012 3.35 AC CANA RD 2.670 AC SRC-Inspection raised by 19 on 07/07/2008 06003 WOODWARD TW-06 C- EX- AT- LAST ACTION 20100922 n CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE 70 A oundation-3 Eff. BASE Standard 10.43000 ontinuous Footing5.0 USE MOD Area UA RATE RCN EYB AYB REDENCE TO MARKET Z ub Floor System-4 I ood 8.00 01 1 01 12,4641 88 60.72 152414196 192 %GOOD 1 57.0 DEPR.BUILDING VALUE-CARD 86,880 Exterior Walls-14 TYPE:Single Family Residential Single Family Residential DEPR.OB/XF VALUE-CARD 0 .: 3iding Average 24.02 MARKET LAND VALUE-CARD 29,86 oofing Structure-03 STORIES:2.0 Stones TOTAL MARKET VALUE-CARD 116,74 • able 8.00 oofing Cover-03 TOTAL APPRAISED VALUE-CARD 116,74 s halt or Composition Shingle 3.0 TOTAL APPRAISED VALUE-PARCEL 120,03 ntenor Wall Construction-2 Nall Board or Wood Wall 14.0 nterior Wall Construction-5 TOTAL PRESENT USE VALUE-PARCEL )rywall/Sheetrock 0.0 - TOTAL VALUE DEFERRED-PARCEL ntenor Floor Cover-09 TOTAL TAXABLE VALUE-PARCEL 120,03 'ne or Soft Woods 8.0 +-----32-----+ PRIOR nterior Floor Cover-14 I F U 5 I UILDING VALUE 75,22 :arpet 0.02 I I BXF VALUE eatin Fuel 02 1 I 9 - 1 I AND VALUE 33,27 ii Wood or Coal 0-00 3 3 RESENT USE VALUE eating Type-03 3 3 DEFERRED VALUE orced Air-Not Ducted 2.00 I 1 rOTAL VALUE 108,49 r Conditioning Type-03 1 1 ntral !.Do I I I I drooms/Sathrooms/Haif-Bathrooms +-----32-----+ /1/0 8.000 PERMIT y drooms CODE I DATE NOTE I NUMBER AMOUNT AS-0 FUS-4LL-0 +-14--+ throoms +-1 1-+ 6 5 AS-1 FUS-0 LL-O I BA S +7+ +-9-+ OUT:WTRSHD: y I - I F E P I SALES DATA* TOTAL POINT VALUE 4.00 1 1 1 FF. INDICATE o BUILDING ADJUSTMENTS 1 5 5 ECORD DATE DEED SALES Duality3 AVG 1.000 I 1 I a BOOK PAGE M R TYPE PRICE Shape/Desigd 5 FACTORS 11.100C 4 1 F S P I 008E 049 1 2008 WL X I Size 1 3 1 Size .950 ro 0 1 3 1994E 1794 1 199 WL E I TOTAL ADJUSTMENT FACTOR 1.05 I 1 1 0095 066 11 1974 WD X I TOTAL QUALITY INDEX Sf 1 +-9-+ I I I 1 I 2 ++----2 8----++ HEATED AREA 2,492 8FOP 8 +----28----+ NOTES - IXED USE PROPERTY,INCOM APPROACH NOT USED SUBAREA UNIT BRIG% SI2E ANN DEP % OB/XF DEPR GS OD UA DESCRIPTIONLTH H NIT PRICE GOND BLDG#L/ FACT Y EY RATE V GOND VALUE TYPE AREA % RPL CS OTAL OB XF VALUE BAS1 30110 789971 EP 135 7 576 FOP 22*3 473 SP 9 24291 FUS 105 9 5768 LRURALAC CE 4 2,80 A 2181 152,41 G DIMENSIONS BAS=W34S6W7N3WI 1S40E2FOP=SSE28N8W28 E30N 12FSP=E9N 11 FEP=N1SW9S15E9 W9S11$N31$PrR=NIOFUS=N3 3W32S33E32$SIO$. FORMATION LAND TOTAL T USE LOCAL FRON DEPTH/ LND CON.rT.ERADILISTMENTS ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND CODE ZONING TAGE EPTH SIZE MOD FACTRF AC LC TO OT TYPE PRICE UNITS TYP AD75T UNIT PRICE VALUE NOTES 0120 400 0 - 1.5620 4 1.0700 07+00+00+00+00 RP 6 700.0 2.66 AC 1.671 I1 195.7 2985ARKET LAND DATA 2.66 29,86RESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E400000029 4/10/2012 GoMAPS - Davie County NC Public Access WATERSHED STRUCTURES .i WATER BODIES i COUNTY—BOUNDARY $ ADDRESS / i DRIVES STREETS �y RAILROAD—CENTERLINE f / PARCELS 1 CITY—LIMITS r/ EJ BERMUDA RUN aCOOL EEhtEE DAVIE COUNTY hfOCKSVILLE 120, EJ nccounties liltt /� DAVIE ! <all other values> ***WARNING:THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction,and is'compiled from recorded Tuesday,April 10 2012 deeds,plats,and other public records and data.Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map.The County and mapping company assume no legal responsibility for the information contained on this map. - - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005852 Tax PIN/EH#: E400000029 Billed To: Carolyn Hines Subdivision Info: Reference Name: Location/Address: 1198 Cana Road-2.7 8 Proposed Facility: Residence Property Size: 3.35 Acres Date Evaluated: 7i Water Supply: On-Site Well �`- Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% C HORIZON I DEPTH Texture group L L Consistence Structure Gr Mineralogy1 HORIZON H DEPTH Texture group Consistence Structure Nit Mineralogy ,1 HORIZON III DEPTHHo- Texture p- Texture group l Consistence Structure Mineralogy ;1 HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION IPS $ LONG-TERM ACCEPTANCE RATE ZZS SITE CLASSIFICATION: ? EVALUATION BY: LONG-TERM ACCEPTANCE RATE: J OTHER(S)PRESENT: REMARKS: LEGEND 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 Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 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 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-gal/day/ft2 DCHD 05105(Revised)