1571 County Line Rd CONSTRUCTION
For Office Use Only
AUTHORIZATION ��IS'I`I *CDP File Number 137174-.1
Davie County Health Department County ID Number. Fl-000-00-051-02
3 f r 210 Hospital Street
Evaluated For: REPAIR
.� ;.. P.O. Box 848Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone:336-753-6780 Fax: 336-753-1680 0 4 / 1 1 a 0 1 9
Applicant: Partick Brooks Property Owner: Partick Brooks
Address: Address: 1571 County Line Rd
City: City: Harmony
State/Zip: NC State2ip: NC
Phone#: Phone#:
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
1571 County Line Rd
Harmony NC Directions
Structure: SINGLE FAMILY Hwy 64 West, right on 901, then right on County Line Rd.
on left past Edwards Road
#of Bedrooms:
#of People:
'Water Supply: N/A
System Specifications
Minimum Trench Depth: a 4
rDesign
ssification: Provisionally suitable Inches
Minimum Soil Cover.
System? OYes QNo 1 a Inches
low: 3 6 0 Maximum Trench.Depth: 3 6 Inches
Soil Application Rate: 0 - a 7 5 Maximum Soil Cover: a 4 Inches
`System Classification/Description: 'Distribution Type: GRAVITY-SERIAL
TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
Gallons
=Proposed System: 25%REDUCTION 1-Piece: OYes O N o
Pump Required: OYes @No OMay Be Required
Nitrification Field 1 3 0 9 Sq. ft. Pump Tank: Gallons
No. Drain Lines .3 1-Piece: OYes ONo
Total Trench Length: 3 a 7 GPM—vs— ft. TDH
ft.-
Trench Spacing: Inches O.C.
9 _ gFeet O.C. Dosing Volume: _ Gallons
Trench Width: 3 @Inches
Feet Grease Trap: Gallons
Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-11
Septic Tank Installer G rade.Level Required: 01 O11 0111 ON
CDP File Number 137174 - 1 County ID Number: F1-000-00-051-02
Open Pump System She(
Repair System Required:OYes ONo ONo, but has Available Space
rDesign
System
Trench Spacing: Inches O.C.
ification: — Feet O.C.
Trench Width: 8Feet Inches
w: — ,
Aggregate Depth:
Soil
Application Rate: inches
Minimum Trench Depth:
*System Classification/Description: Inches
Minimum Soil Cover.
Inches
Maximum Trench Depth: Inches
*Proposed System:
Maximum Soil Cover:
Nitrification Field Inches
Sq. ft.
No. Drain Lines *Distribution Type:
TotatTrench Length: ft Pump Required: OYes ONo OMay Be Required
Pre Treatment: ONSF OTS-1 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 noway guarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
This Authorization forwastewater system Construction shall be valid fora person equal to the period of validity of the Improvement Permit not
to exceed five years,and may be Issued at"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
Im alld,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
Applicant/Legal Reps.Signature Required? Oyes ONo
Applicant/Legal Reps. Signature: Date:
*Issued By: 2140-Nations.Robert Date of Issue: 0 4 / 1 1 0 1 4
01
Authorized State Agent: �% Malfunction Log Oyes
QHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**.
A
CONSTRUCTION AUTHORIZATION 137974
Davie County Health Department CDP Fil Number:
210 Hospital Street FI-000.0"51-02
P.O.Box 848 County F061 Number.
Mocksville NC 27028 Date: 04 / 1 1 / x 0 1 4
Q Inch
OBlock
Drawing Drawing Type: Construction Authorization Scale: ONIA
Q N/q
1.fit
3
Ir5a
y
` COMPLAINT FORM „
s DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
�qtwDate ReceivedName of Complainant � #e4idiliv, Received By G�
Address �J9 t G(/a - S Telephone 3 3 /�V r 0 20
Complaint
Person Responsible for Complaint
Address 6�Uq4&4 00W Telephone
Directions to Complaint
Date Investigated Investigated By
Complaint Justified Complaint Not Justified
Action Taken
i e-() Q--
Date Environmental Health Staff Signature
(DCHD 1/85)
Appraisal Card Page 1 of 1
DAVIE COUNTY NC - 4/4/2014 2:31:48 PM
ROOKS PATRICK Retum/Appeal Notes: Parcel:F3-000-00-051-02
1571 COUNTY LINE RD PLAT:/ UNIQ ID 8502
2528304 D484-PIO ID NO:4890865279 Ownt
COUNTYTAX(100),FRE TAX(100) CARD NO.I of 1
eval Year:2013 Tax Year:2014 1.879 AC COUNTY LINE RD 1.720 AC - SRC=Inspection
Appraised by 02 on 06/13/2007 01002 CALAHAN TW-01 Cl- FR-14 EX- AT- LAST ACTION 20130618
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OFVALUE
oundation-3 1 Standard I 0.2200
ntinuous Footing 8.0c Eff. BASE
ub Floor System-4 S MO Area QUA RATE RCN EYB AYB REDENCE TO MARKET
lywood 11-OC 02 02 1,833 85 36.55 6789 200 00 %GOOD 78.0 EPR.BUILDING VALUE-CARD 52,96
Exterior Wails-10 TYPE:Manufactured Home(Muni) Manufactured Home 3EPR.OB/XF VALUE-CARD
Iuminum/Vin I Siding 32.00 4ARKET LAND VALUE-CARD 22,66
oofing Structure-03 STYLE:1-1.0 Story OTAL MARKET VALUE-CARD 75,62
ble 9.0
tooling Cover-03
ksphattorComposftion Shin le 5.0c TOTAL APPRAISED VALUE-GRD 75,62
nterior Wall Construction-4 TOTAL APPRAISED VALUE-PARCEL 75,62
lywood Panel 26.0
nterior Wall Construction-5 OTAL PRESENT USE VALUE-PARCEL
)rywall/Sheetrock 0.0c OTAL VALUE DEFERRED-PARCEL
nterior Floor Cover-08 TOTAL TAXABLE VALUE-PARCEL 75,62
heet Vinyl/Laminate 7.0
nterior Floor Cover-14 PRIOR
:arpet 0.0c 3UILDING VALUE 62,50
eating Fuel-04 35XFVALUE
Electric 1.0c LAND VALUE 21,98
eating Type-10 RESENT USE VALUE
eat Pump 5.0 EFERRED VALUE
Ir Conditioning Type-03 rOTALVALUE 84,48(
ntral 5.0
drooms/Bathrooms/Half-Bathrooms
2/1 0.00
edrooms PERMIT
AS-3 FUS-0LL-0 +-----------------64-----------------+ CODE DATE NOTE NUMBER AMOUNT
athrooms I W D D i
AS-2 FUS-0LL-0 1 1
If-Bathrooms O 0 OUT:WTRSHD:
AS-1 FUS-0 LL-0 I I SALES DATA
Ce +-----------------64-----------------+ FF. INDICATE
I B A S I ECORD ATE DEED SALES
AS-OFUS-OLL-O I I
OTAL POINT VALUE !09.00 1 1 OOK AGE R TYPE / / PRICE
BUILDING ADJUSTMENTS S I 0717 277 6 00 WD Q I 8200
all 2 BLAVG 0.900 I 1 0353 188 12 00 WD C V
Ize 3 Size 0.870 I 2
+4+ 6
Shape/Desigrq 3 1 FACTOR 3 1 1.000 I W D D I
OTAL ADJUSTMENT FACTOR E78C 9 I 1
OTAL QUALITY INDEX BE 1 9 I HEATED AREA 1,664
+4+ I
+----------42-----------------22...... NOTES
SUBAREA UNIT I ORIG% SIZE ANN DEP % OB/XF DEPR
GS RPL D AL ESCRIPTIO U1T N PRICE COND LDG FACT Y RATE V GOND VALUE'
TYPE AREA % CS rOTAL OB XF VALUE
AS 1,6§4 10 6081
DD 1 671021 617
REPLACE 2-Pre
Fabricated 90
UBAREA 6
OTALS 2,34 7,89
UILDING DIM ENSIONSWDD=N 1OW64S10E64SBAS=V64S15 WDD=W4S9E4M$S11E42 E22N26S.
ND INFORMATION
IGHEST THERADJUSTMENTS LAND TOTAL
D BEST USE LOCAL FRON DEPTH/ LND COND AND NOTES RDA UNIT LAND UNT TOTAL ADJUSTED LAND OVERRIDE LAND
SE CODE ZONING TAGE DE SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE VALUE NOTES
H HOMESrr 0201 298 0 1 1.8720 1 4 1.05001+10+00+00+00-05 RP 6,700.0 1.72C AC 1.96 13,172.2 2265E 0
OTAL MARKET LAM DATA 1.72C 22,66
OTAL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=F 10000005102 4/4/2014