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153 Cress Ln 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 #: 990005591 Tax PINI H#: 5769-87-0309 Billed To: Scott Jamie Subdivision Info: Reference Name: REPAIR PERMIT Location/Address: 153 Cress Lane-27006 Proposed Facility: Residential Repair Property Size: 15.17 Acres AT *fflW*Ae ss ance 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 r7C Tank Date Tank Size Pump Tank Size I System Installed By: E.H.Specialist: Wte : GPS Coordinate: b1 � 3 DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street - Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 REPAIR IMPROVEMENT PERMIT AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account. #: 990005591 Tax PINIEH#: 5769-87-0309 Billed To: Scott Jamie Subdivision Info: Reference Name: REPAIR PERMIT Location%Address: 153 Cress Lane-27006 Proposed Facility: Residential Repair Property Sizer 15.17 Acres AT lt•;W* Thi 5IP-/9Authorization 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 IP/AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat of 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 5 Q,(- Type of Water Supply: ❑County/City lKWell ❑Community Well System Specifications: Design Wastewater Flow(GPD) Tank Size1_(t AL.Pump Tank GAL. it , Trench Width� Max.Trench Depth 3(, Rock Depth Linear Ft.O _: 60-06 _ �(v� Site Modifications/Conditions/Other: ""`" n 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)753-6780. .9, 21— < y � SL Environmental Health Specialist DaEnvironmental DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME PHONE NUMBER ADDRESS '�3 Cr'e ss L441E SUBDIVISION NAME LOT# DIRECTIONS TO SITE rl-) 1Y. (V 10A &t6& &W10 Q res o DATE SYSTEM INSTALLED M3 NAME SYSTEM INSTALLED UNDER ==*'IYIP. TYPE FACILITY NUMBER BEDROOMS `3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBL9M OCCUR RIN E70, , o z: 3 DATE REQUESTED INFORMATION TAKE91BY This is to certify that the information provided is correct to the best of my knowledge.and that I understand t am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1/93 J 1 if DAVIE COUNTY HEALTH.DEPARTM ENT -`- I=MPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION f NOTE:Issued In Compliance With Article 11 of G.S.Chapter 130a ��3 0N '55 L.C� Sanitary Sewage Systems J e it Number Li- l_. ? .-f, � r, Date No Location - �� Subdivision Name' Lot No. Sec.or Block No. Lot Size House Mobile Home— Business Speculation No. Bedrooms No. Baths ,�) �9 "'No. in Family�— Garbage Disposal YES ❑ NO 0— Specifications for System: ._ Auto Dish Washer YES NO ❑ �v,) .; 01 Auto Wash Maohine YES NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. r, Improvements permit by 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-,55985. y' Final Installation Diagram: System Installed by �V Certificate of Completion Date `The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation,but shall in NO way betaken as a guarantee that the system will function satisfactorily for any qiven period of time. Appraisal Card - ffl-3 Page 1 of 1 leval IE COUNTY NC 7/7/20119:50:30 AM IE SCOTT F & JAMIE ANGELA C H7-000-00-058-06 CRESS LN UNIQ ID 13758 D439-P20 ID NO:5769870309 xQ COUNTY TAX,FIRE TAX CARD NO.1 of 1 Year:2009 Tax Year:2011 15.17 AC BRIER CREEK RD 15.110 AC SRC=Inspectionaised b 19 on 09/04/2008 07001 SHADY GROVE TW-07 C-EX- AT- LAST ACTION 20100922 CONSTRUCTION DETAIL MARKETVALUE DEPRECIATION CORRELATION OF VALUEndatlon-3 EH. BASEStandard 0.1600 tinuous Footin 5.0 SEMOD Area UA RATE RCN REDENCE TO MARKET Floor System-4ood 8.0 01 01 2 703 133 91.772507 419931993 N GOOD 84.0 DEPR.BUILDING VALUE-CARD 210 63 Crior Walls-21 TYPE:Single Family Residential Single Family Residential EPR.OB/XF VALUE-CARD 11,99 ace Brick 34.0 MARKET LAND VALUE-CARD 163,53 tooling Structure-03 STORIES:1.0 Story �- OTAL MARKET VALUE-CARD 386,15 able 8.0 tooling Cover-03 s halt or Composition Shingle 3.0 TOTAL APPRAISED VALUE-CARD 386,15 nterior Wall Construction-5 TOTAL APPRAISED VALUE-PARCEL 386,15 )rywall/Sheetrock 20.0 nterior Floor Cover-08 heet Vinyl 6.00 TOTAL PRESENT USE VALUE-PARCEL nterior Floor Cover-14 TOTAL VALUE DEFERRED-PARCEL :arpet 0.0c TOTAL TAXABLE VALUE-PARCEL 386,15 eating Fuel-03 PRIOR as 1.0 UILDING VALUE 195,47 eating Type-04 BXF VALUE orced Air-Ducted 4.0 ND VALUE 109,53 Ir Conditioning Type-03 RESENT USE VALUE entral 4.0 EFERRED VALUE drooms/Bathrooms/Half-Bathrooms rOTAL VALUE 305 OO 9 /2/1 13.000 I F G D I a drooms 1 I ^ AS-3FUS-0 LL-0 0 1 22_---+ 2 athrooms I P T O I 4 `+ AS-2 FUS-0 LL-0 1 1 I PERMIT alf-Bathrooms 4 4 I CODE DATE NOTE I NUMBER AMOUNT O a AS-I FUS-OLL-O I I 1 OTAL POINT VALUE 106.00 s-'' +-12--+0AS I OUT:WTRSHD: n BUILDING ADJUSTMENTS IWDD I I SALES DATA ize 3 Size 0.950 I I I uali 4 ABAVG 1.200 1 1 I FF. INDICATE N 8 6 I ECORD ATE DEEDjj SALES ha a/Desi n 5 FACTOR 5 1.100 1 1 3 OOK AGE M R TYPE / PRICE OTAL ADJUSTMENT FACTOR 1.25 +-12--1 2 0158 871 14 11991 WO V OTAL QUALITY INDEX 13 1 I I I 1 I 8 I I +-----28------+ +--14--+ HEATED AREA 2,3S2 I4FOP 4 4 +-14--+-----28------+-14--+ NOTES OG OPE BROS SUBAREA UNIT I ORIG% AN DEP % OB/XF DEPR GS OD DESCRIPTIONLTH H NIT PRICE CORD LDGYf AYB EYB RATE V GOND VALUE TYPE AREA % RPL CS 25 1BARN 1 41 3 1 58 15.0 10 L 1199211994 S 1 4 1164 AS 2,3 2 1001215843 10 ICON PAVING 1 241 241 5761 4.0 L 11992119921 SN 1 14 34 GD 5763451 23768 TOTAL OB XF VALUE 11,98E OP 112 3351357 PTO 30 8)0 137 DD 19232 348 N'RELArECE &.ATA 2 7050,75G DIAS=W4FGD-W24N24E24S24 W24PT0=W22N14E22SI4$W42S2WDD-WI2S16E12N16$534E14FOP-N4E28S4W28$N4E28S4E14N4E14N32 . FORMTHERAD]USTMENTSLAND TOTALT CAL FRON DEPTH/ LND COND ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND ING TAGE EPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES 380 01.0490 4 1.1100 OS+20+00-10+00 PW9300.0 15.10 AC 1.16 10 825.2 163525 ARKEA 15.10 16353ESE http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=670000005806 7/7/2011 wo �= ­­ DAVIE COUNTY HEALTH.DEPARTMENT 7-IMPROVEMENTS PERMIT AND .CERTIFICATE-OF COMPLETION *�NCTE:Issued in Compliance With Article II of G.S.Chapter 130a Ore5:5 Sanitary Sewage Systems i Zd @ it Number jN me, - ".//.�11�r; 1 ,�� ;��. �� � �.1., Date N2 �? . Location Subdivision Name Lot No. Sec. or Block No. Lot tSize House Mobile Home Business Speculation No. Bedrooms No. Baths `No. in Family _ Garbage Disposal YES E] NO g-- " Specifications for ySystem: Auto Dish Washer YES ❑ NO p 1 /. Auto Wash Ma.hine YES NO ❑ f C�Li 5 `/ �� Type Water Supply _ *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change. 1 1 Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985. Final Installation Diagram: System Installed by Certificate of CompletionDate *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of.time. 1 3, _ S , PPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT JV �- Davie County Health Department Environmental Health Section - P. O.- Box 665 1 Q y ( Mockaville, NC 27028, �,�•CC AP �O�_ fid- �.�`'9-�`- •,�' � . 1 . Application/Permit Requested By Mailing Address i Home Phone Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: neral Evaluation 0 S/Tank Installation S. System to Serve: ff--House u Mobile Home 0 Business Industry u Other 0 Unknown 6. If house, mobile home: Subdivision /' Sec. Lottt No. of People Dwelling Dimensions No. of Bedrooms J Basement/Plumbing No. of Bathrooms a � t- Basement/No Plumbing Washing Machinee--Dishwasher 0 Garbage Disposai 7. If business, industry, other Specify type No. of People Serve No. of SAiTks No. of Commodes No. No. of Lavatorie No. f ter Coolers No. of Showers . f 8. Type of water supply: B--ru blic 0 Private a Community 9. Property Dimensions �-�+• Z A < 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expas ions of the facility this system is intended to serve? Q Yes 2-No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to thEe best of my knowledge, anis- I understand I am responsible for all charcyes incurred , from this applic on. /� Ap/ Dae Signature Directions to Property : A n� ^ h J 1 P C �'- DCHD (10-89) r , Ar . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation /A �NAME ��_ DATE EVALUATED �Y ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE e� o����/ �[✓ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z — HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence LL / Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � r - SITE CLASSIFICATION: EVALUATED BY: AZ 2 LONG-TERM ACCEPTANCE RATE: 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 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 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(01-901 ■■■■■■■■■■■■■■■■E■■■■■■■N■■NN■EEEE■■■■■■■■■■■■■■■■■■■■■■■ENE■■■.■■ ■■■■■■■■■■■■■■■■■..■■■■.■■■■■■.■ ■■■.NE■■■NeetE■■E■■■■.■■■■i NOON ■■■■■■■■■■.■■■■■■■��%■INN■■i■■■■■■ ■■■■■■■■■■■■■■■■■►1■■■■■■■■ mom ■■E■ ■■■EE■■■■■N.■■E■i■■■EEE■■■■■1\EEEEE■■.■■■■E■E■■..■■.■■.`\■■■■■■�■■■ ■..■■.■N■■■■■��■...........■..■ ■.■..■■■■■.■.■■.■.....\`\■■.■ ONE ■■■■■.■■■■■■IE■E■■■■■■NEE■E■E■EEE■■N■.EEEN■■Eto■■■■■■■.■■■..■.e■ ■■..■■■■■■w■■■■■■■■■■■■■■■■.■.��.■rite..■.■..■■■■.■■■■■■■■■■■■■■■■a■ ■.ss■■■■�E■■.■■■.■■..E.E■■■r�r�■��►■■■■■■■■■■■■■■■■■■t■n■.■■Eta■■i�■w■ ■■■■■■.■►I■■■■■..■■■■■E■■■.■C/!%L'N��■■■■1�NOON■■1`l.■■■.■RC1■■■■■■■�■.■■ ■■■■■■■■%■■■■■■■■.■■■N■■.■/Ili■■■ ■■■■�/1■.■■Yi7.■■■■■■■■■■■■■00■■ ■■■■■■■�i■■E■E■E■■■EEEE■■N■■E■■■■■■■■■■■■■■■■■■Et.E■E■■■■■ ■■■A■■■■ ■■.■■■■■■■■■■■EEE■■.E■■■■■NN■■.■■EEE■■■Etw■■■■■■■■■■■■.■�..■■r�■■■■■ ■...■.■■.....w�■E■■.■■■■E......■ ■E■Eee.NE■E■EwE ■■ ■w�■ ■.NOON■ ■■■E■EEEEEE■■.ESE.■■■■■■■■EEEE■.�i■■■N■■.■■.■■■■■■■.■wwE■■■■�EE■■ ■■■.■.■■.■■■■■■■ ■■■■eEEE■■E■E■■■■■■■■■■■■■■■t.E■N■■■/.�■t.N■■ ■EE■ ■■■■■■■■■■■■ENE■NOON- ■■■■■■■■■■..■■■■■■■■.■..■ EH►N■■■■.■ ■■■■■■ ■ ■■■■■■■■■■■.■.■■.■■■■■■■■■..■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MMEMMME mom ME iiiiiii■■iii■iiiiiii■�iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�ii ii mom ................................ ................................ ■.■.■.■..■■■�::�EEE►\.00■■�■■EOE■■■■■■■■■■■.■■..■■■.■■■■■■■■.■■■■■ ■.....■N�EEE■w■EE■■■.E■t.■■■/�■\\t.!!mow■■■■..■■■■■■■■■■■■t■■■■■■w■ ■■■■■■■■■■■t■EEE■■■NEE.■EEE■I(/Jw.E.■■■t■E11���\■■■■■■■■■■■■Nt■■■■■■ ■■.■■■■■■■■■■■...■■■i■..0.■.■�..■■■■■■■..■■EE■■EEE■N■EE.EN■■■■■■■ ■■■■..■■■...■.■■■...■■■■■NOON■EN■■■■■ti■.■■■■■..■■■.■.■■■NONE■■■■ Davie County Nealtl Department and .Mame Nealt§i Ayency 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE,N.C. 27028 PHONE:(704)634.5985 April 29, 1991 Angelina & Scott Jamie c/o Potts Realty P. 0. Box it Advance, NC 27006 Re: Site Evaluation Off Greenbriar Road - 15. 2 Acres Dear Mr. & Mrs. Jamie: As requested, a representative from this office visited the aforementioned site on April 26, 1991. The site was found provisionally suitable for the installation of a ground absorption sewage system. If you have any questions, please feel free to contact this office. Sincerely, AW Robert B. Hall, Jr. , R. S. Environmental Health Section RH/wd Enclosure