595 Duke Whitaker RdOPERATION PERMIT
Davie County Health Department
t 210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Terry W and Sandra E Dyson
Address: 595 Duke Whitaker Rd
City: Mocksville
State/Zip: NC 27028
Phone #:
*CDP File Number 122070 -1
E2-000-00-008-02
County ID Number:
Evaluated For: REPAIR
Qownship:
Property Owner: Terry W and Sandra E Dyson
Address: 595 Duke Whitaker Rd
City: Mocksville
State/Zip: NC 27028
Phone #:
Address/Road #: Subdivision: Phase: Lot:
Terry Wayne and Sandra Edwards Ditke ( IIWAkxAj
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY 601 N. to Liberty Ch Rd, to Bear Ck Ch Rd, then
Duke Whitaker
# of Bedrooms:
# of People:
*Water Supply: N/A
*IP Issued by: 2244 - Daywalt, Andrew
*CA issued by: 2244 - Daywalt, Andrew
Design Flow: 3 6 0
Soil Application Rate: 0 3
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
Minimum Trench Depth:
Minimum Soil Cover:
Maximum Trench Depth:
Maximum Soil Cover:
EWfjwr I "T
inches
*System Classification/Description:
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? O Yes CK No
*Distribution Type: N/A Pump Required?
8 Yes XNo
*Pre -Treatment:
Sq. ft.
8Inches O.C.
Feet O.C.
Inches
Feet
Inches
Inches
Inches
Inches
Page 1 of 4
*System Type: GRAVEL/TRENCH
Installer: homeowner
Certification #:
*EHS: 2244 - Daywalt, Andrew
Date:
Approval Status ,
® Approved ❑ Disapproved-' `
CDP File Number 122070 - 1
Countv ID Number: E2-000-00-008-02
Manufacturer:
used tank
Gallons:
No (Min. 6 in.)
Lat.
/
Riser Sealed ❑
Yes
Riser Height: ❑
Yes
Long:
,
STB:
Yes
Inches
Gallons:
1000
Installer:
homeowner
Date:
Valves Accessible
❑
Certification #:
No
Flow Adjustment Valve
❑
Yes
❑
*EHS:
2244 - Daywalt, Andrew
*Filter Brand:
❑
Yes
❑
No
PVC Unions
❑
Yes
❑
No
ST Marker:
El Yes
El
No
Date:
nforced Tank:
❑ Yes
❑
No
No
Approval Status
®
Approved ❑ Disapproved
1 Piece Tank:
❑ Yes
❑
No
Pump Tank
Manufacturer: Installer:
PT:
No
Gallons:
No (Min. 6 in.)
Date:
/
Riser Sealed ❑
Yes
Riser Height: ❑
Yes
nforced Tank: ❑
Yes
1 Piece Tank: ❑
Yes
rA
❑
No
❑
No (Min. 6 in.)
❑
No
❑
No
/ Pipe Size: inch diameter
Pipe Length: feet
*Schedule:
Pressure Rated ❑ Yes ❑ No
Approved fittings ❑ Yes ❑ No
/
Pump Type:
Dosing Volume:
-
Draw Down:
Inches
*Chain:
Valves Accessible
❑
Yes
❑
No
Flow Adjustment Valve
❑
Yes
❑
No
Check -valve
❑
Yes
❑
No
PVC Unions
❑
Yes
❑
No
Vent Hole
❑
Yes
❑
No
Anti -siphon Hole
❑
Yes
❑
No
Su
Certification #:
*EHS:
Date:
Approval Status
❑ Approved ❑ Disapproved
pply Line
Installer:
Certification #:
*EHS:
Date: / /
Approval Status
❑ Approved ❑ Disapproved
Installer:
Gal Certification #:
*EHS:
Page 2 of 4
Date: / /
Approval Status
❑ Approved ❑ Disapproved
CDP File Number 122070 -1 County ID Number: E2-000-00-008-02
Electric Eauioment
NEMA 4X Box or Equivalent
❑
Yes
❑
No
Installer:
Box 12 inches Above Grade
❑
Yes
❑
No
Certification #:
Box Adj. To Pump Tank
❑
Yes
❑
No
Conduit Sealed
❑
Yes
❑
No
*EHS:
Pump Manually Operable
❑
Yes
❑
No
*Activation Method:
Date:
Approval Status
Alarm Audible
❑
Yes
❑
No
El
Approved ElDisapproved
Alarm Visible
El
Yes
1:1
NO
2244 - Daywalt, Andrew
*Operation Permit completed by
Authorized State Agent: Date of Issue: 0 9 / ol 5 / x 0 1 3
This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE II A. sewage septic System.
Rule .1961 requires that a Type TYPE 11 A.
septic system meet the following criteria:
Minimum System Review By The Local Health Department: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator for the life of the septic system.
Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements for maintenance and
operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the
system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
(& Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Activity Code: S-19 2GT - OP issued NEW Type II Grave Trench
Page 3 of 4
Total Time:(HH:MM)
0 1 Hours 0 0 Minutes
OPERATION PERMIT 122070 - 1
Davie County Health Department CDP File Number:
210 Hospital Street E2-000-00-008-02
P.O. Box 848 County File Number:
Mocksville NC 27028 Date:
O Inch
Drawing Drawing Type: Operation Permit Scale: , 00 Nlock ft.
kof
`b,
cs�„ U�-
V
OPERATION PERMIT
Davie County Health Department
210 Hospital street CDP File Number:
P.O. Box 848 E2-000-00-008-02
Mocksville NC 27028 County File Number:
Date: /
Click below to import an image from an external location: Drawing Type: Operation Permit
Page 4 of 4 P1 P2 P3
Drain Field: I System Final Inspection Log_
Septic Tank:
Pump Tank:
Supply Line:
Pump Requirements:
Electrical Equipment:
P1 P2 P3
i
A= CONSTRUCTION
AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
- - For Office Use Oniv
"CDP File Number. 122070 -1
County ID Number. E2.000.00.008-02
Evaluated For: REPAIR
Township:
Phone: 336-753-6780 Fax: 336-753.1680 0 6/ 2 5/ 2 0 1-- 8
Applicant: Terry W and Sandra E Dyson
Address: 595 Duke Whitaker Rd
City: Mocksville
State 2ip: NC 27028
Phone -:
Address!Road "": Subdinrision:
Terry Wayne and Sandra Edwards
Mocksville NC 27028
Structure: SINGLE FAMILY
of Bedrooms:
9 of People:
*Water Supply: RIA
Property Owner: Terry W and Sandra E Dyson
Address: 595 Duke Whitaker Rd
CRY: Mocksville
StatefZip: NC 27028
Phone r:
Phase: Lot:
Directions
601 N. Jo Liberty Ch Rd„ to Bear Ck Ch Rd, then Duke
Whitaker
h1inimum Trench Depth:
Inches
Site Classification: \
ttinimum Soil Cover.
Saprolde System? OYes Co 1.10 Inches
Design Flow: Maximum Trench Depth: Inches
Soil Application Rate. Maximum Soil Cover: Inches
'System Classificationr0escription; *Distribution Type:
Septic Tank:
Gallons
'Proposed System: .1-Piece:�0Yes ONo
Pump Required: Oyes ONo () tIay Be Required
1.1iirification Field
Sq. ft. Pump Tank: Gallons
No. Drain Lines 1 Piece: OYes QNo
Total Trench Length: ft GPf.t-ys-• ft. TDH
french Spacing: _ 21riches'O.C. Dine Volume: Gallons
Feet O.C.
Trench Width: Inches
8Feet Grease Trap:_ Gallons
Aggregate Depth: inches Pre Treatment: ONSF OTS -I OTS -11
Septic Tank InstallefGrade Level Required: 01 011 0111 01V
6 /0
7 Page i of 3 0--A 5
CDP File Number 122070-1 County ID Number:
E2-000.00-008-02
❑ Open Pump System Sheet
Repair System Required:OYes O No ONo, but has Available Sime
Aepair System
Trench Spacing: 0 Inches O.
*Site Classification: PS 0 Feet O.C.
Trench Width: 0Inches
Design tlw., : .3 6 0 _ ()Feet
Aggregate Depth:
Soil Application Rate: 0 - 3 inches
Minimum Trench Depth:
*System Classification/Description: Inches
TYPE II A. COW SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. Inches
Maximum Trench Depth:
*Proposed System: 25%REDUCTION Inches
Maximum S&I Ccvor.
Nilrification fiel• ft.
Inches
Sq. .
*Distribution Type:
No. Drain Lines
Total Trench Length: 8 4 ft.
Pump Required:
()Yes
()No ( May 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.
f
'Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit; not
to exceed five years, and Maybe issued at the sane time the Improvement Permit Issued (NCGS 130A -336(b)} If the Installation has not been
completed during the period of validity of the Constructlon Permit, the Information submitted In the applicatlon 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
Invalid, and maybe suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible forassuring compliance
with the laws, rules, and permit conditions regarding system location, Installation, operation, malntenance, monitoring, reporting and repair
(1938(b)).
ApplicanUl-egal Reps. Signature Required? OYes ONO
Applicariftegal Reps. Signature* Date:
*Issued By: 2244 - Daywalt, Andrew Date of Issue: 0 6 / 2 5 / 2 0 1 3
Authorized State Agent: r � Malfunction Log OYES f
wrlano urawing vimpori urawing TotalTime:(HH:MM)
**Site Plan/Drawing attached.**
Page 2 of 3 0 1 Hours _ 0 0 Minutes
S-10 - CA'S issued - repair
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
DrawinQDrawing Type: Construction Authorization S
Pane 3 of 3
CDP File Number: 122070 -1
County Fite Number: E2-000-00-00&02
Date: 06/25/2013
Q Inch
A
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a-praisal Card
Page 1 of 1
areenmaa.ay.c• su
YSON TERRY WAYNE DYSON SANDRA EDWARDS
Retum/Appeal Notes: E2-000-00-008-02
95 DUKE WHITTAKER RD
UNIQ ID 5773
3068000
D10 -P11 ID NO: 5801745204
COUNTY TAX (100), FIRE TAX (100)
GRD NO. I of 1
eval Year: 2013 Tax Year: 2013
11.04 AC DUKE WHITAKER RD
10.710 AC SRC- Inspection
kppralsed by 01 on 04/14/2008 02001 BEAR CREEK CHURCH
TW -02 C- EX- AT- LAST ACTION 20110722
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION
CORRELATION OF VALUE
oundation - 3
Eft BASE
Standard 0.3000
ontinuous Footing5.0
US MO Area UA RATE RCN EYB
AYB
REDENCE TO MARKET
ub Floor System - 4
Iywood
xterior Walls - 09
ood on Sheathingor Plywood
Doting Structure - 03
8.00 01101 11 6471110177.001126819 198A1 S % GOOD 70.0
TYPE: Single Family Residential Single Family Residential
30.0
STORIES: 5 -Ranch w/ basement
)EPR. BUILDING VALUE -GRD
88 77
)EPR. OB/XF VALUE -GRD
ARKET LAND VALUE - GRD
TOTAL MARKET VALUE -GRD
19,82
65,67
174,26
able
8.0
TOTAL APPRAISED VALUE - GRD
TOTAL APPRAISED VALUE - PARCEL
174,2
174,2
Doling Cover - 03
s halt or Composition Shingle 3.00
nterior Wall Construction - 5
)rywall/Sheetrock
20.0
nterior Floor Cover - 14
TOTAL PRESENT USE VALUE - PARCEL
134,34
:arpet
6.0TOTAL
VALUE DEFERRED - PARCEL
39,92
eating Fuel - 04
TOTAL TAXABLE VALUE - PARCEL
134,34
lectrlc
1.0
PRIOR
eating Type - 10
UILDING VALUE
89,14
eat Pum 4.0
Ir Conditioning Type - 03
BXF VALUE
24,21
entral
4.0
AND VALUE
63,71
drooms/Bathrooms/Half-Bathrooms
RESENT USE VALUE
21,80
/2/0
12.00
DEFERRED VALUE
41,91
rooms
TOTAL VALUE
177,06(
AS-3FUS -0LL-0
throoms
AS FUS -0LL-O
Moe
AS - 0 FUS - 0 LL - 0
PERMIT
CODE DATE NOTE NUMBER AMOUNT
OTAL POINT VALUE
101.00
+ - - 20--+- - 2,4---+
I U 8 M I B F G I
BUILDING ADJUSTMENTS
I I I
OUT: WTRSHD:
Uell 3 AVG 1.000 2 2 2
ha Desi 4 FACTOR 4
ixe 3 Size
OTAL ADJUSTMENT FACTOR
OTAL QUALITY INDEX
1.050 + - 1 6 - +
1.040 1 W D D 1
1.09 +-16-+---28----+
11 I B A S I
8 8 8
I I I
+--20--+--24-. - +
SALES DATA
FF.
RECORD DATE
DEED
TYPE�/J/j
INDICATE
SALES
PRICE
BOOK PAGE M R
159 380 5 1991
WDU
I V
I I
2 2
8 8
I I
I I
+-17--+---27---+
HEATED AREA 1,232
NOTES
5 F 0 P 5
`FGD'S ALL ONE BUT TWO SI
ES
SUBAREA
UNIT
ORI- % ANN DEP % OB/XF DEPP.
GS
ODE ESCRIPTIONLT NIT PRICE
COND LDG B AYB EYB RATE OV' COND
VALUE
TYPE AREA % RPL CS 1 ORAGE 1 1 19 15.0
1 _ L 198 1983 S3 10
28
AS 1,232 30 9486402
ARAGE 2 3 1,00 20.0
10 _ L 199 1999 53 58
1169
FG 67 3 1809 2 ARAGE 2 2 67 20.0
OP 8 3 231 OTAL OB XF VALUE
L 199 199 S 5
784
19,823
56 2 862
19 2 292
-
LACE 1 - None
EA 2,741 126,81
S
ING DIMENSIONS BAS-W44WDD=N12E16S12W16 528FOP-S5E17NSW17 E44N26 PTR -E30 UBM-E20 BFG-E24N28W24528 N28W20S28 W30$.
INFORMATION
VDDI
ST
EST
USE
LOCAL
FRO.
DEPTH /
LND
COND
THERADJUSTMENTS
NDNOTES
OA
LAND TOTAL
UNIT LAND UNT
TOTAL
ADJUSTED LAND
LAND
CODE
ZONING
TAGE
EPT
SIZE
MODFACT
RF AC LC TO OT
TYPE
PRICE UNITS TYP
ADIST
UNIT PRICE VALUE NOTES
AC
0120
312
0
1.1300
4
0.8100
+01 +00 +00 +00-20
RP
6 700.0 10.71 AC
0.91
6130.5 6567
HAPE
MARKET LAND DATA
10.71 65 67STTE
5000 0
0 1.0000 5 2.50006
700.0 1.00 AC 2.50 16 750.0 1675
6711 0
0 1.0000 5 1.0000
1 250. 3.71 AC 1.00 1 250.0 464iI
6721 0
0 1.0000 5 1.0000
810.0 4.00 AC1.00 810.0 32401
111 6731 0
0 1.0000 5 1.0000
560.0 2.00 AC 1.00 560.0 112
PRESENT USE DATA
10.71 25 75
CDr�` 1507D
11
15k OPI'
O
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