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292 Gun Club RdHEALTH DEPARTMENT RELEASE d,.suvEo Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: John edward Dillon Address: 292 Gun Club Road City: Advance StatelZip: NC 27006 Phone #: (336) 418-0222 Address292 Gun Club Road Road# Advance NC 27006 'Structure: SINGLE FAMILY # of Bedrooms: 3 `Water Supply: PUBLIC Basement: F]Yes ❑ No 'Proposed Improvement: Livingroom addition # of people: 4 For Office Use Only *CDP File Number 120478 -1 E700000153 County ID Number: valuated For: HDR/WWC PERMIT VALID 0 3/ 1 2/ 2 0 1 3 UNTIL: Property Owner: John edward Dillon Address: 292 Gun Club Road City: Advance StatelZip: NC 27006 Phone M (336) 418-0222 Property Location & Site Information Subdivision: Phase: Township: Directions Hwy 158 to Gun club Road on right home on Right Type of Business: Total sq. Footage: No. Of Employees: Lot It is the responsibility of the owner to maintain a 5 foot 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. proposed expansion location should be moved to meet the 5' setback required. 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? Oyes ONO Applicant/Legal Reps. Signature: *Date: *Issued By: 2244 - Daywalt, Andre *Date of Issue:. 0 3 / 1 3 / 2 0 1 3 Authorized State Agent: lyd O'd & **Site P lanlbrawing attached.** Total Time:(HH:MM) 0 1 Hours 3 0 Minutes C Hand Drawing Olmport Drawing Drawing Type: HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release CDP File Number: 120478 - 1 County File Number: E700000153 Date: 031131.1013 Olnch Scale: O Block -':.ft. O N/A --- - - - L -1— - Page 2 of 2 Davie"County Health Department . a "his I�' Environmental Health Section - P.O. Box 848 � ,,5„ 210 Hospital Street O U �'� Courier # : 09-40-06 191 T Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection Name: �� \ 1:.�, 1i` G_1 8 �J� �` G ^ Phone Number (Home) Mailing Address: � C� Z Co- C_ \ j �b \-2-j �> 7 (x, Li U Z (W,afk) A X ja N c r- wc.- 2.+)cx) C Email Address: A GUtit Detailed Directions To Site: Property Address: Z C� Z Cr. , C. (<• � ) � /\ A v c, .n L C yU ( Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under:_ .., J (5, Yh -P 117) Type Of Facility: �'a o S tf Date System Installed (Month/Date/Year): I G �1 Number Of Bedrooms: -Number Of People: `I Is The Facility Currently Vacant? Yes No,If Yes, For How Long?. Any Known Problems? Yes No..: •'If Yes, Explain: Please Fill In The Following Information About The NEW Facility: \ 6 f -1c Type Of Facility: , r...: t �7 (D Number Of Bedrooms:_Number of People Pool Size: ( _G rage Size: Other: Requested By: Date Requested: I ( ig ature) Approved Comments: r IN For Environmental Health Office Use Only Disapproved 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: CashCheck� %Money Order # a�� % ? Amount:$ %O� i Date: ✓- Paid By: t._ l �L/ i %� t� Received By: Account #: �� Invoice #: ��y / Appraisal Card Page 1 of 1 3/1/2013 9:33:36 AM DILLON JOHN EDWARD DILLON JILL PEELER Retum/Appeal Notes: E7-000-00-153 92 GUN CLUB RD UNIQ ID 6989 301537 D198 -P31 ID NO: 5871071018 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 Reval Year: 2013 Tax Year: 2013 6 AC GUN CLUB RD P/O 4 BEAUCHP 5.730 AC SRC= Owner Appraised by 19 on 11/04/2008 03007 BEAUCHAMP RD TW -03 C- EX- AT- LAST ACTION 20121101 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 Eff. BASE Standard 10.44000 ontinuous Footing 5.0 US MO Area QUA RATE RCN EYB AVB REDENCE TO MARKET ub Floor System - 4 Plywood 8.00 01 01 1 593 109 176.30112379dlgfi196 % GOOD 1 56.0 DEPR. BUILDING VALUE - CARD 69,33C xterior Walls - 21 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE - CARD 17,71 MARKET LAND VALUE - CARD 103,43 STORIES: 1 - 1.0 Story rOTAL MARKET VALUE - CARD 190,47 oofing Structure - 03 able 8.0 oofing Cover - 03 TOTAL APPRAISED VALUE - CARD 190,47 halt or Composition Shingle 3.0 TOTALkspAPPRAISED VALUE -PARCEL 190,47 nterior Wall Construction - 5 )rywall/Sheetrock 20.0 nterior Floor Cover - OB TOTAL PRESENT USE VALUE - PARCEL heet Vinyl/Laminate 6.00 TOTAL VALUE DEFERRED - PARCEL nterior Floor Cover - 14 TOTAL TAXABLE VALUE - PARCEL 190,47 et 0.0 eating Fuel - 04 PRIOR lectric 1.0c BUILDING VALUE 72,58 BXF VALUE 9,74 eating Type - 02 ND VALUE 103,43 asebbard Heat 3.0 RESENT USE VALUE r Conditioning Type - 03 EFERRED VALUE entral 4.0 OTAL VALUE 185 75 Brooms/Bathrooms/Half-Bathrooms /1/1 11.00 rooms AS -3FUS -0LL -0 thr0oms PERMIT AS - I FUS- 0 LL - 0 CODE DATE NOTE NUMBER AMOUNT alf-Bathrooms + - 9 AS-IFUS-OLL-O IUOP I 8 8 OUT: WTRSHD: OTAL POINT VALUE 103.00 +--12--+-----25-----+-9--+-----25------+ SALES DATA BUILDING ADJUSTMENTS I F S T I B A S I FF. INDICATE uali 3 AVG 1.000 8 8 I RECORD DATE DEED SALES ha a Desi 4 FACTOR 4 1.050 1 BOOK PAGE M R TYPE / 1 PRICE ize 3 Size 1.010 I F C P I I I I 0906 701 1OP012 WD A I 24000 OTAL ADJUSTMENT FACTOR 1.06C I I 2 0012410702 11198 WD X 1 0 DIAL QUALITY INDEX JOS I 1 9 2 6 1 1 I 1 I I I HEATED AREA 1,369 I SFOP 5 I +-----24-----+---18----+------29-------+ =NOTES WMH IS PP SUBAREA ODE DESCRIPTION LTH H UNITS UNIT PRICE ORIG % COND BLDGX L B AYB EYB ANN DEP RATE _OVR % COND OB/XF DEPR VALUE TYPE GS AREA % RPL CS AS 1,369 10 104455 02 24 24 1 1 D8 3ARAGE BARN HED HED ORAGE 3TORAGE H SITE 26 36 18 24 40 10 1 1 1 1 1 12 936 43 400 28 19 120 1 15.00 15.00 5.10 5.1 15.0 15.0 4,500.0 100 100 100 10 10 10 10 _ L _ L _ L _ L _ L _ L _ L 197 197 19811981 19811981 198 194 198 1976 1994 198 199 198 S3 S3 S5 S5 5 S3 5 0 43 4 10 278 0 0 20 77 450 02 961425 :OP 90 03 2442 OS 366 Fgli(321 72 137 IREPLACE 3i- I Story 2,25 Sn le g SP PAVING 4 20 3.0 00 00 5 7 945 BAREA 2,131 123,79 OTAL OB/XF VALUE _ _ 17,712 TALS ILDING DIMENSIONS BAS=W25UOP=NBW9S8E9SW34FST=W1258 FCP=S21E24FOP=EISNSWI8S5 N21W24EE12NS$ S8E32S36E18S5E29N29$. NO INFORMATION GHEST 1-U." ADJUSTMENTS THERA TOTAL D BEST USE LOCAL FRON DEPTH / LND COND ND NOTES ROA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND E CODE ZONING TAGE DEPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES RAL AC 0120 355 0 1.2620 4 1.4300 +00 +18 +25 +00 +00 PW 10 000.0 5.73 AC 1.80 16 050.0 10342TAL MARKET LAND DATA 5.73 103,43 JrOTAL PRESENT USE DATA I I I I I http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E700000153 3/1/2013