The URL can be used to link to this page

112 Holiday Lnt 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 #: 990006030 Tax PIN!1H #: K500000053 Billed To: Heldia Johnson Subdivision Info: Reference Name: Revised 10/30/13 Location/Address: 112 Holiday Lane -27028 Proposed Facility: Rental Repair Property Size: .38 Ac. ATC Number: 6038 Site Type: ❑New ❑Repair ❑Expansion **NOTE** This IP/ Authorization 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 or the intended use change. Residential Specifications: # Bedrdoms4_ # Bathrooms # People Basement Basement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 0 tom. Type of Water Supply: ❑County/City XWell ❑Community Well System Specifications: Design Wastewater Flow (GPD)&,C� Tank Size ` AL. Pump Tank GAL. Trench Width _ Max. Trench Depth_&.0 Rock DepthZ.Y� Linear Ft. 40' 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)753-6780. Environmental Health Specialist Date: 0 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 JohAe,l ia so REPAIR OPERATION PERMIT Account M 990006030 Tax PIN!EH #; K500000053 Billed To: Heldia Johnson Subdivision Info: Reference Name: LocationfAddress: 112 Holiday Lane -27028 Proposed Facility: Rental Repair Property Size: .38 Ac. ATC Number: 6038 **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.$. 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: w0AT ManufacturerQ Tank Date Tank Size s_ Pump Tank Size Beaoom2� System Installed By �CVIAV Installer#: Dat6: g GPS Coordinate: 1o/3v/13 ��. Awd red c2y oN. Cokka Environmental Health Specialist: Date: X-/ DCHD 11/06 (Revised) �h 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 #: 990006030 Tax PIN/EH #: K500000053 Billed To: Heldia Johnson Subdivision Info: Reference Name: Location/Address: 112 Holiday Lane -27028 Proposed Facility: Rental Repair Property Size: .38 Ac. ATC Number: 6038 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article I 1 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. 0 �- p,, CWOa�'S.T Manufacturer Q ' Tank Date Tank Size System Type: , Pump Tank Size Bedrooms System Installed By: nstaller#: 1' all;Dater GPS Coordinate: r Environmental Health Specialist: Date: p i DCHD 11/06 (Revised) � �,� �t -Dl�' • 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 #: 990006030 Billed To: Heldia Johnson Reference Name: Proposed Facility: Rental Repair Tax PIN/EH #: K500000053 Subdivision Info: LocationiAddress: 112 Holiday Lane -27028 Property Size: .38 Ac. ATC Number: 6038 Site Type: ❑New JRRepair ❑Expansion **NOTE** This IP/ Authorization 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 or the intended use change. Residential Specifications: # Bedrooms Q # Bathrooms 2Z _ # People Basement❑ Basement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size oat, Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) aI/o Tank Size P c AL. Pump'Tank /GAL. c Trench Width .36`` Max. Trench Depths Rock Depth h%/19 Linear Ft. , �d o? 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)753-6780. ex�Sf� �� C.t ►19 et'r C1— ' 1 ti Environmental Health Speciali DCHD 11/06 (Revised) Date: OWL �° We . DAVIE Name & I' Address % i Mailing Address (if different Email Address: Subdivision Name Directions IDof SI Ld It-elld,, Date System Installed Type Facility M 14 Type Water Supply 1AU TY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATq OSWW REPAIR /2 R JAII 0j TelephYne Number �l 0' above) C Lot # Name System Installed Under Number Bedrooms Number People Served Specific Problem Occurring, j9a p � pi Date Requested o2 -11 � 11 Info Taken By d� THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason =� .41 L,b30 . DAVE COUNT ENVIRONMENTAL HEALTH SERVICE REQUEST ='f9' APPLICATION IP/AT OSWW REPAIR /Op7 (( G r Name. e /V/ r' `Jo o �e ti �a Telephone Number Address 0% i SZ10 711�( Mailing Address (if different om above) 9 Email Address: �l `UUU-h --Q Subdivision Name, _ Lot # Dir etio s (Jr Ld-I .Dpo Date System Installed J ( tf°�� Name System Installed Under Type Facility��,�� Number Bedrooms_ Number People Served Type Water Supply �/(%� �� Specific Problem Occurring Y 1171)PG� -�/(/S�T� ate Requested Info Taken By THIS IS TO. CERTIF WHAT TH,E IN F9RMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE,- THAT I .UNDERSTAND THAT I AM :RESPONSI'BLE FOR ALL CHARGES INCURRED FROM THIS,APPICATION. Signature of owner or Authorized Agent i, 6- Initial.Fee Date ` REHS r� Revisit Charge Dater Reason „ Revised 2-2611 ; 0 Alpraisal Card nevte rn.— — Page 1 of 1 OHNSON HELGIA MAE DAVIS Return/Appeal Notes: K5-000-00-053 NOUL CREST RD UNIQ ID 20525 2520766 ID NO: 5747916689 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 .38 AC OFF DEADMON RD 0.380 AC SRC- Inspection kppralsed by 19 on 05/20/2008 05004 FAIRFIELD - TW -05 C- EX- AT- LAST ACTION 20110712 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE TOTAL POINT VALUE_L BASE �-EYBgAYB - BUILDING USE MOD Area UAL RATE RCN REDENCE TO 00 %GOODr 3EPR. BUILDING VALUE - CARD AD3USTMENTS 97 TOTAL ADJUSTMENT TYPE: Vacant EPR. OB/XF VALUE - CARD 4,50 ACTOR 4ARKET LAND VALUE - CARD 7,06 TOTAL QUALITY INDEX STORIES: _ - OTAL MARKET VALUE - CARD 11,56 OTAL APPRAISED VALUE - CARD 11,56 OTAL APPRAISED VALUE - PARCEL 11,56 OTAL PRESENT USE VALUE - PARCEL OTAL VALUE DEFERRED - PARCEL OTAL TAXABLE VALUE - PARCEL 11 56 PRIOR WILDING VALUE BXF VALUE 4,50 AND VALUE 7,06 RESENT USE VALUE EFERRED VALUE OTAL VALUE 11,560 PERMIT CODE I DATE I NOTE I NUMBER AMOUNT OUT: WTRSHD: SALES DATA FF. ECORD ATE DEED INDICATE SALES 0C AGE R TYPE PRICE _ 0478 567 14 OOOA WD I P I V 1 250 HEATED AREA NOTES SE VAC.OVERGROWN W/TREES ROM PHILLIPPE, W F ETUX AS BEEN TAKEN APART 10/0 SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR. GS RPL ODE ESCRIPTIO LT NIT PRICE GOND LDG+tL B AVB EYB RATE V CON D VALUE H SITE 1 4,500.001 L 197 197 Sol 1 1001 450 TYPE AREA CS 8 IREPLACE TOTAL OB/XF VALUE 4,500 UBAREA OTALS WILDING DIMENSIONS ND INFORMATION IGHESTTHE. AD- STMENTS LAND TOTAL ND BEST USE LOCAL FROM DEPTH / LND WHO ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGELPT�' SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP AWST UNIT PRICE VALUE NOTES H HOMESIT 0201 100 0 3.3160 4 0.9500 10-15 +00 +00 +00 RT' 5,900.00 0.38 AC 3.15 18 585.0 706 OTAL MARKET LAND DATA 0.38 7,060 OTAL PRESENT USE DATA 9 http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=K500000053 2/11/2013 }Edit Request Complaint tal Health g Edit Request Complaint Request/ Original Number 8740 F County i Davie Delete? 'ACTIVE I Request Date/Method 2/11/2013 a WA Request Type/Status COMPLAINTOPEN �. Complaint Type SEPTIC Activity Program Group Onsite Water Protection Activity Program Type : 502 - Wastewater / Septic Systems N/A Taken By jBonnie : i Bonnie Lanier EHS DaywaR, Andrew Supervisor Email i Daywa@, Andrew Enter an Additional Email 1, Lakey, Tracie ' Mitchell, Brittany !M1 Notify EHS via R Email plaint Info Person Premise lHeldia Johnson Address 1 1112 Holiday Lane Address 2 City,State,ZiP cModsville North Carolina 27028 Google Map By Address.. Latitude/Longitude F Google Map.. Establishment Lookup... Reset Establishment Conditions Pumped, trouble flushing again/full again Vho made the complaint? Last / First Name lHildia Johnson Address 1 1124 Holiday Lane Address 2 City, State, Zip IMocksville ! North Carolina _ --' l_ 27028 Home /Work /Cell Phone 336 —99"9134 f F Email Address mise Info Owner Type I OWNER Name lHeldiaJohnson Page 1 of 2 Google Map By Address.. Address 1 1124 Holiday Lane{ Address 2 City, State, Zip Modcsville ; North Carolina _ 27028 Google Map By Address.. Home / Work / Cell Phone 336 998-8984 )utcome Followup ❑ Ongoing ❑ Notification ❑ Resolved / Next Insp Date F— Comments Cancel https://portal.cdpehs.com/NCENVRQST/REQUEST COMPLAINT/EditREQUEST CO... 2/13/2013 ' /. �� r �� fjl _,,, •� d �� r �� fjl