2389 Hwy 601SI ►51''x`VEPARTMENT
4,,DAVIE COUNTY HEALTH�
Environmental Health Section PROPERTY INFORMATION /ID,11�-97.
P.O. Box 848
Mocksville, NC 27028 ' Subdivision Name: i
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:307 9:30 A.M. OR 1:00 - 1:30 P.M: ON,THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. ,
DCHD 05/96 (Revised)
r
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department 2 @ 1E 0 W
Environmental Health Section D
P.O. Box 848
Mocksville, NC 27028 S 81997
(704)6 ; 34-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed + Contact Person o
Mailing Address Home Phone
City/State/Zip 1- 1 J Business Phone Fjf 199
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: 0 Site Evaluation [ ] Improvement Permit & ATC Both
4. System to Serve: [ ] House [Mobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People _ # Bedrooms _ # Bathrooms_LL_ bd Dishwasher [ ] Garbage Disposal
AWashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: M County/City [ ] Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes 6CJ No
If yes, what type?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT **XVXT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: Q c -cS WRITE DIRECTIONS (from Mocksv1ille) TO PROPERTY:
Tax Office PIN: # 7 y -� -� tx.� , `
Property Address: Road lame— u -p i 5t)[A
City/Zip ,�z5 o j \ e. 6a.—=S: o
If in Subdivision provide information, as follows:
Name:
Section: Lot #: '
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are
subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or
changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized
Representative of the Davie ounty Health Department to enter upon above described property located in Davie County and owned
I
by to onduct all to2612AWA
prod s necessary to determine the site suitability.
DATE -9-B-97 SIGNATURE �MJ A &I
Revised DCHD (06-96) '
THIS AREA MAY BE USED FOR I)RAWINC7 YOUR SITE PLAN:
f• �
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
v
APPLICANT'S NAME
PROPOSED FACILITY
SUBDIVISION
DATE EVALUATED
PROPERTY SIZE
ROAD NAME Edi S
Water Supply: On -Site Well Community Public V
Evaluation By: ty • Auger Boring Y/ Pit Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Slope %
C,
- �o
HORIZON I DEPTH
Texture groupL
Consistence
Structure
C
Mineralogy
HORIZON II DEPTH
2
"
Texture group
Consistence
TT
Structure
Mineralogy
1 % 1
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
,5
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S
LONG-TERM ACCEPTANCE RATE
t
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:XA
REMARKS:
DCHD (01-90)
EVALUATION BY:
OTHER(S) PRESENT:
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)
LIAR - Long-term acceptance rate - gal/day/ft2
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9,1?ATION NO
Ad' 70— *1042 DAVIE COUNTY HEALTH DEPARTMENT
0 -
Environmental Health Section PROPERTY INFORMATION
1,D
tteP's P.O. Box 848
ame:", Mocksville, NC 27028 Subdivision Name:
-634-8760
Phone #: 704
Directions to r -Irl- - -1 1 1 ---' j< JOA
I, All y Section. Lot: 0 W'd
AUTHORIZATION FOR
N' WASTEWATER
SYSTEM CONSTRUCTION Tax Office PINJt", -
am taywq Road Name: J60 zip:zoa
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This FormlAuthorization. Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits. I . I :
(In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE*** TIIIS AUTHORIZATTON FOR WASTEWATER CQNSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIR ONMENTAL HEALTH SPECIALIST DATE ISSUED
Y:
L� OCCUPANTS— GARBAGE DISPO AL- Y6s oim;
PE.CIFICATION.; BLIL61146 TYPE # BEDROOMS BATHS,
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
ITE�. REPAIR SITE
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 20 NEW S le'l
SYSTEM SPECIFICATIONS: TANK SIZE L2,L)O GAL. PUMP TANK _GAL. TRENCH WIDTH ROCKDEPTH LINEARFT.
OTHER'
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
, .. J,;
"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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. OPERATIONPERMITBY: DATE:
"THE ISSUANCE OF THIS OPERA71ON PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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.
DCHD 05/96 (Revised)
Appraisal Card
Page 1 of 1
5 BANK NATIONAL ASSO TRUSTEE
WELLS FARGO ASSET SEC. CORP.
Return/Appeal Notes: LS -000-00-104
389 5 US HWY 601
UNIQ ID 21673
2533066
NN: 26 - CHANGE OF OWNERSHIP
BD15-4 ID NO: 5746337347
COUNTY TAX (100), FIRE TAX (100)
CARD NO. 1 of 1
eval Year: 2013 Tax Year: 2014
1.290 AC HWY 601 S
1.290 AC SRC= Inspection
kppralsed by 19 on 05/20/2008 05004 FAIRFIELD
TW -05 C- EX- AT- LAST ACTION 20130524
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION
CORRELATION OF VALUE
oundation - 3
Standard 0.1900
ontinuous Footing5.0
Eff. BASE
US MO Area UA RATE RCN EYB AYB
REDENCETO MARKET
ub Floor System - 4
I ood
8.0 59 01 12,57 2 99 69.30 17974 199 199 % GOOD 81.0
)EPR. BUILDING VALUE - CARD
145 59
)EPR. OB/XF VALUE -CARD
3,99
xterior Walls - 10 TYPE: Modular Single Family Residential
Iuminum/Vin I Siding29.0
ARKET LAND VALUE - CARD
17,61
STORIES: 5 -Ranch w/ basement
OTAL MARKET VALUE - CARD
167,19
oo0ng Structure - 03
able
8.0
oCover - 03
s phalt halt or Composition Shingle
3.0
OTAL APPRAISED VALUE - CARD
167,19
-
OTAL APPRAISED VALUE - PARCEL
167,19
nterior Wall Construction - 5
)rywall/Sheetrock 20.0
nterior Floor Cover - 08
TOTAL PRESENT USE VALUE - PARCEL
heet Vinyl/Laminate
6.0
OTAL VALUE DEFERRED - PARCEL
nterior Floor Cover - 14
TOTAL TAXABLE VALUE - PARCEL
167,19
arpet
0.0
PRIOR
Heating Fuel - 04
BUILDING VALUE
151,42
lectric 1.00
eating Type - 10
BXF VALUE
eat Pump
4.00
ND VALUE
17,61
Ur Conditioning Type - 03
PRESENT USE VALUE
DEFERRED VALUE
ntral
4.0
OTAL VALUE
169,030
3edrooms/Bathrooms/Half-Bathrooms
/2/0
12.00
Brooms
BAS - 3 FUS - 0 LL - 0
PERMIT
Bathrooms
CODE I DATE I NOTE I NUMBER
AMOUNT
BAS -2FUS -0 LL -0
Office +14-1
AS-0FUS-0LL-0
IUBMO
I +-----54-----+
OUT: WTRSHD:
OTAL POINT VALUE
100.00
1 1
SALES
DATA
BUILDING ADJUSTMENTS
4 I
FF.
INDICATE
Ize 3 Size
0.940
4 2
7
RECj827
DEED
SALES
uali 3 AVG
1.000 + - - - - - 5 4 - - - - - +
1
I
I I
/
PRICE
BOOTYPE
J7�nO4
ha a Desi 4 FACTOR 4
1 4- L P T O
1.050 +1
IBASO 8
I +-----54-----+
092
TO
P
I
15500
OTAL ADJUSTMENT FACTOR
0.99 1 + - - - - - 54 - - - - - +
+14-+
056WD
X
V
OTAL QUALITY INDEX 91 I I
4 2
4 7
I I
I +14+---40----+
HEATED AREA 2,074
I 7FOP
NOTES
+14-+14+
SUBAREAUNIT
ORIG % ANN DEP % OB/XF DEPR,
TYPE GS AREA % RPL CS ODE ESCRIPTIONLTH H NIT PRICE
COND LDG*YL/B AYB EYB RATE V GOND
VALUE
BAS 2,07 10d 14372 10 ICON PAVING 1 01 01 1,9001 3.501
01 1 1200512001SA 1 601
399
OP 903 235
OTAL OB XF VALUE
3 99
0 97 00 339
BM 2,07410201 2876
2 - Pre
IREPLACE 1,50
Fabricated
UBAREA
5,21 179,74
OTALS
BUILDING DIMENSIONS PTO=N18W54S18E54 BAS=W54N10WI4S44E34 FOP=N7E14S7W14 N7E14E40N27 PTR=E20 UBM=N44 E14S10E54S27W54S7W14 W20 .
LAND INFORMATION
HIGHEST
THRAJUSTMENTS
LAND TOTAL
ND BEST
USE
LOCAL
FRON
DEPTH / LND
GOND�..ENOTDES
ROA
UNIT LAND LINT
TOTAL
ADJUSTED LAND LAND
SE
CODE
ZONING
TAGE DEPTH SIZE MOD
FACTRF
AC LC TO OT
TYPE
PRICE UNITS TYP
ADJST
UNIT PRICE VALUE NOTES
RURAL AC
0120
25
0 2.1630 4
1.07003
+10 +00 +00 +00
1 PW
1 5,900.00 1.290 AC
1 2.314
13,652.60 1761
OTAL MARKET LAND DATA
1.290 17,610
OTAL PRESENT USE DATA
1� IV1wReti 3��" 1U11h
�u�cd�se� 3,373
I q� Zai r
o��iL is. Dnl
�1�� borne
TOAh W. l-evis
Aores
DeQd'ea son
Itzg � a 397
..SONS IO`i' fUf1 4D
0 a3g9
O
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=L500000104 8/15/2013
t� o �°�F
t
All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the implied
iwarranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of U N
Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or ariaing out of P ri nted:Aug 16, 2013
S the use or inability to use the GIS data provided by this website.
BEGINNING at an iron stake found at the right of way of U.S. Highway 601, said iron stake
bang at the Southern corner of the within described pared and at the Western corner of the
property of Robert J. Wescott. Jr., as described in Deed Book 145 at page 748; thence with the
right of way of said highway North 45 degrees 511 minutes 40 seconds 50.00 feet to a new iron
stake set; thence North 56degrees 14 minutes 15 seconds East 288.12 feet to a now iron stake
set, an internal corner; thence North 45 degrees 58 minutes 40 seconds West 165.75 feet to a
new iron stake set in the property line with the property of John T. Byerly as described in deed
Book 126 at page 760, the Western corner of the within described parcel; thence with the B*1y
property North 51 degrees 52 minutes 32 seconds East 690.42 feet to an iron make placed on the
Southern bank oft brunch in the property line with the property of Ralph E. Call as described in
Deed Book 82 at page 34, the Northern comer of the within described panni; thence with the
Call fine South 51 degrees 09 minutes 10 seconds East 188.80 feet to a bent iron found on the
southern bank of a bunch, said bent iron being found North 61 degrees 02 minutes 45 soconds
West 88.01 feet from a rebar found, said bent iron being at the Eastern corner of the within
deml3ed parcel; thence with the Wescott line South 48 degrees, 50 minutes 14 seconds West
645.99 Poet to an iron stake found; thence South 56 degrees 14 minutes 14 seconds West 346.71
feet TO THE POINT AND PLACE OF BEGINNING and containing 3.573 acres as surveyed by
Grady L. Tutterow. RLS, and being taken t%m the property ofLucy S. McClamrock as described
in Deed Book 172 at page 572, and is part of Tax parcel L-5-32. All references aro to the Davie
County Registry. 4/97Ah
SAVE AND EXCEPT
Lying and being in Jerusalem Township, Davie County, North Carolina and
beginning at an existing iron pin, said existing iron pin being located in the
Northern right of way of Highway 601 and being the Southwestern most corner of
the within described property and being the Southern most corner of John T.
Byerly, Deed Book 126, Page 760, thence with right of way of Highway 601 South 45
degrees, 58 min., 40 sec. East 25.00 ft. to a new iron pin, thence North 56 degrees, 14
min., 14 sec. East 350.42 ft. to a new iron pin, thence North 48 degrees, 50 min., 14
see. East 197.34 ft. to.a new iron pin, thence North 45 degrees, 58 -min., 40 sec. West
184.98 ft. to a new iron pin, said new iron pin being located in the Southern line of
John T. Byerly, Deed Book 126, Page 760, thence with said Byerly live -South 51
degrees, 52 min., 32 sec. West 259.97 ft. to an existing iron pin, thence with said
Byerly South 45 degrees, 58 min., 40 sec. East 165.75 ft. to an existing iron pin,
thence South 56 degrees, 14 min., 15 sec. West 288.12 ft. to the point and place of
beginning and containing 1.29 acres as surveyed by Sparks Surveying, July '12,
2004, see Deed Book 330, Page 412, Tax Map L-5-32.