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3348 Hwy 601SATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. t 1 7 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., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634.5985. V%Zo Final Installation Diagram: Syst m Installed by 15 p 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 be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT _ 1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Number Sanitary Sewage Systems Permit . Name r' �� , .:, �, > '': ' --- Date ^? - �'' N2 7912 LA L �. ��-- Subdivision Name Lot No.' Sec. or Block No. Lot Size -�3 0 House _ Mobile Home ---_ Business —_ Industry— r _,. No. Bedrooms —.No. Baths _-2-- No. in Family - — Public Assembly Other No. Garbage Disposal YES p' NOD Specifications for System: Auto Dish Washer YES ,, NO Auto Wash Ma^hine YES NO i + 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 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. t 1 7 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., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634.5985. V%Zo Final Installation Diagram: Syst m Installed by 15 p 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 be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department IRE C E Q N' E Environmental Health Section P. O. Box 665 MAN - 3 1995 Mocksville, NC 27028 Application/Permit Requested B v � /� / U f/S�y 0'�i." • --------------- - - - - - "' - - - _ _ _ _ 1. A pP Q y Mailing Address `9 d W19 Home Phone /�! 0 A/v C 2C Business Phone 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business ❑ General Evaluation Septic Tank Installation Permit 0 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms 3 No. of Bathrooms :2 - ❑ Other Dwelling Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served _ No. of Sinks No. of Commodes No. of Urinals No. of Lavatories - No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: Nf Public ❑ Private 8. Property Dimensions 150,c, 3 F57 lv 6 Sewage Disposal Contractor ❑ Unknown Section Lot # 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? - ❑ Basement/Plumbing ❑ Basement/No Plumbing Washing Machine Dishwasher Garbage Disposal M. ❑ Community *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. Directions to Property:G C SO �/ � v ► O/1 �O/� QC /, 4 �S-f r %�O�tN �O'( cJ ov �-" /1 O'er' G 0%G A ow Awlyls This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. oe -5 - 95o" 4v—Z—do- DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 2. I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section \ Soil/Site Evaluation NAME . � c� e ��o % DATE EVALUATED ADDRESS f2SQIN`_' PROPERTY SIZE -PROPOSED FACIILTY A6'z''SQ LOCATION OF SITE DSS Water Supply: On -Site Well _ Community Public V v Evaluation By:C hy. Auger Boring Pit Cut FACTORS 1 1 2 3 4 Landscape position S S 5 .--5 Sloe Z QS- 0-%0 0-- - a HORIZON I DEPTH " % cbt• ►• Texture group 'C' L QJ_ Consistence Structure C Co r2 Eo Mineralogy L '. L HORIZON II DEPTH l' 130" b" 3o Texture group C Consistence S Structure IVA V_ Mineralogy HORIZON III DEPTH Texture group Consistence Structure, Mineralogy HORIZON IV DEPTH Texturegroup Consistence Structure Mineralogy SOIL WETNESS S S SS RESTRICTIVE HORIZON -- .-- �— - SAPROLITE — --� CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: N EVALUATED BY: LONG -TER CCEP ANCE RATE • OTHER(S) PRESENT: a REMARKS: c. 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 ;lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V+.. -y 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 3C --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/ftz DCHD(01-901 on ■■■■■■■■■■■■M■E■■E■■■■■E■\■■E■■■■■■H■■■■■■■E■■■■�■■■■■■■■■■■■■■■■ ■■■■■■■..■■■■.■■■■■■■...■■■■.■■■■■■■■■■■■■■■■■■■■■■■■e■■■E■■■■■■■■ :::a::::::::::::::::::::::i::::■■:::::::::NONE:::�iEC:Ci::::OEM ...........................:■!■■■M■M■MMM■MMMM■■C■MEEMMOE■CM■MMM■E� .........................................AMEN INS_MMmlMM.....:_.. .......■........................■........ ... . . ... ...... .. ■■■■■EE■■■■E■■■■■■■■■■.■■EEE■Es■■■:■■►�r�,�i�►�■e■n■■ee■�■■■■e■■■M■■_■ MMMMMM:CMMM:M:�MMMM:�MMMMMM:MM CC: ■1��fu CCi■sisi::.::C:::::■��N ONE MMml MMMMml: ::::::::::::::::::::Et:its:C::::::CC:�!■►11�'i�■�::CC■ ■CCCC■CeCMMMMMMM ■■■..■■■■■■..■E■..■■■uEEEEE■■■■�■.s►11!1■.�■■■uuu■■■■■■�■■■■■■■■ ... 1........H■n..................�..�..��..... ■ERIE■■ C ■■mom■■ ■■■■:.■■■■■■E■■■■■■■■■■■■■■■■■■■■■E■.i■�r■■1/rR■■EM�■ e■ :■■■■■Ill .................�....� .......��. ��.�.�%■. �■■■ ■.■■■ ■.■■EEE■E■EEEE■■■ ■■■■ H■■■■■ ■ 11■ ■ 7 m s■■■■■i:::C ■■■■■■■■■■■■■■■■■■■■■■■■■■■■E■■■■e■ i.er ���►�s>�.E ■■■ ■�■ ■EEEEE■■EEEE■■■EME■EE■H MMMMMM MINN MM■MMM■■■9 . EMU EME■E■ ■■.■■■■.■■■■■.■■■■■■■■■■H■■■■■■■■■■EL ■n ■■ ■■■NONE■ ■■.■■.■■EEEHHs■■E ■.■■■■■/ ■ ■ d No ME■EM ■■ .......�......H......�=u..; ....■■ �. � ' No =MMM■■EMENECC ■■■■■■■■..■■■■■■.■.�����===����� ■ � HOER ■ ■■. ■■.■■■■■EEEEE■■E■■IIEEEE :::�::: OMEN ■:■::■E■ ■EEE■E■■■:■■■■■■■■11lE■�IEEE■ E■H■ ■■ ■■■ EEE■■■ MOMEMO C:::::CCC:CC::CCC:�C:i��iiii ■i■iC :C �e M■iC::: ■MM■MM■ lMMM MMMMMM :::MEN CCC ' n ■u■ . . ■■■■OEE■EOEEE■■EEE■EEEEEEEEE■■E■■■■ ■ MEN MHu■E■■ ■EOEEEEE■EENEE■E■EEE■■■EEEEEE■■lEEEEES M■ mom ■ ■■■■■■!■■E■■■■■■■■■■■!EE■■H■■■■UNN■■■■► EI ■HN■HE ■H ■■■■■■.■■■■■■■■■■■■■■■■■.■■■■■■ ■�■�■ /1■■ ■ 11..■MO■■■■■■■■■ :: :::NO'CC.'M .'::CC:MMMM' :M:C:E' •► iJ ::::CCMMMM:! .:MCMC ■C"'MMC:CC:'::CCCM::MCM:C MEN'.��C ME CiiMENEEMENEEN : NONE ■EM:•■MMMM■■:MMMMMMMMMMe . lJM■ CMwMMMMiM■..■1.■■HEEEEMEMO ■ ..........NEE.EE■■■■■ON■■■E■■HOE■■■■■ ■■.ENO■EEOEEI�■■■■u■■■■■■E ■■■■■ElEEE■■EE■■■■EEE.EE■EEE■■■■■E■EEEE■■��■■■■■E■■EE1�■■Es.EE■E■■■E ■■■■■■■■■■■E■■■■■■■■■■■■■■■�■.■■■■■■■■■■■.IEOM■EEE■■■IMM■.■E.EE■■■■■ OMEMMMMMCMM■i■iiC:CM:MMM:CMC:■MC:: iCMMCMCin::iii:MC ■iCMCMCCu:C=C �l■■■■■■.■■■.■■■■■■■■■■■.■■■EO■■ ■N■■O■OwMMMM■■■■■II■■■■■■■■■■■■E■ ■■■■■ !s■■■■■■■■■■■.■■■■■E.■OHEEE■■ ■ ■E■!■E■■■N■.■EEEM■■■■■■■■ Appraisal Card NWRCF RIDENNOYR]EAEETM Return/Appeal N: PreW Nf-{B{N-N[ 348 5 US HWY 601 FLAT: 00 05/140 UKIQ ID 24337 1324000 0418419 ID N7 5]55039155 COUNTY TAX (100), FME TAX (100) CARD NO. 9 of 1 aIYear 2013 TEa Year 2036 LOT38DXWOOD ACRIE; 1.390 AC SRC-Inaretim Ne8 02 On De ] 007 05002 WEST RRUSALEM TW -05 Q- FR -10 EX- AT- LAST ACTION 2032093 CONSTRUCTION O[TALL MARKET VALUE DEPRECIATION CORRELATION OF VALUE [6. BASE st.na. 0.1 ub Fbor System - I SE OD Ar4s K RATE RM EYE AYB EDENCE TO MARKET 1 2390 119 83.30 201788199 1995 %GOOD2.D EPE. WILDING VALUE -GRD 16517 8. 03 ?WWAn alU • 2 T: SIn9N Family ReKMntNI Sln91e Family R.111 Br YPE EPIL /X V O 3,91 LAND VALUE -CARD 20, aollnp Structure - 03 STYLE: 1-1.0 Story TFTAL MARKET VALUE - CARD 189,1 n9 Cow - 03 AL APPRAUIED VALUE -GRD 169,1 MHDP WaN I eaConaCambuQbn-S 20. OTAL APPRAISED VALUE -PARCEL 189,1 M. FNor Cow- 08 PRESENT SSE VALUE - PARC0. O.NAL nterlor Cour-31 AL VALUE DEFERRED - PARCEL AI TAXABLE VALUE -PARCEL 189,1 tlnp Find -03 1LDING VALUE 173,9 .U.g Type • 10 eat 1. VALUE ],go Caml.. q Type - 03 D VALUE 4: NT USE VALU! VeetllroMrN1NN- throoms E:EMED VALUE AL VALU MFV - FU2 -CLL-O N-Bethroans OTAL POINT VALUE 05. +--1{--+ "Las DATA EWS}....If--_.}. _....... SB.......... 1 F. I PGD ISAs Z FA .0 I Z Z I I I ECORD ATE D[B NDICAT! OTAL AD]USTNENT FACTOR 1.1 1 1 1 6 1021 3 O1 WD G V AL QUALITY INDEX 11 S f 1 I I I 30 1WD 1 U V 9 I I 7 1 Z 4 r +-5-+----7{----+11-+ NFATEO AREA 2.082 {Por { NOTES ROM PHELPS THOMAS _4 sUMRG UNR ORIi 4'4 ANN DEP % ovi Be R 1 TOFAGE 1 2 2 I5. 005 00 7 328 GD 650 M 2M0 0 N PAVING I 3.5 _ 995 99 1 Z PAVING 15 1,2 S. 995 99 5 1 36 ] . 1 Story [RAC! 2' 51nN MAU 3,M8 01.78 UILDINODIN ENSIONSBAS-W3657WSOFGD-W26535E26N35 SIWIM14ESF -56E26N6W26 E36N9EIZN31 . NFOR ER ONEST[IRS D ROTES LTOTALD TOT BES 0 BBT VS! 0 COD! LOLL OMiNG TACE TAG DE►7E / ! WD am GOND V AC LC TCDAD PACT IINR C LAND BY TOTAL AD>11fTED LAND OVERIIIDF LAND YNlTS TVP ADIST UMR VE VAL NOTE N NOMESIT 0201 150 0 106204 1.1400 01410+00 a00 PW 6,100.00 1. AC 2.A 14,475 2006 OT NARKETLANDDAT 1.3 20 WAL M NT UE DATA Page 1 of 1 Owner: RIDENNOUR C F Parcel: N6-000-00-090 http://maps.daviecountync.govlitsnetlAppraisalCard.aspx?idP=1470288&Action=Auto 7/29/2016