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4208 Hwy 601Sr ��.�. .....f .«y., •,-,,,.�..s �rw',iHn.N-'n.l'c7'.r«ira..;.�y r.4 ,d.r - y``�'Fk _- �� /yv 5-1.*- y' ' ' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION * NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name t Locati Date Subdivision Name Lot No. Sec. or Block No. Lot Size /Z/l House Mobile Home l� Business -- Industry No. Bedrooms .No. Baths A2 No. in Family _ Public Assembly Other Garbage Disposal YES ❑ NO 2-- Specifications for System: Auto Dish Washer YES ❑ NO []— Auto Wash Ma^hine YES 2 -'NO ❑ Type Water Supply --- �I �/l% Y y 'y *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. 4, 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. Final Installation Diagram: System Installed by 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 Environmental Health Section P. O. Box 665 i Mocksville, NC 27028 MAR 14 1994 1. Application/Permit Requested By e ( V- ( V (_AG N v y c ( ( v r r / / �• Mailing Address T . :7 - 3,D{fHome Phone 76) e;- Ls w L, r 7'0,21 Business Phone 4= y lob y/ 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: ❑ Business ❑ General Evaluation ❑ House ❑ Industry 5. If house, mobile home: Subdivision No. of People : No. of Bedrooms 13 ' No. of Bathrooms Dwelling Dimensions Septic Tank Installation Permit Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes _ No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: 19 Public ❑ Private 8. Property Dimensions 16 Sewage Disposal Contractor, Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing fA Washing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes IV No If yes, what type? ❑ 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: 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. - �- 9� 0 DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: L9'1. 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 WHO (1193) T h DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 4"�Vr^ /lJ ADDRESS PROPOSED FACIILTY I - Water Supply: On -Site Well DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Community Public 41-1 Evaluation By: Auger Boring 4/ Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z -� HORIZON I DEPTH " /`' Texture group 7--2 f Consistence Structure Mineralogy HORIZON II DEPTH 11 Texture group Consistence Structure /l / Mineralogy/.• HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: _/Y EVALUATED BY: /41/ LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 ■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■..■.■■■■■■■■■eee.■■■■■.■ ■e■ �■�. ■■■■■■■■■e......■■e■■■.e■.■■■■eee■■N■■.........■■■.■.■.■■■■....■■ ■■■■■■■e■eee■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■ee■■■■■ ■■■■■■■■■.■■eeeee■ecce■■e■s■■■■■■e■■.■..■.■..■.........■......■.■■ ■■e■■e■■■■■■■eee■e■e.■■■■e■e■■e■ ■■■■■�■■�■_■_■_tee■_n■■ee■e■eeee...■■ ■■■■■■■■■■■e■■■■■■■e■■■■■■■■■■■e�■■�i:eee■■■■■■■.1/........e.■■..■■ ■■■■■■■■■■■■■■■■■ee■Ci%■i/■■■■■ ■a■■■■■■■■■4�eee■■eee■eeeei.■■■■ ■.■■■■■■■■■■■■■■■/ter■■■■■.eee.■■■■■■■■■.■ee■■iii■....■■.......■■..■ ■■■■■eee■■■■ee���■.■■■■a■■■■■■■■e■■■■■■■■■■■■eee■■=■■■ee■e■e■eeee■ ■■■■es■■■eee■��e■■■■■■■■■■■■■■■eee■■■■ee■■■■■■■■e■ ■■e.ee...■ee■■ ■■■■■■■■e■■��.e■■■eeeee■■■■■■■■■■■=■■.■etee■e.e■■■■.■■■■■■■.■■■■■ ■■■■■■■■■,►.■e■■■■■.■■■■■■■e.■■■■e■■■■s■■■■e■.■■eee■■■ ■.■.■ee■■=■■■ ■..e■■.eee.■eee.eeeee■■■■eee■■■■I�e■.■e.e.el�■■■e....e..e.....■ ■■■ .......►.N■■■■e■■e■■■■■■■ee■■■e■■■■e■■■e■■■■e.eeeeCN■■■..eeeee. . ■■■e■■■eeeee■a■■.■.eee■■..eeee■e■■■■..■e.ee■.....■ ■..■.■....■.■■■ ■■■■eel■■■■■.a■■s■■■■■.ee■■■■e■eee■■■..■.■■.■■■■..■■.■.■e■■■■■.■■■ ■e■■■■�1■■■■■eee■■■■■■■■■■e■■■■■■�ee■■■■■■■■■ee■ee■e■■■■.ee.eeee■■ ■.■e■■ii■.e■■■■■e.eeeee■■.e■ee■■■ eee■■■■■■■■.Ne■.■.■.■.....ee.e■ ■■■■■eel■■■■■■■■■■■■■■e■■■■.eeeee■■■ee.e.■■■■■■■■.■■■■■■■■ ..eeeee■ ■eee■■nee■.■■.■■■e■■■■.■.■■■.■.■..■■■■■.......■.....=..e.�i.■.■■..■ ■■■■■e�!■■■e■■■■■ee■■■■e■.e..■ee■ .e■■■■■ .■■■eeN■.■..■eeeee■.■■.■ EMEMEMMENNEN�iiiiii iiiii■�iiiiii ii'�liii■�iiiiii ■.....■\1■■e■■■......■■■...■.■■..■■■■..■■.■.■■■■■..■■■■■■■I..■e■■■■ ....................................■■N■P■■■.■.. 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USE MOD Area IQUALI BASE RATE I RCN I EYB AYB CREDENCE TO MARKET Sub Floor System - 4 02 02 11,936 1 94 1 40.42 17825311994110aAl % GOOD 167.0 DEPR. BUILDING VALUE - CARD 52,43C Plywood 11.00 Exterior Walls - 10 Aluminum/Vinyl Siding32.0 DEPR. OB/XF VALUE -CARD 3,72 TYPE: Manufactured Home (Multi) Manufactured Home MARKET LAND VALUE -CARD 61,00 STYLE: i - 1.0 Story TOTAL MARKET VALUE - CARD 117,15 Roofing Structure - 03 Gable 9.00 Roofing Cover - 03 As halt or Com ositlon Shingle 5.0 TOTAL APPRAISED VALUE - CARD 117,15 Interior Wail Construction - 5 D all/Sheetrock 28.00 TOTAL APPRAISED VALUE - PARCEL 117,15 Interior Floor Cover - 08 Sheet Vinyl/Laminate 7.0 TOTAL PRESENT USE VALUE - PARCEL Interior Floor Cover - 14 Car et 0.00 TOTAL VALUE DEFERRED - PARCEL TOTAL TAXABLE VALUE - PARCEL 117,15 Heating Fuel - 04 Electric 1.0 PRIOR Heating Type - 10 Heat Pump 5.00 BUILDING VALUE 62,07 OBXF VALUE 4,75 Air Conditioning Type - 03 Central 5.00 LAND VALUE 61,00 PRESENT USE VALUE Bedrooms/Bathrooms/Half- Bathrooms DEFERRED VALUE 3/2/0 0.00 OTAL VALUE 127,82C Bedrooms BAS - 3 FUS - 0 LL - 0 Bathrooms BAS -2 FUS -0LL-0 Half -Bathrooms BAS -0 FUS -0LL-0 + - - - 1 6 - - - t PERMIT Office BAS - 0 FUS - 0 LL - 0 0 I W D D I CODE DATE NOTE I NUMBER AMOUNT 8 8 I I +---16---+-------------52--------------+ ROUT:WTRSHD: I B A S I SALES DATA I I OFF. I I RECORD ATE DEED INDICATE SALE TOTAL POINT VALUE 1111.000 BUILDING ADJUSTMENTS Quality 3 AVG 1 1.000 Sha Desi n 3 FACTOR 3 1 1.0006 Size 131 Size 1 0.890-0 TOTAL ADJUSTMENT FACTOR 0.850 TOTAL QUALITY INDEX 94 I I BOOK AGE in MYR TYPE PRICE I I 0166 125 11111992 WD U I V 2 2 8 8 I I I I I I I I HEATED AREA 1,904 I I +---------- ------68----------- --- - -+ NOTES SUBAREA UNIT ORIG % ANN DEP % OB/XF DEP %D GS RPL ODE ESCRIPTION OUN LTH H NITS PRICE GOND LDG# AYB EYB RATE V c VALUE 1 241 241 5761 15.0 _ 1199,ql9941 S31 1 431 371 TYPE AREA % CS ISHOP BLDG 1 BAS 1 9040 7696 OTAL OB XF VALUE 3,71 DD 128 25 129 FIREPLACE 1 - None SUBAREA 2,032 78,253 TOTALS BUILDING DIMENSIONS BAS=W52 WDD=N8W16S8E16 W16 S28E68N28 . LAND INFORMATION HIGHEST JOTHER ADJUSTMENTSLAND TOTAL AND BEST USE LOCAL FRON DEPTH / LND IMOD COND ND NOTES ROA UNIT LAND LINT TOTAL I ADJUSTED LAND OVERRIDE LAND I USE CODE ZONING TAGE DEPT SIZE FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE VALUE NOTES MH 0201 16 0 1.0000 0 PW 6,100.0 10.000 AC 1.00 6,100. 6100 HOMESIT 1 1 1 11.000011 +00+26+00+00+00 1 TOTAL MARKET LAND DATA 10.00C 6100 ,TOTAL PRESENT USE DATA http://maps.daviecountync.govlitsnetlAppraisalCard.aspx?idP=1462493&Action=Auto 7/29/2016