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3332 Hwy 801SDavie County, NC Tax Parcel Report I � O `+ 6-q Tuesday, September 27, 2016 389 Tot 3332 4287 30' Easernent 79�Toj `".,,....., A 141 Davie County, NCimplied WARNING: THIS IS NOT A SURVEY causes of action due to or arising out of the use or inability to use the GIS data provided by this website. arceflnformation Parcel Number: 180000002801 Township: Fulton NCPIN Number. 5788144287 Municipality: Account Number: 82514383 Census Tract: 37059-804 Listed Owner 1: BARNHARDT J TODD Voting Precinct: FULTON Mailing Address 1: 3332 NC HIGHWAY 801 SOUTH Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A,R-20 State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: 4.83 AC OFF HWY 801 Fire Response District: FORK Assessed Acreage: 4.81 Elementary School Zone: CORNATZER Deed Date: 4/1999 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 002110267 Soil Types: PcB2 Plat Book: Flood Zone: x Plat Page: Watershed Overlay: WS -IV -P Building Value: 379640.00 Outbuilding & Extra 7440.00 Freatures Value: Land Value: 53400.00 Total Market Value: 440480.00 Total Assessed Value: 440480.00 141 Davie County, NCimplied All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or inability to use the GIS data provided by this website. NAY w Davie County Health Department �s I� Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 R 1911 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection c / Name: / U/-" 1,� Phone Number ?C (Home) Mailing Address. / d lli'r-ff �h �� = %j`0 F� C, -�ql (Work) lar 'Ile 7 %O 2 Email Address: _dells ci S5 Gi•'o�� G� tai gf� � Detailed Directions To Site: /)/w,/ (, e S 7 i? 0f 5 C T U r h e - Property Please Fill In Theme to lawin ation on Fa�tCi c Name System Installed Under:. itl h i`1 Type Of Facility:.S�/ Date System Installed (Month/bate/Year): 706/ Number Of Bedrooms: Number Of People: 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: Type Of Facilitk: .3(o k 5�d l�r f �c �-/ (-r­r, e- Number Of Bedrooms:_oNumber of People Pool Size:42 4 / GG ge Size: ? -�'O Other: Requested By:T Date Requested: Z— L? (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health S ecialis( l,,. d-1 Date: % 22, 2 *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. 9 Payment: Cash Chec Money Order # 7i Amount:$ 00 Date: a i Paid By: C ubb Received By: Account #: d �Cf qo o6 5 7 Invoice #:;' ' `x Appraisal Card r Page 1 of 1 DAVIE COUNTY NC I00 3/15/2013 9:43:41 AM ARNHARDT 3 TODD BARNHARDT SUZANNE E Retum/Appeal Notes: I8-000-00-028-03 50011 332 S NC HWY 801 (S)39dd NOIivdnQ 3WCN/rON Xdd UNIQ ID 17380 31Va 2514383 D476 -P14 ID NO: 5788144287. COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 4.83 AC OFF HWY 801 4.840 AC SRC- Inspection kppralsed by 02 on 08/30/2007 04001 FULTON TW -04 C- EX- AT- LAST ACTION 20120517 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 Standard 0.1200 - ontinuous Footing5.0 Eff. MO Area UA]BASE RATE RCN EYB AVB CREDENCE TO MARKET ub Floor System - 4 US 01 3 548 142 99.40 355372 20012001 % GOOD 1 88.0 DEPR. BUILDING VALUE - GRD 312,730 ood 8.00 01 xterior Walls - 21 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE - GRD 7,44 ace Brick 34.00 MARKET LAND VALUE - GRD 53,40 oofing Structure - 06 STORIES: 2 - 1.5 Stories TOTAL MARKET VALUE - CARD 373,57 rre ular/Cathedral 13.0 oofing Cover - 03 ksphalt or Composition Shingle 3.00 TOTAL APPRAISED VALUE - GRD 373,57 nterior Wall Construction - 5 TOTAL APPRAISED VALUE - PARCEL 373,57 )rywall/Sheetrock 26.0 nterlor Wall Construction - 6 ustom Interior 0.0TOTAL PRESENT USE VALUE - PARCEL nterlor Floor Cover - 12 TOTAL VALUE DEFERRED - PARCEL ardwood 10.0c OTAL TAXABLE VALUE - PARCEL 373,57 nterlor Floor Cover - 14 'arpet 0.0c PRIOR eating Fuel - 04 - UILDING VALUE 344,83 lectric 1.0 +16-+ BXF VALUE 10,92 +6+ I AND VALUE 52,66 eating Type - 10 6 F U S I RESENT USE VALUE eat Pum - 4.0 +6+ 3 EFERRED VALUE it Conditioning Type - 03 I 0 rOTAL VALUE 408 41 4.0 1 Ims/Bathrooms/Half-Bathrooms 19.00 +16-+ ms +13-+16-+ 3FUS-ILL-I 1FOP1WDD1 PERMIT oms 4 4 4 CODE DATE NOTE NUMBER AMOUNT 2FU5-iLL-1 +11+13-+16-+-16-+ +----40----+-16-+ athrooms IBAS I IFBM IBUG I [entral 2 FUS- 0 LL -0 I1 1 1 I OUT: WTRSHD: L POINT VALUE 127.00 1 3 4 2 6 3 3 SALES DATA +--24--+ 2 2 BUILDING ADJUSTMENTS 0 I IUBM I I I FF' INDICATE 3 Size 0.890 I I 2 2 I IRECORD ATE DEED SALES 4 ABAVG 1.200 I +9-+14-+ 4 1 +7+-16-+ OK AGEM R TYPE /PRICE /Desi 4 FACTOR 4 1.050 5 F O P I I S 0211 267 4 199 WD U V 2500+--24--+9+9-+ +--24--+9+ ADJUSTMENT FACTOR 1.12 - IFGD I QUALITY INDEX 14 1 1 2 2 4 .. 5 HEATED AREA 3,486 I I +12+12-+ NOTES US -B&B OVER FGD&BAS THAT OU ENTER FROM BAS AREA SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR TYPE GS AREA % RPL CS ODE DESCRIPTIO LT NIT PRICE GOND LDG B AYB EYB RATE Vill CON. VALUE 5 2,021) 10 20168 9 P PAVING 1 50 5,00 3.0 _ L 001 001 S 4 6000 UG 51 02 1272 30 ON PAVING 2 3 60 4.0 L 00 00 5 6 144 BM 941 04 4204 OTAL OB XF VALUE 7,440 GD 58 04 26341 OP 22 03 785 us 516 09 46122 T BM 57 02 11431 Eli J( �✓/ /J J�j f // DD 1 2241020 447 / 3 - 1 Story . IREPLACE Sln le 2,70 USAREA' OTALS 5,61 55,37 UILDING DIMENSIONS BAS-W16WDD=N14W16S14E16$W16FOP=N14W13514E13SW24S40FGD=S24E12SIE12N25W24$E24N3E9F 23N32S E15 BM-E40BUG-E16S32W16N32 S32W7SSW9UBM-N21W24S24E24N3 N21W24N16 W15N20W40FUS=N30W16S6W6S6E6SI8EI6 E40S204S7 ..LL ND INFORMATION OTHER LAND TOTAL fir] jUIGNEST r�y�'�` ND BEST USE LOLL FRON DEPTH/ LND COND ryNV�j�pp�C`j7j7 ijT����I URIC LAND SE CODE ZONING TAGE EPT SIZE MOD FACT P (lA�']Np_] VALND PM14CE1 UE NOTES URAL AC 0120 332 01 1.3100 4 1.1700 Ol +16 +00 +00 +00 pW 7,200. 11, 5340 ca en OTAL PRESEN SE I 1ATA J,%SFjEj I I00 E0 50011 1N3WW00 rm3d (S)39dd NOIivdnQ 3WCN/rON Xdd 3WI1 31Va 'ON 8LE8ZIM000 : #*83S 08916SL9EE : X31 08916SL9EE : XV -1 H30Q : 3WdN 10:00 EZOZ/ZZ/E0 3WI1 iWdMl IVN no XB3 http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=I80000002801 3/15/2013 3305-`- _ 3307 .�. f 4 3311, r j All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the implied G �, C+ warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of Pri nted: M a r 13 2013 5 the use or inability to use the GIS data provided by this website. r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900458 Tax PIN/EH #: 5788-14-0379.000E Billed To: Todd Barnhardt Reference Name: Suzanne Barnhardt Proposed Facility: Residence ATC Number: 2601 Subdivision Info: Location/Address: 801S.-27006 Property Size: 5 acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE CONSTRUCTION IS VALID FORXAOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 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. Septic System Installed By: /` 11(L Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: DAME COUNTY HEALTH DEPARTMENT - . T Environmental Health Section f6t j 06 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900458 Tax PIN/EH #: 5788-140379.000E Billed To: Todd Barnhardt Subdivision Info: Reference Name: Suzanne Barnhardt Location/Address: 801S.-27006 Proposed Facility: Residence Property Size: 5 acres ** aj*VyVbgr. 2601 N is mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People% #Bedrooms #Baths_ Dishwasher: Garbage Disposal:Z Washing Machine: 2T' Basement w/Plumbing: P?"' Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply b Design Wastewater Flow (GPD) �fT( Site: New M/ Repair ❑ System Specifications: Tank Size/.2 gP GAL. Pump Tank GAL. Trench Width Rock Depth 19I Linear Ft.�' Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on th f installation. Telephone # is (336)751-8760.**** 0'r, LlAed SGV Environmental Health Specialist's Signature: Date: /l9 DCHD 05/99 (Revised) r • A• • ' ' APPLICATION FOR SITE EVAWATION/IMPROVEMENT PERMIT & ATC Davie County Health Department D Environmental Health Section OCT P.O. Box 848/210 Hospital Street 2000 Mocksville, NC 27028 (336)751-8760 5 ��z'� e- a_ J y / ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refei to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Mailing Address City/State/ZIP 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation 4. System to Service: C#/HOuse ❑ Mobile Home S. If Residence: # People Contact Person 1 (.1L!U h " / Home Phone 75Q-- Business /Business Phone nUl_J lad- — City/State/Zip Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms # Bathrooms 1' 0 Dishwasher a Garbage Disposal b washing Machine A Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: SpeLify type # People # Sinks' - # Commodes # Showers # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 111 County/City 9. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ co= mnity ❑ Yes FVNo j ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED I I BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: nti—� CSC/ ']WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # l I� U► Property Address: Road Name / on City/Zip If in a Subdivision provide information, as follows: Name: i Section: Block: Lot: Date Property Flagged: I 0 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. 1, also, understand that 1 am responsible for all charges incurred from this application. 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 the site sbility. DATE I V SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS• Revised DCHD (07/99) q -1l 711Jt� �ra[7� Account No. p Invoice No. o �y U APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE Davie County Health Department Environmental Health Section TrFEB g0 P.O. Box 848 Mocksville, NC 27028 �F ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed / a A- r/fJa r1; 4aM �'" Contact Person � � 9,4 /moi? 441 y Mailing Address ��f� Gt/ Home Phoneme '7S�g— City/State/Zip I /D Business Phone 2. Name on Permit/ATC if Different than Above :57-q L- Mailing Address ioLll� City/State/Zip 3. Application For: [Fite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: YJ House [ ] Mobile Home [ J Business [ ] Industry [ ] Other 5. If Residence: # People—3— # Bedrooms 3 # Bathrooms [ ishwasher [✓) Garbage Disposal [ FIV*ashing Machine [ ] Basement/Plumbing [ qCasement/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: 141county/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [' ] Yes [4 If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **%tT1 T OF THE PROPERTY MUST BE ,QCQ✓ SUBMITTED WITH THIS APPLICATION. Property Dimensions: '29G• 3 a-- X "' 7,5;cpWPdTE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # -�� - ��3� 9 f(a0��'/� •� Hwy �D/ Ge,�f Property Address: Road Name AK FO/ S K � 14 �" S%d �ih�sr a City/Zip W,41A 464 AIC If in Subdivision provide information, as follows: 001"1L WA3e- Z62,� Name: 1JIX Section: Lot #: / /t Q MTS J F4d 4-&6Y'' �/7 �— (Tn iN C, - 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 Represe tative of the avie ounty/Health Department to enter uponfabovescrib to con ct 1 t 'nes as DATE o`t- SIGNATUR Revised DCHD (06-96) THIS AREA MAY BE USEb FOR DkAIVING YOUR SITE PLAN: property located in Davie County and owned ,essary to determine the site suitability. 47 7AC PC .,yam _ •t' 0) Lij X55 r V/ s • OD 8 ��1:. +•�' + *' '-5.35Ac49 i� t t p,�`2 b 4 `�;. G:66 Ac ti �r R �� yr 341 e • ,� S - �, t' �9Ac � 32 44�� � 33 6.9 8 Ac � 3.02 Ac: o 4. +t' "►' t ' r'-1"7 �'9 4 0 381.52 3.S.R. fey. 1h 46s ^i ti , 3 � -31444 Yt. +y � V G r a• 1Q. t•�:; �. �,. CO IJ�O U� 1 2 A c h 214 Ac <' r? ?,�/ 4J rl 285 pp:'' ,' -r ' t P s p=a 2 9 8 2-2 1782 �6 ti 30 •r'r: w c N .� hll6 8 O ' GT' •ry29 42371 _ 3 4 ,• '' , .. 0 333A 68 29 26.0 o ` u1 `► . �,�k... .7��t ,Qp, 6 443.47 N NT w a •. '[-tt AI •� ; tti• � =t��'� �..'411 % 92 i 5 �Q mCO n (2.2 AC. \0 5 �, i ve co r 2-4 Ln OD 15 1B roe k W • F IN c 66 (; 64 2 . k. 64 N ` r 0 >A • I �: ono 1 t too N �ej � I • Q � c0.p I JO NORTH DAVIE COUNZ TAX MA f . - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit DATE EVALUATED 565 1317-61 PROPERTY SIZE ROAD NAME A-Lj'i9 mi S Public Cut SITE CLASSIFICATION: EVALUATION BY: l LONG-TERM ACCEPTANCE RATE: �.35 OTHER(S) PRESENT: REMARKS: DCHD (01.90) 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 Landscape position HORIZON I DEPTH - . owl • HORIZON 11 DEPTH Consistence HORIZON III DEPTTexture ••�'�l�Si71/�[i�--� group • i�1i�4'l��-1' --- Consistence .Tam Mineralogy Texture group Consistence CLASSIFICATION SITE CLASSIFICATION: EVALUATION BY: l LONG-TERM ACCEPTANCE RATE: �.35 OTHER(S) PRESENT: REMARKS: DCHD (01.90) 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 - 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5 Acre Tract/Hwy 801 S Tax PIN #: 5788-14-0379 Dear Mr. Barnhardt: As requested, a representative from this office visited the aforementioned site on March 24, 1999. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. **SPECIAL NOTE: Due to some complex topography on this tract, the area available for installation of the system is limited. Additionally, placement of the house may require setting a pump station. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. enc(s) If you have any questions, you may contact our office at (336)751-8760. Environmental Health Section FROM.: BARNHARDT ___ FAX NO. : 336-940-3934 v County Health- Department Onmental-Health •Section • 3 '�� P.O. Box 848 210 Hospital Street Courier #: 00-40-06 C UN FAw, Mocksville, NC 27028 Jul. 02 2007 11:20PM P1 ON-SITE WASTEWATER CERT N FOR DWELLING (Check One) Replacement Remodeling Reconnection j� Name: ilanfttC &AladT __..1%one Nvmbcr. • Mailing Address tt' 1� :A (Work} tt 5itc: 1� 4 t 6 k1041 r `J GU D- n,-9 4 tr rt YF tr<la,tf • (AUC- end •k� a Av a Fax: (.336) - 751- 8786 Detailed Directions To Pmlx:rty Addtuss'c! Please Fill In The Followin Information About The EXISTING Facility:w4 I % Name System Installed Under: I }� l2 Type Of Facility:�2:S{y de Date System lastalted (Month/Date/Year): Number Of Redrooms;..5_Numbcr Of P optc:�. Is The Facility Currently V=at? Yes No If Yes, For How Long? Any [Gown Pxobtema7' Yes ' 1f Yes, Cxplain: Please Fill In The Foll ; rii Information About The NEW Facility: Type Of Facility: Requesv um erof People Requested By: 4 rL a e 'P Date ted: 6 For Environmental Health Office Use Only Appmvea Diwx ovcd • Comments: 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 uarantee(extended or limited) that.the on-site wastewater system willfunction properly for any given.period of time. Payment: Cash Check !Money Order # Amount:S Date: Paid By: ----Received By:' Accountl�: 34 Livaicn#: FROM.: BHRNHmRDT FAX NO. : Jul' 02 2007 11:20Pn P2 x � K DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900458 Tax PIN/EH #: 5788-140379.000E Billed.To: Todd Barnhardt Subdivision Info: Reference Name: Suzanne Barnhardt Location/Address: 801S.-27006 Proposed Facility: Residence Property Size: 5 acres ATC Number: 2601 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE CONSTRUCTION IS VALID FORZte: OD OF FIVE YEARS. Environmental Health Specialist's Signature: > � le '%e� r CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 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 1)- - Septic System Installed Environmental Health Specialist's Signature: DCHD 05/99 (Revised) I Date: LAvm riEAL'1'H DEPARTMENT Environmental Health Section % P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900458 Tax PIN/EH #: 5788-14-0379.000E Billed To: Todd Barnhardt Subdivision Info: Reference Name: Suzanne Barnhardt location/Address: 801S.-27006 Proposed Facility: Residence Property Size: 5 acres ** �T*l�lbgr: 2601 N is mprovement/Operation Permit DOES NOT authorize the constructionof a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type#People_ #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal:z Washing Machine: Basement w/Plumbing: P""' Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ i Lot Size t . Type Water Supply 14t Design Wastewater Flow (GPD) U Site: New . Repair ❑ 1 System Specifications: Tank Siz%Z GLS GAL. Pump Tank GAL. Trench WidthL, Rock Depth /Linear Ft.JaL Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1.00.m. to 1:30 p.m. on th f installation. Telephone # is (336)751-8760.**** 8 6 i1 flr,v 1. -0j) ed X Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) t Davie County Health Department ea// Environmental Health Section jo�q P.O. Box 848 • d 21.0 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 /ae Plione: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: Jir��4te.,t7L Phone Number 334' / "7 (Home) Mailing Address: 3332: NC 6/y Fd% SoUltIlp �%If- /n� (Work) cc -/1k, 0_70a Detailed Directions To Site: 6 / 6e, ST _�v Ilulty ;?d/ • _71l I'll Z e� d -A /_,/� 100% -`Y 3 �, el Property Address: me. as Please Fill In The FollowingInformationAbout The EXISTING Facility: Name System Installed Under: / Ol,� �_A ZakGte n tf` : Type Of Facility: u �- Date System Installed (Month/Date/Year): '°' 004Z219 Number Of Bedrooms: Number Of People: 7 Is The Facility Currently Vacant? Yes C1;W If Yes, For How Long? Any Known Problems? Yes / Nd If Yes, Explain: Please Fill In The Following Ihformation.About The NEW Facility: Type Of Facility: ak_�� a-- Number Of Bedrooms: Number of People .Pool Size: N Garage Size:_5G }l zf 8 Other: Requested By: Date Requested: ignature) For Environmental Health Office Use Only Approved Disapproved Environmental Health Specialist. Date: T *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: Cashes Money Order # Paid By: eived By: Account #: Invoice ('Z.` lilt .1 ... . I n l .o n i. Date: �Y1(