232 Indian Hills RdDAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 /Fax # (336)753-1680
REPAIR OPERATION PERMIT
0 ,N
Tax PINIEH #: H700000104
SubdivisionInfo:
Localion/Address: '232 Indian Hills Drive -27006
P opefty, Size:'. 20 Acres
Operation Permit shall indicate the system described on the ATC has been installed
'G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems,"
a guarantee that the system will function satisfactorily for any given period of
Manufacturer /) I Tank Date Tank Size d
(7
system instanea By: JL4'✓k.Le ��G'�p�_ E.H. Specialist: � �e: ( &
GPS Coordinate:
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
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005050 Tax PINfEH #: H700000104
Billed To: Robert Logan 'Subdivision Info:
Reference Name: REPAIR PERMIT LocationYAddr � ::`:232 Indian Hills Drive-27006:..
Proposed Facility: Residential Repair Pcbpe§A� lie: t]lQW4.pa. ' ❑Expansion `
A Tffib'br'fhis58.®fllorization 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 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 # Bathrooms # People_ Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size —az Type of Water Supply: bounty/City ❑Well ❑Community Well ,
System Specifications: Design Wastewater Flow (GPD) . (1 Tank Size( AL. Pump Tank GAL.
It t. V
Trench Width �� Max. Trench Depth Rock Depth Linear Ft.'�r�
Site Modifications/Conditions/Other: �zPLa�
Contact the Davie County Environmental'Henith Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Tele hone # (336)751-8,760.
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Environmental Health
DCHD 11/06 (Revised)
Date:
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Account #: 990005050
Billed To: Robert Logan
Reference Name: REPAIR PERMIT
Proposed Facility: Residential Repair
Water Supply: On -Site Well
PROPERTY INFORMATION
Tax PIN/EH #: H700000104
Subdivision Info:
Location/Address: 232 Indian Hills Drive -27006
Property Size: 20 Acres Date Evaluated:
Community
Evaluation By: Auger Boring I Pit
Public X
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
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: EVALUATION BY 1 ti
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: Q
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
1lZQist
VFR Very friable FR Friable FI -Firm VFI - Very firm EFI Extremely firm
3y'_et
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
Mineralog
1:1, 2:1, Mixed
LYfltsS
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 05105 (Revised)
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Addatt h&
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION 4
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
(y d
44a wo PHONE NUMBER
.SS ��%I GS Vv'NS, DIVISION NAME
LOT #
ONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY 4 NUMBER BEDROOMS NUMBER PEOPLE SERVED Z
VY
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT,
Rev. 1193
Appraisal Card
nAV1F entiNTV_ Nr:
Page 1 of 1
1 r17r7n17 Ce7Re16 AM
LOGAN ROBERT EARL & LOGAN MARY SUE POLKEY 1,17-000-00-104
32 COMANCHE DR _ UNIQ ID 13852
6032400 ID NO: 5769803330
COUNTY TAX,FIRE TAX CARD NO. 1 of 1
Reval Year: 2009 Tax Year: 2012 20 AC INDIAN HILLS RD 22.340 AC SRC= Inspection
kippralsed by 19 on 09104/2008 07001 SHADY GROVE TW -07 C- EX- AT- LAST ACTION 20100922
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION CORRELATION OF VALUE
Foundation - 3
FOBS Funtional 0.1000
ontmuous Footing 8.00
Eff.
BASE
bsolescence
I Standard 10.7000
ub Floor System - 4
I wood 11.100
USE
MOD
Area
OUAL
RATE
RCN
EYS
AYB
CREDENCE TO MARKET
xterior Walls - 09
03
02 11,0421
9538.00
3959
196
196
GOOD 20.0 DEPR. BUILDING VALUE - CARD 7,92
ood on Sheathing or PI wood 0.00
TYPE: Mobile Home (Single Wide) Manufactured Home DEPR. OB/XF VALUE -CARD 70,56
xterior Walls - 30
MARKET LAND VALUE - CARD 203,56
luminum in I Siding 33.0STORIES:
1.0 Story TOTAL MARKET VALUE - CARD 282,04
Roofing Structure - Ol
Flat 4.00
OTAL APPRAISED VALUE - CARD 282,04
Roofing Cover - 12
Metal 3.0
OTAL APPRAISED VALUE - PARCEL 282,04
Interior Wall Construction -4
Plywood Panel 24.0
OTAL PRESENT USE VALUE - PARCEL
Floor Cover 08
Interior -
OTAL VALUE DEFERRED - PARCEL
Sheet Vinyl e 8.0
OTAL TAXABLE VALUE -PARCEL 282,04
Interior Floor Cover - 14
Carpet 0.00
PRIOR
UILDING VALUE 10,34
Heating Fuel - 02
II Wood or Coat 0.00
BXF VALUE
LAND VALUE 157,60
Heating Type - 04
Forced Air - Ducted 5.00
PRESENT USE VALUE
DEFERRED VALUE
Ir Conditioning Type - 01
None 0.02
TOTAL VALUE 167,94(
+ - - 10.-+
Bedrooms/Bathrooms/Half-Bathrooms
/1/1 0.000
I W D D I
3 1
Bedrooms
BAS -2FUS -0 LL -0
0 0
I I PERMIT
Bathrooms
BAS - 1 FUS - 0 LL - 0
+ 5 - + - -10--+-7--+ CODE DATE I NOTE I NUMBER AMOUNT
I I
7 1
Half -Bathrooms
BAS - 1 FUS - 0 LL - 0
1 I I OUT: WTRSHD:
+----------35------.-----+ I SALES DATA
I B A S 1 FF. INDICATE
1 I RECORD DATE DEED SALES
Z 1 BOOK PAGE MO R TYPE /U PRICE
I I 0190 009 9 199 WD Q I 11250
1 - I 0190 091 9 199 V 11250
OTAL POINT VALUE 6.00
BUILDING ADJUSTMENTS
uali 3 AVG 1.000
ha a Desl n 5 FACTOR 5 1.100
Ize 3 Size .900
OTAL ADJUSTMENT FACTOR 0.99
OTAL QUALITY INDEX 95+
-6--+ +-----------36-----------+
I ICAN I
I 3 1
1 0 0
-
1 I I HEATED AREA 981
I+-----------36-----------+
+---13---+ NOTES
ATE LOCKED = 2 AC POND
OWNSHIP CORRECTED LEFT
EIGHBORHOOD CODE SAME
SUBAREA UNIT I ORIG % ANN DEP % OB/XF DEPR
GS. RPL ODE DESCRIPTION LTH THUNIT PRICE GOND BLDG#L/B AYB EYB RATE V COND VALUE
TYPE AREA % CS 01 TORAGE 1 4 121 91 15.Cl 10 L 119711991 S1 151 79
AS 981 LOO 3727869 IMETAL BLDG 1 81 601 4,8001 15.3 L 120081200M S1 1 91 6976
N 36COIC 1368 TOTAL OB XF VALUE 70,560
DD 100O25 95
FIREPLACE 1
UBAREA
OTALS 1,441 1 39,59
BUILDING DIMENSIONS BAS=W7WDD=NIOWIOS10E10$W15S7W35S12E8SllE13NICAN=E36NlOW36S10$N10E36N19$.
LAND INFORMATION
HIGHEST
THEIR ADJUSTMENTS
LAND TOTAL
NO BEST USE LOCAL
FRON
DEPTH /
LND
COND
NO NOTES
ROA UNIT LAND LINT TOTAL ADJUSTED LAND LAND
USE CODE ZONING
TAGE
DEPTH
SIZE
MOD
FACT
RF AC LC TO OT
TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES
MH HOMES IT 0201
145
1 0 1
1.0000
4
0.9800
07 +20 +00 +00 -15
1 PW 1 9,300.00. 22.335 AC 1 0.98 9,114.00 203561 PERKING
OTAL MARKET LAND DATA 22.335 203,560
OTAL PRESENT USE DATA
a
http://maps.co.davie.ric.us/ITSNet/AppraisalCard.aspx?parcel=H700000104 1/12/2012
NORTH CAROLINA
DAVIS COUNTY
THIS DEED made this the 8th day of July, 1965, by CLARENCE EUGENE GRUBBS and wife
MARY LORSNE GRUBBS of Davie County, State of North Carolina parties of the first part,
to THOMAS MARVIN COOK and wife, DISSIB MULL COOK ,il 'Aof Dade
County, State of North Carolina, parties of the second part; WITNESSETH THA the said
parties of the first part, in consideration of($10.00 o.v.c.) Ten Dollars and Other
Valuable Consideration to then paid by the said parties of the second part, the receipt
of which is hereby acknowledged, have bargained and sold, and by these presents do
bargain, sell and cone save and except a right-of-way of egress and ingress running
from the said state soil road to the below -described property; said driveway running
along the North line of F. L. Lowe to said property; and said right is given for so
long as said granteed own 145 feet of property described in the first call below, said
145 feet running with the center of said state &oil road and being a portion of the
Western boundary as described below unto the said par ties of the second part and their
heirs a tract or parcel of land in the County of Davie and State of North Carolina, in
Shadygrove Township, and bounded as follows:
BEGINNINiG at an iron stake, said iron stake being the Southeast corner
of F. L. Lowe, said stake also being in the middle of a soil state road,
running thence with the middle of the above said road South 6. 301 West
145 feet to an iron stake located in middle of said road- thence North
85. 00' West 379 feet to an iron stake; thence South 50 60, West 100
feet to an iron stake located in a North line of Clarence Carter; thence
North 85. 001 West 1,179 feet to an iron stake said iron stake being
located in 0. A. Potts Eatate East line and sa;d iron stake further be-
ing located North 2. 30+ East 943 feet from a ateae; thence with said
Potts East line North 2. 30' East 748 feet to an iron stake located in a
South line of said Potts Estate* thence with said South line d said
Potts Eatate South 87. 3 1
East 1190 feet to an iron stake, said iron
stake being a Northwest corner o% C. E. Grubbs; thence South 3. 301 East
394 feet to an iron stake said iron stake being a Northwest corner of
F. L. Lewy; thence South b• 301 West 150 feet to an iron stake, said
stake being Southwest corner of F. L. Lowe; thence South 83• 70":Eift 334
feet to the place of BEGINNING. Being a 20 acre more or less tract of
land located in Shadygrove Township as surveyed by S. L. Tolbert.
The grontess are given the right of egress and ingress in a driveway runn-
ing from the state soil road as described above along the North line of
F. L. Low for so long as said grantees own 145 feet of psoperty described
above running with the center of said state soil road and being a portion
of the Western boundary of the above described property, and no longer.
STAMPS PAID $1.10
TO NAVE AND TO HOLD the aforesaid tract or parcel of land and all privileges and
appurtenances thereunto belonging to the said parties of the second part and their heirs
and assigns forever.
The said parties of the first part do hereby covenant that they are seised of said
pprreeai"s in fee and have the right to convey the same in fee simple; that the same are
free from encumbrances; that they will warrant and defend the said title to the sane
against the claims of•all persons whatsoever save and except 1965 taxes paid bycantor
and egress and ingress right-of-way an described above so long as grantees own 14
feet of road frontage on said state soil road and no longer.
IN TESTD40MY WHEREOF the said parties of the first part hereunto set their hands
and seals.
ft2921 ugene bn a s (SEAL)
ace
(SEAL)
roue ru s
NORTH CAROLINA
FORSYTH COUNTY
I, Ines J. Roberson a Notary Public of Firsyth Count�1 North Carolina, do hereby
certify that CLARENCE ERAS GRUBBS and his wife, MARY LOR81t9 GRUBBS, grantors, each
personally appeared before me this day and acknowledged the execution of the foregoing
deed of.conveyance.
Witness my hand and notarial seal this the 8th day of July, 1965.
Ino: J. Roberson (SEAL)
My commission expires: January 169 1966 otary blit
NORTH CAROLINA, DAVIE COUNTY
The foregoing certificate of Ines J. Roberson, a Notary Public of Forsyth County,
North Carolina is adjudged to be correct. Let the said deed and this certificate be
registered.
Witness my hand this the 10 day of July, 1965,
n
pity ler Superior Court
Filed for registration on the 22 day of June, 1970 at 3:00 o'clock P. M. and duly
recorded in the office of the Registe of Deeds of Dade County, N. C., in Deed Book 80
Pogo 594.
J. K. Smith, Register of Deeds By: Nancy
Deputy Register of Deeds
• � ' o�n 11oaJ-�L' pAc��� . .
FILED FOR REGISTRATION
1-12-88 10140 Ata
DEED TRANSFER'CHECKEDu�`► _
AND afecaofo m eooK 141 racr 592
J. K Shurq. CLGIS%'• OF
4 .1 ny 9e DAVIE CVJ:.TY ,J. C.
TAX SUPERVISOR
ion! n r,::qac,
NO TA7;ADLE CONOIDERA71024 STATED. ;
Excise Tax Recording Time, &wk and Page
Tax Lot No..........:..,: .................
i'urcel Identifier No................................................................
Verifiedby....................................................................... County on the ............... day of ..:.. ..... ....... ...... ........ .... ,....... , 19........... '
by
i
Mail after recording to ...Thomas•M.* Cook•,..,6930.O1d,•Ya11ey..School•,Road. Kerner sv,i,lle.,,••NC 27284.,. „
I
This instrument was prepared by ..•.Josepll..M....COltrane. Jr.....................:..............:.:.:....:....................,....
Brief descriptlon for the Index +(',
NORTH CAROLINA. Ul"N1"RAL WARRANTY DE ED
THIS DEED made this -70 Januar , 1q..88 , by and between t
. day or .........., y
GRANTOR
THOMAS M: ;COOK and wife,
BEATRICE SMITH COOK
GRANTEE
WILLIAM GRAVLEY COOK; ANITA ELLEN COOK FUQUA; r
and BRENDA KAY COOK MARCHANT
c/o Thomas M: Cook
6930 Old Valley School Road
Kernersville, N.C. 27284
• R
Enter In appropriate bleek for. each parlyt name, address, sod, if appropriate, character of entity, r s. corporation or partnership.
The designation Grantor and Grantee as uAed.herein shall include s111d parties, their heirs, successors, and assigns, and
shall include singular, plural, masculine, feminine or'neuter as required. by context.
WITNESSETH, that the Grantor, for a'vnlunbie cunsiderntioii paid by the ,Grantee, the receipt of which is hereby
acknowledged, has and by th. +c + : ga �I n i n o it i simple, All that
�AStF'� ���I• �� i�: �bo'� s t��' ��aYE ►�E�f �€fAflr€�d
certain lot ur parecl of landAilunted fit the City of . n a... Shadygrove Toenehip.
... Davie County. North Carolina and rnorc p:uliculurly'descrlbcd its ftdl°wN:
BEGINNING at an iron stake,• saidiron stake being -the southeast
corner of -F.- L. Lowe, said stake also being in the middle of a
soil state road, running thence with the middle of the above said
road. South 60. 30' West 145 feet to an iron. stake located In
.middle of said.road; thence North 856 00' West 379 feet to an
iron stake; thence South 50 00' West 100 feet, to an iron stake I!
located in.a.North line of Clarence Carter;* thence North 850 00'
West1..179 'feet to an iron stake, said -iron stake being -located .
in G. A. Potts Estate east line and said iron stake further being
located -North .2°'30' East 943 feet from -a stone; thence with•said x
Potts east line North 20 30' East 748 feet•to an Iron stake
located, in _a south line of.said Potts Estate; thence with .said
south line of said Potts Estate South 87° 3' East 1,190 -feet 'to
an iron stake, said iron stake being a'.northwest corner of C. E.
Grubbs; thence' South 30 30' East 394 feet to an'iron stake, said
iron stak' being'a northwest corner of F.. L. Lowe; thence South
60'301 Wet 150 feet to an iron stake, said stake being southwest :
cbrner.of.F. L. Lowe; thence South 830 30' East 334 feet to the '
place of -BEGINNING. Being 6.20 -acre more'or'less tract of land
located-in'Shadygrove Township as.surveyed by S. L. Tolbert.
N. C. Der AwH, Pum, No. J f� 1970, No" i! 1977
EXHIBIT A
ANITA C. FUQUA AND HUSBAND, MICHAEL LEE FUQUA
WILLIAM G. COOK AND WIFE, MYRA COOK
BRENDA C. MARCHANT AND HUSBAND,-WAYNE M. MARCHANT
T0.
ROBERT EARL LOGAN AND WIFE, MARY SUE POLKEY
TEH: 12085.1
11
BEGINNING at an iron stake, said iron stake being the Southeast
corner of F. L. Lowe, said stake also being in the middle of'a soil
state road, running thence with the middle of the above :said road,.
South 6 degs. 30 min. West 145 feetto an iron stake located in
middle of said road; thence North 85 degs. 00 min. West 379 feet to
an iron stake; thence Souzh 5 degs., 00 min. West 100 feet to an
iron stake located in a North line of Clarence Carter; thence North
85 legs. 00 min. West 1,179 feet to an iron stake, said iron stake
being located in G. A. Potts' Estate East line and said iron stake
further being located North 2 degs. 30 min. East 943 feet from a
stone; thence with said Potts East line North 2 degs. 30 min. East
748 feet to an iron stake located in a South line of said Potts
Estate; thence with said South line of said Potts. Estate South 87
degs. 3 min. East 1,190 feet to an iron stake; said iron stake
being a Northwest corner of C. E. Grubbs; thence South 3 degs. 30
min. East 394 feet to an iron stake, said iron stake being a
Northwest corner of F. L. Lowe; thence South 6 degs. 30 min. West
150 feet to an iron stake, said stake being Southwest corner of F.
L. Lowe; thence South 83 degs. 30 min. East 334 feet TO THE PLACE
OF BEGINNING. BEING a 20 -acre more or less tract of land located
in Shady Grove Township as surveyed by S. L. Tolbert.
TOGETHER WITH ALL EASEMENTS, rights of way and other appurtenances
thereunto belonging.
FOR REFERENCE see:
DB 141-592
DB 82-594
DB 65- 88
DB 57-587
DB 28-511
DB 22- 44
NOTE: THOMAS M. COOK DIED IN FORSYTH COUNTY, PRECEDED IN DEATH
BY DESSIE MULL COOK.
TEH: 12085.1
11