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334 Pudding Ridge Rd• --<.� •�� HEALTH DEPARTMENT RELEASE °�- SAN Davie County Health Department City: 210 Hospital Street StatefLip: P.O. Box 848 Phone #: Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Russell Smith Address: 334 Pudding Ridge Rd City: Mocksville StatefLip: NC 27028 Phone #: (336) 998-2048 For Office Use Only *CDP File Number 122328 - 1 D5-000-00-054-01 County ID Number: Evaluated For: HDR/WWC PERMIT VALID 0 7/ 1 9/ 2 0 1 8 UNTIL Property Owner: N. Russell Smith Address: 334 Pudding Ridge Rd City: Mocksville StatefLip: NC 27028 Phone M (336) 998-2048 Property Location & Site Information Address334 Pudding Ridge Road`' Subdivision: Phase: Lot Road # Mocksville NC 27028 'Structure: SINGLE FAMILY # of Bedrooms: 3 'Water Supply: WA Basement: [_� Yes ❑ No 'Proposed Improvement: Accessory Building # of People: Township: Directions Hwy 158 left on Farmington Road, left on Pudding Ridge Rd. 334 on right. Type of Business: Total sq_ Footage: No. Of Employees: It is the responsibility of the owner to maintain a 5' minimum setback between the wastewater system and any part of the structure foundation, including porches, decks, and any other appurtenances. If you are unsure as to the exact location of the septic system, please have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed. EMAILED aS 14vlarfsr now. f1 -o:a - This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? QYes ONo Applicant/Legal Reps. Signature: *Date:_ / / *Issued By: 2244 - Daywalt, Andrew Authorized State Agent: *Date of Issue: 0 7/ 1 9/ 2 0 1 3 **Site Plan/Drawing attached.** Total Time:(HH3 0 1 Hours 3 0 Minutes O Hand Drawing OImport Drawing p,V j SCE ' c County Health Department 9 1836 'AiVlrolinicntal Health Section P.O. Box K t8 0 �,�„ 210 Hospital Strcct O U �'S Courier 4'' : 09 10-06 1911 MocksvilhC, NSC 271028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATE IFICATION F.ax: (sat) - 75,34080 (Check One) Replacement Remodeling Reconnection Name: —}S� 1 J/)yt,tr�t'l ._._..�Phone Number .3,34e, (Home) Mailing Address: hl -R (Work) _pa IMOLyt (le. 4r, Z 70 Email Address: Detailed Directions ToSite: Alw-T� L D ^LCIf^/C hCp kJ . %nr►�• In sze- B 1,4 /C.tG k- . Property Address:____ Please Fill In The Following/Information About ,'The �"EXISTING Facility: Name System Installed Under: [. W ��UC�i TUGS__ __ Type Of Facility: �OGC-f-e- Date System Installed (Month/DatelYcar):_ cRoZ /7q Number Of Bedrooms:__ Is The Facility Currently Vacant? Yes (S) If -Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: Number Of People: Please Fill In The Following Information About The A'ETV Facility: Type Of Facility: Yi X 4 oi .AZ.SSO 4 �(Number Of Bedrooms: C Number of People _ r r Pool Sizc: Garage Size: y.0X(e 0 Other: _ Requested By: "" Date Requested: 71�3 Signature) - ----. For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist. I)ate:_. _ *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or li d) that the on-site wastewater system will function properly for any given period of time. --,/60, • Payment: Cash Check Toney Orde # Amount:$ Date: s Paid By: //� _.Received ny: - Account #: 0,12, _ Invoice CAS �2232� Frinted:Ju! 02, 2013 All data iss provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied 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 cut of the use or inability to use the GIS data provided by this website. ti DAVIE COUNTY HEALTH DEPARTMENT ' (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR r ; '�: `�� %'s ,' : ; " DATE ,,, t� - , 'y�PERMIT LOCATION ' ti ",," , j j f' �► N° 43 SUBDIVISION NAME HOUSE © MOBILE HOME ❑ BUSINESS acv. LOT NO. SECTION OR BLOCK NO. OF I House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS NO. BATHROOMS Two Bedroom„ Hous_p, 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO Elmei Bedroom House 900 Gal. 900 Sc. xtt.. AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK ,C'1Q_ gal. V - NITRIFICATION FIELD sq.f' t. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY INSTALLED BY CFRTIFICATE OF COMPLETION (8/16/73) r. LCIT) AREA ' 4 r 114i i 4 r By_ *Construction must rc ..' 1 tea. t'✓-',' ^.- - Date— ly with all other applicable State and local regulations G L�f t R E 1 S 7 a e J04 d F� �C Appraisal Card DAVIE COUNTY. NC Page 1 of 1 7/17/2013 2:08:44 PM SMITH NORMAN R Return/Appeal Notes: DS -000-00-054-01 334 PUDDING RIDGE RD UNIQ ID 3758 2518361 D109 -P10 ID NO: 5841394360 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of I eval Year: 2013 Tax Year: 2013 8 AC PUDDING RIDGE RD 7.940 AC SRC= Inspection Appraised by 02 on 08/30/2007 03003 CEDAR CREEK TW -03 C- EX- AT- LAST ACTION 20120524 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE Foundation - 3 Standard I 0.2900 Continuous Footing Eff. BASE 5.00 US MO Area UA RATE I RCN EYB I AY8 CREDENCE TO MARKET Sub Floor System - 4 Plywood 8.00 01 01 1 474 116 81.20 119689198 197 °h GOOD 1 71.0 DEPR. BUILDING VALUE - CARD 84,98 EPR. OB/XF VALUE - CARD 25,75 Exterior Walls - 21 TYPE: Single Family Residential Single Family Residential Face Brick 34.0 MARKET LAND VALUE - CARD 101,15 STORIES: 1 - 1.0 Story TOTAL MARKET VALUE - CARD 211,88 Doting Structure - 03 Gable 8.0 OTAL APPRAISED VALUE - CARD 211,88 Roofing Cover - 12 etal 5.00 nterlor Wall Construction - 5 OTAL APPRAISED VALUE - PARCEL 211,88 D wall/Sheetrock 20.0 nterlor Floor Cover - 08 TOTAL PRESENT USE VALUE - PARCEL heet Vinyl/Laminate 6.00 TOTAL VALUE DEFERRED - PARCEL nterlor Floor Cover - 14 TOTAL TAXABLE VALUE - PARCEL 211,88 :arpet 0.0 PRIOR eating Fuel - 04 BUILDING VALUE 85,43 Electric 1.00 eating Type - 10 BXF VALUE 34,34 eat Pump 4.0 ND VALUE 101,15 it Conditioning Type - 03 PRESENT USE VALUE entral 4.00 DEFERRED VALUE drooms/Bathrooms/Half-Bathrooms OTAL VALUE 220,920 /2/0 12.00 drooms AS -3FUS -0LL -O PERMIT throoms CODE I DATE NOTE I NUMBER AMOUNT AS - 2 FUS - 0 LL - 0 ffice AS- 0FUS-0 LL -0 ROUT: WTRSHD: OTAL POINT VALUE 107.00 SALES DATA BUILDING ADJUSTMENTS FF. lze 3 Size 1.030 +----------51-----------+------31------+ RECORD ATE DEED INDICATE SALES uali 3 AVG 1.000 I B A S I F C P I BOOK PAGE M R TYPE / / PRICE hape/Deslgr4 4 1 FACTOR 1 1.050 1 1 I 00412 316 3 00 WD Q I 14500 OTAL ADJUSTMENT FACTOR 1.081 2 2 2 0012ftOO 6 1198 WD Q I i 1 6000 OTAL QUALITY INDEX 11f 5 5 5 I I I I I I I I 1 +----24----+6-+---21----+------31------+ HEATED AREA 1,275 4STP NOTES +6-+ OWNER SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR GS CODE DESCRIPTIONLTH HUNIT PRICE COND BLDG* B AYB EYS RATE OVR COND VALUE TYPE AREA % RPL CS 25 BARN 60 24 1,440 15.00 100 _ L 197 1976 53 0 AS 1 27 10 10353008 OL/VINYL 16 3' S1' 37.40 100 _ L 198 199 S 20 383 FCP 775225 1575302 ARAGE 3 1 36 30.0 _ L 199 199 5 5 626 TP 24020 40602 ARAGE 3 3 90 30.0 10 L J.199 5 5 1566 FIREPLACE 1 - None TOTAL OB/XF VALUE 25,754 UBAREA 2,07 119,68 OTALS BUILDING DIMENSIONS FCP=W31 BAS=W51S25E24 STP=54E6N4W6$E27N25 S25E31N25 . LAND INFORMATION IGHEST LAND TOTAL ND BEST USE LOCAL FRON DEPTH / LND CONDrl.THENROA.IUST.ENTS DTES ROA UNIT LAND UNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGEDEPTH SIZE MOD FACTF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES RURAL AC 0120 474 0 1.1890 4 1.1900 01 +20 +00 +00 +00 PW 91100.0 7.94 AC 1.41 12 735.0 10115 OTAL MARKET LAND DATA 7.94 101,15 OTAL PRESENT USE DATA 7 q7 -C 9"eer w ��- http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=D50000005401 7/17/2013 Page with Header and Menu t Page 1 of 1 l :f3 I 'E.j Group Tree 1 if, 1 =11, ► H I I 100% M CRYSTAL REPORTS' Main Report Help Files Copyright ® 2008 Custom Data Processing, Inc. All rights reserved. (odpnrptnc version2.0.7 6/13/2013 isd5.2.1 db=kyprodl) https://portal.cdpehs.com/CDPNRPTNCNW REPORTS/ReportView.aspx?POPUP=Y&... 10/23/2013 HEALTH DEPARTMENT RELEASE For Office Use Only . *CDP File Number: Davie County Health Department D5-000-00-059-01 - ®I Environmental Health Section County ID Number: 210 Hospital Street 30 —-Mocksville, NC 27028 Evaluated For: HDR/WWC Phone:336-753-6780 Faz:336-753-1680 Permit Valid Until: 10/22/2018 Applicant: Russell Smith Property Owner: Russell Smith Address: 334 Pudding Ridge Road Address: 334 Pudding Ridge Road City: Mocksville City: Mocksville State/Zip: NC / 27028 State/Zip: NC / 27028 Phone #: (336) 998-2048 Phone #: (336) 998-2048 Property Location & Site Information Address: 334 Pudding Ridge Rd Subdivision: Phase: Lot: Road#: Mocksville NC 27028 Township: *Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: Directions:Hwy 158, left on Farmington Rd. Left on Pud ing Ridge Rd *Water Supply: PUBLIC Type of business: Basement: ❑ YesX❑ No Total sq. Footage: No. Of Employees: *Proposed Improvement: Addition Den to Original home *Release Conditions: It is the responsibility of the owner to maintain a 5' minimum setback between t e wastewater system and any part of the structure foundation, including porches, decks, and any other appurtenances. If you are unsure as to the exact location of the septic system, please have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed. **Site Plan/Drawing attached.** Total Time- (HE -MK) E] Hand Drawing [[Import Drawing lHours 0Minutes Activity Code: S -13 -AUTHORIZATIONS - EXISTING SYSTEM REUSE Help Files Copyright ® 2008 Custom Data Processing, Inc. All rights reserved. (odpnrptnc version2.0.7 6/13/2013 isd5.2.1 db=kyprodl) https://portal.cdpehs.com/CDPNRPTNCNW REPORTS/ReportView.aspx?POPUP=Y&... 10/23/2013 Davie County Health Department Environmental Health Section - P.O. Box 848 210 Hospital Street®� Courier # : 09-40-06 Mocksville,. NC 27028 _ Phone: (336) - 753 - 6780 Fax: (336) - 751 - 8786 ON-SITE WASTEWATER CERTIFICATION FOR 'SLI 1,04t o d (Check One) Replacement Remodelingrj }��, v5c. /� 5 Ccs! a v- A Name: JQ t s 5 5e_ 1( SN" -41, Phone Number �.�.��+ 1 Q9 8 ' •� D _(Home) Mailing Address: :?341 AQ Jj,'nA:k /1i dca c /l°d _ 1330 3qs = 426-7 (Work) j%1hc.kSui !/� 4&, 2702£{ Email Ir'5 M 1'4-K 11 &-7 e— VA- l e-1 . /V-e---i- Detailed Directions To Site: •3.3!/i0tl�a/i n��'ZZI id lett'Ole % 14rm i e✓4"',0A/ Ad, IF 47 Property Address: -33q j9,jJe&jja Ri'dgD �5=000_0(),,05q_ Please Fill In The Following Information.About The EXISTING Facility: / • q Name System Installed Under: Type Of Facility: d USS . Date System Installed (Month/Date/Year):, Is The Facility Currently Vacant? Yes & -------Number Of Bedrooms: -3 Number Of People: If Yes, For How Long?— Any Known ong?_ Any.Known Problems? Yes 5 If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility:".� i_ (��� Number Of Bedrooms:_S Number of People Requested By: Date Requested: 4..�5 8: � (Signature) For Environmental Health Office Use Only Approved Disapproved 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 or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cas Chec Mooney Order # Amount:$ UU•vU Date: Paid By: Received By: 16, W't(,u Account #:3 l OZ Invoice #: Oct 22' 13 10:29a Smith Excavating, LLC aSa.aD' Ica 1 t m Lo t � m m w1 � 6 Z _� g11 i 1 170.00' CD C) CJ W D O O UD Q U / d ! PROP. f -z LLJW / 1 334 PUDDING RIDGE RD. r NORMAN R. SM1TH MOCKSVILLE, NC J 7.93 AC I Abuo � I � I �•J RUSSELL & SHERRY SMITH 269-13 DRAWN BY iEBH- 1"= DATE 10.21-08 SITE PLAN DRAMNG NO. PLAN # ADDITION 1 OF 1 336-998-3494 REVISIONSISKETCHES I 1 10-21-13 2 3 4 P.1 Ica m c Lh m Lo � m m � 6 Z _� V N ti.I U LiJ J Z D7 CD C) CJ W D O O UD Q U UD Co d f -z LLJW mCo o W Q Mj2 a 1u w a Ix O ux1 REVISIONSISKETCHES I 1 10-21-13 2 3 4 P.1