172 Westview Ave � i
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksvifle, NC 27028
(336)753-6780/Fax# (336)753-1680
� REPAIR OPERATION PERMIT
Account #: 990006020 ��x PI�€:EH#: M4130A0013 '
BillctJ TQ: David and Wanda Whitley Su�idi�i:io►1 Info:
Refer�E�ce N�r��e: REPAIR PERMIT Locationi4ddr��s: 172 Westview Avenue-27028
Proposed F��;i€ity: Residential Repair Prap�rty&ize: 1
aTC*P�hTf�fi* �@�uance of this Operation Permit shall indicate the system described on the ATC 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 systern will function satisfactorily for any given period of
time.
� �`tii��y � /
System Type: ���'_S.T.Manufacturer���f l J Tank Date � Tank Size ./
Pump Tank Size� Bedrooms `�_
System Installed By:���"i � 'l���d'� Installer#: Date: . � aOf..3
GPS Coordinate:
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Environmental Health Specialtst: ��
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DCHD 11/06(Revised)
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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 CONSTRLJCTION �
A�count �: 990006020 . � '��x Pl�[,%EH#: M4130A0013
BiEle�Tc: David and Wanda Whitley �u�i�i�risiar� Ir3��:
Refer�r�ce N�n�e:: REPAIR PERMIT LocaiianiAddr�ss: 172 Westview Avenue-27028
Pra�c�s�i9 F,��:iiity: Residential Repair Pfo��r#y Siz�: 1
Site Type: ONew �Repair ❑Expansion
a'�TC Numb�r: 6029
**NOTE**This Authorization 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 FNE YEARS. This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specifications: #Bedrooms � #Bathrooms � #People � Basement� Basement plumbingG
Non-Residential Specifications: Facility Type #People #Seats �
Square Footage(or Dimensions of Faci]ity)� �
Lot Size�R�_ Type of Water Supply: �County/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD)�� Tank Size�� GAL. Pump Tank � GAL.
lA l�
Trench Width - ,+ Max.�Trench Depth,��� Rock Depth� Linear Ft./SC7'�•S'`%
Site Modifications/Conditions/Other: ����v
Contact the Davie County Environmental He�lth Section for final inspection of this system between
' 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760.
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Environmental Health Specialist` � ' " � � Date� .� ��
DCHD 11/06 (Revised)
, � DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQU ST +
APPLICATION IP/ATC OSWW REPAIR �
_ ��� � ���,�,
Name �/ � Vlf; /l,! G � �/� (' Telephone Number � � -
Address ��Z �'�,�t'S-���i . � �l�� .��a�'���(/i���yt'
Mailing Address (if different from above)
Email Address: /�l�-��0-�/�C,�"°�'t�� � ,r��..�
Subdivision Name Lot#
Directions �N� , � 5L N L�-{?.� 0 — (s ����U(' ;�{—�
Date System Installed ', Name System Installed Under _
Type Facility . � , �l�/I �/o�tice.� Number Bedrooms � Number People Served
Type Water Supply Specific Problem Occurring
Date Requested Info Taken By
THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY
KNOWLEDGE,AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED �
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS
Revisit Charge Date Reason
Revised 2-2011
�� IZoj�
i . Appraisal Card Page 1 of 1
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DAVIE COUNTY NC 1/31/2013 8:24:12 AM
HITLEY WANDA WHITLEY DAVID Return/AppealNotes: M4-130-AO-013
172 WESNIEW AV UNIQ ID 22658 .
8850750 D362-P16 ID N0:5735656547
COOLEEMEE CITY(100),COUNTY TAX(100),FIRE TAX(100),SOLID WASTE(1) CARD N0.1 of 1
Reval Year:2013 Tax Year:2013 P/0 LOT 11+22 ERWIM MLS 1.000 LT SRC=Inspection
raised b 02 on 03/22/2007 05001 COOLEEMEE � TW-OS C-OlEX-A7- LAST ACTION 20110712
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE -
oundation-3 Eff. BASE 5[andard 0.4300 "'�
ontinuous Footin 5.0 US MO Area UA RATE RCN EYB AYB REDENCE TO MARKET r'+
ub Floor System-4 '�
PI wood 8.0 Ol Ol 1 736 101 70.70 122735197 194 %GOOD 57.0 DEPR.BUILDING VALUE-CARD 69 96 _
Exterior Walls-10 NPE:Single Family Residentlal Single Family Residential DEPR.OB/XF VALUE-CARD L
MARKET LAND VALUE-CARD 10,00
luminum/Vin I Sidin 29.0 STORIES:5-Ranth w/basemen[ OTAL MARKET VALUE-CARD 79,96 �
oofing Strudure-03
able 8.0
Roofing Cover-03 OTAL APPRAISED VALUE-CARD 79,96
s halt or Com osition Shin Ie 3.0 OTAL APPRAISED VALUE-PARCEL 79,96
. nterior Wall Construdion-5
D wall/Sheetrock 20.0
. OTAL PRESENT USE VAWE-PARCEL
nterior Floor Cover-09 OTAL VALUE DEFERRED-PARCEL
Pine or Soft Woods 12.0 OTAL TAXABLE VALUE-PARCE� 79,96
nterior Floor Cover-12
Hardwood 0.0 +-1 2-+ PRIOR
IUBM 8
Heating Fuel-02 I +-1 4--+ BUILDING VALUE 73,80
il Wood or Coal 0.0 I I BXF VALUE
eating Type-04 2 I LAND VALUE 10,00 �
Forced Air-Dutted 4.0 8 2 PRESENT USE VALUE
ir Conditioning Type-03 I 0 DEFERRED VALUE
en[ral 4.0 I I O7AL VALUE 83 80
Bedrooms/Bathrooms/Half-Bathrooms = I
+----26----+
3/1/0 8.00
Bedrooms
BAS-3 FUS-0 LL-0 VERM2T
Bathrooms +-1 2-+ CODE DATE NOTE NUMBER AMOUNT a
8A5-1FU5-OLL-O +-9-+FEP I
IBA55 8 m
OTAL POINT VALUE 101.00 I +-1 2-+-1 4--+ ROUT:WTRSHD:
BUILDING AD7USTMENTS I I SALES DATA
uali 3 AVG 1.000 I I FF. INDICATE
ha e/Desi n 3 FACTOR 3 1.000 I I RECORD DATE DEED SALES w
. ize� 3 Size 1.000 4 I BOOK PAGE M R TYPE / / PRICE �y
OTAI.ADJUSTMENT FACTOR 1.00 3 I 0230 739 3 199 WD U I z:+
OTAL QUALITY INDEX 101 I 4 0194 449 5 199 WD U 1 �
I 6 0114 449 5 199 WD U I w
I I
I I
I I
I I
+---2 1- --+ I HEATED AREA 1,583
BFOP 8 I
+---2 1---+-1 4--+ NOTES
SUBAREA UNIT ORIG% SIZE ANN DEp % OB/XF DEPR.
GS OD UALI DESCRIVTIO LTH HUNIT PRICE COND BLDGitL/ FACT V EV RATE V COND VALUE
TYPE AREA % RPL CS OTAL OB/XF VALUE
BAS 1 48 10 105131 �
EP 9 7 473
OP. 16 3 4171
BM 61 2 869
FIREPLACE 1-None
UBAREA Z�36 122,73
OTALS
BUILDING DIMENSIONS BA5=W14FEP=N8W1258E12$W12NSW9543FOP=58E21NSW21$E2158E14N46$PTR=N20 UBM=N20W14N8W12528E26$520$.
LANDINFORMATION �
HIGHEST THER ADJUSTMENTS TOTAL
ND BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES ROA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND
SE CODE ZONING TAGE DEPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP AD7ST UNIT PRICE VALUE NOTES
. FR RES 0100 140 170 1.0000 0 1.0000 FS 10,000.0 1.00 LT 1.00 10,000.0 1000
1 1.00
OTAL MARKET LAND DATA 10 00
OTAL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parce1=M413 OA0013 1/31/2013