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185 Redland Road Lot 2.ry r-iti �7�1��R/'5,,�i' �� •T y'`�• 'f � P .�t,' '. 'y'ry'-t^ o.i raF'�: �u'� /q"P^''y�� ,f e �, ��i/1► .ICJ DAV IE COUNTY HEALTH DEPARTMENT' Environmental Health Section PROPERTY INFORMATION .4_.. _ . P.O. Box 848 Duixtions to property: Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lor. fl i AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION NO: 002554 A Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when -applying for Building Permits. (Incompliance with Article 11 of G.S. Chapter 130A. Wastewater Systems. Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMEN T-ftEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ # BATHS # OCCUPANTS GARBAGE DISPOSAL: ,Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPWI O NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. -PUMP TANK GAL/TRENCH IDTH ROCK DEPTH LINEAR FT. OTHER v ` 0 REQUIRED SITE MODIFICATIONS/CONDITIONS_ IMPROVEMENT PERMIT LAYOUT (441 �Waep r FOR FINAL INSPECTION OF THIS SYSTEM PLEASE'CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT s* . G L ' f AUTHORIZATION NO. OPERATION PERMIT BY: SYSTEM INSTALLED BY: U "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1901) "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.D= 02102 (Revised) **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALH) FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS S # BATHS f° L- # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY 1� DESIGN WASTEWATER FLOW (GPD)`�6 d NEW,SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. .- TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER W 1` 1 IIFOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: } _ 1 AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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. DCHD 02/02 (Revised) `t.- y ly �✓ zgmutte's `" ,'� a DAVIE COUNTY HEALTH DEPARTMENT !!! �,5 •• � �' � Environmental Health Section PROPERTY INFORMATION .Name f _ P.O. Box 848 toproperty: r Mocksville, NC 27028 Subdivision Name: b. YM.,Dire�tiolis Phone #: 336-751-8760 x ' Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION AUTHORIZATION NO: 0025521 A Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALH) FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS S # BATHS f° L- # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY 1� DESIGN WASTEWATER FLOW (GPD)`�6 d NEW,SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. .- TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER W 1` 1 IIFOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: } _ 1 AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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. DCHD 02/02 (Revised) `t.- y ly �✓ DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME '_ S o n f/ e PHONE NUMBER ?'-/0- D y ff3 ADDRESS---) Ii SUBDIVISION NAME --R ed/. cp-Ace OAC — LOT# � DIRECTIONS TO SITE I a- c- ,-OSS b , e- o-jr— NAME DATE SYSTEM INSTALLED :20D `� SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS 7? NUMBER PEOPLE SERVED 7 TYPE WATER SUPPLY (ZLL -t'l'i—y SPECIFY PROBLEM OCCURRING (ten o n --Jl"-jle. DATE REQUESTED --17 -O S INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowled , an t I nderstand I �ible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 �.c ��6��34--al9 01.02-5 • ► DAME COUNTY HEALTH DEPARTMENT c Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000955 Tax PIN/EH #: 5861-38-2199.02S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 02 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3671 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRU ION IS— ALI FO A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: �i L 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. apter 30A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken a gu tee that the system will function satisfactorily for any given period of time. J Septic System Instal ed By WN Environmental Health Specialist's Signature DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �� Y/-7— O! P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5861-38-2199.02S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 02 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3671 **NOTE** This Improvement/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 �a�sLcI #People `f #Bedrooms 3 #Baths 2' t Dishwasher: Garbage Disposal: Washing Machine: Basement w/Plumbing: Or" Basement/No Plumbing: Commercial Specification: Facility Type #People . #People/Shift #Seats Industrial Waste: Lot Size D b Type Water Supply 600A)'ty Design Wastewater Flow (GPD) 4,aQ Site: New Repair System Specifications: Tank Size IOWGAL. Pump Tank GAL. Trench Width Rock Depth J Z / Linear Ft. Other: 3 ST TIO-) BCX ES Required Site Modifications/Conditions: hJ-S%qU- Ong G[j,y 70011�2%�QOJn 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 the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date:., 0 ,58F 1 ,38 7845 Christine Carter Milio i). R. 166, Pq. 766 (463.64' This L_ot) Ii.e C o o k Road (11-),r?lv at e J 0 d C Q4 F.I. P. 1 ` .? ", )0, 0 7' w -ST- zj 3 Ln 33,03` N Ft. 6 � 0.7.58 Acres I N f� S 85' 1 i'4?." E 0 () 0' (2) o C\2 L0 30,000 `.) f � . o Il` 0.689 Acrery 'l' s,+ S 85'4,7p4-/- L. 00 + 4 'I'otat AT-eu. '"J" 5 Total lots --- .36 6. ZOITLed ]1.._20 7. MinirnurrI. buildir Front. • .. 3 0 Si&. 8. C g. Public S sSy 10. Public Water f� All utilities und V Total Area in R c� cv . Ii.e C o o k Road (11-),r?lv at e J 0 d C Q4 F.I. P. 1 ` .? ", )0, 0 7' w -ST- zj 3 Ln 33,03` N Ft. 6 � 0.7.58 Acres I N f� S 85' 1 i'4?." E 0 () 0' (2) o C\2 L0 30,000 `.) f � . o Il` 0.689 Acrery 'l' s,+ S 85'4,7p4-/- L. 00 + 4 'I'otat AT-eu. '"J" 5 Total lots --- .36 6. ZOITLed ]1.._20 7. MinirnurrI. buildir Front. • .. 3 0 Si&. 8. 3 Lots 4. 7 6 ha Redl(md Road 0 g. Public S sSy 10. Public Water 11. All utilities und Yoo 12. Total Area in R 13. 314" I. P. S• at 14. Lots 6 through centered on NOTE : This survey is su disclosed bY a fv furnished me as easements, rights assessments, if a record in the Ofj of Court, Town o have b e erL ac q uir Re Owner: Westvieq INC. 2267748700 01/27/04 OS:48pm r. W -LW SAf1NAZ,-_.-......�.,.,ruvVU141aYt t'tttnlll al'/ltl; Davie County Hcalth Department --r EllVironmeata/Health Secrion P.O.. Box 848/210 Hospital Stxuct rte• Wckgville, NC 27028 " (j36)751-8760 ***I1-JP0IiTAXT*** THIS APPLICATION CMNOT DL•' PROCESSED 1114LESS ALL THE REQUIRLD INFORMATION IS PROVIDED. Refer to tho INFORMATION BULLETIN for in5tructioiju. 1. name to be Billed 15&ct t.1C-'2 �}U�y-- Contact l•erao„ Hailing Addreas �2�_ Q'_ -V% .1V1I Clv� n.`` liomc Phanc %7 +J�DiY City/.^,tate/ZIP nl(✓ Itunineas 11110uc�—..)eL 2. Kama on Permit/ATC if Diffsrcat than Above �jr°Ili?. Hailing Address _ >�' rNyM e- City/State/I,iD — 1. Application For: Site Evaluation ❑ hnprove3amit 11ermic/ATC Lt Uutli t 4. system to service- Pf$ouse 0 Nobile Rome D Bu:lincii'.1 O Industry ❑ OL'iitl 5. Type system requested: X Con-oncional ❑ conventional modified G innovative 6. It Residence: PCDPIF —�_ o Bedrooms _3_ tr Vathroaui:: 1/Z ia6rasherCazhago DiapO:wl Mashing Hachinn iE{asrinesa. t�Plwnhing �B1seu.cnC/Na l•l.u„u:,+,� 7. It business/Industry /other: verify type tt Puayle �._ C 5i..h. g couwadsa B Showers a urinals 1t Water cool.:tu IF FOODSERVICE: d Seats toti.mated water Usage (Ballo,i* per Day) S. Type of water supply: Kcouslty/City ❑ Well ❑ Conununity I. Bo yov anticipate addition* or expaiuianis or the facility this system is iuleudul lu serve'.' i y es ANN lryes, %vital type? ***1A1P0RT4JV7'*** C1.IErrrs.vvs7'coAiPLL77VTl1C R QUIR D PROPLICI-V INFORMATION lcl;(1 ttlil rtil) — -' DELOIY. t.itl:ernPLAAI'orSITI.PLANi)IUSTBL-SURifITTE-Dbythe%tient iiAh'rH15APPIACA'1'J0N.__- i'roperfy Dimensions: VZO Z20 .)( 17110K 7sb WRITE UJIMC1'I0IIS (frn,) MUCLSvilic) 10 1 lett( to<'t'1: Tai Ofrt«1'1Jv: Lc��I y • n 2 S -- - Property Address: Road Nanic _ Re`` An I �A City%Lip11 IV ' 1) If in a Subdivision provide infornlalion, as ff ullows. Name; Section: Block. Lot: _�� Date l(o)ne corners flagged: This is to certify that the information pro•-idcd is correct to the best of my knoiricdgc. I understand that any permil(s) issurd hereafter arc subjec(lo suspension or revocatiou, if the site plots or iutemicd use chaube, or if the infurmaliuu submitted in this application is falsified or changed. 1, also, andersraud that 1 um respunsibleJur all chm3•rs ;,rr.urrr rt /runt this application. I, hareby, give consent to the Authorized Represoulalive of lite Davie CVtllltp 11lalth Depar(mti•ol to cuter upon above described pruperty located in Davie Comity and uiviled by __. • _ to conduct all testing procedures as necessary to determine (he rile suitability. DA'Z'E THIS AREA MAY BE. USED FOR DRAINWC YOURSITE PLAN (lit elude a1 uat follotving: Lxislin � and p, upuscct property lines and dimensions, structures, selbacics, and septic locations). Site Revisit Charge Clicltt Notiticaiiun Date: EIIS: C� SS' e,:;, " p o a o Z t� SAMNAZ,INC. FP419 = PHILLIP R BALL CO 1 3367748700 FAV N0. : 3369455268 i HIS DRAWING IS NOT FOR RECORDA770N 01/27/04 05:48pm P. 009 Jan. 2E, 2004 03:36PM P2 NOT A CERTIFIED COPY Mi? IAII/-Rn.AIM n PURPOSE ONLY REDLAND ROAD SR 1442 4D D ► :► ► GRAPHIC . APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department E/Ivirn/ImentaiHealth Section SEC P.O. Box 848/210 Hospital Street 3 �o2 Mocksville, NC 27028 (336) 751-8760 raw D4V-lr N SAV/FCp� l Pl rR ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Ve Mailing Address �V In ')I X-Ad4Z4V� � ! City/State/ZIP 4g)-5 lz� 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: PYsite Evaluation 4. System to Service: ouse ❑ Mobile Home 5. If Residence: # People _ Dishwasher El Garbage Disposal Contact Person Home Phone Z4D �o Business Phone 2L2— a—S City/State/Zip ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms # Bathrooms ID, U Washing Machine Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 9--ffounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 5 -yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: Property Address: Road Name ;R1 -14,V111 / City/Zip If in a Subdivision provide informatio , as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: EA --1- / L "C� 4� (Z' - L 2/ A a 010-- �. Yt- Date Property Flagged: Ir;? ^3-- eq 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 Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by ,lA,(/iP �n,,�� /)c+�t�t� 5 to conduct all testing procedures as necessary to determine the site suitapility. _ ------T 4'iiii�rV, J1illlG�%� 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) Account No. 0 L Invoice No. 3 z 2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.02 Subdivision Info: Louise Smith Adams Lot # 02 Location/Address: Redland Road -27006 see map Date Evaluated: 12 19 O Z Water Supply: On -Site Well Community Evaluation By: Auger Boring I Pit Public ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Sloe %q 20 HORIZON I DEPTH —I O Texture group Consistence S ! Structure C14 Mineralogy r: HORIZON II DEPTH - 7-7 qil Texture group Consistence V 15V Structure R:;'7 Mineralo HORIZON III DEPTH Texture group t -S-149 ; Structure 441 kS� Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O . SITE CLASSIFICATION; r5 EVALUATION BY: - AAyCl1*'C-1p LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: DO) Ows, d I^+ Z rJt TO M)X� �^� P�� 27 "f LEGEND Landscaue 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 05/99 (Revised) uc� looks like, Vo u 've i S ied a Pei, I4 ' �01 t. s DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION Plec5e Cla// &rule APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME A%4- PHONE NUMBER �' 6Y ADDRESS lw SUBDIVISION NAME kedjaAd1'1WP- kl -�`,�LOT # ODIRECTIONS TO SITE JJU�/ 16 bld Al a DATE SYSTEM INSTALLE- 2 �NAME SYSTEM INSTALLED UNDER TYPE FACILITY e- NUMBER BEDROOMS NUMBER PEOPLE SERVED v TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING `? Y�OG�I�Ci 1Ike Tdr DATE REQUESTED INFORMATION TAKEN BY 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. 1/93 "'P'iPn3l�ee s - DAVIE COUNTY HEALTH DEPARTMENT Name. ' r ` s Environmental Health Section PROPERTY INFORMATION P.O. Box 848 uectionsaoproperty: `� f � �",r �� Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 `P Section: Lot: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# - - AUTHORIZATION NO:Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION r- tx, IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL 'HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE il' ' # BEDROOMS < # BATHS -# OCCUPANTS ' GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLYDESIGN WASTEWATER FLOW (GPD)-*-' NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL.%` TRENCH WIDTH ROCK DEPTH LINEAR FT. r, OTHER-; ;,- REQUIRED SITE MODIFICATIONS/CONDITIONS: 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 11 OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. ao-- 26-50 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000955 Tax PIN/EH #: 5861-38-2199.02S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 02 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3671 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 WASTEWATER CONSTRU ION -IS— ALI FO A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: 2 L 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.apter 30A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be�=q%-guhatee thatthe system will function satisfactorily for any given period of time. to— b Septic System Installed By' Environmental Health Specialist's Signature : DCHD 05/99 (Revised) s•al ` DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR VName Telephone Number .�� r 7 % e'J -4 �j% Address Q J - Mailing Address (if different from above) Email Address:? + �� Subdivision Name l t Lot # � �1" elC Nd k ' bode r Directions � Date System Installed Name System Installed Under Type Facility Number Bedrooms 3 Number People Served T e Water Supply 2i Specific Problem Occurringfjq 0 i QI e �7 Date Requested Q?-] L-13 3 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 Clip — /Z -O Zb / Ude Appraisal Card 14 DAVIE COUNTY, NC Page 1 of 1 2/11/2013 11:28:28 AM ILL JONATHAN HILL SARA Retum/Appeal Notes: E7 -140 -AO -002 185 REDLAND RD UNIQ ID 6706 2531234 ID NO: 5861388662 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 Reval Year: 2013 Tax Year: 2013 LOT 2 REDLAND PLACE 1.000 LT SRC=Inspection Nppralsed by 19 on 04/17/2008 03108 REDLAND WAY TW -03 C- EX- AT- LAST ACTION 20121203 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE - 3 Eff. BASE Standard 0.0900ntinuous Footin 5.0 US MO Area UA RATE RCN EYE, AYB REDENCE TO MARKET b Floor System - 4 wood g,0 0101 2 022 132 92.40 188633200 200 % GOOD 91.0 DEPR. BUILDING VALUE- CARD 171,66terior [oundation Walls - 10 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE - CARD 5,16minumNln 1 Sidin 31.0 MARKET LAND VALUE - CARD 36,00terlor 3 - 2.0 Stories OTAL MARKET VALUE - CARD 212,82ce Walis - 21STORIES: Brick 0.0 oonng Structure - 04 TOTAL APPRAISED VALUE - CARD 212,82 lip 10.0c TOTAL APPRAISED VALUE - PARCEL 212,82 oofing Cover- 03 %sphalt or Composition Shingle 3.0 TOTAL PRESENT USE VALUE - PARCEL nterior Wall Construction - 5 TOTAL VALUE DEFERRED - PARCEL )rywall/Sheetrock 20.00 TOTAL TAXABLE VALUE - PARCEL 212,82 nterior Floor Cover - 12 ardwood 1100 PRIOR nterior Floor Cover - 14 +-12-+S-+-12-++ UILDING VALUE 187,27 :arpet 0.00 I FUS I OBXF VALUE 14,30 eating Fuel - 04 1 ILAND VALUE 28,80 lectric I I 1.0 2 RESENT USE VALUE eating Type - 10 2 6 6 DEFERRED VALUE eat Pump 4.00 I I TOTAL VALUE 230.370 Ir Conditioning Type - 03 1 1 entral 40 +-13-++6-+-12-+ edrooms/Bathrooms/Half-Bathrooms PERMIT /2/1 13.00 CODE DATE I NOTE I NUMBER AMOUNT 3edrooms AS - I FUS- 2 LL- 0 throoms ROUT: WTRSHD: AS - 1 FUS - 1 Ll - 0 SALES DATA +- 12-+ FF. INDICATE alf-Bathrooms 1 W D D 1 RECORD DATE DEED SALES AS - 1 FUS - 0 LL - 0 OTAL POINT VALUE 2 2 109.00 +-12-+S-+-12-++ +-13-+---22---+ BOOK PAGE M R TYPE / / PRICE BUILDING ADJUSTMENTS I B A S I I B U G I U B M I 0809 252 10 00 WD Q I 18750 I I I I I 0593 412 2 00 WD Q I 21300 uall 4 ABAVG 1.200 I I I I I 0534 856 2 0 WD A V 3550 ha Desi 4 FACTOR 4 1.050 2 2 2 2 2 0457 082 12 2002 WD X V lie 1 3 Size 0.960 6 6 6 6 6 OTAL ADJUSTMENT FACTOR 1.21 1 1 1 1 1 OTAL QUALITY INDEX 13 1 I I I I I I I I I +-13-++6-+-12-+ +-13-+---22---+ HEATED AREA 1,876 SFOP +6-+ NOTES SUBAREA UNIT ORIG % I ANN DEP % OB/XF DEPR TYPE GS AREA % RPL CS CODE DESCRIPTIO LTH 11NIT PRICE COND BLDG B AYB EYB RATE V CONO VALU AS 946 10C 87416 10 KON PAVING 1 6 2 1,24 4.0 _ 1 L 00 00 S 5 272 UG 33 02 785.'05 OOD FENCE 40 8.7 L 00 00 S 7 243 OP 30 03 101 OTAL OB/XF VALUE 5,164 5 930 09C 7733 BM 1572 02C 1053 DD 144 02 268 2 Pre IREPLACE 1,80 Fabricated USARETALS A 2,96T188,63 O BUILDING DIMENSIONS BAS=W3 WDD=N12W12S12E12$ W12N2W8S2W12S26E13S2E2 FOP=SSE6NSW6$ E6E2N2E12N26$ PTR=N60 US=W3W32W8W12S26E13S2E2E6E2N2E12N26$ S60E60 UBM=W 22 BUG=W13S26E13N26$ S26E22N26$ W60$. NO INFORMATION HIGHEST OTHER ADJUSTMENTS TOTAL NO BEST USE LOCAL FRON DEPTH / LND COND AND NOTES ROA LAND UNIT LAND UNT TOTAL 1 ADJUSTED LAND LAND SE CODE ZONING TAGE EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST I UNIT PRICE VALUE NOTES FR RES 0100 0 0 1.0000 0 1.0000 PW 36,000.00 1.000 LT 1.00 36,000.0 3600 LOC REDLAND OTAL MARKET LAND DATA 36,00 OTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E714OA0002 2/11/2013