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207 Dulin RdPhone: (33 6) - 753 - 6780 Davie County Health Department Environmental Health Section P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 ON-SITE WAS CERTIFICATION (Check One) Replacement Remodeling Reconnection Fax: (336) - 753-1680 Name: +2J— L 4 1 Phone Number (Home) Mailing Address: 33 6 ! £Sa (Work) Email Address: �t ` t-/ Ae-1- Detailed Directions To Site: 0 7 ��.. l i ►� RC Property Address: !C-27 49-,1;,- XJ—- Please Fill In The Following Information About The EW STINJG Facility: Name System Installed Under: Type Of Facility:%'l a %oo Ap Date System Installed (Month/Date/Year): 4m6'j Number Of Bedrooms: 3 Number Of People: Is The Facility Currently Vacant? Yes fNo If Yes, For How Long? Any Known Problems? Yes60 If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Number Of Bedrooms: Number of People Pool Size: aa ' / Garage Size: gd X '�fo Other: Requested By: i 7 Date Requested: (Signature) Disapproved Comments: For Environmental Health Office Use Only Environmental Health Specialist� %`///�/ /J_�-�-�' Date: IZ— 7 �y *Thb 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: Cash - Check Money Order # Amount:$ Date: Paid By: Received By:_ Account #: Invoice #: ID D0 ',1 iz '.L. �� b K� s Printed:Nov 14, 2014 All data is 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 out of the use or inability to use the GIS data provided by this website. iA'LTH DEPARTMENT RELEASE Davie County Health Department tr y 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Brad and Amanda Lag le Address: 207 Dulin Road - City: Mocksville StatelZip: NC 27028 Phone #: (336) 940-3762 For Office Use Only *CDP File Number 122376 - 1 F6-000-00-084 County ID Number: `valuated For: HDR/WWC PERMIT VALID 0 7/ 2 5/ 2 0 1 8 UNTIL: Property Owner: Brad and Amanda Lagle Address: 207 Dulin Road' City: Mocksville StatelZip: NC 27028 Phone #: Property Location 8. Site Information Address207 Dulin Rd Subdivision: Road # Mocksville NC 27028 Township: 'Structure: SINGLE FAMILY # of Bedrooms: *Water Supply: PUBLIC Basement: ❑ Yes a No "Proposed Improvement: Pool (336) 940-3762 Phase: Directions # of People: Hwy 158, right on Dulin, back off Dulin on left Type of Business: Total sq. Footage: No. Of Employees: Lot This release in no way expresses or implies that the existing subsurface sewage treatment and dispose system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? QYes ONo Applicant/Legal Reps. Signature; *Issued By: 2244 - Daywalt, Andrew Authorized State Agent:J *Date: *Date of Issue: 0 7/ 2 5/ 2 0 1 3 *Site Plan/Drawing attached.* TotalTime:(HH:MM) 0 1 Hours 0 0 Minutes "oU'� Phone: (336) - 753 - 6780 M. r Davie County Health Department Environmental Health Section P.O. Box 848 A-- A D RECEIVED 210 Hospital Street _71 13 Courier # : 09-40-06, ocksville, NC 27028 ItY ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Fax: (336) - 751- 8786 MailingAddress: •r MRPA1 f �• t Detailed Directions To S Property Address: (AV I �l�(�Lj t 1 t�� 1f Ne=t [-2 3 0Q Please Fill In The Following Information.About The EXISTING Facility: iiQw �dol a Name System Installed Under: &00ta, Type Of Facility: Pow, L 5.. Date System Installed (Month/Date/Year): Number Of Bedrooms: Number Of People: 1 - 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 J grInformation About The NEW Facility: Type Of Facility:. Pon II n� gyp' Y_ Number Of Bedrooms: hh Number of People Requested By: &0-1-1 Date Requested: (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: Cash Order # Paid By I Q . Received By: Account #: Invoice #: fZ � t Appraisal Card , View All Cards Next Card Page 1 of 1 7HO/7nt3 9e71`7A AM GLE AMANDA S LAGLE BRADLEY SCOTT Retum/Appeal Notes: F6-000-00-084 07 DULIN RD UNIQ ID 9293 2517638 ID NO: 5850464882 " COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 2 eval Year: 2013 Tax Year: 2013 2.209 AC DULIN RD 2.210 AC SRC- Inspection kppralsed by 02 on 09/06/2007 03005 SMITH GROVE TW -03 C- EX- AT- LAST ACTION 20130627 CONSTRUCTION DETAIL MARKET VALUE I L DEPRECIATION CORRELATION OF VALUE - 3 ED BASE Standar0.2500tinuous Footin 8.0 US MO Area UA RATE RCN EYBAYB REDENCE TO MARKET [un"dation Floor System - 4 Walls - 10 I Sldin Structure - 03 02 02 1 904 99 42.57 1053199 199 % GOOD 11.0rlor TYPE: Manufactured Home (Multi) 32.0 1 - 1.0 Story 75.0 Manufactured Home EPR. BUILDING VALUE -GRD 60 79ood EPR. OB/XF VALUE -GRD MARKET LAND VALUEGRD OTAL MARKET VALUE - GRD 46,46minum/Vin 29,63STORIES: 136,880ng le 9.0fing TOTAL APPRAISED VALUE - GRD 136,88 Cover- 03 halt or Composition Shingle 5. TOTAL APPRAISED VALUE - PARCEL 366,84 nterior Wall Construction - 5 TOTAL PRESENT USE VALUE -PARCEL all Sheetrock 28.0 nterior Floor Cover - 08 TOTAL VALUE DEFERRED -PARCEL heet Vinyl/Laminate 7.0 OTAL TAXABLE VALUE - PARCEL 366,84 nterior Floor Cover - 14 PRIOR :arpet 0.0c UILDING VALUE 71,11 eating Fuel - 03 - s 1.0 BXF VALUE 53,95 ating Type - 30 AND VALUE 29,63 at Pum 5.0 RESENT USE VALUE Conditioning Type - 04 EFERRED VALUE cka ed Roof To 5.0 OTAL VALUE 154,69( drooms/Bathrooms/Half-Bathrooms /0 0.00drooms PERMIT S - 3 FUS - 0 LL - 0 le CODE DATE NOTE NUMBER AMOUNT throoms S-2FUS-OLL-O OUT: WTRSHD: ce DATA S-0 FUS-0LL-OSALES TALPOINT VALUE BUILDING ADJUSTMENTS e3 Size uali 3 AVG 111.00 +------------------68------------------+ ISAS I 0.850 I I 1.000 I I FF. ECORD ATE DEED TYPE WD Q V INDICATE SALES PRICE 2150 BOOK PAGE M R 0533 797 2 004 Shape/Design]4 FACTOR 4 1.050C I 0138 71 7 1987 WD U V I TOTAL ADJUSTMENT FACTOR 0.89C 2 2 0179 568 3 1985 WD X V TOTAL QUALITY INDEX 9 8 8 I I I I I I I I HEATED AREA 1,904 +I ------I •_______-" '--'---6g-'--'---'--- + NOTES PLTT04 SOLD 1.IAC(ORIG: 3.3 FOR IOK. SUBAREA GS RPL ODE DESCRIPTIO LTH NIT UNIT 0- % PRICE COND LDG L B�of ANN DEP RATE V % C %D OB/XF DEPR. VALUTYPE HED 1 1 14 10.0 10 _ L S 6 1 864BAS AREA % CS 4 1 908105 2 ARAGE 5 4 2 00 30.0 10 L S 7 4560 REPLACE I - None 0 TOTAL OB XF VALUE 46,464 USAREA 1,90 81,05 OTALS UILDING DIMENSIONS BAS=N28W68S28E68$. ND INFORMATION IGHEST NO BEST USE LOCAL FRON DEPTH/ LND COND�.NOTES T.ADJUSTMENTS ROA LAND TOTAL UNIT LAND UNLAND LAND SE CODE ZONING TAGE DEPT SIZE MOD FACTRF AC LC TO OT TYPE PRICE UNITS TYP AD75T UNIT PRICE VALUE NOTES RURAL AC 0120 40 1 0 1 1.6790 4 0.9400 03 +12 +00 -OS -30 pW 8,500.0 2.20 AC 1.57 13,413.0 2962 HAPE OPO OTAL MARKET LAND DATA 2.20 2963 NOTAL PRESENT USE DATA I I Sams Laq �1�f(q LWIVO P�qj� -0AU(�AaCK http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=F600000084 0 7/19/2013 00'�V -� 1836 Davie County Health Department Environmental Health P.O. Box 848 210 Hospital Street Q Courier # : 09-40-06 J Mocksville, NC 27028 Phone: (336) - 753 - 6780 ®� ON-SITE WASTEWATER CERTIEFICA320 8 (Check One) Replacement Remodeling r Reconnection Name: 'f" C Z., i I P Phone Number. 3 — 140 — 3 i6 a— (Home) Mailing Address: a D i 1;^ R j 3 _ 3'1 (Work) Detailed Directions To Site: /56 410 Dt" Fax: (336) - 753-1680 Property Address: 0% 40H1in Mve—ticf, 6- Please Fill In The Following Information About The EXISTING Facility: 0— Name System Installed Under: 4ti5 6- Type Of Facility: �.£P Date System Installed (Mon"ate/Year): Jr Number Of Bedrooms: 3 Number Of People: Is The Facility Currently Vacant? Yes & If Yes, For How Long? Any Known Problems? Yes If Yes, Explain:, Please Fill In The Following Information About The NEW Facility: Type Of Facility: A&-,4 p Number Of Bedrooms: Pool Size: Garage Size: oZs aS Other: Requested By; 3 Number of People For Environmental Health Office Use Only Approved Disapproved Environmental Health *The signing of this form by the Environmental Health Staffis in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payme Cash Check Money Order # Amount:$ Uv •VV Date: ((/ 155 / y Paid By:( Received By: Account #: Invoice #: gJ V s V 00'�V -� 1836 Davie County Health Department Environmental Health P.O. Box 848 210 Hospital Street Q Courier # : 09-40-06 J Mocksville, NC 27028 Phone: (336) - 753 - 6780 ®� ON-SITE WASTEWATER CERTIEFICA320 8 (Check One) Replacement Remodeling r Reconnection Name: 'f" C Z., i I P Phone Number. 3 — 140 — 3 i6 a— (Home) Mailing Address: a D i 1;^ R j 3 _ 3'1 (Work) Detailed Directions To Site: /56 410 Dt" Fax: (336) - 753-1680 Property Address: 0% 40H1in Mve—ticf, 6- Please Fill In The Following Information About The EXISTING Facility: 0— Name System Installed Under: 4ti5 6- Type Of Facility: �.£P Date System Installed (Mon"ate/Year): Jr Number Of Bedrooms: 3 Number Of People: Is The Facility Currently Vacant? Yes & If Yes, For How Long? Any Known Problems? Yes If Yes, Explain:, Please Fill In The Following Information About The NEW Facility: Type Of Facility: A&-,4 p Number Of Bedrooms: Pool Size: Garage Size: oZs aS Other: Requested By; 3 Number of People For Environmental Health Office Use Only Approved Disapproved Environmental Health *The signing of this form by the Environmental Health Staffis 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. Payme Cash Check Money Order # Amount:$ Uv •VV Date: ((/ 155 / y Paid By:( Received By: Account #: Invoice #: gJ V . - 1 DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003303 Tax PIN/EH #: 5850-47-4026 Billed To: Brad Lagle Subdivision Info: Reference Name: Location/Address: Dulin Road -27028 Proposed Facility Residence Property Size: 2+ acres ATC Number: 3828 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 permits) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 a Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTE W ON S V D F PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 1 ate: tv 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 Installid By: Environmental Health Specialist's Signature : �����e. �91q O6 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street �* Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003303 Tax PIN/EH #: 5850-47-4026 Billed To: Brad Lagle Subdivision Info: Reference Name: Location/Address: Dulin Road -27028 Proposed Facility Residence Property Size: 2+ acres ATC Number: 3828 **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 _j&. gcUC, �I� �#People q #Bedrooms #Baths Dishwasher: Er Garbage Disposal: ❑ Washing Machine: Q� Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type EIn #People #People/Shift #Seats Industrial Waste: Lot Size 2� .5 4Type Water Supply CeiwY Design Wastewater Flow (GPD) � Site: New lad' Repair El It System Specifications: Tank Size COO GAL. Pump Tank GAL. Trench Width �� Rock Depth 1; „ Linear Ft. , Other:I���%lll �D� �, Required Site Modifications/Conditions: (11l5_�1tL �e . —r9c� (' �, !R• �J � 51TP–� kr`3�7 �D C* 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.**** • DZQ V5. 0 i p 1- r - a C$ F ;o fK6 - n- S -0 l7q�n Environment 1 H alth Specialist's Signature: Date. :� ✓ 05/99 2. Name on Permit/ATC if Different than Above t / 11 rrc_ Mailing Address -3 3? y �f %�'^' jr / 7 D/ 3. Application For: ,lt�-8ite Evaluation 4. system to Service: 53 House ❑ Mobile Home /a��, a City/State/Zip �'V1(JCktvi' P ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other 5 Type'system requested: 2 Conventional ❑ conventional modified ❑ innovative 6. 1f Residence: # People # Bedrooms 3 # Bathrooms D-�X (Dishwasher []Garbage Disposal 02' ashing Machine ❑Basement/Plumbing 43 asement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: County/City ❑ Well ❑ Community 9. Do you anticipateadditionsor expansions of the facility this system is intended to serve? ❑ Yes lt�o If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions:y"¢'� WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 5e5- S-7- l 2� , 5 %o L -C,4)5 4— rn Property Address: Road Name _J\/ 1�/� �` 1 c> n 0, /00 City/Zip If in a Subdivision provide information, as follows: +'n Name: Section: Block: Lot: Date home corners flagged: �7 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 to conduct all testing procedures as necessary to determine the site suitability. / l DATE a 3 SIGNATUREW.".1 G G^ �l S �P 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). /,/y -7 0 f4— -O ,J Sign given Revised Dd D (05/03 Account No. Invoice No. tom-✓ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003303 Tax PIN/EH #: 5850-47-4026 Billed To: Brad Lagle Subdivision Info: Reference Name: Location/Address: Dulin Road -270288,E i Proposed Facility: Residence Property Size: 2+acres Date Evaluated: �1 .Water Supply: On -Site Well Community Public :Evaluation By: Auger Boring Pit Cut ' FACTORS 1 2 4 5 6 7 Landscape position Slope % HORIZON I DEPTH a—ZIP p_- Z ^ Texture group(� Consistence Structure_ Mineralogyt `'' HORIZON II DEPTH fo - q r0 , Texture groupS; Gt Consistence StS Structure �G Mineralogyc HORIZON III DEPTH Texture group Consistence. Structure .Mineralogy ORIZON IV DEPTH Texture group Consistence Structure Mineralogy 12 , SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE r SITE CLASSIFICATION: V J EVALUATION BY: v 4A` LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:Q� w L REMARKS:Zl -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 Mois 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) P' fi \\ s E K a „ VKc � �•y n p .�//,�,,�. LNt ' G a £ rb s#o lqo ` RIP r d � fit. nJ�J � �Z ti s`�••, I ALA dt LO 4 _ a , 06 3 , -OztE x .s Lb r MEe 4 f a.- ' . Am, J y: �d WARD �lb In r kt j - � Address F h DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date -// Z/ o � le GAf%TnRC AREA 1 Lot SizeS�� AREA 2 AREA 3 AREA 4 6) Topography/ Landscape Position Sy--� S SSS U U !) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS 1) Soil Structure (12-36 in.) dsz) SS Clayey SoilsPS PS U U ,) Soil Depth (inches) � S S P - PS U U. U Soil Drainage: Internal S S p P PS U U External S S S S PS PS U U U Restrictive Horizons ') Available Space S S S PS S PS PS U U U U g) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification , • V - -�.., U—UNSUITABLE S—SUITABLEPS—Provisionally Suitable Recommendations/ Comments: v - -' • ��' �� Described by Title z Date S:� ,SITE DIAGRAM r DCHD (6-82) U—UNSUITABLE S—SUITABLEPS—Provisionally Suitable Recommendations/ Comments: v - -' • ��' �� Described by Title z Date S:� ,SITE DIAGRAM r DCHD (6-82)