868 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewag reatment d Disp sal Rules (10 NCAC 10A .1934-.1 8) Permit Number
Name"'4zn — Date r .i 0
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business _— Speculation
No. Bedrooms —— No. Baths — No. in Family —
Garbage Disposal YES ❑ NO ❑
Specifications f r Syst m:
Auto Dish Washer YES ❑ NO ❑ f�D
Auto Wash Machine YES ❑ NO ❑
Type Water Supply __—
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by -- —
'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
�r
!BOA
Q
Certificate of Completion _ '!am� Date �-
_—
"The signing of this certificate shall indicate that the system describ d above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
i
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone /a —R,13 '
' C
1. Permit Requgsted By �/ Business Phone
2. Address 0% ,r14/ 95 LrAu'A"2z -; & au woe N:rv;1. c= /,/— C'_ ,:9 7-6.2a'
3. Property Owner if Different than Above
Address
4. Permit To: a) Installer Alter Repair.
b) Privy Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions--) 0 X o "
Bed Rooms_Z Bath Rooms/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes urinals garbage disposal 1
lavatory 1/ showers k! washing machine _t/
dishwasher k- sinks
8. a) Type water supply: Publics Private Community
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions A a ip-r- a. Air s
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
Date
Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
7d To �0,qleemee.
Tm
ia-r
DCHD (6-82)
el /so 945
s Gl�L'_? 7jr
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7-her&_
I''(:?xr
iow Ivey
Address
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
/ SOIL/SITE EVALUATION
�'�✓ Date
Lot Size��
GAr'TnMQ AREA 1 AREA 9 ARFA A ARFA 4
1) Topography/ Landscape Position
S
S
S
S
PS
PS
PS
U
U
U
U
�) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)J
PS
PS
PS
U
U
U
1) Soil Structure (12-36 in.)
S
S
S
S
Clayey SoilsPS
SU
PS
PS
U
U
U
I) Soil Depth (inches)
S
S
S
PS
PS
PS
U
U
U
U
)Soil Drainage: Internal
S
S
S
PS
PS
PS
� U
U
U
U
External
--s
S
S
S
PS
PS
PS
U
U
U
i) Restrictive Horizons
Available Space
S
S
S
S
PS
PS
PS
U
U
U
o) Other (Specify)
S
S'
S
PS
S
PS
S
PS
U
U
U
1) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
S—SUITABLE PS—Provisionally Suitable
Described by _ Title/ Date
6
SITE DIAGRAM f
DCHD (6-82)
Appraisal Card
DAVIE COUNTY. INC
Page 1 of 1
5/5/2011 11:29:00 AM
MCCLANNON WILLIAM R & MCCLANNON CAROLYN M M4-000-00-048
68 GLADSTONE RD UNIQ ID 22484
8772000 D340 -P18 ID NO: 5735682889
COUNTY TAX,FIRE TAX CARD NO. 1 of 1
eval Year: 2009 Tax Year: 2011 1.83 AC GLADSTONE RD 1.600 AC SRC= Owner
Appraised by 28 on 05/09/2009 05005 GLADSTONE TW -05 C- EX- AT- LAST ACTION 20100922
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION
CORRELATION OF VALUE
Foundation- 3
Standard 0.19000
Continuous 5.00USE
MOD
Eff.
Area
UA
BASE
RATE RCN EYB
AYB -
CREDENCE TO MARKET
Floor
Sub Floor System - 4
stem
Plywood 8,0 01
1 01
13,0841
101
69.69 214924199
198 % GOOD 8 1. 0
DEPR. BUILDING VALUE - CARD 174,09
Exterior Walls - 21 TYPE: Single Family Residential Single Family Residential
DEPR. OB/XF VALUE - CARD 12,06
Face Brick 34.00
MARKET LAND VALUE - CARD 22,32
Roofing Structure - 03 STORIES: Ranch w/ basement
TOTAL MARKET VALUE - CARD 208,47
Gable 8.0
Roofing Cover - 12
Metal 5.00
TOTAL APPRAISED VALUE - CARD 208,47
Interior Wall Construction - 5
TOTAL APPRAISED VALUE - PARCEL 208,47
Drywall/Sheetrock 20.0
Interior Floor Cover - 08
Sheet Vinyl 0.0
TOTAL PRESENT USE VALUE -PARCEL
TOTAL VALUE DEFERRED - PARCEL
Interior Floor Cover - 14
TOTAL TAXABLE VALUE - PARCEL 208,47
Carpet 6.0
Heating Fuel - 03
PRIOR
Gas 1.00
BUILDING VALUE 172,28
Heating Type - 04
OBXF VALUE
Forced Air - Ducted 4.0
ND VALUE 20,93
Air Conditioning Type - 03 I USM I
PRESENT USE VALUE
Central 4.0 1 I
DEFERRED VALUE
Bedrooms/Bathrooms/Half-Bathrooms I I
TOTAL VALUE 193,21
/1/1 11.000 3 3
Bedrooms 0 0
BAS -3 FUS -0 LL -0 I I
I I
Bathrooms I I
PERMIT
AS -I FUS-OLL-O +------40------+
CODE I DATE I NOTE I NUMBER AMOUNT
Half -Bathrooms +--------48--------+
AS- IFUS-OLL-O I W D D I
TOTAL POINT VALUE 1106.000 1 1
ROUT: WTRSHD:
2 2
BUILDING ADJUSTMENTS + ------38------+------42-------+6-+-14-+
SALES DATA
3 Size .950 I BAS I FGD I
FFize
INDICATE
uaAV1.000I
I I
RECORD DATE DEED
SALES
ha a/Deal n 3 FACTOR 3 1.000 I I I
BOOK PAGE MO R I TYPE
/U
/
PRICE
TOTAL ADJUSTMENT FACTOR 0.950 3 3 3
00086 061 16 119711 WD I
X
I I
TOTAL QUALITY INDEX 101 0 0 0
I I I
I I I
I I I
+---23---+-15--+------42-------+--20---+
HEATED AREA 2,400
B F0P8PTO 8
NOTES
+-15--+------42-------+
[OWNER
SUBAREA
UNIT I
ORIG ow—T
ANN DEP%
OB/XF DEPR.
GS OD DESCRIPTIONLTH
HUNIT
PRICE
COND
BLDG#L/ AYB
EYB
RATE V
COND
VALUE
1 401
3N
1,20 15.01
10
L 119881199N
SA
I 6A
1206
TYPE AREA % RPL CS 86 HOP BLDG
BAS 2,400 10 16725TOTAL OB/XF VALUE 12 06
FGD 60 0)451 1881
FOP 120)351 292
PTO 336)051 1185
BM 1,20 02 1672
DD 1 57 )2d 801
FIREPLACE 1
SUBAREA
TOTALS5,23 14,92
BUILDING DIMENSIONS FGD=WI4WDD=N32W48S12E48$W6 BAS=W80S30E23FOP=S8El5 PTO=E42N8W42S8$N8W I S$E57N30$S30E20N30$PTR=N15W20UBM=N30W40S30E40
S15E20 .
LAND INFORMATION
HIGHEST
THER ADJUSTMENTS
TOTAL
NO BEST
USE
LOCAL
FRON
DEPTH /
LND
I
COND
ND NOTES
ROA
LAND UNIT LAND LINT
TOTAL
ADJUSTED LAND LAND
SE
CODE
ZONING
TAGE
EPTH
SIZE
MOD
FACT
5F AC LC TO OT
TYPE
PRICE UNITS TYP
ADJST i
UNIT PRICE VALUE NOTES
RURAL AC
0120
378
0
1.9370
4
1.2200
+10 +12 +00 +00 +00
PW
5900.00000 1.601 AC
I 2.36A
13941.700 22321
OTAL MARKET LAND DATA 1.601 22,32
OTAL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/Appraisa]Card.aspx?parcel=M400000048 5/5/2011