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108 Heavenly LnSip 19 11 04:13p Information Services t'lione: 036) - 753- 6780 3367531680 V you-pid per Davie County Health Department I i hjaJc� Envirorin-lental Health Sectiolfls—__ P.O. Box 848 210 Hospital Street Courier 4 : 09-40-06 Mocksville, NC 27/028 . ON-SITE WASTEWATER CERTIFICr (Check One) Replacement Remodeling Reconnection Name: — e >� Q� ►� .�. Ck + Cr Phone Number T _7 9 L /D / 7 (Home) Mailing Address: JL'rJ N �3 ��'76�7" 7 7 (Work) �}— �, , ✓i li 1'1(- C- . I'd204& p Email Address: ii Detailed Directions To Site: W 1S�J ©� p O/ �1� urs ' n �QIJ ) e cc / P— hod r'Yh ;/P_ r9 ,,.J rq:-c 1, �r Z D S! /4-e-ek V e Property Address: 10 W IM4 ✓ Lp i�J e Ad Ala TJ 6 e I In d 0 _ rocQ e. ,[� 1 t, ' i I ,h e- 0,1N JV c� r h So E—o f ; /�1 use e1 jj� e� )) r,� e- y' Please Till 1dThe FolloK�tng Information About The EXISTING Facility. IJ O 5 '%Name System Installed Under: :oKle,55e J' L,41 Type Of Facility: HO U,S E Date System Installed (Month/Date/Year): — Number Of Bedrooms: Number Of People: L1-- _ _ Is The Facility Currently Vacant? Yes No If Yes, For How Long? —I. C' Any Known Problems? Yes doIf Yes, Explain: ---- - — Please Fill In The Fo lowing InforKr n A out Th ilit� aw /O7 7 Type Of Facility:_ % sy Number Of Bedrooms: Number of People_ Pool Size:- rage Other:_- 5 —r7— Requcstec ate Requested: For Environmental Health Office Use Only Approve 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. Paynicut. Cash kQhcckj Money Order if Date: Paid By: r Received By: Account fi: 576 invoice #: w Appraisal Card DAVIE COUNTY NC Page 1 of 1 9/27120118:57:09 AM ILJESSE S REV LIVING TRUST & LAIL ROBERTA P REV LIVING TRUS FB -000-00-139-03 108 HEAVENLY LN UNIQ ID 9787 2522861 D412 -P4 ID NO: 5880572373 COUNTY TAX,FIRE TAX CARD NO. 1 of 1 level Year: 2009 Tax Year: 2011 6.972 AC UNDERPASS RD 6.890 AC SRC= Inspection kppraised by 19 on 10114/2008 07002 MOCKS CHURCH TW -07 C- EX- AT- LAST ACTION 20100922 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE Foundation - 3 Standard 0.2400 ntinuous Footin 5.0 Eff. UA BASE RATE RCN EYBAYB REDENCE TO MARKET b Floor System - 4 SE MO Area 01 2 410 104 71.76175192198 1985 % GOOD 76.0 DEPR. BUILDING VALUE - CARD 133 15terior wood 8.0 01 Walls - 10 [ace TYPE: Single Family Residential Single Family Residential EPR. OB/XF VALUE - CARDuminum/Vln 1 Sldin O.O ARKET LAND VALUE - CARD 69,78terior Walls - 21 STORIES: Ranch w/ basement OTAL MARKET VALUE - CARD 202,93 Brick 31.0 o0ng Structure - 03 able 8.02 TOTAL APPRAISED VALUE - CARD 202,93 oofing Cover - 03 TOTAL APPRAISED VALUE - PARCEL 202,93 %sphalt or Composition Shingle 3.0 nterior Wall Construction - 4 PI wood Panel 18.00 TOTAL PRESENT USE VALUE - PARCEL nterior Wall Construction - 5 TOTAL VALUE DEFERRED - PARCEL )rywall/Sheetrock 0.00 TOTAL TAXABLE VALUE - PARCEL 202,93 Interior Floor Cover - 08 Sheet Vinyl 6.0 PRIOR UILDING VALUE 111,71 Interior Floor Cover -14 BXF VALUE Carpet 0.0 - ND VALUE 46,10 Heating Fuel - 04 RESENT USE VALUE - Electric I.Oc DEFERRED VALUE Heating Type - 10 TOTAL VALUE - 157,81C Pum 4.0 Conditioning Type - 03 ntral 4.0 drooms/Bathrooms/Half-Bathrooms 2/0 12.00 PERMIT drooms CODE DATE NOTE NUMBER AMOUNT S-3FUS-OLL-O throoms jeat S - 2 FUS - 0 LL - 0 OUT: WTRSHD: TAL POINT VALUE 100.00 SALES DATA BUILDING ADJUSTMENTS + - 2 0 - + FF. INDICATE 3 AVG1.000 1FOP 1a ECORD DATEDEED SALali 2 2 BOOK PAGE M R TY / a a/Desi 4 FACTOR 4 1.050 +--31---+-20-+6+-22-+ +------57------+ 0555 416 6 OO WD E IIBAS 3 Size 0.990 IFGD I IUBM I TAL ADJUSTMENT FACTOR 1.04 2 2 2 2 2 TAL QUALITY INDEX 30 9 9 9 9 9 I I I I I +--28--+--26--++-22-+ +------57------+ HEATED AREA 1,653 6FOP 6 +--26--+ NOTES SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR GS OD DESCRIPTIONLTH H NIT PRICE COND BLDG#L Y EY RATE V GOND VALUE TYPE AREA % RPL CS TOTAL 08 XF VALUE BAS 1,652 10 11861 GD 63824 2059 OP 39633 997 BM 1,653 32 23753 FIREPLACE 3 2,250 UBAREA OTALS 4,34 175,19 BUILDING DIMENSIONS FGD=W22BAS=W6FOP=N12W2O512E20 WSIS29E28FOP=56E26N6W26 E29N29 S29E22N29 PTR -EIS UBM=E57S29W57N29 WIS . ' ND INFORMATION IGHEST TH ER ADJUSTMENTS LAND TOTAL ND BEST USE LOCAL FRON DEPTH / LND CONDrN. NOTES ROA UNIT LAND LINT TOTAL ADJUSTED LAND LAND SE CODEZONING TAGE DEPTH SIZE MOD FACTRF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES URAL AC 0120 406 0 1.2180 4 0.8400 01 +20 -I5 -10 -10 PW 9 900.0 6.89 AC 1.02 10 127.7 6978 RR OTAL MARKET LAND DATA 6.89 69,78 OTAL PRESENT USE DATA http://maps. co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=F80000013903 9/27/2011 OF ^ i Uf Af ~ Perm JN — fin J 3:3a - -�` DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name Date 2 fa 34J Location TO FO / Sv., 71f L ti. r- T Gy- VN7 ZPl1J s Subdivision Name Lot No. Sec. or Block No. Lot Size House 4' Mobile Home _ Business Speculation No. Bedrooms -3 No. Baths No. in Family `{ _ Garbage Disposal YES ❑ NO ❑ Specifications for System: /Ooo Auto Dish Washer YES ENO ❑ 30 ,x 3 x /2 SfvNL �� U Auto Wash Machine YES NO ❑ Type Water Supply 61X *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by e_-Z� *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 _ G t� Certificate of Completion Date "The signing of this certificate shall indicate that the system described 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. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name S :sz LA/Z__ Date Z Location TO <'HQ f S uv-rz f L �. r' i &1-- Un zru"ZP/7Js 2G��tiF � le Z). -ro /2-7. rqs -r ,7o.-irs 1VL11ZsV2y Subdivision Name Lot No. Sec. or Block No. Lot Size h•`f 14 House '�Mobile Home _ Business Snerulation No. Bedrooms 2 _ No. Baths _-Z Garbage Disposal YES p NO ❑ Auto Dish Washer YES NO .Q Auto Wash Machine YES NO .0 Type Water Supply tit No. in Family 41 Specifications for System: /000 u 30 i A 3 'X *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 Certificate of Completion Date *The signing of this certificate shall indicate that the system described 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. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name LAit— Address Date 3Z3$ r z vo"Bffa K brz'` � Lot Size fes • Z G^vrs Arc- 27a /'L— GAI TnRc ARFA 1 AREA 9 ARFA 3 ARFA A 1) Topography/ Landscape PositionSS" S� 1:C)S -PS PS PS PS U U U U '.) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S A) . S � S PS U U U 1) Soil Structure (12-36 in.) S S S PS Clayey Soils S ---Q /-(M:) U U U U 1) Soil Depth (inches)�, Cts S �m S S PS U U U U i) Soil Drainage: Internal __.___......6� S PS PS PS PS U U External &> �U^�, ��U----3 ` S PS PS PS PS U U U U 1) Restrictive Horizons Available Space S PS S. PS S PS S PS U U U U 1) Other (Specify) S PS S PS S PS S PS U U U U I) Site Classification PS S U—UNSUITABLE Recommendations/ Comments: Described by SITE DIAGRAM DCHD (6-82) S—SUITABLE CP!--Prpvfs-io'nalIy Suitable A?-- Title Date . ' APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section 2 R 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested By M le• Z -e -,s,S, Business Phone 2. Address F2 sf? �tf&,nVM a A15 ,IV - C . �-i 0 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub -Division Seca Lot No. 5. System used to serve what type facility: Housed Mobile Home Business— Industry.' usinessIndustry' Other b) Number of people 6. a) If house or mobile home, state size of home and\umber of rooms. al- M d6 s� House Dimensions— Bed imensions �� ► XD'oN6 mrd rhe oYff�� �RbO Bed Rooms Bath Rooms Den w/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 2 - lavatory dishwasher l urinals showers �- sinks garbage disposal washing machine J 8. a) Type water supply: Public Private -`_ Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 20 9 yy-kl- %/,9. 2-/ Z 3?;2 ii X y:5_2X/ 9�.z 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? Ny What type? This is to certify that the information is correct to the best of 7mywledge. D -e Date Owner Sig'nilture OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82)