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2389 Hwy 601SI ►51''x`VEPARTMENT 4,,DAVIE COUNTY HEALTH� Environmental Health Section PROPERTY INFORMATION /ID,11�-97. P.O. Box 848 Mocksville, NC 27028 ' Subdivision Name: i "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:307 9:30 A.M. OR 1:00 - 1:30 P.M: ON,THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. , DCHD 05/96 (Revised) r APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department 2 @ 1E 0 W Environmental Health Section D P.O. Box 848 Mocksville, NC 27028 S 81997 (704)6 ; 34-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed + Contact Person o Mailing Address Home Phone City/State/Zip 1- 1 J Business Phone Fjf 199 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0 Site Evaluation [ ] Improvement Permit & ATC Both 4. System to Serve: [ ] House [Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People _ # Bedrooms _ # Bathrooms_LL_ bd Dishwasher [ ] Garbage Disposal AWashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: M County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes 6CJ No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **XVXT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: Q c -cS WRITE DIRECTIONS (from Mocksv1ille) TO PROPERTY: Tax Office PIN: # 7 y -� -� tx.� , ` Property Address: Road lame— u -p i 5t)[A City/Zip ,�z5 o j \ e. 6a.—=S: o If in Subdivision provide information, as follows: Name: Section: Lot #: ' 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 ounty Health Department to enter upon above described property located in Davie County and owned I by to onduct all to2612AWA prod s necessary to determine the site suitability. DATE -9-B-97 SIGNATURE �MJ A &I Revised DCHD (06-96) ' THIS AREA MAY BE USED FOR I)RAWINC7 YOUR SITE PLAN: f• � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation v APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION DATE EVALUATED PROPERTY SIZE ROAD NAME Edi S Water Supply: On -Site Well Community Public V Evaluation By: ty • Auger Boring Y/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % C, - �o HORIZON I DEPTH Texture groupL Consistence Structure C Mineralogy HORIZON II DEPTH 2 " Texture group Consistence TT Structure Mineralogy 1 % 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS ,5 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE t SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE:XA REMARKS: DCHD (01-90) EVALUATION BY: OTHER(S) PRESENT: 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 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) LIAR - Long-term acceptance rate - gal/day/ft2 ■ ■ ■ NESE■■■■ ■Bm■■om■ OBSESSES ■■■■m■■■ ■■■■m■■■ ■■omm■s■ ■■m■■mm■ ■omm■■m■ ■Nom■■M■ ■NEE■■B■ ■■E■■■■■ ■moms■■■ ■■■■M■■■ ■EE■■EN■ ■■■■■BM■ ■■■■■NM■ ■■B■■N■■ ■■ENE■■■ ■■E■■■■■ OBSESSES ■EE■■EB■ ■o■■ME■■ ■■■■ommm ■Nana ■Bno_s■■ ■■II■ar■■ ■mllml\m11w ■■Imm:i�rdow ■■i■■m■■ ■Emm■■■■ ■mommmmm ■i:::: ■■■■EEE■ ■■■mons■ ■ENE■■■■ ■■B■■■s■ ■■■■■■M■ ■NEN■■■■ ■■■■■MM■ ■No■■■■■ OBSESSES ■■■■E■" ■ ■ ■ ■■■moos■ ■Nm■■som ■■■mom■■ ■EN■■ SEEMS SEEMS WOMEN ■■■E■ ■■■S■ ■■■■■ SEEMS SEEMS NEON BEEN ■EE■ ■ ■ ME ME i ■ ■■■N■ SEEMS ■BEN■ MESON BONNE ■■MB■ SEEMS MESON MEN on 0 ■M■■ MEMO NONE ■ ■■MN■■N■ ■E■■■B■■ ■MMM■■■■ ■■moss■■ NONSENSE NONSENSE ■■RENSO■ ■■VAM■M■ ommommom ■■■NEMS■ 0 ■M■■■M■■ ■M■EM■■■ ■■SEEN■■ X■■■ME■■ "N■■■B■■ ■s■E■s■■ N■■■■■■■ WEEMEN■■ ■■m■olmo■ ■■mmol■■■ ■OM■NI■■■ ■NE■K1■■■ ■m■mums■ ■ME■IIE■■ on ■M■■■■■■■■N■ WR■■■■E■M■B■ MORN■■■■B■■■ ■OWEENB■■■M■ Eo■■■■EM■■M■ moa,■■■S■■■M■ ■NUMEEE■EOE■ ■mmommo■■BN■ ammom■MM■N■■ Esso■■■■N■■■ ■NB■■■■N■■N■ ■o■■■■S■■■B■ ■M■■B■S■■Bm■ ■NM■■NB■■■■■ ■N■■■MB■■M■■ ■ESEN■EENE■■ ■s■B■NE■■N■■ ■s■■■■s■o■N■ Esso■■■■■N■ ■■■BN■EBN■■■ ■o■EME■■■M■■ ■s■■s■sss■■■ ■E■■B■s■■■N■ ■■■■N■■■■■■■ ■NEON■■■M■■■ ■MMM■■■B■■E■ ■snm■■EMBB■■ ■maommM■■M■■ soul■■o■■■u on ■BEEN■ ■M■■Mom■BN■■ ■■■■E■■■■■■■ ■■sss■■■BN■B ■EE■■■M■■MN■ ■o■s■o■ESMs■ ■N■■■MMM■■■■ ■EM■■■M■■mo■ ■■sss■■■■■M■ ■■BENE■■N■M■ ■s■■MB■■M■■■ ■S■■■■■B■N■■ ■E■■s■M■■■N■ ■EMO■■M■■■m■ ■MMO■■ ■EM■E■ 9,1?ATION NO Ad' 70— *1042 DAVIE COUNTY HEALTH DEPARTMENT 0 - Environmental Health Section PROPERTY INFORMATION 1,D tteP's P.O. Box 848 ame:", Mocksville, NC 27028 Subdivision Name: -634-8760 Phone #: 704 Directions to r -Irl- - -1 1 1 ---' j< JOA I, All y Section. Lot: 0 W'd AUTHORIZATION FOR N' WASTEWATER SYSTEM CONSTRUCTION Tax Office PINJt", - am taywq Road Name: J60 zip:zoa **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 FormlAuthorization. Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. I . I : (In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE*** TIIIS AUTHORIZATTON FOR WASTEWATER CQNSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIR ONMENTAL HEALTH SPECIALIST DATE ISSUED Y: L� OCCUPANTS— GARBAGE DISPO AL- Y6s oim; PE.CIFICATION.; BLIL61146 TYPE # BEDROOMS BATHS, COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No ITE�. REPAIR SITE LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 20 NEW S le'l SYSTEM SPECIFICATIONS: TANK SIZE L2,L)O GAL. PUMP TANK _GAL. TRENCH WIDTH ROCKDEPTH LINEARFT. OTHER' REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT , .. J,; "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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATIONPERMITBY: DATE: "THE ISSUANCE OF THIS OPERA71ON 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 05/96 (Revised) Appraisal Card Page 1 of 1 5 BANK NATIONAL ASSO TRUSTEE WELLS FARGO ASSET SEC. CORP. Return/Appeal Notes: LS -000-00-104 389 5 US HWY 601 UNIQ ID 21673 2533066 NN: 26 - CHANGE OF OWNERSHIP BD15-4 ID NO: 5746337347 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2014 1.290 AC HWY 601 S 1.290 AC SRC= Inspection kppralsed by 19 on 05/20/2008 05004 FAIRFIELD TW -05 C- EX- AT- LAST ACTION 20130524 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 Standard 0.1900 ontinuous Footing5.0 Eff. BASE US MO Area UA RATE RCN EYB AYB REDENCETO MARKET ub Floor System - 4 I ood 8.0 59 01 12,57 2 99 69.30 17974 199 199 % GOOD 81.0 )EPR. BUILDING VALUE - CARD 145 59 )EPR. OB/XF VALUE -CARD 3,99 xterior Walls - 10 TYPE: Modular Single Family Residential Iuminum/Vin I Siding29.0 ARKET LAND VALUE - CARD 17,61 STORIES: 5 -Ranch w/ basement OTAL MARKET VALUE - CARD 167,19 oo0ng Structure - 03 able 8.0 oCover - 03 s phalt halt or Composition Shingle 3.0 OTAL APPRAISED VALUE - CARD 167,19 - OTAL APPRAISED VALUE - PARCEL 167,19 nterior Wall Construction - 5 )rywall/Sheetrock 20.0 nterior Floor Cover - 08 TOTAL PRESENT USE VALUE - PARCEL heet Vinyl/Laminate 6.0 OTAL VALUE DEFERRED - PARCEL nterior Floor Cover - 14 TOTAL TAXABLE VALUE - PARCEL 167,19 arpet 0.0 PRIOR Heating Fuel - 04 BUILDING VALUE 151,42 lectric 1.00 eating Type - 10 BXF VALUE eat Pump 4.00 ND VALUE 17,61 Ur Conditioning Type - 03 PRESENT USE VALUE DEFERRED VALUE ntral 4.0 OTAL VALUE 169,030 3edrooms/Bathrooms/Half-Bathrooms /2/0 12.00 Brooms BAS - 3 FUS - 0 LL - 0 PERMIT Bathrooms CODE I DATE I NOTE I NUMBER AMOUNT BAS -2FUS -0 LL -0 Office +14-1 AS-0FUS-0LL-0 IUBMO I +-----54-----+ OUT: WTRSHD: OTAL POINT VALUE 100.00 1 1 SALES DATA BUILDING ADJUSTMENTS 4 I FF. INDICATE Ize 3 Size 0.940 4 2 7 RECj827 DEED SALES uali 3 AVG 1.000 + - - - - - 5 4 - - - - - + 1 I I I / PRICE BOOTYPE J7�nO4 ha a Desi 4 FACTOR 4 1 4- L P T O 1.050 +1 IBASO 8 I +-----54-----+ 092 TO P I 15500 OTAL ADJUSTMENT FACTOR 0.99 1 + - - - - - 54 - - - - - + +14-+ 056WD X V OTAL QUALITY INDEX 91 I I 4 2 4 7 I I I +14+---40----+ HEATED AREA 2,074 I 7FOP NOTES +14-+14+ SUBAREAUNIT ORIG % ANN DEP % OB/XF DEPR, TYPE GS AREA % RPL CS ODE ESCRIPTIONLTH H NIT PRICE COND LDG*YL/B AYB EYB RATE V GOND VALUE BAS 2,07 10d 14372 10 ICON PAVING 1 01 01 1,9001 3.501 01 1 1200512001SA 1 601 399 OP 903 235 OTAL OB XF VALUE 3 99 0 97 00 339 BM 2,07410201 2876 2 - Pre IREPLACE 1,50 Fabricated UBAREA 5,21 179,74 OTALS BUILDING DIMENSIONS PTO=N18W54S18E54 BAS=W54N10WI4S44E34 FOP=N7E14S7W14 N7E14E40N27 PTR=E20 UBM=N44 E14S10E54S27W54S7W14 W20 . LAND INFORMATION HIGHEST THRAJUSTMENTS LAND TOTAL ND BEST USE LOCAL FRON DEPTH / LND GOND�..ENOTDES ROA UNIT LAND LINT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGE DEPTH SIZE MOD FACTRF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES RURAL AC 0120 25 0 2.1630 4 1.07003 +10 +00 +00 +00 1 PW 1 5,900.00 1.290 AC 1 2.314 13,652.60 1761 OTAL MARKET LAND DATA 1.290 17,610 OTAL PRESENT USE DATA 1� IV1wReti 3��" 1U11h �u�cd�se� 3,373 I q� Zai r o��iL is. Dnl �1�� borne TOAh W. l-evis Aores DeQd'ea son Itzg � a 397 ..SONS IO`i' fUf1 4D 0 a3g9 O http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=L500000104 8/15/2013 t� o �°�F t All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the implied iwarranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of U N Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or ariaing out of P ri nted:Aug 16, 2013 S the use or inability to use the GIS data provided by this website. BEGINNING at an iron stake found at the right of way of U.S. Highway 601, said iron stake bang at the Southern corner of the within described pared and at the Western corner of the property of Robert J. Wescott. Jr., as described in Deed Book 145 at page 748; thence with the right of way of said highway North 45 degrees 511 minutes 40 seconds 50.00 feet to a new iron stake set; thence North 56degrees 14 minutes 15 seconds East 288.12 feet to a now iron stake set, an internal corner; thence North 45 degrees 58 minutes 40 seconds West 165.75 feet to a new iron stake set in the property line with the property of John T. Byerly as described in deed Book 126 at page 760, the Western corner of the within described parcel; thence with the B*1y property North 51 degrees 52 minutes 32 seconds East 690.42 feet to an iron make placed on the Southern bank oft brunch in the property line with the property of Ralph E. Call as described in Deed Book 82 at page 34, the Northern comer of the within described panni; thence with the Call fine South 51 degrees 09 minutes 10 seconds East 188.80 feet to a bent iron found on the southern bank of a bunch, said bent iron being found North 61 degrees 02 minutes 45 soconds West 88.01 feet from a rebar found, said bent iron being at the Eastern corner of the within deml3ed parcel; thence with the Wescott line South 48 degrees, 50 minutes 14 seconds West 645.99 Poet to an iron stake found; thence South 56 degrees 14 minutes 14 seconds West 346.71 feet TO THE POINT AND PLACE OF BEGINNING and containing 3.573 acres as surveyed by Grady L. Tutterow. RLS, and being taken t%m the property ofLucy S. McClamrock as described in Deed Book 172 at page 572, and is part of Tax parcel L-5-32. All references aro to the Davie County Registry. 4/97Ah SAVE AND EXCEPT Lying and being in Jerusalem Township, Davie County, North Carolina and beginning at an existing iron pin, said existing iron pin being located in the Northern right of way of Highway 601 and being the Southwestern most corner of the within described property and being the Southern most corner of John T. Byerly, Deed Book 126, Page 760, thence with right of way of Highway 601 South 45 degrees, 58 min., 40 sec. East 25.00 ft. to a new iron pin, thence North 56 degrees, 14 min., 14 sec. East 350.42 ft. to a new iron pin, thence North 48 degrees, 50 min., 14 see. East 197.34 ft. to.a new iron pin, thence North 45 degrees, 58 -min., 40 sec. West 184.98 ft. to a new iron pin, said new iron pin being located in the Southern line of John T. Byerly, Deed Book 126, Page 760, thence with said Byerly live -South 51 degrees, 52 min., 32 sec. West 259.97 ft. to an existing iron pin, thence with said Byerly South 45 degrees, 58 min., 40 sec. East 165.75 ft. to an existing iron pin, thence South 56 degrees, 14 min., 15 sec. West 288.12 ft. to the point and place of beginning and containing 1.29 acres as surveyed by Sparks Surveying, July '12, 2004, see Deed Book 330, Page 412, Tax Map L-5-32.