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3362 Hwy 601SHEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Ron Bivins Address: 3362 US Hwy 601 S City: Mocksville StatefZip: NC 27028 Phone #: (336) 284-2438 For Office Use Only *CDP File Number 121065 -1 N6-000-00-091 County ID Number: valuated For. HDR/WWC PERMIT VAUD 0 4/ 1 1/ 2 0 1 8 UNTIL: 'Property Owner: Ronnie w. and Teresa J Bivins Address: 3362 US Hwy 601 S City: Mocksville State[Zip: NC 27028 hone M (336) 284-2438 Property Location & Site Information Address3362 US Hwy 601 S Subdivision: Boxwood Acres Road# Mocksville NC 27028 Township: Directions Hwy 601 South To Boxwood Acres *Structure: SINGLE FAMILY # of Bedrooms: 3 # of people: 2 *Water Supply: N/A Basement: F-] Yes ❑ No 'Proposed Improvement: Expanding Existing Bedroom Phase: Lot 4 Type of Business: Total sq. Footage: No. Of Employees: It is the responsibility of the owner to maintain a T minimum setback between the wastewater system and any part of the structure foundation, including porches, decks, and any other appurtenances. If you are unsure as to the exact location of the septic system, please have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed. This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? QYes (2)No Applicariftegal Reps. Signature: *Date: *Issued By 2244-Daywalt,Andrew A *Date of Issue:_ 0 4/ 1 1/ 2 0 1 3 Authorized State Agent: At M wy d **Site P Ian/Diawing attached.** Total Tlme:(HH:MM) 0 1 Hours Minutes Hand Drawing 0 Import Drawing Davie County Health Department "0e1836- Environmental Health Section P.O. Box 848 O ~ ,�„ s: 210 Hospital Street O U �'% 4 Courser # : 09-40-06 1911 Mocksville NC 27028 Phone: (336) - 753 - 6�� =SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 t(Check One) Replacement Remodeling Reconnection Name: �& J� Phone Number 3 ir- Zc�� z/3� (Home) Mailing Address: 3362 Altvy `ef/ .S %-1/-L/39''-2Z`�Z (Work) ,�ASv1 `�% ,44� .7-7V,10 Email Address: 1^-�✓ld/rI Ss� r� �,e4��,�v , Property Address: ta Z- IrCy H ®L- Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: pan 61 U 1 Y� S Type Of Facility:_ Date System Installed (Month/Date/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? Yes 60) If Yes, Explain: Please Fill In Tb�e.Followi g Infor ation About The NEW Facility: IMM Type Of Facility: % //I �✓� Number Of Bedrooms: Number of People Pool Size: ze: Other: p Requested By: Z Date Requested: (Signature) For Environmental Health Office Use Only Approved Disapproved 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 (Check ,f Money Order # Amount:$ Paid By: Received By:_ Account #: Ow Invoice #: Date: v ,. , Davie County Health Department, Ps t� Environmental Health Section • 7 P.'O. Box 848 210 Hospital Street U 1`t Courier # : 09-40-06 1911 Mocksville NC "2702$ . Phone: (336) - 753 - 6780 ,4 `ON SITE WASTEWATER CERTIFICATION" Y i Fax: (336) - 753-1680 (Check One Replacement Remodeling Reconnection" . ^1 t Name: rI'\ �.. Phone Number 3 F� • 2S;11 l%3�i. (Home) X Mailing Address: 610' / s %�%_ 1%33-.2 20 (Work) `ilZ 4P /y G Z��'�' Email Address: 1-41';Iln is �'�'4•E'4J�/��°v^ (rh., Detailed Directions To Site: s /o Property Address: r _ Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: o,- j j1 t/ i S Type Of Facility:1 ;�7' , RQ Date System Installed (Month/Date/Year): ''✓1 b / Number Of Bedrooms:_Number Of People: s. 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 InforRiation About The /NEW Facility: ' Type Of Facility: / i OX Number bf Bedrooms: Number of People il Pool Size: Garage -Size: Othe% Requested By: ate Requested: L ZD/ -3 (Signature) - For Environmental Health Office Use Only Approved Disapproved ' .Comments: , Environmental. Health Specialist Dater *The signing of this form by the Environmental Health Staff is irino way intended, nor should be taken.as a guarantee (extended or limited) that`the on-site wastewater system will function properlyfor any given period of time. Payment: Cash rhecky Money Order # Amount:$ Date: Paid By: M!Received By: Account #: �Q G Invoice #: _ .: s.. ....... .... 4.:.:+:.�.._.. i .::. ..,yw :+ ... .��:.. �: ♦,!. �. y... \..,. .. ...0 .♦ a C.. ,. ..t.Y ..-4.,-� . .., y�.3n.� ♦ ,. ._...-. s.. _. r ,. r_.. . _... ..-. ._._ . _. ,. -_ � .. �.. DAVIE COUNTY HEALTH DEPARTMENT --�1 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 C.,/ y!S�/ i/, ��rl �' f /�f�%`�, /� -;✓, i%/ Date1 z� a Location Subdivision Name Lot No Sec. or Block No. Lot Size Z, House Mobile Home _ Business Speculation No. Bedrooms ` . No. Baths _ No. in Family Garbage Disposal YES ❑ NO Lcj-- Specifications for System: Auto Dish Washer YES NO ❑ ��v , Y Auto Wash Machine YES NO ❑ �/ „ Type Water Supply �rrJ0/(3A/ "This permit Void if sewage system described below is not installed within 36 months from date of issue. ,l Improvements permit by —�—L "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 )00s Ncertificate 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 eriod of time. CSP 0015 / t: •.�^.. 7, .i..'.w. Py'.1...:d .,J:.}"_f bJ h r'iii.yr� '':.: 5.,, !�?4i • e:l�y :4Zr�.y.�+�w'.,, b , M�.i`'� ..> , DAVIE COUNTY HEALTH DEPARTMENT -!� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - *,N OT E: 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 _ ," ,, "✓ h i ,'J'i ; �� , Date �/ Location Subdivision Name Lot No Sec. or Block No. Lot Sizer� �"^s'' House Mobile Home _ Business Speculation No. Bedrooms ? _ No. Baths No. in Family Garbage Disposal YES p NO p, Specifications for System: Auto Dish Washer YES NO .0 ,/ Auto Wash Machine YES NO ❑ Type Water Supply *This permit Void if sewage system,described below is not installed within 3/6 months from &e 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 in2iicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall inrNO way be taken as a guarantee that the system will function satisfactorily for any given eriod of time. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone, Z57 3 1. Permit Requested y Z45Business Phone 2. Address !; . C 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional ther Type Ground Absorption c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions _ Bed Room -S::2 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 urinals garbage disposal lavatory showers washing machine dishwasher sinks 8. a) Type water supply: Public__z,:::n�__Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 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: r��Jvold I "--- D� 6rl S I U , e, DCHD (6-82) Name— Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot FAr:TnRS AREA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position S S S 4P PS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS U U U 1) Soil Structure (12-36 in.) S S S S Clayey Soils ties) PS PS PS U U U 1) Soil Depth (inches) S S S PS PS PS PS U U U U ) Soil Drainage: Internal S S S S PS PS PS U U U External S S S S PS PS PS U U U i) Restrictive Horizons Awe Available SpaceS (SS' S S PS PS PS U U U U 1) Other (Specify) S S S S PS PS PS PS U U U U 1) Site Classification Rs. U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: Described by�� Title �� Date SITE DIAGRAM L-_ DCHD (6-82) ,� Appraisal Card Page 1 of 1 MNS RONNIE W BIVINS TERESA 7 - Retum/Appeal Notes: N6-000-00-091 362 S US HWY 601 UNIQ ID 24338 732000 D418 P18 ID NO: 5755039091 COUNTY TAX (100), FIRE TAX (100) CARD NO. I of 1 eval Year: 2013 Tax Year: 2013 LOT 4 BOXWOOD ACRES 1.390 AC SRC- Inspection %ppralsed by 02 on 06/07/2007 05002 WEST JERUSALEM TW -05 C- EX- AT- LAST ACTION 20120925 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundatlon - 3 Standard 0.2600 tinuous Footing5.0 ED BASE UA RATE RCN EYB AYB REDENCE TO MARKET S MO Area Floor System - 4 - 2 086 117 81.90 17354 198 198 % GOOD 74.0 EPR. BUILDING VALUE - CARD 128,42C ood 8.0 01101 erlor Walls - 30 TYPE: Single Family Residential Single Family Residential )EPR. OB/XF VALUE - CARD 14,90 1--l-ce minum n I Sidin 31.0 ARKET LAND VALUE - CARD 20,06erlor Walls - 21 STORIES: 1 - 1.0 Story - OTAL MARKET VALUE - CARD 163,38 Brick 0.0 Doling Structure - 03 able 8.00 TOTAL APPRAISED VALUE - CARD 163,38 oo0ng Cover - 03 TOTAL APPRAISED VALUE - PARCEL 163,38 ksphalt or Composition Shingle 3.0 nterior Wall Construction - 5 TOTAL PRESENT USE VALUE - PARCEL )rywall/Sheetrock 20.00 TOTAL VALUE DEFERRED - PARCEL nterior Floor Cover - 08 TOTAL TAXABLE VALUE - PARCEL 163,38 heet Vinyl/Laminate 6.O nterlor Floor Cover - 14 PRIOR :arpet 0.0c 3UILDING VALUE 134,58 eating Fuel - 04 BXF VALUE 9,27 lectric 1.0 ND VALUE 20,0 eating Type - 10 RESENT USE VALUE eat Pump 4.O I I EFERRED VALUE it Conditioning Type - 03 1 I OTAL VALUE 163,91( 4.0 0 I rooms/Sathrooms/Half-Bathrooms + - - - 18 - - - - + 2 /0 12.00 IFSP 1 0 1 1 I [ntral rooms 0 0 1 PERMIT -3FUS-0LL-O +-11--+-11--+-7-+ +-----25------+ CODE DATE NOTE NUMBER AMOUNT hrooms IFCP ISAS I -2FUS-0LL-O I I I oe I I I OUT: WTRSHD: I I I SALES DATA 2 2 1 FF. INDICATE OTAL POINT VALUE 1102.02C 4 4 1 ECORD ATE DEED SALES BUILDING ADJUSTMENTS I I 3 BOOK PAGE M R TYPE PRICE aliunp 4 ABAVG 1.200 1 1 g 0130P548 4 198 WD Q V 450 ha Desi 3 FACTOR 3 1.000 I 1 I 0129 12 12 198 WD V 300 ize 3 Size 1 0.960 +...-22-----+-----27------- I OTAL ADJUSTMENT FACTOR 1.15 I I OTAL QUALITY INDEX 11 1 I 1 I 4 I HEATED AREA 1,882 I I +-----23-----+ NOTES OWNER FROM T.E. PHELPS ET AL FROM MCCRAY DAVID W ET UX SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR TYPE GS AREA % RPL CS CODE ESCRTPTIOjLTM�WTHUNIT PRICE GOND BLDG# B AYB EYS RATE OV I COND VALUE 1,88 10 15413 2 RAGE 28 30 840 30.00 100 _ L 19911991 S3 34 856 11 9 P PAVING 0 0 4,500 3.00 0 198 198 S 0 CP - 52 02 10!;7 SP 18 04 589 1 ORALE 2 3 66 15.0 001 001 S 633 3 - 1 Story OTAL OB/XF VALUE 14,904 Sin le 2'70 BAREA U,TALS 2,59 173, ILDING DIMENSIONS BAS=W25N20W18SIOFSP=W18SIOE18N10 S1oW7FCP=W22S24E22N24 S24E27S14E23N38 . NO INFORMATION [.FIREPLACE GHEST THERADJUSTMENTS LAND TOTALD BEST USE LOCAL FRON DEPTH / LND GOND NDNOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND E - CODE ZONING TAGE EPT SIZE MOD FACT RF AC LC TO OT TYPEPRICE UNITS TYP ADJST UNITPRICE VALUE NOTES HOMESIT 0201 150 0 2.0820 4 1.1400 +04 +30 +00 +00.+00 DW 6 100.0 1.38 AC 2.37 14 475.3 2006TAL MARKET LAND DATA 1.38 20,060 OTAL PRESENT USE DATA CI http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=N600000091 4/9/2013