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311 Ketchie Creek RdHEALTH DEPARTMENT RELEASE For office use Only t ? *CDP; File.Number 122,b8.9-1 Davie County Health Department K2-000-00-040 . 210 Hospital Street County,ID Number. P.O. Box 848 Evaluated For: NEW Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID 0 6 / 2 7/ 2 0 1 8 Applicant: Doug Lakey Address: 166 Horseshoe Road City: Mocksville StatelZip: NC 27028 Phone #: (336) 909-0980 1 Ketchis Creek Road R 1,d # i0loeks�til�_ INGLE FAMILY 'Structure: # of Bedrooms: 3 'Water Supply: WA Basement: [_j Yes FIND 'Proposed Improvement: Prope Owner: Bobby Koontz Address: 3 e Road City: Mocksville State0p: NC 27028 Phone #: Property Location 8. Site Information --- ------Subdivision: _ -._ . -. __-----_.-____ ______----Phase:--- ------_------Lot _ 028 Township: Directions # of people: 2 Davie Academy to Ridge Rd, then to Ketchie Creek Rd. Type of Business: Total sq. Footage: No. Of Employees: 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 0No Applicant/Legal Reps. Signature: __ _— *Date: f *Issued By: 2244-Daywalt, Andrew *Date of Issue:• 0 6 / 2 7 % 2 0 1 .3 Authorized State Aaent: ** �� IOi81 Ilrtle:(tit1:MM) Site Plan/Drawing attached. o Hours o o Minutes �� n- IU_ A rlrn.•rinn ()ImnnrF nrmWIrV1 Not R %d (/c4', Davie County Health Department his I� Environmental Health Section - P.O. Box 848 BONN210 Hospital Street C� Courier # : 09-40-06 Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 751- 8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement odeling Reconnection Name: , r rte/ Phone Number (Home) Mailing Address: , 6Li- - Odj 9-D (Work) Email Detailed Directions To Site: �v0= htia 7z Property Address: _1� 1( Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: ____Type r ,-E z Type Of Facility: Date System Installed (Month/Date/Year): lg Z IS Number Of Bedrooms: ;5 Number Of People:�2_ 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 Information About The NEW Facility: Type Of Facility: - Number Of Bedrooms: — d _ Number of People Requested By: Date Requested: (Sign e) 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 check ) Money Order # Amount:$ / V I/ Paid By: Received By: Account #: Invoice #: �- C /x00 DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorpt on Sewa a Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR 00A/7-11 DATE 672 (I ERMIT LOCATIONG%C E 1842 i 7 c;.taG�rt:i 1! f -rte .R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. HOUSE ©" MOBILE HOME BUSINESS ❑ M House Trailer 800 Gal. 400 Sq. Ft. N0. BEDROOMS .. NO. BATHROOMS i Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO ©— Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO, DISHWASHER YES ❑ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES NO ❑ SITE SUITABLE YES C:r NO ❑ K:ie-� SIZE OF TANK gal. NITRIFICATION FIELD sq. ft.! DEPTH OF STONE IN LINES: I`c' WATER SUPPLY: Individual ❑ ,Public ❑ � r v`'f 3 r. �--C.U- J � IMPROVEMENTS PERMIT BY /_1 ,r'�'' INSTALLED BYI:�i. CERTIFICATE OF COMPLETION By Date 3 7� (8/16/73) *Construction must comply with 441, other applicable State and local regulations LOT AREA ' f 4 bio 31-' 10O �, 6o DAVIE COUNTY HEALTH DEPARTMENT I °t P. 0. BOX 57 I� MOCKSVILLE, N. C. 27028 .:� (704) 634-5985 Statement for Septic Tank Improvement Permits ". and/or Site Evaluations NAME DATE ISSUED ADDRESS PERMIT NO. Ex lunation of charge �.. AMOUNT DUE is SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATENE T. w s Appraisal Card Page 1 of 1 ar�rtnn�i o.cc.n� eu KOONTZ BOBBY D Return/Appeal Notes: K2-000-00-040 11 KETCHIE CREEK RD - UNIQ ID 20075 3248000 - D65JON-P3 ID NO: 5717206106 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 19.70 AC OFF RIDGE RD 20.890 AC SRC= Inspection Appraised b y 02 on 09/04/2007 01003 DAVIE ACADEMY TW -01 C- EX- AT- LAST ACTION 20130404 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 Standard 0.3500 ontinuous Footing5.0 US MO Eff. Area UA BASE RATE RCN EYB AYBL - REOENCE TO MARKET ub Floor System - 4 I ood 8.0 01 01 2,418 107 74.90 18390 197 197 % GOOD 65.0 )EPR. BUILDING VALUE - CARD 119 54 xterior Walls - 16 TYPE: Single Family Residential Single Family Residential )EPR. OB/XF VALUE - CARD 1,07 nthetic Stone 33.0 MARKET LAND VALUE - CARD 78,36 Roofing Structure - 03 STORIES: 2 - 1.5 Stories OTAL MARKET VALUE - CARD 198,97 able 8.0 oofing Cover - 03 ksphalt or Composition Shingle 3.00 TOTAL APPRAISED VALUE - CARD 198,97 nterlor Wail Construction - 5 TOTAL APPRAISED VALUE - PARCEL 198,97 )rywall/Sheetrock 20.0 nterior Floor Cover - 14 TOTAL PRESENT USE VALUE - PARCEL .arpet 6.0 TOTAL VALUE DEFERRED -PARCEL eating Fuel - 04 TOTAL TAXABLE VALUE - PARCEL 198,97 lectric 1.0 Heating Type - 30 PRIOR eat Pump 4.00 UILDING VALUE 125,11 Ir Conditioning Type - 03 BXF VALUE 2,50 ntral 4.0 AND VALUE 96,39 rooms/Bathrooms/Half-Bathrooms RESENT USE VALUE /1/1 11.00 EFERRED VALUE drooms rOTAL VALUE 224,000 S-1FUS -2LL-0 throoms +- 14-+---26---+ +FOP14 I AS-IFUS -0LL-O IFBM I alf-Bathrooms I 2 BAS - 0 FUS - 1 LL - 0 2 8 PERMIT ffice 4 I CODE I DATE I NOTE I NUMBER AMOUNT BAS -0FUS-0 LL -0 0 1 1 +-----40------+ +-----40------+ OTAL POINT VALUE 103.00 I F U S 1 OUT: WTRSHD: BUILDING ADJUSTMENTS 1 1 SALES DATA Size 3 Size 0.990 2 2 FF. INDICATE ha Desl 4 FACTOR 4 1.050 +- 15 - + - - - - - 40 - - - - - - + + - - - - - 40 - - - - - - + RECORD ATE DEED SALES uall 3 AVG 1.000 I F E P IBA 5 I I I I BOOKPAGE R TYPE / / PRICE TOTAL ADJUSTMENT FACTOR 1.04 1 1 1 0105 256 17 1197M WD X I TOTAL QUALITY INDEX 10 2 2 2 8 8 8 I I I I I I 1-15-+-15-+---25---+ HEATED AREA 3,084 - OWDD +FOP15 +---30----+ rNOTES OUSE & 13.558 AC TO KOONTZ JUDY ANN SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR. TYPE GS AREA I % IRPLCS ODE DESCRIPTION LTH H UNIT PRICE COND BLDG L B AYB EYB RATE VR COND VALUE AS 1.12 1001 83888 4 HED 70 20 1,400 5.10 30 _ L 197 1996 5 1 1071 FBM 1,0641 04 3587 1 RAIN BIN 0 0 3,000 1.50 30 _ L 197 1976 S 0 1 42 07 22021 1 RAIN BIN 3 00 1.5 10 L 197 197 S EP TOTAL OB XF VALUE 1,071 OP 14 03 382 S 48 09 3235 21 02 314 4 - 2 Story Single/1 Story EPLACE 2 80Double AREA 3,44 183,90 ALDING DIMENSIONS BAS=W40 FEP-WISS28 WDD=SIOE3ON4W15N6W15$ EIS FOP=S6E15N6W15$ N28$ S28E4ON28$ PTR -E60 FUS=N12W4OS12E40$ W60$ PTR=N40 =W26FOP=S4W34N4EI4 S4W14S24E4ON28 S40 . [DD O INFORMATION HEST THER ADJUSTMENTS LAND TOTAL BEST USE LOCAL FRON DEPTH / LND COND ND NOTES ROA UNIT LAND LINT TOTAL ADJUSTED LAND LAND CODE ZONING TAGE DEPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADIST UNIT PRICE VALUE NOTES ALAC 0120 750 0 1.0000 4 0.5600 +O1 -05 +00 -10 -30 RG 6,700.0 20.88 AC 0.56 3,752.0 783 FLD AL MARKET LAND DATA 20.88 78 36AL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=K200000040 6/18/2013