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111 Log Cabin Rd: HEALTH DEPARTMENT RELEASE Ty Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 PhoneZ53-6780 Fax: 336-753-1680 Tim Moss & Ssfis Home Address: 7800 Airport Center Dr. Suite City: Greensboro State2ip: NC Phone #: Address 111 Log Cabin Rd Road# Mocksville NC 27028 'Structure: SINGLE FAMILY *of Bedrooms: 3 'Water Supply: WA Basement: n Yes ❑ No 'Proposed Improvement: addition expand bedroom # of People: 4 27409 r For Office Use Ont *CDP File Number 120169 -1 E10000001205 County ID Number: Evaluated For: HDR/WWC PERMIT VAUD 0 2/ 1 4/ 2 0 1 8 UNTIL: Property Owner_ Donald L Shaw Addre s.. 111 log Cabin Road City: Mocksvilkire: State2ip: NC 27028 —1 one M Property Location & Site Information Subdivision: Phase: Lot Township: Directions Hwy 64 West right on Sheffield Rd. Right On Turkey foot rd. Right on Log Cabin Rd. 1st, house on left. Type of Business: Total sq. Footage: No. Of Employees: It is the responsibility of the owner to maintain a 5' 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? OYes (DNo Applicant/Legal Reps. Signature: *Date: / / *Issued By: 2244- Daywalt, Andrew *Date of Issue:. 0 a / 1 4 / a 0 1 3 Authorized State Agent: **Site Plan/Drawing attached.** Total Time:(HH:MM) 0 1 Hours Minutes S Hand Drawing OlmportDrawing t` V f 3 ,> �; {•:; � t Davie --County Health Department 10 ?'1836.' Environmental Health Section . �. P.O. Box 848 210 Hospital Street O U �'�"' Courier # : 09-40-06 1911 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATE FICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection' Name: --rim 10i f r f" J 4rhL 1A d fr 1„ Phone Number (o51 (Home) Mailing Address: d u• �� VG //u 7 7 t�1 GI - �� % (Work) /bay -7 , L /O q Email Address: AoQ241 v a_6'%d <_ -S f Q< I �0-0 _ c�'o1yj Detailed Directions To Property Address: i Please Fill In The Following rmation Abodi^The EXISTING Facility: Name System Installed Under: Type Of Facility: Date System Installed (Month/Date/Year): (� / 7 Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes If Yes, For How Long? Any Known Problems? Yes 1T If Yes, Explain: Please Fill In The Following Information About The NEWFacility: -�� ' 1?�J 1p�t 1 t Oy 0( --00 /;N.S Type Of Facility: 4/Tddi k 01 l .413U `GDM Number Of Bedrooms:___y Number of People Pool Size: MIA Garage Size: 2Y �K Z r� � Other: Requested By: %�1%f' Date Requested: S�� /3 (Signature) For. Environmental Health Office Use Only Approved Disapproved omments: Environmental Health SpecialistKAXAC/1VWQWDate: / 3 17 *The signing of this form by the Environmental Health `Staf s 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: Paid By:_ S' Order # Amount:$ Received By: Account #: 1til0 %9 Invoice 0160 ----------------- I 744' 153' 7.8 ac +/- ,/ 4b / / i E&L i / \ I / — — /I - / ' EQSr oma MST CW oar eat onr. 601 11414, oot 60, Tim Shaw* ` 111 Log Cabin Rd. Scale V v 100' Sheffield Township Davie County Health Department '40 P61' Environmental Health Section , P.O. Box 848 C� s„ 210 Hospital Street j O U 't Courier # : 09-40-06 1911 Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection I Name: ( m S hi nj Phone Number �j , S f S 1C (0 (Home) Mailing Address: 1 l-•'6 (Work) L CSv� t VL 2, -no -Li Email Address: Detailed Directions To Site: L ole J Property Address Please Fill In The Following Information About The EXISTING Facility: R Name System Installed Under: Type Of Facility: RIWS-C Date System Installed (Month/Date/Year): Number Of Bedrooms: 3 Number Of People: 3 Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any Known Problems? (S No If Yes, Explain: N��5 pyrt\PthG Q,�ry Cb\ip u-tcll'S Please Fill In The Following Information About The NEW Facility: Type Of Facility: � 4 c(", yy\ C2 q YA c,Q . �Tk Number Of Bedrooms: Number of People 13 Pool Size: Garage Size: Other: ��11 Requested By: 1 V" j k.fw Date Requested: oc' �� )3 CE For Environmental Health Office Use Only Epprov�edisapproved Comments: Environmental Health Specialist *The signing of this form by the Environmental Health Date: 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:$ Date: Paid By Received By: Account #: Invoice #: i rip \C "D �°l ll 0 f r w nl, CoAD" NO TAXABLE CONSIDERATION STATED Tax Lot No. Verified by by................ Excise Tax 0 421 I1 ra.sD role R[d�/n�AnON March 15, 1994 10:05 A.M. DATr_ �n,m7e� ��•7 AND r ="A09D IN DDDKIZ. PA0110 ew ws, Rztemu or urns DAVia CDutm NC 'Assistant Recording Time, Book and Page .............................................................................. Parcel Identifier No.... .......................................................... County on the ................ day of .... .......................................................................................................................... ................................... 19............ Mall after recording to .............................................. .................................................................................................................................................................................................................................... This instrument was prepared by .....George--W.-,Martin/..,A[tozney„at„Law,„Mocicayillea„NC/File No, 6.$40,,x„ Brief description for the Index 8.740 acres, more or less NORTH CAROLINA GENERAL WARRANTY DEED THIS DEED made this ...1.4 .. day of ...............March................................... 19...94...... by and between GRANTOR ALMA B. RICHARDSON (widow) GRANTEE TIMOTHY LEE SHAW Enter is appropriate block for each party: name, address, and, R appropriate, character of entity, e.q. corporation or partnership. The designation Grantor and Grantee as used herein shall Include said parties, their heirs, successors, and assigns, and shall include. singular, plural, masculine, feminine or neuter as required by context. WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in the City of ................... CL ARKSVILLE,................... Township, ..................... DAVIE.................. County, North Carolina and more particularly described as follows: SEE ATTACHED EXHIBIT "A” FOR PROPERTY DESCRIPTION. N. C. ear A— F—, No. 7 0 1976, Rewind 0 1977 - y...,,xn;,re • Ce. „•, er. ,n, vr.i..+w.,• G Wase r..x.e w a..�.,.�.•.w. w. a w .... -,sn Appraisal ,Card DAVIE COUNTY, NC Page 1 of 1 2/6/2013 12:57:54 PM HAW DONALD LEE SHAW INGEBORG BELZL Retum/Appeal Notes: E3-000-00-012-05 111 LOG CABIN RD UNIQ ID 5704 693000 D9 -P9 ID NO: 5801271922 COUNTY TAX (100), FIRE TAX (100) GRD NO. I of I eval Year: 2013 Tax Year: 2013 8.74 AC LOG CABIN RD 8.000 AC SRC- Inspection Appraised by 01 on 04114/2008 02001 BEAR CREEK CHURCH TW -02 C- EX- AT- LAST ACTION 20120919 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE - 3 Standard 0.4000tinuous Footin BASE 5.0 RATE RCN EYB AYB REDENCE TO MARKET b Floor System - 4Flo g 73.50 157262197 197 % GOOD 60.0 EPR. BUILDING VALUE - GRD 94 36 [oundation erior Walls - 21 TYPE: Single Family Residential Single Family Residential EPR. OB/XF VALUE - GRDe Brick - 34.0 ARKET LAND VALUE - GRD 68,12fing Structure - 03STORIES: 5 - Ranch w/ basemen[ OTAL MARKET VALUE - GRD 162,48ble 8.0 oofing Cover - 03 ksphalt or Composition Shingle 3.00 TOTAL APPRAISED VALUE - GRD 162,48 nterior Wall Construction - 5 OTAL APPRAISED VALUE - PARCEL 162,48 all Sheetrock 20.0 nterior Floor Cover - 08 TOTAL PRESENT USE VALUE - PARCEL 113,81 heet Vinyl/Laminate 6.00 TOTAL VALUE DEFERRED - PARCEL 48,67 nterior Floor Cover - 14 TOTAL TAXABLE VALUE - PARCEL 113,81 et 0.0 eating Fuel - 02 PRIOR it Wood or Coal 0.0 UILDING VALUE 99,23 eating Type - 04 - BXF VALUE orced Air - Ducted 4.0 D VALUE 66,08 r Conditioning Type - 03 RESENT USE VALUE 17,77 ntral 4. EFERRED VALUE 48,31 drooms/Bathrooms/Half-Bathrooms OTAL VALUE 165,310 1/1 11.00 Brooms AS-3FUS -0 LL -0 throoms +------------------60.-------------.-.-+ PERMIT AS - 1 FUS - 0 LL - 0 I B A S I CODE DATE NOTE I NUMBER AMOUNT alf-Bathrooms I I AS- IFUS-O LL -O I I I I OUT: WTRSHD: OTAL POINT VALUE 1103.00 1 1 SALES DATA BUILDING ADJUSTMENTS I I§ECORD Quality 3 AVG 1.000 I IJATEDEED INDICATE SALES ha a Desi 4 FACTOR 4 1050 2 2 8TYPE PRICE ize 3 Size 0.970 WD U IOTAL ADJUSTMENT FACTOR _ 1.02 I I WD U 1 OTAL QUALITY INDEX 30 I - I I I I I I I +------24-------+--12 --------- 24........ HEATED AREA 1,740 SFOP 5 +--12- - + NOTES BXF-NV SUBAREA UNIT ORIG % SIZE ANN DEP % OB/XF DEPR TYPE S ARE %RPL CS OD UA ESCRIPTIO T NIT PRICE COND LDG L/ FACT Y EY RATE V GOND VALUE, AS 1,74 10 127891 TOTAL OB XF VALUE OP6 03 154 BM 1 74 02 2557 - 3 - 1 Story IREPLACE 2,25 Single UBAREA OTALS 3,54 157,26 UILDING DIMENSIONS BAS-W60S29E24FOP-SSE12NSW12 E36N29 UBM:1740 . ND INFORMATION IGHEST THER ADJUSTMENTS LAND TOTAL NO BEST USE LOCAL FRON DEPTH / LND CO.. ND NOTES OA UNIT LAND UNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGE EPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADM UNIT PRICE VALUE NOTES URAL AC 0120 1211 0 1.1880 4 1.0700 1+07+00 +00 +00 +00 RP 6,700.00 7.99 AC 1.271 8 515.7 6811 OTAL MARKET LAND DATA 7.99 68112 L HOMSITE 5000 0 0 1.0000 5 2.5000 6 700.0 1.00 AC 2.50 16,750.00 1675 GRI Ili 5310 0 0 1.0000 5 1.0000 385.0 6.99 AC 1 1.0001 385.00 269 OTAL PRESENT USE DATA 7.99iA 19,45( O http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E 10000001205 2/6/2013