212 Hawks Ridge Dr 40 I,
Davie County Health Department
NV4 18 1 onnlental Iealth Section
® P.O. Box 848
c� P
P�
210 Hos pital strcct ® `
Courier# : 09--10-06
E� V1ocl:svillc, NC 27028P"
Mimic:(336)-7.'3-6780 ��( 'Bi% Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Recon 19 3
Name: Thomas and Nancy Riden Phone Number (336) 940-6780 (Home)
Mailing Address: 212 Hawks Ridge Drive (Work)
Advance, NC 27006
Ark 1 c D2s�cU s 33 "71'
7_�3 30
Detailed Directions To Site: From US-64 take 801 N approx. 7 miles then turn left onto Peoples
1 Creek Rd. Take Peoples Creek Rd- for approx. 1 mile turn right onto Marchmont Dr turn
left onto Hwaks Ridge Drive 0/�r��r),. Ill �1, .51 Aa
Property Address:
212 Hawks Ridge Drive, Advance, NC 27006 (Jct( c�(� `fit
iJ,(ja,110 AD - - D
Plcasc'Fill In The Following Information About The EXISTING Facility: a 6+C'X %
Name System Installed Under: Type Of Facility: Home
Date System Installed(Month/Date/Year): 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 NElh Facility:
Type Of Facility: Pool and Bathhouse Number Of Bedrooms: 0 Number of People 0
792 sq ft Bathhouse 97 sq ft
Pool Size: e Size: Other:
Requested By: Date Requested: ti-14-1-1,?
(Signature)
For Environmental Health Office Use Only
Approved i Disapproved
f /
Comments:: 6 mo n 0( G J lest- /c< GrQA2 41—An--Z,
Environmental Health Specialist J d Date: /T��Z
'The signing of this fonn 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 # '?,t-{l�(�a Amount:$ 1QD Date: (1 1 a`
Paid By: VV
Q ,- 1 L bL1-6 (Q„S Received By:
Account#: V Invoice#:
p� DAVI&OUNTY HEALTH DEPARTMEI �J�A
j ; IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued 1n Compliance with G.S. of North Carolina Chapter 130 Article 1.3c !
Sewage Treatment and Disposal Rules (10 NC�C 10A 1934-.1968) Permit Number
Date N0
Name �• ��✓!�/Od n �� E-
_� 11✓ _ -
Location . /�l�.vV / <� — ,�to��;.�r'r � ✓ �irs:a 'V_/i��"V '/f'G'S
6rIy ✓- 'i/ Th owdw cql� -m\jks R0lir: Nc meq,-1 Q-3Sq r
%�fI�C{�yrio�7� �C� IG� ��c t�0ooaf I �W
Subdivision Name Lot No. Sec. or Block No.
i rP
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths ' No. in Family
Garbage Disposal YES NO p Specifications for System:
Auto Dish Washer YES NO ❑ ,��;; Wit'
Auto Wash Machine YES NO p ✓�UlJ�<t�'ll� ���,f'Tx/�
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
CDP
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 _Ze�
I
(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.
•1 ' , • mo
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT tt��
Davie County Health Department �`V'0V
Environmental Health Section R�f,
P. 0. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN
TISSUED.
Home Phone
1. Permit Recj4epted By 067 %4 D Business Phone
2. Address s d Q
3. Property Owner if Differerit than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption
c) Sub-Division MA rchmon+ IQ('re,5ec. Lot No.
5. System used to serve what type facility: House -"'Mobile Home Business
Industry Other
b) Number of people '5-
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions 3A X 7 oZ
Bed RoomsBath 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 " 57, urinals garbage disposal
lavatory showers washing machine
dishwasher sinks
8. a) Type water supply: Public-'� 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 =fknowledge.
Date wn Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE ITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
by r Z5J,c
fo 7l10r0h o-1C't'+ P0,no, til vh d-evd1r,O'r,.Pn+ — 90 f47r0Le /L date..
T le 1 e,- t r, 7— �- �' _ jc o y`o 9 o S firte, g 1, r
P1 It, 4-Ar
�1
lD
DCHD(6-62) \
DAVIE COUNTY HEALTH DEPARTMEN
ENVIRONMENTAL HEALTH SECTION
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST*BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
` Health Section, R O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY:Chli4r Morckrwor# DATE RECEIVED
1t part — 3 St o n d o t'—9 o td end o4*his (office use only)
sfrrt+ - "7trn hi' n'to ejJS
C--y�esno 1. 1 am the owner of the above described property.
yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. 1 hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system.
3 . a a J41L -
DATE 16 Nefi RE
4. 1 hereby authorize the Davie County Health Department to release site
evaluation results from the above described property to the following:
— Owner only
Owners designated representative
_>[nyone requesting results
Only those listed below
DATE S 11�M RE 611
DCHD(11/84)
DAVIE COUNTY HEALTH DEPARTMENT;
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S S
PS PS � US
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) S -Z PS PS
3) Soil Structure (12-36 in.) S S S S
Clayey Soils PS PS PS PS
U
4) Soil Depth (inches) S S S S
S PS S PS
U
5) Soil Drainage: Internal S S S S
Pill PS �S PS
op U
External S S S
PS
U U U U
6) Restrictive Horizons
7) Available Space CP S
PS PS fS PS
U U U U
8) Other (Specify) / �� S S S S
D> �C PS PS PS PS
U U U
9) Site Classification - -
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by �� Title 22!✓ Date
SITE DIAGRAM 'c
DCHD(6.82)
Appraisal Card • Page 1 of 1
DAVIE COUNTY NC 11/2/2012 8:35:00 AM
RIDEN THOMAS K RIDEN NANCY L Return/Appeal Notes: G9-000-00-011
212 HAWKS RIDGE DR UNIQ ID 11996
1304000 D408-PIO ID NO:5890103547
COUNTY TAX,FIRE TAX CARD NO.1 of 1
Reval Year:2009 Tax Year:2013 45.10 AC OFF PEOPLES CRK MARCHMONT 45.110 AC SRC=Owner
Appraised by 19 on 10/06/2008 07203 MARCHMONT TW-07 C- EX-AT- LAST ACTION 20100922
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE
Foundation-3 1 Standard 0.2100
ontinuous Footing 5.00 Eff. BASE
ub Floor System-4 USE MO Area UA RATE RCN EYB AYB CREDENCE TO MARKET
PI wood 8.0 01 01 14,6791143 98.67 6437719881988 %GOOD 79.0 DEPR.BUILDING VALUE-CARD 366,860
Exterior Walls-10 TYPE:Single Family Residential Single Family Residential DEPR.OB/XF VALUE-CARD 4,74
luminum/Vin I Siding 0.00 MARKET LAND VALUE-CARD 632,49
Exterior Walls-21 STORIES:3-2.0 Stories TOTAL MARKET VALUE-CARD 1,004,09
Face Brick 31.00
Roofing Structure-03
Gable 8.00 OTAL APPRAISED VALUE-CARD 1,004,09
Roofing Cover-03 OTAL APPRAISED VALUE-PARCEL 1,004,09
Asphalt or Composition Shingle 3.0
Interior Wall Construction-5 TOTAL PRESENT USE VALUE-PARCEL 424,50
D wall/Sheetrock 26.00 TOTAL VALUE DEFERRED-PARCEL 579,59
Interior Wall Construction-6 OTAL TAXABLE VALUE-PARCEL 424,500
Custom Interior 0.0
PRIOR
Interior Floor Cover-12
Hardwood 10.0 BUILDING VALUE 347,03
BXF VALUE
Interior Floor Cover-14
Carpet 0.0 LAND VALUE 527,75
PRESENT USE VALUE 52,90
Heating Fuel-04 DEFERRED VALUE 474,85
Electric 1.00 OTAL VALUE 874,780
Heating Type-10
Heat Pump 4.0
it Conditioning Type-03 '
entral 4.00 PERMIT
Bedrooms/Bathrooms/Half-Bathrooms CODE I DATE I NOTE I NUMBER AMOUNT
5/4/1 19.00
Bedrooms
BAS-1 FUS-4 LL-0 +----5 2-----+ ROUT:WTRSHD:
Bathrooms I F U S I 3 3 - FF. INDICATE
SALES DATA
BAS-1 FUS-2 LL-1 2 2 RECORD DATE DEED SALES
Half-Bathrooms I I
BAS-1 FUS-0 LL-0 +----S2-----+ BOOK PAGE MO R TYPE /U / PRICE
OTAL POINT VALUE 119.00 0124 313 9 198 WD Q V 15350
BUILDING ADJUSTMENTS +----52-----+ +-20-+----50----+ 0195 348 6 199 WD U I 56000
uali 4 ABAVG 1.200 +20-+ 6 I F B M I U B M I 124- 313 9 198 W D U V 10000
ISAS +18-+ 2 2 I
ha a/Desi n 4 FACTOR 4 1.050 2 I W D D I 4 8 3
ize 1 3 1 Size 0.9500 4 2 2 I I 2
OTAL ADJUSTMENT FACTOR 1.200 1 3 3 +-20-+ I
OTAL QUALITY INDEX 143 120-+1 +15+17-+18-+ +----5 0----- HEATED AREA 4,568
6WDD 2 8FOP
+-22-+18-+ NOTES
OWNER NEW SURVEY 1986
.71 AC TO DAVID POWELL
5.59 AC TO HARVEY YOUNG
15.64 AC TO JOHN BUFORD
SUBAREA UNIT I ORI.% ANN DEP % OB/XF DEPR.
TYPE GS AREA % RPL CS CODE DESCRIPTION LTH HUNIT PRICE COND BLDG#L/8 AYB EYB RATE V COND VALUE
BAS 21360 100 23286155 AZEBO 1 1 100 16.0 10 _ L 199 1994 S3 5 88
FBM 54 04 24174 09 SP PAVING 51 1 5 15 3.0 10 L 1994199 S 2 3863
FOP 60 03 2072 OTAL OB/XF VALUE - 4,743
FUS 1,66 090 14780
UAT . 832 010 819
UBM 1,60 020 31574
DO 75810201 1499
FIREPLACE 3-J.Story 2,70
Single
SUBAREA 7,81 64,37
OTALS
BUILDING DIMENSIONS BAS=W52S4W2OS24E20WDD=W2OS16E22N12W2N4$S4E2S 12E18N8FOP=E15N4W15S4$N4E32N3WDD=E18N23W18S23$N29
$PTR=NIOFUS=N32W52S32E52$S10$UAT=832$PTR=E35 FBM=E20N4E2UBM=E5OS32WSON32$S32W2N4W2ON24$W35$.
LAND INFORMATION
HIGHEST THER ADJUSTMENTS TOTAL
AND BEST USE LOCAL FRON DEPTH/ LND COND AND NOTES ROA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND
USE CODE ZONING TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TY P ADJST UNIT PRICE VALUE NOTES
FR RIVER 0113 500 0 0.8660 4 1 0.9000-05+20+25-10-40 PW 18,000.00 45.10 AC 0.77 14,022.00 63249 SIZE
NH/FL
OTAL MARKET LAND DATA 45.107 632,49
RL HOMSITE 5000 0 0 1.0000 5 2.2500 18,000.0 1.00 AC 2.25 40 500.00 405001100
GRI 5110 0 0 1.0000 5 1.0000 705.0 2.649 AC 1.000 705.00 186
GRI II 5210 0 0 1.0000 5 1.0000 480.0 7.23 AC 1.000 480.00 3474
GRI III 5310 0 0 1.0000 5 1.0000 310.0 17.309 AC 1.000 310.00 536
GRI IV 5410 0 0 1.0000 5 1.0000 40.0 9.395 AC 1.00 40.00 37
GRI IV 5410 0 0 1.0000 5 1.0000 40.0 2.023 AC 1.00 40.00 81
FRSTI 6110 0 0 1.0000 5 1.0000 225.0 5.493 AC 1.000 225.00 123
OTAL PRESENT USE DATA 45.107 52,90
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=G900000011 11/2/2012
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