525 Mr Henry Rd . -a � DAVIE COUNTY ENVIRONMENTAL HEALTH
� � P.O.Box 848/210 Hospital Street
Mocksville, NC 27028
. (336)753-6780/Fax# (336)753-1680
REPAIR OPERATION PERMIT
A�cou�t #: 990006172 � Tax Pi�€:�H#: k3-000-00-007
Sifle�T�: Lee Wiiliams Su�a�ivi�iar� lnfa: ,
Refer�r�ce P�an��: RepairPermit OP LocaiioniAd+�r�ss: 525 Mr. Henry Road-27028
Propc�sgc9 F;��:ility: Residential Repair Pro��►�y S�ize: 2.82 Ac
t�TC hlut�ber: 6061
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 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. s..�.g-��
System Type: S.T.Manufacturer J��'10U Tank Date �� ?✓'� Tank Size �IOOb
Pump Tank Size N q Be�rooms 2
System Installed By:�QYIdU M�IILY Installer#: Date: a I�I I
GPS Coordinate: ,
�E Sy5�4CW1. YlO�I'
Complc-�c� t�ltie.v�
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fi�'R-;c1 E— Mr. �eanr-
Environmental Hea]th Specialist: Date: 3 �
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DCHD 11/06 (Revised) � I N������ I����
, � � , ' DAVIE COUNTY ENVIRONMENTAL HEALTH
• . P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
REPAIR IMPROVEMENT PERMIT '
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �
�ccc�u�t #�: 990006172 �"ax F�i�€iEH#: k3-000-00-007
Billcd 70: Lee Williams Su��ivi�iari 1���:
:_ .-----.
ReFer�nce Na��e: � � LocalioniAddr�ss: 525 Mr. Henry Road-27028
Proposed �aci€ity: Residential Repair P�oper#y S�iz�: 2.82 Ac
ATC Number: 6061 Site Type: ❑New BRepair ❑Expansion
**NOTE**This IP/Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS IP/AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FNE YEARS. This ATC is subject to revocation if site plans,plat
or the intended use change.
Residential Specificatious: #Bedrdoms � #Bathrooms�#People� Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lot Size�� Type of Water Supply: ❑County/City f8We11 ❑Community Well
1 1 °Q� Ne�
System Specitications: Design Wastewater Flow(GPD)o�1{v Tank Size ! GAL.Pump Tank�GAL.
`` a c 8'��
Trench Width 3 lt Max.Trench Depth 3(e Rock Depth�,��Linear Ft.
Site Modifications/Conditions/Other: � - � a�'�Rrc�u-l��YI
�+^.--
Contact the Davie County Environmental Health Section for tinal inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 753-6780.
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Environmental Heal�,h Specialist Date: �^� ��l�
DCHD 11/06(Revised)
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D'avie CdVNTY
210 Hospital Street
P.O. Box 848
Mocksville NC 27028 TEL: 336-753-6780 Fp,X; 336-753-1680 Request ID: 45583
REQUEST FOR SERVICE/COMPLAINT INVESTIGATION REPORT
xEQUEST DATE: O1/27/2014 TAREN BY: Bonnie
SECTION: NIA TYPE:
PROPERTY NLJt�ER: 124978 ASSZGNED TO: Nations, Robert
ESTABLISFIMENT NUMBER:
PERSON OR PREMISES TO SEE: OWNER: Lee Williams
Lee Williams 525 Mr. Henry Rd
525 Mr. Henry Road Mocksville , 27028
Mocksville NC, 27028
(336) 492-7461
REQUESTED BY: HOME:
WORFC:
Cell:
CONDiTION REPORTEn:Page pumped, not been working right for a while. Home made tank. Surfacing.
COA4�NTS:
RECORD OF INVESTIGATION
DATE: HR/MT: CODII�NTS
EAS:
EHS #:
ACT CODE:
DATE: HR/MT: COM[��NTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMl�NTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMt�NTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMt�NTS
EHS:
EHS #:
ACT CODE:
Next Inspection Date: Status o£ Complaint: OPEN Resolved Date:
Complaintant Contacted: NO
� � a�-�� ��� 11 � x�
' , ' . DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
. . ,
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) .
NAME ' '�. P W I I I 1 �Y1�1� PHONE NUMBER ��Z� ` ���
ADDRESS___;)�� /�'��Gl��f/I/ SUBDIVISION NAME �
� LOT #
DIRECTIONS TO SITE /�L �/9"5-C �:./�/1/�111�/C�S�!l � (�'re�n h/ �� Il,(i� • �I�/Cf �l'�
7"G��n/ ' -� : IL�1��1�10� iV���. !'j'l� D N �C� .�
. 1,' 1
DATE SYSTEM INSTALLED � NAME SYSTEM INSTALLED UNDER W l II i�vVl�
TYPE FACILITY l.�S�S NUMBER BEDROOMS NUMBER PEOPLE SERVED �
TYPE WATER SUPPLY ��iG� SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION TAKEN BY
This is to cartify that the information provided is correct to the bast of my knowledge,and that I understand I em nsponsible for all charges incuned from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Hev.1/93
Appraisal�Casd Page 1 of 1
DAV2E tOl37TY'NC � 1/27/2014 10:37:19 AM
ILLIAMS)OHN LEE WILLIAMS MAMIE SUE P Re[urn/Appeal Notes: Parcel:K3-000-00-007
525 MR NENRY RD PLAT:/UNIQ ID 20161
9532000 D72-P24 ID N0:5716692611 �
COUNTY TAX(100),FIRE TAX(100) Elderly Exemp[ CARD NO.1 of 1 -
Reval Year:2013 Tax Year:2014 2.82 AC MR HENRY RD 2.870 AC SRC=Owner
raised b 02 on 04/21/2008 01003 DAVIE ACADEMY TW-01 CI• FR-13 EX- AT- LAST ACiION 20120919
CONSTRUCTION DETAIL MARKET VALUE DECRECIARON CORRELATION OF VALUE
Foundatlon-3 Standard 0.3300
ontinuous Foo[in S.0 Eff. BASE
ub Floor Sys[em-4 USE MOD Area UA RATE RCN EYB AYB REDENCE TO MARKET _
PI wood 8.0 Ol Ol 1 228 303 72.10 90789 1980 1960 %GOOD 67.0 DEPR.BUILDING VAIUE-CARD 60 83
xterior Walls-10 TYpE:Single Family Residential Single Family Residential DEPR.OB/XF VALUE-CARD 6,42 -
IuminumNin I Sidin 29.0 MARKET LAND VALUE-CARD 32,18 �
oofing Struc[ure-04 SNLE:1-1.0 S[ory O7AL MARKET VALUE-CARD 99,43
i 10.0
oofing Cover-03
s hal[or Com sition Shin le 3.0 OTAL APVRAiSED VALUE-CARD 99,43
n[erior Wall Construction-5 OTAL APPRAISED VALUE-PARCEL 99,43
wall/Sheetrock 20.0
nterior Floor Cover-08
heet Vin I/Laminate 6.0 OTAL PRESENT USE VALUE-PARCEL
nterior Floor Cover-14 � OTAL VALUE DEFERRED-PARCEL
ar et 0.0 O7AL TAXABLE VALUE-PARCEL 99,43
+-----16-----+----16-----+
Heating Fuel-03 I g p 5 I F O P I
PRIOR
as 1.0 I I I UILDING VA�UE 62,36
Hea[ing Type-02 t I I BXF VALUE 7,21
Baseboard Heat 3.0 = 1 1 LAND VALUE 31,21
ir Conditioning Type-02 I 4 4
all Uni[ 1.0 I I I PRESENT USE VALUE
I I I DEFERRED VALUE
BeCrooms/Bathrooms/Half-Bathrooms I I I OTAL VALUE S00 78
/1/0 7.00 I +----16-----+
Bedrooms I I
BAS-2FU5-OLL-O I I
Bathroom5 I I _
BAS-1 FUS-0 LL-0 4 I
2 I PERMIT -.
Half-Ba[hrooms I I CODE DATE NOTE NUMBER AMOUNT
BAS-OFUS-OLL-O I I
�ce I 2 "
BAS-0 FUS-0 LL-0 I 8 ROUT:WTRSHD:
OTAL POINT VALUE 3.00 I I SALES DATA c
BUILDING AD7USTMENTS I I FF• INDICATE �'
ize 3 Size 1.060 I I RECORD DATE DEED SALES `�
uaii 3 AVG 1.000 I I BOOK PAGE M R TYPE /U / PRSCE c
ha e/Dest 4 FACTOR4 1.050 I I 0066 503 6 196 WD X I ::
I I �
OTA�ADJUSTMENTFACTOR 1.11 +--10---+---12---+--30---+ "
OTAL QUALITY INDEX 10 I F O P I
I I
7 7 NEATED AREA 1,120
I I
+---12---+ NOTES
10-OBxF-NV
SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR.
RVL ODEDESCRIPTIONCOUN LTH THUNIT VRSCE COND BLDGftAYBEVB RATE OV COND VALU
TYVE GS AREA % CS D8 MH SITE 0 0 1 4,500.00 300 _ 199 1999 SO 100 450
BAS 1 12 100 80752 4 HED 1 30 450 5.10 100 _ 198 1999 SS 30 68
FOP 30 035 7�8 24 HED 1 12 5.1 10 _ 199 199 S 3 184
3-I Story 1 TORAGE 1 12 12 15.0 10 199 199 53 5 3044
FIREPLACE Sin le Z'ZS OTAL OB XF VALUE 6 417
UBAREA 1,42 90,78
OTALS
BUILDING DIMENSIONS FOP=W16BA5=W16542EIOFOP=57E12N7W12$E22N28W16N14 514E16N14 .
LANDINFORMATION
HIGHEST TXER AD7USTMENTS LAND TOTAL
ND BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES ROA UNIT LAND UNT TOTAL AD)USTED LAND OVERRIDE IAND
SE CODE 20NING TAGE DEVTH SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TVP A0)5T UNIT PRICE VALUE VALUE NOTES
RURALAC 0120 600 0 1.5230 4 1.1000+10+00+00+00+00 RP 6 700.0 2.86 AC 1.67 11 222.5 3217
OTAL MARKET LAND DATA 2.86 32,18
OTAL PRESENT USE DATA
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http://maps.co.davie.nc.us/ITSNetlAppraisalCard.aspx?parce1=K300000007 1/27/2014
. �
•Davie EOUNTY
230 Hospital Street
P.O. Box 848
Mocksville NC 27028 TEL: 336-753-6780 FAX: 336-753-1680 Request In: 46361
REQUEST FOR SERVICE/COMPLAINT INVESTIGATION REPORT
REQUEST DATE: 02/2Fi/2014 TAREN SY:
SECTION: N/A TYPE:
PROPERTY NUtIDER: 136577 ASSIGNED TO: Nations, Robert
ESTABLISF�NT NUMSER:
PERSON OR PREMiSES TO SEE: OWNER: Lee dnd Kim WillidmS
Lee and Kim Williams 2505 Farmington Rd
2505 Farmington Rd Mocksville , 27028
Mocksville NC, 27028
(336) 998-7393
REQUESTED BY: Lee Williams HOME:
WORK:
Cell:
CONDITiON REPORTED:Sewage surfacing
COA4�SENTS:
RECORD OF INVESTIGATION
DATE: EiR/MT: COhd�NTS
EHS:
EHS #:
ACT CODE:
DATE: AR/MT: CONd�NTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COA4�NTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: CONR�NTS
EHS:
EHS #:
ACT CODE:
DATE: HR/MT: COMr�NTS
EHS:
EHS #:
ACT CODE:
Next Inspection Date: Status of Complaint: OPEN Resolved Date:
Complaintant Contacted: NO
• �Aprraisal Card Page 1 of 1
, ,
DAVIE COUNTY NC 2 28 2014 1:29:08 PM
ILLIAMS BERNIE RAY . Re[urn/AppealNotes: Parcel;BS-000-00-085
505 FARMINGTON RD- PLAT:/ UNIQ ID 851
79099750 D81-P31 ID NO:5843757817
COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1
Reval Year:2013 Tax Year:2014 1.91 AC FARMINGTON RD 1.930 AC SRC=Inspectlon
raised b 02 on 03/12/2007 03006 SPILLMAN RD TW-03 Ci- FR-OB EX- AT- LAST ACTION 20110725
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE
Foundation-3 Standard 0.60000
ontinuous Footin 5.0 EH. BASE _
ub Floor System-4 USE MO Area UA RATE RCN EYB AYB REDENCE TO MARKET :
I ood 8.0 Ol Ol 1 180 118 82.60 9971719531933 %GOOD 40.0 DEPR.BUILDING VALUE-CARD 39 89
Exterlor Walls-10 7YpE:Single Family Resldential Single Family Residential DEPR.OB/XF VALUE-CARD 70
Iuminum/Vin I Sidin 29.0 MARKET LAND VALUE-CARD 35,57 -
oofing Structure-03 STYIE:1-1.0 Story OTAL MARKET VALUE-CARD 76,16 ��
able B.0
Roofing Cover-03 •
s hal[or Com si[lon Shin le 3.0 OTAL APPRAISED VALUE-CARD 76,16
n[erlor Wall Construction-5 OTAL APPRAISED VALUE-VARCEL 76,16 �
D wall/Sheetrock 20.0
nterior Floor Cover-08
hee[Vin 1/Lamina[e 6.0 OTAL VRESENT USE VALUE-PARCEL
nterior Floor Cover-14 OTAL VALUE DEFERRED-PARCEL
et 0.0 OTALTAXABLEVALUE-PARCEL 76,16
}"-"-'-----'32""'------'-'+'6"+
Heating Fuel-04 I F S P I F E P I PRIOR
Elec[rit 1.0 I I 2
eating Type-10 g 8 I BUILDING VALUE 43,26
ea[Pum q,p I I I BXF VALUE 84
ir Condi[ioning Type-03 I I I LAND VALUE 33,47
entrat q.p +-------------32--------------+ I PRESENTUSEVALUE
I B A S I 2 DEFERRED VALUE
Bedrooms/Ba[hrooms/Half-Ba[hrooms I I 0 OTAL VALUE 77 57
3/2/0 12.00 I I I
Bedrooms I 1 I
BAS-3FU5-OLL-O I Z I
throoms I I I
I I I
BAS-2 FUS-0 LL-0 I I I PERMIT
Half-Bathrooms I +-6--+2+ CODE DATE NOTE NUMBER AMOUNT
BAS-OFUS-OLL-O 2 I
ffice $ 6
I I ROUT:WTRSHD:
OTAL POINT VALUE 100.00 I + -8 -+ SALES DATA
I I FF• INDICATE
BUILDING AD]USTMENTS I I ',
uali 3 AVG 1.000 I � 1 RECORD DATE DEED SALES �;
ha e Desi 4 FACTOR 4 1.050 I 0 BOOK PAGE M R TVPE /U / PRICE �%
fze 3 Size 1.120 I I 0152 773 2 199 WD X V
I I �
;,
OTALADJUSTMENTFACTOR 1.18 +-4-+---------24----------+-4-+ co
OTAL QUAU7Y INDE% I1 I F O P I �'
I I
6 6 HEATED AREA 1,064
I I NOTES
.F""""'Zq""""""+
FROM ADDIE WILLiAMS
SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR.
Rp� ODE DESCRIPTION OUN LTH MUNIT �RICE COND BLDG#AYB EYB RATE V COND VALUE
TYPE GS AREA Mo CS 1 TORAGE 1 8 15.0 10 199 1999 S 5 69
BAS 94 10 7797 OTAL OB XF VALUE 69
EP 12 07 693
FOP 14 03 413
SP 25 04 842 .
FIREPLACE 3-1 Story �25
Sin �e
UBAREA 1,4 99,71
OTAlS
BUILDING DIMENSIONS FEP=W6FSP=W32588A5=528E4FOP=56E24N6W24 E28NIOE8N6WSN12W32$E32N8$520E6N20 .
LANDINFORMATION
IGMEST THERADJUSTMENTS LAND TOTAL
ND BEST USE LOCAL FRON DEMH/ LND COND ND NOTES ROA UNIT LAND UNT TOTAL AD]USTED LAND OVERRSDE LAND
SE CODE 20NING TA6E DEPTH SIZE MOD FACT RF AC LC TO OT TYVE PRICE UNITS TYP ADJST UNIT PRICE VALUE VALUE NOTES
RURAL AC 0120 330 0 1.7770 4 1.2200+10+12+00+00+00 pyy 8,500.0 1.93 AC 2.16 18,428.0 3556
OTAL MARKET LAND DATA 1.93 35,57
OTAL PRESENT USE DATA �
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http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parce1=B500000085 2/28/2014