441 Pineville Rd DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
' � Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
�ccou�t �: 990000706 T�x PI�€iEN#: b500000041
Billc,r� "fo: Grady McClamrock �i��ac�i�i:ior� I��c7:
Refer�E3ce f�ar�i�: REPAIR PERMIT LocationiA������s: 441 Pineville Road-27028
t�rc��c�s�;c9 F��w�i€ity: Residential Repair ��op�rty 5�iz�: 1:22 Acres
a�TC NuFnb�3: 5891 ,
**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.
System Type:�S.T.Manufacturer �Q �5 � Tank Date � Tank Size /
Pump Tank Size / Bedrooms
System Installed By:� ; 1I �� Inspector#: Date: r'("r�
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GPS Coordinate:
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Environmental Health Specialist: ,Vv � Date: IZ
DCHD 11/06(Revised)
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
�cco�a�t #: 990000706 '��x F�I�€;EH#: b500000041
�illcs�7c�: Grady McClamrock ,�U�t�1�JEa3G`tl I�3�t7:
Refere¢�c� �Iar���: REPAIR PERMIT Lac�lioniAd�3r�ss: 441 Pineville Road-27028
Prapc�sec� Fr��;iEity: Residential Repair �rn��rty �iz�: 1:22 Acres
Site Type:Repair(�Expansion()
a�T� t��arnb�i': 5891
**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 Specitications: #Bedrooms�#Bathrooms 2 #People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions ofFacility) •
Lot Size � 2 �L- Type of Water Supply: C�County/City OWell ❑Community Well
. ..
System Specifications: Design Wastewater Flow(GPD)�Tank SizeQ�CGS�n(GAL.Pump Tank � GAL.
�� �� U . ,
Trench Width 3� Max. Trench Depth�� Rock Depth�� Linear Ft. � �%
Site Modifications/Conditions/Other. �dU��h
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the da of iustallation. Tele hone# 336 753-6780. �
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'AUTH�RIZATION NO: � � '� a�1�DAVIE COUNTY HEALTH DEPARTMENT �" �'�'�� Y
Environmental Health Section PROPERTY INFORMATION
Permittee's � ' �1 �, j% P.O. Box 848
Name: �r'�f l %r'i1,->�T�.�_,, Mocksville,NC 27028 Subdivision Name:
,/� Phone# 336-751-8760
Directions to property: �f� ��y-^'_/ /� Section: Lot:
� AUTHORIZATION FOR R (
��,�� WASTEWATER Tax Office P1N:# "r'��Q�Q�Q�I
SYSTF.M CONSTRUCTION
'•ZZ f��/ Road Name: Zip:
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pem�its.This Form/Authorization Number should be presented to the Davie Counry Building Inspections
Office when applying for Building Permits.
(ln compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
� ,
;�/� , %�-�+ �� ,1' ���1,�� ***NOTICE***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION
'`��` '` ti ,�'` �� �d''t- IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALT PECIALIST DATE ISSUED
L-��' ~ � �� ."-� ' � � � �A DAVIE COUNTY HEALTH DEPARTMENT ��r �-��"� . • , ''
��,:"' == t�;� �,�"'`. ," TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
''- Perrfiittee'�' ;' � " � ,
� _...Name:'' �'" ' ; , �'.,° �`'� ,f � �' Subdivision Name: '
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, #Directions to property: � +-' �' ;�''� � %: Section: Lot:
�Ro��� ,�'�uu�ua
PERMIT Tax Of�ce PIN:# ��� �
'�2� ��/ Road Name: . Zip: .
**NOTE**This Impmvement Pemut DOES NOT authorize the construction or installation of a sepdc tank system or any wastewater system.An
YAiJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTTON must be obtained from this Department prior to the
construction/installation of a system or the issuance of a building pernut.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
,
1 f; <' � ,,•f,,:' ,-f' � ,,: ***NOTTCE***THLS PERIVIIT IS SUBJECT TO REVOCATION IF SITE
} , �,. ,;, � � a^; �`,rv;j}�`.;�' PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
IENVIRONMENTAL HEALTI-f SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLIlVG THE SYSTEM.
RESIDENTIAL SPECIFICATION:BUILDING TYPE�L7`#BEDROOMS ��s—''`#BATHS�#OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLFISHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY�_ DESIGN WASTEWATER FLOW(GPD) .�L� NEW SITE REPAIR SITE �
/ � r
SYSTEM SPECIFICATIONS: TANK SIZE�GAL. PUMP TANK GAL. TRENCH WIDTH �.?�E, �ROCK DEPTH � LINEAR FT. �,���
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
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IMPROVEMENTPERMITLAYOUT�(��13FDVED EFFUI�FIT FILTCR# �RI��RtS) IF G" B�LQ�:-; FIF�}IfiHcD Gf2RA��
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**CONTACT A REPRESEN�I'ATIVE OF THE DAVIS COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(�114;'634�8�iSOx
t�w6)?51-E17�q
OPERATION PERMIT ,
'� SYSTEM INSTALLED BY:
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AUTHORIZATION NO.�OPERATION PERMIT BY: �/ ''� DATE: � `,� _
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD OS/96(Revised)
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�. . � - " . � � � �;�DAVIE COUNTY HEALTH DEPARTMENT �' `- '% :J'�",�
' `�� �;, " �f ��' � IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
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� Name:<" � , Subdivision Name:
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Directions to property: ; � ' Section: Lot:
' Il1�IPROVEMENT �?
PERM1T Tax Office PIN:# '�,` �'��"�`"�����j
�•���' ��✓ Road Name: Zip: � �
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An
!'AUTHORIZATTON FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frc�m this Department prior to the
construction/installation of a system or the issuance of a�iuilding pernut.
(In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
�-"ft ***NOTTCE***TfIIS PERMIT IS SUBJECT TO REVOCATION IF SIT'E
'. `"' . . ' ~ ,;�„�•'>'� ; PLANS OR TIIE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE
INSTALLING TF�SYSTEM. ,
RESIDENTIAL SPECIFICATION:BUILDING TYPE rll �#BEDROOMS 'tit� #BATHS .�`'� #OCCUPANTS GARBAGE DISPOSAL:Yes or No
l� .
COMMERCIAL SPECIFICATION: �ACILITY TYPE #P$OPL`��4 �Y' ��#PEOPLE/SHIFT`y� #SEATS '� INDUSTRIAL WASTE:Yes or No
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LOT SIZE �,tTYPE WATER SUPPLY, / {� �;� DE�I.S'iN,WASTEWATER FLOW(GPD) �t -� NEW.�SIf REPAIR SITE L'"
i >"'.�'l,'�:��y,� '�� � '�E•,i ��.���'�� � ' �� .
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SYSTEM SPECIFICATIONS: TANK SIZE �r ?�h GAL. PUMP TANK GAL. TRENCH WIDTH �'""� ROCK DEPTH �? LINEA - �- �
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'�. REQUIREb'SITEMODIFICATIONS/CONDITIONS:•��� � . �y ,
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IMPROVEMENTPERMITLA�'OUT��1lr�6�-�I�V�D CF�Lll:���T �IL.�T��°�� '�iiIa:1�'l'$) 7� G�'� �?I_L�id �����L����I3 �c�l`�i��'�. ''
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**CONTACT A REPRES�NTATIVE OF THE DAVIE COUNTY�HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
'BETWEE�T.St30-9:30 A.M.OR 1:00-130 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(��4}'�S'��'I�O��
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OPERATION PERMIT r �'., r f ,,
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AUTHORIZATION NO._�OPERATION PERMTI'BY: ,/ `' DATE:
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� •*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECI�ION.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.
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DCHD 05�96(Revised) ^ `
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� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
- . APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME � - �' �� PHONE NUMBER ��Y"�S ��
ADDRESS S�� /�i��l✓ �5 �G� SUBDIVISION NAME
i:�l'�S?/� !� . pl�.C , � ?�� LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY /�'1� NUMBER BEDROOMS � NUMBER PEOPLE SERVED L
TYPE WATER SUPPLY � SPECIFY PROBLEM OCCURRING
DATE REQUESTED �'� ��� INFORMATION TAKEN BY ���
This is to certify that the information provided is correct to fhe best of my knowledge,and that I understand I sm responsible}or all charges incurred irom this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93 /f /��Q/
j%CG( LJ
%��c� �9� -�/�-oz� T�� �- r���
Appraisal Card Page 1 of 1
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DAVIE COUNTY NC 3/14 2012 10:52:55 AM
MCCLAMROCK GRADY SR & MCCLAMROCK LUCY � 65-000-00-041 -
29 PINEV0.LE RD UNIQ ID 785 ��
8536000 D81-P3 ID N0:5643358599
COUNTY TAX,FIRE TAX CARD NO.1 of 2 -
Reval Year:2009 7ax Year:2012 1.44 AC PINEVILLE RD 1.250 AC SRC=Inspection
raised b 02 on 03/06/2009 03004 FARMINGTON l'W-03 C- EX- AT- LAST ACTION 20110607
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE
Foundation-3 Eff. BASE Standard 0.4100
ontinuous Footin 5.0 USE MOD Area UA RATE RCN EYB AYB kEDENCE TO MARKET
ub Floor Sys[em-4 Ol Ol 978 I38 81.42 796291968 1968 %GOOD 59.0 DEPR.BU7LDING VALUE-CARD 46 98
PI wood 8.0 DEPR.OB/XF VALUE-CARD 4,50
Exterior Walis-10 TYPE:Single Family Residential Sinqle Family Residential .
MARKET LAND VALUE-CARD 26,40
luminum/Vin I Sidin Z9.a STORIES:1.0 Story OTAL MARKET VALUE-CARD 77,88 �-
Roofing Structure-03
able S.0
Roofing Cover-03 OTAL APPRAISED VALUE-CARD 77,88
s halt or Com osltlon Shin le 3.0 OTAL APPRAISED VALUE-PARCEL 121,72
n[erior Wall Construction-5
D wall/Sheetrock 20.0 OTAL PRESENT USE VALUE-PARCEL
nterior Floor Cover-OS OTAL VALUE DEFERRED-PARCEL
heet Vin I 6.0 OTAL TAXABLE VALUE-PARCEL 121,72
Interior Floor Cover-14
aret 0.0 +"""""""'Zg"""'""""'"+ PRIOR
Heating Fuel-04 I B�'S I BUILDING VALUE 88,06
I I BxFVALUE
Elec[ric 1.0 I I
Heating Type-30 I I LAND VALUE 23,75
Heat Pum q,p I I � RESENT USE VALUE
ir Condi[ioning Type-03 I I EFERRED VALUE
I T OTAL VALUE 111 81
entral 4.0 I I
8edrooms/Bathrooms/Half-Bathrooms I I
2/1/0 7.00 I I
Bedrooms I I PERMIT
BAS-2 FUS-0 LL-0 3 3 CODE DATE NOTE NUMBER AMOUNT
Bathrooms 3 3
BAS-IFUS-OlL-O I I
1 I ROUT:WTRSHD:
OTAL COINT VALUE 5.00 I I SALES DATA � ..
. BUILDING ADlUSTMENTS I . I FF. "
ize 3 Size 1.130 I I RECORD DATE DEED INDICATE ���
ualit 3 AVG 1.000 I I BOOK PAGE MO R TYPE U /ISALES PRICE
ha e/Desi n 5 FACTOR 5 1.100 I I 0165 802 10 1992 WD Q I 1450 �
OTAI ADJUSTMENT FACiOR 1.24 I I - 0211 791 5 199 WD S I 3050 �
OTALQUALITYINDEX 11 I I 0156 760 11199 WD U I 600 -.
I = 0116 760 11 199 W D U I 600 ,,.
+3-+--'------22""""'};'} ..
IFOP I
I I
7 7
I � I HEATED AREA 924
I I
.f"""""""ZZ"""'"'""'} NOTES
REMODEL 7/99
FRM WILSON HINES
SUBAREA UNIT ORIG% ANN DEP % OB/XF DEPR.
GS RPL ODEDESCRIPTIONLTM THUNIT PRICE COND BLDG#L AYB EYB RATE V COND VALUE
TYPE AREA ^/o CS DB MH SITE 0 1 4 500.00 L 200 2004 S 30 450
8A5 92410 75232 OTAL OB/XF VALUE 4 50
FOP 154035 4397
FIRECLACE 1
UBAREA
OTALS 1,078 79,62
BUILDING DIMENSIONS BA5=W28533E3FOP=57E22N7W22$E25N33$.
LANDINFORMATION
HSGHEST TMER AD)USTMENTS LAND TOTAL
ND BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES ROAD UNIT LAND UNT TOTAL ADJUSTED LAND LAND
USE CODE 20NING TAGE DEPTH SIZE MOD FACT RF AC LC TO OT TYPE VRICE UNI75 TVV ADJST UNIT PRICE VALUE NOTES
RURAL AC 0120 230 0 2.2000 4 1.2000 +10+30+00+00+00 pW 8,000.0 1.250 AC 2.64 21,120.0 2640
OTAL MARKET LAND DATA 1.250 26,40
OTAL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parce1=B500000041 3/14/2012