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447 Pleasant Acre DrApplicant: Mike Wamer@North Carolina Address: 175 West New Hampshire Ave. City: Southern Pines State2ip: NC 28387 Phone #: 'CDP File Number 120964-1 M600000011 County ID Number: Evaluated For: REPAIR Township: �roperty owner: Mike Warner@North Carolina Address: 175 West New Hampshire Ave. City: Southern Pines State/Zip: NC 28387 one #: ProDertv Location & Site Information #: Subdivision: Phase: Lot: OPERATION PERMIT �1 Davie County Health Department f ` Lddress/Road C 210 Hospital Street t P.O. Box 848 •" �-�' Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Mike Wamer@North Carolina Address: 175 West New Hampshire Ave. City: Southern Pines State2ip: NC 28387 Phone #: 'CDP File Number 120964-1 M600000011 County ID Number: Evaluated For: REPAIR Township: �roperty owner: Mike Warner@North Carolina Address: 175 West New Hampshire Ave. City: Southern Pines State/Zip: NC 28387 one #: ProDertv Location & Site Information #: Subdivision: Phase: Lot: ant Acre Lddress/Road C 27028 Directions Hwy 601 S. Left at 2nd Pleasant Acre Dr. near HER church. Home # of Bedrooms: 3 on right # of People: 6 *Water Supply: NIA *IP Issued by: 2244 - Daywalt, Andrew Classification/Description: ation/Description: TYPE II B. CONY. SYSTEM WITH 750 LINEAR FEET OF *CA issued by: 2244 - Daywait, Andrew NITRIFICATION LINE OR LESS Saprolite System? QYes QNo Design Flow: 3 6 0 'Distribution Type: GRAVITY - PARALLEL (eq. d -box) Pump Required? QYes QNo Soil Application Rate: 0 - a 2 5 'Pre -Treatment: N!A Drain field Nitrification Field Sq. ft. *System Type: INFILTRATOR QUICK 4 STANDARD No. Drain Lines Installer: I Darrem pruitt Total Trench Length: 3 0 0 ft. Certification #: Trench Spacing:_ Inches O.C. Feet O.C. EH S: 2244 - Daywall. Andrew Trench Width: _ Inches Feet 0 5/ 0 9/ 2 0 1 3 Date: Aggregate Depth: inches Minimum Trench Depth: Inches Minimum Soil Cover. Inches Approval Status Maximum Trench Depth: O Approved ❑ Disapproved ]) Inches Maximum Soil Cover: Inches CDP 1=ile Number 1,20964-1 Manufacturer. existing STB: Gallons: Date: 'Filter Brand: ST Marker: ❑ Yes ❑ NO Reinforced Tank: ❑ Yes ❑ NO 1 Piece Tank: ❑ Yes ❑ No Manufacturer. PT: Gallons: Countv ID Number: L1600000011 Septic TanK Lat. Long: Installer: Certification #: *EH S: Date: / / Approval Status ❑ Approved ❑ Disapproved Pump Tank Date: Riser Sealed ❑ Yes ❑ NO Riser Height: ❑ Yes ❑ No (Min. 6 in.) einforced Tank: ❑ Yes ❑ No `1 Piece Tank: ❑ Yes ❑ No Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes Approved fittings ❑ Yes Installer: Certification #: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved upply Line Installer: Certification #: *ENS: ❑ No Date: ❑ NO Approval Status ❑ Approved ❑ Disapproved / Pump Type: Installer: Dosing Volume: — Gal Certification K: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check -valve ❑ Yes ❑ NO Approval Status PVC unions El Yes El No 11 Approved ElDisapproved Vent Hole ❑ Yes ❑ No \ Anti -siphon Hole ❑ Yes 0 NO CDP mile Number 120964-1 eieutnc Cuuioment County ID Number: M600000011 NEh1A4X Box or Equivalent ❑ Yes ❑ NO Installer: Box 12 inches Above Grade ❑ Yes ❑ NO Certification n: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EH S: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Alarm Audible 11 Yes 1:1 No Approval Status ❑Approved ❑ Disapproved Alarm Visible El Yes 13NO 2244 - Daywalt, Andrew *Operation Permit completed by: Authorized State Agent: Date of Issue: 0 5/ 0 9/ 2 0 1 3 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 11 B. sewage septic system. Rule .1961 requires that a Type TYPE II B. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: N/A Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: N/A Reporting Frequency By Certified Operator: N/A Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywdh a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator forthe life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entdy priorto the issuance of an Operation Permit for a system required to be maintained bya public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect foras long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. UHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Activity Code: S-19206.- OP issuedNEW Type 11 Quick 4B Total Time:(H H:f.1 M ) 0 1 Hours 0 0 rllnutes i OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 120964 - 1 County File Number: M600000011 Date: 05 /09 /013 O inch S I t k = ft Drawing Drawing Type: Operation Permit ca e. , , . OB oc ON/A V -- CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Mike Warner@North Carolina MR Inc Address: 175 West New Hampshire Ave. City: Southern Pines State/Zip: NC 28387 Phone #: I,- Address/Road Address/Road #: Subdivision: 447 Pleasant Acre Mocksville NC 27028 Structure: OTHER # of Bedrooms: 3 # of People: 6 `Water Supply: NiA For Office Use Only *CDP File Number 120964-1 County ID Number: N1600000011 Evaluated For: REPAIR �, Township: I 1 VALIU UN 1 IL: 0 4/ 1 1/ 2 0 1 8 Property Owner: Mike Warner@North Carolina MR Inc Address: 175 West New Hampshire Ave. City: Southern Pines State2ip: NC 28387 Phone #: Phase: Lot: Directions Hwy 601 S. Left at 2nd Pleasant Acre Dr. near church. Home on right System Specifications Site Classification: Minimum Trench Depth: 2 4 Inches Saprolite System? OYes ONo Minimum Soil Cover. Inches Design Flow: Maximum Trench Depth: 3 6 Inches Soil Application Rate: Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: Septic Tank: Gallons *Proposed System: 1 -Piece: OYes ONo Pump Required. OYes ONo OMay Be Required Nitrification Field Sq. ft. Pump Tank: Gallons No. Drain Lines 1 -Piece: OYes ONo Total Trench Length: 2 5 0 ftGPt.1-vs-- ft. TDH Trench Spacing:9 _ Q Inches O.C. Feet O.C. Dosing Volume: Gallons Trench Width: _ 3 6 Inches Aggregate Depth: Feet Grease Trap: Gallons - - - inches Pre -Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 011 0111 OIV Page 1 of 3 CDG' File Number 120964 -1 County ID Number: M600000011 ❑ Open Pump System Sheet Repair bystem Required:V Yes V Ivo uNo, Dut nas HvallaDle Space Trench Spacing: 8Feet Inches O. "Site Classification: PS — 9 O.C. Design Flow:3 6 D Trench Width: — 3 6 8 IFnec hes Soil Application Rate: Aggregate Depth: inches .� 'System Classification/Description: Minimum Trench Depth: Inches TYPE 11 A. CONV SYSTEM (SINGLE-FA(NILY OR 480 GPD OR LESS) Minimum Soil Cover. Inches *Proposed System: 251REDUCTION Maximum Trench Depth: Inches Maximum Soil Cover: Ndrification Field Inches Sq. ft. No. Drain Lines "Distribution Type: GRAVITY -SERIAL Total Trench Length: 3 0 0 ft Pump Required: Oyes ONo OfAay Be Required Pre -Treatment: ONSF OTS -1 OTS -II 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 'Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and maybe Issued at the same time the Improvement Permit issued (NCGS 130A-336(b)� If the installation has not been completed during the period of validity of the Construction Permit, the Information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authortzation shall become invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rides, and permit conditions regarding system location. Installation, operation, maintenance6 monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature, Date: 'Issued By: 2244 - Daywalt. Andrew Date of Issue: D 4 / 1 1 / 2 0 1 3 J Authorized State Agent: A 1 /1111) 11 t a AO � Malfunction Log OYeS i OHand prawing Olmport Drawing Total Time:(HH:I,tl,t) **Site Plan/Drawing attached.** 0 1 Page 2 of 3 Hours 1.1 mutes S-10- CIA ISSUED - REPAIR �� . • • CCNSTRUCTION AUTHOFtIZA'i10N � � ' , . Davie County Health Department CDP File Number: 120964 - 1 210 Hospital Street M600000011 P.o.Box sas County File Number: Mocksville Nc 2�o2s Date: o a / i i / a o i 3 � � Q Inch Dra�ving Drawing Type: onstruction Authorization Scale: , , . OB�ock = .ft. � . . . . QN/A : � ' '. s � ' . _ YL ; � J 1�- � , vf � � ^' � . C� _ [ ' 3 'k' ��5'' ec��. Ct�_ . l. _� � a � � -- _ �� , _ � _ . _ _ _ , _ . (.�,�� - -- -- - ; �,� f _ _ . . � ' f�'a _ $ _ . ln �I _ _ , _. _ � - � �E _ _. � _ _ _ l � __ _�ec�f�c �c�2 ,�� Pane 3 of 3 �. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION ut 11e APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME Wyk WaYVICY (RIM N&Aft S2YVi6eiD, PHONE NUMBER -76q' l94 -ID -'0 sl ADDRESS 'l y7 P1,e6sdn4- 's SUBDIVISION NAME ?bpi 92 9-q LOT # DIRECTIONS TO SITE (OCA 1 5 19 an DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY Kms, C4Yt- NUMBER BEDROOMS (0 NUMBER PEOPLE SERVED TYPE WATER SUPPLY '_ubl f C SPECIFY PROBLEM OCCURRING Se(,J4,e SUY-f06,,i C1 N n bat✓IL yam. DATE REQUESTED 14- 2' 1 _INFORMATION TAKEN BY 0 13 This is to certify that the information provided is correct to the best of my knowledge. and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 Appraisal Cara DAVIE COUNTY NC Page 1 of 1 412/2013 12:48:10 PM RHA\NORTH CAROLINA MR INC Retum/Appeal Notes: M6-000-00-011 47 PLEASANT ACRE DR UNIQ ID 23512 0649240 D311 -P23 ID NO: 57SS064228 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 LOTS 9-12 + 29-32 BOXWOOD 1.880 AC SRC= Inspection kippralsed by 07 on 08/16/2007 05003 CHERRYHILL TW -05 C- EX -B AT- LAST ACTION 20120621 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE oundation - 3 FOBS Funtlonal 0.1000 ontinuous Footing 5.00 Eff. BASE Pbsolescence Standard 10.2600 ub Floor System - 4 _ I wood 8-00 USEO Area DUAL RATE RCN EYB AVB CREDENCE TO MARKET xterior Walls - 21 ace Brick 34.00 01 01 2 901 118 82.60 23962 198 198 % GOOD 64.0 EPR. BUILDING VALUE -CARD 153 36 oofing Structure - 03 TYPE: Single Family Residential Single Family Residential EPR. OB/XF VALUE - CARD 2,91 4ARKET LAND VALUE - CARD 26,78 able 8.00 Roofing Cover - 03 %sphalt or Composition Shingle .00 STORIES: 1 - 1.0 Story OTAL MARKET VALUE - CARD 183,05 merior Wall Construction - 5 )rywall/Sheetrock 26.0 OTAL APPRAISED VALUE - CARD 183,05 OTAL APPRAISED VALUE - PARCEL 183,05 nterior Wall Construction - 6 ustom Interior 0.0 merior Floor Cover - 08 heet Vinyl/Laminate 6.00 TOTAL PRESENT USE VALUE - PARCEL nterlor Floor Cover - 14 :arpet0.00 TOTAL VALUE DEFERRED - PARCEL TOTAL TAXABLE VALUE - PARCEL 183,05 eating Fuel - 04 -lectric1.00 PRIOR BUILDING VALUE 172,87 Heating Type - 10 eat Pump 4.00 BXF VALUE 4,94 LAND VALUE 26,78 %ir Conditioning Type - 03 entral 4.0 RESENT USE VALUE � DEFERRED VALUE fractural Frame - 04 Mason 0.0 OTALVALUE 204,59 eiling &Insulation - 07 of Suspended - Ceilingand Wall Insulated 0.0 + - - - - - - - 3 3 IBAS 3 1 +------31-------+-12--+ verage Rooms Per Floor -5 vera a Rooms Per Floor 0.0 I I PTO I PERMIT I I I CODE DATE NOTE NUMBER AMOUNT drooms/Bathrooms/Half-Bathrooms /2/0 12.00 1 1 1 I 2 2 OUT: WTRSHD: edrooms AS-3FUS-OLL-O I 2 2 I 1 1 SALES DATA I I I FF. INDICATE throoms BAS - 2 FUS - 0 LL - 0 5 I I ECORD DATE DEED SALES O +_12--+ 00 AGE M R TYPE / / PRICE (lice I 1 0136 697 4 198 WD Q V 1000 1 1 0111 598 11 198 WD X V 1 1 0118 455 10 198 WD U I 1000 I 9 I I 1 1 I +-10-+------30-------+ HEATED AREA 2,867 1 6 F O P 6 OTAL POINT VALUE 111.00 BUILDING ADJUSTMENTS ize 3 Size 0.880 uali 4 ABAVG 1.200 Shape/Desigr4 3 1 FACTOR 3 1 1.000 TOTAL ADJUSTMENT FACTOR 1.06 TOTAL QUALITY INDEX I1 + - - - - 2 4 - - - - - + - 10-+ NOTES SUBAREA UNIT ORIG % ANN DEP% OB/XF DEPR GS ODE DESCRIPTIONLTH HUNIT PRICE COND BLDG ftL B AYB EYB RATE V COND VALUE ARAGE ON PAVING DOD FENCE 2 2 40 8 1 1120 20 15.0 4.0 8.7 10 _ _ L L L 197 199 199 199 199 199 5 S 5 4 258 24 6 TYPE AREA % RPL CS 2 AS 2,86Z 10 23681 10 FOP 6203 173505 0 26400 1074 rOTAL OB XF VALUE 2,907 FIREPLACE 1 - None BAREA 3,191 39,62 TALSILDING DIMENSIONS BAS=W31N3W33550E24FOP=ElON6W1056 N6E40N41 PTO=522E12N22W12 . NO INFORMATION GHEST 1.0"'ITAL THER ADJUSTMENTS LAND TOTAL D BEST USE LOCAL FRON DEPTH / LND COND ND NOTES ROA UNIT LAND UNT TOTAL ADJUSTED LAND LAND E CODE ZONING TAGE DEPTSIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTESHOMESIT 0201 400 0 1.7990 4 1.2200 +10 +12 +00 +00 +00 PW 6 500.0 1.87 AC 2.19 14267.5 2678 MARKET LAND DATA 1.877 26,78 OTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=M600000011 4/2/2013 Davie County, NC - GoMaps Advanced Page 1 of 1 http://maps2.roktech.net/davic�_gomaps/index.html 4/11/2013