147 Todd RdApplicant: George Vance and Maxine Riley
Address: 147 Todd
city:
State/Zip: NC
Phone #: (336) 998-4433
Address/Road #: Subdivision:
147 Todd Road
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
'Water Supply: EXISTING WELL
'CDP File Number 121679. 1
18.000.00-036
County ID Number:
Evaluated For: REPAIR ?, '101i3
Township: �/
Property owner: George Vance and Maxine Riley
Address: 147 Todd
City:
State/Zip: NC
Phone 9- (336) 998-4433
Phase: Lot:
Directions
Hwy 64 E. Left on Hwy 8013 Miles approx. Todd Rd.
On right in curve
'IP Issued by: 2244 - Daywall, Andrew 'System Classification /Description:
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
'CA issued by: 2244 - Daywalt, Andrew
Saprolite System? QYes ()No
Design Flow: 'Distribution Type: GRAVITY -PARALLEL (eq. d -box) Pump Required?
QYes QNo
Soil Application Rate: 0 . 3 'Pre Treatment:
Drain field
Nitrification Field
No. Drain Lines
Total Trench Length
Trench Spacing:
Trench Width:
Aggregate Depth:
Minimum Trench Depth:
Minimum Soil Cover.
Maximum Trench Depth:
Maximum Soil Cover:
9 n n ft.
Sq. ft.
Qlnches O.C.
Feet O.C.
Inches
Feet
inches
Inches
Inches
Inches
Inches
'System Type: INFILTRATOR QUICK 4 STANDARD
Installer: jamio barnes
Certification #:
'EH S: 2244 - Daywalt, Andrew
Date: 0 6/ 1 2/ 2 0 1 3
Approval Status
D Approved D Disapproved
OPERATION PERMIT
Davie County Health Department
�t
210 Hospital Street
X,
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: George Vance and Maxine Riley
Address: 147 Todd
city:
State/Zip: NC
Phone #: (336) 998-4433
Address/Road #: Subdivision:
147 Todd Road
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
'Water Supply: EXISTING WELL
'CDP File Number 121679. 1
18.000.00-036
County ID Number:
Evaluated For: REPAIR ?, '101i3
Township: �/
Property owner: George Vance and Maxine Riley
Address: 147 Todd
City:
State/Zip: NC
Phone 9- (336) 998-4433
Phase: Lot:
Directions
Hwy 64 E. Left on Hwy 8013 Miles approx. Todd Rd.
On right in curve
'IP Issued by: 2244 - Daywall, Andrew 'System Classification /Description:
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
'CA issued by: 2244 - Daywalt, Andrew
Saprolite System? QYes ()No
Design Flow: 'Distribution Type: GRAVITY -PARALLEL (eq. d -box) Pump Required?
QYes QNo
Soil Application Rate: 0 . 3 'Pre Treatment:
Drain field
Nitrification Field
No. Drain Lines
Total Trench Length
Trench Spacing:
Trench Width:
Aggregate Depth:
Minimum Trench Depth:
Minimum Soil Cover.
Maximum Trench Depth:
Maximum Soil Cover:
9 n n ft.
Sq. ft.
Qlnches O.C.
Feet O.C.
Inches
Feet
inches
Inches
Inches
Inches
Inches
'System Type: INFILTRATOR QUICK 4 STANDARD
Installer: jamio barnes
Certification #:
'EH S: 2244 - Daywalt, Andrew
Date: 0 6/ 1 2/ 2 0 1 3
Approval Status
D Approved D Disapproved
CDP�File Number 121679-1
Countv 1D Number: 18-000-00-036
i
septic TanK
Manufacturer. existing Lat.
STB: Long:
Gallons: Installer:
Date:
/
/
Certification #:
Riser Height: ❑
Yes
Reinforced Tank: ❑
*EH S:
'Filter Brand:
Yes
Draw Down:
ST Marker:
❑ Yes
❑ No
Date:
Reinforced Tank:
❑ Yes
❑ NO
Approval Status
I-
Date:
❑Approved❑ Disapproved
1 Piece Tank:
❑ Yes
❑ NO
Pump Tank
Manufacturer. Installer:
PT: Certification #:
Gallons: *EHS:
Date:
/
Riser Sealed ❑
Yes
Riser Height: ❑
Yes
Reinforced Tank: ❑
Yes
1 Piece Tank: ❑
Yes
❑
No
❑
NO (Min. 6 in.)
❑
No
❑
No
/ Pipe Size: inch diameter
Pipe Length: feet
*Schedule:
Pressure Rated ❑ Yes ❑ No
Approved fittings ❑ Yes ❑ No
Date:
Approval Status
❑ Approved ❑ Disapproved
Supply Line
Installer:
Certification #:
*EHS:
Date: / /
Approval Status
❑ Approved ❑ Disapproved
% Pump Type:
Installer:
f/ Dosing Volume:
—
Gal Certification #:
Draw Down:
Inches
*EHS:
'Chain:
Date:
Valves Accessible
❑ Yes
❑
No
Flow Adjustment Valve
❑ Yes
❑
NO
Check -valve
❑ Yes
❑
NO
Approval Status
PVC unions
❑ Yes
❑
No
❑ Approved ❑ Disapproved
Vent Hole
❑ Yes
❑
No
Anti -siphon Hole
❑ Yes
❑
No
CDP File Number
121679 -1
NEMA 4X Box or Equivalent ❑ Yes
Box 12 inches Above Grade ❑ Yes
Box Adj. To Pump Tank ❑ Yes
Conduit Seated ❑ Yes
Pump Manually Operable ❑ Yes
*Activation Method:
Alarm Audible
Alarm Visible
County ID Number: I8-000-00-036
Electric EaulDment
❑
No
Installer:
❑
No
Certification #:
❑
No
❑
No
'EH S:
❑
No
Date:
❑ Yes ❑ No
❑ Yes ❑. No
2244 - Daywalt. Andrew
'Operation Permit completed by;
Authorized State Agent
Approval Status
❑ Approved ❑ Disapproved
Date of Issue: 0 6/ 1 2/ 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 II A. sewage septic system.
Rule .1961 requires that a Type TYPE II A. septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: NIA
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
NIA
Reporting Frequency By Certified Operator: NIA
Rule .1961 requires that a Type IV and V septic systems designed fora hometbusiness owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator for the life of the septic system.
Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained bya public or private management entity, unless the
system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and
operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as 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.
(DHand Drawing OlmportDrawing
**Site Plan/Drawing attached.**
Activity Code: S-19204 - OP issued NEW Type 11 Quick 4
Total Time -11-11-11,11.1)
0 1 Hours 0 0 minutes
OPERATION PERMIT
Davie County Health Department CDP File Number: 121679 -1
210 Hospital Street 18.000-00.036
P.O. Box8d8 County File Number:
Mocksville NC 27028 Date:
Q Inch
Cn�lc• nRlnn4 = ft
`' CONSTRUCTION For office use only
' AUTHORIZATION *CDP File Number 121679-1
=" Davie County Health Department County ID Number: 18.000-00.036
210 Hospital Street Evaluated For: REPAIR
r P.O. Box 848
�......• Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 5/ 2 9/ 2 0 1 8
Applicant: George Vance and Maxine Riley
Hendrix
Address: 147 Todd
City:
State/Zip: NC
Phone #: (336) 998-4433
i
Address/Road #:
147 Todd Road
Advance
Structure:
# of Bedrooms:
# of People:
*Water Supply:
NC 27006
SINGLE FAMILY
3
EXISTING VhFELL
Subdivision:
(Site Classification: PS
Saprotite System? OYes ONo
Design Flow: 3 6 0
Property Owner: George Vance and Maxine Riley
Hendrix
Address: 147 Todd
City:
State2ip: NC
Phone #: (336) 998-4433
Phase: Lot:
Directions
Hwy 64 E. Left on Hwy 8013 Miles approx. Todd Rd. On
right in curve
tem Specification
Minimum Trench Depth: 2 4
Inches
Minimum Soil Cover.
Inches
Maximum Trench Depth: 3 6
Inches
Soil Appl�catlon Rate. Maximum Soil Cover:
0 3 Inches
*System Classification/Description: *Distribution Type: GRAVITY -PARALLEL (eq. d -box)
TYPE II A. COW SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Se tic Tank
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
Sq. ft.
2 0 0 g,
p Gallons
1 -Piece: OYes ONo
Pump Required: OYes ONo 014ay Be Required
Pump Tank: Gallons
1 -Piece: OYes ONo
GPM—vs-- ft. TDH
QInches O.C. —
OFeet O.C. Dosing Volume:. Gallons
___8Inches
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
• SOP File Number 121679-1 County ID Number:
18.000-00-036
❑ Open Pump System Sheet
Repair System Required:OYes ONO ONO, but has Available Space
epair System
Trench Spacing: 0 Inches 0. .
*Site Classif�ation:Feet O.C.
Trench Width: 0 Inches
Design Flow:_ Feet
Soil Application
Depth:n Rate: inches
=System Classification/Description: Minimum Trench Depth: Inches
Minimum Soil Cover.
Inches
Maximum Trench Depth:
*Proposed System: Inches
Maximum Soil Cover:
Nitrification Field Inches
Sq. ft.
No. Drain Lines `Distribution Type:
Total Trench Length: ft Pump Required: Oyes ONo OlAay 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 bythe 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 Constrwtion Penn It, the Information submitted In the application for a permit or Construction
Authorization Is farad to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become
invalid, and maybe suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance; monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature: Date: /
*Issued By:
2244 - Daywalt, Andrew
Authorized State Agent:
Date of Issue: 0 5/ 2 9/ 2 0 1 3
Malfunction Log OYes
OHand Drawing Olmport Drawing Total Time:(HH:l,1t.1)
**Site Plan/Drawing attached.**
Page 2 of 3 0 1 Hours _ 0 tt mutes
S-10 - CAS issued - repair
CONSTRUCTION AUTHORIZATION
Davie County Health DepartmentCDP File Number:
121679 -1
y
210 Hospital Street 18-000-00-036
P.O. Box 848 County File Number:
Mocksville NC 27028 Date: 0 5/ 2 9/ 2 0 1 3
Qlnch
Panp 3 of 3
Appraisal Card ` Page 1 of 1
P IZ
nAVIF COUNTY. NC
5/21/2013 3:38:14 PM
HENDRIX GEORGE VANCE HENDRIX MAXINE RILEY
Retum/Appeal Notes: I8-000-00-036
147 TODD RD
UNIQ ID 17390
4892000
D397 -P25
ID NO: 5788340860
COUNTY TAX (100), FIRE
TAX (100) CARD NO.
I of 1
eval Year: 2013 Tax Year: 2013
1.85 AC TODD RD
1.630 AC
SRC= Inspection
Appraised by 07 on 07/19/2007 04001 FULTON
TW -04
C- EX- AT- LAST ACTION 20110725
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION
CORRELATION OF VALUE
oundation - 3
Eff. i
BASE
Standard 0.3300
ontinuous Footing
5.02 Us MO Area
QUA RATE RCN EYB AYB
CREDENCE TO MARKET
ub Floor System - 4
PI wood
8.00 01101 11,6241118182.6011363931198+96d % GOOD 1 67.0
DEPR. BUILDING VALUE - CARD
91 38
DEPR. 08/XF VALUE - CARD
4,19
xterior Walls - 21 TYPE: Single Family Residential Single Family Residential
ace Brick
34.0
MARKET LAND VALUE - CARD
27,51
STORIES: 5 - Ranch
w/ basement
TOTAL MARKET VALUE - CARD
123,08
oofing Structure - 03
able
8.0
oofing Cover - 03
s halt or Composition Shingle
3.00
TOTAL APPRAISED VALUE - CARD
123,08
TOTAL APPRAISED VALUE - PARCEL 123,08
nterior Wall Construction - 5
wall/Sheetrock
20.0
nterior Floor Cover - 12
TOTAL PRESENT USE VALUE - PARCEL
Hardwood
14.0TOTAL
VALUE DEFERRED - PARCEL
eating Fuel - 02
TOTAL TAXABLE VALUE - PARCEL
123,08
it Wood or Coal
0.0
+-----27------+
PRIOR
eating Type -04 IUBM +----20----+
orced Air - Ducted
4.00
I
I
BUILDING VALUE
91,50
Ir Conditioning Type - 03
I
I
BXF VALUE
5,81
entral
4.0
I
I
LAND VALUE
27,13
drooms/Bathrooms/Half-Bathrooms
2
2
PRESENT USE VALUE
/1/0
8.000
7
5
DEFERRED VALUE
edrooms
I
I
TOTAL VALUE
124,440
BAS-3FUS -0LL-0 1 1
I I
athrooms
I
I
AS-IFUS -0LL-0
+-----------47-----------+
fflce
PERMIT
CODE DATE NOTE NUMBER
AMOUNT
OTAL POINT VALUE
108.00
BUILDING ADJUSTMENTS
+ - - - - - 27 - - - - - - +
ROUT: WTRSHD:
Iza 3 Size 1.040 3 B A S + - - - - 20----+
call 3 AVG
1.000 + - - - - - 23 - - - - - +
I
SALES DATA
ha a/Desi 4 FACTOR 4
1.050 I F C P
I
I
FF.
INDICATE
OTAL ADJUSTMENT FACTOR
1.09 1
I
I
ECORD DATE
DEED
SALES
OOK PAGE M R
[1007110290
TOTAL QUALITY INDEX
11 1
1
2
TYPE
/1,1
PRICE
14 119641
WD
I X
I I
2 2 5
4
4
I
I
I
I
I
I
I
I
I
I
+-----23-----+--15---+-8-+-.----24-----+
HEATED AREA 1,229
4FOP4
NOTES
+-8-+
SUBAREA
UNIT ORIG %
ANN DEP % OB/XF DEPR
TYPE GS AREA % RPL CS ODE DESCRIPTIO LTH HUNIT PRICE GOND
BLDG+Y L B AYB EYB RATE V COND
VALUE
10 10151 B6 HOP BLDG 3
3 90 15.0 10 _ L 198 199 S 31
418
02 1139924 HED 3
3 90 5.1 10 L 198 198 S
03 9p
E141,22;
TOTAL OB/XF VALUE
4,185
02 2032
3 - 1 Story
IREPLACE 2,250
Sin le
UBAREA
3,04 136,39
OTALS
BUILDING DIMENSIONS BAS=W20N2W27S3FCP=W23S24E23N24 S24El5FOP=S4E8N4W8 E32N25$PTR=NIS UBM=N25W20N2W27S27E47$S15 .
NO INFORMATION
IGHEST
THERADJUSTMENTS1
I LAND TOTAL
NO BEST
USE
LOCAL
FRO N
DEPTH /
LND
I COND ND NOTES
ROA
UNIT LAND UNT
TOTAL
ADJUSTED LAND LAND
SE
CODE
ZONING
TAGE
DEPTH SIZE
MOD
FACT RF AC LC TO OT
TYPE
PRICE UNITS TYP
ADJST
UNIT PRICE VALUE NOTES
URAL AC
0120
415
0 1.9190
4
11.22001+10 +12 +00 +00 +00
PW
7,200.00 1.632 AC
1 2.3411
16,855.20 2750
TOTAL MARKET LAND DATA
1.632 27,51
TOTAL PRESENT USE DATA
Ao&[# 60%
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=I800000036 5/21/2013