124 Canton Road Lot 18, Sec 2 1 -=• / 0
s' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name !J /, , ✓: `�i_� /tel/ /Date � N��� S
/ � - 7828
Locations
Subdivision Name 5.�l�c�. r /A z//�;1y Lot No. //-9� Sec. or Block No.
Lot Size ZIZ' t House �-'�-/ Mobile Home — Business -- Industry
No. Bedrooms No. Baths No'in Family — Public Assembly Other
Garbage Disposal YES ❑ NO Q'
Auto Dish Washer YES NO E] Specifications for System: '
Auto Wash Ma^hine YES NO ❑ �j� 'r
Type Water Supply — ( C ---- 'kZ
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
yc2l
Improvements permit by — zz/_
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
�a
G�
f'
a'
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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P RMIT...... -yyn�1
Davie County Health Department r y;'
Environmental Health Section 1 51993
P. O. Box 665 M i
Mocksville, NC 27028 1 ��
1. Application/Permit Requested By D-(GC
Mailing Address /2?oC/c'SI/"u-'e, Q;()- �
Home Phone qq52- 7J 7cf Business Phone 9k - 7-� 7 g
2. Name on Permit if Different than Above
3. Application/Permit for: General Evaluation ❑ Septic Tank Installation
4. System to Serve: house ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown I $
5. If house, mobile home: Subdivision VLzl4/L .1�6&&d cJ Section Lot#7'
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms ['Washing Machine
No. of Bathrooms 7'� CDishwasher
Dwelling Dimensions [D-Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: ublic ❑ Private ❑ Community
8. Property Dimensions l A C.--4--- e-O 73 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes GKNo
If yes, what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
This is to certify that the information provided is correct to the bestoLmy knowledge, and I understand I am responsible for all charges
incurred from this application. 6 /, ����+
- `?',3 - Z�s
DATE SIGNATURE
CONSENT FOR SITE EVALUATION IQ @E DONE ON ABOVE DESCRIBED PROPERTY
Fand
ECK ONE: ❑ 1. I OWN the property. ❑ 2. I DO NOT OWN the property.
ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
ve consent to the authorized representative of the Davie County Health Department to enter upon above described
cated in Davie County and owned by
all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
al system.
DATE SIGNATURE
• ' DAVIE COUNTY HEALTH DEPARTMENT �ot
Environmental Health Section
\ Soil/Site Evaluation
NAME �� Q. N �` �'Z-S n DATE EVALUATED 3 93
ADDRESS �� 26 R>°�t 3 62 PROPERTY SIZE `S
PROPOSED FACIILTY o v s a LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By:C f I- Auger Boring Pit ✓ Cut
FACTORS 1 2 3 4
Landscape position L L
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture grOu2
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE (�
SITE CLASSIFICATION: EVALUATED BY:
LONG-TERM ACC E RATE: OTHER(S) PRESENT:
REMARKS: >
LEGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope
Texture
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty clay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay SIC-Silty clay C-Clay
CONSISTENCE
Moist
VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
Structure ,
SC-Single grain M-Massive CR-Crumb GR-Granular AB �ary
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralogy
1:1, 2:1. Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water` or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ftz
DCHD(01-9nl
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Appraisal Card Page 1 of 1
DAVIE COUNTY NC 9/11/2013 1:56:56 PM
HOWELL ANNA I HOWELL BRYAN D Retum/Appeal Notes: F7-060-AO-018
124 CANTON RD UNIQ ID 9482
7752000 D201-P30 ID NO:5860886186
COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1
eval Year:2013 Tax Year:2014 LOT 18 QUAIL HOLLOW SECTION II 1.000 IT SRC=Inspection
Appraised by 19 on 10/16/2008 07202 BALTIMORE TW-07 C- EX-AT- LAST ACTION 20110712
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE C
oundation-3 Eft BASE Standard 0.1800
ontinuous stem 5.00us MO Area UA RATE RCN EYB AYB CREDENCE TO MARKET r
r
ub Floor System-4 �
Ilywood 8.00 01101 11,9721 109 76.30 152713 199 199 %GOOD' 82.0'" DEPR.BUILDING VALUE-GRD 125,23
xterior Walls-10 TYPE:Single Family Residential Single Family Residential DEPR.OB/XF VALUE-GRD 1,00
Iuminum/Vln I Siding 29.00 MARKET LAND VALUE-GRD 30,00 „
ooFlng Structure-03 STORIES:1-1.0 Story TOTAL MARKET VALUE-GRD 156,23
able 8.0
Doting Cover-03 OTAL APPRAISED VALUE-GRD 156,23
%sphalt or Composition Shingle 3.0
OTAL APPRAISED VALUE-PARCEL 156,23
nterior Wall Construction-5
)rywall/Sheetrock 20.0
nterior Floor Cover-12 OTAL PRESENT USE VALUE-PARCEL
ardwood 10.0 OTAL VALUE DEFERRED-PARCEL
nterior Floor Cover-14 OTAL TAXABLE VALUE-PARCEL 156,23
-arpet 0.0
PRIOR
eating Fuel-04 BUILDING VALUE 129,48
lectric 1.0 BXF VALUE 3,00
eating Type-10 LAND VALUE 30,00
eat Pump 4.0 - PRESENT USE VALUE
Ir Conditioning Type-03 DEFERRED VALUE
entral 4.00 TOTAL VALUE 162,480
Bedrooms/Bathrooms/Half-Bathrooms
2/1 13.00
Brooms
AS-3FUS-0LL-O IWDD I
I I PERMIT
throoms 1 1 CODE I DATE I NOTE I NUMBER AMOUNT
AS-2FUS-0LL-O 2 2 r.
alf-Bathrooms I I
AS-IFUS-0LL-O +-------32-------+--12--+5+-----23-----+ ROUT:WTRSHD: T
ffice I B A S I FGD I SALES DATA
I I I FF, INDICATE
I I I ECORD DATE DEED SALES
OTAL POINT VALUE 105.00 1 1 1 BOOK PAGE M R TYPE PRICE '=
BUILDING ADJUSTMENTS I I I
Quality3 AVG 1.000 3 3 3 0110 153 9 199 WD Q I 12400
0 0 0 0117 524 12199 WO Q V 1500
ha a Desi 4 FACTOR 4 1.050 I I I 0190 153 9 199 Q V 12400
Size 1 3 1 Size 0.990 I I I
OTAL ADJUSTMENT FACTOR 1.04 I I 1
OTAL QUALITY INDEX 30 I I I
I I I
+-------31-------+ +-----23-----+ HEATED AREA 1,578
+FOP-----31------+ 6
+---18---+ NOTES
SUBAREA UNIT ORIG% ANN DEP No OB/XF DEPR.
TYPE GS AREA % RPLCS ODE DESCRIPTION LTH THUNIT PRICE GOND BLDG#L BAYS EYB RATE OV COND VALUE
AS 1,578 30 120401 10 ON PAVING 100 18 1,800 4.00 100 _ L 199 199 SS 10 72
GD 69 04 2372 5 ODD FENCE 0 0 200 8.70 100 _ L 199 1995 S5 10 17
OP 15 03 412 6 LFENCE 10 10.4 30 L 199 199 S I 10
DD 14 02 221 OTAL 08 XF VALUE 99
REPLACE 3-1 Story 2,25
Single
USAREA 2,56 152,71
OTALS
UILDING DIMENSIONS FGD=W23BAS=WSWDD=N12W12512E12$W44S30FOP-S5E31N5W31 E31S6E18N36 S30E23N30 .
NO INFORMATION
IGHEST THERADJUSTM EN TS TOTAL
ND BEST USE LOLL FRO N DEPTH/ LND GOND ND NOTES OA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND
SE CODE ZONING TAGS DEPT SIZE MOD FACT RF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES
FR RES 0100 0 0 1.0000 0 1.00001 1 30,000.00 1.000 LT 1.000 30 000.0 3000
OTAL MARKET LAND DATA 30,000
OTAL PRESENT USE DATA
I ( JI -3
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=F706OA0018 9/11/2013
(20Ac)
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<• APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By S�C�/� f"/�Z4,r ell
Mailing Address fle 7"&--1
Home Phone !���'�� Business Phone
2. Name on Permit if Different than Above
3. Application/Permit for: [KG eneral Evaluation ❑ Septic Tank Installation
4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot#
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: 2<Public /yt/ El Private ❑ Community
8. Property Dimensions 12y, 7 7 Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are su ject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
u,S,
Directions to Property:
X jP
( I Y `�
J� x;5 ps
- v
60' S
U�
J(y� a X
• Y" aC
45
This is to certify that the information provided is correct to th f my knowledge, and I understand I am responsible for all charges
incurred from this application. }
.14�7 (Z
DATE l SIGNATURE
FtaonCONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
d
ECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
ve consent to the authorized representative of the Davie County,Health Department to enter upon above described
cated in Davie County and owned by
all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
al system.
DATE SIGNATURE
DCHD(12-90)