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111 Brookdale Dr Lot 10 Section 2- CONSTRUCTION For Office Use Only * AUTHORIZATION *CDP File Number 121455-1 Davie County Health Department County ID Number: -•�•� � EB -100-80015 4 fQ 210 Hospital Street Evaluated For: EXISTING P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 1/ 0 1/ 0 0 0 6 Applicant: Mike Holcomb Property Owner: Mike Holcomb Address: 111 Brookdale Dr. Address: 111 Brookdale Dr. City: Advance City: Advance State/Zip: NC 27006 State/Zip: NC 27006 Phone #: (336) 998-9692 Phone #: (336) 998-9692 Property Location & Site Information Address/Road 4. Subdivision: Greenwood Lakes - Phase: 2 Lot: 10 4 111 Brookdale Dr - - - Advance NC 27006 Directions Structure: SINGLE FAMILY 1-40 East, exit Hwy 801 turn right, going south. Left onto Underpass Rd. Right on Oakbrook Dr. Home on Left # of Bedrooms: 3 comer of Oakbrook and Brookdale. # of People: -Water Supply: PUBLIC / Pagel of 3 Minimum Trench Depth: Site Classification: Inches Minimum Soil Cover. Saprolite System? OYes ONo Inches Design Flow: Maximum Trench Depth: 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: GPM—vs-- ft. TDH ft Trench Spacing: _ Inches O.C. Feet O.C. Dosing Volume: Gallons Trench Width: Inches 817eet _ Grease Trap: Gallons Aggregate Depth: inches - - - Pre -Treatment: ONSF OTS -I OTS -II Septic Tank Installer Grade Level Required: OI Oil 0111 OIV Pagel of 3 CDP'File Number 121455-1 County ID Number: EB -100-B0015 Q Open Pump System Sheet Repair System Required:OYes ONO ONO, but has Available Space rDesign System Trench Spacing: Q Inches 0. . ification: — 9 o Feet O.C. Trench Width: Inches w: 3 6 0 _ 3 6 Feet Soil Application Rate: 0 Aggregate Depth: - 3 inches Minimum Trench Depth: *System Classification/Description: Inches TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. Inches Maximum Trench Depth: *Proposed System: 25% REDUCTION Inches Maximum Soil Cover: Nitrification Field Inches Sq. ft. No. Drain Lines "Distribution Type: GRAVITY - PARALLEL (eq. d -box) Total Trench Length: 1 0 0 ft Pump Required: Oyes ONo OMay Be Required PreTreatment: 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, "the site Is altered. the permit or Construction Authorization 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, 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- Authorized 244- Authorized State Agent: Date of Issue: 0 5/ 0 9% 2 0 1 3 Malfunction Log Oyes OHand yawing OlmportDrawing Total Time:(HHa,IM) **Site Plan/Drawing attached.** O 1 Hours 0 0 Lt inutes Page 2 of 3 S-10 - CA'S issued - repair CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 121455 -1 79n 4J-*.f�f Cf-f DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST ` APPLICATION IP/ATC OSWW REPAIR %Z-269( Name 19Telephone Number 9.9(x/7 Address / % / e- 7 u 644 AA 5 Mailing Address (if different from above) Email Address: M6,1161COm hoo - /DODO 2 Subdivision Name Lot # p A Directions- , W S ON 6222 `G 2. Date System Installed Name System Installed Under Me- Type Facility 1h La -e-- Number Bedrooms 3 Number People Served Type Water Supply Specific Problem Occurring�l' ate iequested I Info Taken By THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason Revised 2-2011 apo X21#65• AI THORIZATION NO: 16 a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permiitee's /� P.O. Box 848 Name: �,� i .� !� lL�! Mocksville, NC 27028 Subdivision Name: it re—e—yj )Qat Lnh� /� Phone #: 704-634-8760 Blo Directions to property: /�/� Ire., f�7/ ' �f Seet3e�� Lot: AUTHORIZATION FOR . '�,✓ �lj;' WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION Road Name: I'00 dC e- Zip: 0�(O **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee s, ,1 Name:{f�C? ,� f' ,f''' Subdivision Name: CS'Y'C-E.}1 U�OD�. l �X r p p_ y: �� fr, ;, i''" % ' ' ,1,- eclac- Direction�to ro ert �. /" /'. Section- � Lot: IMPROVEMENT PERMIT Tax Office PIN:# - - Road Name:8iookda IC -PZ. � P� **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the eonstructian/installation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) • ✓ . ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE .`x ,t"` , ,. F P °r f '� `� PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS —tet # BATHS # OCCUPANTS --7 GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No �5�5')NEW LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. 175-4 A, 1�1?0 � OTHER '1 f / /Z,'-'"' 0 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "CONTACT A REPRESENTATIVE OF THE DAVIE 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 (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: 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 05/96 (Revised) 1 DAVIE COUNTY HEALTH"DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION a Permritee's Name. '�' _L, ` •'r ?' � �-/ Subdivision Name: t0or"r'(_ r7 ,a Directions to property: . i f �` { ` �' Seetiorr �� Lot: IMPROVEMENT f' PERMIT Tax Office PIN:# Road Nae: e: A-0Okd cl � ' P_ Z': p: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction mstallation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section'. 1900 Sewage Treatment and Disposal Systems) • J' , �.M " /�;�� ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE -�_=== PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE #BEDROOMS __7F #BATHS --5 # OCCUPANTS GARBAGE DISPOSAL: Yes or No f5 i COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 's ; " NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH e � LINEAR FT. 1:5 -4 - OTHER OTHER 1 T RP(ITTTRPn CTTP MhnTPTrATT0NC/fY1NT)moNC- e - 4 IMPROVEMENT PERMIT LAYOUT f s i **CONTACT A REPRESENTATIVE OF THE DAVIE 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 (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: 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 NOWAY BETAKEN ASA . GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) • DAVIE COUNTY HEALTH DEPARTMENT V (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Di posal System - G.S. Chapter 13P -Article 13C) OWNER OR CONTRACTOR4 ik oW-eIt'l A DATE PERMIT LOCATION N° 1514 S.R. NO. SUBDIVISION NAME 1 "' LOT NO. SECTION OR BLOCK NO. HOUSE MOBILE HOME ❑ BUSINESS ❑ N0. BEDROOMS _._3_ N0. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO ❑" AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES ❑ NO ❑ SITE SUITABLE YES ❑' NO ❑ SIZE OF TANK gal - NITRIFICATION FIEL sq. ft. DEPTH OF STONE IN LINES: , WATER SUPPLY: Individual ❑ Pu 13c IMPROVEMENTS PERMIT BY ,t House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. r ' INSTALLED BY CERTIFICATE OF COMPLETION By`a/ Date (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA DAVIE COUNTY HEALTH DEPARTIMENT P. 0. BOX 57 HOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and'/o.r Site Evaluations NAME DATE ISSUED ADDRESS PERMIT NO. Explanation of charge AMOUNT DUE SANITARIAN I PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT. Appraisal Card .. Page 1 of 1 5/6/2013 9:54:59 AM HOLCOMB MICHAEL C HOLCOMB KRISTA Retum/Appeal Notes: E8 -100 -BO -015 111 BROOKDALE DR UNIQ ID 7347 36258000 D145 -P4 ID NO: 5871843608 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 Reval Year: 2013 Tax Year: 2013 LOT 10 GREENWOOD LAKE SECTION TWO 1.000 IT SRC= Inspection Appra by 19 on 04/23/2008 03207 UNDERPASS TW -07 C- EX- AT- LAST ACTION 20120502 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE ndation - 3 Standard 0.2400 AYB ntinuous Footing5.0 US MO Eff. Area UA BASE RATE RCN EYB CREDENCE TO MARKET b Floor System - 4 Plywood 8.0 01 01 12,18711 9 90.30 20084 198 197 % GOOD 76.0 DEPR. BUILDING VALUE - CARD 152 64 erlor Walls - 15 TYPE: Single Family Residential Single Family Residential [B.0'ard DEPR. OB/XF VALUE - CARD 1,13 & Batten 12' /L 31.0 MARKET LAND VALUE - CARD 47,50 o0ng Structure - 06STORIES: 5 - Ranch w/ basement OTAL MARKET VALUE - CARD 201,27 ular/Cathedral 13.0ofing Cover - 03 s halt or Composition Shingle 3.00 TOTAL APPRAISED VALUE - CARD 201,27 nterior Wail Construction - 5 OTAL APPRAISED VALUE - PARCEL 201,27 )rywall/Sheetrock 20.0 nterior Floor Cover - 12 TOTAL PRESENT USE VALUE - PARCEL ardwood 10.0 OTAL VALUE DEFERRED - PARCEL nterior Floor Cover - 14 TOTAL TAXABLE VALUE - PARCEL 201,27 :arpet 0-00+--____-30---__-------22-----+ PRIOR eating Fuel - 04 I U B M I B F G I lectric 1.00 I I I UILDING VALUE 165,66 Heating Type - 10 = I I BXF VALUE 1,88 eat Pump 4. EC 2 2 2 LAND VALUE 47,50 Ir Conditioning Type - 03 6 6 6 PRESENT USE VALUE entral 4.00 1 I I DEFERRED VALUE Bedrooms/Bathrooms/Half-Bathrooms I I I TOTAL VALUE 215,04( /2/0 12.00C I I I Bedrooms I I I -------- 30...____+....22___..- AS-3FUS -0LL-O athrooms PERMIT AS - 2 FUS - 0 LL - 0 CODE I DATE I NOTE I NUMBER AMOUNT fflce + - 1 1 - - + I OUT: WTRSHD: OTAL POINT VALUE 1111.00 I FSP I I BUILDING ADJUSTMENTS I I I SALES DATA Quality4 ABAVG 1.200 I 1 I FF. INDICATE Ize 3 Size 0.970 1 1 1 3 RECORD DATE DEED SALES ha a Desi 3 FACTOR 3 1.000 B B I I D BOON PAGE M R TYPE // PRICE 0565 727 8 0 WDI Q I 1 1 19000 OTAL ADJUSTMENT FACTOR 1.16 I I I OTAL QUALITY INDEX 12 + - 1 1 - - + I IBAS I I I I I 4 +5-+--------37---------+ HEATED AREA 1,744 1 6UOP +----21-----+5-+ NOTES SUBAREA UNIT ORIG % ANN DEP % OB/XF DEPR. TYPE GS AREA % RPL CS ODE DESCRIPTIO LTH H NIT PRICE COND BLDG#L/B AYB EYB RATE V CONDI VALUE BAS 1 74 10 15748 9 SP PAVING 5 2 1,2501 3.0 10 L 1994119991 S51 13 112 3FG57 03 1806 OTAL OB XF VALUE 1,125 FSP 19 04 713 BM 76 02 1408 OP 3 0251 72 4 - 2 Story Single/1 Story FIREPLACE Double 3,36 SUBAREA 3,32 00,84 TOTALS BUILDING DIMENSIONS BAS=W52S2FSP=W11S18EI1N18 S18W11S14E21UOP=N6E5S6W5 N6ESS2E37N30 PTR=N10 BFG=N26W22UBM=W3OS26E30N26$S26E22 S10$. LAND INFORMATION IGHEST 0THER ADJUSTMENTS TOTAL ND BEST USE LOCAL FRON DEPTH/ LND I COND AND NOTES RDA LAND UNIT LANDUNT TOTAL ADJUSTED LAND LAND SE CODE ZONING TAGE 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 1.0000 47,500.0 1.00C IT 1.00 47,500.00 4750 1 1.00 OTAL MARKET LAND DATA 47,50 OTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E8100B0015 5/6/2013