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142 Winchester Road Lot 10•—A 0 U b b b DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION t !C n P.O. Box 848 urn 1� Q, r �• � �S�I'�- � Mocksville, NC 27028 Subdivision Name: /7 f/D/11 s / f/ f Phone #: 704-634-8760 -wectionstoproperty: *+.- +� Section: Lot: -I1Z- AUTHORIZATION FOR WASTEWATER Tax Office PIN:# ( SYSTEM CONSTRUCTION " �7 III & Z W%N r ad Name: k7t 011 b R-ip: a �d **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) ***NOTICEs** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED I RESIDENTIAL. SPECIFICATION: BUILDING TYPE _ # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL. WASTE: Yes or No LOT SIZE /�� TYPE WATER SUPPLY C'10 DESIGN WASTEWATER FLOW (GPD) P144 / NEW SITE_l� REPAIR SITE N SYSTEM SPECIFICATIONS: TANK SIZE _Zj?,b GAL. PUMP TANK GAL. TRENCH WIDTH �l ROCK DEPTH /� ' LINEAR FTJ" REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVTMENTPERMIT 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 DCH BY:— /p 9 Y: /00 c/+c/ 14TION NO. OPERATION PERMIT BY: DATE: �CE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE \,.E 1 I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A WHAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ed) (4,�,-, - 4 DAV COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST APPLICATION IP/ATC OSWW REPAIR Name O� /� (i S-�i IU Address 141 GiJQrc�f�L�PS�� Mailing Address (if different from above) Email Address: Subdivisiol Directions Telephone Number 35(, (-?CS�-000 L Date System Installed Name System Installed Under Type Facility Number Bedrooms �3 Number People Served Type Water Supply M1 /tifia Specific Problem Occurring I, In .1 // I i )/11', 1/'—l. r—fJl, s1 I. , 1— _ /7/1 . i 1 Irl L iir.v __Lti�/I ��:L.'.,r A"I//i/ Date Requested I --l-/ —1 7 ' Info Taken By (-P 0'�. 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 GJaA ITZ, 61V AUTHORIZATION NO: 056-6 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Per'mittee's�. /J P.O. Box 848 m Nae: / n SON- Mocksville, NC 27028 Subdivision Name: Phone #: 704-634-8760 Directions to property: Section: f Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION N Z V;NC/es4'paad Name: - 1i2G lip:- **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 a� ; IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pei�mltEee's Name:f"rJt�J"L'�. Subdivision Name:"�� c Directions to property: ( r- - ' ; Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# /� } A47— dill, N h 1- <._/ t- lT f: E��ad Name: E -'t 171 0 j 1 i U- '< Zip: **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/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 '' , -.s s /.ter! ,� t`` j �,•' 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��r,� # BATHS 1 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE J�i`�t TYPE WATER SUPPLY C O DESIGN WASTEWATER FLOW (GPD) �ht1 NEW SITE -4, --'REPAIR SITE 4 SYSTEM SPECIFICATIONS: TANK SIZE ' (_,GAL. PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH /Q LINEAR FNS , OTHER 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: JD9e qc) P AUTHORIZATION NO. os6� 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) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By j//C/G HNOLciZ$�/1/ Mailing Address a e Z2/-�✓,fA) Lit/ • Home Phone S492- % S % � MOCti.Sv7C) Q Business Phone � - .2 2. Name on Permit if Different than Above 3. ,Applicatlon for: General Evaluation Septic Tank Installation Permit 4.: System to Serve: HouseS ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ' `❑,,Other ❑ Unknown 64L5.: If house, mobile home: Subdivision f �oZ9' �(O ' �'" -P&t� Section Lot # Ad ❑ Basement/Plumbing G-r.[.cJ CLUB . No. of People ❑ Basement/No Plumbing c� (J,r}LZL,i�O� No. of Bedrooms � _ ❑Washing Machine No. of Bathrooms _ ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: No. of People Served No. of Commodes No. of Lavatories No. of Showers Specify type No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property Dimensions ..60 77S - 3 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? `NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements �ermits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: /s`$ 7-0 G-z.r,v G�u!3 ��Ic%'� /S fl,000u iMTiG�/ mics ,✓e1G7q 7 0,0,!EE�J job This is to certify that the information provided is correct to the incurred from this application. �- 2 25- DATE my knowledge, and I understand I am responsible for all charges SIGNATURE CONSENT OR SITE EVALUATION TO BED NE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by.the owner: I hereby give consent to the authorized representative of the Davie County Health Department to, enter upon above described property located in Davie Clounty and owned by Lo f-/� �- :- rr►/ S c to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. g- E_� DATE SIGNATURE DCHD (1193) DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section�� S ite Evaluation Uf NAME ��/� •sS' d W ADDRESS PROPOSED FACIILTY DATE EVALUATED _V,,1_ZZ 4 PROPERTY SIZE �-/ LOCATION OF SITE Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit L/ Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH -r- �1 �- Texture group Consistence Structure Ir Mineralogyl ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 2 , SITE CLASSIFICATION: _ D`'1 EVALUATED BY: 2 & !d LONG-TERM ACCEPTANCE RATE: y OTHER(S) PRESENT: REMARKS: LEGEND Landscave 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 :lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Vc-y 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 ,3C --Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralo¢y 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/ft2 DCHD (01-901 Q ealth Depart_ment,�„�.�.-- --- 9 p1 6 Ener m Health S666- , n c_ t' ' FEB Box 848 HoStreet pital ', _ �i �JZ Rl hFP! t =! O '� EN��ROt.Pti E, } h ; . t�ouner : 09-40-06 y U Y ocksville, NC 27028 ��yi�ONMENTAL NEI�t7 tom-, DMIE COUNTY Phone: (336) - 751- 8760 Fax: (336) - 751- 8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement ❑ Remodeling Reconnection ❑ Name: , Tc) F? 6 Leon 2 Phone Number 336' q R $ - Q 2 U -L(Home) Mailing Address: 14-2- W j n cbeS-k r Rd (0 `Q Q $-02 62- (Work) Adyc,nce kjL 2700(o Detailed Directions To Site: 40 ra4. Z 9 al i l e. c � rn rLQ kr aN+y ��-,, n C' lub BOAS 6 v \' MX e � miles i -u rru Property Address: /�/2 Lr/;�t��Site� R4 AAVAAP& �'_ ZXQQ(, Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: i�l 6� /�c-l'o fs IIJ Type Of Facility: goes e Date System Installed (Month/Date/Year): Number Of Bedrooms:-2—Number Of People: Is The Facility Currently Vacant? Yes ❑ No ❑ If Yes, For How Long? Any Known Problems? Yes ❑ No ❑ If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: �" ^ u ' 6 Requested By: (SiE, ° red' ApprovedDisapproved El / Corrunents: ) Environmental Health Specialist—' Number of People. Date Requested:_ For Environmental Health Office Use Only _/ )Ci 2;1171 *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) th;t the on-site wastewater system will function properly for any given period of time. Payment: Caasyh D Check' 2 Money Order ❑ # 116W Amount:$ 490, UD _Date:, L/ Paid By: `�/ , ��eDii%Q/ Received By: • j Account #:� I� Invoice #:Q g Appraisal Card, , Page 1 of 1 vte P-- ur 3/6/2013 9:29:28 AM LEONE JOSEPH S LEONE KRISTINE A Retum/Appeal Notes: E7 -060-A0-010 142 WINCHESTER RD UNIQ ID 7038 5522000 D199 -P22 ID NO: 5871062197 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 eval Year: 2013 Tax Year: 2013 LOT 10 HUNTERS POINTE 1.000 LT SRC- Inspection Appraised by 19 on 11/04/2008 03007 BEAUCHAMP RD TW -03 C- EX- AT- LAST ACTION 20121015 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE Foundation - 3 Eff. BASEII Standard 10.16000 ontinuous Fcoting 5,00US MO Area QUA RATE RCN AVB CREDENCE TO MARKET ub floor System - 4 01 01 11,886110 6 74.20 142191 199 199 %GOOD 84.0 DEPR. BUILDING VALUE - CARD 8.0 119,440 I ood Merlor Wails - 10 TYPE: Single Family Residential Single Family Residential DEPR. OB/XF VALUE - CARD 22,61 Iuminum/Vin I Siding 29-OCSTORIES: 5 - Ranch w/ basement MARKET LAND VALUE -CARD TOTAL MARKET VALUE - CARD 40,00 182,05 oofing Structure - 03 able 8.0 oofing Cover - 03 TOTAL APPRAISED VALUE - GRD 182,05 ksphalt or Composition Shingle 3.0 TOTAL APPRAISED VALUE - PARCEL 182,05 nterior Wall Construction - 5 )rywall/Sheetrock 20.0 ntenor Floor Cover - 08 TOTAL PRESENT USE VALUE - PARCEL heet Vinyl/Laminate 6.00 TOTAL VALUE DEFERRED - PARCEL nterior Floor Cover - 14 TOTAL TAXABLE VALUE - PARCEL 182,05 'arpet 0.0 PRIOR eating Fuel - 04 BUILDING VALUE 122,22 Iectric 1.0 BXF VALUE 29,64 eating Type - 10 ND VALUE 50,00 eat Pump 4.0 RESENT USE VALUE Ir Conditioning Type - 03 EFERRED VALUE entral 4.00 rOTAL VALUE 201,86( 3edrooms/Bathrooms/Half-Bathrooms --\ 12.00 \ 5-0LL-O s PERMIT S - 0 LL - 0 CODE DATE NOTENUMBEINT VALUE 100.00BUILDING ADJUSTMENTS OUT: WTRSHD: 3 AVG 1.000 Vha/Desig� SALES DATA esi 4 FACTOR 4 1.050 +12-+ FF. INDICATE 1WDD1 3 Size 1.010 ECORD ATE DEED SALES 2 OJUSTMENT FACTOR 1.06 + 8 - + 8 4 - 1 4 - ++8-+--22--+ + - - - - - 4 0 - - - - - + OOK PAGE M R TYPE / / PRICE ALITY INDEX 10 I B A S 1 I U B M 1 0191 66 12 199 WD Q V 1300 I 0 I I 0206 783 10199 V 2 +--24---+ 2 2 8 IFGD I a8 I 2 2 I I I 0 0 I I ----+--24---+ +-----40-----+ HEATED AREA 1,388 +FOP+ +10+ +10+ NOTES FENCE LOCKED IN BACK YARD SUBAREA UNIT ORIG I ANN DEP % OB/XF DEPR TYPE GS AREA % RPL CS ODE )ESCRIPTION LTH WT. LINITJ PRICE COND BLDG# L/B AYB EYB RATE OVA COND VALUE BAS 1,38 10 10299 30 ON PAVING 75 18 1,350 4.00 100 _ L 199 1997 5 20 108 5 OOD FENCE 0 0 250 8.70 100 _ L 199 199 Ss 20 43 GD 48 04 1602 237 10 ON PAVING 24 8 19 4.00 100 _ L 199 199 S 2 15 OP 9 03 BM 1 12 02 16621 1 TORAGE 1 2 28 15.0 10 _ L 001 001 S 2765 DD 12 02 192 8 OL/VINYL 3 1 64 37.4 TOTAL OB/XF VALUE L 00 00 5 7 1817 22,610 3 - 1 Story FIREPLACE Single 2,25 142,191 UBAREA 3,20d I OTALS BUILDING DIMENSIONS BAS=W22 WDD=NlOW12S12E4N2E83 W8S2W18N2W8S2WB S28EJO FOP=S2ElOS3EION3ElON2W30S E30 FGD=N20 E24S2OW24$ N20E24NIO$ PTR=E15 BM=E40S28W40N28 W15$. LAND INFORMATION IGHEST TMER ADJUSTMENTS TOTAL ND BEST USE LOCAL FRON DEPTH/ LND I COND AND NOTES ROAD LAND UNIT LAND LINT 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 40,000.0 1.00 LT 1.00 40,000.0 4000 OTAL MARKET LAND DATA 40 00 )TOTAL PRESENT USE DATA I I I 1 1 http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=E706OA0010 3/4/2013