217 Longwood Drive Lot 49E
f
• ` • DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account M 990001597 Tax PIN/EH #: 5861-59-4820
Billed To: Marquis Building Subdivision Info: Redland Lot # 49
.Reference Name:. Location/Address: 217 Longwood Drive -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3238
AUTHORIZA'T'ION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatmen nd Disposal Systems), THIS
AUTHORIZATION FOR WASTEW EIEC -9 TR ION IS ALI FOSRIOD OF FIYEARS.
2
Environmental Health Specialist's Signature: l`' 1e: z
CERTIFICATE O
* * N OTE. * * The issuance of this Certificate of Completion shall nd
has been installed in compliance with Article 11 of .S
Disposal Systems," but shall in NO WAY be t en s a
given period of time..-,,;
.lk r►J
Septic System Installed By:
lEnvironmental Health Specialist's Signature
DCHD 05/99 (Revised)
NIPLETION
tpl of � I'rJ
system described on Improvcm
130A, Section .1900 "Sewage
e that the system will function
L1ol
��=> t
73�
Date: 12
t/Operation Permit
eatment and
isfactorily for any
�� 1..3 u:= cu_
• DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001597 Tax PIN/EH #: 5861-59-4820
Billed To: Marquis Building Subdivision Info: Redland Lot # 49
Reference Name: Location/Address: 217 Longwood Drive -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3238
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatmen nd Disposal Systems). THIS
AUTHORIZATION FOR WASTEW TR ION IS ALI FO PERIOD OF FI YEARS.
Environmental Health Specialist's Signature: e:C-S
CERTIFICATE O
**NOTE** The issuance of this Certificate of Completion shallfind
has been installed in compliance with Article 11 ofS
Disposal Systems," but shall in NO WAY bet en s a
given period of time. �o
7X itJ
ETION
system described on Improvement/Operation Permit
130A, Section .1900 "Sewage Treatment and
e that the system will function satisfactorily for any
Septic System Installed By:
Environmental Health Specialist's Signature
DCHD 05/99 (Revised)
Date: 12 llklD2_
DAVIE COUNTY HEALTH DEPARTMENT
t Environmental Health Section
P. O. Boz 848/210 Hospital Street
• Mocksville, NC 27028 3
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001597 Tax PIN/EH #: 5861-59-4820
Billed To: Marquis Building Subdivision Info: Redland Lot # 49
Reference Name: Location/Address: 217 Longwood Drive -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3238
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type�` `U1�' #People #Bedrooms q #Baths
Dishwasher: 111" Garbage Disposal: ❑
Commercial Specification: Facility Type
Washing Machine: u Basement w/Plumbing: ❑ Basement/No Plumbing: e
#People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water SupplyLo—ilyDesign Wastewater Flow (GPD) Yana Site: New Repair ❑
System Specifications: Tank Size 112AL. Pump Tank GAL. Trench Width �• 1 Rock Depth ) 2 "Linear Linear Ft. qcol
qOther: bI-6Ti2/&rlolj Zcg , VA)CS / A,(.InJ.
Required Site Modifications/Conditions: %1s�qu. Di^l C�11 %� �, le l' �S 4 /�`t�y�% ACL -7'„ /0 felf
Li4-,�
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Al
Environmental Health Specialist's
DCHD 05/99 (Revised)
r�� .49
Date: fZv
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & A
Davie County Health Department
' AU[7"$ 27-1)Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 ENVIRONI?ENML HEALTH
(336) 751-8760 AVIE MUN?Y
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed AA&(L, Contact Person
Mailing Address + O. 21 n.� Home Phone - (g j
City/State/ZIP 'Z tVa Business Phone S G - 3 (Sg
2. Name on Permit/ATC if Different than Above
Mailing Address
City/State/Zip
3. Application For: ❑ Site Evaluation & Improvement Permit/ATC ❑ Both
4. System to Service: iw House ❑ Mobile Home El Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms_ # Bathrooms 2112 -
If Dishwasher 1.1 Garbage Disposal tls Washing Machine CI Basement/Plumbing A Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: 8 County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes I No
If yes, what type?
'IMPORTANT*** CLIENTS AfUSTCOMPLETCTHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: j 2 3 Z7S
Tax Office PIN: # 5296 169 4520
Property Address: Road Name 2
City/zip AoiitJCE NC 7,)Db(p
If in a Subdivision provide information, as follows:
Name: 1�E 0 L J 9 WAI
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
4\04 e--,
hFe4J5
Lem'
Section: Block: Lot: 49 Date Property Flagged: -el7,-
This
This is to certify that the information provided is correct to the best of my knowledge. I understand tha any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and own by
to conduct all testing proceduges as necessary to determine the site suits '1 ty. / q/ 1717
DATE 1S 1 1 1 61-1, SIGNATURE Pr {l
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existingland proposed
property lines and dimensions, structures, setbacks, and septic locations).
C)4L WA"A RZADY
Revised DCHD (07/99)
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. r ::� 7 7
Invoice No.L
.r
APPLIC:AIION FOR SIIE EVALUAIiON/IMPIIOVEMENT PERMIT & ATC
• Davie County Health Department
` Environmental Health Section
P.O. Box 848/210 Hospital Street
Mockaville, NC 27028
(336) 751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE, PROCESSED UNLESS ALL
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for
1. Name to be Billed
Mailing Address iZ,5 k d 19
City/state/EIP U/Y,
2. Name on Permit/ATC if Different than Above
Mailing Address
Contact Person
Homs Phone
E�
Business Phone
City/stag/Zip
JUN t 4 2i;Jl l
RE6111RED
truatNME
.. _•OMNIY
3. Application For:
0/Site Evaluation
❑ Improvement
Permit/ATC
0 Both
4. system to services
O�House D Mobile Home
0 Business
D Industry
0 Other W�• .•
5. If Residence: i People
1 Bedrooms
❑ Dishwasher ❑ garbage Disposal ❑ washing Machine
6. If Business/Industry/Others specify type
1 Commodes f Showers
❑ Basement/Plumbing
/ people _
1 Urinals
1 Bathrooms
❑ Basement/No Plumbing
I sinks
Yater Coolers
IF FOODSERVICE: # Seats Estimated water Usage (gallons per day)
7. Type of water supply: bounty/City ❑ Well 0 Community
e. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes 0 No
If yes, what type?
""IMPORTANT"* CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions:. rc15 WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: it --5-3 F14-54 Pj-t7l)P)�J PILI
Property Address: Road Name IlZaLl 5J,
City/Zip _A111f41led , Al -e , 91—ttt
If in a Subdivision provide Information, as follows: — — %—�,`� 4- /3�:6;1
Name: P c( �� n-
Section: Block: Lot: Date Property Flagged:
This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plans or Intended use change, or if the information
submitted In this application Is falsified or changed. I, also, understand that I am responsible for all charges Incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located In Davie County and owned by
to conduct all testing procedures as necessary to determine the site sults tlity. :
DATE — Y/SIGNATURE - - THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
u
Site Revisit Charge
Date(s):
Client Notlflcation Date:
I EHS:
Account No.
Revised DCHD (07/99) Invoice No.
' - DAVIE COUN'T'Y HEALTH DEPARTMENT
f Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #: 989900136
Billed To: Westview Development Co.
Reference Name:
Proposed Facility: Residence Property Size:
PROPERTY INFORMATION
Tax PIN/EH #: 5861-59-5239.49
Subdivision Info: Redland Lot # 49
Location/Address: USHighway 158-27006 1
see map Date Evaluated:
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L
Slope %
HORIZON I DEPTH
D 2
Texture group
Consistence
` S
Structure
Mineralogy
HORIZON II DEPTH
Texture group}
Consistence
Structure
<
MineralogyI
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
0 -
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS: PW 1 0' 47— V a:0
M
EVALUATION BY: cJ CCP T��A 4,1011
OTHER(S)/PRESENT: _
Landscape
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 ABK - Angular blocky
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/ft2
DCHD 05/99 (Revised)
Easem en t
v
0
15'
N 86'44141 „
W
N
2 74.96'
Typical Setbacks
0 N
Interior Lot
N
49
`—
30'177J
33,874 sq. ft.
0.778 Ac.f
1 5v
N86.447-- w1`—
0
2 74.9 7'
ca
W
sq:d-
AC'. o
. 0
O
050
379552 sq. ft.
0.862 Ac.f
N 86'44 41 "
274.25'
CE)
�D
0)
N
rei 13 U
� O �
LO
'
00
O 10' Public Utilities
c0
coj
cfl }
w
Iin
r -
n
0
asement
43� 42
27y.57'
O
0
F--
m
LO
43� 42
27y.57'
Appraisal Card
DAVIE COUNTY, NC
Page 1 of 1
3/6/2013 10:23:06 AM
ATTLES JEFFREY W BATTLES DIANE Retum/Appeal Notes: D7 -080 -AO -049
17 LONGWOOD DR UNIQ ID 4596
2520092 PHOTO ID NO: 5861594820
COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 Of 1
eval Year: 2013 Tax Year: 2013 LOT 49 REDLAND WAY PHASE I 1.000 LT SRC- Inspection
%ppraised by 19 on 04117/2008 03108 REDLAND WAY TW -03 C- EX- AT- LAST ACTION 20110712
CONSTRUCTION DETAIL
MARKET VALUE
DEPRECIATION CORRELATION OF VALUE
oundation - 3
EN
BASEStandard
10.11000
ontinuous Footin 5.00
USE MO Area
OUA
RATE
RCN EYB
AYB
REDENCE TO MARKET
ub Floor System - 4
PI wood 8.00
011 01 3,1281
102 71.40
224838 2002
2002
% GOOD 1 89.0 EPR. BUILDING VALUE - CARD 200,11
xterlor Walls - SO
TYPE: Single Family Residential Single Family Residential EPR. OB/XF VALUE - CARD 3,30
I I Siding 29.02STORIES:
ARKET LAND VALUE - CARD 36,00
3 - 2.0 Stories OTAL MARKET VALUE - CARD 239,41
e
tooting Structure
oofing Structure - 06
rregular Cathedral 13.0
TOTAL APPRAISED VALUE - CARD 239,41
oofing Cover - 03
s halt or Composition Shingle 3.00
TOTAL APPRAISED VALUE - PARCEL 239,41
nterior Wall Construction - 5
)rywall/Sheetrock 20.0
OTAL PRESENT USE VALUE -PARCEL
OTAL VALUE DEFERRED -PARCEL
nterior Floor Cover - 12
ardwood 10.0c
OTAL TAXABLE VALUE - PARCEL 239,41
nterior Floor Cover - 14
et O.Oc
PRIOR
3UIUDING VALUE 222,19
eating Fuel - 04
lectric 1.0
BXF VALUE 4,44
AND VALUE 36,00
eating Type - 10
eat Pump 4.
RESENT USE VALUE
DEFERRED VALUE
it Conditioning Type - 03
entral 4.00
6 6 rOTAL VALUE 262,63
+--22---+ +-14-+
3edrooms/Bathrooms/Half-Sathrooms
2/1 13.00
I FUS 1
1 I
7 2
rooms
- 0 FUS - 3 LL- 0
1 4 PERMIT
+7-+ +7-+ I CODE DATE NOTE NUMBER AMOUNT
throoms
AS-0FUS -2LL- 0
6 6 1 I
+8+ 1 +-14-+
alf-Bathrooms
3 +6+ OUT: WTRSHD:
AS - I FUS - 0 LL - 0
+-15--+ SALES DATA
FF.
+-14-+ INDICATE
+-9-+6WDD 1 ECORD ATE DEED SALES
R TYPE / / PRICE
OOK Rd
+9-+ ++ 2 0463 046 1 00 WD Q I 23900
+--22---+BAS +-14-+ +--21---+-14-+
I F G D I I I FBM I B F G i 0428 122 7 00 W D Q V 3500
I I I I I I 0382 230 8 001 WD C V
OTAL POINT VALUE 110.00
BUILDING ADJUSTMENTS
Quality3 AVG 1.000
ha /Desi 4 FACTOR4 1.050
Size 3 Size 0.890
OTAL ADJUSTMENT FACTOR 0.93
OTAL QUALITY INDEX 10
2 2 2 1 2 2
4 4 4 3 4 4
I I I 0 I I
I I I I I I
+--22---+ +-14-+ I +-14-+ HEATED AREA 3,182
6 +6+ 6 I +6+
+-15--+FOP20-+ +-15--+ NOTES
SUBAREA UNIT I ORI % ANN DEP % OB/XF DEPR
TYPE GS AREA % RPL CS OjCRIPTIO LT H NIT PRICE GOND BLDG B AYB EYB RATE V GOND VALU
AS 1,08 10 7754 10 PAVING 2 6 1,20 4.0 _ L 00 00 S 4 216CC
FG 33 03 842 1RAGE1 10 15.0 L 00 00 S 7 114
8M 60 04 1949 O/XF VALUE 3,30
GD 52 04 1699
OP 10 03 271
US 1490 09 9574
DD 16 02 242
2 - Pre
IREPLACE 1150
Fabricated
UBAREA
4,32 24,83
OTALS
UILDING DIMENSIONS WDD=N12W14S12E14$ BAS=W14N6W3N2W9S2W9S6 FGD=W22S24E22N24$ S30EI5 FOP=E2ON6W14S2W6S4$ N4E6N2E14N24S PTR=E15
SM=530El5N4E6N2 BFG=E14N24W14S24 N24W21 WISN25 FUS=N24WI4N6W2156 W22SI7E7S6ESN6E7SI3EISN4E6N2EI4 S25$.
NO INFORMATION
IGHEST
THER ADJUSTMENTS
TOTAL
NO BEST
USE
LOCAL
FRO N
DEPTH /
LND
Co..
ND NOTES
LAND UNIT LAND UNT
TOTAL ADJUSTED LAND LAND
SE
CODE
ZONING
TAGE
EPT
SITE
MOD
FACT
RF AC LC TO OT
PEPCEUNITS
FA
TYP
ADJSTUNIT PRICE VALUE NOTES
FR RES
0100
0
0
1.0000
0
1.0000
W
36 000.0 1.00 LT
1.000 36 000.0 3600
OTAL MARKET LAND DATA 36,00
OTAL PRESENT USE DATA I I I I
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=D708OA0049 3/6/2013
18 r�N
Phone: (336) - 753 - 6780
Davie County Health Department
Environmental Health Section
P.O. Box 848
PAIS 210 Hospital Street
Courier #: 09-40-06
D ocksville, NC 27028
Date:
RE
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
Fax: (336) - 751- 8786
Name: // lauerPhone// Number (33(.) SVS- /dS� _(Home)
Mailing Address: /// Loh b f�Jt— (Work)
AA'UGLrt N G d 700 Email 112 er e 6' 17 d 40S , Orli
Detailed Directions To
Property Address:
Please Fill In The Following Information.About The EXISTING Facility:
Name System Installed Under: � 11 " (,il 41 ld Type Of Facility: &(tsp
Date System Installed (Month/Date/Year): Q Q31 Number Of Bedrooms: Number Of People: 3
Is The Facility Currently Vacant? Yes
Any.Known Problems? Yes L:.%
0 If Yes, For How Long?
If Yes, Explain:
Please Fill In The F 11 in Information About The NEW Facility:
Type Of Facility: Number Of Bedrooms: Number of Peopl
Requested By: Lul Date Requested:
(Signa
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Payment:
Paid By:_
Account #:
Money Order #
_Amount:$ 0 ��0 Date: �r
Received Ey: