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116 Bills Way Davie County, NC Tax Parcel Report Friday, September 23, 201 f r I r i r r r r r Ir tti I I I I ' J ti --x i 116 Z J tD , i t i I ` BILI SWAY �I z. Z. ........__...................._......_..................._ _ __..._._._._._......_._.._._... _ -- -----_...---... _._............._..............._............... ...__ ..................._...._...__.........................._._.........................._............... WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: D60000004002 Township: Farmington NCPIN Number: 5862031553 Municipality: Account Number: 82532100 Census Tract: 37059-802 Listed Owner 1: - HUTCHENS BILLY SCOTT Voting Precinct: FARMINGTON Mailing Address 1: 116 BILLS WAY Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006-6649 Voluntary Ag.District: No Legal Description:. 1.01 AC RAINBOW RD N OF Fire Response District: SMITH GROVE Assessed Acreage: 1.01 Elementary School Zone: PINEBROOK Deed Date: 7/2010 Middle School Zone: NORTH DAVIE Deed Book/Page: 008310250 Soil Types: MsB Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 109290.00 Outbuilding&Extra 0.00 Freatures Value: Land Value: 22100.00 Total Market Value: 131390.00 Total Assessed Value: 131390.00 All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of Davis.North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �'oCty C NC or arising out of the use or Inability to use the GIS data provided by this website. Davie County Health Department brN18 EnvironmentalHealth Section P.O. Box 848 C 210-Hospital Street Courier# : 09-40-06 1911 Mocksville, NC 27028 Phone:(336)-.753-6780 ON-SITE WASTEWATER CERTIFICATION Fax:(336)-753-1680 (Check One) Replacement Remodeling Reconnection Name: /// S�(n7 e Phone Number (Home) �- (p� � (Home) Mailing Address: (Work) (� lime, C 0(D Email Address: t Detailed Directions TSite: t� ��LGd./' L!?� &LIQk rl INV 9e: a Property Address: JA-4r &16 Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: ___Type Type Of Facility: Date System Installed(Month/Date/Year):�/ ��(f�! 7 Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? e No If Yes,For How Long? Any Known Problems? Yes t?,/If Yes,Explain: Please Fill In The Following Information About The NEW Facility: 2 Type Of Facility:��((x Number Of Bedrooms: J Number of People Pool Size: Garage Size: Other: Requested By: ;�N (Ase_ p,K) �—/�-�- Date Requested: (Signa e) . For Environmental Health Office Use Only Approved Disapproved �/ Comments: )II4G�lW 110 e, (� j radjnS, Environmental Health Specialist !� Date: 6 *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or ' ited)that the on-site wastewater system will.function properly for any given period of time. Payment: Cashr Chec Money Order # Amount:$ CO3{}y Date: Paid By: Received By: y Account#: �y ��' Invoice#: -7/V/ ' t Davie County Health Department ��;s I�' Envi.xomnenW Health Section ' .• ; P.O.Box 848 210-Hospital Street p lI Courier :09-40-06 -1911 Mocksviille,NC 27028 Phone:(336)-753-6780 ON-SITE WASTEWATER CERTIFICATION Fac(336)-753-1680 (Check One) Replacement • Remodeling Reconnectlan Name: i j Sedl Phone Number — 60 (Home) Mailing Address:- Wdt t� t)r1 6G f� ,, � rel - I_9 (Work) Jvae' Ale, DEmail Address: Detailed D' eetions T Site: rioh ' 6NAtA1Jr L66 I` 4. IMAL Property Address: In Bil.S �y Please Fill In The Following Information About.- is EXISTING Facility: Name System Installed Under: �I �l r�J Type Of Facility: Date System Installed(Month/DateNcar): Number Of Bedrooms: -Number Of People: Is The Facility Currently Vacant? a No If Yes,For How Long? Any Known Problems? Yes CO If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: t&Q t 1'k P_. Number Of Bedrooms: .3 Number of People Pool Size: Garage Size: Other: Requested By: re. &A) ' -e— Date Requested: J* (Signa e) For Environmental Health Office Use Only Approved Disapproved Comments: lw owe home, (I(/iPi ?&drdrug. 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 'mited)that the on-site wastewater system will function properly for any given period of time., Payment: CashC ChecV Money Order # Amount:$_ W,( Date: Paid By: / Received By: Account#: 5Y'Ap Invoice 7/4// D N :5k s APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 w E (336)753-6780/Fax(33 3-1680 AGE Ap I' on r: Site Evaluation/Improvement Permit Authoruza on To Construct(ATC) ❑Both t4k`I 2 J Ipph n: ❑New System ❑Repair to Existing System ion/Modification of Existing System or Facility ( `1 *-IWORTA "THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED OR IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. D APPLICANT INFORMATION u I Name to be Billed C ontact Person Billing Address U SE. Home Phone City/State/ZIP A6 CQ.- Q 1 la Business Phone la — &0 5— 11 I n-14 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included:B-Frite Plan ❑Plat(to scale) (Permit is valid for 60 months with site f�Ian, o exp ration with complete plat.) -Owner's Name �`.\�•v 5ce \KUKC5ZV,S Phone Number Owner's Address -l1 D Property Address. City\4 (1(! Lot Size ` .0 TaxPIN# \LoQ0C)0604400 Subdivision Name(if applicable) Sect' t# Directions To Site:A X-4 l 5 � 1 If the answer to anthe following questions is'yer,s pporting documentation must be.9ttbcbed. Are there any existing wastewater systems on the site? ❑Yes EK0— Does the site contain jurisdictional wetlands? ❑Yes NNS Are there any easements or right-of-ways on the site? 6Xes❑No Is the site subject to approval by another public agency? ❑Yes PKo- Will wastewater other than domestic sewage be generated? ❑Yes&go IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms R #Bathrooms �Q — Garden Tub/Whirlpool es ❑No Basement:0 es LLW Basement Plumbing: ❑Yes &6o IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY:#Seats Type system requested: R nventional ❑Accepted ❑Innovative []Alternative ❑Other &V Water Supply Type:❑County/City Water ❑New Well r- sting Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes �'No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable Fla and Hiles. I understand that I am responsible for the proper identification and labeling of property lines and comers and �ng and flagging or stak' hous facility location,proposed well location and the location of any other amenities. Site Revisit Charge Prorty owner's or owner's legal representative signature %-a�_ Client Client Notification Date: Date EHS: Sign given ❑Yes❑No Account# Revised 11/06 Invoice# f!!Tni I L Parcel#:D60000004002 http://maps.co.davie.nc.us/ITSNetiView.aspx?prid=773084 o vq Davie County, NC - Basic Estate Search 000 Basic Search Real Estate Search Sales Search Q Click here to view the property record card for this parcel . Parcel#:D60000004002 Account#:82532100 Owner Information Tax Codes UTCHENS BILLY SCOTT&HUTCHENS JEANNE T ADVLTAX-COUNTY TAX 147 RIVERVIEW TOWNHOUSE DRIVE FIREADVLTAX-FIRE TAX DVANCE,NC 27006 Pro pe Information Township nd(Unitslrype):1.010 AC FARMINGTON ddress:BILLS WY Deed Information Local Zoning ate:07/2010 Book:00831 Page:0250 lat Book: Page: Legal Description PIN ID 1.01 AC RAINBOW RD N OF 5862031553 Property Values uilding: BXF: 0 nd: 22,10 arket: 22,10 essed: 22,10 eferred: 0600 0 Sales Information o.Book Page Month Year Instrument Qual/UnQual Improved Price 1 003250258 02 2000003250258 Unqualified Improved 0 007700314 09 2008007700314 Unqualified Vacant 0 008310250 07 2010008310250 Qualified Vacant 22,000 Click here to view the property record card for this parcel «Return to Basic Search, All Information on this site Is prepared for the Inventory of real property found within Davie County.All data Is compiled from recorded deeds, plats,and other public records and data.Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information.All information contained herein was created for Davie County's internal use. Davie County,its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or Implied,in fact or in law,including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact Davie County Tax Administration at(336)753-6120. For technical problems related to this website,please contact John Gallimore,Davie County GIS,(336)753-6050 ext.6056. 1.0.2 1 of 1 5/24/2011 1:14 PM N a www. seIectmoduIar. com Lo IL IA Ln co coY �arr�rte.• ------ —;�__»- Misr.. - ,II •• 5��6 KI3`-C2' '•.� 5'U1 xis t" CPTICYA: DATA/:,fl..TY LAYCUT ;�i� -------- ---1 l 1 Dill foal WALL •IDM u•u TOP. n u STF� RF.DRQMAEIt HJ-I1 ---- , �C :gh..7 �t3••1' jg�llg•��a Z• IV'-'U�xi3�2• z Z G, I 0 CI'I.ONAL LUXURY BATH _1 m - -a o . v N A (0 —_.^sSEP*AC SYSTEM �- — .hs� Tan._ -- - --S 85.49 _�._..--- ------- - PP - •�5-- "" �� pp 1 GROUND MEASItRE 209 a., .gs• __.__ A ---.--v a ` EPI Scott d� J Ee Hutchens j �C a C p1 DB 83 P 250 < �• °P9ged j z 2D' , '/Lw YSk st�tic _ EXISTING p. ^ 'ro 6sement a. e ry O � /J'-'.�' DS 831 ' P2 250 1.012 Acres :k ry j o � 1 JOHN & JUDY CARTER ,_.BILLS WAY ` s'2a• w 1-IRON 1 84' EPI _.. ~ � ~ ROap 'EASEAtENt p g 84 -.. �. -.. ,_£R �j PC 617 BENJAMIN SMITH / N 8557'10" w D8 369 PC 7T 1 :270,03. EPI .,o�„uu,i,�u�,,,,, �`�� CAR LE / yy 7rS , E SBORNE, CERTIFY THAT THIS Q. I,GARY IOWEN LEO I,�A Vis. OB 126 Pt; 2 4 BY btE GEED DESCRIPTIONWAS DRAWN FROM AN S RECORDED AS NOTED. - ' SE/1!. xoo WITNESS W HAND D SEAL THIS 6TH DAY OF - i< L-329 i . 2011. ,az�t9,j7!� ,, ,•```,-` STATE DATESURVEY FOR: Owen U.Osborne,1'1.5 N.C. 04/28/10 s6ome GaM 5urveoq, BILLY SCOTT & JENNIE T. HUTCHINS OB NO. FIELD BOOK pr01C55ta1d1 Lzhd 5rAw BEING A TRACT OF LAND RECOROM IN D9 770 PG 314. 536-10 as - Pc. 7391tu ALI .i c 2 pkm066)969499 PIN 5862031553 a N O r7' E S -- 1, THIS MM IS NOT INTENDED FOR RECORDATION. '� •�-� 2.THIS PLAT IS SUBJECT TD ANY EASEMENTS. AGREEMENTS, OR N 04'42 39 FO"erly RIGHTS-OF-WAY OF RECORD PRIOR TO DATE OF THIS PIAT, E LUCY JENKINS WHICH WAS NOT VISIBLE AT THE TIME OF OUR INSPECTION. t x23.8.f• r7e 64 PG 309 3. NO TITLE SEARCH WAS DONE AS A PART OF THIS SURVEY, 10 £pt \ 4. THE SUBJECT PROPERTY IS NOT LOCATFD IN A SPECIAL fXISTNIG \ FLOOD HAZARD AREA AS DETERMINED BY FIRM RATE MAP. EPI 5. THIS PROPERTY IS SUBJECT TO UTILITY EASEMENTS AS MAY PERTAIN �-nC•=5 .ALONG EXISTING UTILITY LINES AS SHOWN. 0— S 85•4y, 5.. O \, 6.ALL DISTANCES SHOWN HEREON ARE HORIZONTAL GROUND MEASURE PP PP AND TME'AREA WAS OBTAINED BY COORDINATE METHOD. 209,98 CDo ;)j f0 t EPI M rot t Je �. n!e Hutchens Q N —•� ;.oa eat PC; 250 vto 0 j \ C -�- J e too. septic, aeD} rA MCI _ EXISTING 't0 tuII It PQr WELL O(�OSq pDo 4 25i j 1,012 d�1Q O N 0 i O � AT-30 JOHN & ,wor 1 _ f CAR JER LEGENDEPI �B►LLS WAY -PP Power 1IN 18 �.�._ 8 -LP Light Pote 86' '28" - 1 -WM Wolor Motor 196, 1"IRON EPI ti CkAVfI RO p , �2Q15f �� O Caton#)nen-nonunented point 84 -� �1ENIT R DSJ84pC e17 O ETP em"np Iron PIP# N -NTP Nev Iron Pipe BENJAMINSMITry / 8''•51 10" 1' +. '-• �-. I -NPL New Pin TrW M DB 36B PG EPI' ,rruuurr -EPL EXlwthp PIn Trot 783 210,030 o�,� rrh -RCP Reinforced concrete Pipe ` "�`.`N CARP'•.,� r -CB Stornwater Ceteh Basin GRAPHIC SCALE / CARy W 7ESIJ 1, OWEN LEE OSBORNE, CERTIFY THAT THIS ►�Af� ?'Q4��Ssby e# eo 100 De Iz5 PO 254 BYSME, DEED DESCRIPTIORAWN FROM AN NS RECORDED ASS NOTED. 3 SEAL WITNESS MY HAND D SEAL, THUS STH DAY DF i� L-�i5 = C - 2011 O) ( IN 7ZBT ) i V I inch . 00 _. SCALE TOWNSHIP COUNTYSTA1E DAZE OwI L Oslurier MSURVEY FOR: 1"-501 FARMINGTON DAME N.C. 04/29/10 sborne Lmd SMryeLLlnq. Inc. BILLY SCOTT & JENNIE, T. HUTCHINS SURVEYED_ NAPPED. COMPUTER FILE: JOB N0. FIELD BOOK t'TW MiI Lad AnV4tr BEING A TRACT OF LAND RECORDED IN DD 770 PC 314. OLD OLA CIAHHN INSMWut ES a u'M 1539-10 29 PG. 73 RMAl6XG noe PXwC9�!)P69199Sr PIN 5862031553 0 i 0 nz FAX I : Bonnie FROM: Jeanne Hutchens FAX: 336-753-1680 FAX: 336-998-7010 PHONE: 336-753-6750 PHONE: 336-695-9370 WMECT: Septic Site Survey Lot DATE: May 4, 2011 COMMENTS: Bonnie, Attached is the Survey of our lot, located at 122 Bills Way,Advance, NC 27006. As we discussed, there is an Existing Well and septic System on the lot. Our plans are to have a 3 bedroom modular home this time, our paperwork sent to your office last time had 4 bedrooms. That's the only change. i believe you found the paperwork under my husbands name Scott Hutchens although Scott Smith had helped us with this previously. we will have the property flagged for the proposed home site this evening ready for the site visit. Please let me know if you need anything else. sincerely, Jeanne Hutchens AINI �� � aP� ke #6111 OWtib tI�-FfX Kms& L'd OLOL-866-9££ sueyolnH d9£:l0 LLt,0AeIN p . �� • a� I FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC ' v Davie County Environmental Health P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 A ite E on/Improvement Permit ❑Authorization To Construct(ATC) )Q Both oti ew System ❑Repair to Existing System >xpansion/Modification of Existing System or Facility MPORTANT'*•THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed C Contact Person Billing Address Home Phone City/State/ZIP N.L. 2 Business Phone Name on Permit/ATC ifDierent than Above_!! Q 4W"1AJ S Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged 4-1— NOTE: A survey plat or site plan must accomparrf this application. Included:❑Site Plan ❑Plat(to scale) (Permit is valid fnr In mn_Qthe unth cite Ann nn rxniration with complete plat.) Owner's Name cmv YVIV6'S Phone Number Owner's Address_ ? S o^ City/Sta e/Zil %-J r SQ1. 0— 7`-kf cps Property Address 661V \:�X int s iJ City Adyayc c N c Lot Size 14z9— Tax PIN# It $$3 Subdivision Name(if applicable) Section/Lot# Directions To Site: 0 w w Sills r..� neon a.. If the answer to any of the o lowing questions rs'�es',supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes ONo Does the site contain jurisdictional wetlands? ❑Yes KNo Are there any easements or right-of-ways on the site? kes❑No -!5e.s, Plock- Is the site subject to approval by another public agency? ❑Yes XNo Will wastewater other than domestic sewage be generated? ❑Yes No IF RESIDENCE FILL OUT THE BOX BELOW #People L #Bedrooms 4 #Bathrooms Z Garden Tub/Whirlpool es ❑No Basement:❑Yes&o Basement Plumbing: []Yes<No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: conventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type:❑County/City Water ❑New Well &sting Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve y Yes ❑No Ifyes,whattype? �_rt,t... 28104 l�ltn/ e�- t.,�\� n�� G Z`lX Z_-k aq:-Vic. This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pennit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and luting a ng o taking the house/facility location,proposed well location and the location of arty other amenities. Property owner's or ownees legal representative signature Site Revisit Charge Date(s): Client Notification Date: Date EES: Sign given ❑Yes ONo Account# �v t/ Revised 11/06 Invoice# � • ' •• j - � �� �;1�s wqy eX�l+N� j e11O' i i Dt+J _ — w��+ 3`_T�_cc \^Jt,y _. r1.ID ' N O T E S N 04-42-_30,, E IAP IS NOT INTENDED FOR RECORDATION. 224.06' LUCy , JENKfNS 1LAT IS SUBJECT TO ANY EASEMENTS. AGREEMENTS, OR To EPJ DS 64 PG 309 I WAS NOT VISIBLE PRIORD'THE TIME OFF OUR INSPECTION. EXISTING TLE SEARCH WAS DONE AS A PART OF THIS SURREY. NIP SEPTIC SYSTEM UBJECT PROPERTY IS NOT LOCATED IN A SPEGAL ) HAZARD AREA AS DETERMINED BY FIRM RATE MAP. � 45ROpERTY.IS SUBJECT TO U71UTY EASEMENTS AS MAY PERTAIN PP S 8J'�'7 7' n P ---P PP E)aSTING UTILITY LINES AS SHOWN. E 270.00 c � NIP . iISTANCES SHO'M�1 HEREON ARE HORIZONTAL GROUND MEASURE THE AREA WAS OBTAINED BY COORDINATE METHOD. NINA � BURKS DB 770 PG 314 (0 E.PP.Osed t° C) Q d 03 EXISTING M O EUCy JF�IKINS } O ofCj WELL O D8 64 PG 309 1,012 Aces t O' N EPI At-- 85'07'31 EGF-ND 205.27• •, W EPI 1 _GRAv�rOAD—L�— 28'EASFMENT P 1 i84 P !r Pote —•--►— N 85.17 45•• W — ER D8 G 677 t Pote rr Metet BENJAMIN SMfT)j l 210.00' NIP ,) non-ronunented point DB ) — cisting Iran Pipe 369 PG 78$ r Iron Pipe r Pn Iron sting Pin Iron i + ` � c) Mforced Concrete Pipe ,► D9 GARY j?6 TESLA fr O :_;....� rnwoter Cotch Rosin GRAPHIC SCALE PG 254 I, OWEN LEE OSBORNE. CERTIFY THAT THIS MRP 1? WAS DRAWN FROM AN ACTUAL SURVEY MADE = SEI u n o so , ; BY SAE. DEED DESCRIPTIONS RECORDED AS NOTED_ WITNESS MY HAND AND S THIS 28TH DAPI OF :ry L-32 2010. I SI' IN FEET } , 1 E I Inch = 60 ft TOWNSHIP COUNTY STATE DATE SURVEY . o,��,L.off.pi.5 F0p- SCOTT & JE1VIVI.E HUTCHII+ FARMINGTON DAVIE N.C. 04/28/10 sborne Land SurvetgInq, Inc, p: MAPPED: COMPUTER FILE: JOB NO. FIELD BOOK Professw LWA 5unekw BEING A TRACT OF LAND RECORDED IN DB 770 PG 314. CLAYTON HOMES 1538-10 29 - PG. 73 9t9 ACADt.w x Ph"("6)969-1999 OLO HUTCHINS MAL NAL.�I•= PIN 5862031553 GoMAPS - Davie County NC Public Access WATER BODIES COUNTY_BOUNDARY ADDRESS DRIVES STREETS ,e RAILROAD-CENTERLINE PARCELS 2007A.,Wl PI . �4 .J CRY_L<Irs aERMeIDA RUN OCOOLEEIEE DAVIE COUNTY ,r N SWLLE BILLS WAY t D C �<< Wednesday,April 21 20 10 0 •••WARNING:THIS IS NOT A SURVEY!... This map is prepared for the inventory of real property found within this jurisdiction,and is compiled from recorded deeds,plats,and other public records and data Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information Contained on this map.The County and mapping company assume no legal responsibility for the information contained on this map. 0770. BK 110 M3 14 • 0314 . 06231 FILED FOR REGISTRATION SEPTEMBER 5, 2008 12:38 P.H. DATE TIME I AND RECORDED IN BOOK-77-0 PAGE 314 DEED TRANSFER CHECKED M.BRENTSHOAF,REGISTER OF DEEDS DATE D VIE OU , BY TAX ADMINISTRATOR B __() DAPUTY NO TAXABLE©0NSmERAT10N STATED STATE OF NORTH CAROLINA COUNTY OF DAVIE PARCEL ID: WARRANTY DEED REVENUE: Drawn By: Vanderbilt Mortgage and Finance, Inc. POB 9800 Maryville, TN 37802 THIS DEED,made this 7h day of August 2008,by and between CMH Homes Inc. d/b/a Luv Homes, Grantor and Nina E. Burks, single and daughter Jessica Lorene Burks,a minor,whose address is 2441 Communications Drive,Yadkinville,NC 27055, hereinafter called Grantee: WITNESSETH: That Grantor,for good,valuable and adequate consideration paid by the Grantee, the receipt of which is hereby acknowledged,has given, granted,bargained and sold,and conveyed, and by these presents do hereby give, grant,bargain and sell,convey and confirm unto Grantee,its heirs, successors and assigns, forever,all that certain property particularly described as follows: SEE EXHIBIT"A" TO HAVE AND TO HOLD the above granted and described premises,together with all and singular,the rights,privileges,easements,tenements and appurtenances 0770 • 0315* . BKIIOPG 315 thereunto belonging,or in anywise appertaining,to Grantee,its heirs, successors and assigns,in fee simple,forever. AND Grantor, for themselves,their heirs, executors and administrators,do covenant and with Grantee, its heirs,successors and assigns, that Grantors are seized in i fee of the above granted and described premises,and does have good right to sell and convey the same in fee simple;that the same is free and clear from any and all encumbrances,and that they,and their heirs executors and administrators, shall warrant and defend the title to the same against the lawful claims and demands of any and all persons whomsoever. This deed is an absolute conveyance,the Grantors having sold said land to the Grantee for good,valuable and adequate consideration. Grantors declare that this conveyance is freely and fairly made,and that these are no agreement,oral or written, or other than this deed between Grantors and Grantee with respect to said land. 0770, BK 110 PG 3 1 b • 0316 . IN TESTIMONY WHEREOF,the said Grantor does hereunto set their hand and i seal this day and year first above written. CMH Home4 Inc. d/b/a Luv Homes By: DAvid Booth Its: President STATE OF TENNESSEE COUNTY OF BLOUNT \\ I, 'J , a Notary Public for said County and State,certify that Da d Booth personally came before me this day and acknowledged that he is President of CMH Homes, Inc. dba Luv Homes Inc, a corporation,and that by authority duly given and as the act of the corporation the foregoing instrument was signed in its name by its President and sealed with its corporate seal. WITNESS my hand and official seal,this day of , 2008. `,,��111 a u►��q��. PF LY • 'VQT"^ ; ` NO ARYP BIC ' • . . �C • (1jvT`t ,.�' COMMISSION EXP: ���►►/lllill1l��\ 770 BK 11 PG 3 11 - 28 0 EXHIBIT A a T fix•—•��- `F's 9 BEGINNING at an iron,Southeast corner of Roy G Potts(Deed Book 184,page 616)in the Northern right of way margin of'Dunn7 rail',and rusts thence with Potts line North 4 deg. 42 min. 30 sec. East 210 feet to a point;thence South 85 deg. 17 min. 45 sec.'£ass 210 feet to a point;thence South 4 deg. 42 min. 30 sec. West 210 feet to a point in the Northetu right of way margin of'Dun n Trall'the Southeast corner of the within described land;thence with the Northern right of way margin of said'Dunn Trail'Nath 85 deg. 17 min. 45aec..WCst 210 feet TO THE BEGINNING containing 44,100 square feet,mbre or less. TOGETHER WITH said land there is also conveyed a perpetual,non-exclusive right of way 24 fat wide of easement of Ingress,egress,regress and utilities leading from the same as is more fully described by Deed Book 184,page 616 Davie County Registry to the state malate nod tight of way of SR 1444(locally known as the'Rainbow Road'.)following an existing roadway, said casement to be perpetual and appurtenant to the above descried lands and to run with the same in the hands of all persons whomsoever. ALSO TOGETHER WITH said lands there is granted to GRANTEES a perpetual easement to insult upon GRANTORS adjacent property within 100 feet ofsaid lands and to maintain such sanitary sewer system out-fall drainage lines as may be required by the proper. authorities in connection with a residence upon said lands. •• • 1 I DEED GOOK _ 197 PAGEM DEED-BOK' 9? _'-_?AGMffl , Se teiire 2jI N •50 A.M. DAT: �TIM�E� RECORDED IN BOOK1(�p . NO TAXACLEa�i4'4.�"r�r ^.... � �....v�'� Iti1MtY 1 SHORE,REGISTER OF DEM OAYIE COUNTY.'N iK Assistanty Excise Tax j Recording Time,Book and Page TaxLot No. ......................:......................... ...................... ..... .. ......... Parcel Identifier No. . ......... ................................................ Veride-d by ....................... ................. ............................... County on the day of .. .. . ...... 19 ........... by ................................................ ........... ... . . Mailafter recording to ..Li�,. ?. 0.�-�--�..... . ........ ..... ......... ... . ....................................................................................................... _... ......... ..................... This instrument was prepared by .GEORGE..W. .MARTIN,..Attorney at- .Law, 10 Court Square, Mocksville NC ••• Brief description for the Index NORTH CAROLINA GENERAL WAR RAN TY DEED THIS DEED made this .. L....... day of S�LrTF ?.p.C.�' l'1�1 7.. by and between GRANTOR GRANTEE LACY EUGENE BURKS, JR. and daughter, , WILLIAM D. DUNN and LUCY J. JENKINS JESSICA LORENE BURKS Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g. corporation or partnership. The designation Grantor and Grantee.as used herein shall include said parties, their heirs, successors,.and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does,grant, bargain• sell and convey unto *the Grantee in fee simple, all that certain lot or parcel gf'land situated in the City of Township, DAV.IE......... ....._... . ........ .. . County, North Carolina and more particularly described as follows SEE ATTACHED DESCRIPTION• EXHIBIT "A" THIS DEED IS BEING RE-RECORDED FOR TITS 'PURPOSE OF CCRRECmINTG Tvp MAT F CVAVTF7"c FAIUF P71 HIS RELATIONSHIP TO THE FEMALE GRANTEE. opt "T=' .00 A.M. *GERGE MARTIN sonIN� TIME OOMlY 1*ML REGISTER OF DU= w N A�lWX ` , NC Assistants �.C- . _. N.C.Itar Assnc.Form No.3'6 1976.Kcvised-6 1977 1e Wdbmmry Cn,Ing.,Bo 127,Y;.IkmvJb<N C 27055 RmbH by Aq­mm 1 Wah the N.C.Ba.Assoc. 1981 , DEED BOOK /617 PAGE1Y - ' � . DEED BOOKffl ""~E�---~ ' ^= The property hereinabove described was acquired by Grantor by instrument recorded in —..'------------------ � ` -------------------------�-----------`------------------------------------. ^& map showing the above described property lorecorded ioPlat Book '----------- Dug*---------. TO O HOLD the aforesaid lot or parcel of luo6 and all privileges and appurtenances theretobelonging to the Grantee bofee simple. And-the Grantor covenants with the Grantee, that Grantor is uu\'ed of the ncomisoo in fee simple, has the right to convey the numo in fee o{nnnlo. that GOa is marketable and free and clear ofall ou000`bruovoo..and that-Grantor will n'urruot and defend the bdo against the lawful claims of all nerov^u whomsoever except for the exceptions br,elnuYLor ututod. Title to the property hereinabove described is subject to the following exceptions: ' � � ` � � set his hand and or if corporate, has caused this instrument to be signed in corporate IN WITNESS WHEREOF, the Grantor has ^ereuumitso by its duly authorized officers and its "nu m be hereunto ��o by authority ", its Board , Directors, m° day and year first — written.— '--'----------------------_------ '`--__—_—_--_------ ---'(muaL) (Corporate Name) WILLIAM D. DDN0 � �'. ---------_-----------------_—' � ' ----_----_--_'--_'������ �� ' �-UCY � �nJ��I���--'__---------'p�,m"o 0. � � Arroyr: -------------------------------------------------------------(SEAL) � --------------------------------------------------------------- --------------------- --''»«cr'tan,wn",n"uueoe"p .' ---------------------------------------------------------------(SEAL) � OFFICIAL SEAL —'--_____n"""^» DAVIE COUNTY State "m,,o"/d, certify that EOR --------------------------------------- —�WIL�IAM'D�—DD2��J�Di'L�C��'.I.'^IEBO�Z0�l_-----____'__ axauo� _ n°,"""^ux "nn"="u b"m," ",° this u^v and u,x""°uax,u the ex."ou"" of the mmxv/"c instrument. Witness my hand and official stamp or seal,this day of ------S-'i- ----------- Aly commission expires: ---------------- - Notary Public x. ^ mm",r o"o/ic of the County and ou^m umx,said, certify that ------------------------------------------ X personally _—_-----___—__--____Xn.xu"nal/y """ e n.f",, m ° this day and ^auu"°ueux,a that he Is - Secretary of � ----------------------------------------------------�-x m",u` o",mu= "",»"=^m". and that by ""6.",u, u"/y I given and as the act of the c"xn",uu"", the m,°coinc u.strvmenu'~u, sig�"uIn Its name by Its --------------- President,sealed with Its corporate seal and ___--_'rresid"nt,""al"u =aha° c*rporateseal*md aMsLemmr -----------oxum------------------- --..... secretary, � p Witness uwhand and official stamp or seal, this -------day ox --------------------------- m____ mx ,vmmmomuexpires:------------------------------ ---------------------------------------- Nm^q' Public -------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- is,')M certified ^" be `"=°m- This /"st,"m°"^ and this `°,uu"um are duly registered at the o"m and time and In the u""^ and P"x" shown on the first page hereof. -----------------------l{MB-I^' ---------------------------anmmTsR OF ooaou FOR----------- -----------------COUNTY y� By ---------------uA-mu��' -----'�2QITJWu"m"ta"^'u"xism, of Deeds mcBarAss=ermwuz /976.Revised@/977_^—W111—aCo..im..Box 127.Yadki_ mc27055 DEED BOOK q PAGE? DEED„a00K 91 PAGE—5. 0 EXHIBIT A DEED FROM WILLIAM D. DUNN and LUCY J.JENKINS TO LACY EUGENE BURKS, JR.* and daughter, JESSICA LORENE BURKS t� BEGINNING at an iron, Southeast corner of Roy L. Potts (Deed Book 184, page 616) in the Northern right of way margin of"Dunn Trail", and runs thence with Potts line No,�h 4 deg. 42 min. 30 sec. East 210 feet to a point; thence South 85 deg. 17 min. 45 sec. East 2l0 feet to a point;thence South 4 deg. 42 min. 30 sec. West 210 feet to a point in the Northern right of way margin of"Dunn Trail' the Southeast corner of the within described land;thence with the Northern right of way margin of said "Dunn Trail"North 85 deg. 17 rain. 45 sec. West 210 feet TO THE BEGINNING containing 44,100 square feet, more or less. TOGETHER WITH said land there is also conveyed a perpetual, non-exclusive right of way 24 feet wide of easement of ingress, egress, regress and utilities leading from the same as is more fully described by Deed Book 184,page 616 Davie County Registry to the.state maintained right of way of SR 1444 (locally known as the "Rainbow Road") following an existing roadway, said easement to be perpetual and appurtenant to the above descried lands and to run with the same in the hands of all persons whomsoever. ALSO TOGETHER WITH said lands there is granted to GRANTEES a perpetual easement to install upon GRANTORS adjacent property within 100 feet of said lands and to maintain such sanitary sewer system out-fall drainage lines as may be required by the proper authorities in connection with a residence upon said lands. NTE:G WM 1612.6 x:\myfiles\gwmveal est\dunn.ailliam d..description.I612.6.pg . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation .APPLICANT'S NAME L �` DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE - Axe' SUBDIVISION ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut i FACTORS 1 2 3 4 5 6 7 Landscape position ,C. Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH ;fell Texture group Consistence Structure Mineralogy 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 SITE CLASSIFICATION: EVALUATION BY:` /_11; LONG-TERM ACCEPTANCE 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 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(01-90) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County Health Department Environmental Health Section ��"(��J7/r• P.O.Box 848 Mocksville,NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED'UNLESS ALL s THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed no.l�21 lel,s Contact Person Mailing Address )Ml n i l if IR(i .'Home Phone City/State/Zip c�211�q •�A 2. Name on Permit/ATC if Different than Above _ Mailing Address City/State/Zip 3. Application For: [vr/site Evaluation [ ]Improvement Permit&ATC [ ]Both ` 4. System to Serve: [ ]House [Mobile Home [ ]Business [ J Industry [ J Other Db`. 0(). t, 5. If Residence: #People---�L #Bedrooms #Bathrooms_ - [zT ishwasher[ ]Garbage Disposal 11,rWashing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other: Specify type #People #Sinks #Commodes #Showers • #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: [tilcounty/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes H No If yes,what type? ' EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**OAVM OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: Sl [1 , [WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 156 4L) ` 14-6 ,nil/g-A Property Address: Road 1 ame D1 i SY),M- P'i l SIS I D. f> �b F U(A City/Zip 0 d .kms)p)p Du m m. 1, Sl 1 D bQ_ �h b 1)L If in Subdivision provide information,as follows: Name: ; Section: Lot#: 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 MILL.ZAm D. 1)0AlAi to conduct all tes'ng procedures as necessary to determine the site suitability. DATE�T,I'9 y SIGNATURE n Revised DCHD(06-96) THIS AREA MAY $E USED F R DRAWING YOUR SITE PLAI4: T�FLzLFR ��1� 4 ckQ 1 \l avie County Health De 18 5 Department �< vironmental Health Section P.O.Box 848 210 Hospital Street U Courier#:0940-06 • Modcsville,NC 27028 Phone:(336)-753-6780 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING Fax.0W 753.1680 (Check One) Replacement Remodeling Reconnection Name r";� f"�' 'f"�'lNs Phone Number .33(p sq(p q.30a (Home) Mailing Address: d, .33 Cv loos- 41 c�R (work) e Me:-, Q-70^— Re c ., Detailed Directions To Site: ti i R �i �� S •r .s � � I ASN S•$(����.1 S S3 TO-C el /U� • DCAp-S2t2-G)-flf2_ 4 1 n!_�Gr& Property Address. Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under-10'r\a A: , U t,ks Type Of Facility: Date System Installed(MonthlDate/Year): Number Of Bedrooms: Number Of People: Is The Facility Currently vacant? fes No If Yes,For How bong?_ —7 r n k 1 �/Ogrs a C G4 }0 n�, Any Known Problems? Yes No If Yes,Explain: •1 Please Fill In The Following Information About The NEW Facility: Of Facility: .3 Type ty:M 6M Number of Bedroams:___�___`Number of People Requested By: & —9LDate Requested:-1,2/.3 f 0 ______ (Signature) 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. Amount*$ Payment: Cash Check Money Order # Date: Received By: Paid By Invoice# Account#: ❑ 2000 SQUARE FEET • 4 Bedroom- 2 Bath MODEL THS28764C -N rrrrrw� �w IL ar[ WASH Ori.wru" L\r9i � OP � y o • „a,�,►,� 0 g F*. '=.moi " ..oMoc.•F 0 '� 0 0 p LUST 11 wsaeoor wuwr oaaa WON L V � NEDW=s . u+t:uv- w•:.v- nor:.air aw•env- ILLNJ 9 �{ Rej GoMAPS'-.Davie County NC Public Access Page I of I Davie County, NC - GIS/Mapping System Click Here To Start Over Quick Search:(County ID or Ow ner Ni :1 Active Layer. HUse-Ittap Tips EJ 00 u9l*j- - ;PARCELS (Map Tips Available) Addre r A z" -Ni 547.65 ­ 12 2 97- if;2 it V4 4V -1 �0 7 C3 7 13 n RD N N E.14 Ae 213 T �4 r V gljv- 0 http://maps.co.davie.nc.us/GoMaps/map/lndex.cfm?mainmapservice=gomaps&CFID=4129... 1/5/2010 4.UTHORILATION•N6: DAVIE COUNTY HEALTH DEPARTMENT/ ' Environmental Health Section PROPERTY INFORMATION Permitle0s;<: r P.O.Box 848 Name: 'P a0, `7r a' � '�:-% ` ` Mocksville,NC 27028 Subdivision Name: e—Y Phone#:704-634-8760 Directions to property: A41 Section: Lot: AUTHORIZATION FOR �0? Jrq�� -?�+ WASTEWATER Tax Office PIN:#� r SYSTEM CONSTRUCTION �K ti Road Name: 1't t I J 14-Zip: ` + a **NOTE**This Authorization for Wastewater kystern 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 whcn 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 RESIDENTIAL SPECIFICATION:BUILDING TYPE :#BEDROOMS #.BATHS #OCCUPANTS f� GARBAGEISPOSAL:Yes or No D COMMERCIAL SPECIFICATION: FACILITY TYPE/� #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE L TYPE WATER SUPPLY /.� DESIGN WASTEWATER FLOW(GPD) 1 -f i� NEW SITE__!__--' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE.,-,4d ' GAL. PUMP TANK GAL. TRENCH WIDTH � 'y / ROCK DEPTH ,fn✓ LINEAR FT. .=. OTHER REQUIRED SITE MODIFICNTIONS/CONDITIONS: IMPROVEMENT P LAYOUT 1iII�' 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: 1� AUTHORIZATION NQ 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) A ZATION NO: 1098 DAVIE COUNTY HEALTH DEPARTMENT -tw Environmental Health Section PROPERTY INFORMATION Permittee s,* P.O.Box 848 Name:` Mocksville,NC 27028 Subdivision Name: Phone#:704-634-8760 Directions to property: &A i Section: Lot: AUTHORIZATION FOR r- , WASTEWATER SYSTEM CONSTRUCTION. Tax Office PIN:#—.?�, � - 7004 17;Llis- Road Name: 7,tYth (9fN 1 L.-Zip. **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 1 I 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 'UTHnR - DAVIE COUNTY HEALTH DEPARTMENT Z fj j if,S IMPROVEMENT AND OPERATION PERMITS VPROPERTY INFORMATION Pefini tt'e .J �/ `✓r^ Subdivision Name: Directions to property`s+ &.? fW. Z Section: Lot: ? _Ur IMPROVEMENT PERMIT Tax OfficePIN:# i`r If -1-2 1/1 Road Name: }7 "31"! r t L 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 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_�#BATHS #OCCUPANTS _GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY_�� DESIGN WASTEWATER FLOW(GPD) NEW SITE L/" REPAIR SrrE SYSTEM SPECIFICATIONS: TANK SIZEZaZ GAL. PUMP TANK GAL. TRENCH WIDTHROCK DEPTH J,,/"LINEAR FT.e��L')� OTHER1 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT **CONT:BETWEEN A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM 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: .r AUTHORIZATION NQA OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 EVALUATIONAMPROVEMENT PERMIT&ATC YT : •J Davie County Health Department t Environmental Health SectionQ f�,/71� 0 P.O. Box 848 Mocksville,NC 27028 SEP 1 2 (704) 634-8760 i ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED rUNLESSALLY ____ THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Contact Person n i qn, Mailing Address– —) c s -+ inti Tcl Home Phone City/State/Zip u()PSDQ U•C, o1?l7b 2. Name on Permit/ATC if Different than Above ?i N: r] '92 Mailing Address City/State/Zip 3. Application For: [vi"Site Evaluation [ ]Improvement Permit&ATC [ ]Both��pp w 4. System to Serve: [ ]House [Mobile Home [ ]Business [ ]Industry [ ]•Other Doo[_LA0. L1f 4, �` 5. If Residence: #People #Bedrooms #Bathrooms [v1 Dishwasher[ ]Garbage Disposal D4"Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other:Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: [eCounty/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ 1 Yes M No If yes,what type? EITHER A PLAT OR ,SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT OF THE-PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 4 . WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 58 a _ _ `l $ 4U mJlJ� ) , - h ` ,, j _ Property Address: Road 1�lame C)'Ll�SYl Q [� �SA n.L +1 C(�6 lei h t i� �U(�L - city/Zip 6 AM 5n P o ,�1�(�1�; �--1 (Z� ,�i_Z�C� 1 S, 1 _If in Subdivision provide information,as follows: Name: Section: Lot#: 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 W-Tt L Z Ani O. Dy ASA/ to conduct all tes'ng procedures as necessary to determine the site suitability. DATE 9 lA7 SIGNATURE Revised DCHD(06-96) THIS AREA MAY BE USED F R DRAWING JOUR SITE PLAN: 4, .• a zv�wA y AID, l Tga-r-LFR Pj 17, V A o ;Aj J, DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAMEAd/- DATE EVALUATED 7 PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME_ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position ,L Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group L Consistence Structure rj Mineralogy 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 SITE CLASSIFICATION: EVALUATION BY:Z(W,6� LONG-TERM ACCEPTANCE 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 OISt 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(0I-90) ■■■■■ec■■■cc■■■■■■c■■■■■■■■■cc■■■■■■■■ce■■■e■■■■■eee■■■■■■■■e■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■�i■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ecce■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ecce■■■■■■■■■■■ ■■■e■■■■eee■■■■■■■■■■■■■■ecce■■■■■■■■■■■■■■■■■■■■■■ecce■■■■■■c■■■■ ■ec■■■■■■ccecece■■eee■■■e■■■■ceeccc■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■eee■■■■■■■■■■■■■■■■■■■■■■c■■■■■■c■■cc■■■■■■■■■ec■■■■■■ec■■■■■ ■■■■e■eee■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ccc■ceecce■■■■■■■■■■■■■■■■■eee■■■■■c■■■■■ ■■■cc■eee■■■■■■■■ecccc■■■■■cc■■■■■eee■■■■■■■■cccc■■■■■■e■c■cee■■■■ ■■■■■■■■■■■■■■■■■e■■■c■■■■■■■■■■■■■e■■■■■■eee■ce■■■■■■c■■eec■■■■■■ ■■ccs■■cc■ecce■■e■■■■■■c■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■c■■ ■eee■■■■■cccccccccc■■c■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■s■■■■■■■■■■e■■ ■■■■■■■■■■e■■■cc■■■■■■■■eee■■■■■■■■■■c■■■ccccc■■cce■■■■■■■■■■■■cc■ ■■■ecce■■■■■■■■■■■■■■■■■■■■ecce■ ■■■■■■■■■■■■■■■■■■eee■■■■■■■■■c■ ■ecce■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■c■ ■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■cc■■■ ■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■c■■c■■■ce■cce■c■■■c■■■■ccc■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■c��__=--=��■■■■■■■c■■c■■■■■■■■■ecce■■■■■ ■■■■■■■■■■■■■■c■■c■■c■■ire■■■■■■■■■■■■■■rcccc■■■■■�`■■■■■■■■■■■■■■■■ MENNEN MENNEN MENNENMENNENiiiiii ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■ec■■■eeeeeeee■■■■■■■eeeeeeee■■■■■c■■cee■e■■■■■■c■■■■■■ccs ■■■■■■■■■■■e■■■■■■■■ccce■■■■■■■■■■■■■eee■■■■■■■■■■■eee■■■■■■■■eee■ ■c■ccee■■■■■■■■■■■■■■■eee■■■■■■■■■■■■ecce■■■■■■■e■ee■■■■■■■■■c■■■■ ■■■■■■■■cccc■■■■■■■■■c■ecce■■■■cce■■■■■■■cec■■■■■■■■c■c■■■■■cc■■■■ ■■■■■■■■■■■■■■e■■■■■ecce■■■■■e■■ ■■■e■■■■■■■■■■■■■■e■■■■■c■■■■■■■ ■■■■■ee■■■■■■■■■■c■eee■■■■■■■■■■■■■■e■■■■■■e■■■■■■■ee■■■■■■■■■■■■■ 1 I I 13 1j - <1 5 A c l Ir c 76 Ac R ) 33 (3 ' fs.5 Ac �22 r`( s, 2 F, . r, - r, 34 (4) --�_ i 67.01 264 (7.5 A c) RAc c) o I i !1.57 Ac) 481,8 4 776 ' Yi N 9• � I � 'iJ c —'g I�g (2) (2.49 Ac) [ a' ,LLr 1003.2 36 1 � j��" 19 93 1 _, a928r� 3Q g 3P Ac o7 ] m 41Ac !35 19.88 Ac f j�/ =� '43 Act 1 3 c 29762Ac) 'AN N32 �. I-- � ' I ..�. I ') ' x.12.9 ):__ A 2^0 2931.4Ac 6 Ac� z_ 9 s e.a7 42.Q/ 292 c' � N �411 ^"<. .•'1 _ 4'C2 2.48 F' I a I I i - '201.7 Ac I 39 3 36Ac . 7 4r, n 1 N :m cO 3.17 (1.02.4 �r m Ac ^ * E9.90 q� 8 �' �. co fiy y, y. a'�1 or \ a ` <n a <v Q pal 42 m 273-4 - )6.01 'v y ; �< YA a M LO o Lo 37 o" v 7 63Aa M LO 9a _ 7.42 �+. 57AC15 AC ^:n 1 �A 5392 -2 a26O.4 I (1.OAc1 F 5 J 145.2 875.2 201.81 !J 4 P , 420.27 eY5 0- �L `r' K. N 2.22 AC 4 6.78° I� •J9� -I 252.60 A'c t N 185 r 197 C �yAcc _ ti .'f 2.05 211 .czf - 4, j � 6.044c / x (6.20 ACJ 20 �� " rs• ,, ' - a �S"G, 9 ^m0 i � 1 ?moi{' '_ `:r •t ,vl�,, - Oar � ,. ( .33 At 3 �I w _ ZI0.1s -3 C�350AcA -- ? 66 Arj f�(I45Acl _ 7 • yQ.[ -Rtco� DEED BOOK R 0- F K PAGE 5 0 PAGE? EXHIBIT A DEED FROM WILLIAM D. DUNN and LUCY J.JENKINS TO LACY EUGENE BURKS, JR. and daughter,JESSICA LORENE BURKS BEGINNING at an iron, Southeast corner of Roy L. Potts(Deed Book 184,page 616) in the Northern right of way margin of"Dunn Trail", and runs thence with Potts line North 4 deg. 42 min. 30 sec. East 210 feet to a point;thence South 85 deg. 17 min. 45 sec. East 210 feet to a point;thence South 4 deg. 42 min. 30 sec. West 210 feet to a point in the Northern right of way margin of"Dunn Trail" the Southeast corner of the within described land;thence with the Northern right of way margin of said "Dunn Trail"North 85 deg. 17 min. 45 sec. West 210 feet TO THE BEGINNING containing 44,100 square feet,more or less. TOGETHER WITH said land there is also conveyed a perpetual, non-exclusive right of way 24 feet wide of easement of ingress, egress, regress and utilities leading from the same as is more fully described by Deed Book 184,page 616 Davie County Registry to the state maintained right of way of SR 1444 (locally known as the "Rainbow Road".) following an existing roadway, said easement to be perpetual and appurtenant to the above descried lands and to run with the same in the hands of all persons whomsoever. ALSO TOGETHER WITH said lands there is granted to GRANTEES a perpetual easement to install upon GRANTORS adjacent property within 100 feet of said lands and to maintain such sanitary sewer system out-fall drainage lines as may be required by the proper authorities in connection with a residence upon said lands. NTE:GWM 1612.6 xAmyfiles\gwm\real est\dunn,William d.,descHption,1612.6,pg