450 Cedar Grove Church Rd (2). . •
DAVIE COUNTY ENVIRONMENT�IL HEALTI-I
�� P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
Account #: 989900194 OPERATION PER1�tax PIN/EH #: 5767-94-1969
Billed To: Brian & Deanna Mcllwain Subdivision Info:
Reference Name: Location/Address: Cedar Grove Church Road-27028
Proposed Facility: Residence � Property Size: 23.25 Acres
ATC Number: 4853
**NOTE** The issuance of this Operation Pernut shall indicate the system described on the ATC 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 b taken as a guaFantee that the system will function satisfactorily for any given period of
time. fQ � �
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System Type: � S.T. Manufacturer Tank Date �� Tank Size
Pump Tank Size
S stem Installed B � � 'Q-�- � � ��� ��T�.t� �' � �g .=` ��
Y y:�, � E.H. Specialist: Date: ��� ,,,
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� DAVIE COLTNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospit�l Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751= 8786
AUTHORIZATION FOR WASTEbVATER SYSTENI CONSTRUCTION
Account #: 989900194
Billed:To: Brian 8� Deanna Mcllwain
Reference Name:
Proposed Facility: Residence
ATC Number: 4853
Tax PIN/EH #: 5767-94-1969
Subdivision Info:
Location/Address: Cedar Grove Church� Road 27028
Property Size: 23.25 Acres
Site Type: ew ❑Repair OExpansion
**NOTE** This Authorization to Constnict (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, pl�t
or the intended use chan�e.
Residential Specifications: # Bedrooms� # Bathrooms �# People y BasementCa'F3asement plumbing�
Non-Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size 3. �.� ��� -� 5 Type of Water Supply: ❑County/City CX�ell ❑Community Well
System Specitications: Design Wastewater Flow (GPD) �'i �aTank Size� GAL. Pump Tank � GAL.
� �
Trench Width �� � Max. Trench Depth 3�' �r Rock Depth� Linear Ft.��
Site Modifications/Conditionsl0ther:
�',� stated in 15A NCAC 1�F`,.1S�i9�:i}
. G.$c.,^'.,�'�.?�i7yTTT7� c.7'.��i.Fc�T=,�c, �
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 930a.m. on the day of�stall�'Lt1Qn. Telephone #(336)751-8760.
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Envuonmental Health Specialist
DCHD 11/06 (Revised)
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Davie County Environmental Health
P.O. Box 848/210 Hospital Street
' Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
IMPROVEMENT PERMIT
Account #: 989900194 Tax PIN/EH #: 5767-94-1969
Billed To: Brian & Deanna Mcllwain Subdivision Info:
Address: 480 Rabbit Farm Trail ' Location/Address: Cedar Grove Church Road-27028
City: Advance �
Property Size: 23.25 Acres
Reference Name:
Proposed Faci�ity: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Autliorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to
revocation if site plans, plat or the intended use change.
Pemut Type: C33�ew ❑Repair ❑Expansion Permit Valid for: C�S�i ears ❑No Expiration
Residential Specifications: # Bedrooms / # Bathrooms� # People '� Basement�t7 t3asement plumbingQ�
Non-Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Design Flow(GPD):� Type of Water Supply: ❑County/City �11 ❑Community Well
SiteModifications/Permit Conditions: �.�., ,.s...,,d in 1��, �i��� 18.�.2.� ��(a)
rT��
�cc�pted Systems m�y also be u5�p
Initial
Site Plan
Environmental Health Specialist
i.p.l I-06
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APR��� FooB
Type of Applicatio
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FOTZ SITE EVALUATION/IMPROVEMENT PERMTT & ATC /
4 Davie County Environmental Health `�,
` P.O. Boa 848R10 Hospitsl Street �"
Mceksville, NC 27028
� (33�751-8760/ Faz (33�751-8786 _ �: �� (, ,
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uah prwemeat Permit Authorizatio
ya �r to Existing Syatea► anaion/Mod�'mation of Exiating Syatem or Facility �.
'��TFI�$�I,ICATION CANNOT BEPROCESSED UNLESS ALL OF TIIE REQUIRED
��ROVIDED. Refer to the INFORMATION BLJI.LETIN fa instructions.
INFORMATTON
Name to be Billed 81" 1 Q vJ �'i � 1 � W A.i h Contact Person �� O� �'1 1�► G�.. M� I�W !�
Billing Address �$t7 Ra.lo hi t. �Qy'�'�^ Home Phone
City/State/ZIP ����,N,j,.� �[ 2.'Y bb Business Phone GD9, —3'7 "1 '7
Name on PermiUATC ifDi,�j'erent than Above
Mailine Address
YROYEKTY 1NN�UKMAIIUN 'llate House/raci�ty C:ome
NOTE: A survey plat or aite plan must accompany this applicatioa. Included: Site Plan
(Pamit is vali for 60 months with aite plaa, no expiration with eomplete plat)
Owner'sName ���pr�J� C� Phon
Owner's Address City/State/Zip_
Properry Address e City�
Lot Size 'i •��i [� G. Tax PIN# �'T �,'''j 1�D
Subdivision Name(if applicable)_�� o.. Sectioa/I.o
Directions To Si�e: (�h 1 v In tL __ � r d .✓ wo u G j++a. �J
P1at(to scale)
Number�
���
ff the answer to any of the fo ow' questioiu '` yea ; suppoRin docnm�tation muat be atiached
Are there any existing wastewater syetems on the aite7 � No — P D S 5� � ��
D o e a t h e a i t e c o ntain juiiadictional wetlands? es No
Ace there any easements or right-of-waya on the site? Yes o
Is the aite aubject to approval by another Public agency7 Yes
Will wastewatv other than domestic sewage be genaated'1 Yes No
IF RESIDENCE FILL OUT THE BOX BII,OW
# People # Bedrooms �_ # Bafluooms _� Garden Tub/Whirlpool Yes
Basement es No Basement Plumbing: es No
IF NON-RESIDENCE FILL OUT.Tf� BOX BII.OW
Type of Facility/Business Total Square Footage of Building # Peopie
# Sinks # Crnwnodes # Showers # Urinals
Estimated Watet Usage (gallons per day) (Attach documentation of similaz facility water consump6on)
FOODSERVICE ONLY: # Seats
Type syatem requested: Conventional Aooepted Lmwative Akcmative Other
7
Water Supply Typa County/City Water New Well Exiating Well � Community Well
Do you anticipate additiona or axpansions of the facility tLis eyatem is intended to aerve7 Yes No
�yfS� W}1b�ij�1C�
Thia u to certify Uwt �e infmmation provided on thia application is irue and co:rect to the best oF my knowledge. I understand
th�t any permrt(s) or ATC(s) isaued haeafta are aubject to auspension or ievocation if the eite is akerecl, the intcnded use
changes, or if ffia infocmation aubmiued in thie app&ca6on ia fsb�ed or changed I hereby graet right of entry W tho Authorized
Representative of the Davie County Health Deparhnent to canduct necessary inspections to ddecmine compliance with applicable
lavre and mles. I underataad tbat 1 am reepons�le for the proper identification and labeling of pmperty linea and cornere and
loca ' and flagging or sWang the /ho�/ls dfacility location, propoaed well location and the locatioa of any othet amenitiea.
I ,Y�/L�n.. � �/e�"�^"V Site Revisit Chacge
Property owna'e or owna's (cgat repreaentative signature Date(a):
7 I�v�! �f Client Notification Date:
� EIIS:
Siga given Yes No
Revised 1 U06
A�„r# ��g q o 019y
Invoice # 7���
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� DAUIE COUHTY 19-11-9i
srap�oTH �49. 00
�apUNA � Real Estate
� Exc(se Tax
R.t�l�w'M1t _ ..n
05�35�1
IRID FOR REG�511qi�DM
October 11, 1996 10:10 A.M.
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Assist�t
RecarAln� T7me, Book and Page
TxxLot No . ...............�-�........................................................................ Parcel IdentiEer No. ..........................................................................
Veri6edby ........................................................................ County on the ................ day of ........................................................, 19............
br...........................................................................................................................................:..................................................................................
Mail after reeordln� ? c..l./A4.Y..�'�-.....kL/.�......5.. o.�:� .........................:.. .. ........................ .............................................
.... ... . .........
..�./.!�F.... '�d.4�...�r.'r:o.�L....l 1►.�...R..d.• .............M. . o �...k.s .d.<'//�...,..,rl�..4':.�.........�..7 0.-�.............................................:.
This inatrument waa prepared by ......Clive I. Goodson
. .. ...................................................................................................................................................
Brief deacrlption tor the Index Tax Lot 46� Tax Map K-11
NORTH CAROLTNA GENERAL WARRANTY DEED
TSI3 DEED made thia ....lOth• aAY of �• •-••� ••••• OCtOber�•••••• •�� �••� •• :� 1� 96 �� �, by and between
GRANTOR
RENAN LINDSAY CARTER. Single
DEED TTi�::'�:FEA C�'!ED
DA "�• i�,_, • ��DY � ' '
TAX 5UPEHV���
GRANTEE
CHARLIS W. COPE and wifa,
VIRGINU B. COPE
Enler ln aPVroO►I�k bixk f�r ueh part�: o�me. addres�, and. it sPO�PNate, chu■eler ot wU/7� aq. �ryo�'stlon �r yutcershlµ
TLe deaignatton Grantor nnd Grantee sa uaed herein shall include eaid partiea,their he3re, succeeeacs, �nd aeel�aa, rnd
ehall include ain�ular, plural, msaculine, feminine or neuter as requlred by contexk
WITNESSETH, that the Grantor, for a valuable conaideratton paid by the Grsatee, the receipt of whtch ia hereby
sclrnowledged, haa and by theae presente doea grant, bazgain, aell and convey unto the Grantea in fee almple, sll that
certain lot or parcel of lrnd nituated in the City of ............................................................. ................................................ Townehip,
...........Ad.Y.�,s ........................... County, North Carollna and more particularly deseribed aa follows:
see attached Exhibit "A" for complete property description. Said
Exhibit "A" is incorporated herein by reference as if fully•set
out herein.
N. C. Wr A . Form No. 3 0 1976, RrYbed O 1977 - l.�.wwww � p. Ma, w �n, r.euw.�., r. t t�o66
hwY W ��rwtiM wit� �M N. C. N/�sa. - p!1
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GoMAPS - Davie County NC Public Access
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Davie County, NC - GIS/Mapping System
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http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=412... 4/ 10/2008
�. , ,� � ' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Heaith Section
` , Soil/Site Evaluation
APPL�A�TitII�FC���SiA'ri'i�1 Tax PIN/EH #: 57f,��P'r��Y INFORMATION
Billed To: B�ian & Deanna Mcllwain Subdivision Info:
Reference Name: Location/Address: Cedar Grove Church Road-27028
Proposed Facility: Residence Property Size: 23.25 Acres Date Evaluated: �% � a 3— ��
Water Supply: ' On-Site Well " Community Public
Evaluation By: Auger Boring Pit Cut
tviineraiogy
TTl1TTrJlIAT TTT TrT]T�T
HORIZON IV DEPTH
Texture group
SOIL WETNESS
TT[�TTT/�✓T�T<lT Tt/lTTrllITT
SITE CLASSIFICATION: P�i EVALUATION BY: �.� ��Q !�d rl S
LONG-TERM ACCEPTANCE RATE: �' a 7� OTHER(S) PRESENT: �!,l -P a Ul v� Q/ ���l ��^'oy v`
REMARKS :
LEGEND
r,�n s ane Position .
R- Ridge S- Shoulder L- Linear slope FS - Foot slope N- Nose slope
CC - Concave slope CV - Convex slope T- Tenace FP - Flood plain H- Head slope
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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
�ONSISTENCE
a'I4is.t .
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
�
NS - Non sticky SS.- Slightly sticky S- Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P- Plastic VP - Very plastic
�tri�ct�
SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralo�v "
1:1, 2:1, Mixed
1YQt� '
Horizon depth - In inches
Depth of �11 - 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 r�r-Ur� n�inc in....:..,,.,.
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