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447 Childrens Home Rd�� K - �" s: '♦ - . . 7 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 Account #: 990005171 Biiled To: George Robert Reynolds Reference Name: Proposed Facility: Residence ATC Number: 4917 OPERATION PERMIT Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5813-74-5907 Childrens Home Rd.-27208 7.67 **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 be taken as a guarantee that the system w 11 function satisfactorily for any given period of time. .� � % v '" `�CJ��'I -''% � -_ i System Type:� S.T. Manufacturer � Tank Date� �� Tank Size :; ,�` �"% � G- �- j Pump Tank Size � , � + � � �, �% � � � � �'�.' �"° �� i c:.� ( l � �; ��_ System Installed By: C �') V�j �► � �� E.H. Specialist: ' fl�1N� CY► Date: 1— Z— U� _ DCHD 11/06 (Revised) �S � i ' , , , , ' ,�, „ . � DAVI� COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 AUTHORTZATION FOR �VASTE�VATER SYSTENI CONSTRUCTION Account #: 990005171 Tax PIN/EH #: 5813-74-5907 . Biiled To: George Robert Reynolds Subdivision Info: Reference Name: , Location/Address: Childrens Home Rd.-27208 Proposed Facility: Residence Property Size: 7.67 ATC Number: 4917 Site Type: C�fNew ❑Repair ❑Expansion *�NOTE** This Authorization to Constnict (ATC) MiJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pemut(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 plzns, p11t or the intended use change. Residential Specifications: # Bedrooms� # Bathrooms a-- # People � Basement❑ Basement plumbing0 Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size �' c��'�� Type of Water Supply: ❑County/City L�Vell ❑Community Well U �O� /�oc�0 System Specifications: Design Wastewater Flow (GPD) ` gU Tank Size / GAL. Pump Tank GAL. /i r � / Trench Width �� Max. Trench Depth 3 G Rock Depth�� Linear Ft. � 3.3 p� ,�3 stated in 1vA �li;,1,C :E8�1.1�3E3�3(51 �j Site Modifications/Conditions/Other: ��DtF d Sy�tc�ma i��y t�l� bs us�� S�O ��.�� t� Contact the Davie County Environmental Health Section for finat inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone #(336)751-8760. To� a l o� 5 33' of . a5 � �..�d4��,��ti S' � 5� .� r�"' a�� —J v"� c r�i r� a Q � 'Sr : � a ��, =� ! I� -- � _� v �" / �fPd �� P �9r�¢ -� 9r ; —_.._ U-2 w a�� l�l/� u�� u. 5 ��N-�� / ��nvu•onmental Health Specialist Date: ( O � �� ...nrrr� i � �n� /n__.:__.1\ � , ,� ' , , . �, •, Davie County Environmental Health �•• • P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005171 Billed To: George Robert Reynolds Address: 465 Childrens Home Road City: Mocksville Tax PIN/EH #: 5813-74-5907 Subdivision Info: Location/Address: Childrens Home Rd.-27208 Property Size: 7.67 Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization 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. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: 5 Years ❑No Expiration Residential Specifications: # Bedrooms� # Bathrooms d� # People � Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Desig� Flow(GPD):�� Type of Water Supply: ❑County/City �11 OCommunity Well Site Modifications/Pernut Conditions: Site Plan � � � � __ � �, � � � �— � `' -e �, �- ' — � i r � �P p fU� ��Q c'" tPr�p�..�� .� 7d � ti� I d�tu s�(�►� � t2�1 Environmental Health Specialist i.p.l 1-06 , rr � lu�� 5 � �f.a.0 � � Date l�— � � —d � Go1��lAPS - Davie County NC' I'ublic Access Pa��e 1 of I Davie County, NC - GIS/Mapping System zoom To Scale: ��'a36�fi Click Here To Start Over Qui�k Search:([:ounty ID or Ot�aner Name) . � �.. + — ,:{ �F�� Yt'� u ---. ' J' % '' � � A[tive Layer. ❑Usel+tap Trps GIS IrrFormation � Cor�tacts � Departments � Darta C r� � � - ,� N � � � � �� Fr�,F.�_EL �,��!1.:�pTlp_.'.;��Il.�k.il�i r� Map Layers � Results � AddressJNamefPartelSearch � Tools �� ' a.-„ _ j. . � +�. <+" �. � '� �,�_iin�aps.c��.cla�� ie. nc.usiG��iti��laps,�n�apr 1ncle�.cYm i U�?�4i?UUS r� • . • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005171 Tax PIN/EH #: 5813-74-5907 Billed To: George Robert Reynolds Subdivision Info: Reference Name: Location/Address: Childrens Home Rd.-27208 Proposed Facility: Residence Property Size: 7.67 Date Evaluated: �� —�`�' � � Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit FACTORS 1 2 3 Landsca e osition CC L L L Slone % t., � � Texture group Consistence Structure Mineralogy HORIZON II DEPTH 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 RAT. SITE CLASSIFICATION: � � _ � C G7 � v �� Public Cut 5 6 EVALUATION BY: _ LONG-TERM ACCEPTANCE RATE: 0-�-�-`� OTHER(S) PRESENT: REMARKS: � LEGEND Landsc pe 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 T�xtur� 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 .ON4I�T .N . . lYlfliSt VFR - Very friable FR - Friable FI - Firm VFI - Very �rm EFI - Extremely firm '33� NS - Non sticky SS - Slightly sticky S- Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P- Plastic VP - Very plastic StrLct�re SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogv 1:1, 2:1, Mixed lY��S 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) 7 LTAR - Long-term acceptance rate - gaUday/ft2 DCHD OS/OS (Revised) ■��■��■■��■■�■■��■■�■■��■■�i■�i��■�e��■■■■��■■�■ ■��■■■■�■■■��■��■��s�■■■■��■�i�■i��■��■�■■■■�■�■��■ ■�■��■��■■�■�■�■■��■■��■ ■�i��u��■��■�■■■■��■��■ ■��■■��e��■■��■■�■■■�■■■��■��■■■�■■■■■ ■��■■■■■�■■��■��■�■■■■i��t��■■��■■��■��■ ■��■��■■■�■■■■■��■��■�I�il��■■�■■�■■■■■��■ ■■■�■�■��■��■��■■■�e��■�■■��■��i��u��■■■��■��■��■ ■��■��■�■■��■��■��■��■\IL'�I��■�■��■■■■■�■�■ ■��■■■�■��■�■��■��■■��■��n�u■��■��■�■■�■■��■ ■��■�■�■■�■��■�■■■��■�i��t��■■■�■■�■■ ■■��■��■■��■■�■■■ ■�i��t��■��■■■■�■■■��■ ■��■��■■��■��■■��■�■■��■��i��■��■■■�■■■�■ ■��■��■■��■��■��i��■��■�■��■ ■ ��■�■��■■ '===��■ ��■�.��■ ��■��■■ ��■��■ ■��■��■ ■��■��■�i��■ ■��i■■�■ ��■■�i��■ ■■��■■�■��■ ■��■■�i��■■ ��■��■ ■��■ ��i��■■ ��■�i■■�■ ��■��■■ �■��■i■■■■ �■��■■i■��■ ■��■■��i��■■ ■■■■■■��i��■ ■■■��■i■��■ ■■■�i: a�i■��■ ■�_��+s��i■��■ ■R�=��r��■i■�■■ �'��.'�� ,�� t1�111�� ■i�►�n�r��i��■ it►��:.�:��i■��■ ■-a■�n�a:.o��■ ■�r.�ir��a�i��■ ■�■■��■�■ ■��■■��IYfarJ■ ■��■��Il�■■ ■��■■�I��■ ■��■11��■■ ■��11��■■ ■iC=��11��■■ ■��■��L'��■�■ ■■■■��■■�■ ■■��■��■ ■■■��■ ■■■■��■■ ■■■■��■■■ ■��■��■ ■■��■��■ ■■�■��■�■ ■■��■��■■ ■■■��■��■�■ ■�■■■�■��■■■ ■��■��■■■ ■��■■■��■��■■��■■��■■��■��\■��■■��■■�■��■ ■■��■■■■■��■�■�■��■■■�■�e�■�■��■■�■■��■■■■��■�■■��■ ■■��■■■�■��■��■�■��■■��■��■�■■■■■��■��■��■��■■ ■■■■��■�■■��■��■��■■�■■��t■■��■��■��■■■��■■■��■��■��■■■ ■■��■■■��■�■�■�s■�■��■��■��■��■��■��■��■■■ ■��■■■■��■■��■■■■��■ ■��■��■■■��■��■��s�■�■�■ ■■t��■��■��■■��■�■��■■��■■■��■�■■�■■�o��■�■ ■��■■�■■�■■�■��■�■■��■�■�■��■■■�■��■��■■■��■ ■ i ■�■■�■■��■��■■��■��■��■��■��■��■��■��■■��■ ■��■■�■■■■�■��■■■■��■■■��■��t��■��■ ■��■��■■■��■��■��■■■��■��■■��■■��■��■■��■ ■��■■■■��■��■��■��■��■��■��■��■■��■ ■��■��■■��■■��■��■■��■■��■��■ ■��■■��■��■■��■�■ ■■■�■�■��_��■�■■�■�■��■ ■��■��■■��■■■��■��■�■��■��■�■■�■ ■��■��■■��■■��■�■ ■��■■�e��■��■��■��■��■��■■■■■■��■■��■■■■■ OCT-07-2008 13:58'Fr•om:�MPLOYEE RELATIONS 919 662 4324 To: . .. -. APl'LICA'I'ION I�Ql� SI'f ��,VAr UA'I'IQN/.lMIaItOVL�MI:N'C PlaftMl lyawi� Couqly �rnvir+►nmcnlul Ilsuili► P.U. tioa &f81210 1luepllWl l�It'tct Mu�kavllle, NC 2TU28 (3]6)7 761U FaY(3J6)9:i1•ATaG Appl�i�iun Nor. {uali�nlhn�iAvurn�nk I Autharirntiun'1'u CuNttful;l(A,'I"Cj � t'ypcaYAppti��ion aw Ya � u ixfmina Sy�cn� �+xpw�,�iunlMixliAcutiai iif lixienng ��,� � � o r�� '� �:. �--- ., ;��TC � �;T - 8 2008 1�.__ __ __. f'� � ;:; "'Ef�:TF,L NFALTN �„"�,�- ___ . '.�._ C�7U;;lY ss�1M1'fJR7i1N'ly•• Tk�f�l AI'PI.ICATIQN C.ANN07`L�ti Pkf�Cli.tiSr�)11N1,1iS5 ALt, qlT'lllfi Kt3QI.111iNil INIr[)R1rf�TIC�N IS ('R4VIDl;f� H�lertutha IfYl�b(iMA�'fON 11U1»i.�'1"IN fi�r iaslruclimin ra4u��y Nt�no to Ix Qill4til ,��b1L'��,��s , Cuntuct I'etenrt �b4.�cf. `'1,_� 1�illinQAtidrass_„yy5_ _ IlomoNhono�j�,,,_��,�� _,_,�„ C'i1y/5talc2lP �}a11.�"E�, h�i-� �� 13�iiuss F'honc l�„1`,,,,,,j��L�,Q_ ., ,,.._..._... Namc an f'cmiiUATI: (fiJ�jJ'ar�nt than Abovo MaiUng Addr�:t.s o �� ..�� PEZUPCR7Y IN�ORMA'PlON •1?atc li Ntl1 t,: A survoy pl�t ar Wle pl�u musl w:aumpuny Wie ap�liculinn I 1�rmi1 ia v �J fi mwtll b with ell� lon, nu ox i tio th Ownu�s Numa�� r �� Owncr's Address, � r Property Addrece L,utSicu.;�].,_(� i'nal'INN�,,��, pircctinsie "rn ,S;tut (� OW M1iwCt t0 Uiry Ofltiu I011uvrmp quo9lianp ip'�W► : QYrj�U11111g IN)CW11CIlq Arv Ihcro mry exi�ing wantowalr,r ayslans utt IInJ SIta7 YCe) L)oca lho pilq cnntaill,iuriedi4hiunul wutlancls7 Yex Aro thcm mry oasemon�a or ri�l�t•uf-wuys on tlw 6i�e? Ye� 191hC M1itQ M1llb�w."t 10 UpryttilYu! 6y lu�Dt►�Cr rubli0 ugcnCy? Yas Will uni�wwnt¢t i�lbwr Ihtm dumaotlo �owoea Ua ac�em�eJ7 Y� � T'co�la �,_. N Flcdro��rn� �` # 1 oscmcnt: Y�; Nu 13ascmcot I'lumbini� Ya.s �d _/i�' %'�Zi scnla) � �' '"q' �V s�u... ,��'"� �$ �13-7�! 5Ro7 �IPoQr vcs No 1F• NUN-RESIUli,Nt".� l�lt.t. b[.Il"fl�lii I1QX I�EsLOW 1'Ypa af I`ACi11n'1I3L19lI10a9,�.� '1'o1nl 5qut�m A�x►wgc nl'Ruildin� , it PCaplC ,�,,.,, f� Sink� 1J Gu��unciJc� I! Sl�owcrs H Urinuls._---.._ _ �'stiniatcd Wuter tlsu�c (�i0�.�r�s par dny) (Allach Aocumcnta�inn ofsiniilsu• laoility watnr cai9unip►icn�) ��c�n��r�vr�r.•, r��i_Y: � Scros 7j�po systoln ru�µw�{ Cunvcntioncl 1yq�r 9��1y Typn: CounrylCity Wmqr cptnsl Inno�n�iro Allen�ntiva tt11w,•�� Naw Wull Wciatina Wcl� Camnumity Wall I?u yuu unUuipace octdiii�o�s ar aKpamions uf'the Ii�:flily lhir pye�m i� inianda! ui wrvo7 Ycs No If yca, what rypq7 _ ti, 'll�is ia to uarlil'y thot �ha iiil'am�ptiuu txavklwl ��u Ihie uppliuntiun is Irue nnd �ture�.y to tho hqs! of my klx»vinlqa. I u�rlcrsla�ul uuu �uiy �wnnit(d) arA7'L'(ea iaauod I�ercallar ura e��bj�cl to euy{xuaion �u nsvnc��ian ifttw aita i� alicru�l. Iha intanctMi u�o chango�, ur' if �hv infimnauon aubmiflal in Ihia uppGculan is ILlbifal or chpnge�, 't hareby grwu tight al'cmry lo q� nutlx,riRed Reprosdnlulive of ilw 1)avio Cnunty 13uaU1� Ihfparl�r�oullu cund�eet ncxsaury insFwcti�r�n la clatem�ina enmplini�ce a�i►h upplicabla laws nn ulc�x 1 uruleraw�! Iluu 1 nm rosput�iblo fur tl�o pruper kkntificati��n iuul Inl�aliiut ol'proporty ti�ba m�J cumara wu1 I� li ' Il ing or atnk' � hv i�ir�waJl�e I�,y oeutlon, ryra��opOd w411 1441!{i4N10.t1d lhC I�H:At1�1n uCCny olhar amani1�49 w�.�.�. IYo{xrty awner'o nr�nwnar's Ie �'0��'tlS�II n�IYC Yipn�lure Siio Itaviait Churgo Dnie(a} �,..,.._ ��Q D Clinnt NMiliculpx� Ihi4�' Dalo GI7S:r� 9i({t1 �iv�K� Ycg �lo Accamt p �'� I fidviycd ! IIU6 lnvoicu N %L��` `/ / CG 2i. (2.74, 196 �o NoY-�h „��`_ `�� b i �� (�/h,1a�r�is l�o�►� �� '►'1alee a- �� f-% C�I i�0� {��ivl s Vlb vYt e cJ-�`l �}-p �� 1M G� /�e. L��-i- `�-(,J t/Y1 i�/1. r �- . � � � K� IQ �C�� Childrena Home Rd 1, Gsorp• Rob�rt Ston�, c�rtlfy ihut thls plat Mas drarn und�r my Fll�d for r�qlstratlon af ' o�clock M SR 1329 fup�rvlalon irom on actual surv�y mad• under my aup�rvlslon (d��d descrlptlon NOTES• / �/'`'�'�R //� I/� r�cord�d In Book �—, Paq• " —, •tc•) (oth�r): thaf Th• boundarl�s not 1'��11 l l liL�� f L� �urv�y�d ar• el�arly Indlcat�d as drarn irom InformoTlon }ound In Book , �. Zoning: R/A � :y,,v�,� , 20 and recorded pay• • that rh� rat�o ot pr�cislon as co�eu�at�o �s �i�o,000: that thts 2. Minimum Building Setback Distances' plot ras pr�por�d In accordanc• with G.S. 47-30 0• cm�nd�d. Wltn�ss my ortqlnal Front• 40�, Rear' 3��, SIdB' �r'J� • �� , alOnoture, r�plsiratlon numb�r and s�al In Plat Book Pa9• 13 October 2008 • RB 418 O PG 8 3. Watershed Classificotion: Outside of Watershed District. rn�: aar o+ , A.D. . 4. No USGS or NCGS Monuments found within 2000' of site. M. Br�nt snoaf, Repl�ter of Deed� � � Seal or S1amD George R. Stone 1�" "' F�liny F•• oaid 2 ChSRu�328Rd ChSRu1328Rd �N CARO surv�yor p • SITE L 3162 y EPUTY � # =O�oFESS%p''•��ti,9 • R�qlsirat lon Nump�r Scorlett Ln�� .a SEAL�: � � L-3162 � W SR 1329 �'.�� {��0 Childrens Home Rd � �'�.SUR`�•''c'� c�ROBER� vcinity �lap (Not to Scale) p PK-Nail Fnd O Intersection j of SR 1328 dc SR 1329 �.c.orq�Itoc.rt stcn..rrot.alaia lana surv.yw,L-sta2,c�tlfy w a,. of tM(olowMp w indicatW thw, � or �; T-6 � a. Thot Nb plat M of a wrwy that cnatp a wbdivMlon of land rM►�n TIC t0 Intersection Of t►�ana ot o eourity w munkipopty that ta�on ordinaw�tnat SR 1328 & SR 1329 r.pulat«paroel.ot lana; �, n. nwc tna pwt a or o wrr.y tnat w�w w�.u�n ponion or c �� R � county w munklpolftY that N unnqulat�d w to an ordlnanu � �k' I that rpulate�Da��of land: � � a That thh plat h of o wrvy of an�xbthW Dac�l or paruh PROPERTY UNE CALL TABLE ot hnd; O d. That thb Plat N of a wrwy of anotMr catpory,wch w tM f— •— rxombinatbn of�xMlrq porc�,a court-ord�nd.�,ry.r a otn.. T-7 T-5 T-Bor w/cap Fnd t/2" EIR Fnd COURSE BEARING DISTANC axcepUon to t►�dsfinitbn of wbdlvWon: 1/2" f:fR Fnd � � s. That th�Infomwtbn wdWbM to thb wrvyor b�ucA that I am w / �� L-1 S 04°57'12"W 158.77' u�b��a��'�Qi m� o L-2 N 77°39'18"W 301.08' abia�y�.�a��ed��a��(a�en�wn(a>an�.. �� ? L-3 N 04"57'12"E 114.79' , p Qr I L-4 S 86°03'16"E 298.62' Georga R. Stone I Pror i�,a s�,��,�-a�ez z � � Tax Lot 25.01 • Exempt Minor Subdivision � �r Tax Map B-3 / Tax Lot 25 Tax Lot 26 Tax Lot 27 TIE UNE CALL TABLE � n/f Tax Map B-3 I Tax Map B-3 Tax Map B-3 Yvette M. Reynolds n/f Retha Mae Reynolds n/f John C. McEwen i n/f John C. McEwen �g RB 733 O PG 1052 RB 418 O PG 896 or Pouline M. Mccwen, �~ or Pauline M. McEwen, COURSE BEARING DISTANCE � o / trustees of the trustees of the , � Exteting � o�° I McEwen Revocab�a McEwen Revocabie T_2 N 73°15'01"W 102.00' � � Gravel Drive 3 � Llving Trust Living Trust � �,• . � c� / RB 676 O PG 512 RB 678 O PG 509 T-3 N 73°15'01"W 64.46' ,�� T-4 N 18°12'35"E 249.18' �'ti��` ti .� .d�`� T-5 N 86°00'15"W 107.52' � � Shed T 3 ,� `'f T-6 S 26°30'17"W 207.84' ,��.' --- '"� ' T 2 a T-7 N 86°00'47"W 101.89' _ �' i T-8 S 03°16'24"W 468.30' l � � �� E�3�- F�4`�-- --,�---- Angle Idrony _ T-9 N 79°57'05"E 160.21' ' 1 Q'�Sy � Angle Iron Fnd T-10 S 75°41'38"E 825.60' '�CENTER LINE OF Shad ``�_�-6-+ F-8�� '\ � � —' T-11 N U4°54'12"t 32�.6?' � El�� _ REVISED ACCESS EASEMENT � �\ � � LOT 1 � T-12 N 04°57'12"E 121.62' FROM 20' WIDTH TO 30' WIDTH Tax Lot 25 � £�g , ,.� '—' o d (15' EACH SIDE OF C/L) Tax Map B-3 CENTER LINE OF \~ �t Part of Tax Lot 25 o N � � SEE EASEMENT CALL TABLE n/f Ratha Mae Reynolds PROPOSED 30' ACCESS �19 Tax Map B-� ~ � „ I REF: RB 733 O PG 1052 FOR RB 418 O PG 896 �EMENT EXTENSION � `�s�. 0.937 Acres �-j- j � ' FOR EXISffNG EASEMENT DESCRIPTION (15' EACH SIDE OF C/L) �-� Square Iron Bar Fnd CAIl TABLE FOR CENTER LINE ��@ Fnd SEE EASEMENT CALL TABLE IRS Contra� Corner 2 37.80' OF REVISED 30' ACCESS EASEMEN ��2�� E�R F�a g IRS Control Corner COURSE BEARING DISTANCE S� � � � Tax Map B-3 E-1 S 07°39'20"E 166.49' �, � � r� n/f Retha Mae Rr;�nolds �� E-3 N 77°13'39"E �48.03' � .�0 RB 418 0 PG S,a � O I ~ E-5 S 66°22'10"E 109.41' -o E-6 S 81°39'58"E 61.51' � E-7 N 89°05'08"E 94.96' � R�W � R�W Angle Iron Fnd E-8 S 79°26'11"E 66.32' E-9 S 62°12'S5"E 204.17' Chil dren:.� Home R o ad X : NMP - Nonmonumented Point 5..�' . 1329 Tax Lot 28 50' P�blic R,/W 20'+/— Pavement Tax Map B-3 n/f Loflin Handle Company, Inc. DB 138 O PG 232 i� R/W — Riqht—of—Way �� FC — Face of Curb EIP — Existing Iron Pipe BoC — Back of Curb Subdivision of the. EIR — Exiatlng Iron Rebar PP — Power Pole P — Poat LP — Light Pole �+ CM — Concrete Monument MH — Man Hole R e tha Mae R e yno J IRS — Iron Rebar Set CH — Chord Dietu�ce P/L — Property Line P/0 — Part of C/A— Controlled Accese DB — Deed Book CP — Concrete Pipe PB — Plat Book Pro�ner y CMP — Corrugated Metal PiQe RB — Record Book STATE OF NORTH CAROUNA CPP_Corrugated Plaetic P�pe PG - Paga COUN7Y OF DAVIE Axle Fnd -F- 100 Yeor Flood Boundary CB - Catch Basin I (we) hereby certify ihat I am (we ars) the owner(s) -o- overhead uti�itios -S- Sewer une of the ro described hereon, wh(ch is Ixated in LOT 1: Part of Tax Lot 25 -X- Fence WM - Water Metar P P��Y Tax Map B-3 Fnd - Found wV - water volve the aubdiviaion juriadiction of Davie County and that i,�,r Review Offlcer of Davfe Coun{y _ Record Book 418 O Page 896 n/f - Now or Formeriy BM — Bench Mark 1 hereby adopt this subdivision plan with my free cs that e mop or plat to which this certification LOT 1 Area: NMP — Nonmonumented Point TBM — 7emporary eench Mark is xed meets alf tatutory requireme te for recording. C� - center une RRS — Rail Road Spike conaent, eatabliahed mtnimum buildtny setback lines 0.937 Acres +/- by coordinate geometry EP — Edge of Pavement CN— Cable Televiaion Pedeetal and dedicata all atreeta, 011syt, WOlkt, pa►ics and TP — Telephone Pedeatal ETB — Electric Traneformer Box Review Off�COf: SCALE TOWNSHIP COUPJTY �A� �� -w- water une CO - sonitary Sewer Clean out other sitee and eaeements to publlc or private use � �'�"`*`f �� as noted. Dat4• 1 = 100' Clarksville Davie t�orth Carolina 10-13-2008 �� 20� 3C1� /a p,�. . b$ �' Owne�: "NO APPROV QUIRED BY THE COU PUWNING DEPARTMENr" SURVEYED: Stone Land Surveying Company �oe ,�,o. Retha Mae Reynolds SC,QB George Robert Stone, PLS L-3182 12308 465 Chiidrens Home Road I�AAP N0. GRAPHIC SCALE — FEET o,e, o,,,,,,,�,� Mocksville, N.C. 27028 Planning Diroctor wuwPm: 151—B South Main St (336) 998-4733 �2308 ,�� /_ _ �S� GRS Mocksville, N.C. 27028 ��/�7 Da�te ! • '. - ', • Davie County Environmental Health • ` P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fas (33�751-8786 WELL PERMIT Account #: 990005171 Tax PIN/EH #: 5813-74-5907-Well Billed To: George Robert Reynolds Subdivision Info: y� � Reference Name: Location/Address: Chiidrens Home Rd.-27028 Proposed Facility: Well/Private ' Property Size: �7.67 Acres ATC Number: 0012 Actions of the employees of the Davie County EH Section shall in no way be taken as a guazantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any fact/circumstances upon which this permit was issued. Permit Type: New,� Repair ❑ Abandonment ❑ Proposed Well Location Diagram ► � Comments: I`�\�S� Cc� w,�p ly w.� 1� a� � 5�:� �oack5 ��:1�� vt�c.�5� S�I ��-`l Ce rC� fJ � li dd.'duc� � �1 �ac.e�.�.�� J/►ior 'fo %%�!'��i`u4' EHS: W.P. 7-08 Date: l�' �'y � Certificate of Completion Diagram h Sg / � ,(t� I �' ,,,i•--• I^� '� \i �� n � �� i 3� l ��` � � � — 1 v _� �Q` \ � __._ ' � � u.c'rtn,;:nu Driller: ,R r � �� v� �.l�.Q �. � � Certificadon #: '��j () Grout Inspected: j— 1 4( —�� Well Head Inspected: 1'� 0" � q GPS Coordinates: � 3 �� ( , -r( �S` � �(J �Q �?j 7, �3 EHS: �`i%%�!�/� Date: / ��O �Q CATION FOR PRIVATE WELL PERMIT Davie County Environmental Health P.O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Faz (336)751-8786 �,/ ***IMPORTANT*** APPLICATION CANNOT BE PROCESSED UNL�SS ALL OF TT� REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name to be Billed ��0�( �� l� CX� Contact Person b�P_�YGL Billing Address �� y -� Home Phone �� 3-�3 a 3 City/Sta.te/ZIP /'{��C�(l�J�� ,� � oZ%oc'� Business Phone � %a�/-aq�j-��f Name on Permit if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged /D -?—O� NOTE: A survey plat or site plan must accompany thi application. Included: B-Site Plan ❑Plat (to scale) Owner's Name GL� � Y1 Phone Number ��, 3—�%�a 3 Owner's Address S C ` � 1-Z � City/State/Zip �70 ag Property Address City Lot Size � %. (P % #� Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: DEVELOPMENT INFORMATION Permit Type: New Well Well Repair Well Abandonment Other (specify) Facility Type: Residential �Food Service Church Commercial Other Are There Any Septic Systems Cunently On The Site? YES I�IO Do You Intend To Install A New Septic System On This Site?� YES NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions, the specific locadon of the facility and any existing or future appurtenances, the location of any existing septic system, sewer lines, water lines, any existing water supplies and any surface waters. The applicant is responsible for identifying and mazking the property lines and comers. The applicant is responsible for making the site accessible. By signing this application, the applicant si�es that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary 7/1/08 /0 — % O� Date Site Revisit Charge Date(s): Client Notification Date: EHS: Account # 5/7 / Invoice # 7n t� � , , •. - .. , - � � ti DAVIE COUNTY WELL CERTIFICATE OF COMPLETtON CHECKLIST Applicant: ��.Qov�-e �C.e� vt o�� File #: Site Address: � f ��.� ev� f� o✓►� -� (�� Subdivision: Lot: / Permit Type: New Well Well Repair Well Abandonment Other Facility Type: Residential V Food Service Church Commercial Other Initial Inspection r Were Setbacks Maintained? Yes � No What is the Grout Depth? i�5 ft. If No, Explain: What is the Type of Well? �..p What is the Casing Type? l-� u��u'��y�-� � What is the Casing Depth? � ft. What is the Well Diameter? �� in. . .• What is the Well Depth? ft. Is There an Access Port? �/ Is There a 4" Pad? _,/1/� /(/�}� What is the Casing Height? ( 3" What is the Static Water Level? What is the Grout Thickness? �, in. Was a Well Screen Installed? Type of Drilling Fluids Used: (,� ��( -� T Well Grout Inspection Date: �-��-� 9 u GPS Coordinates: I� 3c,° I,�t $5 � t�l �� EHS ID: � 1`i � 3� �� 3G Well Head Inspection ft. Is the Well Contractor ID Plate Complete? '� Contractor Name: � r�,�,,._,� �u� i� C o Contractor Certification #: Depth of Well: Casing Depth and Inside Diameter: Is There a Vent? ✓ Is There a Hose Bibb? ✓ Is There any Grout Settlement? � What is the Yield? GPM Is the Pump Installer ID Plate Complete? Pump Installer Name: Date Installed: Depth of Pump Intake: Pump Horsepower Rating: Screened Intervals: Opening for Piping & Wiring >_12": _ Packing Intervals (Sand Packed Wells): Yield in GPM or GPM/ft.-dd: Static Water Level and Date Measured: Date Well Completed: �-�`%O �/ Well Head Inspection Date: (-- � a- v`� EHS ID: 2 i 4 0 Construction Completed Date: 1- ��-I - v`� Sample Date: Gu�S'�� C�n ��a c�o� Certificate of Completion Date: � :�� d � Authorized Agent: � Contractor Reports Received Date: Results Mailed Date: