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277 Harvest Ways � Permittee's`,. DAVIE COUNTY HEALTH DEPARTMENT NameE:_ t%L-1 -1 C?'j Environmental Health Section PROPERTY INFORMATION // P.O. Box 848 4Directions to property: � #-.% 1 �,x.)A j `f Mocksville NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: AUTHORIZATION FOR ��f • F .w,� 1�%K WASTEWATER T Off PIN # Lot: .� SYSTEM CONSTRUCTION ax ice AUTHORIZATION NO: 002758 A Road Name: �� � Z1pp: �! **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 FornVAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Ai ti le 1 -of G.S. Imhap er 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ! ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. "- . .VIROPI~ ENT. L H L-IC1S ,ECIALI$gI" A ISS D RESIDENTIAL SPECIFICATION: BUILDING TYPE HQJ% # BEDROOMS --21 # BATHS _? # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE�IPE WATER SUPPLY) DESIGN WASTEWATER FLOW (GPD) �—` NEW SITE REPAIR SITE SYSTEM REQUIRED 7CATI0 S: TANK SIZEGAL. PUMP TANK GAL. TRENCH WIDTH n 1 1 Ot�IER .t 1� I.�STi 0,){ -{� U MODI CATIONS/CON I ONS: IMPROVEMENT PERMIT LAYOUT [X�SiI►J�a��' _ JrvrJ 7 ^Q0 � a�T ROCK DEPTH IJ n` LINEAR FT. vJ - c ii-- -I QE COT-- FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT 32 SYSTEM INSTALLED BY: 7\AtL.l- k = 112, QUID 4 STS AUTHORIZATION NO. r`✓LJ'" OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY M DESCRIBED A OVE 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. DCHD0= (Revised) Nei qn (O J-0. -b' 513V -k DAVM 1� COUNTY HEALTH DEPARTMENT <,A-31 Environmental Health Section La.LLPROPYTY INFORMATION P.O. Box 848 Diriectio�n4sf`to I'ro'p,ert,y: Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 T- - Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION NY AUTHORIZATION NO: 00275, Road Name: -,�qZkWip: **NOTE** This Authorization for Wastewater System Construction MUST 139 ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Perm=its. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11-6f 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. k JRO��hNT A�L HtAL19.SiTCTALIST-, 6-AIISSUD RESIDENTIAL SPECIFICATION: BUILDING TYPE J(XJ�S# BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE — # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE, PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SP 71CIFICATIO S: TANK SIZE ----.-�GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH N LINEAR FF. 0ENR REQUIRED ;ITE MODI C AT10 N S / C 0 N b I T '10 N S -Tt M L 0 L > �- t r--1 LI S vyT EF — /6 111 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT 32 SYSTEM INSTALLED BY: 94,1by mlt�, Z16 C P-Amz d- LA7 4 (N QuIcy- Lt STh > 411? AUTHORIZATION NO. OPERATION PERMIT BY: DATE 7 "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT INDICATE SY TEESCRIBEDA OVE A BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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 02/02 (Revised) F -z F & 1. .�17 ff '5-q,3 / IMPROVEMENT PERMIT LAYOUT LEVI S- F 1 AL:,,;F 7� FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT 32 SYSTEM INSTALLED BY: 94,1by mlt�, Z16 C P-Amz d- LA7 4 (N QuIcy- Lt STh > 411? AUTHORIZATION NO. OPERATION PERMIT BY: DATE 7 "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT INDICATE SY TEESCRIBEDA OVE A BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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 02/02 (Revised) F -z F & 1. .�17 ff '5-q,3 / t a co ,�.(192) otz � (000 � � ��h tq"3A 3dH k, k � a t ak M tQ t a co ,�.(192) otz � (000 � � ��h tq"3A 3dH t � lVl�l DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) �G NAME OWi% PHONE NUMBER ADDRESS OCS�i SUBDIVISION NAME LOT # DIRECTIONS TO SITE /5-9 `d D d If' Al UfAl U) 17Nfh /16 lln% AG1 4dNIJ DATE SYSTEM INSTALLED TYPE FACILITY V'� TYPE WATER SUPPLY F SYSTEM INSTALLED UNDER dJefGt�SCtl11!'� ' *00MS NUMBER PEOPLE SERVED, PECIFY PROBLEM OCCURRING PUMP ON SL DATE REQUESTED? (I INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 y„ yR"'t'Iw�a y,�, n:r'-+�-i-i'r��� • .,F q a }°`�"1i"a 'K�T u�+:ef�"fi �-'w^'st Y'M1T Dry>s ^'A,� Ott �.! sP7"jC'Ci,q"[�'�J ��� f�,�- � }/��.� 1`7 NO Q y DAME COUNTY HEALTH DEPARTM_EN�'' nvironmental Health Section PROPERTY INFORMATION r /� \XmP O Box 848 U NameINCL '- � •�";y Mocksville,NC 27028 Subdivision Name: i tPhone# 704 634-8760 '4 Directions to Property � ` l r3Section I� AiTTHORIZATIONFOR C ': ; WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION 4� Road Name JS **NOTE**This Authorization for Wastewater System'Construction MUST BE ISSUED by the Davie County Enviromnental Health Section to;issuance of an Buildin Perimts:This Fonn/Atithonzation Number should be resented to the Davie Coun Buildui Ins t< f Y g P ty gP� y Office when applying for B'uildmg Perrmts t (In comphancewlth Article 11 of G S „Chtet'130A,Wastewater Systems,Section 1900 Sewage Treatment and Disposal Systems) 3' ***NOTICEI* THIS AUTHORIZATION FOR WASTEWATER CONSTF a c ��a � IS VALID FORA PERIOD OF FIVE,PEARS ; ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED , RESIDENTIAL SPI CIFICATION BLLDING TYP u #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL Yes of o� COMMERCIAL SPECIFICATION FACI ITV TYPE #PEOPLE #PEOPLE/SHIFT #SEATS IlVDUSTRIALbWASTE Yes of Na r r , m t: A ' s`LOT SIZEa TYPE WATER SUPPt Y° ' DESIGN WASTEWATER FLOWy(GPD) b NEW SITP r' REP�iIR SITE 1 ;SYSTEM SPECIFICATIONS TANK SIZE GAL PUMP TANK' GAL TRENCH WIDTH _- ROCK DEPTH LINEAR FT ¢¢ �` K REQUIRED SITE MODIFICATIONS/COND NS }1 , y �t ra IMPROVEMENT PERMIT LAYOLFTZs� r a y ` r ,�� � � � rh 9� %4x_ i gr t " w l� � , I � 1' 1 A%« + , } V t % "" , a � 3• [- a � I ,i , ,% ,) �. t � t ��, � , ,,t,, d :� n �, �i , � �Vt r •, t m I {�P 1 � Y. 9 ' yz yet •� 'q v ti.�Y 9f 1..P ��y �.a �.K,v.,. ' 1 r"7 ,yw1% w�i.y k tV � t `' I J ....: � 4,,,�,Y` t �.t Y, ;° + .�:I 1 � < �� d k yt CONTACT A REBRESENTA OF THE DAVI COUNTY HEAL�'H"DEPARTMENT FO ""FINAL'INSPECTION OF THIS S r z r % '� r i'' BETWEEN k8 30 9 30"A"NI OR 100 �1 30 MOT THEyI�AY OF INSTALI ATIOIV`fiEI EPOLIE IS"(704)634 8760 a I`: t t, 1 y x ia:fa l 1 `u ��,iu, 7" fCa:..y y J W % -i{• & a r d OPERATION°PERMIT t `r , r C a 1 SYSTEMINSTALLED�Y I 1 e 4 X p {{, AUTHORIZATION NO O OPERATION PERIvfIT BY ° `� ` DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED'ABOVE HAS BEEN INSTALLED IN COMPLIANCE � �: WITHAARTICL&11 tOF GtS CHAPTER]130A SECTION 1900 SEWAGE TREATMENT�AND DISPOSAL SYSTEMS BUT SHALL IN NO WAY BETAKEN GUARANTEE,TIiAT T HE SYSTEM WILL'FUNCTION SATISFACTORILY FOR ANX GIVEN PERIOD OF TIME t 4 tE a1 s 1 i DCHD 05/96(ROVISCd)�° ' "�` a x '"� 7+ i r , J ✓1 i 4 l �"Y'-AwrH �•+wae ': 5 's:.. M:-.+� .., ,.a. �.: i ,R � ... 7: ^, .S:u/'i«f"1,t kk,`a'`t.f t ,},... � �`Y,'5:+• Y •""'Y"` �� 3* w� I° gig, xrrY -weg,"fy e i.. _y,,.,,y, rW Y Yi. �AUTHORI�ATION:NO: Q DAV IE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATIONl�� i?errmtt@e s�. P.O. Box 848 Naifie: �1 t 4s F� L� 1 �� N Mocksville, NC 27028 Subdivision Name: 11Phone #:704-634-8760 Directions to property:` �' ham- Section: Lot: AUTHORIZATION FOR Tax Office PIN: i�tti� "` �1l'��7.V �S► ` WASTEWATER SYSTEM CONSTRUCTION r . Road Name:Zip va,� 7� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior { to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. ' (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 1 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST- DATE ISSUED'i,, (Y YY _..:`.ot 1, �r.. i! iJ! L ".++v M'�i ';. /� Y 1.{ r 9i ,i l� 'i +. G. - S .<i< ,... ..- 'F !a 't_1 'r� 1 �t�✓ ,� � ! {./rt/�{_/�' /ji 4 " DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFIORMATIONZ j ; Perrtut `] Subdivision Name: 4 Directions to property: ` r ��- Section: Lot: IMPROVEMENT 4 PERMIT Tax Office PIN:# Road Name� La Zip: **NOTE** This Improvement Permit DOESNOT 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 consnuction/mstallation of asystem 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) ; „ p ***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 # BEDROOMS j # BATHS_ # OCCUPANTS GARBAGE DISPOSAL: Yes orQTJ COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No tollool 11 LOT SIZE TYPE WATER SUPPLY C� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE !N� GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH LINEAR FT. Q OTHER t 1 REQUIRED SITE MODIFICATIONS/CONDITIONS: "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. 014 THE DAY OF INSTALLATION:. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: Q �� cp 33' 0 T ) � U ray AUTHORIZATION NO. 01 ` OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS" BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) "..." ., APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 M (704)634-8760 t� ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed M)rl\ne_1 0 f • IrA Arla'(�fP_ �-`DP.ij,�Gllil'tl Mailing Address I q l C re- P k �Eo A City/State/Zip i e-tio51 %�_0')-73L4 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone 9173-- -2 9-7— 1'i Ole Business Phone City/State/Zip 3. Application For: [ ] Site Evaluation [ improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ ] Mobile Home [ ] Business [ ] Industry [`�ther FV)n1)I ar LmLp 5. If Residence: # People -,J— # Bedrooms -3 # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [Washing Machine [ ] Basement/Plumbing [ 1 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: [.County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [-TN'o If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A.lL)Pia"F THE PROPERTY MUST BE SUBMITTED WITH T APPLICATION. Property Dimensions: o� 5 S % GtGr� 5 ; WRITE DIRECTIONS (from Tr TO PROPERTY: Tax Office PIN: # 0 Ly U 1 S 9 N 4v �! (] 00__ -- Property Address: Road NameV e'�' i m),a Q � P -Q — (�pau S city/zip 1 Z 0M-12 1�1(1 11/ P,S+ �,1�.,)/2 �t D=�161, 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 NiC1-c2e) s' I`�('�aricP•S-rAe11,SQn f -i to conduct all testing procedures as necessary to determine the site suitability. DATE ISD'7 SIGNATURE�CUJLp`�P,fc���{� Revised DCHD (06-96) THIS AREA MAY $E USED FOR DRAWING YOUR SITE PLAN: \ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT V r Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By � L Mailing Address Home Phone L1 P10 D M �^ 2. Name on Permit if Different than Above h ((_r 1 Q and 3. Application/Permit for: General Evaluation i •. 4. System to Serve: 0 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If house, mobile home: Subdivision t No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: Public 8. Property Dimensions No. of Sinks No. of Urinals No. of Water Coolers _ Water Usage Figures _ ❑ Private Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? htt,� a CSD I,1 �.(EQVEI NOV U 3 f994 ❑ Septic Tank Installation ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing 1Washing Machine Cvi Dishwasher ❑ Garbage Disposal ❑ Yes k No ❑ Community `NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. Gq — W� a 4, �/ CaL��L DATE A SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 4 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the D vi County Health Department to enter upon above described property located in Davie County and owned by ea U to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. _ \Aa , DATE :IGNA TUR DCHD (12-90) ,. DAVIE COUNTY HEALTH DEPARTMENT :. Environmental Health Section Soil/Site Evaluation NAME O htJ '� �l 1� DATE EVALUATED ADDRESS \' PROPERTY SIZE PROPOSED FACIILTY I -F O v S t LOCATION OF SITE ""A Water Supply: On -Site Well Community Public Evaluation Bytom Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position ,_.S S Sloe % _ /_ Q�o F- s d , I `o HORIZON I DEPTH �• �' Texture group IC Consistence -T ELI Structure Mineralogy I' HORIZON II DEPTH ` 4 -Z 4 Lil Texture group Q" L_ C Consistence F Structure C Mineralogy► t I i ' ' HORIZON III DEPTH Texture group Consistence t'v P -T ]- Structure MineralogyI tj HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS SS SS Ss RESTRICTIVE HORIZON - — — SAPROLITE — — CLASSIFICATION 7.S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: •S EVALUATED BY: �Co J LONG-TERM ACCEPTANCE RATE: p OTHER(S) PRESENT: REMARKS: �cr�v� z%_, �GEND 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 flay 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 -Nonplastic SP -Slightly plastic P -Plastic VP -Very plastic Structure 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic 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 - gat/day/ft2 DCHD(01-901 0776~ BK i i b PGIO 4 S 1045 EXHIBIT A BEING KNOWN and designated as revised Tax Lot 10.01, being a 1.00 acre tract, on a Recombination Survey for Michael F. Dellisanti and wife, Margaret Dellisanti, as recorded in Plat Book 8, Page 355, Davie County Registry, to which reference is hereby made for a more particular description. TOGETHER WITH AND SUBJECT TO septic system easements set forth in DB 322, PG 836, and in Plat Book 8, Page 355, Davie County Registry, and subject to a 30 ft. access easement as set forth in Plat Book 8, page 255 Davie County Registry to which reference is hereby made for a more particular description. SUBJECT TO easements and restrictions of record. FOR BACK TITLE, see DB 322, PG 836, and DB 177, PG 448, Davie County Registry. See also Tax Map H-5, Pcl 10.0 1, located in Mocksville Township, Davie County, North Carolina. Note: Doris Kathleen DelliSanti died in 2006. TErrAF X: /My Files/Real Est Desc/Rowe, Ralph, File No. 22236.1 WITNE'SSl+ T11: THE GRANTOR, for valuable consideration paid by the GRANTEE, receipt of which is acknowledged, has and by these presents does convey unto the GRANTEE in fee simple, all that certain parcel of land situated in Mocksville Township, Davie County, North Carolina (the "Property") and more particularly described as follows: SEE EXHIBIT "A" ATTACHED HERETO TO HAVE AND TO HOLD the Property and all privileges and appurtenances thereto belonging to the .GRANTEE in fee simple. THE GRANTOR COVENANTS with the GRANTEE, that the GRANTOR is seized of the Property in fee simple, has the right to convey the Property in fee simple, that title is marketable and free and clear of all encumbrances, and that the GRANTOR will warrant and defend the title against the lawful claims of all persons whomsoever, except for the exceptions hereinafter stated. Title to the Property is subject to the following exceptions: 1. Easements and restrictions of record. 2. Ad valorem taxes for 2008 and subsequent years. • • SCHEDULE "A" D. T. BOO; pAGL07 That certain tract of land containing 25.57 acres, more or less, located in Mocksville Township, Davie County, North Carolina, and bounded, now or formerly, by natural boundaries and/or lands owned by and/or in the possession of persons as follows: on the North by the lands of John M. Koontz, et ux (Deed Book 111, Page 662) and Angela D. Koontz (Deed Book 111, Page 664); on the South by the lands of Barbara P. Clontz (Deed Book 171, Page 632); on the West by the lands of B. L. Angell (Deed Book 102, Page 135-7); and on the East by Harvest Way (formerly Old Highway 158); said tract lying approximately one-half mile North from the Town of Mockaville and being more specifically described as follows: BEGINNING at a point in the center of Elisha Creek as evidenced by a nail in middle of the bridge on old U. S. Highway 158, Margaret C. Pope's corner; thence with the center of Elisha Creek and Margaret C. Pope's line North 74 deg. 10 min. West 630 feet to a point in the center of Elisha Creek at the mouth of Nelson Creek; thence North 71 deg. 40 min. West 242.0 feet to a point in said creek at mouth of branch; thence South 88 deg: 40 min. West 346.0 feet to an iron pipe on the North side of a ditch; thence South 52 deg. 05 min. West 472.0 feet to an iron pipe; Margaret C. Pope corner in Angell line; thence North 86 deg. 15 min. West 431.0 feet with Angell line to an iron pipe and Walnut stump; thence North 04 deg. 25 min. East 726.0 feet with Angell line to a point in center of Elisha Creek, Laura C. Koontz corner, which said point is 20 feet North from a witness iron; thence South 65 deg. 30 min. East 297.0 feet with Laura C. Koontz line, a point in center of Elisha Creek; thence with Laura C. Koontz line North 82 deg. 27 min. East 1627.0 feet to an iron rod on the Western edge of Old Highway 9158, which said iron rod is 21 feet West of the centerline of said Highway; thence South 03 deg. 20 min. East 797.0 feet with said highway to the POINT AND PLACE OF BEGINNING, containing 25.57 acres (D.M.D.) and being the "CreekTract" of the W. W. Campbell Estate and also being Tract 95 (A) of the Ella (Mrs. J. B. Campbell Division as referred to in Book 34, Pages 211-213, Davie County Registry. Also see Will of W. W. Campbell on record in the Davie County Clark of Court's Office in Estate File 71-E-73. • Davie County YlealiFi De artment and .�fome ..1lealtFi � yency • 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 November 15, 1994 John H. Ervin 390 Salisbury St., Box 365 Mocksville, NC 27028-0365 Re: 1 Site Evaluation Harvest Lane/27 Acre Tract Dear Mr. Ervin: As requested, a representative from this office visited the aforementioned site on November 14, 1994. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Charles E. Little, R.S. Environmental Health Section CL/wd Enclosure ': i.. ....