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942 Hwy 801N (2)DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003975 Tax PIN/EH #: 5862-48-2688 Billed To: Lucy Prater Subdivision Info: Reference Name: Robert Stone Location/Address: 942 NC Highway 801 North -27006 Proposed Facility: Residence Property Size: 0.691 ac ATC Number: 4404 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS CTION IS VALID FOR A PERIOD OF FIVE YE Environmental Health Specialist's Signature: Date: Z�v�/ 4� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. 23 Septic System Installed By: I; b s of J -7O-7e4 Environmental Health Specialist's Signature: GYiI Z , Date: Z V. DCHD 05/99 (Revised) Account #: 990003975 Billed To: Lucy Prater Reference Name: Robert Stone Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street C� Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5862-48-2688 Subdivision Info: Location/Address: 942 NC Highway 801 North -27006 Property Size: 0.691 ac **NOTES* -This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths Dishwasher:45" Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size a ( d t� Type Water Supply Design Wastewater Flow (GPD) Site: New e Repair ❑ System Specifications: Tank SizAo GAL. Pump Tank GAL. Trench Widt�� Rock Dept,4/1� Linear Ft42& Other: Required Site Modifications/Conditions: accepted Systems may also be use IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date DCHD 05/99 (Revised) t �. �VIRONMc r�t1UN � EVALUATION/IMPROVEMENT PERMIT & ATC 1 avie County Health Department J Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751=8786 Permit ❑ Authorization To Construct(ATC) Aoth ***IMPORTANT*** 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 Lvc-,l D1Z47 CI Contact Person ZO 16 6 ?--1 S70N L Billing Address T4 2 I PI W y t; 01 Home Phone ' City/State/ZIP j0 j .-4 IJ C-j�- N C 27 O Ofc Business Phone 33&-998- 7 Name on Permit/ATC if Different than Above SA ✓✓lam /AS A d oy Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 onths with site plan, no expiration with complete lat.) Street Address qgy 14 WY 80.1 I -A City WMO C KSJt t <<' Tax PIN# �y Subdivision Name Section/Lot# Lot Size O , (f'J l A C _ Directions To Site: 05 158 O LA N Ki Q WT O 1.4 N 0 W 4 80 To y Z ti,A it .901 U1 1= O �, A A -T t' A S L? C. -T i m V - I S'f # N S HO � -51 7c c1 i Date House/Facility Corners Flagged - Z " O If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? 91�es ❑No Does the site contain jurisdictional wetlands? ❑Yes 6�Ao Are there any easements or right-of-ways on the site? {fees DNo Is the site subject to approval by another public agency? V�es ❑No Will wastewater other than domestic sewage be generated? ❑Yes Ao IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms '— # Bathrooms I Garden Tub/Whirlpool ❑Yes o Basement: ❑Yes Vf%lo Basement Plumbing: ❑Yes Ao 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: LConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:.%( County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes L40 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 understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to deter,nine compliance with applicable laws and rules on the above described property located in Davie County and owned by 40—'a �h� l� AM rte_ e y #044 -to� perly er's or owner' gal representative signature Date Sign given ❑Yes 40 Revised 2/06 Site Revisit Charge Date(s): Client Notification Date: EHS: Account #%b Invoice # . ; • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003975 Tax PIN/EH #: 5862-48-2688 Billed To: Lucy Prater Subdivision Info: Reference Name: Robert Stone Location/Address: 942 NC Highway 801 North -27006 Proposed Facility: Residence Property Size: 0.691 ac Date Evaluated: 15-714o Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % t, HORIZON I DEPTH Texture group Consistence r Structure r Mineralogy' J HORIZON H DEPTH -? Texture group C Consistence Structure /L Mineralogyl' HORIZON III DEPTH Texture group ,4 A 42 ALL Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE AZT— SITE CLASSIFICATION: EVALUATION BY: 1Z LONG-TERM ACCEPTANCE RATE: o OTHER(S) PRESENT: REMARKS: i(/OC�L4 //;7t �V_5'y 42/v)1, P 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 r(1NRTCTF.NCF. Moht VFR - Very friable NS - Non sticky NP - Non plastic FR - Friable SS - Slightly sticky SP Slightly plastic FI - Firm VFI - Very firm EFI - Extremely firm S - Sticky VS -Very Sticky 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 No 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) LTAR.- Long-term acceptance rate - gal/day/ft2 , DCHD OS/OS (Revised) _ �. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ �iiiiiii�iiiiiiiiiiiiil�iiieiii i iiiiil�i iiEHIMIN iiiiiiiMENNEN ■■■■■■■sa/■■■■e■■/■■■■■■�■■■■■�■iiia■■u■■■■■i1■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ I. George Robert S -ono, car tlfy that this plot was drain under trey supervision from en actual survey made under my supervision (deed "acrmptien recorded in Book Pape_ etc.) (other), !hal the boundaries not surveyed are clearly Indica»d as dean from Inter+ation found In Beets . Page ' that the ratio of prsoislen as calculated is 1/10.000: that this plat was preporod in accordance with G.S. 47-30 as amended. Witness my original signature, registration numkor and seol t h u 27 day of I , A.D.Apri2006 - . • RB 584 O PG 114 Seat or Stamp George R. Stone CARO V� S ••Q�oFE� !p .9 SEAL ' 0 L-316,2. :4 cF RO B ER�� Surveyor L 3162 Rages n v� ran wusa. �elw R i,ICT FOR RIECORDATIOM, nil HUNG \Form Building l George Robot t Stone. PrWoolatol Lad Surveyor, L`7 L-31t-y3�2. carWy to ane a of the Palm ng IndieBase. or Ea,: Ba. : © a. That the plot In of a survey that crsrstes a nubdMebn of bot dein the area of a amsttyr or mumlolpaBd Cwt has an ordinance that rsgtdsees parser of b f* r'1 b. That this plat 4 of a survey, tlwt M I000lnd In such portion of o LJ ooany or manicipa/b that Y unrpulated as to an ordYwrwv Ut•t rerAdn paredbi of bot; CJ c. That the plot Is of a wavey, of an adWng parol or parser of ior4 E] d. That !hr poet M of a stun yr of another odagery. such on the Iwomildhosen of etttr- po, I a court-ordered survey or ether , m* 'on to the ddbddm of suEdvbion; e. That the Infsnmoeon evolable to this surveyor In such that 1 am unable to mudes a dsterinl odon 1s the bad of my prefsedenN abfty an to provislors combined In (a) thxough (d) above. George R. Stone Professional (.and Surveyor. L-3162 • Subject Lot is a Minor Subdivision Tax Lot 53 Tax Map C-7 n/f C. Wayne Prater and wife Lucy M. Prater RB 584 O PG 114 IRS Control Coater 12.2' 1. S 01.38'56"W 218.00' IRS Control Corner FOP Port of Tox Lot 53 P Tax Lot 53 0.691 Acres +/-a Tax Map C-7 n/f C. Wayne Prater V) Hou•* jco and wife oro Lucy M. Prater 42.T'- Z Gravel 10'+/- Gvel Rood t -- RB 584 O PG 114 61 N 01'38'56"E --. it 218.00 NMP TE -6 - 10'+/- Asphalt Road ------ - - ---- ------ ----------------------------------- ---------- --------------- - - - ---- r----- - IRS-----—----------�.- - IRS rE-4 Shad Shed Proposed Access Easement See Coll Table R/W - Right -of -Way LEGM FC - Face of Curb EIP - Existing Iron Pipe BoC - Bock of Curb OR - Existing Iron Rabor PP - Power Pole P - Peet LP - Light Pole CM - Gorier•!• Monument MH - Man Hol• IRS - Iron Rabor Set CH - Chord Distance P/L - Property Una P/0 - Part of C/A - Controlled Accssa DB - Deed Book CP - concrete Pipe PB - Pkrt Book CMP - Corrugated Mato& Pipe RB - Record Book CPP _ Comgat•d Pkwtic Pipe PG - Po99• Basin -F- 100 Year Flood Boundary -0- overhead LINFtim ce - Ca4ch -S- Sewer Una -X- Fong will - water Meter Fnd - Found WV - water Vats n/t - Now or Formerly eM - Bench Mark NMP - Nonmonum•ntsd Point TBM - Tasnipornry Mark CL - Center Lina RRS -Roil Rooaadd SOW EP - Edge of Pavement CN - Caine Television Pad•atal TP - ToktphonI Pedestal M - FlectHe Trarieformor Qox -w- water lin• CO - Sonhory Sewer Clow Out 80 0 80 160 240 GRAPHIC SCALE - FEET Tax Lot 53 Tax Map C-7 n/f C. Wayne Prater and wife Lucy M. Prater RB 584 O PG 114 NOTES: 1. Tax Lot 53, Tax Map C-7, and the proposed lot aro located in a R/A Zoning District. 2. Minimum Building Setback Lina: Front: 40', Rear. 30', Side: 15' 3. Proposed lot will be served by public water and a private septic system 4. No USGS or NCGS Monuments found within 2000' of site 5. Total number of lots created: 1 6. Proposed lot area: 0.691 Acres +/- STATE OF NORTH CAROUNA COUNTY OF DAVIE I, John Gallimore, Review Officer of Davie County, oe tity that the crap or plat to which this certification Is offixed meeb aU statutory requirement* for recording. Review Officer. Date' "NO APPROVAL REQUIRED BY THE COUNTY PLANNING DEPARTMENT" John Goillmore, Plan rector Date Axle Fnd S 8xUna 122158"W 191.55' 1 & i /4" EIP 1/2" EIR Fred Tie Line N 88°13'33"E 335.31' U -Channel Iron Bent/Fnd CALL TABLE COURSE BEARING DISTANCE TE -1 S 89617' 51 "W 11.92' TE -2 S 88°37'18"W 10.00' TE -3 N 00a00' 11 "W 645.94' TE -4 N 00`20"1 YE 298.76' TE -5 S 88021'04"E 21.83' TE -6 S 00e20' 13"W 297.52' TE -7 S 00.00'43"E 646.16' "TE" - Tie Line Call do Easement Call Flied for regltirat'on at a' c lock PO — and recorded In Plot Book _..—_. Page K Brant Shoot, Register of Deeds F 11 Ing Fee Pold by Tax Lot 52 Tax Map C-7 n/f C. Wayne Prater and wife Lucy M. Prater RB 584 O PG 114 Proposed Access Easement See Coll Table I TE -7 DEPUTv-ASSISTANT M Asphalt Drive � I i - t--• i Site I I � t � Gravel Drive 1 i Asphalt Drive NC HwY Sot i v � . 3t s^ iza Vicinity Map (Not to Scale) RB 584 O PG 114 N.C. Highway 801 60' Public R/W 26'+/— Pavement R/W R/W 3/4" EIP Fnd ' Tie Une S 8724 191.43 V 3; 4" t1p 7:1d 1 TE -1 TE -2 TE -3 10'+/- Aspholt Road 1/2" EIR Fnd �. ... Tax Lot 44.01 --------- Wood Lane Tax Map C-7 1 - - - - - - -- n/f C. Wayne Prater and wife - .. Lucy M. Prater RB 584 O PG 114 Tie Line ' N W38'20"E 334.22' Tax Lot 44 Tax Map C-7 ' n/f Lelia N. Essie DB 195 O PG 203 A R i CORDATiO R/W R/W Division of the: C. Wayne Prater I (y►e) hereby certify thot I am (we aro) the owner(s) & Lucy M . Prater of the property described hereon. which is located in Property the subdivision jurisdiction of Davis County and that I hereby adopt this subdivision pion with my fns Part of Tax Lot 53, Tax Map C-7, consent, esk"shed minimum building setback lines Record Book 584 O Page 114 and dedicate aN streets, alleys, walks, parks and 0.691 Acres +/- by coordinate geometry other aka and easements to public or private use SCALE TOWNSHIP COUNTY STATE DATE as noted Owners: 1" = 80' Farmington Davie North Carolina 4-27-200, C. Wayne Prater Lucy M. Prater Stone Land Surveying Com an ice Na. Oe3e Ow.t.(.) Lucy M. Prater suRVEYtD: y 9 P Y Lucy M. Prater SC,DB,DTGeorge Robert Stone, PLS L-3162 7606 Lucy M. Prater MAPPED: 113 Dium Lane Phone (336) 995-4733 MAP NO. Date ownw(•) GRS MorkSville, N.C. 27028 7606 Davie. County May 16, 2006 Ms. Lucy Prater 942 NC HWY 801 North Advance, NC 27006 Re: 942 NC HWY 801 North Tax Pin #: 5862-48-2688 Dear Ms. Prater As requested, a representative from this office visited the above site May 10, 2006, to perform a site evaluation. Based on the information provided on the Application for 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. 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 or the intended use change. Improvement Permit System To Serve:410e- Wastewater Design Flow: System Type: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other System Location: W z- Nc I -1w �y N Valid: Cls Years ❑No Expiration Site Modifications/Permit Conditions: Date ps-i.p.letter 2/06 Parcel #: C70000005301 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #: C70000005301 Account #:58469420 Owner Information uildin Tax Codes BXF• RATER C WAYNE& PRATER LUCY H Land: ADVLTAX - COUNTY T Market: 42 HWY 801 N ssessed: FIREADVLTAX - FIRE TAX eferred• DVANCE NC 27006 Property Information Township nd (Units/Type): 0.690 AC FARMINGTON ddress: 942 N NC HWY 801 Deed Information Local tonin Pate: 12/2004 Book: 00584 Page: 0114 lat Book: 0008 Page: 341 Legal Description PIN 691AC OFF NC HWY 801 N 5862483512 Property Values uildin 66,08 CI BXF• Land: 13 31 Market: 79 39 ssessed: 79 39 eferred• Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00584 0114 12 2004 WD Unqualified Vacant 0 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search 0 Page 1 of 1 oA.l2- �0 U R� Davie County Web Site 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 the 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 the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1463830 9/14/2016