175 Ijames Church Rd,„>_.ry "'.�. ..-.. ..-_:r,-., ,:._. >-,. .o ...;--'-..�....y..:ar .tet. .•b �.. d.,.. �....a.,_ ,.. _ a., _-. __, .. ... - -, ,
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
1. *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name r' ;F� Date
2�� ND :1
. Location �� i'/--�,�'� - �rrr(��� -���� � iii,� ..z� ��'•���---
Subdivision Name Lot No. Sec. or Block No.
Lot Size C�2� House Mobile Home Business Speculation
No. Bedrooms 62 No. Baths No. in Family
Garbage Disposal YES ❑ NO EfI— Specifications for System:
Auto Dish Washer YES ❑ NO Q--
Auto Wash Machine YES ❑ NO El--
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by � f
*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 day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
LJ
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed incompliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE'COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name y ,2FS� Date "
Address Lot Size��
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S S
PS PS PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S
Loamy, Clayey, (note 2:1 Clay) 1-$S PS PS PS
U U U
3) Soil Structure (12-36 in.) S S S
Clayey Soils PS PS PS
U U U
4) Soil Depth(inches) S S S S
PS PS PS
U U U
5) Soil Drainage: Internal S S S
PS PS PS
U U U
External S S S
PS PS PS PS
U U U
6) Restrictive Horizons
7) Available Space S S S S
PS PS PS
Tj U U U
8) Other (Specify) S S S S
PS PS PS PS
U�^ U U U
9) Site Classification 1
U—UNSUITABLE S—SUITABLE Provisionally Suitable
Recommendations/Comments:
Described by Title � � Date
SITE DIAGRAM
DCHD(6-82)
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requested By oA R S&413 siness Phone
2. AddressW_ ago� y 1 ,LL W
3. Property Owner if Different than Above
Address
4. Permit To: a) Instal l-1ZAlter Repair
b) Privy Conventional her Type -
Ground Absorption
c) Sub-Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. aj If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms f;7— - Bath Rooms_Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water-using fixtures:
commodes urinals garbage disposal
lavatory showers washing washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes L-No
9. a) Property Dimensions 444
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
YKIe-4 Z�a�Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
�S
DCHD(6-82)
i,
DCFD eeoll��.v
Ksp saa aeisarneanas
NO TAXABLE CONSIDEil"TiI:.,LIATEQ n'��s�� �n9�=A•M.
oars IZO 281
NO KO LSH Rcode��o VCWS
,OMr L en0at aame,xe ea'axrDe
• WK OOle1rY.t-
in,
C•'r
Assistant
• Exelse Tax Recording Thno,Book and Page
Tax Lot No.................................................
......................................... Parcel Identifier No. ........... .. .................................................
Verldedby........................................................................County on the .............day of.......... ..........................................19............
by ............................................................................................................. ............... ..........................
n./J.............
y..,........................................-
Grantee,... 1..0.......L1lA.1G...: 6�..,..m �C.K�,C�...x..11 r..l,�........
Mall after recording to ........................ ........................
.......................................................................................................... ................... ..........................................,......................
This instrument was prepared by..RobeX.t...tl,...Raisbeck,,.Jr„_Att,Qtne y.ak..i aw,.MocksxillQ,.,N& ..2102.&.........
Brief description fur that lades 2,41 acres
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this.....A...day of..........Af�. ers.-f.. 1:7.91. ,by and between
GRANTOR GRANTEE
RHONALD RAY MEADOR CHARLOTTE MEADOR SHORT and husband, .
ROBERT JAMES SHORT
Enter In appropriate block for each party:Panic,address,and,It appropriate,character of collar,e.%corporallon or partnership.
The designation Grantor and GranLee as used herein shall include said parties,their heirs,successors,and assigns,and
shall include singular,plural,masculine,feminine or neuter its required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Cranlee, the receipt of which is hereby
acknowledged, has and by these presents does grunt, bargain, sell and convey unto the Grantee In fee simple, all that
certain lot or put-eel of land situated in the City of_ .... ....Mocksvillp... ••,•„•. Township,
............Davie County,North Carolina and more particularly described as follows:
A certain tract or parcel of land lying and being on the South side of Ijames
Church Road 01307 in Mocksville Township adjoining W. D. Booie, Sr. on the
East and West and Mrs. Ruth Baker on the South and described as follows;
BEGINNING at an iron pin in the center of Ijames Church Road #1307, the
Northeast corner of the within described lot, the said point being North 85
degrees West 156 feet from the Northwest corner of W. D. Booie, Jr.; thence
South 4 degrees West 369.0 feet crossing a branch to an iron pipe in Mrs. Ruth
Baker line; thence with the meanderings of said branch and Mrs. Ruth Baker's
line the following two courses and distances: South 51 degs. 15 min. 150 feet
to an iron pipe, South 32 degs. 20 min. West 208.0 feet to an iron pipe;
thence North 4 dog. East 657.5 feet to an iron pipe near the Northern edge of
Ijames Church Road #1307; thence South 85 degs. East 209.0 feet to the POINT
AND PLACE OF BEGINNING, containing 2.41 acres, D.M.D.
ec L'.aur Awue.Farm N...J y I97e,ar.l,ee a.1977—w.�mw..•a.,...•..u,,rw..w,s e 7w„
MVHS File 7127.1 Inv ti