1924 Junction RdDAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section d/
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 989900149
Billed To: Home Improvement Services
Reference Name:
Proposed Facility: Residence
Tax PIN/EH #: 5735-45-8944
Subdivision Info:
Location/Address: Junction Road -27028
Property Size: 15 acres
**NOTES* This-Improv%ent/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 _
Dishwasher: Garbage Disposal: ❑
Commercial Specification: Facility Type
.--X!/ #People .2 #Bedrooms _
Washing Machine: 00"Basement w/Plumbing: ❑
S #Baths Q'
Basement/No Plumbing: ❑
#People #People/Shift #Seats Industrial Waste: ❑
Lot Size ,4 G Type Water Supply n Design Wastewater Flow (GPD) Site: New;2'0"'Repair ❑
System Specifications: Tank Size./" GAL. Pump Tank
[all Ii1;10,F
Required Site Modifications/Conditions:
IMPROVEMENT
FINISHED GRAI
system between 8:3
GAL. Trench WidthL 1_� Rock Depth / Linear Ft. Od
1T LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
ntact a representative of the Davie County Health Department for final inspection of this
:00 P. p.m. on t e tallation. Telephone # is (336)751-8760.****
Environmental Health Specialists Signature: 4aaa�4
r � Date:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 989900149
Billed To: Home Improvement Services
Reference Name:
Proposed Facility: Residence
ATC Number: 2961
Tax PIN/EH #: 5735-45-8944
Subdivision Info:
Location/Address: Junction Road -27028
Property Size: 15 acres
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
e --
**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 WASTE W CONSTR TION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: s Date:
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 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. IV -'r
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Date: /Yl %r1 -�
TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
p""- 1"'�'Oe
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes PMVo
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
# 5`73r - #.5-U*4-
Tax Office PIN:
Property Address: Road Name nnldipa j&d
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
n I S.,A J,. C21 aJ at Rd
Date Property Flagged: slzi OI
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter arc 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 ant responsible for all charges incurred front
this application. 1, hereby, give consent to the Authorized Representative of the Dayic County Health Dcp:►rtment
to enter upon above described property located in Davie County and owned by stephetv &-rA
Jr -
to conduct all testing procedures as necessary to determine the site suitabjlity.
DATE f4/ SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLA"n Ae all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locatiib s).
Revised DCHD (07/99)
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No. �7
Invoice No.
I
1,
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS'ALL
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for
THE REQUIRED
instructions.
NO
e
1.
Name to be Billed tJ
t'0/'d1Ce' Contact Person
N
%
P�rK
I -777
Mailing AddressA
I
Home Phone 7S
�.3
/
City/State/ZIP U4 �L/11l e L ���
`
Z� Business Phone
~ 77
2.
Name on Permit/ATC if Different than Above
Mailing AddressCity/
to/Zip
3.
Application For: Site Evaluation
Improvement Permit/ATC Il Both
4.
System to Service: ❑ House Mobile Home
❑ Business ❑ Industry ❑ .Other
5.
If Residence: # People _
# Bedrooms
# Bathrooms
Dishwasher U Garbage DisposalWSJ asking Machine L1 Basement/Plumbing
1.1 Basement/No Plumbing
6.
If Business/Industry/other: Specify type
# People
# Sinks
# Commodes # Showers
# Urinals
# Water Coolers
IF FOODSERVICE: # Seats Estimated
Water Usage (gallons per day)
7.
Type of water supply: R County/City
❑ Well
CI Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes PMVo
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
# 5`73r - #.5-U*4-
Tax Office PIN:
Property Address: Road Name nnldipa j&d
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
n I S.,A J,. C21 aJ at Rd
Date Property Flagged: slzi OI
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter arc 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 ant responsible for all charges incurred front
this application. 1, hereby, give consent to the Authorized Representative of the Dayic County Health Dcp:►rtment
to enter upon above described property located in Davie County and owned by stephetv &-rA
Jr -
to conduct all testing procedures as necessary to determine the site suitabjlity.
DATE f4/ SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLA"n Ae all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locatiib s).
Revised DCHD (07/99)
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No. �7
Invoice No.
I
1,
W Pc
Nates*
I. 7,,nl W R-20
1, aeerp. Robert !tom. ewflfy tact ibis plot wee how soder se
s"Wvfe/w firm 44 441041 sees" ill• *Oder ea sspervl-slon
rsarded 1• MN -a . ►spa 6 . off.) (other): fast fed
�• L, �.•1(e1 4' _ .. • . ` ..
v `r".
y IAF
r'l.
1
Pew -----L that The .4110 at pr441s144 44 441e01eted Is Id'Moee7 fast tble
plot am proposed Is 44seedoeoa vita 6.8. 47-30 44 ao•ded.
+l
sle"two. regfstraflea *mbw ssd seal
splen wee repel; p..+ a land.
�
This -t w/ at M43Y . s.0. 2000.
•
W Pc
Nates*
I. 7,,nl W R-20
1, aeerp. Robert !tom. ewflfy tact ibis plot wee how soder se
s"Wvfe/w firm 44 441041 sees" ill• *Oder ea sspervl-slon
rsarded 1• MN -a . ►spa 6 . off.) (other): fast fed
(do" des*f 1pf144
►000der Iso, not
o.rreyed Ore slowly INleatod as drew frm IOlw"Otlea feved Is seek
Pew -----L that The .4110 at pr441s144 44 441e01eted Is Id'Moee7 fast tble
plot am proposed Is 44seedoeoa vita 6.8. 47-30 44 ao•ded.
Wit"se to or Ipleal
sle"two. regfstraflea *mbw ssd seal
splen wee repel; p..+ a land.
�
This -t w/ at M43Y . s.0. 2000.
±
3441 or stamp C4or+ge R. Stoner PLS
f
Surveyor
V
ealaPill an L 3169
Plat Revisions: 7 -Or •-•2000
DO 197 ria J00 see l s tr of l oo Resew
1. Deed References
Do 3X PC 40
2. Zoning Clo"fication
S I V53'37"E
3. Ownen;
���I! • 044.
Na urneft. "Jockey AZ MK"
fid; ,,�fr.SSb .
4 %
5. Drainage & Utility Easement Dt
6. Subdivision Certificate
• SEAL
7. Title Block
0 L-3162 J W
Tax Lot 35
�►�; .,su••tt�'..�''g
Tax Map M-4
ROGER
M. M. Wagner
D8 103 • PG 76
1.M C&Wob 1�
arm K W �►
Ik 231>012.Oe/ w 0 Z
C 007401.000 w
Sets F40br. 0.0014103 R Nt7► \
Z o -�►
N °_ �o �'•
tl \
we
OW" COMMON, o.
0,401 A~
M O J
ane■ A MID
Tax of 38.04
T M-4
11i
la
d
O.,r4.s
J O
N f.
SS
L e►w v
n
<o 0o
..x�:.`.'Fl+)....zW..r.r_�_sA+t1�.�.a._bT .._..+.a.w �..� _.....,n rwu.--..[__..4'�i.•..�i1L. ...rr�
0,X ,
Z wlatsr, Shed Clo■■ificntli' 05 -IV Protected bar A.w. +/- �✓
I Illy Acts to be served by public wooer and sewer � \� r 3lunch,vn Woad ,tS1P LIM
4. AN uWdm to be kietoNed Underground
I Three (3) prgpo«d late (Public 60' R\ W)
a Told subdlvfeion ar■a 1.488 Acres�4 s0,
7. Average lot crew 0.489 Acres 00831.1 cot,..
8. N=fnofwrnwfts found wdMe 2000• of project \. \ - Tax mop ax IM 4-13
8sari'fg rsf►erwwe PA 7 • P10 13 for sii+e consistency � $ o+l•T. Deadman
a 1 \
E.
Qo \• Tax Lot 38.04 * D8 59 O PG 21
91. Nundbs► 4 Arbars set d ane now property cartes r N 1
1Q Setb■cllsr rrw* 4d'. 9aclr 30', Sides 15' , ,�4 dab^ i� \` Tax Map M-4
11. No new ■best cons&ucdon proposed meq, ``bTax lot 1 ` 1
12. The following drninoge and/or utility\\\'p7*
ty so, \` Tax map
easefttsrtb ane dedkoted; �� 'o'e \ M-4- 13
A. 10' a"exterior lines ��j x ` O� �Area in gquestionion�p (OverloP)
8. 10r each side of interior lines
223.38' \ � 62.58'
Tax Lot 38.04 \9`f ,•1 i�-ftp .cool,. S. 87043'50'•E d .
Tax Map M-4 �J\ found s 011 30n
_
n/f John Grose-
t�� f n ! •rivet sc SLJY
1/2" UK J .vifr .w. :Y).,) •vv. / rload 'I
\ �- 98.59'*
010, DB 197 O PG 384
N 57 40'20'W o,,� DB 197 O PG 386 1 I 1
\ rot `
\ too HAWKNEST, Phse ne
Ofg I PB7@PG I�
164.38' ons ' -
t
\ N 60.59'00"W °r b
0 120.46' end te ,.� `°°oma / ' 1
N 59.23'55"W a I
j 1 ' , HAWKNEST, P ase ns ! 1
A�
OR 7 @ Pr; 10% i 1
1 (we) lmehy awtlfq Rat I am (we am) the ow l r(s) \ Y�y �-N 54056�50"W
of the pfopsrl�i dseaAsd Ifereen. wh10o! is booked h .\ Y�2 ' 45.47 /( •, 0 I Q 1 1 I
the subdivision Jlrlsdlation of Dore Courtly and that
I Honbhr adopt this eubd hileel plan w11h "W free \ ~- N 57 53 35"W ;
4 salbeok lif■s � • I I D � $ I I'I I
I oen■wlf, est,abldied ""nurn buMn 2 p a Tax Lot
oetsr ails' and easeents ego public ads use andi\ ���e �N 45'61205"W D
mi I Tax Map M-
65.49' , I f o 3
I
4+m �-.-- ` N 36'50'55"W
�liI �' I
I 1
ansA-
N I .,
% 7 - ow.stl 66.95' o v
36603'40"104 � � , 0
- - ..- ftba &. is-&" ■
Of hereby certify the# the s6Nlvlsles
Piet sham heroes hes been fount to
60*17 with the Covell sebdivlslee
Roselotioos. with the easptios of
seek ver loess■, if any. were noted is
the 01116106 of the ploos1Rs 9~4 sed
that It hes ►ase oderwed for recordist
to the eff lee of the Resister of
000446 it Is here" MIN tkot
doss not 1041640 psrsvel to Instell
sed 6111120 soeitery fesliltlie Ref
does It Inslv40 oNrovsl for the
eenstrestlee w eeevraesy of
kolldinp er streetwes.'
,P
The Dols C=* Fhmft sood hsrsiv gpwmed
to fhd pot for one A&iui�-�� � L
ardaweR.
odu
Cllalft t� cm ft plo r
State of North Carolina
County of Davie
/,John Gallimore , Review officer of Davis County, certify
that the map or plat to which this certification is affix'
meets all statutory requiements for recording.
'view Officer
Date: Za=o
f��il�'1Y"fAI.StT
PCOM it"
Being a Portion of Tax Lot 38.04
LEGEND -calor Lr» \ 92.33. , HAWKNEST, Phase Ore I Tax Map M-4
' "tower- -'"'e► -
C~ Line N 21040'00'V
I PB 7 L2 PG 15
Er - E3111111111111 rb" Film er _ p a f Deed Book 197 •Page 384
-no�of
�► last. \ �i / I Deed Book 197 O Page 386
Merle - add t +-►(�..' 65.76' , y ' do
-PA - -+a N 02525'= I i 1 Being a Portion of Tax Lot 37
no 0,r► - c/. �na.g�e d� %Ad _ SIM� s 1 r Y I Sanitary Sewer Tax Map M-4
-r- 100 year nsN eslydaty - :�; own I Deed Book 339 • Page 458
�". ;.*"d fie` iio��oi'a,rs 12" Water Main
■■■■■■■■■■
■■ass■■■■e
Total Subdivision -Phase Two Area 1.468 Acres +/-
SCME TOWHO4r COLMY sWE tali
1 " - 100' Jerusalem Davis North Carolina 5-01-21
Owners:
John Grose, Ann M. Morison, Stone Land Surveying Company ,on N,
331 Paris Avenue MT.BLGeorgeRsbort slws, pts L-3142 �
Mocksville, NC 27028 wwpm 113 Drum Lan. Phone (336) 996-4733 1UI 110
(336) 751-3323 GR4 Mock•vlie, N.C. 27028 Sam
filed for registration at 2�.�.5 s'slaae
1, enew Robert 1✓y /f4AOetlfrtl LoW Sa%fir ► L -310L
cW* ort lay !ea Y at • "- IV and er"sft; • "ralddse
BEAF&C
of Wad eetb do ove r O OwO; or nYd;"1144 so
a" rsew M"
splen wee repel; p..+ a land.
S 20'3243"E
George R. Stone
In Plot MM _i_. pew
llelsumteal L
later s1 0a4M
8.38' Ch
pllla$ tea paid
L-3
S 20"2307'E
104.53' Ch
MMTt -AN i STAIR
0,X ,
Z wlatsr, Shed Clo■■ificntli' 05 -IV Protected bar A.w. +/- �✓
I Illy Acts to be served by public wooer and sewer � \� r 3lunch,vn Woad ,tS1P LIM
4. AN uWdm to be kietoNed Underground
I Three (3) prgpo«d late (Public 60' R\ W)
a Told subdlvfeion ar■a 1.488 Acres�4 s0,
7. Average lot crew 0.489 Acres 00831.1 cot,..
8. N=fnofwrnwfts found wdMe 2000• of project \. \ - Tax mop ax IM 4-13
8sari'fg rsf►erwwe PA 7 • P10 13 for sii+e consistency � $ o+l•T. Deadman
a 1 \
E.
Qo \• Tax Lot 38.04 * D8 59 O PG 21
91. Nundbs► 4 Arbars set d ane now property cartes r N 1
1Q Setb■cllsr rrw* 4d'. 9aclr 30', Sides 15' , ,�4 dab^ i� \` Tax Map M-4
11. No new ■best cons&ucdon proposed meq, ``bTax lot 1 ` 1
12. The following drninoge and/or utility\\\'p7*
ty so, \` Tax map
easefttsrtb ane dedkoted; �� 'o'e \ M-4- 13
A. 10' a"exterior lines ��j x ` O� �Area in gquestionion�p (OverloP)
8. 10r each side of interior lines
223.38' \ � 62.58'
Tax Lot 38.04 \9`f ,•1 i�-ftp .cool,. S. 87043'50'•E d .
Tax Map M-4 �J\ found s 011 30n
_
n/f John Grose-
t�� f n ! •rivet sc SLJY
1/2" UK J .vifr .w. :Y).,) •vv. / rload 'I
\ �- 98.59'*
010, DB 197 O PG 384
N 57 40'20'W o,,� DB 197 O PG 386 1 I 1
\ rot `
\ too HAWKNEST, Phse ne
Ofg I PB7@PG I�
164.38' ons ' -
t
\ N 60.59'00"W °r b
0 120.46' end te ,.� `°°oma / ' 1
N 59.23'55"W a I
j 1 ' , HAWKNEST, P ase ns ! 1
A�
OR 7 @ Pr; 10% i 1
1 (we) lmehy awtlfq Rat I am (we am) the ow l r(s) \ Y�y �-N 54056�50"W
of the pfopsrl�i dseaAsd Ifereen. wh10o! is booked h .\ Y�2 ' 45.47 /( •, 0 I Q 1 1 I
the subdivision Jlrlsdlation of Dore Courtly and that
I Honbhr adopt this eubd hileel plan w11h "W free \ ~- N 57 53 35"W ;
4 salbeok lif■s � • I I D � $ I I'I I
I oen■wlf, est,abldied ""nurn buMn 2 p a Tax Lot
oetsr ails' and easeents ego public ads use andi\ ���e �N 45'61205"W D
mi I Tax Map M-
65.49' , I f o 3
I
4+m �-.-- ` N 36'50'55"W
�liI �' I
I 1
ansA-
N I .,
% 7 - ow.stl 66.95' o v
36603'40"104 � � , 0
- - ..- ftba &. is-&" ■
Of hereby certify the# the s6Nlvlsles
Piet sham heroes hes been fount to
60*17 with the Covell sebdivlslee
Roselotioos. with the easptios of
seek ver loess■, if any. were noted is
the 01116106 of the ploos1Rs 9~4 sed
that It hes ►ase oderwed for recordist
to the eff lee of the Resister of
000446 it Is here" MIN tkot
doss not 1041640 psrsvel to Instell
sed 6111120 soeitery fesliltlie Ref
does It Inslv40 oNrovsl for the
eenstrestlee w eeevraesy of
kolldinp er streetwes.'
,P
The Dols C=* Fhmft sood hsrsiv gpwmed
to fhd pot for one A&iui�-�� � L
ardaweR.
odu
Cllalft t� cm ft plo r
State of North Carolina
County of Davie
/,John Gallimore , Review officer of Davis County, certify
that the map or plat to which this certification is affix'
meets all statutory requiements for recording.
'view Officer
Date: Za=o
f��il�'1Y"fAI.StT
PCOM it"
Being a Portion of Tax Lot 38.04
LEGEND -calor Lr» \ 92.33. , HAWKNEST, Phase Ore I Tax Map M-4
' "tower- -'"'e► -
C~ Line N 21040'00'V
I PB 7 L2 PG 15
Er - E3111111111111 rb" Film er _ p a f Deed Book 197 •Page 384
-no�of
�► last. \ �i / I Deed Book 197 O Page 386
Merle - add t +-►(�..' 65.76' , y ' do
-PA - -+a N 02525'= I i 1 Being a Portion of Tax Lot 37
no 0,r► - c/. �na.g�e d� %Ad _ SIM� s 1 r Y I Sanitary Sewer Tax Map M-4
-r- 100 year nsN eslydaty - :�; own I Deed Book 339 • Page 458
�". ;.*"d fie` iio��oi'a,rs 12" Water Main
■■■■■■■■■■
■■ass■■■■e
Total Subdivision -Phase Two Area 1.468 Acres +/-
SCME TOWHO4r COLMY sWE tali
1 " - 100' Jerusalem Davis North Carolina 5-01-21
Owners:
John Grose, Ann M. Morison, Stone Land Surveying Company ,on N,
331 Paris Avenue MT.BLGeorgeRsbort slws, pts L-3142 �
Mocksville, NC 27028 wwpm 113 Drum Lan. Phone (336) 996-4733 1UI 110
(336) 751-3323 GR4 Mock•vlie, N.C. 27028 Sam
GILL TABLE
COLRX
BEAF&C
DISTANCE
L-1
S 20'3243"E
96.10'
L-2
S 20e36'29E
8.38' Ch
Rod; 13.700.85'
L-3
S 20"2307'E
104.53' Ch
Rad; 13.70085'
L-4
S I V53'37"E
130.06' Ch
Rat 13.700.85'
L-5
S 75019'13"w
83.13•
L-6
S 5r39'23" yf
150.00'
L-7
N 06"00'2VV
107.5®"
L-8
N 20'25' 13"w
104.53'
L-9
N 20.30'43" w
104.46'
0,X ,
Z wlatsr, Shed Clo■■ificntli' 05 -IV Protected bar A.w. +/- �✓
I Illy Acts to be served by public wooer and sewer � \� r 3lunch,vn Woad ,tS1P LIM
4. AN uWdm to be kietoNed Underground
I Three (3) prgpo«d late (Public 60' R\ W)
a Told subdlvfeion ar■a 1.488 Acres�4 s0,
7. Average lot crew 0.489 Acres 00831.1 cot,..
8. N=fnofwrnwfts found wdMe 2000• of project \. \ - Tax mop ax IM 4-13
8sari'fg rsf►erwwe PA 7 • P10 13 for sii+e consistency � $ o+l•T. Deadman
a 1 \
E.
Qo \• Tax Lot 38.04 * D8 59 O PG 21
91. Nundbs► 4 Arbars set d ane now property cartes r N 1
1Q Setb■cllsr rrw* 4d'. 9aclr 30', Sides 15' , ,�4 dab^ i� \` Tax Map M-4
11. No new ■best cons&ucdon proposed meq, ``bTax lot 1 ` 1
12. The following drninoge and/or utility\\\'p7*
ty so, \` Tax map
easefttsrtb ane dedkoted; �� 'o'e \ M-4- 13
A. 10' a"exterior lines ��j x ` O� �Area in gquestionion�p (OverloP)
8. 10r each side of interior lines
223.38' \ � 62.58'
Tax Lot 38.04 \9`f ,•1 i�-ftp .cool,. S. 87043'50'•E d .
Tax Map M-4 �J\ found s 011 30n
_
n/f John Grose-
t�� f n ! •rivet sc SLJY
1/2" UK J .vifr .w. :Y).,) •vv. / rload 'I
\ �- 98.59'*
010, DB 197 O PG 384
N 57 40'20'W o,,� DB 197 O PG 386 1 I 1
\ rot `
\ too HAWKNEST, Phse ne
Ofg I PB7@PG I�
164.38' ons ' -
t
\ N 60.59'00"W °r b
0 120.46' end te ,.� `°°oma / ' 1
N 59.23'55"W a I
j 1 ' , HAWKNEST, P ase ns ! 1
A�
OR 7 @ Pr; 10% i 1
1 (we) lmehy awtlfq Rat I am (we am) the ow l r(s) \ Y�y �-N 54056�50"W
of the pfopsrl�i dseaAsd Ifereen. wh10o! is booked h .\ Y�2 ' 45.47 /( •, 0 I Q 1 1 I
the subdivision Jlrlsdlation of Dore Courtly and that
I Honbhr adopt this eubd hileel plan w11h "W free \ ~- N 57 53 35"W ;
4 salbeok lif■s � • I I D � $ I I'I I
I oen■wlf, est,abldied ""nurn buMn 2 p a Tax Lot
oetsr ails' and easeents ego public ads use andi\ ���e �N 45'61205"W D
mi I Tax Map M-
65.49' , I f o 3
I
4+m �-.-- ` N 36'50'55"W
�liI �' I
I 1
ansA-
N I .,
% 7 - ow.stl 66.95' o v
36603'40"104 � � , 0
- - ..- ftba &. is-&" ■
Of hereby certify the# the s6Nlvlsles
Piet sham heroes hes been fount to
60*17 with the Covell sebdivlslee
Roselotioos. with the easptios of
seek ver loess■, if any. were noted is
the 01116106 of the ploos1Rs 9~4 sed
that It hes ►ase oderwed for recordist
to the eff lee of the Resister of
000446 it Is here" MIN tkot
doss not 1041640 psrsvel to Instell
sed 6111120 soeitery fesliltlie Ref
does It Inslv40 oNrovsl for the
eenstrestlee w eeevraesy of
kolldinp er streetwes.'
,P
The Dols C=* Fhmft sood hsrsiv gpwmed
to fhd pot for one A&iui�-�� � L
ardaweR.
odu
Cllalft t� cm ft plo r
State of North Carolina
County of Davie
/,John Gallimore , Review officer of Davis County, certify
that the map or plat to which this certification is affix'
meets all statutory requiements for recording.
'view Officer
Date: Za=o
f��il�'1Y"fAI.StT
PCOM it"
Being a Portion of Tax Lot 38.04
LEGEND -calor Lr» \ 92.33. , HAWKNEST, Phase Ore I Tax Map M-4
' "tower- -'"'e► -
C~ Line N 21040'00'V
I PB 7 L2 PG 15
Er - E3111111111111 rb" Film er _ p a f Deed Book 197 •Page 384
-no�of
�► last. \ �i / I Deed Book 197 O Page 386
Merle - add t +-►(�..' 65.76' , y ' do
-PA - -+a N 02525'= I i 1 Being a Portion of Tax Lot 37
no 0,r► - c/. �na.g�e d� %Ad _ SIM� s 1 r Y I Sanitary Sewer Tax Map M-4
-r- 100 year nsN eslydaty - :�; own I Deed Book 339 • Page 458
�". ;.*"d fie` iio��oi'a,rs 12" Water Main
■■■■■■■■■■
■■ass■■■■e
Total Subdivision -Phase Two Area 1.468 Acres +/-
SCME TOWHO4r COLMY sWE tali
1 " - 100' Jerusalem Davis North Carolina 5-01-21
Owners:
John Grose, Ann M. Morison, Stone Land Surveying Company ,on N,
331 Paris Avenue MT.BLGeorgeRsbort slws, pts L-3142 �
Mocksville, NC 27028 wwpm 113 Drum Lan. Phone (336) 996-4733 1UI 110
(336) 751-3323 GR4 Mock•vlie, N.C. 27028 Sam
J •
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
' APPLICANT INFORMATION
Account #: 989900149
Billed To: Home Improvement Services
Reference Name:
Proposed Facility: Residence Property Size:
Water Supply:
Evaluation By:
PROPERTY INFORMATION
Tax PIN/EH #: 5735-45-8944
Subdivision Info:
Location/Address: Junction Road -27028
15 acres Date Evaluated: 3d P>
On -Site Well Community
Auger Boring Pit
Public
Cut iii
FACTORS 1 2 3 4 5 6 7
Landscape position L 1
Sloe % �-
HORIZON I DEPTH
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 RATE z
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY:
OTHER(S) PRESENT:
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
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 - Non plastic SP - Slightly plastic 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
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 - gal/day/ft2
DCHD 05/99 (Revised)