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363 Juney Beauchamp Rd- DAVIE COUNTY ENVIRONMENTAL HEALTH i P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT Account #: 989900035 Tax Plpl/EH #: E70000006504 - Billed To: Richard Short =`Subdivision:lnfo: Reference Name:Location/Address: 363 Juney Beauchamp Road -27006 Proposed facility: Residence -:� ° . i'per#ytSixe: 6.448 Acres ATC plumber: 5892 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 1 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. System Type: S.T. Manufacturer Tank Date Tank Size Pump Tank Size Bedrooms: System Installed By: Inspector# Dater GPS Coordinate: Environmental Health Specialist Date:_ DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900035 •"'Ta;( FIN/EH #: E7.0000006504 Billed To: Richard Short Subdivision Info: Reference Name: Location/Address: 363 Juney Beauchamp Road -27006 Proposed Facility: Residence Property Size: 6.448 Acres ATC Number: 5892 Site Type: G(New ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(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 plans, plat or the intended use chance. Residential Specifications: # Bedrooms_3 # Bathrooms 25 # People_,!5�Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People —# Seats Square Footage(or Dimensions of Facility) Lot Size aL Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 3W -Tank Size/650 GAL. Pump Tank GAL. n/ Trench Width �Max. Trench Depth Rock Depth_IZL Linear Ft. Site Modifications/Conditions/Other: ;?Sc,�b Ate` Contact the Davie County.Environmental Health Section for final inspection of this system between Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 989900035 Tax PIN/EH #: E70000006504 Billed To: Richard Short Subdivision Info: Address: 348 Beauchamp Road Location/Address: 363 Juney Beauchamp Road -27006 City: Advance Property Size: 6.448 Acres 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: 6New ❑Repair ❑Expansion Permit Valid for: IX -5 Years ❑No Expiration Residential Specifications: # Bedrooms 7 # Bathrooms 2.5—# People c5 Basement Basement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: VOCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: Site Plan Environmental HeI i.p. 11-06 System Type LTAR Initial a e/ Repair ru>Q o D ■ ,/� l J�14h )14f, Oaf Date J` Account #: 989900035 Billed To: Richard Short Reference Name: Proposed Facility: Residence ATC Number: 5892 Tax PIN/EH #: E70000006504 Subdivision Info: Location/Address: 363 Juney Beauchamp Road -27006 Property Size: 6.448 Acres Y6-'339 Surveyon CaNfkatka Suneyon C 'Vfkato to, SYD M'w' Review Offiwr Davie County R'gi'tw of Deed, .•+`^"+�^•'•" aw•rrrr �" �"'ev'w�• r"'� = i Mkl ReabtnDoa A. j SEAL t') ' e.ar euuor eo } I -2W f NOAPPROVALIgUMMBTTHE, ' •'W�;!nr ` �" DAVIE CDUM FLVMHuDB%ZWM . 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X11 &BION AmIm Mo i � rfi M • e-�r- ;—w�.ti �l.y Kopf MYRI 54 JW pMW-WU NIIWJ. .MEY BEAXMAAPROADSR — ryl AI,Yi DLIf i r»'M'[ I•�-o.a w.,.�.lwr ,tw.r ianvr wY 1tt scum KLAIt I x,NxE)JI ..a1aTMdLr' X lAlllf . x 7J7 k,0D7 PR1'JNJ JJ 71DJ RRNsruaw I IfNJNJN7Ae� n�usJunJr mu Cd— MUT roR w Irw - a �Y R _ . LILA RUTH WILLIAMS l aYe ew wr, FMTO" D®s DB III MG 327 s W H MG 392 __� _ eu��iwn p �...iwa�w.a r) AZN.M SCYf • M6USNfE RI M!®Rt 5E61513495 O aw�w alitDi G— M.C. O osr earY rus 8 OYsot D11C YAMGaI N. WII aL11S I• . Y00' a YYw III7LL 1°IO R DYD MBae GRAPHIC SCALE d rwess MOIL AP'NHL7H! /Yl t_rfR �AS_OC /1fS. P/ r r rro rw eons 1 n t wr rv, o DtYDRa MLY 3aDM BR (1/a' Ittelp) wamv-wtr norm pwaw m W :Stti °O 'w:w.a�rw.irr' f a rar) - IGvlArc w /7ta a . y �l aoww 1 a W EaD M1 NO GiDDE}IC ODMtA01. YOMIDmP)9 /GVHD ►IIRDf 1Y 20(* M=f T— OP IT JOB N0: 33$0-31C. 0859 8K 85 9 PG 25 1 0257 02Q15 Davie County, North Carolina Excise Tax Paid $ 4_ FILED FOR REGISTRATION 5 -Is -al) MAY 18, 2011 10:37 A_x_ DATE TIME DEED TRANSFER CHECK�D AILD RECORDED IN BOOK859 PAGE 257 M. BRENT SHOW, REGISTER OF DEEDS DATE BY DAVIE COUNTY, NC TAX ADMINISTRATOR BY DEPUTY This instrument was prepared by: WADE H. LEONARD, JR. Mail After Recording to: Grantee C�I—p 0"70g". '0' Brief Description for Index: P//� DEED STAMPS. S v' Uv Parcel Identifier No. � % (,7 .i NORTH CAROLINA GENERAL WARRANTY DEED THIS DEED made this 17TH day of MAY, 2011, by and between LILA RUTH WILLIAMS, WIDOW, 291 JUNEY BEAUCHAMP ROAD, ADVANCE, NC 27006 Grantors, DALLAS G. WARDEN, 346 HWY 801N, ADVANCE, NC 27006, Grantees. THE DESIGNATION Grantors and Grantees as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. WITNESSETH the Grantors, for a valuable consideration paid by the GRANTEES, the receipt of same is hereby acknowledged, has and by these presents does grant, bargain, sell and convey to grantee in all that lot or parcel of land situated in Davie County, North Carolina, more particularly described as follows: BEING ALL OF PARCEL 5, CONSISTING OF 6.448 ACRES AS SET FORTH ON PLAT MAP FOR LILA RUTH WILLIAMS RECORDED IN PLAT BOOK 10, PAGE 339, DAVIE COUNTY REGISTRY. No Title Search requested or performed. The property hereinabove described was acquired by Grantors by instrument recorded in BOOK , page in the Register of Deeds of the aforesaid county. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the GRANTEES in fee simple. And the Grantors covenants with the Grantees, that Grantors is seized of the premises in fee simple, has the right to convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantors will warrant and defend the title against the lawful claims of all persons whomsoever, except hereinafter stated: 0859 9K859pr, 258 0258 Title to the property hereinabove described is subject to the following exceptions: IN WITNESS WHEREOF, the GRANTORS have hereunto set their hands and seals the day and year fust above written. 44 - & 1'/ SEAL) (SEAL) (SEAL) (SEAL) STATE OF NORTH CAROLINA County of I certify that the following person(s) personally appeared before me this day, and; each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stqed therein and in the capacity indicated: p 41-e� Names) ofprincipal(s) Witness my hand and official seal, this the / d of �'� . 20// (Official Seal) �.ONNA 19i1-1Oficial Signature of Notary O 2 N0.q v o cNotary Public > '�� Notary's printed or typed name % 0 �� IC My commission expires: /'a'U / J 1' ,JJP4V FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC P p Davie County Environmental Health E C E I V E A MAR 01 7nl A�11 � P.O. Box 848/210 Hospital Street Mocksville, NC 27028 MAR � � 2U�2 BY:O 161 (a (336)753-6780/ Fax (336)753-1680 P fiP BY: R M 1J Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct (ATC) P-56-th Type of Application: ❑New,System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE; REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name ia=clkp + Contact Person $PrvLQ Address $ pw r L, Home Phone -33(p 40-7 (o 4• a `i- City/State/ZIP AA I . 1&t, - ice pJ C ,)--7 O Business Phone SA -,-^c Name on Permit/ATC if Different than Above - Mailing Address /S YKUYEKIY 1N11*UKMA'I'IUN *Date House/Facility Corners Flagged - -2V -/Z NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan; no expiration with complete plat.) Owner's Name KJ 5 -'r Phone Number Owner's Address J Lt h L ��,,, ��,,, J1 City/State/Zip A Aute-aCc 2 ZO D co Property Address . 72 (a 3 13 amu. e► JI�,.p C.C k yn. g W J City J o- Lot Size G . c{ ti R, Tax PIN# - &I f,' -K) ' 3 A C�) C-700006,50((- Subdivision -70QQ06j0(fSubdivision Name(if annlicahlel Section/Lot# Directions To Site: .1 "ro (3t, �, , e� (�, .n ie�9 � ;a ltd' 7 c7 �/c�/�,�P1 If the answer to any of the following questions is•"Yes",supportinp. documentation must be attached: Are there any existing wastewater systems on the site? /Yes No Q/ b -t U vc d -P r' L1J 1 ru ✓L�5 Does the site contain jurisdictional wetlands? Yes t/No Are there any easements or right-of-ways on the site? '_Yes ;;&o Is the site subject to approval by another public agency? Yes x' No Will Will wastewater other than domestic sewage be generated? ^Yeses 0 IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms_ #'Bathrooms 5 Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes EVo Basement Plumbing: ❑Yes RNo 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: OConventional KA"ccepted ❑Innovative ❑Alternative- ❑Other Water Supply Type: Q 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 If yes, what type? ❑ No 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 hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and loea ng a flag ors in a house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Pr perty owner's or owner's legal representative signature Date(s): 3 - / - / Z2—_ Client Notification Date: DateEHS: rrc-e�--W --7 bD IQS�`f cL Sign given ❑Yes ❑No Account #�� Revised 11/06 Invoice # YNVO i Ce 4f g6l „" J ,>b S T)Q parva, 9-5il;>, J APPLICANT INFORMATION Account #: 989900035 Billed To: Richard Short Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: E70000006504 Subdivision Info: Location/Address: 363 Juney Beauc amp Road -27006 Property Size: 6.448 Acres Date Evaluated: ,j—f oil/ 2 On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4, 5 6 7 Landscape position Slope % o HORIZON I DEPTH Texture groupC Consistence C Structure 6 43k Mineralogy HORIZON H 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 S LONG-TERM ACCEPTANCE RATE 13 1 SITE CLASSIFICATION: EVALUATION BY: Aaa LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS 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 Muhl VFR Very friable FR - Friable FI Firm VFI - Very firm EFI - Extremely firm NS - Non sticky SS - Slightly sticky S -sSticky 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 Mineralog 1:1, 2:1, Mixed LYo� 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 05105 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■e■te■■■■t■■s■■e■t■tee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ee■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■t■■■■■■■■■■■■■■■■■■■e■■■■rte:..�■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■eye■■■_�■■te■■■■■■t■■■■■■■■■■■■■■■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■Int■■11■■■■■■■■■■■■t■■■■■■■■■■■■■■■e■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■u•9111■e•�■�■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■e■ liAlliRik MENNEN iiiiiiMEMNONMENNENl�l ■■■■■■■■■■■■■■■■■■■■ere■■■■■■■■■■■a!■■■■■e■■■■■■■■■■■■■■■■■■■■■■t■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■nom!■■■■■t■■■■■■■■■■ee■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■■■■■■■■■■■■■■■■■■■tet■■■■■■■■■■ ■■t■■■etre■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■rte■■■■■t■■■■■■■■■■■■■■■e■■■■■t■t■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ DAVIE COUNTY.HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 2- .drQ Q M (336)751-8760 Account #: 990001194 Tax PIN/EH #: 5861-543495 Billed To: Norman Williams Subdivision Info: Reference Name: Norman Williams Location/Address: Juney Beauchamp Road -27006 Proposed Facility: Residence Property Size: 100 X 200 ATC Number: 2448 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 CO ON I ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature !Date: fl8 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. " Il y O ` r li r 00 t Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: .1 .I ■■■■■■■■■■■■■ ■■■M■■■E■■M■■ ■■■■■■■■■N■■■ ■■e■EEE■■EM■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■ ME ■■ ■■ NEON NEON ■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■ME■E■E■ ■M■MEMEMM■MMEM■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■E■■■ ■■■■■■E■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ mommomMENNEN MEMNONMEMENOMEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■N■■son■N■�o■■■■ams■■sN■o■■■■■ ■■■■■■■E■■■■M■ ■■■■M■■■M■■■■■■■M■■ ■N■■■■■■■■■■■ ■M■■■■ME■■■E■ ■■■■■■■■■■M■■ ■■M■■■■■■■■■■ ■■O■■■■■■■■■■ ■M■■M■■MMMMM■ ■■■■■■■M■■■■■ ■■■■■■■■■■■■■ ■■o■■■m■■m ■■■■Ee■■e■ ■o■■■■Om■■ ■■■■■■EE■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■■NEEM■■■ NEON ■■M■ ■ iii ■■■O■■ ■■■■■■ ■■■■■■■■■■■ ■E■■e■■EEE■ ■A■■■■■■■■■ ■■■MEMO■■■■ ■■■■■m■■■■■ ■■E■EME■■■■ ■EM■M■MME■■ ■ENE■■■■■■■ ■M■■■■■ ■■M■■■■ ■■MEMO■ ■■M■■■■ ■■■mons ■■■■■■ Nona■ ■E■N■■ GoMAPS - Davie County NC Public Access Ul LCY Ln 0 CY• p¢ t 2f t G x �r LAUREP- CT -1� y ROBBIELL LN:=off---� iIl- ''t _ 0 FgGc t �r �. IJ F q Y rARDue Lr o ^_ RIVERSTONC TRTR•L o 338r(� �L * * * WARNING: THIS IS NOT A SURVEY! * * * This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. WATERSHED STRUCTURES WATER BODIES COUNTY—BOUNDARY STREETS " RAILROAD CENTERLINE PARCELS CITY—LIMITS BERMUDA RUN COOLEEMEE E] OAVIE COUNTY EJMOCKSVILLE nccounties OWE. <all other values> Friday, March 9 2012 ,,., y .�uo�,,.,,. � . .. � �,