457 N Pino RdDAME COUNTY HEALTH DEPARTMENT
{' Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001050
Billed To: David McClannon
Reference Name: David or Angela McClannon
Proposed Facility: Residence
Tax PIN/EH #: 5833-25-3514
Subdivision Info:
Location/Address: North Pino Road -27028
Property Size: 2 Acres
ATC Number: 2658
**NOTE** 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 2 #Bedrooms_ #Baths 2
Dishwasher: Z-10, Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #S/eats Industrial Waste: ❑
Lot Size `%C/ Type Water Supply r'// Design Wastewater Flow (GPD) �b d Site: New M"' Repair ❑
i l
System Specifications: Tank Sizepd�GAL. Pumps ,T(ank GAL. Trench Width Rock Depth �— Linear Ft.�
4&/A57yOther: 'L-,2��
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APP;
FINISHED GRADE. ****NOTICE: Contact a representative
system between 8:30 a.m.
to 9:30 a.m. or 1:00 p.m. to 1:30 p.m.
hel0/1
FFJ UENT FILTER RISER(S) IF 6 " BELOW
County Health Department for final inspection of this
of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: Date: 41-6
DCHD 05/99 (Revised)
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001050
Billed To: David McClannon
Reference Name: David or Angela McClannon
Proposed Facility: Residence
ATC Number: 2658
Tax PIN/EH #: 5833-25-3514
Subdivision Info:
Location/Address: North Pino Road -27028
Property Size: 2 Acres
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 WASTEWATFAR CONSTRUCTION IS V �ID FOR A PERIOD OF FIE YEARS.
Environmental Health Specialist's Signature: �J� Date: A� —/6/
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall ' c
has been installed in compliance with 11 of G.
Disposal Systems," but shall in NO� en as a
given period of time.
Septic System Installed By:
system described on Improvement/Operation Permit
130A, Section .1900 "Sewage Treatment and
4that the system will function satisfactorily for any
Environmental Health Specialist's Signature: Y c Date:
DCHD 05/99 (Revised)
F,y__
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department
Environmental Heaft Secdon
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
D
ENVI
**'nWCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Nasty to be H. McGlannon Contact Person—Nv1 ck or Ar aoo,
Mailing Address 2b3 -DHtZNFr2 Q(J,. Home Phone Wl a -aJ�R 3
city/state/ZIP M OCI<Svikk / N, C. / a7oa9 Business Phone---) 5 1 —I qC4
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For:Site Evaluation Improvement Permit/ATC moth
4. system to service: House a Mobile Home ❑ Business ❑ Industry ❑ Other
5. If
Residence: # People 2 # Bedrooms 3 # Bathrooms _1
LY Dishwasher ❑ Garbage Disposal M Washing Machina ❑ Basement/Plumbing ❑ 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: ❑ County/City a/
Well ❑ Community
it
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B_1N0
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 2 /fc, -c,S�
Tax Office PIN:' #-7�c
Property Address: Road Name No r+k •I'1 N0
City/Zip
If in a Subdivision provide information, as follows:
Name:
Section: _ Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
N -h P4. -rb�n
Q�ahfi �,n (^'a�1�. SAID.
O
R', t oQer" Ni- -exp __"_,7
Date Property Flagg;—/.s"--o v
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 1 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 f_ie►G gu)1ehea /O ho r 6n
to conduct all testing procedures as necessary to determine the site suit ility.
DATE SIGNATURE J
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations). _
Site Revisit Charge
Date(s):
Revised DC HD (07/99)
Client Notification Date:`
EHS:
Account No. QS�
Invoice No.
,moi`,
. DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990001050 Tax PIN/EH #: 5833-25-3514
Billed To: David McClannon'.; Subdivision Info:
Reference Name: David or Angela McClannon Location/Address: North Pino Road -27028
Proposed Facility: Residence Property Size: . 2 Acres Date Evaluated:
Water Supply: n -Site Community Public.
Evaluation By: Auger Bo ing Pit Cut
••
vo®e®awe
HORIZON I DEPTHConsistence
�,srs•�
. r,���:r.��
- .. � ru�r�■r��r�r�z�rv�r�
Consistence
Mineralogy
HORIZON III DEPTH
Texture group
�., rv�■.F
MNOT=
rMmi-
•
r ,,ren
-
RJrr9 •A -
WN.,.
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
•
U • •
W_�WI��f��»����5�
•
��W�
�pA W4
611r��
SITE CLASSIFICATION: ;� EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: l OTHER(S) PRESENT:
REMARKS:
LEGEND �r9�
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 I .
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)
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ENVIRONMENTAL HEALTH SECTION
P.O. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #: (336)751-8760
May 2, 2000
David H. Mcclannon
263 Danner Rd.
Mocksville, NC 27028
Re: Site Evaluation(s)/Lot(s) (#'s)
11 Acres -N. Pino Rd
Tax # 5833-25-3514
Dear Client(s):
As requested, Clint Dorman, Environmental Health Specialist with this office on
April7th 2000, evaluated the above -referenced property at the site designated on the plattsite plan
that accompanied your improvement permit application. According to your application the site is
to serve a 3 -bedroom home with a design wastewater flow of 360 gallons per day. The evaluation
was done in accordance with the laws and rules governing wastewater systems in North Carolina
General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A, of the North
Carolina Administrative Code, Rule .1900 and related rules.
Based on the criteria set out in I SA, Subchapter 18A, of the North Carolina Administrative
Code, Rules .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a
ground absorption sewage system. Therefore, your request for an improvement permit is
DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following:
1) Massive soil conditions
2) Soil wetness conditions
3) Shallow soil depth
4) Large and frequent rock formations
5) Complex topography
These severe soil or site limitations could cause premature system failure, leading to the discharge
of untreated sewage on the ground surface, in surface waters, directly into ground water or inside
your structure.
The site evaluation included consideration of possible site modifications, and modified,
innovative or alternative systems. However, this office has determined that none of the above
options will overcome the severe conditions on this site. A possible option might be a system
designed to dispose of sewage to another area of suitable soil or off-site to additional property.
For the reasons set out above, the property is currently classified UNSUITABLE, and an
improvement permit shall not be issued for this site in accordance with Rule .I948(c).
However, the site classified as UNSUITABLE may be reclassified as PROVIONALLY
SUITABLE if written documentation is provided that meets the requirements of Rule .I948(d). A
copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop
a plan under which your site could be reclassified as PROVISIONALLY SUITABLE.
You have a right to an informal review of this decision. You may request an informal review
by the environmental health supervisor with this office. You may also request an informal review
by the N.C. Department of Environmental and Natural Resources regional soil specialist. A
request for informal review must be made in writing to the Davie County Health Department,
Environmental Health Section.
You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must
file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail
Center, Raleigh, N.C. 27699-6714. To get a copy of a petition form, you may write the Office of
Administrative Hearings or call the office at (919) 733-0926. The petition for a contested case
hearing must be filed in accordance with the provision of North Carolina General Statutes
130A-24 and 150-B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute
130A-335 (g) provides that your hearing would be held in the county where your property is
located.
Please note: If you wish to pursue a formal appeal, you must file the petition form with the
Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The
date of this letter is (DATE). Meeting the 30 day deadline is critical to your right to a formal
appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that
you might request. Do not wait for the outcome of any informal review if you wish to file a formal
appeal.
If you file a petition for a contested case hearing with the Office of Administrative Hearings,
you are required by law (N.C. General Statute 15013-23) to send a copy of your petition to the
North Carolina Department of Environment and Natural Resources. Send the copy to: Office of
General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service
Center, Raleigh, N.C. 27699-1601. Do NOT send the copy of the petition to Davie County Health
Department. Sending a copy of your petition to Davie County Health Department will NOT
satisfy the legal requirements in N.C. General Statute 150B-23 that you send a copy to the Office
of General Counsel, NCDENR.
Please call or write this office if you have any questions or need any additional assistance, as
follows: Telephone number: (336) 751-8760
Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
Yours very truly,
('Dorman_.
Mail To: 2-o3 C16 ty6Ze� R cP. rnotkS,,.��BK 35 I PG b�0 S
WARRANTY DEED, -Form WD -601 Printed and for sale by James Williams & Co., Inc., Yadkirivilie, N. C.
STATE OF NORTH CAROLINA, Davie County.
THIS DEED, Made this 7 day of-NOVeMber 2000 , by and between Eric >~ U902e Mr('_1 annon
of Davie County
and state of North Carolina, hereinafter called Grantor, and- David H. McClannon and wife Angela M McClannon
of Davie County and State of North Carolina, hereinafter
called Grantee, whose permanent mailing address is
WITNESSETH: That the Grantor, for and in consideration of the sum of Dollars
and other good and valuable considerations to him in hand paid by the Grantee, the receipt whereof is hereby acknowledgged, has given, granted, bargained, sold
and conveyed, and by these presents does give, grant, bargain, sell, convey and confirm unto the Grantee, his heirs and/or successors and assigns, premises in
Farmington Township, Davie County, North Carolina, described as follows:
The above land was conveyed to Grantor by . See Book No. , Page
TO HAVE AND TO HOLD The above described premises, with all the appurtenances thereunto belonging, or in any wise appertaining, unto the Grantee, his
heirs and/or successors and assigns forever.
And the Grantor covenants that he is seized of said premises in fee, and has the right to convey the same in fee simple; that said premises are free from en-
cumbrances (with the exceptions above stated, if any); and that he will war r a n t and defend the said title to the same against the lawful claims of all persons
whomsoever.
When reference is made to the Grantor or Grantee, the singular shall include the plural and the masculine shall include the feminine or the neuter.
IN WITNESS WHEREOF, The Grantor has hereunto set his hand and seal, the day and y r first,above ritten.
(SEAL) �ti- ta�4—s'' (SEAL)
Eric Eugene McClannon (SEAL) (SEAL)
COUNTY.
STATE OF NORTH CAROLINA Davie
t & OFFICIIAL SE
70
I,
Eric Eugend McClannon
, a Notary Public of said
Grantor, personally appeared before me this day and acknowledged the execution of the foregoing
Witness my hand and notarial seal, this the G day of /A/,, J
My Commission Expires: ,/ a — O S
STATE OF NORTH CAROLINA COUNTY.
•,�, t%iu1R�,aS�tlLxXjifYO,S
, a Notary Public of said County, do hereby certify that
".
, N. P. [SEAL]
Grantor, personally appeared before me this day and acknowledged the execution of the foregoing deed.
Witness my hand and notarial seal, this the day of ,
My Commission Expires: , N. P. [SEAL]
STATE OF NORTH CAROLINA, Davie COUNTY.
The foregoing certificate(s;f of Betty S. Gunter, Notary Public of Davie County, NC,
is (2i� certified to be correct. This instrument was presented for registration this 16 day of November, 2000.
at 10: 15 A. M.,*YK, and duly recorded in the office of the Register of Deeds of Davie County,
North Carolina, in Book 351 , Page 605
This the 16dayof November , A- D„ 2090
HENRY L. SHORE By t!•
Register of Deeds XK%VsWDeputy Register of Deeds
This Deed drawn by Michael J. Parker, Attorney, Mocksville, NC 27028 NTE
BEGINNING at a point lying in the centerline of North Pino Road, said point being the southeast corner of
the Fogg tract (Davie County Tax ID # B-4-33), and said point of beginning also being the northeast corner
of the within described tract; thence from said point and place of beginning with the centerline of North Pino
Road, South 15 degrees, 16 minutes, 27 seconds West 331.87 feet to a point lying in the centerline of North
Pino Road, the southeast corner of the within described tract; thence North 88 degrees, 00 minutes, 00 seconds
West 30.82 feet to an iron lying in the western right of way of North Pino Road; thence North 88 degrees, 00
UJ
minutes, 00 seconds West 200.79 feet to an iron, the southwest corner of the within described tract; thence
¢
North 02 degrees 00 minutes 00 seconds East 323.00 feet to an iron, the northwest corner of the within
U)
described tract; thence South 88 degrees 00 minutes 00 seconds East 277.00 feet to an iron lying in the western
zo
right of way of North Pino Road; thence South 88 degrees 00 minutes 00 seconds East 30.82 feet to the POINT
~
AND PLACE OF BEGINNING and containing 2.00 acres as taken from a survey of Phillip R. Ball, dated
ce
October 10, 2000.
u�
in
Also conveyed with the above described tract is an easement for the placement and use of nitrification lines for
0
a
'L
Z
use in conjunction with the placement of septic and sewer system on the above-described tract on that certain
c
3.00 acre tract and lying directly West of the above-described tract with said easement tract having the
►"-
m
following courses and distances:
cc
w
BEGINNING at an iron, the northeast corner of the within described easement tract and said point of beginning
z
also being the northwest corner of the above-described 2.00 acre tract; thence from said point and place of
cc
r -
beginning South 02 degrees 00 minutes 00 seconds West 323.00 feet to an iron, the southeast corner of the
w t
within described tract; thence North 88 degrees 00 minutes 00 seconds West 404.50 feet to a point, the
o
southwest corner of the within described tract; thence North 02 degrees 00 minutes 00 seconds East 323.00
feet to a point, the northwest corner of the within described tract; thence South 88 degrees OO.minutes 00
a
seconds East 404.50 feet to the POINT AND PLACE OF BEGINNING.as taken from a survey of Phillip R.
°
Ball, dated October 10, 2000.
The above land was conveyed to Grantor by . See Book No. , Page
TO HAVE AND TO HOLD The above described premises, with all the appurtenances thereunto belonging, or in any wise appertaining, unto the Grantee, his
heirs and/or successors and assigns forever.
And the Grantor covenants that he is seized of said premises in fee, and has the right to convey the same in fee simple; that said premises are free from en-
cumbrances (with the exceptions above stated, if any); and that he will war r a n t and defend the said title to the same against the lawful claims of all persons
whomsoever.
When reference is made to the Grantor or Grantee, the singular shall include the plural and the masculine shall include the feminine or the neuter.
IN WITNESS WHEREOF, The Grantor has hereunto set his hand and seal, the day and y r first,above ritten.
(SEAL) �ti- ta�4—s'' (SEAL)
Eric Eugene McClannon (SEAL) (SEAL)
COUNTY.
STATE OF NORTH CAROLINA Davie
t & OFFICIIAL SE
70
I,
Eric Eugend McClannon
, a Notary Public of said
Grantor, personally appeared before me this day and acknowledged the execution of the foregoing
Witness my hand and notarial seal, this the G day of /A/,, J
My Commission Expires: ,/ a — O S
STATE OF NORTH CAROLINA COUNTY.
•,�, t%iu1R�,aS�tlLxXjifYO,S
, a Notary Public of said County, do hereby certify that
".
, N. P. [SEAL]
Grantor, personally appeared before me this day and acknowledged the execution of the foregoing deed.
Witness my hand and notarial seal, this the day of ,
My Commission Expires: , N. P. [SEAL]
STATE OF NORTH CAROLINA, Davie COUNTY.
The foregoing certificate(s;f of Betty S. Gunter, Notary Public of Davie County, NC,
is (2i� certified to be correct. This instrument was presented for registration this 16 day of November, 2000.
at 10: 15 A. M.,*YK, and duly recorded in the office of the Register of Deeds of Davie County,
North Carolina, in Book 351 , Page 605
This the 16dayof November , A- D„ 2090
HENRY L. SHORE By t!•
Register of Deeds XK%VsWDeputy Register of Deeds
This Deed drawn by Michael J. Parker, Attorney, Mocksville, NC 27028 NTE
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soi]/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990001050
Billed To: David McClannon
Reference Name: David or Angela McClannon
Proposed Facility: Residence Property Size
Water Supply:
Evaluation By:
Tax PIN/EH #: 5833-25-3514
Subdivision Info:
Location/Address: North Pino Road -2702
2 Acres f Ve. Date Evaluated: 4z�' FO
Ems`
On -Site Well Community
Auger Boring Pit
Public _
Cut
FACTORS
1 2
3 4 5 6 7
Landscape position
%
L
Slope %
HORIZON I DEPTH
Texture group
r,
/V/_ 1/71/1
Consistence
Structure
Mineralogy
HORIZON II DEPTH
'
Texture group
Consistence
r
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
SITE CLASSIFICATION: . /C ✓ 7(��� EVALUATION BY:
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
ois
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)