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148 Oakdale Circle Lots 7-8 P/O 9 ' - DAVIE COUNTY HEALTH DEPARTMENT / Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 ' Account #: 990002683 Tax PIN/EH#: 5746-83-7931 Billed To: Tammy Stewart Subdivision Info: Oakdale Lot#4 Reference Name: Location/Address: Oakdale Circle-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3432 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 ST UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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 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. L i /<r Septic System Installed By: !/ Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) FE E TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department 3 1 2003 Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAM COUNTY 1 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 1 TQh�" �n M mn %l �P 1,�N C f Contact Person ( .v Q �� Mailing Address ,Ll()� a 1 I (�► 1 Home Pho q q$ �a( 1 15 City/State/ZIP _Cool Q`P me e � Y C ����l/ Business PhotCP-11 (D$ D% ' '�a(OC( -) 2. Name on Permit/ATC if Different than Above Mailing Address \— City/State/Zip 3. Application For: �YSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms U Dishwasher U Garbage Disposal Washing Machine U Basement/Plumbing / \J�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: Qeounty/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes KNo If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN �MUSTBESUBMITTED by the client with THIS APPLICATION. � Property Dimensions: S e-e .r WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 57 �.g 3,71 3 i . Property Address: Road Name V A' lC.A4A,L C,&d v City/Zip `.5 0 If in a Subdivision provide information,as follows Co Name: 6 );- Section: Block: Lot: Date Property Flagged: 3 ot Z e 3 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. 1,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 to conduct all testing procedures as necessary to determine the site suitability. esy ( DATE .�( -/f g > SIGNATURE k JC1aXVnA4 At THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed grope li , ovations). Site Revisit Charge Date(s): Client Notification Date: v' EHS: Account No. 3 Revised DCHD(07/99) Invoice No. c�=,- / 5 '" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION , Account #: 990002683 Tax PIN/EH#: 5746-83-7931 Billed To: Tammy Stewart Subdivision Info: Oakdale Lot#4 Reference Name: Location/Address: Oakdale Circle-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% 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 SITE CLASSIFICATION: 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 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 Mineralog 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) t DO IMX03 P y Mea Tet t.► 21 Iv C_ WARRANTY DEED-Form WD-601 Printed and for sale by James Williams k Co.,I.e.,Yadkirivme,N.C. STATE OF NORTH CAROLINA, Davie County. THIS DEED Made this 6th day of July el ,1998 by a„d betwimn Shelby Jean Bell Schenck and but and Rrlon Schenck of Rowan county and state of North Carolina,hereinafter called Grantor,and Steve T. Stewart and wife, TAmmy B. Stewart of J.Davie' County and State of North Carolina,hereinafter called Grantee,whose permanent mailing address is tt WITNESSETH:That the Grantor,for and in cot"ideration of thelum of SED dn118rs and 01C -^--^--pollen and other good and valuable considerations to him in hand paid byy+Grantee,the receipt whereof is hereby acknowleddgged,has given,granted,bargained,sold •: and conveyed,and by these presents does give,grant,bargain,aell,gonvey-ind confirm unto the Grantee,his heirs and successor and assigns,premises in Jerusalem Township, I Davie County,North Caroline,described as follows. BEING known and designated as WThree(3),Block tB"as the same appears on a map of "Oakdale Subdivision"recorded in Plat Book 4,Pages 28A and 28B,Davie County Registry, to which reference is hereby made for a more particular description. 11 00f1 DAVIE COUNTY 07-10-98 $8- p0 sraDRFY" 8.00 NARp{JNA Real Estate Excise Tax The above land was conveyed to Grantor by No title search performed or requested .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 andfor successors and assigns forever. And the Grantor covenants that he is seized of said premises In fee,and has the tight to convey the same in fee simple;that said premises aro free from en- cumbrances(with the exceptions above stated,if any);and that he will we r r a n t and defend the mid 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 W TN• S W ERE F.TbF G antor has semunt et his hand and seal,the day and year first above written. t,wuU:: r (SEAL) `SEAL) 1 (SEAL) Via'- ..(61 tj STATE OF NORTH CA0. NQ��L.•f� —COUNTY. "'"a••,`:•".,•r�.,!�'. �� 1� _I�r ,a Notary Public of mid County,do hereby certify ir Shelby J an Bell Schenck and Marlon Schenck Grantor,personally appeared before me thisda and acknowledged the execution of the foregoing deed. .rte;t'%;��� l- •.. Witness my hand and notarial seal,this the • —day of ya•, My Commission Expires: •I f'g g rant; AL) STATE OF NORTH CAROLINA COUNTY. 1, a Notary Public of said County,do hereby certify that 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.ISEAL) STATE OF NORTH CAROLINA, Davie COUNTY. The foregoingcertificate(IQ of Sttate K. Pealer NotA= Public of Rowan_County is 6W certified to be correct.This Instrument was presented for registration this in -day of July. at 1-91 APM.,P.M.,and duly recorded in the office of the Register of Deeds of Davie runty, North Carolina,in Book 901 Page A4 This the IQ —day of July A.D.,19_18 Henry L. Shore By_ � Register of Deeds Assistant,9re*44 Register of Deeds This Deed drawn by wade H. Leonard, Jr.