330 Pineville Rd .
.•
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
���f}Z��Z ��j�}-2jj,p P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
�l'ANA C�l�iq ui� �'�}��IZ�iZ (336)751-8760
Account #: 990001424 Tax PIN/EH#: 5843-44-7576
Billed To:_.Bn�}al-kleweEF— Subdivision Info: �,330
Reference Name: Location/Address: Pineville Road-27028
Proposed Facility: Residence Property Size: see map
ATC Number: 2744
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** T'his Authorization for Wastewater System Construction MLJST BE ISSLJED 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 S ge Treatment a isposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CON T VALID R A PERIOD OF FI YEARS.
Environmental Health Specialist's Signatur • 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. '�J�'� 4 Z
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Septic System Installed By: � � �''� � � 21 M�%S
Environmental Health Specialist's Signature: e: � � � �
DCHD OS/99(Revised)
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.
, DAVIE COUNTY HEALTH DEPARTMENT
•. • Environmental Health Section (�`U� �C
P.O.Boa 848/210 Hospital Street
�/ Mocksville,NC 27028 �_�_ �/
l�����(,(e/I�Q ��r-�j (336)751-87G0
------.._
I�ia�Q ��' u�{� �a VEMENT/OPERATION PERMIT �� � --�-
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Account #: 990001424 Tax PIN/EH#: 5843�1-7576 2�
Billed To: R�.�Cal-Hewet�r Subdivision Info: `�
Reference Name: Location/Address: Pineville Road-27028
Proposed Facility: Residence Property Size: see map
�,TEC�,�V�nb�r: 2744
**N is mprovemendOperation 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 M •�"�nM� #People_�_ #Bedrooms � #Baths 2
Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: � Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: �
, Lot Size Type Water Supply��}� Design Wastewater Flow(GPD) �l�f� Site: New❑ Repair L1
System Specifications: Tank Size�� GAL. Pump Tank GAL. Trench Widt���, Rock Depth 2�~Linear Ft. ��
Other: � �1��+�'�i o-� �ggc�,S �r.S-`3'To.� L.r-��.5 �O.C. w��rJ.
t/� � ��
Required Site Modifications/Conditions: �'�=t' � d�� I�l. (��b-rv,�_ ��ST�� p..3 C.�STp�,ti2
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6`�BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie CountyHealth Department for final inspection ofthis
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(33G)751-87G0.****
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Environmental Health Specialist's Signature: ate: �
DCHD OS/99(Revised)
� • APPLICATION FOR SITE EVAWATION/IMPROVEMEM PFAMR dc ATC Q � � � O ' (`t �' ai�
, • � • Davle County Health Department +
Environmenda!He�r/th Se�dfon $� 2 7 2000
p.0. Box 8�8/210 �ospitia]. etrNt
. ldoak�vill�, NC Z70Z8 � •
(336)751-9760 � ENVIRO�Jh9ENTAL HERLTH
DAVIE COUNTY
�**2l�ORTAH?+t�* THI8 IIpPLIGATi02i t�NlQ�? 9� PROC688�D VNI,E88 71LL '1'� REQIIIRSD
IN1'OR�AT=ON i8 pit�1t20ED. A�ter to th� iN1"0�111Ti0N Bt1Lt+�TiN !or iaetxuations.
i. 11aa. to b� ssu.d coutao! 11+s�oo
Ntil� �dL��� �j�)��(1 .�, ��A',ilflll7Y1�Y�UJ . a�� � -/RIJrW� '�
���.�.�.�:=p �1,�,�.�.�� �yda� �.�... �. .S�r��' �g2���3
3. Ma� on �rait/1►TC i! 01!l�zya! than 71ban
/��iliaq l�ddr��• Cit=//tab/=ip
�. 1►pplioatioA tor: C�81t� �valnation 0 Tmprov�ab p�rsiti/711'C 0 8oth
s. �.t.a tio e•=.sw� O 8ous• [�Mobii� Bom� U Hnsia�s• O industry 0 Oth�r
a. �! tt��id�nc.: � p�opl� �_ � B�dsooma '� i 8athrooms �,_
O Di�hxt�!►�r O oarbaq� Di�po�al [?�lhahinQ WdlSa� 0 saaa�nti/plwbinQ 0 �as�at/1io plusbinq
6. 2! swi���/zs►du�trr/Ott�r� fp�oilY lyp� f P�oPl� _ t sink�
�
� Coar�od�� � dhox�s� f Osiaalt � �htt�s Cool�s�
_! ��00�8=RVICi: � S�ats sstimat�d Nat�r tlsaq� to•llon. r•= �ir�
�. s�. o: ,�t.= .��p: �co,u�t�/ca�r o xai a co��
•. Do yoa�aNcipate addiNon�or espswion�ot t6e Ueqity th�system b intended to krve? `�1 Ya 0 No
uya,.�6.t cy�! ��t I.�.��ti,� & .
**•IMPORTANI'"*'CLIENT3 Mi1ST CIDMPLElETHE REQUIRED PROPLRTY INFOttMAT10N REQUESfED
H+E40W. Either s Pi.AT or SITE L'L.AN MUST BB SUBMIT?ED b the tUedt wtt6 TNIS APPWCATION.
Ptopecty Dimenelons:.�.�-e._r�� WRITE DIRF.CflONB(�i�om Mak:vllle)to PROPEitTYs
Ta:Odice PIN: �# �,����'' yL�-7�7 jv �p�-� R-.c . +� Q o n P•ne.�1/�
Property Addrte�: Rwd Name �n.e�J�L��c. � ��-�' �`t r�-� • Y�a�.,, ��•�•^P^P -
� ctty�z�p � c� s Z7�3�
� It lo�Snbdiviston prvvlde Intorm�don,a follaw�:
N�me:
Seonon: Block: Lott Mta Property Pis�ed:
��a�f� �
Thi�is to eerNly t6�t the inibrm�Noo pro�vided b eorreet to t6e bat otmy i�nawled��. I ander�bnd that�ay permlt(�)
tasucd hereafler�re enbj�ct to�mpenelon or revocaHon,if the dte pl�n�or intended ase ehanae,or i[the Inform�Non
�abmitted in t6b spplicadou le li�lsified or c6an�ed. I,also,andtrstand tltm t ani responslble jor a►l ebaiges lncamtd froni
rbb appilcodo�. I,Lerebr,`ive eowent to the Aat6o►�ized Aepc�eenhtive oi the Davte Coanty Halth 1kp�rtment
to eoter apon abwe deacribed property located In D�tvie Coanf�►snd m►ned by
to condact dl taHnt proccdara u aecaasry b determine the�ite�aiMbWty.
DATL 7�a/"�OC�O �
$IGNATURL
THl3 AREA MAY BE U3ED FOR DRAWQIG YOUR$1TL PI.AN(Iaciade all of t6e[ollawin�s E�HnQ�nd propaed
property Ilna and dimeaalons, strnctara, tetb�cks, aud repNc IocsNoas).
� Site Rcvb�t C6�r=e
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►D 5 Client NoHBaHon Date:
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S�i Acconnt Na �-
Revlsed DCE@(07/99). 1 Involee Na a� fl O
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. i
' ' ., � . DEED �E00
K�PAGE� 1
�' t1� ': � . � . . � . � .
'W!1 TOt �--�^��- �
'�°WARMN7'Y DBSD—Porm WD-601 Printed �nd for ule by Jame�WWkm��r Co.,Ine.,Y�dkirivIDe,N.C. �i
� � Davie - -- �
� ". ;STATE OF NORTH CAROLINA, County. I'
,�.�THIS DEED, Made thi���_dar of�,�BIlua�t�,19�.1��by and betwoe*+ ' I�
� .�_ J. Hu�h Brock and wife. Sue L. Brocic oj Davie • co,,,,�y li
' ; and ttate of North Cuollna,bereinaftct called Crantor,and A nnie LO�A Hunte r I�
of DaViB County and State of North Cuolin�,hcrcinafcer I+
` • . cdled Gr�ntce. , . .
'. Ten 10. 00)
WITNESSETH: That the Crantoq for and in condderadon of the�um of� Dollan J
and other good and valuable contiderattoni to hlm in hand pald by the Grantee,the cecefpt whereof b hereby�eknowled ed,hu given,gronted,bug4lned,iold I!
and•convcycd,and by thex precentt doe�give,grant,bugaln,ull,convey�nd confvm unto the Grantee,hu helr�and�or�uccewon and atsign�,premiae�ln
�` I ' . Farmin ton � Davie i
$ Townihip, County,North Carolina,deuribed ru follows:
:' � ' • . • i
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� BEGINNING at a stake on the North side of the Farmington-Wyo • ;
` � Road, now Highway 1432; thence in an Easterly direction with '
� • the road 105 feet to a atake; thence in a Northerly direction ' �+
with the line of Louise Cuthrell 105 feet to Louise Wright's �j
.�l . corner; thence in a Westerly direction 105 feet to Louise Wright's . .
. � line; thence with Louise Wright's liae 105 feet to the BEGINNING,
; . i .containing one-half (1/2) acre, more or less. .
,� . ' . '
, ' . . .
f ' ' . . This is the identical property described in a certain deed from
�; . � Freddie Wright et al to James Cuthrell, recorded in Deed Book
,�� ,, •:� • 64, at page 146, Davie County Regiatry, to which said deed �
� reference is hereby made for a more particular description of �
,:;��:��:' said land.
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.1'� .�4Pe. �� }�n�. � ��Y . . . .
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+ �y�,',�� ;��t' '�str�� �t • {
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� ��F`���.;�,d�,+ '`1_ . "P.: ..$3. �� • .
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� :r The abova land wu conveyed to Gnntor by ' .See Book No. ,Pa�e' ,
i � TO NAVB AND 7'O HOLD The abore deurlbed premiu�,with all the appurtenance�thenunto belonging,or 1n any wiu�ppertaininQ,unto the Gramee.h4
i• ',.;:.he'vs and�or�ucceuon and auignt forever.
.:R' And the Gtmtor covenantt that he it xiud of�a1d pnmiut iu fee,and hu t}�ecight to eonvey tfie wnqin fee dmple;that�aid premiui ue free from eo- ' �
�'`�-'`;cumbranca(with the excepdon�above uaced,lC any);and that he wUl wa rr a n t and defend the uid title to the wme against the lawfui clalms of all penont
:',whomwever.
, •I ' When refucnce i�made to the Gnntor or Gtantee,the tingu1at ahall lndude the plural and the muculine thall include the f minIne or the neutar. �
,;.., ,: ,..1N WITNESS WHEREOF,The Grantor hat hereunto ut hb hand and ual,the diy and ye Ilnt ove written. �
.. i ,: •� (SEAL) (SEAL)
j t, (SEAL) � (SEAL)
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i
� „ y STATE OF NORTH CAROLINA Davie COUNTY. ;;�\ �,,,.,,,,J !,'•.,.
�,I�� t _ Erlene W. Robert� ' '��'• • �
� ,a Notay Public o!�ald County,do harcby certlfy�tA�t '�� • '• s �
� ! . J. Hugh Brock and wife S»P �._ Brock , ' \'.+'����y'•; . �`'.'
. • •� Crantor eraonoll a eared before ma thb da �nd acknowled ed the execution of the fore oin deed. � R �•��.��T-.:��'',�•' "�
�P Y PP Y B B B • .. . • .)
T' 1 1 r%�}
�� ; Witnes�my hand and notuial seal,thb the 2 3 day oE Q��
� .. •My Cbmmission Exp'vu: - NOv. 5� 1975 � ,�^,T_:...�.������.�•,;,_;,i
� � STATE OF NORTH CAROLINA COUNTY. ��o ��� •� �� '
� ,�� �
, �� �r�n�r��„���•..
,a Notuy Publlc of said Coun[y,do hereby cenify th�t ��
.,� . , ��
• ��: Crantor,penonally appoared before me thb day and acknowledQed the oxecutlon o the foroQoing dced. �
�' , ` Witnc��my hxnd and notul�l aal,thi�the_ day of � ,19—..
,, � ';.. My Commiuion Expirei: ,N.P.(SEAL) i
't STATE OF NORTH CARULINA, pU(�y, !
�
� . The foregoing certifiate(�)of � I
. � a
'"';i�(we)certified to be carrece. Thls inittument wat pre�ented for reaLeratlon thb — y of ,19 , �
at � � A.M.,'!'S�7vl„aad duly�ded!n the of(lce of the Regi�tec of Deeds oC County, �
,.�, Nocth Caroltna,in Book�,PaQe , [�� I
� �. 'tldi che..��d�y of ,A.D.,191.Z.
�
t;,.
,.� �Y� - � BY I
_ ``��` egiiter of Dccd� Auivant,Dcpury Register of Deed� !
� a �:;
° ,� t %�. i Dced drawn by �
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. = � � � DAVIE COUNFY I�EALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990001424 Tax PIN/EH#: 5843-44-7576
Billed To: Royal Howell Subdivision Info:
Reference Name: Location/Address: Pineville Road-2702
Proposed Facility: Residence Property Size: see map Date Evaluated: �� ('o �
Water Supply: On-Site Well Community Public -�'
Evaluation By: Auger Boring ✓ Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition J� L
Slo e%
HORIZON I DEPTH p -CO o -
Texture rou G�
Consistence SS
Structure
' Mineralo �: �
HORIZON II DEPTH - 1
Texture rou �i
Consistence ` �S-
Structure �
Mineralo � 1� (
HORIZON III DEPTH
Texture rou .�.
Consistence S
Structure . �
Mineralo � 1 : �
HORIZON IV DEPTH
Texture rou �
Consistence
Structure
Mineralo
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 plas�� l�o�j A
� �C"i�
Structure r
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky 3
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineraloav
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-gaUday/ft2
DCHD OS/99(Revised)
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. � _
March 1 , 2001
TO WHOM IT MAY CONCERN:
I, Joseph Garrett caretaker of Mary Ella Anderson, state it
is 4K if Royaf Steven Howell taii lines or repair area runs over
on our property on Pineviile Road.
osep Garrett
. 947 West Lake Ave.
Neptune, NJ 27461-2068