1093 Rainbow Rd ' . � . .
: � HEALTH DEPARTMENT RELEASE x�r �ff,�P �����3�3r�,�,��4
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""��� �� �*CDP Fi1e Num���,� �,����
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, 'i � Environmental Health Section � �a��Y�� �U��'k,y� �
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210 Hospital Street �iY2 333��� 3�3��,�����'S �(�y
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Mocksville NC 27028 '�' 7.� p/����//'� � y�� , y��3� �;��
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Phone:336-753-6780 Fax:336-753-1680 ""'"'""'
Permit Valid Until: 05/O1/2019
Applicant: Brad Rogers Property Owner: Lynn and Janet Parrish
Address: 125 Griffith Road p��ess; 1093 Rainbow Rd
City: Advacne City: Advance
State/Zip: NC / 27006 State/Zip: NC / 27006
Phone #: (336) 817-4197 Phone #:
Provertv Location 6 Site Information
Address: 1093 Rainbow Road Subdivision: Phase: Lot:
Road#: Advance NC 27006 Township:
*Structure: SINGLE FAMILY
# of Bedrooms: 2 # of People: Directions:Hwy 158 turn left on Rainbow Rd. off
of Redland Road got approx. 1/2 mile on right in
front of church.
*Water Supply: N/A Type of business:
Basement: � Yes ❑X No Total sq. Footage: No. Of Employees:
*Proposed Improvement: Bedroom addition
*Release Conditions: Maintain 5 foot setback to any portion of the septic system
**Site Plan/Drawing attached.** Total Time:(HH:IIIl)
OHand Drawing OImport Drawing xours Minutes
Activity Code:
: HEALTH DEPARTMENT RELEASE � �F�r ��f,rP �SP:��n��,��� ,
"�.. ��i�� '�CDP $�9�N �timbA�'` ���,�s� ��fu�,:
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- ��1 -' �, Davie County Health Department �� �6 ��Q����� ��'� �� �' f �,�
Environmental Health Section 5 CpuntY#miNUmber �
. E.3�i " '�O�. " Y� 3 � _;.
210 Hospital Stxeet ,,3 �3` 3 �,���� i 3��y �' '�, � ���
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Mocksville� NC 27025 � ��valuat�c��Fo� �� 3t��` �vr��i33 ��
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Phone:336-753-6780 Fax:336-753-1680 ��"�° �"�' "��" "`� "'�� "' " """ � ' '
Permit Valid Until: 05/O1/2019
This release in no way expresses or implies that the existing subsurface sewage treatment
and disposal system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? �Yes �No
Applicant/Legal Reps. Signature: *Date:
*Issued By: Nations, Robert *Date of Issue: 05/O1/2014
Authorized State Agent:
**Site Plan/Drawing attached.** Total Time:(HH:D4d)
OHand Drawing OImport Drawing xours Minutes
Activity Code:
' • . . rr . . - ' '
Davie County Health Departinent
�O�i 6ft� � Environmental Health Section ��� �, ,
4 (i�� . P.O. Box 848 �;- '�
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� .}�`,�;, � 210 Hospital Street ��� �$
p� ,� : Courier# : 09-40-06 , ��;: : ,
Mocksville, NC 27028
Phone:(336)-753-6780 Fax:(336)-753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: �('�� l`O C�2 r S (�o nS-���e.`}.d n ..��- Phone Number 33�0 �1 7 L{�q 7 (Home)
MailingAddress: �ZS Gr�-F{��-�I1 I�q (Work)
J�vcnc,e NC Z�oo c� Email Address: bi r�r'aa�r.S �_T c�-�p �, n�e�
Detailed Directions To Site: 7wn Le� on Ka.n�oc�� KC! O�� I�ed�Gnd /�d Go
��� f r�► �� �n �-� in Fi'cn-� Q� C�i�rc.�.
1'f�-0�o -0 0 -0`��
Properiy Address; /QCj 3 a�r aul 1/Gn c¢ �l'l�� LZoOG
;5 O�C.
Please Fill In The Following Information About The EXISTING Facility:
Name System Installed Under• tf' /Yl�( � Type Of Facility: f�I[�vsc ��e�lvoN� /-�4d`� •ah
Date System Installed(Month/Date/Year): 02 Number Of Bedrooms: Z Number Of People:�_
Is The Facility G�rrently Vacant? Yes � If Yes,For How Long?
� Any Known Problems? Yes No If Yes,Explain: � �
Please Fill In The Following Information About The NEW Facility: , ?
Type Of Facility: �2c�r0 oM t�Qa�-�i ol� Number Of Bedrooms: 2 � Number of People Z
Pool Size: Garage Size: Other:
Requested By: ��� Date Requested: �/�
(Signature)
For Environmental Health Office Use Only�
Appr ved Disapproved - - -__.._
, � d�d7 �
Comments: �/.�'1��? �S�� G�' �O H/ O/
� y � s s y<� . .
� Environmental Health Specialist Date: �.--�''�
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
� (extended or limited)that the on-site wastewater system will function properly for any given period of time.
Payment: Cash Chec Money Order # Amount:$�b�, (} Date:
Paid By: . O Received By: �I�NJ-� y
Account#: ��7 d� Invoice#: ����D _
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S Printed:Apr 16, 2014
All data is provided as is without warranry or guarantee of any kind either expressed or implied including but not limited to the implied warrantie
of inerchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie,North
Carolina,its agents,consultants,contrectors or employees from any and all ciaims or causes of action due to or arising out of the use or inabili
to use the GIS data provided by this website.
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�� ' � WARRANTY DEED-Fm�e WDd01 trinted�ad for uk►y 1�n Mitliama h Co.,t�c..Yadk6i�0te.N.C, '
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. . .STATE OF NORTH CAROLINA, DAYIE ��ty, '
. . THIS DEED,Madethu�iLdarof�. A�LSI ' ,19�.Q.�bymdbetwa��([lliam '�. Stttllh and wlf�
� • . _�_.r�e-88.SL�.e_�t� ol- Davie Co�.q
� a�datattu(NorthCuolina,hercinaftersalkdC:raator,and_�e.Vflfl R8Y Parrlsh 817f� W1EQ. .18flCt �`,p.AI'Y��h_,
. � _�.�._ of navie Cwnry,odsuuorNonhcudws,AerelnaRee
� c+ikd Cr�nteq whuse pennanent nwilin`addren is
• . WITNESSE7N:71�a�thcCronmr,turanJinsMuidrncioeof�hesumof##{�bb�k#############* ',�###*##*###**###��� �
^ � and.iohrr sood aod wlua�k eandd.taeiw�r a him in h,ad paW b}�tbe(:nmer.d�c reeript w6neof b hersb��e4�arled{td.ha�{iven,aaated.bar{aNed.wW
anJ cm�veyad,and by thew pr.a.nts d�xs Rire,arant,b+r�h�,�rll,convty�ad wnfuro unW lhe Gnntes,hu ht'v�andlw weto�wts�nd wl�nt,premi�n w
• .,..__....__...FAL�11.�.RYxRJL�_.Tuwnship,�.�D.d�/IC Couniy.NwthCaroliaa,dexribeda�fdlow�:
:i � TRACT Ia�.BECINNING at a ■tone tha Northeait eorrtar ot the withie de�cribed ,
. •• tract Northwoet mrner of Johnny G. York (Deed Book 88, page 405) te the ICne
�� � of Douglas Grubb (daed book 93. page 92) old Northeast corner o[ Willism D. . .
� ; .. Smith (Deed Book 54, page 5161; thenee with the York line South 06 degstes •
; � 55 mtautes 23 eecoade Weet 427.32 feet to ao axle; thence South 07 degrees ��
�� 00 minutes 41 eeconde West 507.35 feet with the ltne o[ Wtlltam E. Plowman
� � (Deed Hook 56, page 144) to an Iroe pie the Southeast corner o[ satd•trac! tn ,�
�• the Northern line of Lynn Parrtah (Deed Book 88, page 413); thence North 87
' degrees 51 minute� 33 seco.nds West 213.04 teet to a� Iron pin: the Southwest
� � eorner of said tract; thance North 06 degroee 59 minutes 15 �econd� �ast � .
� ; �936..53 feet to se iron ptn the Northwes! eornar o[ ratd tract; thenee South
� $7 degreea 21 minutea 42 secands East 212.89 feet to POINT. AND FLACE OF
� � � � BEGINNING containing 4.56 acres ae survoyed by Francls 8. �Greeee datad •
� � 4/4/80.
'..} . � For reterenca aee Deed Book 54, page 516.
�� . � I • _ • TRACT II: BEGINNING at ae iron pte the 3outhwest corner o[ the within �
� •�' �� �' deecribed tract Northwest coreer ot Lynn Rayparci� Deed Book 88. page
413 ln the Eaetern Y[ght ot way margin of SR 1444; thertce from khe SEGINNING , .
� North 54 degrees 36 m[nuta� 23 seconde East 204.62 feet to an tron pt�: thence •
�� with the �line o[ Lynn Ray Parr[sh (Deed Book 88, page 413) South�05 degreas
25 minutea 35 eeconds East 127:11 feet to ao lron pin; thenee North 8? dagree■
'25 minutes 42 se�onda Weet 179 feet to POINT AND PLACE OF BEGINNING
Icontaieieg 0.25 acre ae ehowa on a plat by Frac►cte B. Greeoe dated 4/4/80. .
� �For re[erence �ea Deed Book 54, page 516. ,
,� , . Tht above laod wu conveyed to Gnntor Fy .See Book No. ,taRe .
TO HAYE AND TU HOlO The pAove dc.cribcd ptrmimt.witb�1)the appurtenancss�enamo Aelon�LK.o�M aq+Me sppctuinitq�unto tM CnMee.6k ,
heMt ndlur wcceswrs and aai�ns for.wrr.
� Aud tht Gnntor cuvenant��h�t ha is teized u(pN pttmifet in kr,snd ha�t6e��'ht�o conver tht wnt ia Rt dmyle;that uid premiva arr fne Gom eo-
. eumbrance�(aritL tIk excrp�iom�bovv sa[.d.It anYl:nnd�hat he wIU wa r ra n i an�dekad�he wid tHk�o tAe uma api�w the lawful etaima of all penon+
. whomwcrer.
�;( .. . �Wl�en rc(.reoc.is nude tn[6e Gryn�oe or Gnntce.�he dn�y�y sha11 fncluds the plural�nJ�be mucul{ne�h�ll intlude the kminine or the neuur.
•IN WI7NfSS WHE0.EUF,T�e Grantor hai hrreuntu�ct��Is hand r��eal.U�e dar�d yeu�tt�bove rrit tn, r
_� (SEAI) � _ (SEAL) .
' .� (S6AL► . (SEAL)
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STATB OF�N(Nl� GR(Stl,t� ��� COUNTY.
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. • 1,=.al1������iSr4�'.' _ �a N.�qry Pubtic of uid Counry.do henbr catifr that . • .
',� : ���I�2+_D��JyLLtrLan�L*�ILo�E�.�L� yrnith • .
Gniitay prfs+nad/lP�u��efnn uV�L'u day�nd�cknowlcdged the e.ccutiun o[d�e fureruln/{dsed. ..'.��
wknn+my b�d and n�uv' Lihi�dis _�t_daY of�t ./ % 19�0.
_�� . My Commb�foiv�spGtM"� �2I--19�/--- --�+� � - --- �__Le'F��I.(SEAL1 �
.:� =_�—=rr:c.:.i+r!1� ----------— -- - -'— - — �'.
SfATE UF Ni7RTH CA1i LInA.�� �_ � � �
�� -� �' -- ---� , .}1QRTFtC��'OE�J �•aid County,do 6ersby cer�ifr�hat 1 .
f
. . Crantor.p.rwna�lr appr�rrd befurc me thi.d�y and�cknowled�ad� � �,t... k ��i '�Ax td. �
.�� � _
Witneu iny hand and nuarial xd.this qw..__. �(..;e%�: .19—.
�' __�__._.. S 1 O.Ofl
My Cwnmiuiw�E�pYe�: __ _ ,N.T.(SEALJ
� ' S7ATE OF NOltTH CAR<)LINA,_.�_��F' +� _tWNTY,` �
.Tl�e(ore{uM�eettifinu(�of_—��dDO�s- �r��•�tt3L]L��l�.j L�' O��L�tV3a mL�nlv f
. L(adq«rdfird tu be cuncct.�Thu inu.tuinrn�wa�praented for rr6utration thu22� day of�rii .1 q 80. �$
� . ,' ,. at Z tls_1�/,P.M.,aod duly recwded in the o(fice o(the 0.r6b[n o(Ikcds o( � � Counqr, 1 •
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r�.,«h ca��r��.u�nW►.l.],4—.r��_699 • � . � f
7L4 the_22�day o(__.�r... —.A.D..19 8� i
• M._ , J. K. Snit2t ey_..��l�'� • i
. � �Rrp�tyurikoa� � w»bwe.pepu�rRe�hmrurl�� .
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ThfiDeeddrawnEy_HL'.11r.yt_P..�1Cdn HQ�� II. _Mart(n E� Van �j�Y�_Atternn�va.+ Mnej�vllle_ N_C_ �
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: . � HEALTH DEPARTMENT RELEASE �� �F�r nff��P ��P ��,�,�'3���,�� �
?+",�+._.. ��f �'d,n � f �'y y y F ��. y �m��' 3 �' .
� *CDP Fi1e Numbe�,`1 3 M '
. ��1 .�, Davie County Health Department ''_ ��' ��Q �� ��`��'��'��' ���'�'
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Environmental Health Section �p�tY � N����' E J
• R�".S.S � j F ��}�js � .,ff6I3`R' 3n2�Z
210 Hospital Street ; �Q, , ,. � � � g �� �� £
�< Mocksville, NC 27028 ,� 3 yEvaltxxt�ti'�,�'a� � �� � ��� ��s���, ;'��
` �{�R�1�1���'i _ �..�,3,Y3�� ,,,,,�Z���, ',,;'
Phone:336-753-6780 Fax:336-753-1680 �' � ' "'' °
Permit Valid Until: 05/O1/2019
Applicant: Brad Rogers Property Owner: Lynn and Janet Parrish
Address: 125 Griffith Road Address: 1093 Rainbow Rd
City: Advacne City: Advance
State/Zip: NC / 27006 State/Zip: NC / 27006
Phone #: (336) 817-4197 Phone #•
Pronertv Location t Site Information
Address: 1093 Rainbow Road Subdivision: Phase: Lot:
Road#: Advance NC 27006 Township:
*Structure: S2NGLE FAMILY
# of Bedrooms: 2 # of People: Directions:Hwy 158 turn left on Rainbow Rd. off
of Redland Road got approx. 1/2 mile on right in
front of church.
*Water Supply: N/A Type of business:
Basement: � Yes ❑X No Total sq. Footage: No. Of Employees:
*Proposed Improvement: Bedroom addition
*Release Conditions: Maintain 5 foot setback to any portion of the septic system
**Site Plan/Drawing attached.** Total Time:(HH:bIId)
OHand Drawing OImport Drawing xours Minutes
Activity Code:
. , . .
HEALTH DEPARTMENT RELEASE , �f��r,r�«+���� �Y��:������3 � �� � f ,�
����- ;� +�cn���',�'��������s , ����y,� ''
D� '�Jtit� Ot�° t��� � �'�� f ��i,�
�� � Davie County Health Department �'���„ � � � j,�, ; v� ,�
3 }� p�r � r 1�1 �
Environmental Health Section � �,�����,��"������ u ',,3 h� ,
�'��' � 210 Hos ital Street �" "����� ti` ° '' ��`� ''
p � �� �s,� _ � �� ��d ° .
� F Mocksville NC 27028 t , ���.�'��+��'�`°� 3f�� 5 ,a���'€'
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��.. �'f��r��� : f 33f1��Sil'j•S �� A '5r' ,
Phone:336-753-6780 FaxE336-753-1680 � "" �' �'� a '""�' , '�
Permit Valid Until: 05/O1/2019
This release in no way expresses or implies that the existing subsurface sewage treatment
and disposal system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? �Yes �No
Applicant/Legal Reps. Signature: *Date:
*Issued By: Nations, Robert *Date of Issue: 05/O1/2014
Authorized State Agent: +
**Site Plan/Drawing attached.** Total T�me:cAg:�>
OHand Drawing OImport Drawing xours Minutes
Activity Code: