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205 Raintree Road Lot 13 �avie County, NC . Tax Parcel Report a�� Monday, October 3, 201 E � 5 'S � • 11 �! S i �4 � �� , � -r--�_ �l5 f� , j�"'� r 4' �' � �~`' ___ y5 / 5` 1 �r � �5 �'f �� r,� , ��r � �•••�„� 55 —.sr ��5 I{,,— �, � I� 1'31 �I 203- --�, _ rt. � } �.r�r �7�5 "-'-^-�� ti � f rrl �'' �'+ f � r "-�-�.�,..,�-.,..� f :,.�' fi r �_f��j�,��`�� l r'' lfi �� r ��.._ �,,! ~-'-^-t�—�—�---.,,,` r' ��, 4 I1+r ``_ r-„' ;� ` r;. ` i ,� f '~.� j,;. _......_.....................- r±..............-- ..__...__.._........._....................�......................................... ...-� L.__................................................................................................._...._._.._.. ...........-- - .........................._....._._ --... WARNING: THIS IS NOT A SURVEY ��_,__,.� ._. ,. _ti�_ �,oFw.,9o„ ,..,. __ _, __. _ __ _._ _---__.. �._� , �..�,,�M�,� v_rom�,_ ,�.r__�__ .� _ e �.�,� . _, �.��m, __ ��, �:,:� � ,. ,,,�� _Parcel Information � � Parcel Number: E8020A0013 Township: Farmington NCPIN Number: 5871776615 Municipality: BERMUDA RUN Account Number: 8303951 Census Tract: 37059-803 Listed Owner 1: RADCLIFFE KURT " Voting Precinct: HILLSDALE Mailing Address 1: 205 RAINTREE ROAD Planning Jurisdiction: BERMUDA RUN City: ADVANCE Zoning Class: BERMUDA RUN,DAVIE COUNTY R-20,CR State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006 Voluntary Ag. District: No Legal Description: LOT 13 RAINTREE ESTATES SECTION ONE Fire Response District: ADVANCE Assessed Acreage: 1.01 Elementary School Zone: SHADY GROVE Deed Date: 8/2014 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 009650081 Soil Types: GnC2,GaD,ChA Plat Book: 0005 Flood Zone: Plat Page: 029 Watershed Overlay: BERMUDA RUN,DAVIE COUNTY Building Value: 168150.00 Outbuilding&Extra 25630.00 Freatures Value: Land Value: 38000.00 Total Market Value: 231780.00 Total Assessed Value: 231780.00 ��i All data Is provided as Is without warrenty or guarentee of any kind either expressed or implied including but not limited to the 9�"'6� Davie County� implied warranties of inerchantabitlty or fitness for a particular use.All users of Davie County's GIS webslte shall hold harmless the �Tr County of Davie,North Carolina,its agents,consuttants,contractors or employees from any and aii claims or causes of action due to �OUN�t� 1�l., or arising out of the use or Inability to use the GIS data provided by thls website. � • , Davie County Health Depa.rtment ��,4�ie I;y�.��';� Environmental Health Sectioil " � �,. , . : A� �t . `� ; P.O. Box 848 � �_ : `" ' ,� � 210 Hos ilal Strect � C? .. � ;; �' d�4� Q.' • "�` ;` Courier# : 09-40-06 � . U'��; . '" Mocksville, NC 27028 Phone:(336)-753-G780 Fa�:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: �V M1 1 11�1�GL��i V PhoneNumber \g�g) Z�� 2�`��(Home) Mailing Address: ��2. �Lc I�)M�J.�S F-y t�25� (Work) GI�M 14or.��Z-�012 Detailed Directions To Site: � '�`J� �{�j� R l�H T �N �d� 5�v�1-� _ l_�F� c� N �R�r�1QE� R.� P�f �=Na fl� (3t.�aGx �� 7 Property Address: ?�Q 5 ��')NT �i � �� , Z,�� Please Fill ln The Following Information About The EXISTINC Facility: , Name System Installed Under: � ��1`� ��1�'� J G��` �� Type Of Facility: ��.� Date System[nstalled(Month/Date/Year): IZ I9 I�°XI Number Of Bedrooms:_�Number Of People:_� Is The Facility Currently Vacant? Yes � 1f Yes,For How Long? Any Known Problems? Yes � If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Number Of Bedrooms: Number of People Pool Size: Garage Size: ,�1` Other. Requested By_��Gp�,�,�. ��y��f,1.?._ Date Requested: 9��/��p (Signature) � For Environmental Health Office Use Only Approved Disapproved �..�Comments: �� ,j� �1� Il�U W! TYUr'IZ GC.�(._ l�C1Y'h �3� ,$ /�f7�G cSl/Sfff�'!. Environmental Health Specialist ~ Date: 9—/2 —�(,� *The signing of this form by the Environmental H th 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 Check Money Order # Amount:$ Date: Paid By: Received By: Account#: �� 0 Invoice#: � DAVIE COUPITY HEALTH DEpARTMENT � IMPROVEMEN'TS PERMIT AND CERTIFICA7E OF CUMPLETIOPI � � ssued 4�t Complfance w�th G.S,of NoRh Caroil.�a Chapier 130--Article 13c, ;�� Permif Number �� Randy Sisell Date � ^ `+-�� i1�° 2519 � �+ �tia� d„ �0 � �; . a06 � ��k �� a��g �� Subdivision�iame Rain'i'ree Es�ates Lot No. �� Sec,or Block No. ? Lot Slze House Mobile fiome Bust.�ess Speculation `.a �, No.6edrooms No.6aths No.En Famtly . Garbage Dlsposal YES Q NO ❑ Specifications for System: Y Auto Dish Washer YES p NO ❑� : Auto Wash Machine YES ❑ NO �j ' 7ype V'Jafer 5uppty . 'This permii Void if sewage system described betow fs not lnstaited within 36 months from date oE issue. ` ThS.s is an experminate7. se�tags eystem� ta bs designed hy aurnars Eng. Specs for sewage system provided hy Plr. Steve Steinbecki State SoiI. SpeciaSist. : y - . Ftn'Cse 5:.��eti �l��r.e�� r,y�'�Ny� /��+�1'��-�Yt,�..' '».SI�.Uu(?t',.� n ��c�.:P y�OrX!� �2,,�'➢�t�, . ��Y3o` �a�.�..w.i.�. �rMSY �N FP`1.�""� �� ' 5et 5�+c a� cNtrF-`c.V. ��S�� . ' . � + j ' ��. LM ��9�� . � . „_ : . � _ �^_ _a - - r�"'�`�� ;: � w . .. 3 ,. .. � . e . . . _ �_� � — -�— . . _.... . _. ... . .. ., _V — . ' �..��+'`''�"�' �f lmprovemer�ts permit by�•• �T ' �� •Contact a reptesen;ative of the Davie Counry tie�lth Oepartmettt for tinal finspectEon ot thEs system between 8:30- s�� 9;30 A.M. or 1:00-1:30 P.M. on day of completion. Te�ephone Number:7o4-s34-5985. F� �� Finat lastalla,fott DEagram: System Instatled�by�� -�t• l !_� '•' ,` • . �: �� _ . . �2 , �� • t;. w� . �� ;< !► ;a . �� . �.° • 1;: �'�; i�. ' CertiNcats of Completlon �� Date .�`<<-'f r ' •The slgntng of ihis ce�iifleate shaq indteate that the s,�stem described above has been EnstaUed Sn complia�ce with tfze stattdards set torth In the above regulation,but shali En NO way be taken as a guarantee 2hatlhe system w�tl functiott, satlsfactorkty for any given period of time. ?,�r� :, • • DAVIE COUNTY HEALTH DEPARTMENT S p.ti,,,� ` � , � IMPROVEMENTS PERMiT ANQ CF�TIFICATE OF COMPLETIO 'NOTE:Issued En Compiiance With Article I I of G.S.Chapter130a �D�'�1�'��,�,..P �Bo�S �s Sanitary Sewage Systems _ POrfniE Number '� . .; n t � Name 4... �� L'�oc� �.>�'C� �� 1�4��— Date � "�`�' ju Np C1�iCR.c� '?f Loca;ion , "� � � � '?.�.�Ea \�.Q.s� �G.��e,"t e� �av 0.taL ¢ , Fa�.. �•�?��:b ; .` t +�;�i.,�. � �� _ �,u�s [.,t ,.:�, \',...�.�-�.,,;. �: �."�4 �� ;. .�.,�.� ��Ai�� , � SubdivisEon iJame �At r�� =�.�� Lot NQ.__—��____Sec,ar Block No. " �� Lot Size House�Mobile Home Buslness Speculation �� t vo.Be drooms 3 No.Ba t bs No,in Fam i ly �� Garbage Disposal YES ❑ NO ❑ Specifications fo; System: �� Auto Dish WasEie,� YES ❑ NO p ` �'�' L'•'� i t Acrto Nlash Machine"``o S ❑ + NO Q • , � o U x ,� �( � t.�» �T� �� Type Water Supply � � 'Thls parmit Votd tf sewage system desb'bed below is not installe wit�n�j rs fr m�te of issue. This permit is subjact to revocation it st� la s,9,yxty„ niended us c� �Q� � � � � ��r�...o��.� �► . � , :. • iJ�J' 1, � f" ^— . ., , ...�.�..r-r` � +J t„`• . . - ' �(� ' 1 C� i1 J 't. . .. . s , �..�i � . � j'�-_._.-�.�� j � �f( ; j..+ ; . ... . .. � ;{ �, . � Improvements peCmit by'_ `'+_� n�'`,_�n ��i��w�9 "Contact a representa;ive of the Davie County Health OepaRment fo; Fnal tnspac�Jon of thls system between 8:30- . ;4 9:30 A.M. or 1;Op-1:30 P.M. on day�of completion. Telephone Number:704-634-5985. �. { Finai installation Diagcam: System instailed by . p :� �-J: " " • �� `;; . �.�� c> � 'y f V . . �F � • :: . , �i !� CeRiEfcata of Compteiiori �� Date � � - 'The sEgning of th4s certi�cate shafi indicate that Iha system described above has besn instalied in comptianca with tFtie standards set forth in the above regulatton,but shall in NO way be taken as a guara�tee that ihe system wi�!iur,ction • satisfactori:y for any given period of time. . ,; . . '� ;�} � � . � ` � �{) 1J •.. . ..�.,�__�_�___..........__.___._..........�_._ . � _.... .. , ; 2�� 1�� - � ,.,� _1,�� X �N `,` � ` ��3 GA2pG� ��17�o.t� �''.., � __ .� rr-�--_ f ..... ..,.. � -_- __ �, ,, ; _..�_ �� + + ...__ _� ; --,� � __ �,,;� � r; � ..��_ f� �, � � ��.Ov I "� r f,,� i r' �� _" --_.. � ; c�, ��` � � ' �a � 1r �� .�21'�1� �t' � �G � ��.7�� `�'� 'a`'�' .,��1�1 � � 2U.3 ��' r? �� ..� �r �� . � ! � �F` ;- - ,.�; E � i ; �+ .�cC�S . : ; � � �r� .�s �.s �,� , 3�� _ .+ . � � r�f _ --�' `� � " ` ; : , , , . . , ; ; �R �'� _ , _� , ._ 7�� a � - _� ; - _. . _ --v_ -- _..�_t � �_ �Q - ,='�-._.�a ,�,,,.,,-�- ��;; ,.- _ _ � -�- . Ict+�� .. �_ �� , _ . f,� -- ....._`.. : � `�Y� Sr P'��G � , : ; , F }� � ; = N ` ' �c� �� _�_ : z: . T � . ...�. ,-,.� . .--�...._ _..__. .. ��.�.�- 1�- �..._ . �___�__ , ;, ..,.�.�.,r.,__, , r __._._.....__ _�... : ��, r .y ` �(}L� �.�, J�'�,�� '� %� :' r` ,...l1_,_,.._�-''�� ..Y ��i: :`f, 3� �� , i� ,rj t �": < <,J � '� ,�'� �1�C� ': 1 t �- ,;r ' ``�, .._ _f , j, `�1�1 �r,' �: �. ��` 3�� , �f ' 32� � . ��- ; : r ( , J rn . ?,' ` h��r"��r ff� r' ` j L�� _,,.iff�'r~�� , ,�,:_____.,_,_._ I` �.°.�-�'` % ,' --' � ..-�"`-- 1� . �� nIH]D,� f �` � � r �� , t� �o�� s Printed:Jun 18, 2014 Ail data is provided as is without warranty or guarantee of any ktnd either expressed or implied including but not Ifmited to the imptied warranties of inerchantability or titness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina,its agents,consultants,contractors or employees from any and all clafms or causes oi action due to or arising out of the use or i�ability to use the GIS data provided by this website. , � 1l :0� �; - -��. p_;, - - DAVIE COUNTY HEALTH DEPARTMENT �p , ��,,� � ` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETIO *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a � ��m � Sanitary Sewage Systems �� Permit Number Name L.. . �� ,�� t�� > �,c..', �•`�•;—` Date � � - 1^l ~j�� NO ��;� Location ^��"�i � ��•�w� ��Q.� �:'_ "'\{� �.� �c�`�i C.�.�; ,: , 1 a n �� t t'';I: --�— �~:�{,� � �� t-. �-J U'4=—��, 3 3 ,^',:.� �,«-,�, =� t.,�;��t 1' - "`. ,r j � �l� oT-c1 .':k. . Subdivision Name �P� r��:�-� �=' ��Cc'.�e= Lot No. L--?._ Sec. or Block No. Lot Size House _�.- Mobile Home _ Business __ Speculation No. Bedrooms � Na Baths No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: '�_� _ �=?,�,� Auto Dish Wash�r,� YES p NO ❑ ` � � Auto Wash Machine "'`�Y.�S ❑ NO ❑ � O U �j; �,� , r �ti `� � `-f �-1.:�G� Type Water Supply '�..,'�'�-�� --- ',, _--__.�_____.__._____.. 'This permit Void if sewage system desc�bed below is not installec�within�5 years from date of issue. This permit is subject to revocation if si�e��lans�Qr the,,intended use change: ��-�- �h� l...t � �� i �'u�� ' U r S � -� t�_------- � � I,�U� L'.l 2" � _.____�.._��--..---__ :�� .. ('` �, �J �I � J �> �._ - �------- �_ < r-� � :; .ti �,� Improvements permit by�� 1 ^, .'-� * ` � �'A~u:3 "Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by � �p Pi1'�� Certificate of Completion �� Date l �� "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. ....... _ . �.. , �., . !} :U� a, ' DAVIE COUNTY HEALTH DEPARTMENT <;Yt; . .,�, ;, :�. ..- �.,.-.�- . �t '"'' ti � IMPROVEMENTS PERMIT AND CERTIFICATE OF,�COMPLETION ' *N TE• 'n m lian Wi hA ti I II f . . ha �� '!�'j ��C� ` \ �rc'� �`�� r O .Issued i Co p ce t r c e o G S C pter 130a � C.1 i yt ! Sanitary Sewage Systems Permit Number . Name � .',� ' '' `� -� !''�- ' _ Date � � �"% N� ��,�,L - �_� �--t-, ,� _ � � ; $, Location '�, `� �' , ^�__`\ t,�_ � �,�. ', � . . ;, ; ; . .. , � _�t Sl � �- � {• , i -, � -_.� �...._� .;�_ . t.. , "' , .,.. . — _ , � , . , , . . ... ;� .: ,'� � �.. ' — — ---- l � Subdivision Name `�C{� ��'��' �- 1�= `� '��-=� Lot No. � -� Sec. or Block No. Lot Size House �� Mobile Home _ Business _— Speculation } No. Bedrooms -� No. Baths No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: � - ., . `�,- Auto Dish Washer YES ❑ NO ❑ � " '�� Auto Wash Machine ��YES ❑ NO ❑ _ ;! `- � �:' ,�� ,; � `, �_i `' :. _ �• � � ;�-_ �ype Water Supply �...,�.! . . --- , •, _�__-__. _ .. . � , 'This permit Void if sewage system described below is not installed;within 5��years from d�ate of issue. This permit is subject to revocation if siteA�lans�or,the intended use change. � `�� ' , _ ,,', � - : _ __._.___� r � � � � � � ��.� � � �. , �-- ) � }-� _ _�, � -- f_,_._,_._._.��__..___....._ .__. L j � -; � c.) , _—._�._.___.__._.._ __._._._.....-� �, . Improvements permit by ` `��`�`-' 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30-P.M, on day of completion. Telephone Number: 704-634-5985. � ,.�� 'Af �✓) �i . Final Installation Diagram: System Installed by ��%%�"k''- �`�%� �� ',�, t � �t {,,_�'i; ; l '� ( ��> . .� , _ *�� , Certificate of Completion �� Date �,,��f''�� "The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. _. ,. `• .`� �`l .�ea.bd�-. ��ov--- �� TZ�'-- �e c�� =-i�D /1,�c��'�%� /y�/�'/� i B ;�� - - - ------- -----.{A � �n0�� a / �'1�a � . WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT ` NP.ME C' ��G'��`S�D�� PHONE NUMBER ��a �� ADDRESS �� e`� ��e-S SUBDIVISION NAME �-�'��- � ��1✓. . /✓C .��od 6 • � --�'=�� ' � SUBDIVISION LOT# 1 `� �iv� � ��' �yt � �,f' �u/ �� Sa� . � DIRECTIONS TO SITE , �'� — � �- --- -- --- � DATE SYSTEM INSTALLED � eQ � � � �-'- �� NAME SYSTEM INSTALLED UNDER � �^ ��`��N � SPECIFY PROBLEMS OCCURR NG /�� /�'N�S �d0� Lt��ut�d�. �D�/✓�� c7��- . DATE REQUESTED �� ' 9d INFORMATION TAKEN BY �� DAVIE CO�UNTY' HEALTH DEPARTMENT ` . � �•- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name =� �'� Date � �f :'� i��` � �� Location �� -�� _ _ Subdivision Name ;�;ais'T:�'=�.: n'�'�=;'.:` Lot No. _ _ `s`- Sec. or Block No. Lot Size House Mobile Home _ Business _— Speculation No. Bedrooms __ No. Baths — ,_. No. in Family J Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO � Auto Wash Machine YES.❑ NO �0 Type Water Supply __— "This permit Void if sewage system described below is not installed within 36 months from date of issue. I�1.L'.a �.,ti x �� -s�''lE:.�� ..�i.�..:� �_ �"� � �'' }� i.,��a ...s�.,", r.�. t� . t ;� ��- J �*',',` ' � i6 � , �t� � r.�;,A ':,'C: ;� :.� 1,, . �. r3 s i �t+°,:,�u:iE: S�SGE:�, ! ..`.#"1::;� �t. taEf yi�'♦ �r��1��fi �il,�.,:,.,yt ..s��p .,�_ �3 . __ .. ,.a. .. ._. ,. ' : . J �t. L�. ,.;�b� :,.� . ,�. . � ,. � ..6.. , .,�� 1°: .. � � ' ; . ' ., .�. !t � , �� .ir ,, c—_ � _.. N,,.,-....�--j i; � • _ °� . H } �,'' ��....� � � �_. � �g � e" � . < . ' f; �, , ��y�+f� . . � . ?V u>!t-.E'-a�+.' . 8 .. _�.,.,_._._....it.g...' . ,, � ) t� � ,y:. y �•r� �� ( .. R� fy-�;�' i g� �'f � r �g: ' x .� . . .. � 6 f �, �] 1'�vk•5`. . � _ . . � �t� ;_..� ) , . .. - 'ti ' � �� . ' '� e � Improvements permit by� .,—�a-� �i4� �� _ ` i�: ,: '`Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by�rnG�,�- C�Y� � - _ , , , Certificate of Completion 'M�� Date ��f Z"�� #The signing of this certificate shall indicate that the system descri6ed above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. . . . . ..... . .. .. . ..... ._. ..,.,._.. .. ........ .......... . .-.,..5� ` � � DAVIE CO�UNTY' HEALTH DEPARTMENT " �P. ��-• IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION , , *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article�l3c. Permit Number Name ��r�;ie� Si�sQ2.l _ Date � " �� '., � `. �`.f�� Location Qn� n,a«�,�A�, � �I Subdivision Name Rain7res E�taiCas Lot No. Z 3 Sec. or Block No. Lot Size House _ Mobile Home _ Business Speculation � No. Bedrooms _ No. Baths _ No. in Family Garbage Disposal YES 0 NO ❑ � Specifications for System: , Auto Dish Washer YES ❑ NO � '! Auto Wash Machine YES.❑ NO �� . �; Type Water Supply _ ___ '`This permit Void if sewage system described below is not installed within 36 months from date of issue. r . � This is an �x�€rt�inetel sd2+�age syst��n� t4 b� dessic�nacl 6y c��ners Enc�. S�ecs far l' sewage syat�m p�avid�v by t�l�. Steve St��nbeck? 5tatt� Soi�. 8p�cial3,s�. ;i � � � � „�,1,. e��1,tC J,��r... �.1„•.,,� �" �°`' � /�t Ij1. a�� .. r� ,� , �x ��t 0 ;,'i,�a�r.,�`Tt�-: •f.,. �.� y C�rP�'� ?�C fi`� `.r� ,�d. � r �� ': +-'�x jr�� ,7a r„� ��x� - ',`�1lSt �p. tac, y,ti.t.. � . . � �. r �; �,e .�� u�, ��<�.it� . J !� ; t.,�' S J � �� ' i - �' �s�`�'F� � , ;; .,. ,. .. . � „ . l�r _ a _ _ �_ . _ �a�,C,� ,� � . � _ . �. . _ . q _ A _ � _ `' . , _ _ �� , � . �,�c..��,�.� �t �r,.:.' e.,, ,�-<1. Improvements permit by�.�1�w.�.�j_g �``� ii � l "Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- '� 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by��.� L4� _ .__ � - � � G'°� - . . , , . .. �� . � . � ' � � Certificate of Completion •�� Date ��f 2-�� _ 'The signing of this certificate shall indicate that the system descri6ed above has been installed in compliance with � the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function ' satisfactorily for any given period of time. �._ . , : � . — - :;�. ° -,...�:�s....�.,�a.;�.e....�,�:.:�,, .�.._.:.� .-m.:,�.�,e.g.::._:.W.,�._ .--r.., �,.,_...� �.:..,�...._.�_.._,. . . . Fe_ -- .�.,.,.._, ...�m.� ... . . DAVIE COUNTY' HEALTH DEPARTMENT � IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name Randy Sisell Date � ' y'�� 2519 Location 801 Advance _ Subdivision Name RainTree Estates Lot No. �3 Sec. or Block No. Lot Size House Mobile Home _ Business __ Speculation No. Bedrooms _ No. Baths No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO �� Type Water Supply __— 'This permit Void if sewage system described below is not installed within 36 months from date of issue. This is an experminatel sewage system� to be designed by ownQrs Eng. Specs for sewage system provided by h1r. Steve Steinbeck� State 5oi1 Specialist. ��nZ.eC s;�s,�[., ��•� (,`N"S � �Zj�Nc� �,�'' �� • f X j,�, �.I 5 iy �. �►��i��G �,� � v' �«Q - �� t:�' },r ��x 3�' �a�.� cx.,..�.:z_ ��a5� �y��f, �fl��'�r� �� t K.7 T'k.[1.� E�`�$l.�►:�L : � �,�� u '� � V✓ y1, \ :U e�s'.4 /�V _ _ 1 t� _ _'_ _� _ _ tv+�`^'��`v _ _ � - 3 - -- � o _ _ _ `k_ - - - _ _ _ _ � - - 6_ _ �� Improvements permit by ��*� �°' ;�„�, ,+��- "Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by �� -i—�� !!✓ �� Certificate of Completion � ��"`� Date ��`/L�� ' i in f hi ertificate sha�l indicate that the s stem described above has been installed in com liance with The s gn g o t s c y p the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DEcD BGOY_.I_I„�� I�GE� . � STATE c)r NORTH CAROLINA ) ) SEPTIC TANI� AGREEMENT COUNTY OF DAVIE ) T�� undersioned , R. F . SISELL and wife , SHARON T . SISELL, owner o� Property located at Lot 13 , Raintree Estates , Section l, Rainrree Road ("the site") , and described in instrument as recorded in Book 111 , page 699 , Davie Public Registry , hereby acknowl?dges that they applied tc . the Department of Health , Davie GPunty , for a permit to install a regular type septic tank sewage disposal system on the site ; the Depart�rent evaluated the sit? for suitability for such a system in accord with the regulat�ons promulgated by the North Carolina Commission for Health aervices as 10 NCAC l0A . 1900 et seq ; that the Department classif?-ed the site as unsuitable for a regular type septic tank sy�-tem; however , an appropriate permit was issued by the Department allowing a special type system to be installed. The - specifiC=ations and design of which is attached hereto as E�hibit "A" as �rescribed by the State of North Carolina and Department of Heal�h, Davie County . Th� undersigned further acknowledges that the construction .. and ins #�allation of such septic tank system is their responsibility� and tha� neither the Department nor its officials , employees , or agents ��arrant or guarantee that the said system installed pursuant to the j�ermit issued by the Department will function in a satisfactory manner �or any given 'period of time , or that, the Department , its officiajs , employees or agents assume any liability for damages , consequ?ntial or direct , which are caused, or which may be caused , by a ma� function of such system. Th? s document shall be placed on the public records of the Registei of Deeds of Davie County and indeaed therein under the Grantor Index in the name or names of the undersigned , and the foregoi��g acknowledgements shall henceforth be binding on all persons claiming any right , title or interest in the site�. An(� the undersigned further agrees for themseTves , their heirs and assigns , that they shall indemnify and hold harmless the Departm?nt and its successors , as well as Davie County , for any damages or other claims of any person or persons whatsoever arising out of the installation, operation , or failure , of said septic t-ank system. c Us� of the singular masculine pronoun forms herein shall be deemed �o also include the plural and feminine forms as the context may require . This the 27th day of February , 1981 . � / � /. � ��j' ' / •�.'�c�t,-C„� (SEAL) R. F . SISELL ,.��i<<.��-�- �. �i.��/ (S E A L) SHARON T . SISELL �:-�;;;:;;�;-�•�;:� NORTH CAROLINA - FORSYTH COUNTY I � P.oberta Lynn Blackwell (Clark) , a Notary Public for said County and State , do hereby certify that R. F . SISELL and wife , SHARON 'r . SISELL, each personally appeared before me this date and ack+iowledged the due execution of the foregoing instrument . Witness my hand and notarial seal or stamp , this the 27th day of �'ebruary , 1981 . G �i�I ' �' ti./,�..•/� I t(�-�'_�'1�-/�/1�/. �Y.�-1�i zr�icc�,:,� , , l-:.'c.�_ �i:� Nota�ry Public My commission expires : >M� OFFICIALSEAL '+'a�,n� Notary Public,North Carolinn �4'i'��` County of Forsyth S e p t emL_e r 2 8 , 19 81 ?��.:i��• Robert� Lynn Blackwell ,,,_;r My commissionexpiresSept.28,1961 �� '� Randy 5issel' DEED BOOK ��p.qGE l�� • • Raintrae Eutatou Lot �13 . r Lo�r Pre3�uro (i�odified� Sy�tem � , � ' f1ATERIaLs LIST ,�'�. QU15F�IT1( DESCRIPTION CG�I! 240 liRaar tt. 1�" PVC pipe (100p�i� ranifold&la�erals . � PVC FI7TINGS ' 18 1�" elbows 6 1�" tees 1 - 1�" threaded union 1 1�" g�te or globe �alve (bronze� 1 . 2"-12" reducer for pvmp .? 11" throaded cups 7 1�-T' throaded unions TRNKS 1 1000 oallon tuo(2) compar�ment tank � - 900 gallon tank for pump chamber � , well tile for pu„�p chac�bor accas� . (at least 6" ABOVE gradQ) PU�1P„CONTROLS�A�kRf� � - septic �ank effluent purp (f�yera SR4� �;�� u:- �-,GS` .� � � ' sat level controls approx. 8" � ttigh L�ator alarm systora (outdoor receptable with suitabla wire as requirad for 110 VOlt aBru3.Ce) � �THER fiATERIAIS 7 yards3 of fine waahad gravol (3/F3"—'f") 2 . - concrete blocks 1 .. 4" Bit � 3/16" Bit 4 ftancly Si,ael�� wrer � ftainTree Estates� Lot � 1:i THIS IS OiJLY A ROUGH URF.WING SHUWING THE TYPE UF Alt�rnative Sewage �ystem (Expdrimental) i Q � r I S�IL i-�L1,CEf�iENT THHT WILL BE REG1UIfiE� FOR SAIu SYSTEl�I. � � � � i UNUER I�!� CUf�DITIGf�S IS THIS DRAWING TU 6E COWSIUERED THE + � � � ��; If�1PR0VEl•�EwTs PERf��IT THHT f�lU5T BE ISSUE�. ? I i � �' � � ' i i g � � � JQ ` 30' -� After digging the area ' q �� out it is suggested that ' ' �o �� CUVER ��iATERIAL �he �ottom and side c� _ i� S 6" ua l ls be scraped very � �' �;a� IX ( ) GFtHUEL well. I � `�!,`" "o � Pipe � O � C� C-� Q O � ; � ; z �� SIX (6") GRAUEL ' � � � � ] �A � --- _ � o '° p �F" 4 4' �y , U _ � 3 ��I � I e y H ' � � q ' i a '� w j �, � y , � �i z � A . � � THREE (3) r"EET OF CDURSE SAND � � a' . . Q w � =' .� O � � a � ' N N � '� '� rl �,' �� .. a A p The bottom of the dug out : �� w ,� e H nust be level. I v o � . x _ \ . i � q � . W � 30� � a o i � ' a J i Afier the praliminary work has been completed, the area described above must be roped off , � i u � and all tratfic kept off tha area during consiruction o f t h e h o m e. � i � ,� A . � ' ~ ~ . hIATENIHLS TO BE U5ED IN FILL'AREA � � � •� � � ! � A a o H >, ... Three (3j feet of course sand , � � � � -� � N o One (1 ) foot of regular sewage disposal gravel W y � � � � . i ,� � , v ro w .��i � ., _ o Pipe would be placed in the gravel I A � , o � .;' ~'c� � wi�h 6" on the bottom and 'o" on top. � " a w� u: Cover material shall be a good clay loam soil � � a �� ,� � i ` ' � ° j " �, ' �? � � v � � I � , x � i � !ti1! � .« o " c . o f � � °Q Z I .� a w � o . � w w � DAVI� COU:ITY HEALTH DEPARTNiENT � , ENVZROiQ.+ISP7:'AL HI'�.LTH SECTIOI:J M1 � P.O. BOX 57 �� , MOCKSVILLE, P1.C. 27028 ��V � (704) 63�-5985 STATEP�Id'I' FOR SEPTIC TAtdK IP'�ROVEMEi2TS PE&�lITS AND/OR SITE EVI�LUATION5 NI�PYE ai�itdy 53.8�i.3. DA"1'E ADDRE3S Route '1 PERP9IT NO. 2519 ladvattco' i�!.C. 27QOG EXPLANATIOtd OF CF:ARGE Sai�/Si�d E.valuation �nd Trprav��ont� Peru�it E;:F��nintaJ. a�wagti �ispes�l �y�ten ft4�nTro: C�ta�eE La�: ,� 13 Al`�0[JfdT DtJ� ;"2q•d� S�ITARIAN �. 1'lan�a PLEASE REyIIT TFiE ABOS7E Ai';OU:VT OF REC�IPT OF THIS STATEMEI�TT. *NOTICE> Evalua�ion(s) can not ba corapl�ted unCil payment is received. Im�rovemants P�rmi�(s) can n�t b� issued until payment is received. � 4�'��. .�.-::� . � . � . . , . - �zi�itE C�u�tn#� �Ett1#� �9e�rttx#mEx�# ttn� �uxite �e�1#1� c�gezic� � P. O. BOX 57 �Hnchsbille, �Vnrtlt �arnlitcu 27II2K OFFICE OF THE DIRECTOR .�JU1�7 29� 1CJ8O . TELEPHONE � � 704/ 634•5985 � '1'0: Mr. Randy Siscll Raintree listates Rt. 1 Advance, N.C. 27006 From: Robert B. Hall, Jr. Sanitarian Ed Speas , Sanitarian Davie County Health Department P.O. Box 665 Mocksville, N.C. 27028 Re: Evaluation Request for a Conventional Ground Absorption Sewage Diposal System Date of Evaluation: July 25, 1980 Findinbs; Soil horinb ��1 : 7b��soi1, shallow (�1-6") brown in color; Subsoil shallow (2-3") l�rown plasti.c clay with mixed mincrology, saprolite encountered at 8-12", this is a brown saprolitic material with slight clay content. Soil boring #2: No topsoil, no subsoil, soil appears to have been removed from this portion of the lot. The saprolite in this area is brown with mixed minerology. Soil boring #3: Topsoil (8-12") brown in color and very silty, subsoil shallow (12-16")brown plastic clay soil ' with mixed minerology. Saprolite encountered at 18". The topography in the rear of Lot 13 makes it unsuitable. Given the above noted soil conditions on Lot 13 this lot is unsuitable for a conventional ground absorption sewage disposal system. At your request we will consult the State Soil Scientist, Steve Steinbeck, and the District 5anitarian D.Y. Mcl3rayer regarding this lot and possible sewage alternatives. cc: D.Y. McBrayer, District Sanitarian cc: Charlie Marshall North Central Regional Office Wildwood Farms 720 Coliseum Drive Rt. 5 Winston-Salem, N.C. 27106 Mocksville, N.C. 27028 cc: Steve Steinbeck, Soil Scientist Sanitary Branch � P.O. Box 2091 - Raleigh, N.C. 27602 i • g DAVIE COUNTY HEALTH DEPART��iENT PERCOLATION TEST RESULTS DATE�S�'cY CJ NAT�'iE �� J ' LOCATION ,%✓�,(�� p��`l� FINDINGS: HOLE N0. COt��NTS ,�f1C.�/16 f S��'��G'l" 1. � �i��' � z. `,Jo Su�s�,��- �^ 3. .Si��.�/`�� ,G�� 4. u/i`�� i.✓�� 5. �� / 6. �y: � �� s��'�� LOT DIAGRAP,i ;�D�' �r e•i�� 3 / , � ��o,(��/—��sa.'/ .s%1�3/��t/ 'S�—��' �`� �p,'/ — �—/� '. ,(JreavN :r✓ t'�/o� Ct«a�d��,� y'�`��, �' / � �i ,, �� 3� ;�/'c�c,�J.v i h/ /4� .. .ssy,ds�.� _ a 3 �-�w,��/�s�� X _ -�a/6" �� -.'�/. .�,',��/�„�evQ/� 9.� r y .�-u ds-�.'/ �' �/ �y� ��,, ,b%��, �/�s-�� /y Si�fJ/'f1��L� 1�1zIL�6c1�21C�'Y(� GL'� . S"G'�.'� G!/�i�� i?'I��j�P C� �'�'�c�•��/ � �"'"._ ,o� �� "' /�S ��S �' .V/'c�wN 3�� G��//'4(� fe i�/d'�C'04',l�P�%G /Z / 5,��c /,• S�c' �/��,��1 l� l�� X Q � 1�"l �'- i�`s ,f- Q ,��,� Sc�/�� l'/�� (�'Bss/�i�f aj� S—��l'J�, O 2��''P,r%��r.�� S`�,�� C'�Gt�� w S�P.�f' �� _ �lo %�s�,/� /l�o -�u�js�,`/ .�� ,�jf�.�i1� 7� 1��A�e �<�e� ��rDd�� fo� �i� �� l�� r - � • DAVIE COUNTY HEALTH DEPART��iENT PERCOLATION TEST RESULTS DATE �/°��j� i . � i�til'1� f':�i'.li.�� f�� . i f LOCATION � ��.� _�f.,+/�/�� FINDINGS: HOLE N0. COP•�i�NTS 1• ;�L1�/.,,?f/.�i�� ,�f�� , �/ � �„ �; � � ��f � 2. ,��'ii"_. .1/.�� ` ��-� '7� ��Y � ,�' �>,�'�// -'� � �� ' �S ��f � �� . � � � � ,� / � �:� � �,�..,��..! .�� 5. ,�fjc'^��'a%'l C� �1J � � 6. �y: , . LOT DIAGRAI'�i � � � 6 ,. d � ✓ ' �� + • . �. `� �� ' � DAVIE COi7PITY fi�ALTH DEPART^7�N'P EP]VIROP7MENTAL HEALTH S�CTIOtJ �^ �P, o. IIOx 57 ,�,G��.�-�,c MOCKSVTLLE, N.C. 27028 �� (704) 634-5985 Statei�ant for Se�tic Tank Improvementis Permits and/or Site Evaluations NAbIE rCAti�7 S%lcLL DATE �?- //'�, ADDTtESS /��. 3 �y� 2 y�� - C PERPIIT I�10. Zs� l� —� �j,�v�i�G.�' �'./ .?-7uv� � .� EXPLAI3ATIO�T OF CHARGE �r.�. ��.�•-- �.•t��s�cr,-.--�`-'/.�.t....�.'{...� "-�' �.�_,:�f—...o _ ,��.�. �—��.� �iOUiJT DtJ� 'r��D�� SAtdITI1RIAN �} I�I'1 Q...n� PLEASE REi�2IT TIi� ABOVE Ai40UIQT OTI RECEIPi OF iHIS STAT�;9EIQT. *NOTICE: Evalua�ion(s) can not be co:npl��c until pa�z:�ent is rEcaivad. Inprov�man�s F�rrm�t(s) can not be issu�d until puyzn�n� is r�c2ived. Randy Sisell� Owrer RainTree Estates� Lot � 13 THIS IS GNLY A ROUGH DRAWING SHOWING THE TYPE OF Alternative Sewage System (Experimental) SOIL PLACEf�ENT THAT WILL 8E REqUIREO FOR SAID SYSTE�. UNDER NO CONDITIONS IS THIS DRAWING TO BE CONSIDERED THE I�IPROVE��iENTS PER�7IT THAT f'IUST BE ISSUED. Q.� , 1 30� � After digging the area out it is suggested that COUER (�ATERIAL the bottom and side walls be scraped very SIX (6") GRAVEL well. Pipe Q � SIX�(6") GRAUEL� � � � O 4� 4r TNREE (3) FEET OF COURSE SAND The bottom of the dug out " must be level. . 30� After the preliminary work has been completed� the area described above must be roped off and all �raffic kept off the area during construction of the home. I�ATERIALS TO BE USED IN FILL AREA Three (3) feet of course sand One (1) foot of regular sewage disposal gravel Pipe would be placed in the gravel with 6" on the bottom and 6" on top. Cover material shall be a good clay loam soil