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294 Sain Rd Lot 24 ♦ ' �� ! • � � , �� , • DAVIE COUNTY HEALTH DEPARTMENT . � Environmental Health Section P.O.Boa 848/210 Hospital Street . Mocksville,NC 27028 � � (336)751-8760 �/,�/ � �C��j(, ��T Account #: 990002963 Tax PIN/EH#: 5749-45-8308 DS Billed To: Debbie Shores Subdivision Info: Reference Name: Location/Address: Sain Road-27028 , Proposed Facility: Residence Property Size: 1.5 acres ATC Number: 3608 -- AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 WASTEWA CO TRUCTIO IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs 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 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. � / C� t �n�s�e C � �� lns ' r .� �; �/ r Septic System Installed By: �" /J � Environmental He�alth Specialist's Signature: �(/Y�� Date: .� DCHD OS/99(Revised) � � DAVIE COUNTY HEALTH DEPARTMENT • � ' �� EnvironmentQl Health Section � � ` P.O.Boa 848/210 Hos ital Street � .� — � P � Z C� � ' Mocksville,NC 27028 (336)7S]-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990002963 Tax PIN/EH#: 5749-45-8308 DS Billed To: Debbie Shores Subdivision Info: Meadowridge Lot#24 Reference Name: Location/Address: Sain Road-27028 Proposed Facility: Residence Property Size: 1.5 acres ATC Number: 3608 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiJTHORIZATION FOR WAST'EWATER 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 PERNIIT IS SUBJECT TO REVOCATION IF STTE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �1�� #People 3 #Bedrooms� #Baths �'� Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing:❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �' y ��S Type Water Supply ��Y Design Wastewater Flow(GPD) �� Site: New�Repair❑ �I ►t 1 System Specifications: Tank Sizel�� GAL. Pump Tank GAL. Trench Width� Rock Depth (2 Linear Ft.� ocher: __� �1�T�1�T1'o� l��Cc-S � , Required Site Modifications/Conditions: .� � �� c� `' �.�� vF-� l.l J� INIPROVE119ENT/OPERATION PER1�ilT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6 u BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this s�em beriveen 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.**** /��. 1 L}p' `' 35� 'I •�E�� lJ� ��-1 � , � 3 . � � �, tl Z 1 �-� =�l)� - - '�2" H , � ^ � � � . ��o�,�. � � � �� T � � v �4�-T�TI�h: - 22��c� ��17 ZS�o�flcaC�to.� s� Environ ental Health Specialist's Signature: Date: lU �� DCHD OS%99(Revised) "� . � t — � ; ' • . , � . D � � �dt� � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE ATC Davie County Health Department ��T 2 Environmenta/Hea/th section 9 2Q03 P.O. Box 848/210 Hospital Street Mocksviile, rrc z�oas E�mRoruME�vratN • (336)751-8760 DAVIECOU�yiy�� ***IMPORTAN'1'*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQIIIRED INFORMATION IS PROVIDED. Refer to tha INFORMATION BIILLETIN for instruc�ions. � c r- . �le��- : 1. Name to be Billed�'� � � �'�,s Contact Person _`�'�� ---•tns-c�S' Mailing Addresa � Home Phone �� ji7p){ �I�� (� `� 1 City/State/2IP / '/�E _ �� . Business Phone ��-J' ��$�' O 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC �Both 4. system to service: �House ❑ Mobile Ho�e ❑ Business ❑ Industry ❑ Other 5. lype system requested:� Coaventional ❑ conventional modified ❑ innovative 6. If Residence: # People �_ # Bedrooms �_. # Bathrooms �� iahwashar ❑Garbage Disposal �fashing Machina ❑Sasement/Plumbing �Basement/No Pliunbing •v 7. If Buaineas/Induatry /Other: verify type $ People # Sinks 1 # Co�odes # Showers # Urinala ; # Water Coolera ! IF FOODSERVICE:; # Seats Estimated Water IIsage (galions per day) ; 8. 7ype of water supp�y:� County/City ❑ Well ❑ Community t 9. Do you anticipate �iditions or expansions of tlie facility tliis system is intended to scrve? ❑Yes �NO ;. �'. �A If yes,�vhat type? I �� yii" ***IMPORTANT�**CLIENTS MUST COMPLETB THE REQUIRED PROPERTY INEORMATION RCQUCS7'CD , BELO�V. Eitl�cr a�PLAT or SITE PLAN MUST BE SUI31ViITTED by the clicnt witl�TIIIS APPLICATION. � Property Dimensions: � �J 0�/I.P.sL `�� VRITE DIRECTIONS(from Mocicsvilic)to PROI'[:IiTY: Taa Officc PIN: # T��(�D�O d b��c�..� � � ��m►� yl/ � �' 5� � �' ys.. g� og �,��_ �- - Property Address: Road Name s Y� c;cyiz�p /"1'L2r��i1�;lf�,- � � If in a Subdivision provide information,as follotivs: Namc: ��•2c--�6�-�-c o�G� Section: Block: Lot: � Date home corncrs IIaggcd: /d '��,3 This is to certify that the information provided is correct to the best of my kno�vledge. I understand tl�at�ny permit(s) issucd hereafter are subject to suspension or revocation,if the site plans or intendcd use change,or if tlie inform�tion submitted in tl�is application is falsiGed or changed. I,also,uiiJerstand t1�at I aui responsiGle for all ckarges i�rcurred fi•onr tlris applicatiou. I,hereby,give consent to tl�e Authorized Representative of the Davie County Hcaltli Departn�ent to enter upon abo�•e described property loc�ted in Davic County and o�vncd by to conduct all testing procedures ns necessary to determine tlie sit itabili . DATE _ I U' Z�^�� SIGNATURE ^ �� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the follo�ving: �xisting aud proposed property lines and dimensions, structures, setbacks, and septic locations). ' ' � Sitc Rcvisit Cl�argc Date(s): • Clicnt Notification Date: EHS: Sign given Accouut No. �� Revised DCHD(OS/03 Invoice No. ��ro �, � �; -�- .. : � • •dct 27 03 01:29p p.2 w �^' _ �-^ � _1` �'`` � ---�_ '�`"--�.��OAp~S�` _ R �643 '�-�. � 1 �` R� va�No � S �asa•�o. � � �ss.�. Raa;o. � �"�a asasr S x�Q',r � e ''e•zs• a p � � x�e�a vo�rb � � �u � � � � � � d � � � � � a $ c � `" � � + W � z � � 61,315. sq.tt. • d 1.407E ACreB (dmc1� 1� � x 3 �X � 1 ,� KEIVN�TH t. FOSTER �,�6 f A/W GA,tI f. .� y OF3 384 PG 900 � � REi3Af+.FWND w W � ! a � p { N LEGBND p �' Q 1 ��'s�s �awc�mr w�e � 1 �'� -- - mcrrt ar vu,� urc w � � � ------ u►�rwou o¢o oat w.s a Y � 1 x/f MOw O:t F�Rufk�V o � � � 'ss,�, o0 occo�ooK � ' � I Lot 22 r°Ce p�,,�a eoex I Meodow Ridge pEgf3t FWND 01AD D00��E�°'�'''� � PB 7 PG 129 n �"�°"� I S s\ c�l or (ouscx�c iaoa vow+o) � C�P�11C S�J.E ?� s)S� O ww C�[w wON Sit) 30 � 0 :5 50 �00 �t,� �O f f � 9K►w�sEt� . J � O WwutKeA POutt � vROPO�fl'G •, K£4NFlYf L FOSTER, P�S z�z c�-,vrr,f-r n�r DEBB/E L SHORES 7N�S AUP WRS ORIH'h'G'NOf�AIY SUPERV.'S/ON FRO,�/AN AC�Z� fJ£10 SURi�'A/!DE UN4ER A/Y SUPc'RYI'SlGY✓ON OC708ER 27 2D O.I ;/F[1RTflc'R�RTIfY THAT ACCOAO/h'C TO�f�fCD.�l1RYEY, 7H£PROPEXTY UNfS �o�� R„ �tND LOC�tT,ON Of Ail STRUC ES.IRE RCCURAIEIY 2zco srus crrF�c PAwcwar surF r-tr SNON7� kE . p wrnrsron-sue.u. r�oRrrr etia�trru Z»o� J" 7ELEPHOWE: 3J6/ 773-8830 �/1 ,,�� ...�r�,i.,� W1P OI: � . ir. _ ,'. �..0 A R '•. � Q `� Z.� �fESS/C�U�i•" LOTNO.t_ ` SE0. P.B, ' tt;. — '`=::Qe �(�'9�: 5'E A L �, r�,�,T MOCk:SVILLE � `�''� � i-2552 �:� TNt LOT " TA% BIK. ^ IMP H-S '� S1TE �'Fya��.Su�oS�Q p.ur. bAV1E co.iw^�. n.c. � • ',•� ��,��„+•`' �Ea.�oN �:,o� 1" = 5b• � z9�o—o3a D 05 Z6Z w z N 1 Q_____ __'_______________♦ �'^ v J v' -P o 0 �O � 05�Z6Z w ` 203.04 ------- --------------------- o � 920.7 200 ��96Z N 200 ------ - �' � � ---------�--- � ----------- ---, �414) ---------- ��V � ---- � � � (�� so O � � . oo D � N, 3 � ��`, O � � � �l N '�, 00 � � � � w � y �,, � o � D �' � . �D `'' ,� � � �, � .�`'' " '� c 1 � �ti 7Q� � _,_� ti �W � � - __ V tv D � --, Q 34� f�� , � , ' ' ' . • . DAVIE COUNTY HEALTH DEPARTMENT � . Environmental Health Section Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002963 �f�.�; F-:,3/EH#: 5749-45-8308 DS Billed To: Debbie Shores Subuivision Info: Reference Name: Location/Address: Sain Road-27028 Proposed Facility: Residence Property Size: 1.5 acrers Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca sition Slo % HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH Texture rou Consistence Structure Mineralo HORIZON III DEP'TH � Texture rou Consistence Structure Mineralo � 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 � Laadscape Position R-Ridge S-Shoulder L-Lineaz 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 truct re 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-gaUday/ft2 DCHD OS/99(Revised) . . MPLI[:AIION FUR SIIE EVAL1JAl1UN/INPROVEMENT PFAMIT d�AT� ,._,,� , ' W ''{ Davle County Health Department [� � [� []vV � ;; . • ' • . Env/ronmenlal Hes�Ith 5e+ctfon D ,�' j . P.O. Hox 8!8/210 Hospital Stsaet aoaka,►��., Nc z�ole JU�. , � I 1336)751-8760 ♦wwIl�ORTANT*t• TiiI3 APPLICATION CAI�PTt�1' H� PROC.63SED iJNLE83 ALL,, t"'`;'"' INFOR�TION ZS PROVZDED. Refer to the INFORMATION BtTLLETIN for inatruations. 1. Ilaas to be eluea KE N�J E T N L-. �o s�e R • ooatact F.raoa Kt N as T H L• Fos-�2 �taslsaQ 1►aare„ _l 8 (o �^ll A P�.E TiZF� L�N C ea�s phooe ?04-54io-7�� City/8tate/L2? 1=�OGKS.l��.�t, /J .C. . �'7U?�' ,Busit►es� Phone 33(o-1Z3"�38�0 Z. Iiaa� on Pesalt/J►?C ii Dittez�eat than 11bwa Mailitp Addseas Cit7f/8tate/Zip �. ]►p�liaatioa sor: j� Site Evaluatioa U Improv�emeat Pesmit/]1TC 0 Both 1. syates to service: td Honse � Mobila Home 0 Businesa 0 Iadustry C] Otlser a. i! Rasidenaa: � Peopie �_ f Bedroc�s 3 _� / Bathsooma Z- 8�iahxa�her � Oasbaqe Disposal 8'�ashinQ Nachit� O Hase�ent/plusbiaq U 8asement/110 PluaobinQ 6. i! Snaineas/Iaduatsy/Other: specilY tYP� # people / Sinta i Ca�odea * Bhoxers * Uriaals � Nater Coolera Ip TOODSERVICS: � Seats _ $atimated Nater tlsage (qaiions par aay) 7. Typ� o� Natar suppip: 0'Conaty/City U Asll 0 Co�unity s. Do you anticipate additions or e:pansioas of tLe facilltJr t6b=ystem b intended to�erve? 0 Ya 0 No lf ya,w6at type' "'•IMPbRTANT'••CLIENTSIIlUSTCO�1lPLETETHG REQUIREDPROPL+RTYINFORMATIONREQUESTED BELOW. Eit6er a PI.AT or SITE PI.AN blUST BESUBb!!I?'ED b the cltent with TH1S APPLICATION. Property Dimensions: 2 04-X 3b�X !�SX 250 WItCTg D�tECfIONS(from Mocicsville)to PROPERTY: Tas Ottice PIN: i! 5�7 4� - '4 3- S`7 9$ L A.s-r o►-► V S �w.� � S 8 Prnperty Addrar. Road Name �A i►� Ro a c� To 5,��►� Ra�o �s R 1 b 43� Tu R�1 City/ZipMcc.KS��11C a1v?.8 �►G,NT oN SA�..� _ �4PPRar. o.� W�ILL tf ia s Subdivbion pr�uvide laformxtion,xs tollow�: -rc, S �-rs n� ��r NAme: CYIEA�DWRI.OGE �p��PoSED� � Sat�on: Block: Lot: 24- Date Property I�lsgged: G •018 -�4 Thia ts to certify i6at!he informAtion prnvided i�correct to the beat of my knowledga 1 undentand 16at�ny permit(�) issued 6ereafte�ar�e subject to au�pension or revocation,if We aite plans or Intended uae c6ange,or if t6e informatlon aubmided In thu spplication ia talaif�ed or c6�nged I,olso,unda�ta�d tbat I an�re�onslbl�jor ail cliclgu tncurrcd fnoer tJhis opplicario,r. I,her�eby,give consent to the Aut6or'rud Repr�aeotative af t6e Davie County Health Departmer�� to enter upoa sbove desc�ibed pr�operty located in Davie County and owaed b� 1'�ENNETFf_ (,., F4�TE R, _ to conduct all te�ting procedurss as necasary to ddermiue the�ite aitabiljh. DATE � • Z 8 - 1991 SIGNATU 7'HIS AREA lHAY BE USED FOR DRAW�IG YOUR SITL PI.AW(Iaclude s11 of the toiloaing: E�tting and proposed property Ilna and dimeasions, structures, setbulc�, and uptic Iocatlona). Account Na �,`�� Revia�ed DCHD(07/98) lavoice Na �� , • • llAVIE COUNTY HEALTH DEPARTMENT . ' . ��, Environmental Health Section • ' � Soil/Site Evaluation APPLICANT�1VFORMATION PROPERTY INFORMATION Accounf #:� 989900654 Tax PIN/EH#: 5749-43-5798.24 Bilied To: Kenneth Foster Subdivision Info: Meadowridge Lot#24 Reference Name: Kenneth Foster Location/Address: Sain Road-27028 � Proposed Facility: Residence Property Size: 1.39 Acres Date Evaluated: Water Supply: On-Site Well Community Public V Evaluation By: Auger Boring Pit .� Cut FACTORS 1 2 3 4 5 6 7 Landsca sition � L Slo % 3'!O HORIZON I DEPTH p -ZZ Texture rou ('i Consistence iC, Swcture � Mineralo : ' HORIZON II DEPTH 2 p Texture rou G�' L� , Consistence Swcture Mineralo � HORIZON III DEPTH - Texture rou Consistence Structure �G Mineralo ' HORIZON IV DEPTH Texture rou Consistence ' SWcture Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE �'j CLASSIFICATION LONG-TERM ACCEPTANCE RATE L O• SITE CLASSIFICATION: � EVALUATION BY: �1 l LONG-TERM ACCEPTANCE RATE: ��3J OTHER(S)PRESENT: REMARKS: LEGEND � Landscape Posttion 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 ex � 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 �ONSISTENCE �Ioist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic uc ure � SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky � SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogx l:l,2:1,Mixed � Notes Horizon depth-ln incties 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 ' bCHb (Revised 05/99) . ,. , � . �, � � ltJ � � V � � , APPUCAT(ON FOR SITE EVALUATION/161PIi01(ERiEM PEEtMIF&ATC � � Davie County Health Department 2001 Environmental Health Section M AY - 9 P.O. Box 848/210 Hospital Street . Mocksville, NC 27028 ��RONMEMALHEALTN (336)751-8760 DAVIECOUNTY ***I1�ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORt�TION IS PROVIDED. Refer to the INFORMATION BULLETIN £or instructions. 1. Name to be Billed `�E N�.1En� �• i"a$`j�3(� Contact Peraon _11_E N ��STb'yL, Mailiaq Addreas l U� m�P� TV�� LLk� Some Phone 7�4-5�(0-�7��j8 ctty/state/z=p i r10CKSu��E �N C, a?OZ8 susineae Phone 3'3Co-'72 3 —$E�O 2. Name on Permit/ATC if Different than Above � x.tiing Add=eas City/State/Zip 3. Application For: Q�Si�e Evaluation ❑ Improvemen� Permit/ATC [:] Both 4. Syate.m to seZ,.i�e: [,�ouse ❑ Mobile Home � Business ❑ Industzy 0 Other s. if xesidence: # People � Bedrooms 3 � Bathrooms �_ PJ Dishwasher t7 Garbage Diapoaal &I�Washing Machine @'Basement/Plumbing ❑ Basement/No Plumbing 6. If Bus3neas/Industzy/Other: Specify type � People � Sinks # Commode� # Showers # Urinals i Hater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (qallona per a$y� �. �pe of water supply: t�t"County/City ❑ Well ❑ Community s. Do you anticipate additions or eapansions of thc facility this system is intended to serve? ❑Ycs ly'� Ifycs,what typc? ***IMPORTANT�**CLIENTS MUST COMPLETETHE REQUIRED PROP�RTY INFORMATION REQUGS7'ED BELOW. Either a PLAT or SITE PLAN b1UST BESUBMITTED by the clicnt witL TH[S APPLICATION. - Property Dimcnsions: �55 X a�� x�o x as3 Wf2ITE DIREGTIONS(from Mocksvillc)to PROYGR7'Y: Tax Ofiice PIN: # 5�49 45 83 o S u s i s a tio�� - R�4 N-T o N Property Address: Road Name �''J l�3!� Ro/�p �A�� R D /ip p roX � 1'z. M l , Clt}'/Zljl `mOGKSv��c; /JG LO'� dN R��rT If in a Subdivision provide informalion,as follows: Name: fnF�Dacu Ri�GE Pa�r,- o r- Section: � Block: Lot:o�-5� Date Property Flagged: S—�`�"a� This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hercafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted iu this application is falsificd or changed I,also,undersland that I am responsible for al!charges incarred from thls applicalion. I,hereby,give consent to the Authorized Representative of the Davie County Healt6 Department to cntcr upon above described property located in Davie County And owned by /�c NiU�TH �G�s� -f"'os�� to conduct a!!testing procedures as necessary to determine the site suitab' 'ty. DATE .�—D�—d/ SIGNATURE THIS A.REA MAY BE USED FOR DRAWIlVG YOUR STTE PLAN(Include all of the following: Eaisting and proposed pro�erty lines and dimensions, structures, setbacks, and septic locations). . Site Revisit Charge : `�� Date(s): / ` Client Notification Date: EHS: � J AccountNo. `o'�� Revised DCHD(07/99) Invoice No. � v 1 , � ��f�' � • � ' ' � DAVIE COUNTY HEALTH DEPARTMENT • ' � � Environmental Heaith Section � Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH#: �5749-45-8308.24 a Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot#1/2 of 24 Reference Name: Location/Address: Sain Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: z 3 !ll Water Supply: On-Site Well Community Public �� Evaluation By: Auger Boring Pit �C./ Cut FACTORS 1 2 3 4 5 6 7 Landsca sition .1� Slo % HORIZON I DEPTH Texture ou • Consistence SWcture Mineralo HORIZON II DEP'TH � Texture ou Consistence ' Structure / �� Mineralo �'/ HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON N DEP'TH Texture rou Consistence Structure Mineralo � SOIL WETNESS RESTRICTIVE HORIZON • SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , � SITE CLASSIFICATION: � EVALUATION BY: �/ LONG-TERM ACCEPTANCE RATE: t �' OTHER(S)PRESENT: REMARKS: ` LEGEND Landscape Position R-Ridge S-Shoulder L-Lineaz 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 �ONSISTENCE Mois 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 truct re SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic MineraloQv 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 DC�ID OS/99(Revised) ■■■■��■�■�■■��■��■��■��■■�■■��■■�■■��■�■■�■��■�■�■��■��■�■■�■■�0 ■■■��■■�■��■■��■��■�■��■��■��■�■■�■�■��■�■■��■■��■ ■��■■��■■��■��■■�■■��■ ■��■■�■�■■t■�■�■■��■��■�■ ■■�■�■■��e■v■■�■�■■��■■��■��■��■■■��■■■■��■■��■■��■ ■��■�■��■�■�■■■■��■�■■��■�■■�■■�■�■��■■■■��■�■ ■■■��■�■��■■�■��■■�s��■■�■�■v�■■�■�■�■��■■��■��■■■�■�■■��■�■■ ■■■■��■■��■■�■��■■��■�■■�■�■��■��■��■�■��■�■�■■��■�■■ ■■■��■��■■■■��■■�■■��■■�■■��■■�■��■■■��■�■��■��■�■�■��■ ■■��■■■■■■�■■��■��■o��■■��■■■��■■�■��■��■��■ ■■��■��■■■■��■■��■■��■��■��■��s�■■■�■��■��■�■■■ ■■��■■■■■■��■s■��■■��■��■�■■ ■■�■��■��■��■■s■��■■■■ ■■■�■■■■■��■■�■■��■�■�■��■�■�■■■■��■��■�■■■��t■■■■ ■��■��■■�■■■■■■��■■��■��■��■■�■■■■��■�■�■■�■�■■��■ ■■■��■��■■■■■��o��■■��■��■■�■■��■■��■�■■�■�■■�■�■��■�■■■�■■��■ ■■��■■��■■�■■�■■■■��■e�■■�o■■�■s■��■��■■■��■�■��■■■■■■�■�■ 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Box 848/210 Hospita! Street � CouMer #09-40-06 Mocksville, NC 27028 Phone#: (336) 751-8760 ' July 5, 2001 Mr. Kenneth Foster 186 Maple Tree Lane Mocksville,N.C. 27028 Dear Mr.Foster. � On July 3,2001 this office evaluated two lots on Sain Road which are part of lot 24 in the Meadowridge subdivision. Based on the soil conditions and complex topography this office deems the two lots be grouped together to create one lot. This will allow for the required repair area for the proposed septic system. If you have further questions, please feel free to call our office at 336-751-8760. Sincerely, /'��•t��/��• Robert B.Hall, Jr.,R.S. Environmental Health Section RBH: di �.:'t � . : � � . � � p � � � p � � ,� . : AP LtCATION EOIi SITE EVACUAT ON/16tPIi0YEhSFM PFltMIF&AT . Davie County Healtf�Department ��° . Environmenia/Hea/1fiSection �:fAY � � �� P.O. Box 848/210 Hospital Street . Mockaville, NC 27028 �� (336)751-8760 EI�MRONMEIVfAI HEAIi}{ AAVIE COUNTY , t**II�ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNI.ESS ALI, THE RFQU=R�D INFORt�TION IS PROVIDED. Refer to the INFORI�ITION BULLEfiIN for insttucti'oiis. 1. Namo to be Billed '\��.1ti.jZ� i..• (US�1(� Contact Poraon ilEl`1 �OS'Tt-�Tt. Msilinq 1►ddreaa L U� m�P�,E TV'� 1.A'� 8ome 8hono ?�4-5�(0 -77,>�s A �.t7fl8tAtsIZZP �.�,CrtScs�.��C �I�C. .�7o�f� � a,��ese pt,or� _ 33fa-';,2 ?� �;8 S'O 2. Name oa Yosmit/ATC if Differant Yhaa l►bove _�, - Nailing �lddress City/State/Zii� i; 3. Application For: C�Si.te Evaluation � =mprovement Permi�/ATC C1 Hot:'��. a. s�t� to s�,►i�e: [Y�iouse ❑ Mobile Home ❑ Business D Industry 0 0�;ner , . 5. if Re9idance: � People * Bedrooms 3 R Bathrooi^.: ,�`_ � &f' h3s►g !lachina t9'Haeameni/Plumbinq O Sasemnnt/Nc Plumbir.g Diahraeher t3 Ga�baqe Diaposal Nas 6. If Bueinasa/Iaduatsy/Othar: speaify type � People � :ili%.T . 1 Commodea # Shoxera � vriaals # U7atnr Coolor. IF E`OODSERVICE: # Seats Estimated Water Usage �gaizona �= day) ,, ,^. �. 1`ype of xater supply: 61'Couaty%City Q Well G �t:om�nuni,t� s. po you anticipate additions or czpansions of tLe facility this system is intended ta serve? D Yr, ` 'M'f�� lfycs,what type? _ ._.... _._ ;' ***IMPORTANT't**CLIENTSMUS7'C01�lPL�TETHE REQUIREDPRUP�RTY ITIFORMATIONF.��I'rS"'ED � BE[AW. Either a PLAT or SITE PLAN MUST BESUBMlTTED by the dicnt witL TH(S APPLICATIOh� Property Dimensions: _ �30 X 300�C $ S X a7 7 WRlTE DlRECTIONS(from MocksviUe)�.I'�fs1•l:li7'Y: Taz OlTice PW: � 5� 49 h� 83 0� ��-� �s a ��r-a� - R�c�,�T; � � Property Address: Road lYame `J� F��.,r 1`�o t�p �A�►-� R.c A D p-�p v-ox � � , M! . City/Zip �''Y1pcKs�•{I� N� �.oT e� R��kT ; � If in a Subdivision provide informalion,as tollows: ._ � Name: O1ER�OW R.I�QE �� _.._. A,rT o F Section: Block: I.ot: d` Date Property Flagged: 5--d 4`d! This is to certily t6at the informatioa provided is correct to tbe best of my knowledge. I understand thut Lny J rr�:it(s) . issucd hereafter are subject to s�tspensioa or revocation,if the site plans or intcndctl use change,or if the I��i.r�a.lion submitted in this application is falsificd or changed !,also,undersland tha�I om responsible jor all charges in�rr�✓red from rhis application. I,hereby,give consent to the Authorized RepresentaHve of t,he Davie County Health Dep�rtti,c��t to enter apon abovc dcscribcd property locatec!in llavie County and owned by }�t NN�Tt/ �G�-i� -f"'ns�.. lo conduct aIi testing procedures As necessary to determine tt�e site suitab' 'ty. DATE �-D�-d/ SIGNATURE , ;: TIiIS A.REA MA"Y BE USED FOR DRAWING YOUR SITE PLAN(Inclade all of tLe following: Eaisting...id=proposed property lines and dimensions, structures, setbacks, and septic locations). . Sete Revisit C4�� '�;��.... _ Date(s)� .—.. . � CUentNotifcation Datc: �� - , F.HS: . , _ , Account Na ' � � � `/�1 Revised DCHD(07I99) Invoice No. , � ��. a/ i _ �t f�t� sn ��n ��y. �• Now Or Forme�ly � � `. �, GEORGE McDANIEI & � ��..� � � � ANGEIA M. UIORK , • . � �o N � x MARY W. HOLDER � � . , = i � � � � — 06 189 PG 039 g . �N � �O�O t�'i� � --.——--� —-- N 0 23'07' E 253.Q5' Toto1 . • o � Q p �_��--- � � 6 �� e� I' �249.55' 3.50' . d � � �� p � Z � � �� O � J o N �G ab ,`O� c �y�.. n��.,� v � � u'� 8 w� l �i� � .. •g��{�t111Z>>)Y ^`�+ e�� C� � � 70 y _ � N!� � _ �`� ' �`jtd� �^�� Y �:° �.}. O�` �`>��. _ . p�i �- � � to N c0 `F � "N- ' Y, r��s�ei�e��•, � e � tp ^� Z . 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' Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH#: 5749-45-8308.b Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot#1/2 of 24 Reference Name: Location/Address: Sain Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: • 7 -3 -� � Water Supply: On-Site Well Community Public (/ Evaluation By: Auger Boring Pit � Cut FACTORS 1 2 3 4 5 6 7 Landsca osition .G � Slo % � l '• N •� HORIZON I DEPTH _ �� Texture rou Consistence Structure � Mineralo HORIZON II DEPTH '• k G`� S'6� Texture rou > Consistence /' / Structure Mineralo - ` HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture ou Consistence Structure • Mineralo SOII.WETNESS RESTRICTIVE HORIZON • SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION:�_S. . G'/��tL°QQf'J � �ALUATION BY: !l 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 firtn EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-V�ry Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic truct re SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic MineraloQv 1:1,2:1,Mixed ote 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 DC�ID OS/99(Revised) . - ' ,... D�1lI�CaUNTY�i�I.T�I D��T1VI�NT � ENVIRONMENTAL HEALTH SECTiON P.O. Box 848/210 Hospital Street - CouMer #09-40-06 Mocksville, NC 27028 " ' Phone#: (336) 751-8760 • July 5,2001 Mr.Kenneth Foster � 186 Maple Tree Lane Mocksville,N.C. 27028 Dear Mr.Foster: � On July 3,2001 this office evaluated two lots on Sain Road which are part of lot 24 in the Meadowridge subdivision. Based on the soil conditions and complex topography this office deems the two lots be grouped together to create one lot. This will allow for the required repair area for the proposed septic system. If you have further questions,please feel free to call our office at 336-751-8760. � Sincerely, I��fi� �•��O'�• Robert B. Hall, Jr., R.S. Environmental Health Section RBH: di ' � ` J ' • � em.ler - Caxolina Pro erties December 30, 2004 To: Enviromental Health Dept. I, Debbie Prachel, have approved a 25% reduction field for the septic system at Lot�24 Meadow Ridge. � Debbie Prachel � Z � � - O `� Date 130 Hwy 801 South • Advance, NC 27006 � � � Phone: 336-99$-7777 Fax: 336-998-0879 .,'�� •,-ti.� e .., , .4� '„` ��, .. , h'�. ,... . r � , ,. '+F �`'�. , . .r � .. �. i :}r:�,.... .. .r ;� r�k�s_(� �ti ��k�e. . � � . . , � Pemr.ttee�.� �'` �, 1 DAVIE COUNTY HEALTH DEPARTMENT Name: `� 3� ►-F �� C � L � Environmental Health Section PROPERTY INFORMATION ` P.O. Box 848 Directions to property: ` � � � �� I L' Mocksville,NC 27028 Subdivision Name: �l�� C.�G�Ul.0 �t C`--[-, -=' �G� �� ,� {✓� _� �� Phone#:336-751-8760 � �„� �~ � � Section: � Lot: AUTHORIZATION FOR ��y �� , VVASTEWATER Tax Office PIN:# ��J+ - U 3U n , SYSTF.M CONSTRUCTION �� t � Q AiJTHORIZATION NO: �� A Roa Name: � k � ��'Zip: �-7��C> **NOTE**This Authorization for Wastewater System Conswction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applyino for Building Permits. (In compliance with Artide 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) '/� —,�j / - * *NOTICE***THIS AUTHORI7.ATION FUR WASTEWATER CONSTRUCTION ff�``��/� .�'� _..(�' —� "�C.J� IS VAL[D FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED � G � RESIDENT'IAL SPECIFICATION:BUILDING TYPE � #BEUROOMS�#BATHS�N OCCUPANTS�GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLF/SHIFT #SEATS INDUSTRIAL WAS7'E:Yes or No � �A C�t`j- �) LOT SIZE � TYPE WATER SUPPLY 4 �v DESIGN WASTEWATER FLOW(GPD) ��v NEW SITE REPAIR SITE � SYSTEM SPECIFICATIONS: TANK SIZE �x�GAL. �UMP TANK �!Ov GAL. TRENCH WIDTH �� r, ROCK DEPTH L v'L!• LINEAR FT.Ll��f �►s �t�ted in 15A r�CA�C 28A.1969(5) �'� �5 .�j /�P��c.G� �U Y\ OTHER P.��DtC[j Sv�tsmc �n��,��r��$�,E� � REQUIRED STI'E MODIFICATIONS/CONDITIO : f IMPROVEMENT PERMIT LAYOUT , U �`N >--t � �� NS �. T,,�s�ta11 P�.m, � 'la�k ,� , � `,l� �� W 3� � , '� �t,�...�+-.�.��G �r�v�� 1 ow� , o� `�w" � t ��7Q�tG,![•! �/ �f �tv+FS NZAY �O�P �Y� a� ��, �Nr i/ ,�/ . n„� ��r ;� �-1 �.P r .c.-►d. c o � ``�a ��acr, � � � �� .�r-c 5 vyi�.-��' b-� o�-�} �f � .. ' n. ` � �_ �. - J �a� � �y l�? o�' w�y `�' �� ^-,(7 _P1'`N<`r' /� � �'�- (,. .ca s� 1 D �7YG� '��`-f �`1} � 1( � 1�,r� � � ` � 5/ � P Gr ---._._ FOR FINAL INSPECfION OF THIS SYSTEM PLEASE CALL BETWEEN 830-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: ' _ ;,:: AUTHORIZATION N0. OPERATION PERMIT BY: DATE: ��THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE W1TH ARTICLE 11 OF G.S.CHAP'fER 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. . �y �o��,�> 9�9�,v��'� _ : �ia:��-.=+� :,:: ��s, ,..�;';; -,..:�..� : . �sy � - r�.:s• - .J:_< � . r-.-,-.,,� .- i�� _t'.,.5��..s.m,:- ,. , ..r:��fi ,� ,... „ f -'r:�,^ a{�a i, T � µ ,. _ , . - • ' . Permitt��,� ,:�, DAVIE COUNTY HEALTH DEPARTMENT Name�� --f�' �� ` -� � �s' ��" � �� Environmental Health Section PROPERTY INFORMATION � � � ,. P.O. Box 848 � Directions to property: � } �- �-- �'"+ / U' Mocksville,NC 27028 Subdivision Name: �'�-* �� + �'`�►�' �=, _' { � � ,� w} � j �. . Phone#; 336-751-8760 j � l.,� .�� .+. --3i. (', r� C. � 1__f Section: i Lot: AUTHORIZATION FOR �, �� WASTEWATER Tax Office PIN:# �r��l ��~ - L"3 � . SYSTF,M CONSTRUCTION �,t �j � AUTHORIZATION NO: �O Z��T A Roa�Name: � G� r n �'�G#Zip: �- �C%�� **NOT'E**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Fom�/Authorization Numt�er should be presented to the Davie Counry Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) � �'% .' ,• �,s ' / — �*NOTICE***THIS AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION � 'O�i ��c-�t� L�-'' � �) `� G•' � IS VAL[D FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED .� � /' L/ '� G r RESIDENT[AL SPECIFiCATION:BUILDING TYPE ,� ' #BEDROOMS�#BATHS�#OCCUPANTS�GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLFJSHIFC #SEATS INDUSTRIAL WASTE:Yes or No �t/�S � �/ LOT SIZE /� �`TYPE WATER SUPPLY �U DESIGN WASTEWATER F[.OW(GPD) ��v NEW SITE REPAIR SITE l/ SYSTEM SPECIFICATIONS: TANK SIZE � �� GAL.,UMP TANK ,,v��GAL. TRENCH WIDTH �4 ', ROCK DEPTH 1 v i�• LINEAR Ff. Ll��f OTHER C-�� J 'U �,PG`(,.t G� �U j� REQUIRED SITE MODIFICATIONS/CONDITIO /: � IMPROVEMENT PERMIT LAYOUT , U ��V' 7 -t � �f �� A�'�"_�/ � �'� ��j��a I � 7�-c Il t � 'U�� _-----_ � • / `•--.r..�.7 �C� r r 1 i ��`--'`'------,-_.... �13 4 � ,, `� �lu.. ��r>ZG 'I rov+7 �v«''" • . �5 �� ,, ti� � ` � st��r, ;. ' '1 r . � 1� !- r I'� �' � � �y �� G� C+�� \ �S. � ��. n � _ i , �� "'' `� , `� 1�1 �.p d -P N�. t0 � r., ��j�/ J � . �\� 1��' � ,��.f �.,1 M1-{'S •Y` l� �� U. � L�� "i., .� ` . - � . _ 5 � G o c� ( � L+1 0� �-U c• ` �F � ,t °' � �...�/�T-�/c�- � y Y �, _ ¢ � , � ��J C`"fi' I �a'� I U !{•'G✓I'� ��`"r ��, !� �--- �, � 51 y 1�4 �r,� -r r � % �'r� • . i l _J "'------- �`-`—____. FOR FINAL INSPEGTION OF TFiIS SYSTEM PLEASE CALL BECWEEN 830-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT � SYSTEM INSTALLED BY: �,: AUTHORIZATION NO. OPERA'I70N PERMIT BY: DATE: ••THE ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 SATISFACTOgILY FOR ANY GIVEN PERIOD OF TIME. , .�,D_��> �l k�'g�b5�'(� G�`�K , : � � • � DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME I 1 0 �� (► _(' c,. 1 C��S�dr-c�( PHONE NUMBER�,�� — �Z�'J� `T ADDRESS�I.-�� i vl i�/� SUBDIVISION NAME LOT # DIRECTIONS TO SITE I l� �,) �d �(�n� 1�� '�K i�- G-- 1 DATE SYSTEM INSTALLED� �6� NAME SYSTEM INSTALLED UNDER ��l1 �1 -Q � $��S � � TYPE FACILITY � � NUMBER BEDROOMS �1 � NUMBER PEOPLE S RVED ^ � TYPE WATER SUPPLY�/' sP IFY PROBLEM OCCURRING SL.� � a c � v. 4 � � �w DATE REQUESTED � — INFORMATION TAKEN BY ^�d� This is to certify that the informa6on provided is eoneet to the best of my knowledge,and that I understand I am r�sponsible lor ali charges ineurr�d from thia application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.,/9a • • • • ' �' ' BK522PG048 � _ .. � Davi�County,North Carolina 12252 Excise Tax Paid S 5 0•o o . . FlLED FOR REGISTFTATION No�vp�rber 6, 2003 3:10 P.t4.� DATE TtME ��a�� AND RECORD[D IN BOOK�ZZ PAGE 48 M.BRENT SHOAF�REGISTER OF bEEDS ' _ �TJ�'7y.n.. DAVIECOUNTY,� TAi��DMpA{TRAT011 �, • Exebe Ta::SS0.00 Recordla=Iaformallon DnRed by:Taman A.Flemiis,Attoreey K L�w,MxksrWe,NC 27028 � Msll to: Grantee(Pj P.O.Bo:6Q8.Mackavilk,NC 270]E TAX MAP: �"/-s,/c0 G 1 WARRANTY DEED THIS DEED made t}us�day of 4l�Fl�E�U ,2003,by and betweea KENNETH L.FOSTER and wife,GAII.F.FOSTER,(iRANTORS,to DEBBYE L.SHORES,the GRANTEE: WITNESSETH: ' . THE GRANTORS,for valuable considcration paid by the GRANTEE,receipt of which is aclrnowledged, have and by these presents do convey unto the GRANTEE in fa simple,all that certain parcet of land situated(the "property")in Mocksville Township,Davie County,North Carolina and more particularly describcd as follows: DESCRIPTlONA7TACNED HERETOASEXNIBIT"A" . TO HAVE AND TO HOLA the property and all privileges and appurtenances thereto belonging to the ' GRANTEE in fa simple. THE GRANTORS COVENAIVT with the GRANTEE,that the GRANTORS are seized of the property in fee simple,have the right to convey the property in fee simple,that title is mazketable and free and cleaz of all encumbrances,and that the GRANTORS will wazrant and defend the dtie against the lawful claims of all persons . whomsoever except for the exceptions heninafter stated. Tltk to the property is eubjcct to the toIIowing exceptiona: Easements and restrictions of record. • The tetms GRANTOR and GRANTEE as used herein include the masculine and the feminine,lhe singular -, and the pinral,as the context requires,and the hein,successors,and assigns of the parties hereto. •..,. • -;' �. ' . , � ,,'�� . . �/ � • . �:t.� O� ' � • � ( �l 5 d � 9 �'� .� - /�-� ��` g ' � � � ��-J �5 I � �� ,� 11 � 3a � y � ; . • • • � 6K522PG050' . ` . EXHIBIT"A" BEGINNING at a tebar in the southwest comer of the heroin described tract,said rebaz being the northwest comer of Lot 22 of Meadow Ridge,Plat Book 7,Page 129;thence with the eastem line of George McDaniel,DB 189,Pg.39,and Angela M.Mork,North 00 deg.23 min. 07 sec.East passing through a rebar at 249.55 feet,for a total of 253.05 feet to a point;thence with a curve to the right South 78 deg.58 min.10 sec.East with a chord distance of 165.56 fcet and a cadius of 956.57 feet to a point;continuing South 72 deg.36 min.12 sec.East 119.25 feet to a rebar,beiag the northeast wmer of the hetein described tract and a new comer for Kenneth L.Foster and wife,Gail F.Foster,DB 384,Pg.900;thence with Foster's new westem line South 26 deg.39 min 09 sec.West 300.44 feet to a rebar,being the sovtheast comer of the herein • described uact,said rebar being located North 59 deg.57 min.57 sec.Wcst 255.28 feet from an iron;thence wich the northem line of Lot 22,Meadow Ridge,Plat$ook 7,Page 129,Notth 59 deg.57 mia 57 sec.V✓est 165.44 feet TO THE POINT AND PLACE OF BEGINNING, containing 1.4076 acres,more or less,as surveyed by Kenneth L.Foster,Professional Land Surveyor,on October 27,2003. Job No.2950-03A. Subject to easements and restrictions of record. For back title,see DB 384,Pg.900,Davie County Registry. See also part of Tax Map � H-5,Parce161,located in Mocksville Township,Davie County,North Carolina. T63s property is not aubject to the Reetrictive Covenants in AB 340,PG 285,or as pmended and is uot aubjcet to the Homeowners Association By-Lawa in DB 340,PG 292,Davie County Registry. • TFlTAF xlmy fikY�fYcal al dnc.1.4076�aa�Shora.Debbie L • t � -"�� .. �, . . . • , . . .,. _ , . � .. .. ..` .. ';M, . : _ . .: ',: . - ' . � . � .. : � " .;` . ::�.� . ;';':. . . A B 8 4 P 9 0 � � 0683i MailTo• • " � S � WARRAM'Y DE6D-Form WD�601 Princed u�d for ule 6r]una Wllliam�8 Co.,tne.,Yadkirin'lle,N.C. STA7E OF NORTH CAROLINA, Davie County. THIS DEED,M,a�� 23 a,�ot Auqust , 2001 �y��y�� William J. Bowler n^� urife, Carol �, 8otialer ot �,,,,,�. �ndsateofNorthGrolina,EeninafuralledGrantm,tnd Renneth L•_ Fea and Wi P� rai 1 F_ �atpr of County and Stata of North C�roWu,Lereinaher . colled Cnntee,whox permanen[m�ilins addree�u , K'ITNESSEiH:77ut the Cnntor,foc wd in wntlderadon of the ium o! Ten Dollars and OVC*************** � and other good�nd vilwbk considenHom to him in Aand Raid by the Gr�*��e,the rcccipt abereo[b here6y uknowledged,6u`iven,aranted,bargained,wi and co��e�ed,�nd by theu premap doet si.e,g.et,bvpm,uU,convey and eontirm onto the Gnintee,hh heir�and]ot wcceswn and wipu,promiu�!n �{p�,ti r�+..#��e Township Davi e Counq,Nonh Grolina,de�cnbed u followr. � BEGINNING at an iron stake in the southern edge of the right-of way of Sain Road (SR 1643), a corner for George W. Martin, and said point being 1050 feet from the intersection of Sain Road and Oak Grove Church Road; runs thence with the southern edge of the said right-of- way South 70 deq. 51 min. 40 sec. East 236.74 feet to an iron stake, a corner fos George W. Martin; thence with the Martin line Sonth 23 deg. 18 min. 23 sec. West347.00 feet to an iron stake; thence continuing with the Martin line North 59 deg. 58 min. 49 Sec. West • 255.29 feet to an iron stake; thence continuing with the Martin line North 26 deg. 37 min. 50 sec. East 300.46 feet to the Beginning, contaiaing 1.819 acres, as surveyed by Sam P. Hall, RLS, �anuary�1991. DAUIE COUNiY 06-30-0! I . �260.00 . • ��v•o� • - f t D�.ErJ TR:aM1tSF[R ChECKE7 �1T`--"_-z.`'_`i Rv_L-'�h,.�nr rnz��...:n�;��_. Prepared by Wade H. Leonard,Jr, • 76e�bme land wu conve�ed[o Gnncor b� � .See Sook No. ,PaQe TO HAVE AND 1'O HOLD Tho abo�e deurlbed prcmix�,wi�b all�he appur[enana�theremw belonpnj,or In�nr w6e appertaieing,nn[o d�e Crantee,hb helrt and/or succenon and usigns fomer. . And the Granwr cormanq that he is teized of said premixf in ke,and haf the [to convry the ameln fee dmpir,t6at pid premife��rs free[rom en- cumbnnces(with the e:eepdoro above ttated,if any);and chat Ae will wa rra n t an�de&nd t6e uid tieb w ehe ume asairut the lawful claim�o[ap penon� whomwera. When reference u m�de to ehe Cnntor or Gnn[ee,[he dn�y]�rhaIl inelude the plunl and the maualine�Aall Indude the&minine or the neu�er. iN ��,7'�eCnntor hereunto�et 6it band snd nil,the day u�d 7ear fvq abme wcitten. � �'f (SEAL) (SEAL) - �--�`-� •� �-'"--RO� • (SEAI.) (S1EAL) SfATE O NORTH CAROL A �� COUNTY. ++��y� , i, ,y�Io blte o[uid Counry,do hereby eerti[y[hat K �—M Gnntor,penonally appeucd be(ore thu dar and aeknowkdeed tho exeeution of the fomgo eed. �l�0 v � Witneu m�hand and nouria! N4 d+e � day of a� � MyCommipionExpira: ��•�DZ- ,N.P.(SEAL] STATE OF NORYH CAROLiNA CWNTY. . � � I, ,a Notac�Publie of uid Counry,do henbr tertify ehat Gnntor,perandly appeued bafore me thi�day and acknowledged the ezecueion of tha(tue�o'vy dad. Wimeu my Aand and nocaiat seal,[hia che day of , _, My Commidon EzpSret: �N.P.(SEALJ SI'ATE OF NOR7H CAROLINA, DBV�C �NTy Theforegoingcenifcate(lju[ �(yst� Howell NOtBTY Pub11C of Dsvie COunty is(�eertl(ied to ba torreet.Thu irotrument was prcaneed[or n`isvaHoa t}.Ea 30 day o[ �8ue t Z0�1 . �� 1 2:0 S g�,�p,M.,and ddy ncorded in the oCfice of the Re��er nf Deedi of Davie Counq, North Corolina,in Book��,P�ge 900� . Th3fthe�A_.dayot AuQna_t ,A.D.. �QL � M. Brent Shoaf By �,�� C �1�1��.��J Regis[er of Deed� A»(uant,AXd4Y�7Cteeistu otDecd� Th(s Deed dnwn by . . r:�`� '� ",. • DAVIE COUNTY HEALTH DEPARTMENT � Environmentai Health Sec�i'ion P.O.Boz 848/210 Hospital Street � Mocksville,NC 2702$ • (336)751-8760 . ��., Account #: 990002963 Tax PIN/EH#: 5749-45-8308 DS Billed To: Debbie Shores Subdivision Info: Meadowridge Lot#24 Reference Name: Location/Address: Sain Road-27028 Proposed Facility: Residence Property Size: 1.5 acres x� ATC Number: 3608 �. � 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 WASTEWA O TRUCTIO IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: Date: CERTIFICATE OF COMPLETION **NOT�** The issuance ofthis 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 peiiod of time. � I (�' , �K:S��C . � �' .5,� ��'� , , r f Septic System Insfalled By: /J �'' v ' /� r Environmental Health Specialist's Signature:_(/ Y�� Date: � _ DCHD OS/99(Revised) ' � DAV�COUNTY HEALTH DEPARTMENT �. � . � � Environmental Health Section � ' P.O.Boa 848/210 Hospital Street � Z � �— r� � ' Mocksville,NC 27028 .'.�� (336)75]-87(0 IMPROVEMENT/OPERATION PERMIT .. �!. Account #: 990002963 Tax PIN/EH#: 5749-45-8308 DS Billed To: Debbie Shores Subdivision Info: Meadowridge Lot#24 Reference Name: Location/Address: Sain Road-27028 Proposed Facility: Residence Property Size: 1.5 acres '� ATC Number: 3608 **NOTE** This ImprovementlOperation Permit DOES NOT authorize the construction ofa septic tank system or a�y wastewater system. An AITTHORIZATION FOR WASTEWATER SYSTEM CONSTRUGiTION must be obtained from this Department prior to the construction/installation of a system or the issuar�ce of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment andDisposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR Tf�INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Ot)Jic. #People -3 #Bedrooms�_ #Baths �'� Dishwasher: � Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing:❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �' � ��"S Type Water Supply ��Y Design Wastewater Flow(GPD) �� Site: New u Repair❑ �i �� i System Specifications: Tank Sizet�� GAL. Pump Tank GAL. Trench Width�O Rock Depth IZ Linear Ft.� , Other: � �1�T(�1�T1� I�K� Required Site Modifications/Conditions: ..� �. �`�� .� �- �`�� '� . �..t� I1�IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUEIVT FILTER. RISER(S) IF 6"BELOW FINiSHED CRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis s�em between 8:30 a.m.to 9:30 a.m.or l._•0��,to 1:30 p.m.on the dayofinstallation. Telephone#is(33G)751-8760.**** ��. 1�j� , � � �� ' •�E�� I� �`' �� . �, . i� �e-�3 � ` ~' tl �.� :�(�} ktz" � � ^ � ' � � ' �—�o'�ur.S• '1 � '75� ' � � �'Q,LT�TI Jiy -22��c� �'��1� ZS�,�pc1�wJ s�i Environ' ental Health Specialist's Signature: Date: � c./� � 1 _J - DCHD 05199(Revised) r� � . f-- �