151 Sourwood Ln �+"•h � . .. .. .K—� . .4, ',i- , ` . :.. .. .,. - C�.. r - . .
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- �--. �ry�-�=•:�•� DAVIE COUNTY'HEALTH DEPARTMENT
.�
^,.�y� �' ''� � , �r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
_.. ._._. .
� �� ___.
`NOTE: �ssued in Compliance with G.S. of North Carolina Chapter 130 Article 13c � �
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.�sss) Permit Number
Name S� P �.y < <'��� �.� c� -, :� �: Date ��) " -a � ;',`�. N0 E'°''z d�
`; — t�a::1 E_��
,�_ocation ���\ � "`, �\��� .-.�.� �.�-i�L, �, =� �� fi•.z' ��:� , ���, .� �1`�l Q U i�� d `��.
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1 c�{ �,;, c . �? `. ,� ��: � � .
�� • ��:::V���.�` l 1_'#t'e��: �\C� �:�T�.`�_ � �l,�x �''1 r�`..� ,��
-- �150u�u�aU� ,C,� _ .. , 4
Subdivision Name Lot No. Sea or Block No.
Lot Size ` � � � House � Mobile Home _ Business Speculation
No. Bedrooms �—_„_�� No. Baths ��'�-�- =No. in Family�
Garbage Disposal /»YES p.�,NO ❑ � '
Specifications for�System: '
Auto Dish Washer YES p NO ❑ � - �' - r
J t�� o J c. `;j, `'�.,.;.�:;-�--- �--� - \`�.-.:�J
Auto Wash Machine YES ❑ NO ❑ ��-- Y r
. o � ^� �V, \'• -- � ,�1� ,
Type Water Supply t_ c? �� �., �� _ �` .� y ��_ ..
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
�� - ,
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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'"'�''��-�
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Certificate of Com letion� Date� v �� ` �
. , r
"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.
i
� APPLICATIO�N FOR SITE EVALUATION/IMPROVEMENTS PERMIT
� Davie County Health Department
Environmental Health Section �
� P o. BoX sss � REC�IYF.t� SEP � �
Mocksville, N.C. 27028 .
- . ::
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. `+
� Home Phone ���-g��O
1. Permit Reque ed By Business Phone ��
2. Address � � 3 �c�' d�� �7c� _� l✓.G c�7oo 6
3�Prop�riy_Qwn D erent=than`Above�`-��-�-��--C°v��-�.'
Address /��o� ��.,�sz , ��. (�70��
4. Permit To: a) Install v Alter Repair �
b) Privy Conventional Other Type
��,,.
Ground Absorption
` c) Sub-Division �f Sec Lot No. �-
5. System used to serve what type facility: House Mobile Home Business
. Industry Other
b) Number of people �
6. a�If house or mobile home, state size of home and number of rooms.
House Dimensions � �XSG
Bed Rooms.�—Bath Rooms � � Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
What type business, etc. .
Estimate amount of waste daily (24 hours) 30'��-��
7. Number and type of water-using fixtures: . �
commodes 3 urinafs � garbage disposal - �
lavatory 3 showers� washing machine ��
dishwasher � sinks � -
8. a) Type water supply: Public Private Community �
b) Has the water supply system been approved? Yes �No �
9. a) Property Dimensions �� �� X o?O 8��
b) Land area designated to building site ��d�
c) Sewage Disposal Contractor a-��^�
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? ,�/�
What type?
This is to certify that the information is correct to the best of my knowledge. ,
�'� - �`� , �
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL�LAWS
Allow 5 days for processing
Directions to property:
_ �� ' � ac�` ��� ��� �' ��.�
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DCHD(6-82)
i
• DAVIE COUNTY HEALTH DEPARTMENT
� ENVIRONMENTAL HEALTH SECTION 1
SITE EVALUATION CONSENT FORM
� � 1. Complete the form below and return to the Davie County Hea�th Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
• Environmental Health Section
Site Evaluation Consent Form � '
IOCATION OF PROPERTY: DATE PECEIVED
,/, r►�c:�.� r�,.�-�Pa.t�/��n2��+ ��� (office use only)
.. �2,:,_.e ,c:�'.,.0",��!�.-.ti w � /���
yes � no 1. I am the owner of thE above described property.
yes no 2. I am not the owner of the above described property, however, I certify that I
have consent from_o���� P�L�� , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
yes no 3. I hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above describe�property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal system. �
_ �� • 1
OATE SI NATURE
4. I hereby authorize the Davie County Health Department to release site
� evaluation results from the above described property to the following:
Owner only
�Owners designated representative
_Anyone requesting results
—Only those listed below
DATE SIGNATURE
DCHD(11/84j
,
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PHOTOGRAPHY BY C — 6 C — 7 C - 8 �ti`�R-�
ALSTER 8� ASSOCIATES, INC. — i
COLUMBIA, SOUTH CAROLINA D - 6 D � 7 D - 8
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ft OF PHOTOGRAPHY: MARCH 28, 1976 E - 6 E - 7 E - 8
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,,: , . � .. . , . .e + �_1 t rk�:� r� �y�k�,�5 '! 1?I�,p� �
j. This Deed dnfted by:�arr F. Ha be e r ' :;�5� 1 � �
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j MilI•this Deed lo:�l�SGAL��C V'nC ` . —�—��I � , �-"-��-==,—�D i '' .
(1�mt! lrol N�mMtl . .lClltl ,..lSl�lq � .121P1�tH� '4�„ i
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STATE OF NORTH 4AROLINA . ' � ;��� 4s�,,'+�f°i�r �
' COUNTY OF 1XHt6�EK% DAVIE QUITCLAIM DEED, r, '
,;. .. .. ` '.' . 1 i � �}�atii� ��,i
' ' WANDA JANE SpRY • MeC�1Lt.ou . . .'' � " '' �i ,�'zi, 'i �
• i� Know�dt Men by ihae Praents,Th�t ,
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. I . . . . , . . . :�.x ti 4� .�.. :
• oti2c��Ktounty,N.C.in eons(denlion of TEP! DOLLARS AND OTHFR VALUAALl' CO►IS�bFpATIOtSC � po����� , � «
' •.'DENNIS CLAYTON McCULLOH ' S .;�t N i�� '° r �,,�
. ? tetttred of . . , � r -•
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ha�he�eby rde�ud md forever qulidofined,unto DENNIS CLAYTON'• +��(TI,IA}# : - .xl;! r �i �t;"7 � S'.'
� . ' ' . , ' • � ' . ,. . , r - 7;ii�ra. �.�+?r�"'
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. � , � . �.� . . .• . - •�: �` � 'i �
. , � . .-. •—�� �F �
�nd'�Jrcfri�nd�ssigris foreyeq�II tuch dght,lUle�nd{nlerest.u she nay h�ve In oi lo ill[htt pucel of land lyint 41,, �, ;,;.:
, FarmincZton � Davie • Nor�h�Carolina ' '�` + � ?��w �`�y."P M �`.
.deurlbed�s follows : : S, y p r;,..
� tr..a.Tiiv► , ��. . o�o� , GGT"'—' - . •. . . . .. �� • . 1 r> _' .
� 5l
� � 1 1 �' '�<<efY .. j�'
BEGINNING at an izon'pin in the �,�estern lina o£�Charles Cook, said pin �", q;'`��;,��'� +.-:
- being �located South 1 degree Q minutes West.9A�8�feet from Georqe Craver�.et��,�i;���;� i;
� • cozner; tihe same being the.Northenst•corner o£ tfiat tract described by ,'�. ��� �`;Y'
" deed recorded in�13ook 89, Pacje 131; and running thence £rom sai�l:point o£,�;-�,,�ft t4� ��'?�;
(. . beqinning with the lines of.Charles Cook South Ql. �legree• n,tnintites taest;!.;';;;,,,:i.;',,�,^r,��;. .:"��:;t•.
� 208.7 feet to an iran pin, a new corner in the line of,Charles Cook! tihenc0�,t��ti+��] � Sa�:'.
i s . North 8A degrees 10 minutes West 208.75 feet'to a new:iron' pinr.,thence :' x�f j��`fi"�, �t,y,.
' � �.Aiorth O1 degree_0 minutes �ast 208.7 f.eet•to an iron pin;.a neW;coineri i '�,'�;��'���i��� �"�',
c• thet�ce South 80 degrees 10 minutes �F.ast 2�8.75 feet to ThF•POItJT�:AND 7;''e o-s��•. � ��"�`�
� FLACF. OF BECINNING, containing .1.0 acres� more. or.leas� as;surveyecl,and'��'��}+�f'�� �� ";`A;•
i ` :'�latted�by Roy TurneY� Augu'st 26. .1977. �h ; �, �';`;�,��y,r"� ti� �
. � c " r k � n �t-.�r ti�y..
. -� . . . . . , . .. ;: . . .. .., . .� : ;.�; � . .� �'�:; Y�i�,r.r�i� rr r�Yt''K'(�`'�'t�$t{1���� q=y'�:. .
f� TOGETFiER WITH the above-described land' there is conveyed a"right-b£ wayt#;��,,�,�`�,fi�+�b' ��'
`� �. 25 feet in width'for .the purpose.of in,qress, egress8n�i�regresei•;the�d°, ', F ;1r°��c� � ��`
3 • �astern margin of which begins at tHe Southeast.co'rner'of.,the above x� ?��` ` ��Sf FP��
;.s;• �.described land end runs thence South 04 .deqrees 08. min�tes�West• 63f Q5 feeti#�'�r�`s� y�'
�;` '. to an Yron.pin in theppurtenaritrtohsaid landsaandntofrtuns�tithqth3��ame''�''�E�'�`r�#"���'�%i '"`i':'�
� Said easement to be a ,, y
` ; �in the hands of ell persons whomsoever. ;; � :,;� ;A+ ;,,�',' ,s a `;� '''x;;���;4�� i� ,,�
. � ' , . , r j t�"r a�c4 .a,
�;• egresa�anddregresadwhichaisRreserved9bythecgran;:orse�gSaid�ehBemen�eeej✓.�„Yt`s�:;�p��x � ?,�':
,;� being 25 feet in width and having an ita Fastern bounAsry':a:lii►e heqi�ning�`��:',.'+�r di:��'
k.: at the Routheast corner�of the above describerl one:acre'traCt and:�runfiing,ri,',".�,3;'+Y; . 1':r
� �a thence North 1 deqree 0•minutea F.ast 7.�8.7 fee�:to bn iron pin{ the '�t "�','i(`> +�i'� ' �,: '
•�Northeast .corner of the�above deacribed trac*. Said easementi to be,.�ty��.'!�����«�r��::!'� ar
�� . eppurtenent to said lande end to ruri with the same in the h�nds of hll 'r`�° 4 i} �f, t`;;
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.' pAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Y P. O. Box 665
� ' Mocksville, N.C. 27028
� SOIUSITE EVALUATION
Name � S �Q`�-4 �O �%N�P�bz e h Date ��b ` � � ��
Address �� ��- �, Lot Size �',�
� �- �
FACTORS AR 1 AR AR 3 AREA 4
1) Topography/Landscape Position S
� � � PS
U (� U U
2) Soii Texture (12-36 in.) Sandy, S � PS
Loamy, Clayey, (note 2:1 Clay) �, � U U
1 �
3) Soil Structure (12-36 in.) - S S
�Cla ey Soils PS'� � - � � PS
U U U U
4) Soil Depth (inches) - � S
PS � � � PS
� , U U U
,
5) Soil Drainage: Internal � S
. � PS PS
- U U U U
�
External �'' , S
� � � � �.PS
. U - - U U U
6) Restrictive Horizons __—„ �� °-.4 ` -
.
7) Availabie Space � S � ` �
PS PS PS
U U
8) Other(Specify) S � S ' S S
_ PS - PS PS
U U
9) Site Classification .
U—UNSUITABLE ITA ovisional{y Suitable
Recommendations/Comments:
Described by \��a,��y�.� Title � '�'� Date �2�
SITE DIAGRAM -
�
�
�� �
S
, _
• r
DCHD(6•82) . , . � �
Pazcel#: D70000014001 Page 1 of 1
���1�
Davie County, NC - Basic Estate Search �o����;`
' Davie County Web Site
Basic Search Real Estate Search Tax Biil Search Sales Search �
Vi�w Pro�er[v Record for this Parcel View Ma�for this Parcel View Tax Bil►Information
Parcel#: D70000014001 Account#:48898000
Owner Information Tax Codes
MCCULLOH DENNIS C ADVLTAX-COUNTY T
151 SOURWOOD LANE FIREADVLTAX-FIRE TAX
DVANCE NC 27006
Pro e Information Townshi
nd(Units/Type): 3.130 AC FARMINGTON
ddress: 151 SOURWOOD W
Deed Information Local Zonin
ate: 07/1991 Book: 00160 Page: 0064
lat Book: Pa e: �
le al Descri tion PIN
.14 AC OFF HWY 158 5861692382
Pro e Values
uildin : 265 58
BXF• 93 20
nd• 36 22
Market: 395 00
ssessed: 395 00
eferred•
Sales Information
No. Book Page Month Year Instrument Quat/UnQual Improved Price
1 00160 0064 07 1991 WD ualifled Im roved 2 000
View Pronerlv Record for this Parcel View Mao for this Parcel View Tax Bill Information
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All information on this s(te is prepared for the inventory of real property found within Davie County.Ali data is compiled from recorded deeds,
plats, and other public records and data. Users of this data are hereby notified that the aforementioned public Information sources should be
consulted for verification of the information. All informatfon contained herein was created for the�avie County's internal use. Davie County,
its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or
fmplied, in fact or in law, includfng without limitation the implied warranties of inerchantability and fitness for a particular use.
If you have any questions about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120.
1.5.9
http://maps.daviecountync.gov/itsnet/View.aspx?prid=1471737 6/15/2016