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1215 Underpass Rd � , � DAVIE COUNTY HEALTH DEPARTMENT - - -s Environmental Health Section , , P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 Account #: 990004015 Tax PIN/EH#: 5881-32-4585 Billed To: Ernest Hall Subdivision Info: Reference Name: Location/Address: Underpass Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4446 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSiJED 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 CONS 6 S V LID F PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: Date: 0� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on ImprovemendOperation 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. ��` ,���1 -------- �"` wa`"' w f �• , , `• 1 ��-� �,, c� ���� � �. , . �� � ; � rN ., �1 �%�a �� ` ��y a i, ������.� GL>a� P� �,� .� G � 2> �P 1�G� �,,�' i.cu.1 k � �t ��� � s� � � 3�' .tl i'�Soa Septic System Installed By: � �-" � 1�'�� Environmental Health Specialist's Signature: Date: D� DCHD OS/99(Revised) . DAVIE COUNTY HEALTH DEPARTMENT � ' •! ' -, Environmental Health Section , � P.O.Boz 848/210 Hospital Street � Mocksville,NC 27028 � �p ' " (336)751-87(0 I�`6` ��, IMPROVEMENT/OPERATION PERMIT Account #: 990004015 Tax PIN/EH#: 5881-32-4585 Billed To: Ernest Hall Subdivision Info: i21S Reference Name: Location/Address: Underpass Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4446 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An AIJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type '�3bU��� #People_� #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 I �� Type Water Supply��1 1 Design Wastewater Flow(GPD) ��� Site: New�Repair❑ System Specifications: Tank Size ���GAL. Pump Tank GAL. Trench Width �(o�� Rock Depth iJ � Linear Ft.��� Other: l .L)�c,� KI��(l�l�l�� . ,���--`��� ��� KC�J��,���/�cS'ivr�' Required Site Modifications/Conditions: _ LL .� C�:�3`tZ`�t,2- ��J�C7F� � �'� �� � .l� 11�1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6" BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to 1:30 p.m. on the day of installation. Telephone#is(336)751-87G0.**** � ���1���"�� �1 � � �NIS �-�-1G�'�t��Z �' � �� �,,�1'�11��NG-� 1/�C�1� c� � � � � d. _ . S ..,� i- 3 � �- �� � � � � � G� ��,����NC�-� �� � �p ��,, ��� � �� �' �� `0�1 � b ����l� � .- , , ,, �.� a'(��� � � s�.,�' �2� �,.� . �� d� ' Date: 110� l (��:.'`�. �,��+���S0 fi� DCHD OS/99(Revised) j{ n . � �.��,� . . ' ` • Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Improvement Permit Ernest Hall 1138 Underpass Road Advance,NC 27006 Re: 1 Acre Tract/Underpass Road Tax PIN#5881324585 Dear Client(s): This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the conshuction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve: l �L'Wastewater Design Flow(GPD): �(� Valid: �Years ❑No Expiration System Type: ❑Conventional I�Accepted ❑Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions: Site Plan ' G � 4i � � � (� � ( � � p� ��Z I � d I I p � U'� ��} VijJ I �/ �r jQ A- ( � Q �� �`� � � '" —i �j R► � �i � � ➢ I � � ►5 , — �, � U �--�2��� --� 3� �'o -Zc�'�' ''7 Envi a S ec' 1 t. Da e i.p.letter 7/06 Feb 28 06 1,0: 17a davie county envhealth 336 751 8766 p. 3 . . • • �� � � r `� � ' ..,....� .. �fM � ' �APPLICATIO�T FO'�} :��'�, EVALUATION/IM1�ROVEMENT PERMIT &. ATC � ���-'�. , ':, ; � � U ��-�-�� a � County Health De�:�artment , �._�.. . ��"' '��"��+ �� ironmentatHealth .!;ection :. � �'' ;`�i. �_ � + 06 . . Box 848/210 Hospitfil.Street , i����' ,�� �Z 0 20 Mocksville,NC 2'70 2;8 . �� '� " (33 '751-8760/Fax(33�1!i1-8786 Applicario For: ❑ S' u���ptiJ�iFYt�roveme ermit ❑ Authoriz2.:ion To ConstrucC(A'1'C) 3�"Both �p� � � �+,� ***IMP TAN7*"""T � ICA'TION C.4NNOT BE PROCESSED i:`7LESS AI.L OF TH E REQiJIRED INFORM TIO�Li OVIDED. R<•fer to the INFORMATI�N BULLE A:[N for instructions. APPLICANT 1NFORMATiON Name to be Billed �� __ Co��.tact Person Billing Address p�� • H ame Phone �°" City/State/ZIP__�����r��� � 2'7D0� Bu siness Phone_'_ � Name on Permit/ATC if Di,fj`'erent tlYan Above Q'17�► Mailing Address City/S9fite/Zip PROPERTY IN7�ORMATION Nv"fi: r��urvC _ a,, r...,..,�•.�,.rmm�an /���� � C""' Y p;s:c.c:._�;.-----•:.�... ,y this appliCation. (Permit is vali for 60 mont s}�r�th site plan,no expiration with i plete plat.) Street Address �,Br L�SS �U. City ;. . (�Q�(/(� Tax PIN#��� � Subdivision Name Sectign/Lot L t ' Direct' ns To Sitc;: /1 / Date House/Facility Corners Flagg�:d • • If the answer to any nf the followu�questions is"yes',supporting docume�;tatio must be attachud. Are there uny existing wastew�iter systems on the site? L]Y::s o 1Joes the site contain juris�lie:lonal wetlands? r1Y�;s o Are thcre any easements or ril;ht-of-ways on the site? OY�:s o Is the site subject to appro�•al by another public agency7 ❑Y�:s o Will was[ewater other than dcmestic sewage be gcnerated? pY•:s o IF RESIDE B FILL OUT TH.E:BOX ELOW #People E #Bedic>oms #Bathrooxns� �"D Ci�arden Tub/Whirlpool C]Yes o Basement: Yes �;No B��ement Pluinbing: QYes �To —. �_.. IF NON-RESIDENCE FILL QL1T THE BOX BELOW Type of Facility/Business . Total Square Foo•:age of Building_ #People #Sinks #Commodes �.#Showcrs #Urinals Estimated Water Usage(gallons p�.r day) (Attach doc;umentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type syste�i requested: OCoavcntionsil C:lAccepted ❑Innovative OAIt:icnative rlOther Water Supply Type: County/City V�'ater C]New Well flEr isting Well O Community Well Do you anricipate addirions or expansions o£the facility this system is inteaded to serve7 U Yes �No If yes,what type? _, _ This is to eertify tliat the informati�n•�rovided on this application is true at�ct correct to the best<�f my knowledge. I understand that any persnit(s)or ATC(s)issued herea!�[er are subjeet to suspension or revoc:e�ti�n it'the site is altcred,the intended use changes,or if the infom�ation submitted in this arplication is falsified or changed. I und�:�stantl that I am responstble for a11 charges ir:currect from this application. I hcreby grant cight of entry to the Authorized Repre=;entative of the Davie County Health Department to conduct necessary inspections Yo dete[mine compliance with applicable lar.;s and rulcs on the abuve described property located in Davie County and own�ed by'� ,_. � Site Revisit Charge ' Property owner's or owner's le 1 represen ative signature . � � Date(s):_ Clieni Noiification Date: te LHS:^ o f Sign given pYe� ONo Account# Revised 2/06 Invoice# • � � • ,t • DAVIE COUNTY HEALTH DEPARTMENT � . Environmental Health Section � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION �� Account #: 990004015 Tax PIN/EH#: 5881-32-4585 Billed To: Ernest Hall Subdivision Info: Reference Name: Location/Address: Underpass Road-270 6 Proposed Facility: `Residence Property Size: see map Date Evaluated: . � Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �Pit� ± Cut FACTORS • 1 2 3 4 ' S 6 7 Landsca e osition Slope % �j� ' HORIZON I DEPTH (S - 1� -�'Z . � v,- p Texture rou ;_ LL '�L CL Consistence �55. � S Structure � Mineralo � HORIZON II DEPTH � p- Texture rou � J G Consistence . Structure Mineralo HORIZON III DEPTH Texture rou <, L' 1. Consistence F- Structure - Mineralo HORIZON IV DEPTH Texture rou � ��' Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION �N • .- a� LONG-TERM ACCEPTANCE RATE Q , , `� SITE CLASSIFICATION: EVALUATION BY: �� �� �`/ ' LONG-TERM ACCEPTANCE RATE: c cY OTHER(S)PRESENT: x�M.�ucs: ..s�.1� �eC� ) ..1 ti''Vt�12-Y kf���,'� LEGEND , T,andsca�e 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 � 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 .ONSIST .N . . 1��415� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm ��'e.t ' NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic ,S.tT1i�YuI'� SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�v 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/OS(Revised�; �� ■��■�����■��■���■■■■\�■■■■■■■■�■��������������1��\■���������■■�■��■ ■�■■�■■����■�■■■■■�������■�����■ ■■■�■�■����1��������■■■■■■��■■��■ ■��■�■■■■��■����■�■�����������■��O■■■■■■■���11■�■■■■����■���■���■■ ■■■■������■��■■■■�■��1�������������■i■��������11��■��■�■■���■■■■■■■■ ■■■���■■■■■�■■■�■����tGi���■�■■��■■�■�■�■■■��11■�■��■■�■■��■�■�■■�■ ■■■■�■■■■�■���■�■��■l!9�]��■�■�■■IA'rl�■�■�■■■■��■11��■�■■■�■■��■�■���■■ ■�■■��■■■■�■��■�■�■�■�■�■�����■IIl�1r9�■■■■■■��■11��■■�■■���■�■■��■■�■ 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■�■���■�■���■��■�■�■■■■��■■�■������■■■��������■��■■■�■��■��■�■��■■ ■�■���■��■������■���■��■�����■■��■■�■����■��■����■■������■■��■��■ ■�■�■�����■��■■�■■�■■■����\����■ ■����������■�■���■■�����■�■�■��■ ■■��■����■■\������■■���■�����■■�����■����■■■■■■�■���■��■■����■■�■■ ■■��■���■■�■■��■■�■�■■�����■■�■�■����■��■�■��■■■■���■�■■�■�■�■�■�■ Certificate of Survey I, Donald J. Moore, certify that this plot was ! drawn under i from (an actual field ary ) —�Mat the boundaries not surveyed are Oa� shown as broken Iirm plotted from infomtatbn fond N C G S "UNDERPASS" 1990 in Bode AnPoup"a that the ratio of precision as calculated by iotihdes and depatures is 1: 10,000; X=1,582,251.71 4' o� ft plot ua° preWed h ocaardmve 'nth G.S. 47-30 Y=811,869.689' ; 4- as my or sgnaftu�egstrrobw nxrnber and SPC 1983 / / @� sed �N o . , �. , �C C ARN P P 801 seveyor— IR Sl TE L-3482 NC V r Registration Number O `O ECM .tK 0 / ERNEST T HALL. EDITH HALL& WIFE 6 Q` �O 8p69�34S,�L �p r'� �h� �� • � � DB 168, PG 196 I, Donald J. Moore Professional Land Surveyor Vicinity Ma Nol_H�_ certify to one or more of the following as '�j not to scale irydicoted thus, [X]: CP ['r] A. That this plat is a survey that creates a subdivision / t 9p of land within the area of a county or municipal- ity that has an ordinance that regulates parcels 0 0' p of land; ^.j` �p .- [ ] B. That this plat is a survey that is located in such C IR / portion of a county or muncipolity that is unregu- (/U LOT 1 loted as to on ordinance that regulates parcels of 1.000 Acres. \ land; _ / ,( 43560 Sq.ft j ) C That this plat is of a survey of an existing parcel or porcels of land; D That this plot is of a survey of another category, o such as the recombination of existing parcels, a \ Court-ordered survey or other exception to the Z O yy definition of subdivision; [ ] E That the information available to this Surveyor is CON such that I am unable to make a determination Uj COR R to the best ppf my professional abilityas to pro- \ EAI T ions contained in (A) through (Dabove `r ! I �' , , ! ��0 NIR QT4eyor Dote Sz0•�0 LINDA H. BERRIER & HUSBAND, 6O �� N O T E S ROBY G BERRIER tK New Iron Pins set at all new corners DB 167, PG 892 tx unless otherwise noted. This plat is subject to any Easements, Agreements, or Right-of-Ways of record prior to the date of this plat, which was not visible at the time of the survey. 1 (we) hereby understand that this plat is approved as exempt from the Subdivision Ordinance of County. This is a fornly subdivision and is for the exclusive purpose of conveying land among family Davie County Zoning: R-A merrbws within the third degree of lined kinship. These lots/trocts shill not be used for the purpose of sale or budding development, either now or h the future, except for those famiy members. Addtfonal NIR All lots to be served by individual private septic systems approvals may be required by Davie County or its successor agency before any subsequent sal �d e or txing All utilities shall be installed underground development may occur. Total number of Lots created is one Total area = 1.000 Acres. ! ! Property is not located in a special Flood Hazard Area t designated on the FEMA community flood panel Owner(s) Date \ Property is not located in a protected Watershed Area. 1 further acknowtege that my lined family mernbers who wll be conveyed the newly created far,ly tots are: � Building Setbacks per Davie Co. Zoning: 1.) E 11` V 11-411 � A I L I �utj 071 )r Lot N Minimum Front yr rd: 40 feet Minimum Side yard: 15 feet Minimum Rear rd: 30 feet (Name) (Relationship) Underground utilities may exist which were not visible at the time of the survey. NC-One-Coll 1-800-632-4949 should be contacted before any ground disturbing activity APPROX. 82 ACRES No Approves Re(lood by the Davie County Planning Department. REMAINING S to ChairTnon, County Plarining Board ,,6'�0�, Certificate of Ownership and Dedication I (We) hereby certify that I (We are) the owners) of the property shown Q' and described hereon and thot I (We) hereby adopt this plan of subdivision �1 1.000 ACRE with my (our) free consenir t. establish rtirrun building likes, and dedicate all NEW L 0 T streets, alleys, walks, parks, and other sites to public or r private use as \� noted Further, I (We) certify the land as shown hereon is within the subdivision jurisdiction of Davie Canty. LEGEND i r < `� 0 ECM existing control monument 4 Aj_ 1 ' -. l • new iron rod (set this survey) Date Owner O CP computed point (no point set) AN E J existing ongle iron Date Owner MB.L. minimum building line R/W right-of-woy Owners: REMAINDER DETAIL Ernest Hol 1138 Underpass Road NOT TO SCALE CCORNER ONTROL Advance, NC 27006 EAI (336) 998-4057 nd Farrdy Subdvdw Plat for: PIN. DAVE COMITY 4o feeiiilio survey By: Moore Land FLED FOR REGISTRATION AT oa 'CLOCK — M. Review Officer of Davie County Donald J. Surveyor Ernest T. Hall & wife Edith Hall F80000014001 certify athe map or plot which D.J.M. Ptd � - 200 AND REGISTERED N PLAT BOOK tifthat lt tLand Surveying, Mapping, Subdivisions, this certificotbn is affixed meets all DMg. By: Underpass Road D.B. Ref. PSE Shady Grove Township, Davie County, North Carolina statutory requirements for recording. P.O. Box 2281. 130 NC Hwy 801 South, Advance, NC 270% DB. 168, PG. 896 M. BRENT SHOAF, REGISTER OF DEEDS D.J.M. Phone: (336) 998-01.0,0 Fax= (336) 996-4998 Ratio of Precision: Review Officer Date Fie No.. WWW.Carot1aSurVeyor-com Scale 1" = 50' Date: 41/16/06 11:10,000 ASSISTANT/DEPUTY 0066DA06 Copyright ©2006, Donald J. Moore, P.L.S., L-3482 N.C. � ' Underpass Rd. � � . 34'-11 7/8» � • � J J p � 5' � C � � � � � 11 ,� �■ �U �� • y � o � NR Building And Desgin, Inc. Q � �c�c. s�s9s � 3524Yadkinvill Rd. � PMB#312 Winston-Salem NC 27106