131 Ward Rd � ' � DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section �� 3./�/a�
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
� (33G)751-8760
Account #: 990003472 Tax PIN/EH#: 5850-17-1383
Bilied To: David Carmichael Subdivision Info:
Reference Name: Stephen Hungerford Location/Address: Ward Road-27028
Proposed Facility Residence Pro ert Size: see ma
ATC Number: 4004
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTR�JCTION
**NOTE** This Authorization for Wastewater System Construction MLTST 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 WASTEWATER CONSTRUCTION IS VALID FOR A PEWOD OF FIVE YEARS.
Environmental Health Specialist's Signature: li���/ Date: �/�/D Sf
CERTIITCATE 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. �./ g'rD
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Septic System Installed By: ,�„✓'/l�l sa�
Environmental Health Specialist's Signature: f�l,� Date: �
DCHD OS/99(Revised)
� � DAVIE COUNTY HEALTH DEPARTMENT �
, •
Environmental Health Section �
• P.O.Boz 848/210 Hospital Street �/�,/ ;
Mocksville,NC 27028 °
(33G)75]-87C►0
IMPROVEMENT/OPERATION PERMIT
Account #: 990003472 Tax PIN/EH #: 5850-17-1383
Billed To: David Carmichael Subdivision Info:
Reference Name: Stephen Hungerford Location/Address: Ward Road-27028
Proposed Facility Residence Property Size: see map
ATC Nurpber: 4004
**NOTE** Th�s Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater '
system. An AUTHORIZATION 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 #People �/ #Bedrooms� #Baths�_
Dishwashe� Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply�� Design Wastewater Flow(GPD)� Site: New I� Repair❑
/� ��
System Specifications: Tank Size .�AL. Pump Tank GAL. Trench Width�� Rock Depth� Linear Ft.��
Other:
As atatad in 15A NCAC 18A.19S9(5)
Required Site Modifications/Conditions: ���s���� ��4Gt1'i� ma�-8I;o b� u�ed
IR1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. R[SER(S) IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis
system between 830 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 .m.on the day of installation. Telephone#is(336)751-87G0.****
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Environmental Health Specialist's Signature: Date: �
DCHD OS/99( e � ed)
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. March 2, 2005
To Whom It May Concern,
This statement is to certify that Steve and Lorena Hungerford do hereby give permission to
Dave and Grace Carmichael to build a house on the property located at 3125 Highway158,
Mocksville,NC 27028.
Signed, �
�" J� dtCi-� -O{-�.J
���� ��
Steven W. erford Lorena L. Hungerford
Notarized`����„'�`' � J:
(/ W
•"�L`""' OFFICIAL SEA1.
� Notary Public,North Carolina
���
��fl!�
S�,�U� ,� COUNTY OF FORSYTH
��� STANLEY W;FJ NGEF�FpRD
My Commission Expires � �+� `(.�
� �� � • . � �KSb8PG198 �
. Q'�'7�0 3
Davie County,Nort Carolina
Excise Tax Paid $ - �j 4(7
Fl�ED FOR REGISTRP,?!ON
August 31, 2004 3:52 P.t•i.
DATE T!1iE
p��F�C�C�p AND RECORDFD IN BO�K 568 FAGF 798
M.BRENT SFtOAF,RcGISTER OF D�ED�
0�1"R�M4i..l�i�.irrr�.ar� DA�'i�MY ��1�`2�-�.��
/�YMIt�i11A� BY
eputy
Excise Tax:$ �75"d� Recording Information
Drafted by:Tamara A.Fleming,Attorney at Law.
. Mai1 to:Grantees @ I��� INCS�Gq,a4 ��,n/}Q,� �t, l-�;�J}�h'�G�.l��� n/� �o'Z'��0
1 ,�
TAX MAP: F-6, Pcl 2
WARRANTY DEED
LIiCILE H. YOITDT�
THIS DEED made this3ls�'day of August,2004,by and between�;;•,.,�; ; �. ;: .: :.; rustee
of the Clyde W.Young Irrevocable Trust,dated August 29, 1995; hereinafter referred to as the
GRANTORS, to STEVEN WILLIAM� HUNGERFORD . and wife, LORENA L.
HUNGERFORD; hereinafter referred to as the GRANTEES;
WITNESSETH:
THE GRANTORS,for valuable consideration paid by the GR.ANTEES, receipt of which
is acknowledged,have and by these presents do convey unto the GRANTEES in fee simple,all that
certain parcel of land situated (the "property") in Farmington Township, Davie County, 1�Torth
Carolina, and more particulazly described on attached "Exhibit A."
TO HAVE AND TO HOLD the property and all privileges and appurtenances thereto
belonging to the GRANTEES in fee simple.
THE GRANTORS COVENANT with the GRANTEES,that the GRANTORS are seized
of the property in fee simple, have the right to convey the property in fee simple, that title is
marketable and free and clear of all encumbrances, and that the GRANTORS will warrant and
defend the title against the lawful claims of all persons whomsoever except for the exceptions
hereinafter stated.
Title to the property is subject to the following exceptions:
Easements and restrictions of record.
• . • • � ' � BKSbB ,PGlq9 �
The terms GRANTORS and GRANTEES as used herein include the masculine and the
feminine,the singulaz and the plural,as the context requires,and the heirs, successors, and assigns
of the parties hereto.
IN WITNESS WHEREOF,the GRANTORS have hereunto set their hands and seals the
day and year first above written.
GRANTORS:
Clyde W. Young Irrevocable Trust, dated
August 29, 1995
By:
, a C'� - U EAL)
Trustee
******************************************************************************
NORTH CAROLINA
COUNTY OF
I,a Notary Public,of the aforesaid County,do hereby certify tha�UCILE H. Y��tee of the
Clyde W. Young Irrevocable Trust dated August 29, 1995,Grantor,personally appeared before me
this day and acknowledged the execution of the foregoing instrument.
Witness my hand and official stamp or seal, this,3�5�'day of August, 2004.
..�� —
��V H.�'M9Y C:'_ !
��` �=
(Notary Seal) - �°=
n.,a.c ir;
:•.�,.
��"'"��°`'��`� Notary Public
'�4,
iiihiFli.��`
My commission expires: 0���1�
********************* ** **********�****************************************
ise foregoing certi�cate�of 2�bnica �. Puckett, N�tarv P�lic of Forsyth Co�ty
�se certified to be correct. This instrument and this certificate are duly registered at the date
and time and in the Book and page shown on the first page hereof.
M. BRII�T SxC)AF Register of Deeds for Davie County.
By Q, -,�.�-�Deputyk�Register of Deeds
, .. • , , � B� 5b8PGa � �
EXHIBIT "A"
BEGINNING at an iron in the southwest corner of Joshua J. Richardson, DB 391, Pg.
539, said iron being located South 50 deg. 50 min. 35 sec. West 101.60 feet from an iron which
is further located South 50 deg. 49 min. 04 sec. West 198.78 feet from an iron in Joshua
Richardson's southeast corner and located in a 12' gravel road locally known as Ward Road;
thence from the POINT AND PLACE OF BEGINNING South O1 deg. 29 min. 37 sec. West
36.73 feet to a point in Hwy. 158; thence with the centerline of Hwy. 158 South 50 deg. 52 min.
00 sec. West 203.73 feet to a point; thence continuing South 51 deg. 56 min. 29 sec. West 102.61
. feet to a point: thence continuing South 53 deg. 44 min. 51 sec. West 86.98 feet to a point in the
southeast.corner of the herein described tract, said point being located North 83 deg. 46 min. 45
sec. West 291.:18 feet fram an iron in the northern line of Wachovia Bank& Trust Co., DB 94,
Pg. 782; thence with Wachovia's line North 83 deg. 46 min. 45 sec. West passing through an
. iron at,81�84.feet and 808:36 feet, for a total of 85836 feet, to a point in the centerline of Cedar
Creek; thence with the creek's centerline and continuing with the line of Wachovia Bank North '
35 deg. 09 min. 18 sec. West 51.25 feet to a point; thence North 63 deg. 16 min. 20 sec. West
89.72 feet to a point; thence North 84 deg. 32 min. 23 sec. West 82.94 feet to a point; thence
South 89 deg. 44 min. 09 sec. West 103.01 feet to a point; thence North 78 deg. 03 min. 14 sec.
West 89.46 feet to a point; thence North 65 deg. 54 min. 10 sec. West 24.98 feet to a point;
thence North 29 deg. 10 min. 42 sec. West 57.98 feet to a point; thence North 07 deg. 28 min. 31
sec. West 108.32 feet to a point; thence North 13 deg. 12 min. 46 sec. East 87.62 feet to a point;
thence North 11 deg. 18 min. 19 sec. East 34.06 feet to a point; thence North 45 deg. 30 min. 20
sec. West 27.09 feet to a point; thence North 69 deg. 02 min. 40 sec. West 73.72 feet to a point;
thence North 60 deg. 55 min. 15 sec. West 71.83 feet to a point; thence North 34 deg. 38 min. 02
sec. West 209.86 feet to a point; thence North 14 deg. 22 min. 51 sec. West 69.22 feet to a point;
thence North 17 deg. 34 min. 28 sec. East 60.09 feet to a point; thence North 46 deg. 18 min. 32
sec. East 111.54 feet to a point; thence North 32 deg. 20 min. 36 sec. East 123.29 feet to a point;
thence North 37 deg. 25 min. 09 sec. East 103.85 feet to a point; thence North 03 deg. 13 min. 09
sec. West 38.38 feet to a point; thence North 48 deg. 50 min. 17 sec. West 47.81 feet to a point;
thence North 06 deg. 30 min. 24 sec. West 198.57 feet to a point; thence North 10 deg. 52 min.
16 sec. 'vVest 101.78 feet to a point;thence witii the centerline of Sugar Creek North�1 deg. 16
min. 50 sec. East 51.58 feet to a point; thence North 03 deg. 52 min. 29 sec. East 86.34 feet to a
point; thence North 08 deg. 30 min. 21 sec. East 27.48 feet to a point; thence North 35 deg. 26
min. OS sec. East 92.60 feet to a point; thence North 44 deg. 55 min. 38 sec. East 103.59 feet to a
point; thence North 38 deg. 04 min. OS sec. East 69.02 feet to an iron on the east bank of Sugar
Creek; thence with the line of Ward Farm Associates, DB 407, Pg. 395, South 88 deg. 43 min. OS
sec. East 891.00 feet to an iron in the base of an 8" tree at a fence corner; thence continuing with
Ward Farm Associates South 12 deg. 29 min. 40 sec. West 858.00 feet to an iron axle; thence
continuing South 75 deg. 58 min. 12 sec. East 575.61 feet to the peak of a stone; thence South 75
deg. 58 min. 12 sec. East 84.39 feet to an iron; th�nce North 64 deg. 12 min. 39 sec. East 204.17
feet to an iron in a roadway locally known as Ward Road; thence South 02 deg. 17 min. 02 sec.
West 151.92 feet to a 41" willow oak tree; thence South 19 deg. 49 min. 47 sec. West 8.01 feet to
an iron; thence with the northern line of Joshua J. Richardson, DB 391, Pg. 539, South 19 deg.
49 min. 47 sec. West 195.92 feet to an iron; thence continuing South 45 deg. Ol min. 28 sec. East
. '. �.,�. � � B�c5b8PG801 �
88.48 feet to an iron; thence continuing South Ol deg. 29 min. 37 sec. West 236.44 feet TO THE
POINT AND PLACE OF BEGINNING, containing 52.120 acres,more or less, as surveyed by
Grady L. Tutterow, Professional Land Surveyor, on August 23, 2004. Drawing No. 20904-4.
Subject to easements and restrictions of record.
For back title, see DB 184, Pg. 618, and DB 77, Pg. 564, Davie County Registry. See
also Tax Map F-6, Parcel2, located in Farmington Township, Davie County,North Carolina.
. NO TITLE EXAMINATION REQUESTED OR PERFORMED.
z\my file\ta�real est.desc.�.Swicegood;T.Kyle�file#9002.10
+
. . � ( • � _^ �
(� �`�C1
(� V ICATION FOR SITE EVALUATION/IMPROVEM1tENT PERMIT&AT 0�
OV� � Davie County Health Department � ��' ��� ; �
2 p� �-�� Environmenta/Hea/th Section �� �S l-� ��'
�P� P.O. Box 848/210 Hospital Street � e � /,�
��11 Mocksville, NC 27028 , �� 1�('/ �,is'
0�,��(�U�y (336)751-8760 ��' ��
E
***IMP *** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
TION IS PROVIDED. Refer to the INFORMATION BULLETIN for ins�ructions.
1. Name to be Billed �_� 1'1 V 1� �`�'1►\�`\�����lc�,�, Contact Peraon ����'S��.,�
Mailing Addresa _1�•�•�� ���'� Home Phone � (� �'��'�'0 p��j
City/State/ZIP l-,�,:��i 5�t l,l,� N"� 'Z.��r�.3 Buaine3s Phone ' 3� <o-SS-o �� �
�
• 2. Name on Permit/ATC if Different than Above G
Mailing Addresa City/State/Zip
3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both
4. system to service:�House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. Type aystem requested:�Convantional ❑ conventional modified ��l4no��ve
6. 2f Rasidence: # People �� # Bedrooms -��� � Bathrooms y_
�Dishwasher ❑Garbage Disposal �Washing Machine ❑Basement/Plumbing ❑Hasement/No Plumbing
7. If Husinesa/Induatry /Othor: verify type # People # Sinks
# Commodes # Showars # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallona per day)
S. Type of water auppiy: ❑ County/City � Well ❑ Community
9. no You anticipate additions or espansions of tlic facility tl�is system is intcnded to scrvc? 0 Ycs ,�1 No
If yes,�vl�at typc?
�, ***IMPORTAN7"`**CLIENTS�11UST COAIPLETE TIIG REQUIRED PROPGRTY INrORMAT[ON RCQUGSTGD
- BELOW. �ithcr a PLAT or SITE PLAN MUSTBESUBNIITTED by thc cl(ent with TIIiS APPLICATION.
Property Dimensions: �� L�X � � '_� X � 1`�k �� ti tiVRITE DIRGCTIONS(from MocksviUc)tu PROPGRTY:
Tax Offic �Ic NP`.^ # ��g 5� �� �- 13 �' -3 U.�.N vJ�`r �`_��� ����i v 1+�'i��� �1�
�.e�—��✓e,�:. .�
Property Address: Road Namc �1 �`�1 ��C�F�� �
1 �
City/Zip 3
r-�
If in a Subdivision providc information,as follo�vs: ,����
Name: ' �"P�"�'
I � v �
Scction: Block: Lot: Datc homc corncrs IIagged: /. ,` � `�
Tliis is to certity tl�at tlie infoni�ation provided is corrcct to tl�c bcst of nry Icuo�vledge. I undcrst�nd tl�at any permit(s)
issue� l�crcaftcr are subjcct to suspcnsion or revocation,if tl�c sitc plans or intcndcd usc cliangc,or if tlic information
submitted in this application is falsificd or changed. I,also,uir�lerstn�r�l tllat I aui respo�1siGle for al!cliarges i�tcrured front
this applicatiou. I,hcreby,givc conscnt to tt�e Autl�orized Represcntativc of tlie Davie County IIcalth De��n�rtmcnt
to entcr upon above described property located in Davic County and o�vned by ����j�P� -_�_r-►crR� �c��
lo conduct all testi��g procedures as necessary to determine the site suitability. ����
` � 1
DATE �—'�'�—� s SIGNATUI2� 1 1 '� '� � C.Lv�1�'�v�-��Cf��
THIS AREA MAY B�US�D rOR DRA�VING YOUR SIT�PLAN(Includc all of tlic followiiig: Existing and proposcd
property lines and dimensions, structures, setbacks, and septic locations).
� /�� Sitc Rcvisit Cl�argc
i (�
Dntc(s):
� �/����-- 1 � �
� L�'� i` - Clicnt Notification Datc:
� �
EFIS:
' ���
-�S ��C ��-�-�'-�' 3- ��-�---
Sign given � Account No.
Revised DCHD(OS/03 ��'�, � � Invoice No. �� /
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, • , DAVIE COUNTY HEALTH DEPARTMCNT
Environmental Health Section
Soi]/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003472 Tax PIN/EH#: 5850-17-1383
Billed To: David Carmichael Subdivision Info:
Reference Name: Location/Address: Ward Road-27028
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Proposed Facility: Residence Property Size: see map Date Evaluated: f���,/�I�-S
Water Supply: On-Site Well; 1� Community � Public
Evaluation By: Auger Boring � Pit Y Cut
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FACTORS 1 2 3 4 5 6 7
Landsca e osition � .�. L-
Slo e% � � ��
HORIZON I DEPTH �- , �� -> " �- �� o /
Texture rou � sC� .,L c` , ..�G
Consistence
Structure
Mineralo
HORIZON II DEPTH �,1 �• �, '�)'' =� /, , -• �i
Texture rou C' �=-- C'
Consistence ' l �
Structure � ; 1 / /.�!"
Mineralo �' -/ ` '/ � .�
HORIZON III DEPTH �� �' °i
Texture rou
Consistence �
Structure �
Mineralo
HORIZON IV DEPTH
Texmre rou
Consistence
Swcture
� Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION (,
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY: ,��.t3 �/
LONG-TERM ACCEPTANCE RATE: - OTHER(S)PRESENT:
REMARKS: � �� ��� ` � � l�
LEGEND �
Landscape Position
R-Ridge S-Shoulder L-Linear siope FS-Foot slope N-Nose slope
CC-Concave slope CV-Convex slope T-Tenace 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-Ex[remely firm
Wet
NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
tructure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineraloav
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) I
LTAR-Long-term acceptance rate-gal/day/ft2 , '
/
DCHD OS/99(Revised)
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ENVIRONMENTAL HEALTH SECTION�
P. O. Box 848/210 Hospital Street
' Courier #09-40-06 ,
Mocksville, NC 27028
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�, ,� n�,� ; Phone # (336) 751 8760 .
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February 2, 2005 �'
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Mr. David Carmichael � � eN
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P.O. Box 434 �,�
Lewisville,N.C. 27023 �
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Re: Site Evaluation/Ward Road ��
Tax Office PIN: # 5850-17-383 ,�
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Dear Client:
As requested, a representative from this office visited the aforementioned site on
January 31, 2005. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
unsuitable for the installation of an on-site sewage system.
The reasons that lot 53 is not suitable are : .1941. Soil Characteristics
.1942. Soil Wetness
.1943. Soil Depth
.1944. Restrictive Horizons
.1945. Available space
If you have any questions,please feel free to contact this office.
Sincerely, ,
��,:����,/,,``��,' -
Robert B. Hall, Jr.,R.S.
Environmental Health Specialist
.4 '
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$.%-.sr..m..�me. �iu-�.�:�,:.-'.R:`.da�'w�" ^ea�
� � � � ENVIRONMENTA� HEALTH SECTION �
P. O. Box 848/210 Hospital Street
' Courier #09-40-06
Mocksville, NC 27028
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` ''� '�� ,Phone # 336 751 8760�� "
� x_ ,.��,...�.'��a_ ��_�x����,,�.w.�����.��.� ��.... ._ _. .�....�_ ��.) . . _.. .��._�..��,.�� . �..,�....,�....w����m�.���
February 2, 2005
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Mr. David Carmichael .,� d'� � n �
P.O. Box 434 S � �`1 v
Lewisville,N.C. 27023 j� //� `�
l
� � �
Re: Site Evaluation/Ward Road ; ���
Tax Office PIN: # 5850-17-383
Dear Client:
As requested, a representative from this office visited the aforementioned site on
January 31, 2005. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
unsuitable for the installation of an on-site sewage system.
The reasons that lot 53 is not suitable are : .1941. Soil Characteristics
.1942. Soil Wetness
.1943. Soil Depth
.1944. Restrictive Horizons
.1945. Available space
If you have any questions,please feel free to contact this office.
Sincerely,
��'�`����• �
Robert B. Hall, Jr.,R.S.
Environmental Health Specialist
, � .
. �
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