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184 Westridge Road Lot 43 OPERATION PERMIT F6- tv "ice se n Davie County Health Department *CD Number 136836-1 210 Hospital Street ' I=s-1110-co-o2 P.O.Box 848 uinber. Mocksville NC 27028 Evalubte- d Far: EXPANSION Phone:336-753-6780 Fax:336-753-1680 Township-- F ownship-- Applicant: Robert Stone Property Owner: Laity Wood Address: 113 Drum Lane Address: Cay: Mocksville Cay: State2ip: NC 27028 'State2ip: Phone#: (336)998-4733 Phone#: Property Location & Site Information rdress/Road #: Subdivision: Phase: Lot: 43 184 Westridge Drive Advance NC 27006 Directions Structure: SINGLE FAMILY 140 East exit Hwy 801, Bermuda Run Exit#180 tum right,. Stay on Hwy 801 tum left on Hillcrest, then i*of Bedrooms: 3 eight on Westridge. #of People: "Water Supply: PUBLIC *IP Issued by. *System Class ification/Description: TYPE it A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPA OR LESS) 'CA issued by: 2140-Nations,Robert SaproliteSystem? OYes dNo Design Flow: 3 6 0 GRAVITY-SERIAL Pump Required? 'Dist QYes (DNo Soil Application Rate: 0 3 *Pre Treatment: Drain field rNonDratin can Field 1 2 0 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD Lines 5Installer: Brin McDaniel A Total Trench Length: 3 0 0 It. Certification#: 1118 Trench Spacing: 9 Inches O.C. — &Feet O.C. *EH S: 2140-Nations,Robert Trench Width: 3inches &Feet Date: 0 4 / 1 7 / 2 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 _ Inches Minimum Soil Cover. a 4 Approval Status Inches Maximum Trench Depth: 3 6 ® Approved❑ Disapproved Inches Maximum Soil Cover. 4 Inches �36836- 1 E84110-CO-034 . CDP File Number County ID Number: Septic Tank Manufacturer. Lat. STB: Long: Gallons: Instaer. Date: Certification#: *EHS: *Filter Brand: ST Marker. ❑ Yes ❑ No Date: r Reinforced Tank: C] Yes 11No % %ApprovalSatus t Piece Tank: ❑ Yes ❑ No 'i❑,Approved C1�DIsap��oved�� Pump Tank Manufacturer. Installer. PT: Certification#: Gallons: *EHS: Date: / / Date: RiserSealed ❑ Yes ❑ No ----------------- RiserHeight: ❑ Yes ❑ No (Min.6 in.) 71' forced Tank: ❑ Yes ❑ NO D Approved❑ E}Isapproved Piece Tank: ❑ Yes ❑ No d ��� y %� Supply Line Pipe Size: inch diameter installer Poe Length: feet Certification#. *Schedule: 'EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No 3 Approval status f �,� �❑ Approved❑�I�Isapprove�f Pump Requirgment Pump Type: Installer. Dosing Volume: - Gai Certification#: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Status PVC unions ❑ Yes ❑ No "r"C& idlTiDliappraued Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No 36836 - 1 E8.11 10-CO-024 CDP Pile Number County ID Number: Electric Equipment NEMA4XBoxorEquivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade E] Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: - Alarm Audible Approva[Stotus �� j ❑ .Yes ❑ No ❑ �►p�roved❑�arsappr��ed, AlarmVisible ❑ Yes ❑ N o r� 2140-Nations.Robert *Operation Permit completed by, Authorized State Agent: Date of Issue: 0 4 1 7 / 2 0 1 4 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A,Rules for Sewage Treatment and Disposal,15A NCAC 18A A900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE If a sewage septic system. Rule.1961 requires that a Type JYPE 11 A septic system meet the following criteria: Minimum System Review By The Local Health Department: N/A Management Entity: OWNER Maximum System InspectionlMaintenanceFrequency ByCedified Operator: N/A Reporting Frequency By Certified Operator. NIA Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywth a certified operatoror a private certified operator forthe life of the septic system. Rule.1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator forthe life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** °t OPERATION PERMIT 136836_ .i Davie County Health Department CDP File Number: 210 Hospital Street E8-1110-CO-024P.O.Box 848 County File Number: Mocksville NC 27028 Date: �> Q Inch Scale: . (�Bbck ft. DrawingDrawing Type: Operation Permit 08lo I e 0 T\-111 7-7 ------ - . 11 17 I CONSTRUCTION For office Use Only `i AUTHORIZATION *CDP File Number 136836-1 Davie County Health Department E8-1»0-C0-024 tY p County ID Number: f` 210 Hospital Street Evaluated For: EXPANSION P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 3 / a 6 / a 0 1 9 Applicant: Robert Stone Property Owner: Lary Wood Address: 113 Drum Lane Address: City: Mocksville City: State2ip: NC 27028 State2ip: Phone#: (336)998-4733 Phone#: Property Location & Site Information Address/Road #: Subdivision: Westridge Phase: Lot: 43 184 Westridge Drive Advance NC 27006 Directions Structure: SINGLE FAMILY 140 East exit Hwy 801, Bermuda Run Exit#180 turn right. Stay on Hwy 801 turn left on Hillcrest, then right on #of Bedrooms: 3 Westridge. #of People: `Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally Suitable 71nchesMinimum Soil Cover. 1aSaprolite System? OYes QNo Design Flow: 3 6 0 Maximum Trench Depth: 36 Soil Application Rate: 0 3 Maximum Soil Cover: a 4 Inches "System Class ification/Description: 'Distribution Type: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons `Proposed System: 25%REDUCTION 1-Piece: OYes QNo Pump Required: OYes QNo OMay Be Required Nitrification Field 1 a 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 4 1-Piece: OYes " ONo Total Trench Length: 3 0 0 ftGPM vs— ft. TDH Trench Spacing: 9 Peet O.C. g nches O.C._ Dosin Volume: Gallons Trench Width: Inches 3 8Feet Grease Trap: Gallons Aggregate Depth: - - - " inches Pre Treatment: ONSF OTS-I OTS-II Septic Tank Installer Grade level Required: O I OII O 111 O IV Page 1 of 3 CDP File Plumber 136836 - 1 County ID Number: E8-1110-CO-024 ❑ Open Pump System Sheet Repair System Required:OYes ONo ONo, but has Available Space rDesign System Trench Spacing: ( Inches 0. ification: Provisionally Suitable — 9 4. Feet O.C. Trench Width: Q Inches w: 3 6 0 3 Feet Soil Application Rate: 0 Aggregate Depth:- 3 inches Minimum Trench Depth: a 4 Inches 'System Classification/Description: TYPE 111 B.SYSTEM W/SINGLE EFFLUENT PUMP Minimum Soil Cover. 1 a Inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Nitrification Field 1 2 0 0 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 4 `Distribution Type: GRAVITY-SERIAL Total Trench Length: 3 0 0 ft Pump Required: OYes ONo OMay Be Required Pre Treatment: ONSF OTS-I OTS-II 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7: 'Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. elf 2( This Authorization for wastewater System Construction shall bevaild for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued at the sametime the Improvement Permit Issued(NCGS 130A-336(b)} If the installation has not been completed during the period of validity of the Construction Permit,the information submitted In the application for a permit or Construction Authorization is found to have been incorrect,falsified or changed,or the site is altered,the permit or Construction Authortzation shall become Invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance6 monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps.Signature- __ Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 3 / a 6 / a 0 1 4 Authorized State Agent: Malfunction Log OYes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 136836 - 1 Davie County Health Department CDP File Number. 210 Hospital Street E8-1110-CO-024 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 3 / a 6 / a 0 1 4 p�. Olnch DrawinE Drawing Type: Construction Authorization L Scale. OBiock i J-11 -L Paae 3 of 3 • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC "CEIVED Davie County Environmental Health D pA P.O.Box 848/210 Hospital Street ue; Mocksville,NC 27028 W laatat (336)753-6780/Fax(336)753-1680b C # Application For: ❑ Site Evaluation/Improvement Permit ❑ Autho Wtion To Construct(ATC) ❑ Both O3 Type of Application: ❑New System ❑Repair to Existing System &Wxpansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name 1 C a `�� c5 Contact Person Address 1 sof Home Phone 3 3 City/State/ZIP Mo l�S V J k L, ti �J C Z 70 O 0? Business Phone Email :SI ,< �/ Q 1 t ✓1 e Name on Permit/ATC ifDiffe ent than Above 161 H C x'743 r4 v Mailing Address t l D R 0 M City/State/Zip Yyj ac J1 S / C C c IJC Z. 7bC PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name Phone Number Owner's Address ,Q, City/State/Zip Property Addpss City Lot Size ?� Tax PIN . Q QZ Subdivision Name(if applicable) Section/Lot# o/0-1 Directions To Site: Specify Problem Occurring: IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No BasementJL bing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW . Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats i Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: a<ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating a aggin mg the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge PropertyOwner's or owner's legal representative signature Date(s): 11 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# /✓�o 51(0 Revised 11/06 Invoice# DAVIE C:UUNI'Y KEALrti Jr.YAK1mL'IY1 , (Septic Tank) Improvements Permit and Certificate of Completion (ter" o"u d Absorption Sewage Disposal System - G.S. Chapter 130-Article 130) /NER OR CONTRACTOR 7, rrn . kR...j 4e t.s DATE sZ la 17 7 PER frT iOCATION �,�p 5 Qaa�Q • �� N 3 S.R. NO. SUBDIVISION NAME U1Gst r-;i)G'f LOT N0. SECTION OR BLOCK N0. .1 HOUSE d MOBILE HOME 0 BUSINESS ❑ • House Trailer 800 Gal. 400 Sq. Ft. . NO. BEDROOMS NO. BATHROOMS Two Bedroom House' 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ['' NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO, DISHWASHER YES Q^ NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES Er NO ❑ a 9 ;W(,Q C`'eve rrir?'w l SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK Mob gal. 4z&94 4 0 NITRIFICATION FIELD __ sq. -ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT .BY . MIA,& INSTALLED BY 19 661 CERTIFICATE OF COMPLETION By Date��/--fie?� �,�_ (8/16/73) *Construction must a with all other appl ca a State and local regulations LOT AREA • ' C1Scy-lPt C'•caw~ 1Y}� A.a CZ L oa�nl* ane 12V e -Al • � 4 i • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION _ PROPERTY INFORMATION CDP# 136836 Parcel# E8-110-Co-024 fo: I Robert Stone Westridge 5s: F' Septic Expansion 184 Westridge Drive Date Evaluated: r' i i Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 1 7 Landscape position 1 Slope % HORIZON I DEPTH Texture groupI Consistence Structure ! I Mineralogy HORIZON II DEPTH 1 Texture groupI Consistence i I Structure I Mineralogy i I HORIZON III DEPTH Texture group . Consistence I Structure i Mineralogy HORIZON IV DEPTH r Texture groupi Consistence I Structure i Mineralogyi SOIL WETNESS 1 RESTRICTIVE HORIZON SAPROLITE i CLASSIFICATION f LONG-TERM ACCEPTANCE RATE i SITE CLASSIFICATION: EVALUATION BY: I LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope 1 CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S -Sand I-S7 Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SII.-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay `; SIC-Silty clay , C-Clay ON4IST .N .E . 1!.'14151' VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm i NS-Non sticky !! SS-Slightly sticky . S-Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic j Structure SC-Single grain' M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:11 Mixed Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) i 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-Lone-term accentance rate-val/davM2 rerun nvnc(ID—A-4% I 3 b 1 I, George Robert Stone, certify that this plot was drawn under my I,George Robert Stone,Professional Land Surveyor,L-3162,certify to one 141 supervision from an actual survey made under my supervision (deed description of the following as indicated thus, ® or �. STATE OF NORTH CAROLINA Filed for registration at o'clock M recorded In Book *, Page _, etc. ) (other): that the boundaries not n / lr sur veyea are clearly Indicated as tlr awn from Int area(ion tountl in Book o. That this plot is of a survey that creates a subdivision of land within COUNTY OF DAVIE �ttA A CA �1'_ ��t, ?a Page • that the rot to of prec Islon a1, calculated Is 1 0,0001, that this the area of a county or municipality that has an ordinance that �Y�O M4' 201—TF— and recorded e�.o plat was prepared In accordance with G.S. 47-30 as amended. witness my original regulates parcels of land; River Road S � signature, reglstrotlon number and seal y • I, Andrew Meadwell, Review Officer of Davie County, 301 v s o S 10th March 2014 EJ b. That this plat is of a survey that is located in such portion of a certif that the map or plat to which this certification In Plat Book �, Page R this day of A.D. county or municipality that is unregulated as to an ordinance S.R. Mixed meets all statutory requirements for recording. 6soz that regulates parcels of land; I+.J 1 368 IS of M. B ant Shoat, Register of Deeds �a Sea I Or Stamp George R. Stone C. That this plot is of a survey of an existing parcel or parcels R/W Review Officer: ►yW.+►/ F i I ing Fee Paid 2!s weSfr' - <_�L� of land; R/W rage Rd Surveyor Date: �' rn v � d. That this plat is of a survey of another category,such as the • u` 3162 * B 5 ® PG 5 by recombination of existing parcels,acourt-ordered survey or other 7-ASSISTANT = CARO Registration Number D8 101 ® PG 804 exception to the definition of subdivision; "NO APPROVAL UIRED BY THE COUNTY PLANNING DEPARTMENT" * RB 940 ® PG 942 Q•�O(T�SS�p' �9 E] e. That the information available to this surveyor is such that I am �� /►.� /�� d'� 2 �/'•, unable to make a determination to the best of my professional •'Q SEAL ,� ability as to provisions contained in(a)through(d)above. ' I 'I nn` Director 00 J CJi r;y�-31620 :0= George R. Stone, PLS Dot •• (Not to Scale) '- Profession I and Surveyor,L-3162 - C� r-----"- Vicinity Map R08ER * Exempt Recombination Survey of Existing Parcels i 0 � t a R/W 60' Public R/W eMe�` width �` r EP p ov r►�estrldgfe Road k � EP / V 1 l 0 I I Ca N l I Fife o tt 1 0 tv W Ca. I —. \ay �'• M 1 t LI 6, W , �. �. f I L-4 T-2 — — R/W C A t t _ I n 1 5/8" EIR Find ( 5/8" EIR Fnd o I t t.N I A I EQ Well til 11 r' a m m I 1 ,t v y i n lc I 1 OleCLQ ;GOfne< It '1 �� I 1 (we) hereby certify that 1 am (we are) the owner(s) F,Q ('0 of 11 1 �, 1 `� of the property described hereon, which is located in the subdivision jurisdiction of Davie County and that I hereby adopt this subdivision plan with my free �•� r m '1 I I I consent, established minimum building setback lines a i ! and dedicate all streets, alleys, walks, parks and '1 other sites and easements to public or private use HoU$e Dab House f t I a13 �v X x— •-�� �� LOT 45 f , WESTRIDGE rII Section Two )AMowns(.) - CO ����� t a ti 1` ib dnt P!? 5 PG 5 / I , r 1 I I I+ rr I-- t -Old P/L I 3/ Datell Owners ' \ I - O .� LOT 42 lir New P/L WESTRIDGE LOT 43 R \ Section Two u o Owners: PB 5 ® PG 5 0.520 Acres +/- l !._OT 44R I Larry Amos Wood �_J 0� 0.505 Acres +/- Janice Harris Wood \ N I 184 Westridge Road Advance, N.G. 27006 Kaitlin o- NOTES: 192Westridge Road 1. Zoning: R-20 \ Advance, N.C. 27006 2. Minimum Building Setback Lines: s t 0' Utility & Drainage Easement Front: 30', Rear: 30', Side: 15' - — (Note: Per PB 5 0 PG 5, the Front Setback is 40' V- 1/2" t/2" EIR Fnd t 2" EIR Fnd and the Side Setback is 20') �ej EIP, Fnd 1/2" EIR Fnd / 3. Watershed Classification: None �° :-7 L-6 4. No USGS or NCGS Monuments found within 2000 of site �o � \R_ WESTRIDGE TaxLot 6 Tax Map E-8 SECTION TWO REVISED / n/f C. Page Truitt & Doris S. Truitt DS 107 0 PG 567 REVISION OF LOTS 43 & 44 LEGEND FC: EIP - Right-of-Way Bo - Face of curb REFERENCE PLAT BOOK 5 ® PAGE 5 EIP - Existing Iron Pipe BoC - Back of Curb EIR - Existing Iron Rebar PP - Power Pale P - Post LP - Light Pole CM - Concrete Monument MH - Man Hole LOT 43R LOT 44R IRS - Iron Rebar Set CH - Chord Distance Being Part of Lot 43 Being Part of LOT 43 P/L - Property Line P/0 - Part of & Part of LOT 44 & Port of LOT 44 C/A - Controlled Access DB - Deed Book CP - Concrete Pipe PB - Plat Back WESTRIDGE, Section Two WESTRIDGE, Section Two CMP - Corrugated Metal Pipe RB - Record Book Plat Book 5 ® Page 5 Plat Book 5 @ Page 5 CPP=Corrugated Plastic Pipe PG - Page Reference: Reference: -F- 100 Year Flood Boundary CB - Catch Basin PROPERTY LINE CALL TABLE TIE LINE CALL TABLE -O- Overhead Utilities -S- Sewer Line Tax Lots 24 & 23 Tax Lots 23 & 24 -X- Fence WM - Water Meter Block C Block C Fnd - Found wv - water valve COURSE BEARING DISTANCE COURSE BEARING DISTANCE n/f - Now or Formerly BM - Bench Mork Tax Map E-8-11 Tax Map E-8-11 NMP - Nonmonumented Point TBM - Temporary Bench Mork Deed Book 101 0 Page 804 Record Book 940 0 Page 942 CL - Center Line RRS - Rail Road Spike C-1 S 39°32'14"E 152.62' chord, 153.40' arc, 440.00' radius T-1 S 57030'29"E 121.96' chord, 122.35' arc, 440.00' radius Record Book 940 @ Page 942 Deed Book 101 0 Page 804 EP - Edge of Pavement CTB - Cable Television Pedestal TP - Telephone Pedestal ETB - Electric Transformer Box C-2 S 29003'05"E 7.65' chord, 7.65' arc, 440.00' radius T-2 N 27055'49"W 110.01' -W- Water Line CO _ Sanitary Sewer Clean out C-3 S 28°11'03"E 5.67' chord, 5.67' arc, 440.00' radius T-3 N 27055'40"W 110.01' LOT 43R Acreage. 0.520 Acres +/- LOT 44R Acreage: 0.505 Acres +/- f 1/2" Rebar Set Control Corner L-4 S 27054'06"E 104.30' T-4 S 65029'57"E 80.67' Area Computations by Coordinate Geometry L-5 S 62003'27"W 200.34' L-6 N 27°55'29"W 109.98' SCALE TOWNSHIP COUNTY STATE DATE L-7 N 27054'00"W 71.80' OLD PROPERTY LINE CALL TABLE 1" = 40' Shady Grove Davie North Carolina 3-10-2014 40 0 40 80 120 L-8 N 35019'36"E 189.76' L-9 S 54047'56"W 89.44' Stone Land Surveying Company L-10 S 63°56'10"W 111.54' COURSE BEARING DISTANCE SURVEYED: Business Firm Certificate Number: C-1704 JOB N0. GRAPHIC SCALE — FEET OL-1 N 65°31'53"E 109.41' MAPPED: George Robert Stone, PLS L-3162 1MAP NO. MAPPED: OL-2 N 57053'58"E 91.39' GRS Mocksv Ile, N.C. 27028 998-4733 1114 DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (round Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR DATE 2 LI J 7 % PERMIT F� T , LOCATION M1311 S.R. NO. SUBDIVISION NAMEUfC'�rri� �P LOT NO. SECTION OR BLOCK NO. HOUSE 00 MOBILE HOME BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS ., NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES Ur NO ❑ Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES Q- NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES Q" NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE, OF TANK / 60 gal.i L , NITRIFICATION FIELD 1,1„s'] sq. ft. DEPTH OF STONE IN LINES: _,�! •• WATER SUPPLY: Individual Public ❑ IMPROVEMENTS PERMIT BY,. �i,�,r� INSTALLED BY ` C_ CERTIFICATE OF COMPLETION By Date.�✓— ",z.?�� (8/16/73) *Construction must o with all other appl a State and local regulations LOT AREA Ct J C-9 :1; rl f COMPLAINT FORM DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION Date Received Name of Complainant w�u� vu Cwci _WL" Received By `-�'- Address Telephone Complaint S� ��— Person Responsible for Complaint W—& � Address Telephone Directions to Complaint Uj&tAA� • "1u��-- -�- w �llA ern, Aj) cel - �'` h r �. cam- �H� tLu,> Date Investigated _ Complaint Justified Action Taken Investigated By Complaint Not Justified Date Environmental Health Staff Signature (DCHD 1/85)