202 Starr Lane Lot 13DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION O; �U
'NOTE: Issued in Compliance With,Article 11 of G.S. Chapter 130a _. '
'Sanitary Sewage Systems _ r Permit'Number
N_ 8022
Name���—nuc ___Date J _ 0
Location QA_, �'Sw �'•0_�'� urn `� C3.r� ^rs*oc� �1 _r C�rD_�a.
0-1 F r .� , , h �> A - d T�•
Subdi s nName ✓�i�LO, LbtiNoi`1, 7K, dry nYR rJk' .1 ',-
Lot Size ` _ House - Mobile Home ____ Business ___ Industry
No. Bedrooms --.No. Baths 4 No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO ❑
Specifications for System: -�
Auto Dish Washer YES ❑ NO ❑ oo 0o,.,�� �, 1 oJ,
Auto Wash Maohine YES ®' NO��i
J
Type Water Supply _ W UU'
*This permit Void'if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation it site plans or the intended use change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM,
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'Improvements permit by
'Contact a representative of the Davle County Health Department for final Inspection of this system between 8:30.9:30 A.M.,
1:00.1:30 P.M. or 4:30.5:00 P.M. on day of completion. Telephone Number: 704.634.5985.
Final Installation Diagram: System Installed by11� �u�^
/6o rPrte�
^b �.
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Certificate of Completion ZZ__ Date
'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.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
� r
Davie County Health Department
S �gvYr�/ Environmental Health Section
^1 P. O. Box 665 Gl�o
Mocksville, NC 27028
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1. Application/Permit Requested By
Mailing Address
2. Name on Permit if Different than Above
Home Phone
Busl ess Phone '3'10 99,P A
3. Application for: ❑ General Evaluation Ugeptic Tank Installation Permit -16-q l
4. System to Serve: �] House L3 Mobile Home ❑ Place of Public Assemblbly� a ly-
❑ Business ❑ Industry ❑ Other I ❑ Unknown rfi c i
5. If house, mobile home: Subdivision 14 I� %� j Section Lot #
No. of People ` r
No. of Bedrooms
No. of Bathrooms o�
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Sinks
No. of Urinals
❑ Basement/Plumbing O1t�
❑—lBasementtNo Plumbing�n �y
Irk Washing Machine(°
❑ Dishwasher
❑ Garbage Disposal
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: ❑ Public Qk� p rivate ❑ Community
8. Property Dimensions /"��??4� Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 9 --No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
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Directions to Propertg:.
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This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible
incurred from this application.
DATE SIGNATURE
Cy
charges
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative the Davie County Health epa eni to enter upon above described
property located In Davie County and owned by b
to conduct all testing procedures as necessary to deter said ' e's sui ty for a ground absorption sewage treatment
and disposal system.
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME DATE EVALUATED
ADDRESS S P T—D, PROPERTY SIZE C>s.S�Ap
PROPOSED FACIILTY ` \ OUng LOCATION OF SITE)\ '
Water Supply: On -Site Well: ✓ - -- Community '" Public_ - - - -
Evaluation ByP�L Auger Boring Pit - - -- - Cut - - -
FACTORS
1
2 3 4
Landscape position
Slope X
6
HORIZON I DEPTH
Z'
Texture groupCl.
Consistence
Structure
G
Mineralogy
HORIZON II DEPTH
j I F_
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure .
Mineralogy
SOIL WETNESS
5
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
,
SITE CLASSIFICATION:
LONG-TERM QAACC\EEPT�AAI
REMARKS:
DCHD (01-901
RATE:
EVALUATED BY: p
OTHER(S) PRESENT: \wv�
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 •,lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
Moiev CONSISTENCE
VFR-Ve.ry friable FR -Friable -FI-Finn 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 ..
Structure .- .
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 - gal/day/ft2
Location Map n.t.s.
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THIS PLAT WAS PREPARED TO SHOWN A DIVISION OF ROBERT V. HARDIN PROPERTY.
ALL TRACTS SHOWN ARE 5.00 ACRES OR MORE AND DOES NOT CONSTITUTE The undersigned hereby acknowledge that I am (we ane) the owner of the �00FQMe Ceunly. I, a Notary
property shown and described hereon, which b located in the subdM31an Count/ end Yale aloreseW owft that
Jurlsdietlon of DwAe County and that I hereby adopt this plan of
A SUBDIVISION AS DEFINED BY THE DAVIE COUNTY SUBDIVISION REGULATIONS. 3ubdM3Ion with my (our) free consent, establbh minimum building pvvonaltv °00'p1� °- e1 the fme °n ' °"d
aebroeledged trdhe and- -6
eregehrg MsbumenL -
setback linea, and dedicate all streets, allege, walks, parks, and other WIlness ng' heand -6 1 seal."the dry
sRes and easements to public or private use as noted. of
SEAL OR 37AYP
JESSE BOYCE.JR DIRECTOR OF PLANNING
Parcel 14 1
Paul Owens
D.B. 69-507
�a
_ _ S 86°35'30"E Total 880.68'
407.59' �-.__--------
473.09' stone Found
✓�Dy gyp' .Q-
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I
1 �
8.528
Acres 10.
o 002 Acres
N 6 Ri,,r# 3'77 2.5-0,
rh C14 OO r )
Parcel 20.85 `�
o r` N
Roger Dale Pack Z Parcel 20.01 rn n
D.B. 190 - 344 Joe V. Starbuck o
D.B. 181 - 270 Cn
jq
S Tigr b � e.►�
Parcel 15 �1 bh 51 ,�°9 tic
Randall Keith Carter 9 �� 41 eh1 4
D•B. 112 - 347 °
Pdcel 19 01
D,By107e!S oo adway
I, o Ray Oat43, Comfy that thb Pk.t was drawn under My
superMelen frem an actual surrey made under My V*VVblon (deed d.eorlptlan
recorded In Book 11110. Pape 35e, etc.) (other): that the boundaries not
surveyed are dearly kwlmw as drawn from kAonn e" found M Book as MLOA
Page ! that the rano of pradolon os calculated Is 1:10.000. that thb
plat was prepared M aeeadanp 11th GS. 47-30 as amended. W1tno= r y orVnal
algnetuw. regytratlen nW6 and seal
thb 1 ST ,4ly of June AX1995
Seal or Stamp
1 $ °� 0'
NIP .4 �P6 b°�� ctar'VPre)
A COS '� r
One
_�—P�P
.� �6� ,, access eae°me�16� NIP S --- 35 �11E
°��`�°4 ti��,6° �.� ° , 3100' N
�W f I� ° � y� y��w I I
O
ro
to
S a 05
oN 'N o^ 1 01 0 �
0
Z Z iq K A im A rF� 2 Parcel 20.04 i I
Daniell. Robertson ^ �• Pt
Parcel 20.03 w#D.B. 183 - 177 ,t�� A
Kazimierz Zakamarek �5' a7&J-''q o ��ro
D.B. , 82 - 860 v • � � �
0
signed
Date my rommbalee Now
signed
Date
Parcel 1
Peter W. Hairston, Jr,
"Cooleemee Plantation"
4c 4 g_ ys7�{ �' 5 3
/P
pl',X jr 54 4Z QJ or75 b0� co3.9
IV
'n
S-)76 9 2 res a �1 `L1� d
36100 co
w Acre Q(a Pim Parcel 20
LO
ro t° `14 3 Pa f a° P g
N M V) In 8 rC@/ Gj� �j1 W a
D.Bso'.
a c� O2 ebb `a
,� N D'S 786 90 I ��b` 9 c11
�5 0 2 2 5
688 �° °4� N �
Zo P z��
1 _1 g0 O5. eUd el ZO OS p P15
06. /
7 �� n D.g ort 86 38.
N 7� 511W 209.95 • NIP Rah f 186 N 74 °30, Qp
N 77� O" \ o`ay S7r7r/o•S'f;�s f9,0 2p7 454
S Deed /A6 QP
Se � Por
ce/ 20
North CaroMo. County. I, a Notary
Public of the Coun4r and State aforomid cer ft that 50'
C. Ray Cates, a mgbtered land surwyo►.
personally appeared before me on thb day and
acknowledged the execution of the foregoing Instrument.
WRAW3 ny hand and of c 1 seal, this the day
of , t 9
SEAL OR STAMP I 1
NOTARY PUBLIC
My eor wnisaten ex*w
LEGEND
R/W - Right -of -Way
EIP - Existing Iron Pipe
EIR - Existing Iron Rebar
P - Point
CM - Concrete Monument
NIP - New Iron Placed
P/L - Property Lime
C A - Controlled Access
RCP - Reinforced Concrete Pipe
CMP - Corrugated Metal Pipe
CCP- Corrugated Plastic Pipe
-F- 100 year Flood Boundary
-0- Overhead Utilities
-X- Fence
The foregoing certificate
(HERE GIVE NAME
AND OFFICIAL TITLE OF THE OFFICER SIGNING
Is certified
THE CERTIFICATE PASSED UPON)
NOTARY PUBLIC to be correct.
� - Center Line
CL - Center Line
EP - Edge of Pavement
FC - Face of Curb
PP - Power Pole
LP - Light Pole
MH - man Hole
R - Radius
CH - Chord Distance
P/0 - Part of
SE - Sight Easement
PB - PlotdBBokk
C4 -Catch )asin
F -Fence ost
-S- Sewer Line
NOTE : THIS PLAT IS SUBJECT TO ANY EASEWNTS. AGREEMENTS, OR
RIGHTS OF WAY OF RECORD PRIOR TO T14£ DATE OF THIS PLAT.
NO HORIZONTAL GEODETIC CONTROL MONUMENTS ARE LOCATED WITHIN
L000 FEET OF THIS PROPERTY.
THIS SURVEY IS SUOJECT TO ANY FACTS THAT MAY BE DISCLOSED OY A FULL
AND ACCURATE TITLE SEARCH, NOT FURNISHED TO W AS OF THIS DATE.
Notes
1. Minimum lot size is Tract 11, 5.016 Acres
2. Property is not in a Flood Hazard area.
3. All lots are to be served by Individual sewage facilities.
4. All lots are to served by Individual wells.
5. Property is Zoned R/A
6. Minimum setbacks Front = 40'
Side = 25'
Rear = 40'
7. Iron stakes at all corners, except asshown on plat.
8. Total area = 62.673 acres (by dm.d.) including
all rights of way and easements.
9. Parcel numbers shown refer to Davie County Tax Map K-8
200 0 200 400 601
■■■■■■■■■■
■■■■■■■■■■
SCALE
1 " = 200'
SURVEYED:
CRC
GRAPHIC SCALE — FEET
MAPPED:
CRC
This day of
Probate fee paid.
Henry Shore. Register of Deeds
by
Flied for registration at
DEPUTY -ASSISTANT
o' c I otic M
19 and recorded
In Plat Book . Page
Henry Shore, Register of Deeds
Filing Fee Paid
by
DEPUTY -ASSISTANT
PLAT FOR
i
Seaford Acres
Section Two
TOWNSHIP COUNTY STATE DATE
Fulton Davie North Carolina 03-21-1997
C. Ray Cates
119 Depot Street JOB NO.
3336
Mocksville, NC 27028 MAP NO.
Phone (704) 634-3735 3336B