228 Starr Lane Lot 11DAVIE COUNTY HEALTH DEPARTMENT
I IMPROVEMENT PERMIT and OPERATION PERMIT
IMPROVEMENT PERMIT sG'74 (or o'
**)TOTE** This improvement permit DOES NOT'authorize the construction or installation of a septic tank system or any wastewater
system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CDNSTRUCTION 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 S.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME lJ D� PROPERTY ADDRESS &AM t-� �.+ 0: I � DATE
LOCATION - 077 c JGJJ
SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER
RESIDENTAL SPECIFICATION: BUILDING TYPE —A�/# BEDROOMS -,,V # BATHS # OCCUPANTS V GARBAGE 61 PM:'Yese
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS _ INDUSTRIAL WASTE- Yes/No
LOT SIZE Si,fll e .TYPE WATER SUPPLY {�/L. DESIGN WASTEWATER FLOW (GPD)If� NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE/&( GAL. PUMP TANK GAL., TRENCH WIDTH ��� ROCK DEPTH LINEAR FT. fdoO /
OTHER
REGUIIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE .INTENDED USE CHANGE. ,YOUR WASTERWATER SYSTEM CONTRACTOR MUST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
IMPROVEMENT PERMIT BY
4.
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:38 A.M. OR 1:00-1:30 P.M. ON THE.DAY OF INSTALLATION. TELEPHONE # 1S (704) 634-8760.
*#THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 R
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 10/95
Davie County Health Departeent�
ypT. ENVIPONMENTAL HEALTHISECTION p
PYA : 3
P.O. Bax 665' rw
Mocksville, N.C. 27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
(Issued in compliance with Article 1l of
G. S. Chapter 130A, Wastewater Systems)
,r
***This Authorization, For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to .>
issuance of:any Bilding Permits. This Form/Authorization Number should be presented to the Davi 1tounty Building Inspections~
Office when applying for Building Permits.+++
Q �, // / 'r q AUTHORIZATION NUMBER '.
NAME L'/ ®'il/�.0 DATE ?/I Qb N2
NAME ON IMPROVEMENT PERMIT (If different than above) �a94e-l— !l
SITE LOCATION lJ/fJ Yore AGS
COMMENTS/CONDITION ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM
*#MICE*" THIS AUTHORIZATION FOR STEWRTER'SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5).,YEAR5
,
ENVIRONMENTAL HEALTH IPECIALIST" 'DATE
� e.
DCHD 10 9J
y / i NCr APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie Count Health De artment ati Juv
�� >q ren Environmental Health Section
P.O. Box 848 �—
S�b Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED. ,�
1. Name to be Billed 7e 9B -c.. I'f Contact Person K VIb r L / u 7
Mailing Address R ®/ a0z /Z / Home Phone
/S�/
City/State/Zip 14 Alrt/ tAle a 2MIG Business Phone
2. Name on Permit/ATC if Different than Above Pe CK
Mailing Address -r-r: 3*
' /State/Zip �Zadne — Afe, �7y4�o
3. Application For: [ ] Site Evaluation ler9provement Permit & ATC [ oth
4. System to Serve: PTIfouse [ ] Mobile Home [ ] Business [ ] Industry [ ] Othe
5. If Resi ce: # Peopled� # Bedrooms # Bathrooms ishwaslier [ ] Garbage Disposal
[ ashing Machine {�asement/Plumb' g [ ]Basement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Wate Usage (gallons per day)
7. Type of water supply: [ ] County/City Well [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes JylryO
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A FLAT OF THE PROPERTY MUST BE
SUBMITTED WrrH THIS APPLICATION.
Property Dimensions:(�Q Dl�J fi 1 WRITE DIIiECTIONS (From Mocksville) TO PROPERTY:
Tax Office PIN: #j7%la ✓l_�-,pp 9(�
Property Address: Road Name)} iCl
If in Subdivision provide information, as follows:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are
subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or
changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized
of the Davie County Health Department to enter upon— above described property located in Davie County and owned
1Cs4'r/`rQ /
�IA/ to pfindyef &1i - 4cedures as necessary to determine the site suitability.
DATE
Revised DC (06-
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APPLICATION FOR SITE EVALUATIONAMPROVEMENTS PEI
Davie County Health Department
Environmental Health Section
u P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By
Mailing Address /,? /
FEB 13 1996
I/ tl-/AA Home Phone 7�� SGPd
V(2- 27dd C Business Phone 15-19- -9 �D
2. Name on Permit if Different than Above
3. Application for: General Evaluation WSeptic Tank Installation Permit
4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
No. of People
No. of Bedrooms
No. of Bathrooms
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
❑ B
Ba�asement/No Plumbing
9�?<ashing Machine
f�'D�ishwasher
❑ Garbage Disposal
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: ❑ Publicrivate ❑ Community
8. Property Dimensions Z Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes DYITo
If yes, what type?
'NOTE: Improvements Permits shall be validfrom date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
IIAI y 6 y A"M
%/c
/2iC/yT o .., /�u�y P•a
EGi Oni ;Fi,veivto Li0 RJ
T
4Vy—/J
Tax Office PIN:. #. 996 - a5-9- 3y 46
PROPERTY ADDRESS, as follows:
Road Name: &,v��//� ,/3t o'ED /f% mlir E
city: WJ1,,YWCE
SUBMIT A PLAT WITH THIS APPLICATION.
Revisions effective October 1, 1995.
G'e /
/247 el / �v 9�k1 Gef�dc
This is to certify that the information provided is correct to the best of
incurred from this application.
DATE
knowledge, and I
6.11CRTII I.Ttl
I am responsible for all charges
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. W2. I 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 representatiy rth Da vig Cour}ty Health Department to enter upon above described
property located in Davie County and owned by f5d6P/
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system. e G ' /j /f
DATE 11 SIGNATURE
DOW (1193)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �//t �� DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE�2r�r'
Water Supply: On -Site Well 6/ Community - - Public
Evaluation By: Auger Boring �/ Pit Cut
FACTORS
1 2 3 4
Landscape position
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
/ E
Texture. rou
Consistence
Structure
Mineralogy/
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
Pr
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATED BY: a�{a ZI
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
OTHER(S)PRESENT:
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 -Floodplain H -Head slope
Texture
S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt
SICL-Silty play loam, SIL -Silty loam CL -Clay loam- SCL-Sandy clay loam -
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR-Vey 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
.5C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic -
Mineralo¢y
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
Davie County Nealtir Department
d and Aome Nealt§ Ayency
210 HOSPITAL STREET I P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-5985
February'`27, 1996
Robert D. Dalton
121 Austine Ln.
Advance, MC 27006
Re: Site Evaluation
Seaford Road/Advance
Tax PIN: #5776-59-3496
Dear Mr. Dalton:
As requested, a representative from this office visited the aforementioned
site on February 23, 1996. Based upon the information provided on the
application for site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable for the installation of an on-site
sewage disposal system.
I£ you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall,.Jr., R.S.
Environmental Health Section
RH/wd
Enclosure(s)
Location Map n.t.s.
d'
i
C"I
CV
m
I"
0
0
N
0
N
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-
���
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
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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