311 Seaford Road Lot 1DAVIE COUNTY HEALTH DEPARTMENTCJ. UO°, Tte
'IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION , 3
'NOTE Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems _ ! Permit Number
Name `v� N o�\ 4\Qe _'Date -1 ' I--) N2 8203.
Location :� 1 \' , r �� \o C'I: �; rm' S� F. �Q� ^,A
Y6
Subd vision Name ✓vim �JC� Lot No. Sec. or Block No.
Lot Size = - House Mobile Home --- Business ___ Industry
No. Bedrooms —� .No. Baths ? 5 - No? in Family, Lt. Publlc'Assembly Other
Garbage Disposal YES [3 NO [vf Specifications for System:. a
Auto Dish Washer',. YES S' NO ❑ /� 3< 1ti
Auto Wash Ma^hine YES L� NO L] NO
x ✓ 1 ����
Type Water Supply i"r
'This permit Void if sewage system described below is not installed within 5 years from date of issue.'
This permit is subject to revocation if site plans or the intended use change
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM. -
r
i
1310:
Improvements permit
'Contact a representative of the Davie 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 by -- SLi 21 �
F 3
r oo
7
�i0v E 1V
f \�
too w
;r
Certificate of Completion ''—E — Date �� t
'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
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By '1TDnyA4- f f \( tt e r 1 U t I'� I NtC`-
Mailing Address PC bnll1` kVM-1 c0- NC 2120 UL,
2. Name on Permit if Different than Above 0 (A av\, Lk
3. Application for: Urdeneral Evaluation
4. System to Serve: ouse
❑ Business
❑ Industry
5. If house, mobile home: Subdivision
No. of People
No. of Bedrooi
No. of Bathroc
Dwelling Dime
RM
Home Phone C09 -074(o
Business Phone 9 01 8`a I D d
❑ Septic Tank Installation Permit
❑ Mobile Home ❑ Place of Public Assembly
❑ Other
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
❑ Unknown
Section Lot #
❑ Basement/Plumbing
asement/No Plumbing
mg Machine
)s washer
❑ Garbage Disposal
No. of Showers Water Usage Figures
7. Type of water supply: ❑ Public nvate11 II ❑ Community
8. Property Dimensions '3 (),A - Sewage Disposal Contractor W nknol �IY\,
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve?
If yes, what type?
❑ Yes Com] No—
'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.
Directions to Property: tp 4 E cLs T R - C3,C) I S v(-4� � " ' rVi /
of Ped
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNA RE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 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 representativthDavieiPu0ty Health Popartment to enter upon above described
property located in Davie County and owned by I
to conduct all testing procedures as necessary to det6rnKe aid site's 2ss iii r a round absorption sewage treatment
and disposal system.
O �e-9
DATE SIGNATURE
DCHD'(1193)
N 02 • - 51 E
, I
1
1
I�
PARCEL 5
RAIDALL KEITH CARTER
0
R 112 - 347
.,3,cL L, " L)c—
/ C B 1-5-58G
23 E—
523 59 5
=88 ACRES
946 73 3g6.6Z• ��. ,,
S06'-,15' 55. PARCEL _
o e
44, 2 _—
2
6.861 ACRES \
(to E S. R.1813 CIE 301 EASE-)
�F• _'_-- \ _ S 07•_28 _.SOw�-- . —
s ,6• a j�
• � r73 C`C
S 57.
58•-
29.267ACRES
S. R. 813 E 30 EAE.) co 75.1, —
1
On
o'
L n
i } W
E» �
n
r� of
r.0
9.4 �yP• — —.190 00 _
N o7- %6 4..r
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME/ B Ty DATE EVALUATED4S
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE 0t����/
Water Supply: On -Site Well rt� Community Public
Evaluation By: Auger Boring t/T- Pit Cut
FACTORS 1 2 3 4
Landscape position L 27
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH �t
Texture group
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
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATED BY:
LANG -TERM ACCEPTANCE RATE:_ OTHER(S) PRESENT:
REMARKS:
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
CONSISTENCE
Moist -
VFR-Ve-y friable FR -Friable FI -Film 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 - -- -
.3C -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
DCHD (01-901
Davie County Nealtlf Department
and Noine AealtFi 9yeney
- - 210 HOSPITAL STREET/ P.O. BOX 665
- MOCKsvaLE. N.C. 27028
PHONE: (704) 634.5985
September 1, 1995
Hud R Well Hare
c/o Potts Realty
Attn: ,Debbie M ler.
P. 0. box 11
Advance, WC 27 )G
Re: Site Evaluation
Seaford Road/3 Acres
Dear Mr. & Mrs. Hare:
As requested, a representative From this office visited the afbrementioned
site on September 1, 1995. 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.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert H. 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
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
- APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
(704)634-8760
11
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed
Mailing Address P D a D--iG //
City/State/Zip 09 eLU Oey� t✓,' 7-20
2. Name on Permit(ATC if Different than Above
Contact Person
Home Phone
Business Phone
. Mailing Address City/State0p
3. Application For: [ ite Evaluation [ ] Improvement Permit & ATC
[ ] Both
4. System to Serve: [&Mouse[ Mobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People—0— # Bedrooms # Bathrooms ��
[-"Dishwasher [ ]Garbage Disposal
['J'Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing tr X,
6. If Business/Other: Specify type # People #Sinks # Commodes
—
# Showers # Urinals # Water Coolers
If Foodservice: # Seats EstimatedWat r Usage (gallons per day)
7. Type of water supply: [ ] County/City [ ell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes jr] No
If yes, what type?
poRiyv
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** Ai AMOF THE PROPERTY MUST BE
'SUBMITTED WITH TMS APPLICATION.
Property Dimensions: �S - C o 7- WRITE DHtECTIONS (from }j ocksville) TO PROPERTY:
Tax Office PIN: #
Property Address: Road Name .S t
City/Zip
If in Subdivision provide information, as follows:
Name:
Section: Lot #:
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
Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned
all
DATE c?' A4—q7
Revised DCHD (06-96)
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN:
as necessary to determine the site suitability.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION / LOT__-I�!e
Soil/Site Evaluation
APPLICANT'S NAME / _e2
PROPOSED FACILITY
SUBDIVISION �G,i2Swek!'
DATE EVALUATED CZ1J s AQ %
PROPERTY SIZE
ROAD NAME
Water Supply:
On -Site Well j/
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
Texture group
FACTORS
1 2 3 4 5 6 7
Landscape position
Sloe %
Q
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
i- I -
Texture groupG
Consistence
r i
Structure
/( y—
Mineralogy
HORIZON IH DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: YEVALUATION BY: A`m/&
LONG-TERM ACCEPTANCE RATE:_ OTHER(S) PRESENT: -
REMARKS:
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 clay loam SIL - Sily 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 - 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 -tern acceptance rate - gal/day/ft2
DCnD(01-90)