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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)