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121 Sonora Drive P/O Lot 61DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002442 Tax PIN/EH #: 9900 -EH -02442 Billed To: Richard Collins Subdivision Info: WCnDtlr.Lu�-q /PAgroF L-aT co t Reference Name: Location/Address: 121 Sonora Drive -27006 Proposed Facility: Residence Property Size: see map ATC N gnber: 2083A�%� LsCb) **NOTE** is Improvement/ peration Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type M • 1-1DN►t:, #People LP #Bedrooms Ll #Baths 2 Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type /+ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Uor3 ty Design Wastewater Flow (GPD) q90 Site: New ❑ Repair System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width 3(P" Rodr.A� Linear Ft. mor Other: 1 D1'0-TQ-160noa 'FOX. �s 10 , 2k;boc-rod S TS - so r MATS lea. -P, . 1%7 ii Required Site Modifications/Conditions: -blV T 51k�A- Y.' IAMTEZ. 1 S f � • 90'`'1C IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 11-7 J03-���60- L GILL. l�t..t-OLJ -To OS -5 1SZD M . Flo+ - IF 1poToe ; aCVA% Q �► �60 � � o � Q.2i1�sz, Poss,gt Phot r AZ1 C-� ISSvL�� r:! L.,s —o.Q4j,J a .3aS/ C -A"4 Environmental Health Specialist's Signatures Date: 9 02- `� ✓ DCHD 05/99 (Revised) to /t co e f, rr-A a -sl,, DAVIE COUNTY HEALTH DEP Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FO (Check One) REPLACEMENT ❑ REMODELING ❑ 2002 %EIVT , LECO , � ❑ Name: !e!Ct ►^ rA C PLS Phone Number: 7qO 3 7 pme) Mailing Address:—/ cJ O n d ct- 0 /` 9±0 0 3 / (Work) A&evaA c e AIC ,?-;70 C Detailed Directions To Site: 6 e to G- a- Q a/ n fC�- t� e - n d 1, ?' p n ";.n r) O t^ Property Please Fill In The Following Information About The Existing Dwelling. Name System Installed Under: 1:;�D 7 1�O 4� S Type Of Dwelling: /4"1 o Ue AcAl '�—' Date System Installed(Month/Day/Year): to Number Of Bedrooms:p ? Number Of People: Is The Dwelling Currently Vacant? Yes ❑ No If Yes, For How Long?. Any Known Problems? Yes ❑ NoK If Yes, Explain: Please Fill In The Following Information About The New Dwelling - Type Of Dwelling: A16 A (Kf f �''ll e- Number Of Bedrooms: L Number Of People: Requested By:, For Environmental Health Office Use Only Approved ❑ (Dn/i�saappp/r/�oved ❑ �y n, '��`� ('nmmnnlc- Wi & P_ � w�� � � 1 • �"v 1 `� Requested: 5 rq qJEnvironmental Health Specialist Date Z '"The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a euarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. ou Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ .50 Date: Paid By: Received By: Account #: 4 Invoice #: ti f' ea_l� U -JI-_ 1_1� q__� awe mmwwlk.Lw�'y Excise Tax �S FILM MR PrGI-S7 RATION March 12 1993 11:34 A.M. - ANo,x167 sAGe 534 HENRY L C=GL^TCR OF DEEDS Cr DAV C OUNTY,INC Q (,f/,r,J DepuuttyC�/J�J� Recording Time, Look and Page TaxLot No........................................................................................... Parcel Identifier No........................................................................... Verifiedby........................................................................ County on the ................ day of ......................................................... 19............ by.............................................................................................................................................................................................................................. Mail after recording to.........(0..7�%..rC:.io2s.�6......s.rc./.....✓....��.....(`......2................ .................................................................................................................................................................................................................................... This instrument was prepared by ..... W..a de...I1.....Ise,Q.>1.c�.4�.r....!7g................................................................................... ..................... Brief description for the Index NORTH CAROLINA GENERAL WARRANTY DEED THIS DEED made this ...1........... day of ....Mar.c.h........................................... 19....9.3..., by and between GRANTOR- GRANTEE Potts Real Estate,lhc. Richard L.' Collins and wife, Lucretia A. Collins Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e -q. corporation or partnership The designation Grantor and Grantee as used, herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land situated in the City of............................................................. $hady..,GrOVe........... .. Township, ........D.ay.i.e .......................... County, North Carolina and more particularly described as follows: Lying and being in Shady Grove Township, Davie County, North Carolina and being part of Parcel No. 61, Davie County Tax Map G-7-4, Block A, Plat Book 4, page 144, 145, Davie County Registry and beginning at an iron placed, said iron placed being located Soutl- 05 degrees, 02 minutes, 45 seconds West 384.95 feet from an iron found, said iron found being the Northeast corner of Elmer Lee Archibald, III Deed Book 122, page 198, Parcel 143, Tax Map w G-7, and being the Southeast corner of Lot No. 6 La Quinta Section 2, Map 2, Plat Book 4, page 144, thence from said beginning iron placed South 85 degrees, 39 minutes, 42 seconds East 60.79 feet to an iron placed, said iron placed being located in the Western edge of Sonora'Drive, thence with said Sonora Drive South 18 degrees, 06 minutes, 05 seconds East, chord equals 85.56 feet, radius equals 514.23 feet and arc equals 85.66 feet to a point, thence South 18 degrees, 24 minutes, 48 seconds East, chord equals 69.82 feet, radius equals 449.56 feet, and arc equals 69.89 feet to an iron placed, thence North 85 degrees, 39 minutes, 42 seconds West 122.23 feet to an iron placed, thence North 05 degrees, 02 minutes, 45 seconds East 143.48 feet to the POINT AND PLACE OF BEGINNING as surveyed by C. Ray Cates March 1, 1993. With the RESTRICTION that Grantees or successors in title maynot grant any easement or right of way of ingress, regress and egress over hereinabove described property to Sonora Drive nor may Grantees by any other means, by sale of said property, or otherwise, allow hereinabove described property to be used as a means of access to N. C. I9nr Ax—c. Perm No.3 © 1976, Revised © 1977—Jeme,wllrems&Co..Im..Box 127,vedkimiOe.N.C.27055 said Sonora Drive,without written consent P„°,•"I I•v A. ---w 1,1-N. C. 98, A.wc.-1991 of Potts Real Estate, Inc. a, i €t 4.c.. w; 1 IV € Permitt e's �yy�� `� AVIE COUNTY HEALTH DEPARTMENT Name:— -��°i�`l f _._� ..t t Environmental Health Section PROPERTY INFORMATION -" P.O. Box 848 Directions to ro ert +=) t -�' t t / ! f P P Y ` I Mocksville, NC 27028 Subdivision Name: ;; �,.rt U1.p `% Phone #: 336-751-8760 /t t.;4 t,g'IN_.i v'� r� Section: Lot: t AUTHORIZATION FOR f :.� *'r.�lt.}�^-1 i { r ! i...: �, div % WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION AUTHORIZATION NO: A Road Name: L`�+� `:�.>'- �`� ')---Zip::" **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of CLS:-Ehapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ♦"'7 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,.� .� f ,' --';n.• ! I'`� IS VALID FOR A PERIOD OF FIVE YEARS. -ENV19-0 EN4;ST DA ISSUEDTI 1 RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ # BATHS # OCCUPANTS (/.-I GARBAGE DISPOSAL: Yes oQNO� COMMERCIAL SPECIFICATION: FACILITY TYPE �, }, # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE 1- CTYC PE WATER SUPPX 4, DESIGN WASTEWATER FLOW (GPD) ��D NEW SITE REPAIR SITE i( SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH` ROCK DEPTH � <- LIgNEAR FT. . OTHER l ``sT ft 1 %y j 1 U ax i���t.I L. i r�-1 l i t /.: C • i�� 1 tJ . REQUIRED SITE MODIFICATIONS/CONDITIONS: � ( OA G6. 10 J Q . ��:� � i 0 x [[ L)L) [, IA r Vb= C 5 L)r (- IMPROVEMENT PERMIT LAYOUT �- mix`" �� ... ._.. ....... f t; _uhlT �G *"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Name: me1.. a%td#Y ( Environmental Health Section PROPERTY INFORMATION t_ # , t t^ . P.O. 'Box 848 Directions to property: t a. r '' f s 1 �'' I Mocksville, NC 27028 Subdivision Name:' ..r a Phone #: 336-751-8760 r s ! ,'�,�� x- i la t �. .) (.. Section: Lot: AUTHORIZATION FOR WASTEWATER - - SYSTEM CONSTRUCTION Tax Office PIN:# AUTHORIZATION NO: a) A Road Name. i.. 1 `,.,.,-, �, t ..Zip:- **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of Qj.SrGhapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r r„w ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DAY -E ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS (,,- GARBAGE DISPOSAL: Yes or'No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)'` NEW SITE REPAIR SITE / SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH -~ - .' ROCK DEPTH �~ LINEAR FT. f >; yt OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: lv 1 tit t. c”, o4l t) a l_ , Via, IMPROVEMENT PERMIT LAYOUT IN t i G "*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: +yF AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) Y f 4