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213 Calahaln RdAccount # Billed To Reference Name DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (33G)751-8760 990003925 Tax PIN/EH #: 5709-63-5849 Barry & Julie Grubb Subdivision Info: Julie Grubb Location/Address: Calahaln Road-27028 ATC Number: 4364 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA S IS ALI OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: � CERTIITCA' **NOTE** T'he issuance ofthis Certificate ofCompletion all inc has been installed in compliance with Article 1 f G.S Disposal Systems," but shall in NO WAY be t as a given period of time. �`� Q�,tL y �b��-�2 S� �O�.�q9►I�a1� (�� J Septic System Installed By: Environmental Health Specialist's Signature : DCHD OS/99 (Revised) 57ep�t.%►� ETION tem described on Improvement/Operation Permit �A, Section .1900 "Sewage Treatment and t the system will function satisfactorily for any � I� 8 �� �1 ,, , . , .,, , � DAVIE COUNTY HEALTH DEPARTMENT - ' Environmental Health Section '. `�� P. O. Boz 848/Z10 Hospital Street Mceksville, NC 27028 (336)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990003925 Biiled To: Barry & Julie Grubb Reference Name: Julie Grubb Proposed Facility: Residence Tax PIN/EH #: 5709-63-5849 Subdivision Info: Location/Address: Calahaln Road-27028 Property Size: **NOTE�* This Impro4emeiidOperation 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 11 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 CONTItACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �1�� #People � #Bedrooms � #Baths � Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: � BasementlNo Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size .� Type Water Supply �/�Design Wastewater Flow (GPD) �_'� Site: New �Repair ❑ �c�� �� � � �� t System Specifications: Tank Size���t�GAL. Pump Tank GAL. Trench Widtt►��O Rock Depth N/,A� Linear Ft.� . _ �. �� l Other:3 Required Site Modifications/Conditions: � tMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF G" BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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)751-87G0.**** � b �-��►1� � � � >� z �►��A "�• � � '� � v / , ����� Environmental Health SpecialisYs Si DCHD OS/99 (Revised) , 4 � �� � �-� �IrJF� ��S ��rZ�� �. M�x � �� c-� �_PrE1 32,, Date: M�r-13-2006 12:5Bpm From-Centex Homes Const i Warrn. 336-56d-1OT2 T-615 P.002/003 f-193 . . •. � ' ' , .' -� ,�4PPLICATIO OR SIT� EVALUATION/iMPROVEMENT PERMIT & AT � � Davie County �iealtl� Department n ��� � D Errvirnnmental Health Section �'� P.O. Box 848/210 Hospital Street � MaA � � �� (336) 51-8760/1Fax (33�751-8786 / Pemric t7 Authoriz¢tion To Constmct(ATC) �•' THIS APPLTCATION CANNOT EE PROC�SSED UNLESS ALL OF.THE REQUIRED LS PROVIDED. Rcfcr to the INFORMATION BULLETII�f foz in�ttuctions. ' ,�r� � � � �� MA� � `� �406 Or��7ENT h�A�� CO Nn�K APPLTCANT INFORMATION Name to be Billed ,8�2 R eu .c TUI/C M, Grubb Contact Person �Gt,lir� �� Billing Address �T 1g Sa19 wiek S� • Home Phone(�G) SO-02�3 Ciry/state/ZIP WiNS�er—Sal�r� 1rG �110� BusinessPhone(3'3�) SGy-//72. r' Name on Pernvt/ATC if D�erent than Above � �iai.ine Address Citv/5tate/Zin . PROPERTY INFORMATION NOTE: A survey plat or eite plan must accompany ihis application (PeYmit is valid for 60 mon�hs with site plan, no expirarion with complete plat.) • Street Address � Ciry,�Lr—k�yi /iC I�C Tax PIlV#, ' Subdivision Name Secvon/Lot# -- Lot 3ize Directions To Site:��� NHN. GW W. puf e��f��✓i/lt �(-a ffi� iN%hler'finn n f i�LtJ . �__n.__i_.._.� _n� n —_. . _ ... ../L�_L ._n. _ � �_a l-- Date Houst/Faciliry Comers Fla�ed ��(�. � 7. 3�(0 _ II [hz answa to any of tbe' fotlowlag questiods is "yes", suppotpag docmnairatiori�must.be aRaeLed., :: _ • � �' _� _. _" • ._ � � •- - � Are' thrre wy existing weauwatei systems on the siie`T ` C�Ycs iBi�To Does the site conrain jtuisdictional wedands? t7Yes�B'f�lo Are tUere any easements or right-of-ways on the sice? ❑Yt9'8'IGO Ts the site subject to approval by another public agcncy? OYes�� Will wascewa[er othcr thau domestic sewa�e be�cncrazcd? DYest�flo IF 12BSIDENCE FILL OUT THE BOX BELOW # People ,_„�_ # Bedrooms _� # Bativooms Garden Tub/Whirlpool es CJNo Basement:lFSYes QNo �asement Plumbin�: DYes f�io � IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FaciliryBusiness�Pn� Q Total Square Footage of Btti]din t� People 3 # Sinks �J 3� Co�odes �_ # Showers � _ # Urinals Estimated Watei Usage (gallons per day) �(Amch doeumentarion of similar faciliry water consumption) FO�DSERVJCE ONLY: # Scau _ __ 7 /.1��Q�'cJ�,Q �,O�C.(,�n•�c,c�� Typesystemrequested �Conventional C1A�ceptcd ❑lnttovative DAltunative t70ther Water S�pply TypeYl Counry/City Water ❑ New Weil OExisting Weu ❑ Communiry Well Do you anticipace addiiions or expansions of th� facility this systcm is inunded to sttve? 0 Y�s '� No If yes, wi�at type? 7'his is to eertify thst the infont�ation provided on this appl;cadon is aue and conect to the bcsc of my lmowledge. I understand thac any permii(s) or ATC(s) issued Iiercafrcr are subject to suspcnsion or revocation if the site is altered, the intendcd use changes, or if the iafotmation submitted in this application is falsified or cluinged I understond thar ! am responsiblclor nll chargu iac:�rred from this apylication. I hereby grant righ� of entry to che Audiorized Itepres�nwave of che Davie Co�+ty Heal�h Deparnnent co conduct necessary inspectiv� to determine ca lianee with applicable lsiws and nilcs on the above dr.scribed property lacattd ia Davie Coanry and owned by �O,pILU �. ���eeiP i�. Mi�Q�L_. %� �.,./h-L _ - .�, �� - � ��' Site Revuit (�arge operty owne�'s or owner's (egal reprtseatari�e signaturc Date(s): �0 � Client Notificntion Datc: Dat - - - �- EHS: ��- Sign givcn OYes �No Acco�mt # Itevised?J06 Invoice t� `i�� ��. � � �� ��► � "` "_' , .� , '�� aa r� � , � � ` � � °�� , . ,,.�, � � . 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'�'�� .�'� s ��.. h� R'�� � 3 ^. -__. s� � 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION Account #: 990003925 Billed To: Barry & Julie Grubb Reference Name: Julie Grubb Proposed Facility: Residence Property Size: R R IN RM I Tax PIN/EH #: 5709-63-5849 • Subdivision Info: Location/Address: Calahaln Road-27028 Date Evaluated: �� ' Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit FACTORS 1 2 3. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence HORIZON IV DEPTH Texture group Consistence S Wcture SOIL WETNESS SAPROLITE LONG-TERM ACCEPTANCE SITE CLASSIFICATION: —' LONG-TERM ACCEPTANCE RATE: REMARKS: � Public Cut 5 6 EVALUATION BY: v � OTHER(S) PRESENT: 7 LEGEND I, n s pe 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 T.extur� S- Sand LS - Loamy sand SL - Sandy loam L- Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C- Clay .ON�T4T �.N . M41S� VFR - Very friable FR - Friable FI - Firm VFI - Very frm EFI - Extremely frm � NS - Non sticky SS - Slightly sticky S- Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P- Plastic VP - Very plastic $tll1�t11L� SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic MineraloQv 1:1, 2:1, Mixed Nates 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 - gaUday/ft2 DCHD OS/OS (Revised) ■■��■���■�■■�����■i�������■■■�■�■��s■������■�■■t■■��■■�■■�����■�■�■ ■■�����■■■■■������i■���■��■■■■■���■■�■�■■■■■■■■■�■��■�■■�■���■�■�■ ■��■■■����■��■����i■■��■■�■�■�■■■ ■���■■�■■■■��■����■�■■���■�■��■■ 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■������■■■■��■�■■■■■■■��■��■��■■■��■��■■��■■■■�■���������■���■■■�■ ■�����■■■■�■���■���■�■��■�����■����■■■�■��■■■■����■�����■�■��■�■�■ ■����■�■■■■■■■��������■■■■■■��■■■■■■���■��■�����■■■�■���■�■���■��■ ■�■■■■�■�■����■■■�������■�■■�■■■■��■�■��������������■■■�■�������■■ ■�■■��■■■■����■■■■■■�■■���■■��■��■�■■�����������■�■�����■■�������■ ■■�■■■■■������■■■�■��■��■��■v��■ ■■■���■�■����■�■■■■■■��■�■���■�■ ■�■■�■■■��■�■■��■■������■�����■�����������������■■■��■��■��■��■�■ ■��■■����■■��■■■■�������■������■�■��■�■�����■■■����■■���■■�■�■��■■ ■■�■�■■■��■■����■■�■�■����■����■■■■����■�■�■■�■�������■■■�■■■���■■ ,. _ _.� . . �., ., . . , ' APPLICATIO R SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department ��"'''r� ��� Environmental Health Sectiofz ��� P.O. Box 848/210 Hospital Street 2 ��,�06 Mocksville, NC 27028 t��R (336)751-8760/ Fax (336)751-8786 pplic ' r;;��:E�t��valt mprovement Permit ❑ Authorization To Construct(ATC) ❑ Both �+' `"�•y1E� �' Qi ** ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF.THE REQUIRED FORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. ' APPLICANT INFORMATION -� // Name to be Billed ,Q�1 Q Ru � fU�/� /��%. G'r'��b Contact Person �l.t,�� e. �it,t�b�j Billing Address a i18 S�dAWick .S� • Home Phone(,336) �v50-o293 City/State/ZIP y1�j/�f5f'O�l- SGtIeM l�G �7l03 Business Phone(33G) .S�6�i-!/?2. Name on Permit/ATC if Different than Above i�laiiing Address PROPERTY INFORMATION _ __ NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address � City 6�QGK5Vi �IG h�C Tax PIN# �7Oq(�c 3 S g �I q Subdivision Name Section/Lot# ----- Lot Size Directions To Site: r' If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes �'I�10 Does the site contain jurisdictional wetlands? ❑Yes�'f�io Are there any easements or right-of-ways on the site? ❑ Yes B1Go Is the site subject to approval by another public agency? ❑Yes ��1 Will wastewater other than domestic sewage be generated? ❑Yes►�No IF RESIDENCE FILL OUT THE BOX BELOW # People �_ # Bedrooms _� # Bathrooms Basement: l,�(Yes ❑No Basement Plumbing: ❑Yes C�r1�10 IF NON-RESIDENCE FILL OUT THE BOX BELOW Garden Tub/Whirlpool f�'Yes ❑No Type of FacilityBusiness ��f?$; �nC Q Total Square Footage of Building # People 3 # Sinks � # Commodes �__ # Showers �_ # Urir.als Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats 7 (�.2.Q��Q. Type systemrequested: '�Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type� County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes '�No If yes, what type? This is to certify that the informatiori provided on this application is true and correct to the best of my knowledge. I understand that any pernut(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred from this appliattion. I hereby grant right of enhy to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to deternune com liance with applicable laws and rules on the above described property located in Davie County and owned by �Q,p�N `. ,� �R,ei B��i�4J�—• /�L�` ,r � _' .. .snn.�.c� � � /��„�,.i�-• _ Site Revisit Charge �roperty owner's o or��vner's lega] representative signature �e� � Date Sign given ❑Yes ❑No Revised 2/06 Date(s): Client Notification Date: EHS: Account # J z� Invoice # �/„� , . ��� i � `. � � � � � � ;.. � � �ONC�RD LN � ; �� �' l 277 :�--'_._--"m_. . , . , , .., � . . .. .. . . .. �. . � (29.74A) � y��� � �' 4137 - �'"'°� '� °., .: � c �, � . . � i � +� ti , � �, � E : � ... � �� � . ?� �£ � ._ i �5 g � .�� ^ .���# . . .. . ° , �' ,i � � � < �i �� I � J �� r � Q, � t y�i ''. \\� , x t ^ � � �` } t2B�il] s �e � - �„ u a I • . _. « - . � � � � . - . . , .�„ 7 f? �28 t yn,,�` : . . Y�". .....�(y`V � ' ���.�� -. w �-�.. � �� � , CeB2 .�� �� �' U,, ��� I . � � l a''��:' �`°'� .. ' ° �I Q , . .,. . .. ..... .s •,,. � . r e . M �. .. , � : a ��3�y�'� ° 4n � O� � ,_ � ���. 9Q '�, , t . � . � t, '; � �, � � � %� �% ��CV� �" , . . c"� �r<r� ._ ���. � PaD ��� �" � � 5 � � � � ,.., o., i,iP t5<on}; � � . 4 ,��; s r� ���.J ;�;; S7' � �� tas_t�t.) ;iii ,� � . 7955 1 �t� �°"- ��c7, iu k ��8 ,::� �5849 � ��{J� '.,�;., .� �.... , �,u,, ,� ; ,,. �9r ' . � ; . . .. . �..� � . � . , . . . . .. � � �. ��� � .. � .. � � �', ' g� ..: �,, i \ ..: . r���.. � ._ . .9 . . �i.� . �.i . "^`6�" � �� �\:i��' .- . _ m��v�� j�.,.� ,� �� `' ,w,"" � �, pau "� °�ui �°s PeC2 � ^ ..- ; � ~� � �,. �� � � �.w-� � --� �� .. "� : w�. � ' rr � �.. � € �; . ,�"..� �.--` a�, >� , � !` � � � �� aB ���- � �.� � � {6.36A} ��. �3 . . . ;�gp.""-' ..,...'"'` � ���� i a r �� r � � � �,.� ..� �..,.��,�o� .......� �. Ax�� � � 6 .- r .: ,�,r`' . , ���'� . "'� _ . ;o ��VA��� ., �V ;. ;�.. ` V� < ,, � �✓� ..- . �,��. ��05. ����. � . �� � - . � „��' ,.- � � ,� � . r. 3 t- � � � ..� � � - a �,�_ � _ n , e :� � � � � , _. � � ' � ,� � sf� � � � . � .. � N�l . v I v rY..t, . . �. � ��� � �.. `01 _�—.� . � � ,,—':^"'"'".. �--� � (97 45A) � �347 \ \ �. � . � � � . . � ..aa��. . . . .:�. ! ..�. . . .�� _ .. � k r'� � � �-.�� � � ;,� " � APPLICATI p d C� � ��� D 2 0 20e�- � , ��R ..r Rl ti� R SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-$760/ Fax (336)751-8786 '�.� -�� r �� eG� 3 jZd/� (r � m�' � Permit ❑ Authorization To Construct(ATC) ❑ Both *�F6�7'ANT*** THIS APPLICATION CANNOZBEPROCESSED UNLESS ALL OF.THE REQUIRED vFORMATION IS PROVID�D. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed ��x �. J��.�+ ��L�/%�� j`'�, �.�'t'�c�b Contact Person ° Billing Address �? ? 1 S�4 wick .S� • Home Phone (.33�) fo 5'0- 02q.3 City/State/ZIP Y1/iNSfot�!- Saler� G1G � 710 3 Business Phone (33G ) S'G�i -!/ 72 Name on Permit/ATC if Different than Above Maiiing Address PROPERTY INFORMATION City/S NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address e�� ��Qcksvi 11e J�C Tax PIrt# $Z D�fo � S g i-{ � Subdivision Name --�� Section/Lot# �--- Lot Size Directions To Site:Tk� Nwv. �� �n! au�- o-F T'1rxK5✓r'11e -�l-o �-h� in(fersxfioir o-� ✓NZ�Lnf�"; C'u�4%a.(�v I2�s. If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes t�'No Does the site contain jurisdictional wetlands? OYes�'No Are there any easements or right-of-ways on the site? ❑Yes �o Is the site subject to approval by another public agency? ❑Yes ��1 Will wastewater other than domestic sewage be generated? �Yes►�No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ONo Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type systemrequested: '€+7Conventional OAccepted OInnovative �Alternative OOther Water Supply Type�°•�] County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes E� No If yes, what type? Tlus is to certify that rhP infnrn,atinn nrnvi�ied on this a�nlication is true and correct to the best of my knowled�e. I understand that any pemut(s) or AT r if the information subr HARRY L. MILAtiI Dl.: 15oa35s 3853 fi•om this applicrrtio� PERRIE A. MILAM ��. issoo�a PH. 336-492-5165 conduct necessary ir 155 CALAHALN RD. �ate� =� �7�� 66-��49I25 '1 Davie County and o MOCKSVILLE, NC 27028-9706 �-�-1= :?' y � ,�-�:.� r. �._--� . ��.,� ,,.�'" �� �. ,;�,_ _.t; � Property owner's oi / _ �r �� � . ......�iJWA Y BRANCH BANKING AND TRUST COMPANY � `7i�v ADVANTAGE � �'" � $ (��J - 8 � � Dat� CLEMMONS, NORTH CAROLINA � 'Z . • � c .Tlerna cl�iyiutt�uY _�..:��1Ji�.fl/, :__ _�.,_/--,.-'''��%_ _M' Sign given ❑ Yes [ �; 0 5 3 10 i L 2 L�: 5 1 L 8 5 9 1 2 6 9 ��' 0 3 8 5 3 Revised 2/06 Certificate of Survey I hereby certify that the subcJivtsion plat 5hown hereon has been � .-----_._. I Donald J. Moore, cert►fy thak thisp lat was pound to I with the Goun SuEadlvlslon Re �attons, with the / \ a�n ix�der aton froAi (rn c�tual field wrv excepttonG�oF�such �aricmces, If�, as are noted In the minutes of that the boundarieg not gurv cre the Planntng Board cu�d that It hds been approved for recording \ 131 ghown as br hne5 plotted from tnPormatl faund In the OfPice of the Regtster oP Deeds. It is heraby noted that such EIP tn B�ook as ,Paqe Noted "that the ratto of preciston ���Q� por recordations doea not include approval to tnstatl and e as calculated by 11Stltudes a�d de res ►s Itro.000; utiNz� sanit factlltles nor does tn Include oval for the that this plat was prcpered �►accor�wtth 65. 4�-30 � �p'" Q5 CNT1�G�. GO►15tI'UG�IO►t O►' OGGUpG7►1Gy Of kJUIIG�lI1G�.3 CA1GJ 9tPUGttX'P.S. W� / \ m� Witne55 mt� ortginal 5t�ure r�istration n�rlber �d DiAVIV Hv. KOGN�ITZ \ti � 1357 seal thls 5th day o March, b., 2006. s� � ELIZABETH A. KOONTZ / a? �. Director, Davte Gounty Plcming Department Date ���-�-2� �°''� � , 1313 F SEAL-STAMP rv�°r 'ihe Gounty Planning Boc�d hereby approved the FMaI plat Por / � L� N th� Harry"L.. Mtlam Subdiviglan, NPK wI G4� � b �hio: � 6 ` � 5 � # F�r I'� mber / � , Si TE �,�; k��' y�yy� � 4�' i � i t a y ' o 4i �E"�i� ;Y '(� ` � = r � � r �r � � _: ? �:': � Date G atrman, Gounty P pnntng Board ` . s � h . s � � '., 4 �< � 39 s ' � 1 r .. J �r�_:� A �y t i43 r i z „ � I hereby certtfy that t h e Davt� Gounty Health Department has y,o . � evaluated the SubdNt5lon ent►tlad "H a r r y L., Mlfam" wtth s o� respect to criterta and condittons established by state law or p 3� 6 4 ( �, Donald J. Moore _ , Professional Land Surve}ror promulc�ated thereuncter and the game ig Found to comply w�th � � No.1=�-certify to one or more of the following os y�ch criterla and condittons EXGEPT as found In such evaluatton. �ndicoted thus. [X�: For detaila of thts evaluatton and for Ilmitat►or� see the written � . �/ICIt'1it MCt [ ] A. Thot this ptot is a survey that creates o subdivision report on Pile at the 5atd depc�'tment. � of IQnd within the area of a count�y or municipal- ` I"tOt t� SCa�@ ity that has an ordinance that regufetes parcels � � of land; IMPORTANT NOTIGE: NIR NAFZRY L. MILAM • � [ ] B. That this plat is a survey that is locc►ted in such THIS GERTIFIGATE DOES NOT GONSTITU7E A PERMIT OR DB q8, P6 388 6 portton of a county or munctpolity that is unregu— APPROVAL ON IND�VIDUAL LOTS IN 5AID 5UBDIVISION / Q lated os to an ordinance thot regulcrtes parcels of FOR INSTALLATION OF SEWAGE SYSTEMS. � Iand; [ ] C. That this plat is of a survey of an existing parcel / � �j ` or parcels of land; '� � . .� [ ] D. Thot this plat is of a survey of another cotegory, such os the recombinatian of existing parcels, a Date Gounty Health OFficial .^� �� �� � Court-ordered survey or other exception to the � ,` /_`` � � definition of subdivision; � `S� [ ] E. That the information available to this Survey�or is /� � 0 , such thQt t am unabfe to make a determinetion / � to the best of my professional abilit as to pro- �' � s �� ' visto�s contained in (A) through (D� above. � � � ` ^ /• '� cP. / � � �j 56,, �� �..J O � Surveyor��-'���—��� Dote p��' �. '�, •O sb''- �� ' � ��'� ° \ ` g Gertificate of Ownersht and Dedlcatlon h�O hOO �/• `� � p � � �• ♦ . �' I (We) hareby certify that I (We are) the owner(s) oF the property shown / � • r' cr�d de5crtbed hereon and that i (We) hesreby adopt thts plan of subdnris�on �' ♦ � ` _ � wlth my (our) Free conser►t, e5tablish mintmum 6uildtng Ilna�, and dedicate all / '� �� � streets, al►cys,walks, parks,and other sites to pubiic or prNate use as �' ,� � noted. Further, I (We) certlfy the Icmd as sho� hereon 15 within the gubdtvtslon �`� � W NPK ,,�"' ,�4• ' p a �urisdfction of Davie Gounty. �' •� !�� �,"�'� ' z � / �.` �� �`' ` � /• 2N � Date Owner / t . /� LOT 1 �♦ NIR . � �' 1.519 Aeres. ` t / 66t5a Sq.ft. .� �/� TOTAL AREA � � /� .` /, / NI � / ' ,,��`� CONTROL •� �• � l���. CORNER � � .�.`�� •� //� F � t .` �i' r � �. � i � �� oo ..� i � \ � �• ,y�`�' 'o �� o'� c � i ��s6, 'O ���C�. ./,^2�� ���� � \���. IN � INTERSECTION N O T E S � 5��� �` // �� � \�2 US HWY 64 & CALAHALN RD New Iron Pins set ot all new corners HARRY L. MILAM � '� /� `p0 unless otherwise noted. bB q8,P6 388 � / \ Thls picat t� sub�ject to any Easement�, Ac,�reements, or •� // N�W LOT Rtght-of-Wcays of record priar to the date of thts plat, � (.514 AG \ whtch wa� no� vtstble at the t►me nF the survey. � �/ � HARRY L. MILAN( ' Davie County Zoning; R—A `�,.' DB 98,P6 3�88 Af1 lots to be served by pubfic water. Ail tots to be served by lndivldual private septic systems. 1 f�Pi'ROX. 44.4ZA�G All utilities shall be installed underground CALL N.C. OIVE-CAI.L CENTER 1 REMAININC� Total number of Lots created is one BEFORE YOU QIG Total area = 1.549 Acres � NIR � / �N� 6 LEGEND Property is not lacated in a specio� Flood Hazard Area CONTROL � '_ -�"� Q E�t� extstinq tron ptpe designated on the FEMA community flood panel. CORNER � e.,, �, � ,* � ,� � ; � �� Q �ia extsttnq tror, rod Property is not located in a protected Watershed Area ' ; Vs � ; � � > a � . , � .--�` REMAINDER DETAIL ° H�� new tron rod (set thts survey) Building Setbacks per Davie Co. Zoning: .� a� � _ � , � � ew�s extsting spike M1n�mum Front yard: 40 feet ; , q � + 6a,g F , s� 7 NOT TO SGALE p Nr�s s�„ke (set this su��ey) Minlmum Side yard: f 5 feet ! ^ �X � � ; : �f c � _ ^ Q � exlsttng notl Minimum Rear yard: 30 feet pW,��., o NplG nail (set thts survey) HAr�l� L. P'illam 1-800-632-4949 � GP computed pairtt (no point set) Underground utilities may exist which were not visible at ��5 �s��Q�n �� .,� � fire hydrunt the time ot the surve NC-One-Cali 1-800-632-4949 AVOID UTLITY �AMAGE y' MoGkSvllle,NG 71028 IT`S THE LAW t�►,8,�, minimum buitdinq tine should be contacted before any ground disturbing activity. �3�� �2_�� r.uF now or formerly R/t^l riqht—of—way SUbdivt5lon Plat fOr: P•�.N. pAVfE GOUNTY 1, Survey By: °5�1Ot1Q j,� �onc�ld J 1�foore �� i I�ru �. Mt Ic�m ����� FILED FOR RE615TfZA�TION AT o'GLOGK •M• �rtif Wthpt,the m �a'@ lut to whtGh D.J.M. � ��eyor Gd(ahcm Road 200--AND RE�i�ST�RED IN PLAT BOOK }y��s certiftcation t5�fflxed meet5 all Land 5urveyinq, Mapptnq, 5ubdivisions, �'lanninq DrB. Ref. �,� pwg. By: Galahe�n Townshlp, Davle Gounty, North Garolina • statutory req,uirements for recording. PA. eox 228i, i3o t� �wy 8oi south, �vanc,e, r�+c 2roo6 DB. q8, P6. 888 M. BRENT SFIOAP,R�6IS'i'�i2 OF D�DS D.J.M. Phono: C336) Qq8-0100 Foac:: (336) q98-4498 Rata of Precisbn: i2evrew OFftcer Date File No.: V�V�I�.Garo I tna5urvayor.GOt11 Scale: t" = 40' Dote: 3/Q5/15 I:IOlJ00 A55�5TANT/DEPUTY Gopyrlght�2006,Donald J. Moore, P.L.S.,L-34b2 N.G. 0420DA06 �, Cwrye Rooert Stona. Profewiw�of i.ond Surwyor. �:.-3�E2. certify to oM 1 , e ---...----�---- — of the fo7lor' a.;��c.c m�.. �, - STATE OF NORTH u � �. d t o. .�Q e•.o�,o•. c• _o c�o c k - —M t D y�a. m .iq (� �}'" NOTES: COUNIY OF DAVIE �0 1 ', G�c�p• Rob�<< S�ons, c��±�}y tnat rh,� p�o� ras Era�n unds� my suD�'v�,►.on f�om on acrua, �urv�Y �tl• r •uD�r �s�en (d��A C�scr �p•��.on 1. Zon�ng: R-20 d a r�c o r O e C �n B o o k _3—. P e • _-�- , �rc. ) (o�!��r): s�a! rt+• Dou�dar ��.�s ro+ C'� a. That this pWl a oi a wrv�y tl,d:ryata a n�F+1Nor.ot Vond rithin 2� ----�- °`.p ' °��` e ,�'. _ot s�!r�y�d ar� c!�or!y Ind�co•�tl Of ArO�n from 'nforrtqi��on �oun0 '� Book .__—__. � tn�ono o�a county or munic}pa8ty Mpt!q�or or�no.nu tMt 2. S e t b a c k O i s t a n c e s: F ro n t 3 0�, B Q C�( 3 0�, S i d e ��J�, - -�----- -�-�- � - � �- � � pay•_.--�. �nc+ tn• ra•��o ot pr�c�s�on oe coico�a��C �s 'i�G.000�. +�o� +P��s nquWtrporoebof wM: SIdC Adjacent to Street 25�. I, John CiO���TO(6, Review �ffICC� of pavie COU(�1�}!� ,yr{� / � �- , pio� was D��Po��O in acco�0onu ■���� G.S. �7-30 as �m�e•o. w �n�ss my o���Q�na� _ 3. NO USCis or NCGS Monuments found Witfll(1 ���y that the map or plot to which this COffR1COt10(1 �,..ot B��k ^_ �j _ _ �aq� ��N F�ed :AniE� Rd f�.Qnprure, ��p�es•at�c�� ��umD�r onA a�a� --I D T1w+, Ma p�nt �o�a wn+y tt+ot•s tocotW�n wc�po*tion d a 18 aTTIXEd !MQt! all atatutory requirements for rocording. � � SR !30i - cow+ry a �nunlcipafrty ttwt Is un uW44 os:c on or�nonc� ZdO�� Of �O CCt. 27 Se tember 2004 "9 p i M. a-e�• s�oo�, e.�:��e� o� ��..�� ,n,. ____ eo, o+ --��___- , A.o. --------- . tn� �g�b,« vo�ur�+ 'on°; 4. All Utitilies shal! be instailed underground. + DB 206 O PG 399 Review Jfficer . ,o F 8. �, e i._; c That Ms plot a o1 o wrvey o�an exrting parce�or porceb 5. Total Number of New LOtS: 2 - Coiaha�n Rd _.� � ot b�a: 6. Lots 1 dc 2 shali be served by publ;c water. Qate• sk ,3�3 „eai o- S+amD GeO�9e R. StOne - --�--------- - ------- --- - - 7. �ots 1 dc 2 shaN be served by Drivate septic systems � 4 u r v�y o� ^. d. That t�'s pUt is of o rurv�y ot ar#Mr�bqpry, wch va tM _.. ..--. �-� r�combkatiw�of axi�ti^9 Daro��. o court-ad�red wnry w dhe. �9 - --- _ .__.------- ---------_- ,��, CARp � 3is2 - ---- �xceptipn fo Me e�n���w+�f�.oer.�sio�. "NO APPROVAL REQUIRED BY �'HE COUNTY PLANNING DEPAR'fMENT" ����.:�Y-Ass 5.n+�? O�.�FE-SSIp�'"���.9 a.c�f,.,. G„ Numo.- ' '` , i . +�en.��ramac�aw�oe�.to mr.�.V.yor n nxn,nor �m John Gallimoro, Planning QirCctor 2 �� �y,9'. - �nabla to mak�c tMt�m+inatiwi to th�D�rt ot'nY P^��+ond �.�i8 :Q C C A �'', obllity w to;+rovitbm contain�e ��n rpj Mra.�g� �d; a0ov� --- — : JiJ1L • c� : L-3162 � W oot� �S '�"r, rn •�" �� Z George R. Stone v5RZ�1�52d �'�y O: � ___u ---- _---- -- � . �,�-1 -- ---- - --__ G1.� SUR`�:�•'•�'` ; �o„a s�...,b,, _-�,es � R ER�' vcinity Map (Not to Scale) OB � Np t/2" EiR Fnd _ ._ CALL TAB�E `-- - / �- '� COURSE BEARING DiSTANCE ,.a�� L-' N 51°31'23"W 61.?4' ��� � L-2 N 59°35'31"W 90.83' ; !� � r- ,�,�Q �� L-3 N 59°35'31"W 2.71' I ' k / L-5 N 31°03 18'E 30.41' 11 , '� �` � /� L-6 N 31°03'18"E 299.55' , ; ; � PK-Nail �nd ----�- , ���° ,.N � L-' N 50'27'39"E 48.57' � `` , -C�G R�y�^�� L-8 N 50°27'39"E 180.00' Tie tine , 9� �-9 N 35°53'38"E 125.64' Tie Line ,� ' S/ ,N�tSI ,�oto� ,., L-?0 N 21°16'17"E 109.70' Tie Line ' L-1 1 S 06'23'1 1^E 30.67' Tie Line � � �2 �� �-12 S 64°23'26"E ?66.61' Tie une � p�1 �'y2 �-'3 S 64°24'20"E 39.1�' Tie Line `� ', , ,�0,� 1-14 S 63°51'S3"E 67.60' ?ie Line L-?2---�-----� ` � j� ~ L-'6 N 56°00'44"W 39.40' Tie �ine 1 ' � �` �' } �� �/N Tax �ot ?4� `' '� / Tax M2p G--2 � / nff Steve� �. Berry . . � � �-`" and w+f'e � �, 1 j' unda Lee Be�ry RB 561 O PG 9?2 , � i '�� �/ � Ex�st�ng 30' Access Easement , 1 -� / (Refererce KB 561 O PG 972) � / �` T-Bar w/cap Fnd in Line Center Line of Proposed Easement Foliows � �, PK-Nail Fnd ---� '� N ' Property Line from Point A to Point B / i � �_�3 , � ', � �1 �5' Each Side of Referenced Property Vne � ',e ,' / 'o�`� I _ , °� _ 1 �+ � ' �`°, NMF --t► �-_ �/2, E�R Frid .;x � � � tl �' ` 1c• , / � � / _ L-14— � , � �t%2" EIR Fnd in Une � L-- - _ __ _ _ _ 1/ - � 7 , � , 6 --- - _ RS '�� '� � � _ ___ - - - - - - , � _ __ � � �` � __ - '� _ - - - - 2 cIR . d ,r,rave , r,.v.E � I.- 1 % C� / '� ___"-__�_ _ . _ _ ' - _ _ � _ _ _ _ ..-�-- _- , _ � _. _ _ _ ' _ ' ', . . _ . � - .. • - - - - _ --- - - 3S.7g•� 2 EI nd - _ _ - - - _. _ L � r�_ _ - -_ . .- � . .. ._ ... . . � � t;' R , 1 ', - _ - --- - - --__ , d , � 1 �� �_ - --- - -- - _ ;' - "�2' EIR Fn PK-Nail Fnd -�+ - -_._ �', ' - _- _ - _ � _ � ��• � -- - � Point B Roint A ` `' --__ r __ - _ , _ 9 - - _ - __---- __-- - - - , -�__ _ F � i .. L-4 _ t--- , �0.00' lotal ___ , ll�S P t` Prp - ._ . -- _ - _I � - -j � _ - � N�IP , I N 31°03'� E 2 IRS ,n Uho�ed p Aose� - � - - - - - - - - , � 2p. __. ' � 179.98' orallci fo th A�cess fQ - - - _ _ _ _ _ L-3 ' N iR5 Placed in Une -- - -- -- - , , o �Ose�ent Repr�c�fhe�n �d9eno qd�it;o,� F _- - --- - PK-Nail Set- ' tn �f R6 56 i f�e fx�sf���Ows � P� 972 9 w --_-� i., - - � � Lot 1 � � ot 2 0� Q���� L 2 , �� � J.SZ5 Acre + '- +� '.J: . Ac�es r - '-j � i '�' Taz �ot ?.02 ��6 _� �' a�"o N Tax Map G-2 Q/ NMP-- , � o o n;f Jeff�ey Wayne Cai� ' � � N o DB 208 O PG 399 I � i �`'a � , � '' oQ 6� C � L-1 --r--- �tc c�` �e � ' a�o, oc��o�� \C,° � a � �� �ti �o �c N M P-- -�► ; M � Go /Go��' GoQo�cGc 182.29' �-�s- —;--� � I 2i 4.»• rotai s a2�28-os��w ��� 0°`�\°G " Div2stion o f t he: t ' -T-Bar wfcap Fnd ~-- '40.97� �� �'o NMP -�---1-• S 42°28'05"W --'v ------- --'��--------o'v --'�.��_—�_� .„ E!P Fnd r ] ] -�� '----- 65:.54' S 36 0� 14''W Je f frey Wayne l� ai(�li '� . - - I ---_.__ . ��15 "'�-- ��TS; Tie Line --- Property ���0 1� Tax �_ot 4.0, R �W - Righ!-of-wo�., 'C - iace ,-,' C„rh �-�- E.IP �uating !ro� �ipe Bo! - BocK o� (:u�t TQX Mop '�-2 fiR . Fx�tti��g i�or. Reba� �i- - Vcwe Fo�e n;f Ca4aha!n �r16!1dShlp , c�-+ o• 'Ok '�C' ;1�� TOx M�G '�-2, p - poat ,_F - i:qr:i �o�e Boptist Church � CM - Concrete Mon�me�r Mh - Mo� Hoie �B 1 12 O PG 63' �Rs - �o� Reto� se+ c*, - cho�e ���ce�c� ��eed �ooK 206 � page 9 - P%�L - P�opertti ��_ine "/0 �`art ::' r OB 209 0 ��i 9�� . � CjA - Cont�ou�d n��:ess :.�e � :���d Fsook ' DB 2'2 O PG 335 rc'a� Area ���_.o`. '� � R26 Acres +� - CF Concrete oipe �'B - °.at 3ook �'.27� �Q„C�e Fe2` + '- Ex�'US;vP Cf K/W !:MP - Co-�ugoted Meta� P�pe RB �� Reco�d r"iook (we; nerecy ce!t;fy ••at ��^.� �re arej !^,e cw^,arle,; ot t�e p�operty . �r�� a��a �_�t 2 �;�J9 P,c�es +�-- CPP _ ':or�ugated P�artic Fipe F'G - �'age -F- ?OG Year ��ood Bo�ndar� .^6 Catch Bosr Oesr�bed ne�eon. r^•:cn :e oca!ed i� the suod�v�aior ju.sd:ctio� ol -0- Overheod UJtilities -S- Sewer '_i�e Dcvie :our'y a�d +ha` tie�eby aaopt 'his s�bdivision p�or with r•y �ree T�% ��a -`-Q-'4"� �eet +, - f xC US•VP. Of F+/�y 8C t CS8'Tie^l -X- �ence WM - Wate� Meter corsent, estoGl�shed mmim„m buildiny setbock ;`�es and dedicate a!� /��'�Cti [�2tefrr;�ngd by ��OO�di�U+2 �OR�PUttlt��0�, �nd - Fou�d WV - Wate� 'Jalve r/f - NOM or �o�me�!y BM - Bencn Nork s+,�ee!s, a�ieye, waik�, parlcs ar4 othe� si!es a�a easeme^!s ?c C:�b:'c o- SCAL.E T0INNSHIP COUNTY STATE dATE NMP - Nonmon.�mented �oin• ?F3M - Temporary Bench Mcrk p��va!e ,:se as �o'ed 1 .= F,V� �;QiOhO'� uC'r�B NO�th �:O�011n� 9-2?--2���4 Cl �e^te* ._ine RRS - Rml Rood Spike E� - tdge of PovemeM, CN - Cabie Teievis�on Pedeeto� TP - ?�iephone �'sdestoi '?9 - E�xtnc Transformer E3oy NO -w- wate� ���a CO - Sanitary Sewer c��� o�+ /0-/l-� ' oW�er: 5��: Stone Land Surveying Company ,� _--- �----_.� slgned . _� .- ___.__�_--� - --- ....___ _._-..__. �� e � J e f f r ey W ay n e C a l i S C,`�: G e org e R o b e r t S t o n s, P L S L-3 1 6 2 �?0 04-t 60 0 60 120 �8 0 4 8 6 Ca la ha ln Roa d �� � , . . , -.. . .. z r. ,,. . �,, �uw rro. Mocksviile. NC 27028 , F . ';`%�4- '� -. ___ _ siq�eo ------ -------- -- --------- 336-492-7348 GRS ',� . �.< GRAPNIC SCALE - FEET �°`e Davie County Health Department Environmental Healtli Section �� � P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 March 29, 2006 Barry and Julie Grubb 2718 Sedgwick St. Winston-Salem, NC 27103 Re: 1.519 Acre Tract/Calahaln Road Tax PIN# 5709635849 Dear Client(s): As requested, a representative from this office visited the above site March 28, 2006 to perform a site evaluation. Based on 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. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S: Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit System To Serve: �" \���.-��.%� Wastewater Design Flow: �'�� System Type: ❑ Conventional � epted OInnovative ❑Alternative ❑ Other System Location: �rz�l� � ��-�i� '�t,_`�� G�s ��r���� Valid: C�Years ❑No Expiration Site Modifications/Permit Conditions: � C%�� C`�(„r '�� �� � � ate ps-i.p.letter 2/06