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194 Hilton Rd a.le.....+ ...- yy.._..:.`v .:i.3.:�- .-..'r.-...:.ter; .: .-.- _...... .. , - r .. _.-. - ..,, - ., a .. •- .. '�... DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION "NOTE: .Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name �,� z 10ti Date U - `-1 - �;`L. N0 1 J . Location �',� 1 �� Lr LA ;:.. Subdivision Name Lot No. Sec. or Block No. Lot Size 'House Mobile Home _ Business _— Speculation No. Bedrooms No. Baths No.,in Family Garbage-Disposal YES O NO ❑ Specifications for System: Auto Dish Washer; YES ❑ NO ❑ r c. Auto Wash Machine YES p NO p 0'j Type -� Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. l r{' / 1 p \ a e� Improvements permit by *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by P�d� �yV)p( ) j /oG Certificate of Completion Date *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 PERMIT Davie County Health Department OCj 2 Environmental Health Sections RO. Box 665 R Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 1. Permit Requested By Business Phone 2. Address 3. Property Owner if Different than Above Address 4. Permit To: a) Install-P/—Alter Repair- b) epai j b) Privy.Conventional V Other Type .Ground Absorption c) Sub-Division Sec. Lot No 5. System used to serve what type facility: House Mobile Home Business Industry Other b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms D-- Bath Rooms—Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory -'— showers washing machine dishwasher n sinks / 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions 1, —a 6 V b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information iscorrectto the best of my knowledge. to 15• �%/.U�t' � ��/t�>�� .,vr?ti.... Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6-82) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name ��,�,� Date Address Lot Size yl:y FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S ($) S PS PS PS 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) P$ PS `R U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils PS —PS PS `Y� U ��_2_L 1� 4) Soil Depth (inches) S S S S �S`` —'sU � U) 5) Soil Drainage: Internal S S S S PS PS PS PS U External —S S PS 6) Restrictive Horizons 7) Available Space S S_ S S f 8) Other (Specify) S S S S PS PS PS PS U U U � ) U 9) Site Classification U—UNSUITABLE S—SUI ABLE PSS—Provisionally Suita le Recommendations/Comments: Described by Z'// Title ��v Date SITE DIAGRAM � 2 lv � DCHD(6.82) - Davie Caunty dkaltFr 7ye arfinenl and Nome AealtFrncy 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE, N.C. 27028 PHONE:(704)634-5985 November 9, 1987 Mr. Clint Tucker Rt. 1, Box 441 Advance, NC 27006 Re: Site Evaluation Off Hilton Road Dear Mr. Tucker: As per your request, a representative from this office visited your site on October 28, 1987, to deter-mine the soil/site suitability for the installation of a ground absorptibfi sewage system. Unfortunately, due to the reasons noted below, we must classify this site unsuitable: 1) Soil made up of 2 to l clay. 2) Shallow soil to saprolite. 3) Drainage mottles present. We sincerely regret this classification and are more than willing to discuss this matter further, upon your request. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Enclosure RH/wd "• DEW BOOK NORTH CAROLINA DAVIE COUNTY EASEMENT THIS DEED OF EASEMENT made and entered into this 20 day of October, 1988 by and between THURMON TUCKER and wife, DORIS TUCKER, parties of the first part and CLINT VILLARD TUCKER, party of the second part all of Davie County, North Carolina: W I T N E S S E T H THAT FOR AND IN CONSIDERATION of the sum of TEN ($10 .00) DOLLARS in hand paid by party of the second part to parties of the first part the receipt of which is hereby acknowledged said parties of the first part for themselves, their heirs and assigns do hereby give, grant and convey unto the said party of the second part, his heirs and assigns a non-exclusive, perpetual easement of ingress and egress for the sole purpose of establishing a sewer easement perk field and necessary lines and maintenance thereto upon the following described properties: BEGINNING at an iron located in the Northeast corner of that 0.5964 acre tract hereto conveyed by parties of the first part to party of .the second part and running thence North 06 degs. 00 min. 00 sec. East 164.78 feet to a point; thence North 00 degs. 55 min. 45 sec. West 150 feet to a point; thence South 86 degs. 39 min. 58 sec. West 44.26 feet to a point; thence South 02 degs. 33 min. 19 sec. East 150 feet to a point; thence North 86 degs. 29 min. ' 49 sec. East 39.87 feet to a point; thence South 06 degs. 00 min. 00 sec. West 163.64 feet to a point; thence South 86 degs. 00 min. 00 sec. East 10 feet to the POINT AND PLACE OF BEGINNING. The above easement is to be appurtenant to the said 0.5964 acre tract heretofore conveyed by parties of the first part to MARTIN AND VAN HOY ATTORNEYS AT LAW MOCKSVILLE,N.C. •1 • DEFD BOOK party of the second part and is to run with the same in the hands of all persons whomsoever. IN TESTIMONY WHEREOF the aforesaid THURMON TUCKER and wife, DORIS TUCKER have hereunto set their hands and affixed their seals to this easement of ingress and egress this the day and year first above written. Ar AL) MARTIN AND VAN HOY ATTORNEYS AT LAW MOCKSVILLE,N.C. t. I' NORTHt CAROLINA DM BwK l7.4Yi,= COUNTY I. a Notary Public of the County and State. aforesaid, certify that THURMON TUCKER and wife, DORIS TUCKER personally appeared before me this day and a the execution of the foregoing instrument. w�uLC_ HaA4 WITNESS my hand and official stamp or seal, ,�: _,:�da �MTE R October , 19 88 of D"IE My commission expires: co �� Expires MAR. 24,1990 151L-1:ZC1' 9 a No r ubl i s NORTH CAROLINA,CAROLINA, COUNTY The foregoing certif ate of a Notary Public of - Coun " , is certified to be correct. This instrument and this certificate are duly registered this day of , 19_IL, at !2,'-55 A.M. ,B=. , Book Page BY Re ter rof Dee s Assistant/Deputy, Register of Deeds MARTIN AND VAN HOY ATTORNEYS AT LAW MOCKSVILLE.N.C. SOIL, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION 44 Name JJ' �- Date Address ,! '� t�� Lot Size FACTORS ARE 1 ARE AREA 3 AREA 4 1) Topography/Landscape Position S S S �S� 4—s PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS PS U U 3) Soil Structure (12-36 in.) �SS S - Clayey Soils (f <P9 PS PS U U U U 4) Soil Depth (inches) _ S S PS PS U U U 5) Soil Drainage: Internal S S 5PPS PS U U U U External S S S p '� PS PS PS U— U U 6) Restrictive Horizons 7) Available Space S S PS ' PS PS U U U 8) Other (Specify) S S S S PS PS PS PS UUC U U U 9) Site Classification J U—UNSUITABLE S—SUITABLE PS-Provisionally Suitable Recommendations/Comments: Described by � �` Title Date SITE DIAGRAM CIFA � p0 Bo S c, A DCHD(6-62)