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125 Lefler Ln y � . . � . 1. � �. f ✓ . - DAVIE COUNTY HEALTH DEPARTMENT Environmentai Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003980 Tax PIN/EH#: 5746-61-8209 Billed To: Kevin &Alisha Cu�tiss Subdivision Info: Reference Name: MCd-��fG� �US��L LocatioNAddress: Lefler Lane-27028 ATC Number: 4424 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED 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 fo uilding permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Sectio ewa e eatment and Disposal Systems). THIS AUTHORIZATION FOR WAST TR CTIO IS ALI A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Si ature: Date: ��o CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treahnent and Disposal System "but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period o�_ . _„Y� j � �p �a � �� �z � . � � � � � + � ��� �`.�� L�1-�� F�oa�- �%Z �� ro $� 1�c�AL. �,to-lo� ' � \ Septic System Installe By: �,ll � Environmental Health Specialist's Signature: - ate: � � DCI-ID OS/99(Revised) `j' ;'. . . . ' • DAVIE COUNTY HEALTH DEPARTMENT �' • � Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 � . ,. . :_. �` IMPROVEMENT/OPERATION PERMI , _. < T Account #: 990003980 Tax PIN/EH#: 5746-61-8209 Billed To: Kevin &Alisha Curtiss Subdivision Info: Reference Name: /�E��o�tc� ���EK Location/Address: Lefler Lane-27028 Proposed Facility: Residence Property Size: **NO`�E�*�s�mproveme4iidOperation 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 CONTRACTOR MUST SEE THIS PERMTT BEFORE INSTALLING SYSTEM. G � Residential Specification: Building Type �� �� #People��" _ #Bedrooms 3 #Baths � � Dishwasher: ❑ Garbage Disposal: ❑ WashingMachine: ❑ Basement wlPlumbing: � Basement/No Plumbing: ❑� . � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑� Lot Size �`� "} ��Type Water Supply� Design Wastewater Flow(GPD) �J(L� Site: New� Repair���� System Specifications: Tank Size�uC{�GAL. Pump Tank GAL. Trench Width3�,� Rock Depth N � I;inear Ft�3-� Other: �(����1��_�� 1«�l�'.1��� ��Eltil. ,� 1 "�1�,Z'(-1�►� �}Ct=S � � Required Site Modifications/Conditions: �c�C-� � F�FF �'��, .�� �� FROM ►^���.. �l=i� ����{�.� C-�"�� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie CountyHealth Deparhnent for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 130 p.m.on the day of ins al�ation. Telephone#is(336)751-87G0.**** ��-. ,,.��,�r� � . � , t� �� � �`�' _ � ��� � �o , , . r � �� 1 ��j--1�� 1^���� �f3t� -��X.����►''+ . No`"�s� , ,� ��75' ��r , 1i1 � ��: , � �- �IZ�t�t� ���� `�z � � � � �'T� . � y�,,��z�,� ��-�,�2 �a L ! Environmental Health Specialist's Signature: 'Date: Cp DCHD OS/99(Revised) rr-_ ,. May 15 06 03x36p� davie county envhealth 336 ?51 S?86 p.3 r t . , - . '�- �, � � � � . . �. � � � � � � � TION FOF.SITE EVALUATIONlIIViPROVEMENT PERMIT&ATC �`� D Davie County Health D�.partment � r-.�► �6 Environmental HenIth Sectiors 1,�,,, �3�q ��p� 16 r.0.Box 848/210 Hospiial Street �r ' a ntocksv�!le,1Vc z7�12s �6 ��,j}► , (33�751-8750/Fax{33 751-$786 ��ON�ENTA�. ��!' Yv�� EpI7�DLr pp��F,F� ar: ite Evaluation;Improvemeat Fermit Authorisation To Construct(ATC� ❑Both , •••IMPORTANT""THIS APPLIG�TION GlNNOT BEPROCF�S�D T:1+II,E3S ALL OF T7[E REQUIRED INFORMATION iS PIiOvIDED. P.:fcr to the INFORMATtON BLJLLE 7!N for inshvctions. APPLICANT INFORMATIO�i Name to be Billecl ' ' � G u�tact Persom� �:;1�P� ` Billing Address U C� I tomG Phonc " _(�,� CitylState/Z� `�' Bisiness Phone !J y`_�z3�'" �1�� . �/ t a 6:I y!a ,- a3 j-�,�`�7 Natnc on PermidATC if " erer:t• Above /C e,i�!� t � � MailingAddresc = �rCitylState/Zip (�' ' PROPERTY INFORMATION ���_��p- �OZO9 N�TE: A s�cvey plat oc aite ptan�ts:�accompany this application. ply/e. (Pertnit is valid for 60 mand��with site pian,no czpiratia�t with m�i�ictc plat L 5 DO�dv a Street Addisss ;L��l c�_r �f City�Eri f�'C. Tax PIN# [�OS Subdivision Name Section/Lot# ' Lot Siu: D' ctions To Sit�:: C'� �_ ?,►'Ls 1rN L,E�'f'' Di"l � D ` `/�P_ fLC.✓,{� i(� -�p r�TL��� n_f� LeFt- IS�- h�cts e e:a � l � . , Date House/Fac7ity Comqrs Flagg�i If the answec lo nnp of the foifowuig q ustioos is"yes",snpporting documei i�ation miut be attach�. Are there any existing wasieWater systerte oa the site? LIY:s i6i�a Does thc site wntain juris�lictional wctl�i.i? []Y�� . Are there any rasc►mnts o�r�;ht-n[ways on the site? :]Y ss E�o Is the site subject to approt al by ar�ther public ageacy? ❑Y�LliCo , FVill wastevmter other tt�ui dc�mestu acwage be genccatcci? UY�B190 IF RESIDENCE FILL OUT THL'BOX BELOW • #People ,_, #Bedruoms �_ #Bathroom�_ Garden Tub/QYhirlpoot ` es E1Na _ Basement:�Yes �o Basement Pliunbing: �Yes BNo IF NON-RESIDENCE FII.L Ot'T THE BOX BFZOW Type of Faciliry/13usiness Total Square Foo�age of Buiiding___ #People #Sinks #Commod� N Showcrs {i Urinals - - Estimated Water Usage(gallons p�:r day) {Attach doc umcntatinc►of similar facility waier consump[ion) FOODSE1tVICE�NLY: #5eats - Typesystemnquested: {dEonvtnliunit ❑Accepted Ulnnnvative UAltemative ❑Other_ - . Wata SuppiyType:G Cnumy/Ciry Illiuer O New Weli �istiag Well n i;ommunity Well Do you anticipate additioas ar expansians of the fac�lity this system is inten 3ed to serve?G Yes � If yes>what type? _ � — 'f his is w cerrify that the mformation E�mvided on this apptication is uue an:t mnect tn tLe best o f my Imnwledge. 1 understand that any pernrit(s)or ATC(s}issued htreaf.a are subject ta suspeasian ar nvoc:dion if thc siu is altcred,U►e intended use changes,or if the infom�ation subimtfed'm this appli�tion i4 faisified or changed 1 unde.•stand that l a�n resprmsi6lefor o!!charges rncurred • from this applicatiun. l hereby grant i ight of entry to tt�e Authorized Repraxntative of the Davic County�iealrh Depa�tment tu conduct necessary irupectians to decemm�e pliance with applicable law:azx]rutes on the abnve desenlred properry tocated in . navic Coanty and��wned try�r���'� �t n1 A'1=:1 W i�u 5 k K r , j _.� Sitr Revisit Charge . rop ty wne I or owncr's legal r�p nseat�tive sig�ature ��' Date(s):_ 5- ��-G�'� ClientNodficationUate: Date EHS'_ Sign givcn OYes l7No - Accaunt# �( �O Reviud 2lUG • Imoicc t1 `��1//�i/ �� �7 � , � wr t 'T��s.•�,�-c � '+ �'(°� ,�` a � � �. �f� �� ' �,� �R gr �,5� z �� r� 5 S�` , ). � �14� /' ..GK�,�a �. 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Tax PIN/EH#: 5746-61-8209 Billed To: Medford Foster Subdivision Info: . Reference Name: , ' Location/Address Lefler Lane-27028 �: ' Proposed Facility: Residence Property Size: � � Date Evaluated: � �o Water Supply: On-Site Well ! Community Public " Evaluation By: Auger Boring Pit Cut FACTORS : ` 1 2 3 4 5 6 . : 7 ' _ ` Landsca e sition L- r Slo e% -�2� , y ; . HORIZON I DEPTH �•-- � —Z�- �-.- , _: ; � Textare rou � :Cl. � �'J-- .. Consistence � . C; Fr S� , . ' ' Structure L�3PC G� ; Mineralo , � , , HORIZON II DEPTH , � � �j . ' Texture rou S� Consistence v F'/�' � , .. Structure . a ` 2r, . Mineralo .. ; - N-►�rl , , HORIZON IIIDEPTH �-;. _ .- 2"?.• - Texture rou � G . ��. Consistence •. ; . � _ '. Structure , . . � . , ;�: ;.� A , . : , . ,t., � Mineralo � . ,;,, ,.� s . HORIZON IV DEPTH ` . .. , Texture rou . .r �Q , ; . Consistence • _ Structure ; , Mineralo � �; . SOIL WETNESS - RESTRICTNE HORIZON _ SAPROLITE . _ - CLASSIFICATION' s , . , LONG-TERM ACCEPTANCE RATE �.� O.3� .?� ' . _ '• . SITE'CLASSIFICATION: � �`-'V ��` EVALUATION BY:�� - ��P � . _ , , ; LONG-TE �. : � .. , RM ACCEPTANCE RATE: �'� OTHER(S)PRESENT: ; . _ . , REMARKS:��'n Q[�►`��J' �� �t/'�l� 1�}+��� �{7c�S3 yN�'i:�� 'C"t7 �:'. C.�t—' � �►�s'�-l�6 'd�3 27"t LEGEND , ` T,andsca,pe Position ' ��G r ia� �e�L—• ' . , , . , _ . ' 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�turg _ , 4 S-Sand LS-Loamy sand SL-Sandy loam - L-Loam SI��-Silt , � i - "'SICL-'Silty clay loam SIL-Silty loam CL-Clay loam' SCL-Sandy clay loam �� Sandy clay SIC-Silty clay C-Clay . SC- . CON4I4T NC . ' a'�35� , ' VFR-Very friable FR-Friable , FT-Firm . : VFI-Very firm ' EFI-Extremely firm ,. ` , _ . 3�'gt . . . �.. _ ; ,. , _ NS=Non sticky SS-Slightly sticky S-Sticky 'VS -Very Stick ' �; ' ' . Y NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic . 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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 Constr-uct 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: � �� ��"�1�='�L`' Wastewater Design Flow:� C�� System Type: ❑Conventional Accepted ❑Innovative ❑Alternative ❑Other System Location: �L�����.D"T � �t�St= Valid: l�Years ❑No Expiration Site Modifications/Permit Conditions: ��� tJl�-�%1� �l'MQ � ��/.�,,t � Environm ta peci 'st ' ate / ps-i.p.letter 2/06 � �.s � � �,a c��r n�. �w -u�. . I�''� . � „��*'�` r :.�j � �� t�'�� � ' ���� F +h' ��� 1 wr�ry3�` s�� yav?`- �m �� ^� �"t � �- � r�.e 'pt y, '�40 '+ �^t` '�' .� � �'h��.^' r�'S. +s� ' .A� J�X R # �k�" �,, .9' �:,�� ' a � n. � u, i s� � �`� �' � �.. �' .,��xt3+..,'�'„� ��j� '��•:r�r�°v'p '' �i ��a � � � � • �a �°� �� �& �'�'� �am 5,��.,, �I s�;�,� �" g � , . ���. .� � ������� f�.�;� .�. . r�� �„� � � ,��� '", K ' � � �. ~ f ��W�a ������ ,��� ` �s ,��� � � r� +»,� , � �.".3;' �'" � �.b�+'a �a"�a '�� �rt,� iw}�� �' X .....c���l ' �,.. ' ` . ,. i *aa�. `' '��`�'`,�,�y+yg`*'�,�"�� ���r h " ���,� �'� s ,v� ,�'� . 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D.B. 125, , � FOR �ESCR3P'i07J REB� `�\ `� . . � ' ///CORNER N `� `� • NEW i� 6j,3�` , iRo►r i�' , `36, � ' �� . � , � � � ' � , '� ' 'f EX5 ` • J' � 'O . .' �.� , � �� I `� .,Lh,,,��1' . •\ �'"� . / N 6s*��� '�. ��,o� t . � �ew� J��� � . .. •�� � � �. /'� ��1. y 1 y*°/` �` . in . �.� � • . , � ' , • '.� . \ ; p. 1 r.._._ . _ SeP�07 �2006 4�4�„n PM HP LRSERJET FRX , . ! �0021004 � . . . �it b i i P���b �. ; . . , . ; � 4C�345 � t��snutio� � U Y 9 ZOdb 3;38 P.M. �'�S�Ul7hol+srt/►� � O�IiE �IME . . , i Ibl!lQdKb7 Z..!'l49E?b3 � 81b1IF.1�ti15iER OF D�DS � tO�V� aE�O TRANSFEA CM�CKED � ��rE �-/9-a� sy TAk ADb1lNISTRq70R ` D PUTT • i r NOR'�CAROLII�A GENEYtA1.V�+ DETsD Exci�e'Tsx: � Parc�Ideati5cr Noy: Yerlfkd by Cvunty.oe .,� AiY of . �20 By: MaNHar to 'I'�i�c+asnumeas wss piepArt�by: WilliamR DeCmw,h.— O L 1 Brief de�cripdon for Qu ln :0,T81 acre�Plat Bootr 8,P�ge 353,Lefkc Laae.j� vill�IJ�27028 TMS DEEti a�aAe�I,u day o!'July,Y006,br awd betweca . � ' ' t3�OR GRANTF.E f iltedford A.Fa�ta�ad wl[�, K,e�te�E, �ud wi[e, . lKsry VV.Foq�r AWb�F.C 3q 7437 HiZh��y d01 Sorth 73S Ra�Ro i Mocklril}!r 2�IC 27028 MOcktvUlt� $`J'02S ; Enter ia 'atebtockfo cuhpart . m.ne,addna�.aad,if o�rfate,c6ar�tate of,enti ,e. o tio�er ecebip.. Tlu desigratian Ciuetor aad tco sa uand iieLeia�hltit imcInde aid pae�tas,duic h n,succesaors,a�•asig.+r,�nd ehall tnetuda singu]�r,plural,m`seutine,fdminine er aeuter a+reqvired by contcxt. w['TNESSETH.thac chs[�anoot.fat a vAlusbie cowidenttioct pa�d by the Grsntee,tbe 'pc ofwhich is hueby 4eluxtwkdgec�,has and by theee pt+errata daes graat.�sraa��ell srtd coovey ttr�o tht Crantoa iat fcc:iu�p�e,�ll ��costqin lot ttt pucol of fam,d sit►ottd in tlye 7atuastetn 7umwl�ip.navio County�North Cu.�olias md R�ac�pa�ticttkrly tltsCtibCd� tollOwi: Sca EXFi�IT"A"stt�ched�iereto w►d incorpbaated 1�ezoin bY nfe:eact. " The proparry Iseitiosboue da�cr3bed waa acquirod hy Gsantor by ln4aumen!rocorded i 800k 1�5,Page 56. � A tsrap ehowing the z6ove deqcrihed prope�ty is mcorded tnP lat Hoak�,Ys�e 3 S3. � ; NC$nrAusociatioaFonn No.3 4'r 1�?6,Revisrd�11977.2Q02 ' P:iated by Ag:cement witla she NC Bar Aasociation—1981-Chicsgo Tit1e Iasuinace omipaay Sep 07 2006 4:52PM HP LHSERJET FAX P- ?.___.._._ 08l22I2006 15:48 FAX (�J003l00� � � �Kbl tP� lb . To HAv�AN�TQ HO►L�the a!'o�id lot flt p�rcel aftacd and s1I privileget aod a , cQeceto belc►�,ging eo t1,e Grantee in fet titt�+k. A�d thc Gr�ar�cvr coveneat,with�4rwnee,tlwtt Cirantoris celzed of�e prarrises i�r aiti3ple,l�as the night to convey the seine in tvc simpk,that titk is medcc�ablc aod fl�ee aod clear of ap ancumbrances��u,d t!u►t Gr r vKill vrur�at and defend tbe 6tk ags:'ast�e lawfvl cfa�m�of all penons�tpm4oever,othe�t6ap the foltowing e�oaptioas: Eae ts;restridion��od rigks�otwsy oicecorc[.ff ' any,and 2006+►d valotem taxea. IN Wl7NBSS w�REOF,the Cfraatos haf duly wcer,�ted 8sc fo�egoiaa ae o eho dsy,�ttd v t a vvrittan. � (Enttty Nama) � M a. By: J � 7itk: W.F ' By: ' �A[) Titic: HY �..._._. . . Tie�.• . � State of No�th Cacoliru-Connry of ��- � i,.��� 1nA�r s�c�mderctghedNoc�yFabiicof � Vi�- ar�dsniealoresai4ucttifYrhatMedrord A.Foater�md Msry W.Fester,either ing p�eom�lyknown to me arpe+ovea byestieG �vidence.perea�ly sppes�d bet�+e rne thic+day,tach eda�ovkdaieg w ate t$at he or ahe vo y sipicd the f �omg ias a,t for tbe purpwc stated therc'ra. W imess�rtun��ad NotuW scamp or�a]tW�_�!�of ,2001v, My CammissJon Enpina: ' �. � ��++�r�u qo�A CraR,y•p���, No Ulic M/tRt'N/►c.i.OyVSR1► tki�+ Numc:,�Ly�ha�. L.owP r,� Sbtr ofNorth C�mtlns- ' 1,the vaderri�ned Notsry PubUc ofthe Coun�a�sd St�te aforessid,certify tba pe,�onaqy ceme 6efore me this day and ac�owlad�ed d�at he is of . a North Gmtina ar c rpvrAtioa/licnieed liabfliry campany/g�nerat putnerbhipllimited putnatebip(atrilce tivough the irwppiiable),and Waf by aut�C,rity given aad os tlLe,�t o#snch�ntity, Le u�ned tl�e foregoiag 4uwa�ent in ia s�maa oa itc beh.lf as its act aryd deed Wltneas hend�ud Notarlal�tttttp a set1,this . dnr oF�,,,,,_, ,20 � My Commtssian�acpins: i : No � Pu61ic Sta�ofNoir�Qwliot•CoimfYaf . ,_,_„ 1,d+cundenig�udNotaryAcb�icdf d�e Couatyaad Sata afotesaic�ce�titY�}�at�. wftnees mp b�nd�ad Norsrial:tamp ot seal,t6is day of z0 My Comma�aioa Expird' .., • Nota �ublic 'rhe fOa�ote6 C�4(�?of is/�ta artifkd to be conect Thie iastnntscnt and tbis arti6cate�rc daiy rcgietarod at tbe 6�tc tae�e a�d in the Hook aod P.Qe a�owa on tbe fuK p�gt beceot Rsgiytcr of neca� !bT Cttuooty Hy: Dcputy/Aasis�ant-Rtau r of Deeds NC Bu Assxiatian FotwNo.3�19')b,It,evised g►i 4?7.Z002 Printed by Agreanene w�id�the NC II.r Ae�ocLhon—19B i—C'hieago TStic Insmmnce rnpsny SeP 07 2006 4:52PM HP LASERJET FAX • � -- P.�3.,__ .__ gei2212oos t5:as�f ax �oaa/oo4 � 8Xb1�1 P6i6 �� . . � � . � .. ., BEING al1 of that certain 0_781 acre tract as shown on ptat map for Medford A. . Foster recorded in Plat Book 8, Page 353,Davie Coun Registry,ta which referencc is hcrelry made for a mort puticular descrigti n, TQGETHER WITH and subjecE to thc Z0 foot wide p tual aasement of ing�ess, egress�nd regress more particularly d�scribed in Deed ook 125,Pege 56.Davi� Cou�ty Rcgistry, TOGETHER W�TH the right to use the existing well � 10 foot widc w�tez line Z casement as shown on the plat recorded•in Plat Book 8, age 353. However this ' right to use thc well and water Iine easement shall ba granted to Kevin C.Gurtiss and wifc, Atisha F. Curtiss persanalIy and sha[t not bc urtenant to or nm with . thc tand. . rF F . � I . � . � � � ' . , t' �- v ►.ux�rtu� "'�. � . � C4RHEit : t�'�,�'� , . . � • • • . - ' ' . . �' p?,� . . • vc�rnkG � � �. .� , - ��0" � 6��,d i�we} h�reby undar�stand tAot � - 0� `� . , . 0 ' .Subdiv�b�on Ont'mana of Davi W . ,�,:a. �' • ie far tM exclu;nro purpoae � � within the third deyree of fin Q . . e nseAn4�;��y� f�b . . ����'� ' nb Yhr fu�ure�pccept far tt►o: � - ,`• , may be r�equi�ed by Darie Cc � S Si•ii'15` • "� �4.$4 �;Sra- eubsequent eo�e or buifding c � �G�-��� ¢t Lari a�pa� X t �� � <'�`s c�� t� •�� � �o w - i a5 �`�� . Ormen �� � ��"� • / �' ` : !;' �,� v , `~ �y?� � , �„f►� CG�QIQWI�QE�t fl'i� � ���, ���� \ � . ��` � r�. 1 . - � � _ . �` . � Name� � . . . � . 2 ` � � _ � _ . Nome � � .. 3. � � ` � � . --y�'A= 0.78.1 AG". � '. Name - ` ` �. C�►�PllIE� 8Y U�ht.0. � ` . , . . _ 4, � ' Nam� . �•� 5, � .` � • . • . 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