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151 Pine Forest Ln , , DAVIE COUNTY ENVIRONMENTAL HEALTH � ' ' � : P.O.Box 848/210 Hospital Street �' � Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 �� OPERATiO1�I PERMIT - Accn�ant #: 990005635 T�x F�iNi�H#: J20000003806 6iElc�`f�: Danny Walker SuE�di�fi�ioii Ir�fc�: _ R�fer�r�ce Nar��e: LocationiAdi�r�ss: Pine Forest Lane-27028 . f�rc��c�s�ei Fr�s�iEiEy: Residential . . �fo��r�y �iz�: 4.55 ��T�*��*'�'The�is uance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 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. . � System Type;_��e�.T:�Manufacturer�� Tank Date� Tank Size UU Pump Tank Size / Bedrooms: 3 System Installed By:g�i� � U P Installer# Date:��_ � - I GPS Coordinate: - � . � -- —_ _ ws�s �� _ _ b�,�'� `o a�, '��\'�'' (�3'—� � 1' S� ��' \�� }) � �s �� ,,,� �,• � ��-7' �S� Environmental Health Specialist T Date: ��Z . t DCHD 11/06(Revised) . ' ` , , i 1 , � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 . ' (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION }�ccr�u�t �: 990005635 � " ';; ,7"�x:F�I�IEH�: J20000003806 � , �il1c� T�: Danny Walker �uki�i�fi�ioti.lr��o: . . :< £��Fer�r�ce P�la��e: ' � ' �LocationiAdi�r�:�ss: Pine Forest Lane-27028 f'rc�pc��c9 Fr��:i€ify: Residential , ` ; , :'°, �'�b��r#.y �iz�: 4.55 , �.;, � : � a,TC E�u�tber: 5996 � . . Site Type: �INew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior tq issuance of any building permit(s),(in compliance with Article 11 of G:S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms_,�#Bathrooms � #People 5 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size��_ Type of Water Supply: ❑County/City �1 Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) 3(i^�Tank Size�(��Y'AL.Pump Tank � GAL. Trench Width�� Max.Trench Depth�� Rock Depth�[� Linear Ft. !`� a�"�o Site Modifications/Conditions/Other: � ��1�� Contact the Davie County Environmental Health Sectio�t�for final inspection of this system between 8:30-9:30a.m.on the da of installation: Tele hone# 336 751-8760. �' 3(02� � @� ��i`1) ,�b �, _T ` �3 r � � ��''' '"'{�� 5�� ,`�% t�' � . r � ' ��c1 5b�^�' ��\ weu � � ��'� , �� ;�> � � � , - � � � �' � Environmental Health Specialist l� - Date:� D�Z DCHD 11/06(Revised) : � . • , , , .. � , APPL�CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: � Site Evaluation/Improvement Pemut �'Authorization To Construct(ATC) ❑ Both Type of Application: ONew Svstem ❑Repair to Existin�System ❑Expansion/Modification of ExistinQ Svstem or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION B[JLLETIN for instructions. APPT.TCANT iNFnRMATT(�N Name a %c�+-+2 � 1N4�� Contact Person Ss�� Address � .$ ., � z,// � Home Phone �� — y��', — 7/a � City/State/ZIP��G�s w�/e iU c o'L'7 0�8 Business Phone,�3 G - `3'o g— 3 a 3 5 Email ,!7/� I.J� /KQ/' yc� y4 tioa . co� Name on PermitlATC if D�erent than Above Mailing Address City/State/Zip � PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE:. A survey plat or site plan must accompany this application. Included: O Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name' " Phone Number Owner's Address City/State/Zip Property Address ��e,��j , � City Lot Size�,,j s (�i Tax PIN# ��Ud 3� Subdivision Name(if ap 1'cable) Section/Lot# Directions To Site: ��p� b4l,�/� �'/�1�j N� 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�� Does the site contain jurisdictional wetlands? Y�e ~/No Are there any easements or right-of-ways on the site? �es No Is the site subject to approval by another public agency? _Yes �-� Will wastewater other than domestic sewage be generated? Yes �o TF RF,STnENC:�FTT,T, ni JT THF.RnX RF,T,nW #People #Bedrooms � #Bathrooms Garden Tub/Whirlpool ❑Yes 0� Basement: ❑Yes o Basement Plumbing: ❑Yes �#6 iF�TnN-RF�TnFNC;F FTi.L,niJT THF,RnX 1�EI,OW 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: # ats Type system requested: onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water New Well �Existing Well 0 Community V�ell Do you anticipa e additions or expansions of the facility this system is intended to serve? 0 Yes C3'No If yes,what type. .��y�1/1'l.ro o�n See 5 i�� Q�� ._.. ..r....._______._.�,___ _ - — — _-1--._._.�_._.___,.___..._..._._.�..______..._.�__.____.�..____..._ This is to certify that the information provided on this application is true and conect to the best of my knowledge. I understand that any permit(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 hereby�rant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or the house/fac'lity location,pr osed well location and the location of any other amenities. � • Site Re�isit Charge rope er's or owner's legal representative signature Date(s): � "�I � °2 Client Notification Date: Da e EHS: "' �i ,� �+ � Sign given ❑Yes ❑No �� "" -"""� `�� Account# �C�3� Revised 11/06 Invoice# �� . • `' ' ' Davie County Environmental Health _. P.O.Box 848/210 Hospital Street � Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 ' IMPROVEMENT PERMIT Account #: 990005635 Tax PIN/EH#: 5718-03-7444 Billed To: Danny Walker �� Subdivision Info: Address: 383 Rainbow Road T � Location/Address: Pine Forest Lane-27028 City: Advance ( 1Q, Property Size: 4 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DO�S 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,plat or the intended use change. Permit Type: �1ew ❑Repair OExpansion Permit Valid for: �5 Years ❑No Expiration Residential Specifications: #Bedrooms�#Bathrooms�#People�Basement❑ Basement plumbing0 Non-Residential Specitications: Facility Type #People #Seats - Square Footage(or Dimensions of Facility) Design Flow(GPD):,�� Type of Water Supply: ❑County/City �.Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial � Re air o Site Plan � Y�mi/�/✓ . 4 , ., �� , �� _ �, .� a,� � ell � w �, `"��se , 1 � • � ��(o t � �� ' ��Q Environmental Health Specialist Date s"' �--- i.p.l 1-06 , . : �(��l ��Nu�j u� � ' ..` . , , ' . , ��N� D � A.PPLI�A,�,'� OR STTE EVALUATION/IMPROVEMENT PERMIT & ATC ��E Davie County Environmental Health ,� �p�� P.O. Box 848/210 Hospital Street ��,� � • Mocksville,NC 27028 �U.� (336)753-6780/Fax (336)753-1680 � �, Y;---' �, Applic�ion For: ite Evalu�tion/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System a ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility *�*IMPORTAN7"`** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name � �/��' Contact Perso a r/i✓ . � ApJ Adcti-ess 3 S'3 '—iPa!N flbJ � . Hoine Phone 6 '�- C7o1- City/State/ZIP ��,��ce .�C 27aA� Business Phone 97 '��2�G Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged ��`�� NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site lan,no expiration with complete plat.) Owner's Name C .`t� �ov Phone Numbe �6 � —7,�y Owner's Address /S,r i� a' L,✓ City/State/Zip�v c�Sv.� /,e �/� ' 70� Property Address ,3" :� S L City G Y'-` l Lot Size � �C�� Tax PIN# _Q - Subdivision Name(if ap licable) r Section/Lot# �� r � /1 D�ctions To Site: � We59f' �p~ , .S ��1r a �� ,S�`' � /`O S� '° 4 �°�S a If the answer o any of tlie following questions is"Yes",supporting docum�e tation must be attached: Are there any existing wastewater systems on the site? Yes v1�10 Does the site contain jurisdictional wetlands? Y� � Are there any easements or right-of-ways on the site? "�Yes ' Is the site subject to approval by another public agency? Yes �� Will wastewater other than domestic sewage be generated? Yes .�NO IF RESIDENC� FILL O��'THE BOX BELOW #People #Bedrooms �_ #Bathrooms o� Garden Tub/Whirlpool ❑Yes o Basement: OYes o Basement Plumbing: ❑Yes �Pdo IF NON-RESIDENC� FILL OUT THE BOX BELOW Type of Facility/Business 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 system requested: C�(:onventional ❑Accepted ❑Innovative ❑Alternative ❑Odier Water Supply Type: ❑ County/City Water ew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this sysfem is intended to serve? ❑ Yes �'No If yes,what type? __ This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(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 hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to detennine compliance with applicable laws and rules. 1 understand that I am responsible for the proper identification and labeling of property lines and corners and locatin � d flag ing or staking the house/facility location,proposed well location and the location of any other.amenities. ` '�� Site Revisit Charge Prop r o� n r' or owner's le al representative signature l Date(s): � � / l Client Notification Date: Date EHS: _J"� �\ Sign given ❑Yes ❑No C�4 ��, � Accoun[# �IG"�i� Revised 1 1/06 �� C�� Invoice# _`�� _ -- / � . � : ` .� : Davie Coun.ty Environmental Health � . , P.O.Box 848/210 Hospital Street � Mocksville,NC 27028 - (336)753-6780/Fax(336)753-1680 � IMPROVEMENT PERMIT Account #: 990005635 Tax PIN/EH#: 5718-03-7444 Billed To: Danny Walker � Subdivision Info: Address: 383 Rainbow Road Location/Address: Pine Forest Lane-27028 City: Advance Property Size: 4 Acres Reference Name: Proposed Facility: Residence **NOTE**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,plat or-the intended use change. Permit Type: �1ew ❑Repair ❑Expansion Permit Valid for: �5 Years ❑No Expiration Residential Specifications: #Bedrooms�#Bathrooms�#People�Basement❑ Basement pluinbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):,�� Type of Water Supply: OCounty/City kJ.Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial " Re air o Site Plan } �4 . � _ �,� �'t ��"� � � _ � �� . ` �'1 ��a . �� ,� Environmental Health Specialist DateS2��,�� i.p.l l-06 ' ' , • •, • DAVIE COUNTY HEALTH DEPARTMENT . . . • ,. . � - • �� ' Environmental Health Section " � Soil/Site Evaluation ArrLiCANT IivFORlviaTION PROPERTY INFORMATION Account #: 990005635 Tax PIN/EH#: 5718-03-7444 , Billed To: Danny Walker Subdivision Infa Reference Name: Location/Address: Pine Forest Lane-27028 Proposed Facility: Residence Property Size: 4 Acres Date Evaluated: ��/� -- Water Supply: On-Site Well J`� Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% " � o HORTZON I DEPTH p= —$ Texture grou L, �'� G Consistence ,.? Structure � C Mineralo HORIZON II DEPTH - 2 L Texture rou •j, ' L Consistence �/ Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo ' HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION � � S LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: ' EVALUATION BY: LONG-TERM ACCEPTANCE RATE: • 3 OTHER(S)PRESENT: REMARKS: LEGEND i,andscape Positi� , R-Ridge S -Shoulder L-Linear slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace FP-Flood plain H-Head slope Texture • 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 ciay SIC-Silty clay C-Clay CONSISTENGF. 1174is� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � 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-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv_ 1:1,2:1,Mixed � No es 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) TTAR _T.nna_tPrrn arrPnfan�P YATP- (TS1�IlIaVIfY7 Tl�TTTl1C//1G in_._:__�� ■��e��o��e��r,��i��■ ■��■��■��■��■��s��v��o��i��■��■��■��■ ■��v��■ ■��i��o��■ ■��i�■��■��■ ■��s��;e��■ ■�w��■��■��■��o��e�i��■ ■��i�■��■ ■��t��s��ii��■ ■��■��ao■��■�a��■�o�i�v�■��o��■��■ ■��s�s��■ ■■��i��e��o��■ ■��e��■■��i�■��■��■��■�■ ■��t■��i�o��o��■ ■��■��■■��■�v��i��■��■��t■ ■��e��i��o��■ ■��■��■�■�vo�a��■��i�■�,��■�■��■ ■��■��■��o��e��oi��■i��■��■��■ ■��s��i��i��e��■ ■��■��■��v�t��i��i��■��■��■ ■��■ ■��i��o��■��■ ■��■��■��t��o��i��i��■��■��■ ■��t��t��t��■ ■��o��t��■��■��■��■��i�■e��■ ■��■��o��s��■ ■��o��■��■��■■��u��■��■ ■��■��■��■��■��I��I��■��■��■ ■��e��i��i��■ ■��■��■��■ ■��i��s��■��■ ��t��t��■ ■��■��■�■��■��o■��i��n■o��v��■ ■��s��tt��o��■ ■��:.��i��■ ■��o��•_�r��it��■ ■��■��t��■_��::��■�■ ■��t��i��■ ��i��■ ■��i��■ ■��■��■��e��■�e��i��■��■ ■��i��.��i�� ■��■■��i��s��i��■��■�■ ■��s��i�-��■��s��■ ■��■��■��■��i�■��c.��.��,■��i��■��■��■��■ ■��/��1��E'�1��W 7Ii��0��1��/��v��■ ��0��I��e��ll��/�� ■��0��0��I�e�\��i�l��/��e��■��■ ■��■��v�■�■��■�■■��1��■■w��■I1��■��■ ■��1��2'"'A��1��■ ■��■■��■��n�■e��ti��e��■ ■��a��na��i��o��■ ■��■�■��i��c��o��■��■��■��■ ■��e��o��■ ■��■��■��■��■ ■��■��i��■��■ ■��■�■��■��ti��a��■ ■��■■�■��■��i��■ ■��■■��u��■��■��■ ■��n��ti��■ ■��11�■��■��■��II��0��■ ��11��//��fl��■ ■■��■��■��■��11��■��■��■/■��■�11��■��■ ■��11��■ ■��/i/��Il��/■ ■��■��o�■��■�n��■��■��s��■ ■��i��.��■ ■��■��■��■ni��o��■��■ ■�■��■��■�ii��■ ■��i��.��■ ■��■��n��s�■��►��■��■��■ ■��,i��■ .��o��■ ■��■��■��■�■��i��■r!.��s■��■ ■��e��.��o��■ ■��■��■��■��i��►.��■��■��a��■ ■��►.��■ ■�■��■■��■�■��■��■��■ ■��a��■�■��■��■��■ ■��■t��■ ■��t�■ ■��■�■��s��■��■��■ ■��■ ■�o��■��■��■ ��s ■��■�■��■�■��■ ■��o��o��■ ■��■�� ■��■��■��■ ■��■��■ ■��t��t��■ ■��■��s��■��■ ��t�� . � � � , • • ` . I /� _�. . f� J , �j' S� '�' ' - --��. ��',. I a� in � �� '� I . I''� j b , �,!;c.0 i �• � �J / � � r e ` / 2 � D � Q ; --- _ , , � � { ��,�;```� �--�iltn � �;�� ti�- /)`� � i c�l� I 1 i -,.. <� oa.Yir I 1� All data is provided as is without warranty or guarantee of any kind either expressed or implied including bdt not limited to the implied "�',V�� '��"'��`�. warrenties of inerchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the Counry of `�U Ci� ��, � Davie,North Carolina,its agents,consWtants,contractors or employees from any and all claims or causes of action due to or arising out of I ti the use or inabiiity to use the GIS data provided by this website. P�I nted.NOV O9� 2��2 ',, • • ! I. Geo�ps Rob�rt Ston�, c�rliTy that t�is Dlat raa arawn una�� mr � I.(��qenopertxone,rromeiono�i.arwaurvey�r.�—�ioc,�.n��w.,w iivu �� aup�rvlaion f�om an tual surray moE� unEe� my suDe�vlelon(A��A O�ecrlpflon of�etollo+rin9cai^dkat^ANus, � or �; ' ncordad in Book_L.. Pa9a�, •fc.7(othar): t�ot 1�� boundario noi � �nurv�y�d-�are c1�arl�.IndlcoME aa dfara from latormotl-oq found 1e Baok . � y 7�ptthisylvtleofowrvayVataeatesaaubdiriawnoflarMMRhin . / Puqe ' that t��ratio ot D��clslon aa calculale0 Is Ii10,000: t�at t�ls lheureodacaunp�ormunictpafityNatha�an«dinancathal O plal �as DreDar�d In accordanc� rith G.S. 47-30 aa a�mnd�d. Wltn�� my orl9lnal rpuWtesparcoboflond: . � � �Ipnatura, reDistratlon numDv-ao0 ssal In Plat Bo� / 0. 1Tot N1a Dbt te.of o�urvey Nat ia bcated in such,portion of a �e i, 9 aay or February A D. 201� ► DB 91 � PG 34 � county a mu�uTipalRy that te unrequlated m co a�«d��a�ro �� . Uat royulates porcele of land: • � / S B4 I of S t OfnP George R. Stone . � a That MIe Dbt b of a�urvey af on eziatinq parcN w parcela F I I In9 Fee . � � . . of WrM; " Surveyor �Cj / ,�N CA(�� L 3162 � a jhat Nia Dbt ie of a wrver ot arather rnte9ory.such oa the br � Ol�L' �„SS,� �� rocomblrwtion of aAatfnq parceb,a tourt-orde�ed wrvay or oiher �k =• .OFE ��N 9 R.oi.r.ario�Nurtber ��epYantoNadefinkionof.�,na��.�o�; � v � �Q� S�L "��•� � a That tha fnformation wailabb W this surveyor b euch that I am . / � � unable to maks a detarmiration to the best ot my D�tasebnal aDility as W provi�ions conWined in(a)Nrough(d)obwa. �;� L-3162�,:_ � ��9?� ��°�� P R E LI M I NARY George R. Stone, P� i c ..suR,.•• 5 . ��oorp'� . Profasaional Land Surveyor.L-3182 "``` NOT FOR RECORDATION, + Exempt Minor Subdivision DEEDS, OR BUILDING / I Tax Lot 38 Tax Map J-2 n/f Clifton Dewey Cooper ID6 91 O PG 34 . I L-4 LOT 1 I � ,,,SP��n9 Pa rt of Ta x Lot 38 __ __ Tax Map J-2 I Branch '——� 4.552 Acres +/— �. � ;' Tax Lot 38 Tax Map J-2 I \ ` ,' � n/f Clifton Dewey Cooper e�o� ;"Proposed Septic ;� DB 91 O PG 34 Tax Lot 38 ch � � � Feld \ I Tax Map J-2 � ` � �� `�� 63.98'� �' n/f Clifton Dewey Cooper � � �� snea ' �e s� � ac 3a POND � � Q � -_ � ��'� P�oPosed Pine Fores; I � ��,, House � 15'+/— Private Gn -----a I � \ I Exiating BuiMing .3O'+/- Existing Acce � i Reference DB 105 ` �i � N N� 2207 ila well❑ ero�ch�� j 9 �J.5'+ - See Note a L-6 � � ---- - _ _ . _ _ ._. __ .. . ..\ ---� -- - - - . _ \ � ' L-2 . L-1 . �� / / Tox Lot 37 Tax Lot 10.02 Tax Map J-2 STATE OF NORTH CAROUNA Tax Map J-2 / 165 O PG 41��rd Cartner COUNTY OF DAVIE n/f Thomas A. Cartner / � & Rebecca T. Cartner � I,Mdrew Meadwell, Review Officer of Davie County RB 307 O PG 525 certi(y that the map or plat to which this certification is a�xed mcets all statutory requirements for recording. i COURSE BEARIMG DISTANCE I. 6eorqa Robert Stone, certify that ihis plat wae drawn under my I,GeageRob�tStone,ProfeaaionalLondSwveyor,L-3162,certifytoone Filed for repisiratlon ai o' clock M supervislon from an actual survey modo under my eupervlslon (deed description ofUefollowingasindicatedthus, or �-y recorded in Book �, Paqe # , eic. ) (oiher): that the boundarles not � �1 ' survayed are clsar ly in�icated ne drara from intormarlon }ound lfl Book o, ��-y��p{a��.ey�at createa a subd'rviaion of IarM within , 20 and recorded / Pape � ihat the ratfo of precision as calculated Is Ii10,000: thai this � I a t ras Ue aroa of a couMy or municipaAty that haa an ordinance that Pine Fo�e3i Ln O D prepared In accordance rith G.S. 47-30 as amended. Wltness my oripinal ragulateaparcelsofland; � y% � / siynarure, reyletrailon numbar and aaal \o' � 9 Februa 201 1 b. nac u��8 ac�g.or a s� i� P i a� Book , Paqe i1 �\� ihls day of ry , A.D. * �B 9� O PG 34 � P �Y�t ia located in nuch portion of a SITE • � aunty or muniCipaflty that is unrogulated as to an ordinance M. Brent Shoaf, Reqister of Deeds 1 � Uot rogulatea paroela of land: / S2al Of Stamp Filinq Fee Paid �� George R. Stone � c. Thot this plat is of a survey of an exiatlnq parcel or parcela V / �G � �A� Surveyor oflond; �J r� Shady K�oll L� �n �'� ��/�" L 3162 � a. nqt cn�s Pbt�s or a survey of another category,s�n as tne br SR 1153 �� Q•,O��SS/O'. 'y9 Req I s ir a t I on Number rsombination of eziatinq parcela,a court-orderod aurvey or other DEPUTY-ASS I STANT /�, A,9�� eacepYwn to the d�nRion of subdiviaion; ��v 'Y '�� •Q� S c�L �•. � e. TMt the infortnotion avoilobb to this aurveyor b auch thot I am / • / I � �r� uwble to make a detertnination to the beat ot my protesaio�al B_e�ry- � � L-3162 ' W aNlity as to provisiona eontained in(a)through(d)above. Shody K�oll� �• � eTY � ' ��c?°.S�R��°��° P R E LI M I N A RY George R. Stone, PLS Q T D e °° Rd �ROBER� Profeeaional Land Surveyor,L-3162 Vicinity Map (Not to Scale) NOT FOR RECORDATION, : Exem pt Minor Subdivision DEEDS, OR BUILDING / I I NOTES: I Tax Lot 38 ,t 1. Zoning: R/A Tax Map J-2 2. Minimum Building Setback Lines: n/f Clifton Dewey Cooper ' ' Front: 40', Rear: 30', Side: 15' DB 91 O PG 34 � � 3. Watershed Classification: WS-III BW � I 4. No USGS or NCGS Monuments found I within 2000' of site. I Tax Lot 38.05 ' ' S. All distances shown are measured I L_4 Tax Map J-2 I I horizontal ground distances. n/f Hatem Rafie I � 6. The owner will remove a portion LOT 1 & Kendra Rafie of the existing building to provide RB 693 O PG 418 � ' the required 10' setback within 60 I ' Part of Tax Lot 38 days of the date the subject plat ,sp��g \ is recorded. - - - _ - - Tax Map J-2 Branch � - - � � 4.552 Acres +�- I �. � z � Tax Lot 38 � I � � ;� � �. Tax Map J-2 \ I ` � ' ��-.� n/f Clifton Dewey Cooper I I eron�h�, ,� Proposed Septic ; DB 91 O PG 34 i _ F'ield ; �i � Tax Lot 39.02 Tax Lot 38 � � � �. , Tax Map J-2 Tax Map J-2 �� . 63•g8, � �� x n/f Eugene W. Nail � i I & Normo V. Nail I n/f Clifton Dewey Cooper � � , �� , Shed �I \�. DB 91 O PG 34 POND � O � � '�, DB 209 O PG 426 � - � , , �� , `�� Proposed Pine Forest L ane � �, I �\ � � , , House � � � _ _ _ _ _ �, 15 +/— Private Gravel Road ��` I � I Existing Building 30'+/— Existing Access Easement , `� r �, N � Reference DB 105 � PG 641 `�\ , � Qr � � � N 2207 flag we110 � � ��h � �_� � I _ _ _ �J.S'+ - See Note 6 L-6 � � . - - - .. _ _ _. \ __� _ n � �� I � � J L-2 � L-1 �� ` . � ` � � � / � � ` � I` i ' / 1 � � Tax Lot 37 � ' � Tax Lot 10.02 / Tax Mop J-2 ; ', n f James Ra ord Cartner i � STATE OF NORTH CAROLINA Tax Map J-2 165 O PG 41 � ' ' il COUNTY OF DAVIE n�f Thomas A. Cartner , & Rebecca T. Cartner / ' � ' RB 307 O PG 525 ' r I, Mdrew Meadwell, Review Officer of Davie CountyI i i certifv that the map or plat to which this certification / i � � is affix e d m e e t s a 4 1 a t a t u tory req u i r e m e n t s f o r r e c o r d i ng. i i 0 m COURSE BEARING DISTANCE i � 0D � Review Officer: / i i' � ,o Date: L-1 N 86°45'00"W 850.12' i � � o L-2 N 85'29'49"W 357.33' � � / L-3 N 21'OD'35"W ��7•42� PRE�11N1NARY Pine �'orest Lane i ' � '~ "NO APPROVAL REQUIRED BY THE COUNTY PLANNING DEPARTMENT" • L-4 S 86 07'03 E 500.15' � �� w � L-5 S 09°47'S9'�E 362.21' 15'+/— Private Gravel Road � �I � , �—s s ss°45�oo��E 798.34� NOT FOR RECORDATION, 30'+/— Existing Access Easement ' � ; Planning Director �-7 S 05°51'23"W 30.03' DEEDS, OR BUILDIN� � i' Date Reference DB �1 � PG 34 I � , �I �I � ' � � I � i i � i i i i / Site �Zan for: � � � � , R/W — Right—of—Way �GEND FC — Face of Curb � i , EIP — Existin Iron Pi e BoC — Back of Curb { i I / EIR — Existing Iron Rebar PP - Power Pole D anny Michae Z Walk er ' �) I / P - Post LP - Light Pole � I CM - Concrete Monument MH - Man Hole � I � ' IRS - Iron Rebar Set CH - Chord Distance & Me liss a Nic o l e Walk er ' I I/ P/L — Property Line P/O — Part of i i , CfA — Controfled Access OB — Deed Book CP — Concrete Pipe PB — Plat 800k �� I � CMP — Corrugated Metal Pipe RB — Record BookII' � CPP_Corrugated Plastic Pipe PG — Page LOT 1 � , —F— 10o Year Flood Boundary CB — Catch Basin I (we) hereby certify that I am (we are) the owner(s) —0— Overfiead Utilities —S— Sewer Line POft of Tax Lot 38 � -x- Fence wM - water Meter of the property described hereon, which is located in Fnd - Found Wv - water valve the subdivision jurisdiction of Davie County and that Owners: Tax Map J-2 i n/f - Now or Formerly BM - Bench Mark Deed Book 91 � Page 34 NMP - Nonmonumented Point TBM - Temporary Bench Mark I hereby adopt this subdivision plan with my free Clifton Dewey Cooper 4.552 Acres +�- by coordinate geometry � C� - Center�ne RRS - Rail Road Spike consent, established minimum building setback lines Wilma Jean Cooper � EP — Edge of Pavement CN — Cable Television Pedestal pnd dedlCOte all St�eCts, all Wolks, rks and 155 Pine Forest Lane SCALE TOWNSHIP COUMY STATE �`T� ,Shady Knoll L ane ' TP — Telephone Pedestal Ef8 — Electric Transformer Box �� —W—Woter Line CO — Sanitary Sewer Clean out other sites ond easements to public or private use �cksville, N.C. 27028 1" = 100' Catahaln Dnvie North Carolina 2-09-2011 °g "°ted. Stone Land Surveying Company ,S.R. 1 � 53 � 100 0 100 200 300 S��o� < �oe No. Business firm Certificate Number. C-1704 ' � own«(•) MT,DB George Robert Stone, PLS L-3162 0511 1r1AF�PED: 113 Drum Lane (336) 998-4733 M� �' 5�' Public R/W 2�'+/— Pavement � GRAPHIC SCALE — FEET o�c. �,� cRs Mocksville, N.c. z�o2a 051> (Formerly Poor Boy Road) i� - I � �� . ., . . ,, . � �. . , . � . ., . 338. p3 \'�, , . . � '`, � , , � . , � ., + ; 209 B92 �, 1 � � , . f ' � , � � ' , � , ay � j � �. _ ��,�j. , \` I � � `/ I . � � . � � �� ! 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I � � � \ '- , ^ , , 7 p' - �� -,, , , � - � � � ' __ � , , � � 2 , , �./ , � . , , � , , , , � , , , 1 ' � , � , , , ,, � , , i , , � 378 � � i � � � � � � 90 5609 ; , � � i � �� 4647 ; m ti � �, �, ( 1 . 40Aa ' � INDEXED ' ti � m . � 2652 � pN 3692 I � 5745 . 05 2670 � _ �, 0549 � i ,� � 4598 � 0 50 � � INDEXED ON 1544 INDEXED ON 6513 4 INDEXED ON 5745 . 09 5745 . 09 i 5745 . 09 ' I ;