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467 Pineville Rd •, . , � � p �1 �,r ,.:; � , � , � ��„'!a . ti_-."; � � DAVIE COUNTY ENVIRONMENTAL HEALTH �-�i P.O. Box 848/210 Hospital Str�et — - Mocksville,NC 27028 ' (336)753-6780/Fax# (336)753-1680 . j p 0�-� ,�/�� OPERATION PERMIT lw 1 Account #: 989900074 Tax PIN/EH#: 5843-35-#�� ,/ Billed To: Dennis Howeli Subdivision Info: Pj,v��f��`�/pc� Address: 2420 Highway 64 East Location/Address: .klu�-64-�fest-2�028�NeUi 1�GK.oc� City: Mocksville ,� Property Size: 1.115 Acres a� Reference Name: Proposed Facility: Residential �Te� �o�� _ **NOTE**.The issuance 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. � 1 � System Type: '�� S.T.Manufacturer� Tank Date � � � Tank Size (� Pump Tank Size � / / � r� . r� �1 � System Installed Ey: n LVY��G,�(uk C/�E.H. Specialist: / Date: � �'�S _,�.r 3 co G c��.. �.-r�- �� a�� 3� �l , b.� Lu�.� � � � y � bc � � o o v �1r,�� . � � ,� � G� � 1n' M � � � V � / " N GM . q a� �" �� . .. ��lr�`�� ►4 . � . 1 � � �cP�<<r f�� K � � � � , � 3 � � ._ � {o�'! �-- ,� 'rtU � �6 ��'rv`"�`J �� t�-e.v � ��e '�-� 7 W � �C� DCHD 11/06(Revised) • , . , _ . . � �. � 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 f�ccount �: 989900074 "��x�I�€.�EH#: 5843-35-5824 ' `�iflcs� �'�: Dennis Howell Sufadi�Ji:ian lnfc�: ��:fer�r�ce �lar��: REVISED PERMIT LocaiiortiAd�r�ss: H�,�:;�d �n►p�+-��n�Q }�-,ve�;l1 e� �ro�c��c9 F��cility: Residential ��o��r#.y �iz€:: 1.115 Acres eaT'C f�Iumb�r: 5063 Site Type: ❑New ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to 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 SpeciC►cations: #Bedrooms � #Bathrooms � #People�Basement❑ Basement plumbing❑ � Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size �• �� Type of Water Supply: �ounty/City ❑Well ❑Community.Well 0 System Specifications: Design Wastewater Flow(GPD)3�� Tank Size �i�vGAL.Pump Tank N/�GAL. 2 , � ,, ,� 33 �a� Trench Width 7�C �IVIax.Trench Depth3� Rock Depth �o� Linear Ft. � A s s t a t e c l in 15A f�CI�C 18;1.1��9(5} ��d d-F o�.5�i A��a�wcx�0 rt 6 S i t e M o d i f i c a ti on s/Con di tions/O t he r: �`�y��,��t�r�,�r ��-,e- al�� ^ �es^�a � r ��L Contact the Davie County Environmental Hcalth Section for Snal inspection of this system between � . �b /3 d 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. i � ; ` - � ` � i • � ` ��rC'� �� ..�p� ';' �r � �� i� � �° � I a �� u�' Es� �` � ,c� �� ti � -�� . �u.� c y . +� � � � �Ot� � � � . s...., J , ,� P �` � �4 � . , ,�.`� � �i` .G � , � � � �,h b�,�. � - .s 1�� b � h �� s � �"� 0 w , i �;�� nS � h � . � � y _ �r 't y � �o' J� �n3�e t7 0� �u /r �� ,S�P7'� c �� a�aX;GH �3 � T Environmental Health Specialist --�9�� / Date: `� � �/( DCHD 11/06(Revised) ��C��u�"��,3 , v�0 ,,y °' �� . , ' � ' � DAVIE COLTNTY ENVIRONMENTAL HEALTH � �"g , ; ,� . P.O.Box 848/210 Hospital Street • , Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM ONSTRUCTION . Na1rf��i/�� rn»��rlc�y��,� � ��i�,��l�ufl�Ct��lar� �/��z�s,G��n�� / S8'Z�h Acc�►u�t �: 989900074 � �� "��x Pi�€%�H�: 5843-35-�63' Billed T�: Dennis Howell t/I�� J(j'�'� SuE�cfi�i��iori Ir�f�: R�'f8C�E1G�' RIs�E31�': ny`��tYl I�� h LacatiortiAdi�r�ss: ��/✓��;//e�'"'`' Pro�c�s�;d F,��:i€ity: Residential (- ��,� ��r�.y �ix.�: 1.115 Acres ATC Nut�ber: 5063 Site Type: C71�1ew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to 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 Specitcations: #Bedrooms � #Bathrooms�#People � Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) / �' Lot Size •l�� Type of Water Supply: C�'County/City O Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) / U� Tank Size �ov�AL.Pump Tank GAL. � � Trench Width J�! MaY.Trench Depth 3�f/Rock Depth �a / Linear F��/t�. �� r As stated in 15A I�CAC 18A.1cg�ad5� �5 �3�oT a��y Site Modifications/Conditions/Other: �F��,��.,,��r�a�.,,�.��,�;,�T��, � Contact the Davie County Environmental Health Section for final inspection of this system between ; 8:30–9:30a.m.on the da of installation. Tele hone# 336 751-8760. � ' I � � �`' ' � ^ � � �f i � � � o� i _� � , ` �( � �J . �r� � �'� (`,,_ cy �� , �G J ` � `� � �'u 7 4 � d�+�r—J r J S � 1 � � � iO � rI � s I�i\ � Environmental Health Specialist Ji�i� Date:�� DCHD I 1/06(Revised) � , . , ' ,. ,, �� . ��. � �. Davie County Environmental Health �� s�� ' • P.O.Box 848/210 Hospital StreFt — �,'� Mocksville,NC 27028 � (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT �! $g'2. Account #: 989900074 Tax PIN/EH#: 5843-35-�85� Billed To: Dennis Howell Subdivision Info: p,,/ Address: 2420 Highway 64 East Location/Address: est-27028 ��""-� City: Mocksville Property Size: 1.115 Acres �' Reference Name: Proposed Facility: Residential **NOTE**This Improvement Permit DOES NOT authorize the constructior� 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: QNew ❑Repair ❑Expansion Permit Valid for: �5 Years ONo Expiration Residential Speci�cations: #Bedrooms�#Bathrooms�#People `� Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) _ Design Flow(GPD): /v� Type of Water Supply: �nty/City ❑Well ❑Community Well � F+� stated in 15A f�CAC �_8�1.1�E�(5) � Site Modifications/Permit Conditions: �zccep'tEd Sy:�tems ma�� al�o k�L �as��? � � ' 7 S stem T e LTAR q! Initial � r •�'�- � Re air '1�c� p.�1- t3� S te Plan o� � U . �� - � -� 3 � � � , _ -� �s 4;- � � �,, N ' � — n � � - -� J � � � � � �� c � �,' Q � J � r fl�'`�� a�� — � � ( � ,�:i%�/ Date� ' ��' ( d Environmental Healt Specialist i.p.11-06 - � � \�t � � � . - _� ��.;��.�l1t . . ,;,� ' .i�,i . ��'`�s �1", :� • "i . . '�._, � . � fiPPLICATIpI��bR IT EVALUATION/IlVIPROVEMENT PERMIT & ATC z F��\ Dav County �nvironmental Health • - `��'�j� .U. Box 848/210 Hospital Street ,�'�;�:'R��°'��C;�U'� Mocksville,NC 27028 , (336j753-6780/Fax�36)753-Y680 i,, �r �,�, Application For: ite Evaluation/Improvement Permit J�j'Authorization To Construct(ATC) ❑ Both ' Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Faci(ity ***IMPORTANT*** THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED � INFORI�IATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed "i)E'i1,�i ; j��C„-.° /� Contact Person � Bil�'riZg Address �y�� ;� r1 r,�.�, ',5t� Home Phone �i�; s- 5�i�, City/State/ZIP ,�t��(�S c l�«% �' c ��c%1 � Business Phone - t ' o�� ti Name on Permit/ATC ifDifferent than�Above t:�� ' ; �. Mailing Address ' ` � City/State/Zip . .:. :.... .. •i . PROPERTY 1NFORMATION �'*�ate House/Facility Corners Fla ged 2��j(I NOTE: A surti�ey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plaf(to scale) (I=ern�il is valid for 60 months with site plan,no expiration with complete plat.) � .. ..;".� Owner's I�Tame_L - , ;� N��,.��e (/ Phone I�umber i;• S � ?S`�Yi�- Owner's A�dress z,y�7 e; „ S Hi� L`�' z- City/State/Zip ;�1�e l�s�, /4 �'�C Z 7��b' � Property Address _ City ` Lot Size Tax PIN#__<"j8y�3-�,�J`�- 77(a 3 Subdivision Name(if applicable) Sect' /Lot# Directions Site: o � i N 6 �( �Q( ry/j �, . / /V l7 � et1 '/ -� -t' , i i le /1 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 �No Does the site contain jurisdictional wetlands? Yes �No Are there any easements or right-of-ways on the site? Yes ZiNo Is the site subject to approval by another public agency? Yes ;�No � ' Will wastewater other than domestic sewage be generated? Yes�No IF RESIDENCE FILL OUT THE BOX BELOW ' #People _ #Bedrooms #Bathrooms_�� Garden Tub/Whirlpool ❑Yes ErTQo� ' Basement: � e.�N-o 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 system requested: C�onventional ❑Accepted GInnovative ❑Alternative ❑Other Water Supply Type:'�County/City Water ❑ New 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(sl or ATC(s)issued hereafter are su�;ect tc�si�sper�ian or rel�ocation if the sit� is�!tered,ihe intended use changes,or if the iuformation submitted in this application is falsified or changed. I herc;by grant right of entry to tl�e Authorized Representative of the Davie County Health llepartment to conduct necessary inspections to deternline compliance with applicable � laws'ancl,.rules. I understand t1�at I am responsible for th:,pr�per identification and labeling of property lines and corners and loca�i�g and flagging or staking�he house/facility location,proposed�vell location and the location of any other amenities. �Z�—��G��``�' Site Revisit Charge ' Propei�ty uwner's or ow�ner's legal representative signature Date(s): Z -� S�- i�' Client?votification Date: � Date ----- LHS: — ------ , Signgiven ❑Yes ❑No �W -Account# ��9gboa7� Revised 11/06 �c�� a2C Invoice# � � �n�/5�-f '��'� .3�51/I ., �-.Gc�APS -Davie County NC Public Access Page 1 of 1 :� . .i Davie County, NC - GIS/Mapping System ��"'!°/� � '� Click Here To Start Over � �,��. � ;, � �;;, i�uir€*. 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I✓ .-Y;;':•._• 198.00 �--- S 85'Ol'3°� �' '; . • _ Q o � ._.::�. �.� S gg•01'34' W \ � � o � I . aw ' --�--- --. _._. _ . _ _.. ._ ...._ ._ /� _...._ ____Y V K / �. - � _ . \\- . . •v`�'.� // . / \ / � I I l �� `-j.�� 1�- ---�..� ., �s, .._- . � . f • • • ' � DAVIE COUNTY HEALTH DEPARTMENT » - ,� . . � , �, , • � Environmental Health Section - � � Soil/Site Evaluation APPLICANT INFORMATION �'ROPERTY INFORMATION Account #: 989900074 Tax PIN/EH#: 5843-35-��5$2� Billed To: Dennis Howell Subdivision Info: Reference Name: Location/Address: Hwy 64 West-27028 �� Proposed Facility: Residential Property Size: 1.115 Acres Date Evaluated: � Water Supply: On-Site Well _ - Community Public �� Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L___ Slope % , J HORIZON I DEPTH .— Texture grou G C Consistence - J � � $ Structure � L Mineralo � X S HORIZON II DEPTH — - Texture rou - , C: S'; C, �i e Consistence ' S ' ' Structure w'« �Irx� k!� ' Mineralo S'��c !�1�' 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: � �� 5 OTHE (S)PRESENT: ,`f � s, �� REMARKS: `I � � � .D � LGND i,ands�p�Position , R-Ridge S -Shoulder L-Linear slope FS -Foot slope N-Nose slope CC -Concave slope CV-Convex slope T-Terrace FP-F1ood 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 clay SIC- Silty clay C-Clay CONSISTENCE l�uis� -Very friable FR-Friabie FI-Firm VFT-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-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic MineraloEv 1:1,2:1,Mixed IYQt�S 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.nno-tPrm arrentanrP ratP_ oal/riav/ft� r�nTTn nc�nc m__.:__�� , �,. >•i.:: • •i . ; ` � • 5 ry . � ' - tt. 84•t2'28• C -�� •!��.� - + .-' . �.1 f 30.pp + . , • � , . �!7 • 5 F�•1`.2y, � � .. �-•` V-► ��•3Q � . 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CRA!}Y L, :u�CLA�lRnc'h'. ,SR_ � - • � . � „� . ..._ 0857 AK 8 51 PG I 3 8 0138 01�73 FlLED FOR REGIS?RATION APRIL 15. 2011 12:59 PH CATE TIME �n�• AND RECORDED IN BOOK857 PAGE 138 M,BRENT SHOAF,REGISTER OF DEE AVIE COUN :.�^� Davie County,North Carolina BY y Excise Tax Paid$ 3 . (� ASSISTANT . 5. cAo Do not write above this line Excise Taxr-�3d-99,—�- Pazcel ID: BSOl0A0002 Mail after recording to:Peebles Law Firm,PC 102 S.Cherry Street,Winston-Salem,NC 27101 This instrument was prepazed by: David H.Caffey Brief description for the index: Lot 2,Grady L.McClamrock,Sr • NORTH CAROLINA GENERAL WARRANTY DEED � THIS DEED made this the I st day of April,2011,by and between GRANTOR GRANTEE DENNIS HOWELL,single LE�A PRUDE Addresr m� Sylj �Z�g �_Pineville Road Mocksville,NC 27028 This property is my primary residence T'he 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 Granror,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged,has and by these presenu does grant,bargain,sell and convey unto the Grantee in fee simple,all that certain lot or parcel of land situated in Township,Davie Counry,North Cazolina and more particulazly described as follows: BEING KNOWN AND DESIGNATED as Lot(s)2,as show�on the map of GRADY L.MCCLAMROCK,SR.,which map is recorded in Plat Book 7,page 157,in the Office of the Register of Deeds of Davie County,North Cazolina,reference to which map is hereby made .for a more particulaz description. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee • simple. And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in fee simple,that title is mazketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against the lawful claims of all pe�sons whomscever except for the exceptions hereinafter stated. Title to the property hereinabove described is subject to the following exceptions:Ad valorem taxes hereafter becoming due and payable;and restrictive covenants,easements and rights of way of record,itany. � . � 0857 AK 8 51 P� ( 3 9 �D��NESS WHEREOF,each individual Grantor has hereunto set his hand and adopted as his seal the word"SEAL"appearing beside d his signature,this sealed instrument being executed and delivered on the date first above written. l�,n,,.�.� �9�9�v�/� (SEAL) (SEAL) Denms Howell,single S�tL'L�"'g.,, NORTH CAROLINA—FORSYTH COUNTY .� Q�� a' �`�, I, �t'12 �• (��'1-e-S ,a Notary Public of Fvrsc.�S�-� Counry, �� l y� North Cazolina,certify that DENNIS HOWELL ,personally appeared before me this day and _� ��i� N s acknowledsg�d the execution of the foregoing insmiment. Wimess my hand and officia]stamp or seal, _�, tlus 'j - day of April,201 I. ig 5�� My Commission Expires: �v'S /3 , � Notary Public The foregofhg��a�t��s)of is/aze certified to be correct This instrument and this certificate aze du]y registered at the date and time and in the Book and Page shown on the first page hereof. REGISTER OF DEEDS FOR DAVIE COUNTY By: Depury/Assistant Register of Deeds