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301 Speaks Rd _ _ OPEi�ATION PERMIT or �ce se n v ,,, . D�vie County Health Department *CDP.File Number 161521 •2 ,. , �� 210 Hospitai S�et � . � �' _ '� _ ,,, os-000=�-a23=o2 � County ld Nwnber;, ' � P.O.Box 848� .. _, �`°�� Macksville N� 27'028 ' .EvaluatedFor. N�N Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Scott Smith Property owner. ,�une Freemann �,ddress: $2g piedmont Drive Address: 524 Salisbury S�reet ��Y� Lexington ��y- Mocksvilte State2ip: NC 27295 State2ip: NC 2702$ Phone#: ��36)782-1647 Phone#: Pro ert Lo�cation � Site tnformation Address/Road#: Subdivisan: Phase: Lot: 30'[ Speaks Rd Advance NC 27006 Directions scructure: SINGLE FAMILY Hwy '158 to Rainbow Rd. left. go 1.2 Miles Speaks #vf Bed�voms: 2 on Left, house 9/2 mile on left #of People: � 'Vl/ater Supply: NEW WELL 'IP Issued by. 2aao-Nauons,Robert 'SYstem Classificatbn/0escription: *CA issued by: 2t40-Nat�a�s,Robert Saprolite System? QYes QNo Oesign Flow: a 4 � "Oistribution Type: GRAV►TV•PARAt.t.EL(eq.d.ba�c) �mp Required? QYes �No S�il Application Rete: � , a *Pre Treatment: Drain fleld N��+fication Field 1 a � g SQ�ft� "`SyStem Type: �NFILTRATQR QUICK 4 STAMDARD N�a.Orain Lines � 3 Instaper. �ua�rin Total Trench l.ength: 3 0 0 �• Certification#: Tr�ench Spacing: _ g Inches O.C. '+ Feet O.C. '"EH S: 2�40-Nations.Robgrt - Trench Width: 3 Inches — . gFeet Date: 1 a / 1 1 / a 0 � 5 � � Aggregate Depth: inches , Minimum Trench Depth: a 4 Inches �;� Minimum Soil Cover. 1 . a -� i4pprpval5#atu5��r. ,h��;� „,� �a;i � Inches � . � � � Maximum�r�nch pe�th:'3 6 ; � }Approved LO D�sapproved Inches �� `` Maximum Soil Cover: � �} Inches � _ _ _ _ _ CDP File Number �61521 -2 • Cour�ty,ID Number: °�`a°a°°-oz�-°2 Se tic 7ank __ Manufacturer. ��'f l.a�. ' � Long: STB: �SO `� ' Gattons: �� lnstaaer: AaG��illy Calayton D�$: 0 9 / 1 4 / a � 1 5 Cectification#: 26s� "EHS: 2144-t�at;ons,Robe�t *Fiiter Brand: POLYLOK PL-122 Wittr Pipe Adapter � � � I 1 � � 0 1 5 ST Marker. ❑ Yes � No Date: . . . _ . . . . . . . , �` •;��Appmv�a�Steitus "�' ��:�- �, Reinrorced�antc: ❑ Yes � No '�� Approue�d �� : ��sapptroved� ��_ 1 Piece Tank: ❑ Y�S � NO ' Pump Tank Manufacturer, instaAsr. PT: Ce�tification#: Gallons: 'EHS: Date: � � Date: � � RiserSealed ❑ YeS ❑ No RiserHeght; D Yes ❑ NO (Min.6 in.) � � ," �' �a=,� �}1pPro�r"aiStat�is �� a�� einfo�ced Tank: O Yes ❑ No ' ' ` � ;A O �Appro�re�Cl�.�isappro�ed 1 PieCe Tsnk: ❑ YeS ❑ NO � �� Supply Line P�s Size�: inch diameter Ins#aaer. Pi�e Length: feet Certification#: *Schedute: =EHS: Pressure Rated ❑ Yes ❑ Na Dete: � � Approvedf�ttings p Yes ❑ NO �_ �.�.' Approval�taf�us � _ � � ; t - 3 �� p��v�v��"�D�sapprouedf } �� ,� ,4��=..�� t�..�}�.�.��p� Pump Type: tnstaHer. Dasing Volume: — G� Certification#: � , Draw Down: �n�he,� `EHS: *Chain: � � Date: Valves Accessible ❑ Yes ❑ No � Flow Adjustmer�t V�hre ❑ Y�s ❑ No • Check-vatve ❑ �(gS ❑ NO L `� ` - Appmvei Sfatus � ' Pvc unions Q Yes ❑ Na �} � A roved CI�'D�sa �roired �RP t PP � �"ent Fio1e�;❑ Yes�� D No �ar �.. .��z,=..�� . o�, _,�� Anti-siphon Hole ❑ Yes ❑ No CDP File Number 16'ISZ� -2 , • ' County ID Number: 0&ADO-00-d23��2 • Electric E ui ment NEMA4X Box ar Equivalent ❑ Yes ❑ No lnsta4er. Box 12 inches Above Grade Q Yes ❑ N0 Certification#: 8ox Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump ManuallyOperabie ❑ YeS ❑ NO � 'Activation Method: Date: � � �� A�prov�l Status �� A�aRn v s b1e �0 �Yes� �l� �No � �� r�.. � � ❑ Yes p Na � AppravedCl :C�isappra�etl� : 2140•Nations,Robert *Operatian Permit completed by� Authorized State Agent� Date of I�sue: 1 a / 1 1 / a 0 1 5 OwnerlApplicant Signature: This system has been instailed in compiiance w�h applicabie NC Generai Statutes:Article 11�Chapter 130A, Rules for Sewage Treatment and Oisposat,l5A NCAC i8A:�900 et. Seq.,and ad conditions of the Improvement Permit and Construction Authorizetion.This property is seNed by a SeWa9@ SBA�IC SySt@C11. Rule.196 i requires thet a Type septic system meei the following criteria: Minimum System Review ByThe Local Health Department: Management Entity: Minimum System InspectionA+Aaintenance F�equency ByCertified Operetor. Reporting Frequency By Certified Operator. Rule.1,961 �equires that a Type 1V and V septic sys#ems designed fora home/business owner must maintain a valid contract w�h a pubtic management entityw�h a certified operatorora pmrate ce�ified operatorfotthe tife ofthe septic system. aule.1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid�contract with a public managemententitywith a ce�tified operatorforthe life of the septic system. Rule.1961,{2)(e)requires a contract shall be executed between the system owner and a management ent�y prior to the issuance of an Operation PeRnit for a system required to be maintained by a public or privafe management ent�y,unles5 the system ownerand certified operatorare the same. The contractshall require specific requ�ements formantenance ar�d operafion,responsibiities of the owner and systems operator,provisions that the cont�act shall ba in effect foc as[ong as#he system is in use;and other requirements for the continued proper perfonnance of the system. tt shall also be a cqnd�ion of' the°Operation Permit that subsequent`owners`of the systems execute such a contract. t�Hand Drawing Olmport Drawing :� � �-, **Site PIan/Drawing attached.** ��f _ _ _ _ OPERATION PERMIT t?avie County Health OepaRment ' CDP'�ile Number: 161521 -2 21�Hospital Str�eet ` P.o.soxaas � County File Number: ns-000-00-02�-02 Mocksv;ne tvc z7o2s Date: ! ! . , . ,, .� . .�, . . pincn Drawing Drawing Type: Operation Permit Scale: . QBbck = .ft. pN��► � � - � � � � ��,.� � .�,_......� �� _ _ �~� l .�.. _._._. �_ _� _ �_ �. --�-- 1 �� f I _ � � ____ - � � � j ..._ _ ,____ , � � � , �� - . � _ � _._;� � t�� , Y �..�. ,....�.� � ,.ri.. .,��,...�.....�. .,.... �...��...�. �...�„�, .�Y.,,.�..�,�.�.ww.. { . ..M.�..n. .�. .�w„ :..�,m. .�..�. ..�W...�,..�,.�..,..�.�.:.,.�.. �� .. l � I . '�. .��. � . .... �� /\ � ...-�.-.+.e � . � .. . � ,-� _��,,� � � -i--Y� —-1--tf -�,----r �� ;�� - �I I �� ___. _ � � �.� ' l � �..^.. .� !�� . _ - �,_ k.��., . : � _ �� .� . � _ � ,:.� �. I '� �� _ 1 _ �� .1 � _ I � I __�� '` ' �_ _ , ,..� ' � � '� ,.• __ _ . �. � ``�o �-- l _ � _ , � , :_ � �� , ---� ----�- �,.� ` � � _ _ ---� - ,� �---�--�---�—f..,�,,;.: E ��...W �...__.,� �.... � i � _ � � _� �� , � �. � � _ Well Aba�donment Record Fo�on�e us�o�w Davie �� CDPFI/e Number '�61521-4 ` 2�0 Hospita)Sfreet,P.O.Box 848 ;; , „.. �°" •�� _ �, . - � �F1N Numbec:;D6=00„0,=00-02�-02 ` � �` � � Tax Lot#: ' Tax Block#: � P.O.Box 848 �'y--�" 27428' Evaluated For..'W��-�BANDQNMENT. ! Mocksville NC Phone:336-753-6780 Fax:336-753-168Q Property Owner: �une Freeman APP��t� Scott Smith Address: 524 Salisbury St. Address: 828 Piedmont Drive ��y; Mocksville C�ty: Lexington State2ip: NC 27Q28 State2ip: NC 27028 Phone#: (336)477-5059 Phone#: (336)782-'1647 Site Address:301 Speaks Rd Direc6ons: Hwy'158 to Rainbow Rd. left.gv 1.2 Miles Speaks on Left,house 1i2 mile an left Dniling Contract r �`�� 1 a _ �� . / Well l�oCatiorf � � � r y Lafitude: Dnller RegistraGon , , , , , , , , , , , , , , , , , , , , , Longitude: � Well: Ft Type: Nearest Structure;, , , , , Fill Material: aterial: Me#hod: Total Depth: � , , , ,Ft From:, , , , ,Ft To , , , , , Ft Diameter: , , , , , In. From:, , , , ,Ft To , , , , , Ft Static Water. , , , , ,Ft From:, , , , ,Ft To , , , , , Ft WaterRemoved: CementPlug:From:, , , ,Ft To, , , , Ft Plumbing Removed: Weil Grouted: Casing Removed: , , , , Ft Comments: ° . an � Issued By: 2�4o-NaGons,Robert *�are of lssue: � � / e 9 / � � � 5 Authorized State Agent: _ �,, : �� , _ ;_��'�y'''� �Hand Qrawin�C�Import Dr�win� _ _ _ V1►et� Abandonment Recor�d � • ��2�� a Davie County Health Depa�tment CDP File Number: �a �,,.,h, �. 210 HOspit�t Street � D6-Q40-00-023-02 � P.a BQX� County File IUum�er: , `� " Mocksv�lte NC 27028 Date: .1,'�./�0 g,/��,0,I 5 Y�'�4a n e�,� � Q��Cfi Drawing Type Weti Abandonment Record Scal�; . . . QBbck . QN/A — ft. � C � � ' � _ .�� ~�' � � � �; � � { �,. �� _�� : � . . .__... ..�..;..._ ....a.�mm.........______. ..: .�: .�.. _._.�� _� � '�� . ..__.;}_ � : '_. ! ; � L'�� f t� �� '�^� �� . �-�- ,�.c��-�► .��_� _�,�,� _�'.�. �� .�_ __ _. '� � �r c�. � � _ __._I. �� i I � � I �, , .;��.. Q---� �,..��.�to��.,� ,�..�.,��.-�� .�� t� �__ � ._ �� .��.:.�....��. � ._..._.�.I.��. � � � � ��...... �__..��.� _� �� _�-,�,� .-,- _:�_ � I _�.�.__.. � [ _. �.;,_ �..:: I: �.�. --� ,�� .L � . .��..� a � i — � - ----� ' � �_ _ ___. . �� _. _ _:, �_ �.� .�, ,� .�. .,��.... � ��,� � � , , M � .� _ ; � � _ ... .�. .__::� �. � � �� ____ , � �. � _ � —��o.'� `, . _ _ `.�. ._w�" '�' � � , � � : ._ I Page 2 of 2 �.��a •.Wei•I Abandonment Record L�' "" "' Davie Ca�nry Fteatth Department �r 161521-4 � - 210 Nospital Street CDP File Num6er: � P.o.eoxs�s County File Num�er: Q6'°°°�0°�02�D' �,��,,, MoCksvilte NC 27028 Date: .�._�.f � 9 / a � 1 � Drawing Type Weii Abandonment Record Page 2 of 2 � APPLICATION FOR PRIVATE WELL PERMIT 4/�A�� Davie County Environmental Health �; d�� P.O.Boz 848/210 Hospital Street � ' Mocksville,NC 27028 �v a � � ; (33�753-6780 J Faz(33�751-8786 ***IMPORTANT�** TI-IIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF TI�REQUIItED INFORMATION IS PROVIDED. APPLICANT INFORMATION ame to be Bille Contact Person��i j� illing Address ; � Home Phone ity/State/ZIP .� �7245 Business Phone�3 co 7f32•/L tl'� mail ' „vJ�s c •t a--- ame on Permit if D�erent than Above N G R�►� ailin Address pi S ur v� Ci /State/Zi ,ti� G Z7t,r1[� PROPERTY INFORMATION *Date House/Facility Corners Flagged OTE: A survey�la,t or site lan must accompany this application. Included: ite Pla Plat (to scale) wner's Name .J�cN� � hone Number 'i7Z�Svsg wner'sAddressS,'t4 5a��sb�+Y S� City/State/Zip�la�s�•//r ,vL 77�yt roperty Address30 5 City ✓��r N L 27W� ot Size 1,ac Tax PIN#_ (�•oOv• ov O23 �v'Z ubdivision Name(if pplicable) Section/Lot# irections To Site: ��e lS� (�) �artibuu. R [Ll SP�,k S �o( �/�/ �J^ DEVELOPMENT INFORMATION ermit Type: New Well Well Repair Well Abandonment Other(specify) acility Type: Residential ✓ Food Service Church Commercial Other e There Any Septic Systems Currently On The Site? YES NO� o You Intend To Install A New Se tic S stem On This Site? YES � NO TERMS AND CONDIT'IONS: Ihis application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions,the specific location of the facility and any e�cisting or future appurtenances,the location of any existing septic system,sewer lines,water lines,any existing water supplies and any surface waters. The applicant is responsible for idenrifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application,the applicant signifies that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to deterrr►ine the best location for a well. � 6�rl�eS gt ned � Date Site Revisit Chazge ate(s): lient Notification Date: HS: 7/30/09 Account# Invoice# _ _ _ _ CON.STRUCTI4N For Office Use Oniv `� �AUTHORIZATION "CDP File Number 161521 -2 �°�`� Davie County Health Department County ID Number..��oo-00-023-02 � � �� 210 Hospitat Stre_et Evaluated Eor. (�EW � �.��. P.�.�Box$48 ��Township: � Mocksvilie NC 27028 PERMIT VALIO UNTIL: Phone:336-753-6780 Fax:336-753-1680 1 0 / a 3 / a 0 a 0 Appiicant: ScottSmith PropertyOwner: JuneFreemann Address: 828 Piedmont Drive Address: 524 Salisbury Street Crty: Lexington C�y: Mocksviile State2ip: NC 27295 State2ip: NC 27028 Phone#: (336)782-1647 Phone#: . Propertv Locatfon 8� Site Information Address/Road #: Subdivisan: Phase: lot: 301 Speaks Rd MocksviAe NC 27028 Directions Structure: SINGLE FAMILY Hwy 158 to Rainbow Rd. left. go 1.2 Miles Speaks on Left, house 1/2 mile on left #of Bedrooms: 2 #of Peopie: 1 � "WaterSuppiy: N�►vw�� Svstem Specifications Minimum Trench Depth: a 4 Site Classificativn: PssnanowP�acement Inches Minimum Soii Cover. 1 a Saprolite System? QYes QQ No Inches Design Flow: a 4 � Maximum Trench Depth: a � Inches Soil Applicatan Rate: � , a Maximum Soil Cover: 1 a Inches *System Classificatan/Description: *Distribution Type: �Ravmr-PARALLEL(eq.d-box) TYPE II A CONV SYSTEM{SINGLE-FAMILY OR 480 GPD,OR LESS) Septic Tank: � � � � Gallons "Proposed System: 25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes QNo Q May Be Required N�rification Field 1 a � $ : Sq.ft. PumpTank: Gallons No. Drain Lines 1-Piece:QYes QNo TotalTrench length: 3 ft GPM vs— ft. TOH Trench Spacing: _ 9 Olnches O.C. Dosing Volume: _ GaQons (�Feet O.C. Trench Width: Inches _ 3 _ �Feet Grease Trap: Gallons Aggregate Depth: - - � inches Pre Treatment: ONSF OTS-) O:TS-11 SepticTank InstallerGrade Level Required: (�I �II C�III C�IV oenn � nf 4 CDP File Number 161521 -2 County ID Number_��'000-oo-ozs-o2 ❑ Open Pump System Sheet Repair System Required:OYes C�No ONo, but has Availabie Space eaair Svstem Trench Spacing: 9 Q I�ches O. . *Site Classification: PS Shallow Pfacement — Q Fest O.C. Tr�ench Width: Inches Design Flow: a 4 � — 3 . �Feet Aggregate Oepth: Soii Appiication Rate: � , a inches `� Minimum Trench Depth: a � "`System Classification/Description: Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil COvBr. 1 a (nChes Maximum T�ench Depth: a � Inches 'Proposed System: 25%REDUCTION Maximum Soil Cover: � � N�rification Field � a � � . . Inches Sq.ft. N o. Drain Lines "Dist�bution Type: Gw�v�TY-PARALIEL{eq.d-box) 3 TotalTrench Length: 3 0 � � Pump Required: �Yes �No C7May Be Required P�Treatment: ONSF OTS-I OTS-II "Site Modifications No grading or construction activity is altowed in areas designated for system and repairwithouf approval of Health Department. % � "Permlt Condltions The issuance of this permit bythe Heatth Department in no wayguarantees the issuance of other pennits:The permit holder is�esponsible forchecking with appropriate goveming bodies in meeting theirrequirements. ! Thls AuthorizaUon iorlNastewater Syatem C�anstruction shall b�vaUd tcr a persa�equal to the perlod af validity of tt�Improverf�nt Pert»It,not tn ejcoeed 8v�e years,and may be issued atthe sametime the tmprovement Pertnit lssued�NCGS 130A-336{b)}It the Installatlon has not been eexnpleted dudng the period of wtidity of the Construction Permt�the information su6mitted in the apptication feX a permit or Canstruclion Authorizatlon ts found to have been Incorrect,fatsified or changed,or the�its is alUered,ltfe pennit or Constructbn Authorizatl�shall become invalid,aad may be suspended or revolced{.1937(g)).The person owning or corttrotlfr�y the system shall De responslble torassuring eomptiance with the laws,rules,and pertnit con�itlons reganding system locallon,Instaltation,operatlon,malntenanc�monitiodng,reporting�d repair' (1938(b)). Applicant/legal Reps. Signature Required? QYes �NO ApplicanULegal Reps.Signature� Date:",� � 1 *�� By. 2�ao-Nauons,Robert Date of Issue: 1 � / a � j a 0 1 5 Authorized State Agent: --� —�-----�'-- Malfunction Log DYeS '.�; ;.' �Hand Drawing Olmport Drawing **Site PIanlDrawing attached.** Page 2 of 3 CON$TRUCTION AUTHORIZATION • • �' DavieCountyHealthOepartment CDP FIieNUtl'1be1': 16�521 -2 � ' 210 Hospitai Street D6-A00-00-023-02 P.o.Box aas County File Number: nnocksviue tvC 2702$ Date: 1 0 / � 3 1 � 0 1 5 Q incn Drawin� Drawing Type: Consfruction Authorization Scale: . . , pBiock = . .ft. oN�A r� "','� � -_ � � __.__.� `.--�``�� " M - �-v�-�P � — . U� � ' ; ��:�` ,�� a�, �- _��,.� � _ _ � � �G -�h�� _. � ._ . _ �- -�,,__ -��`�- _ -_ _ __ � . � � ,-�� .� � . �. ._ � � ' : I , - �-��— - — -�=� 1 ► � ,,,,.. -ti, ----'-� . � �_, :��_. � .� � b � � �j �� :�� - � �� r ' �� I ��-� ..�.... �'"� I I I I I I I I I I C I �� _ �� i i � � f � _ , , ( � Vh� � �� _ �„--- '� 5 '."` - —.. ' i � 1 I � ' 't�r` G� �_ _.�� `,�..' �=-- �-- �C'� _ �;+n �� I I _ � � � rJ li� , . _ ��,�- �ONSTRUCTION AUTHORIZA710N � � �- � . Davie County Health Department 210HospitalStr�eet I� v �-e.�� CD File �lumber: ��52� � ��j P.o.6ox sas 1°��Y . ps-000.00.02�.0: �f� �..�.-G�n�e°c�sv��e Nc ��a2s� /Y,�7��°�tY File Number, �� _1 .0 / � 3_/ � 015 /�.�� K 5�o�(-eo( '� a - � ( —/� SLIu�,-� /l�r/O Date: � - - Ctick batow to import an image f�om an extemal location: Drawmg Type:Construction Authorization . ._.-------- ��" � � �— 1 •' . �- ./ • � (N� i G, �op •� �� r � '� a'� � K�9 'fi p� /1� � �� a� �� i ��N. . � -�� o ' a< < � � - �w 5�.�� ,�g �d -. . � . ; . APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health �� P.O.Boa 848/210 Hospital Street n '� � � � Mocksviile,NC 27028 V� (336)753-6780/Faz(336)753-1680 ��` p ication For: ❑Site Evaluation/Improvement Permit ❑lCuthorization To Construct(ATC) ❑Both '�.- � Type of Applica6on: Q4�Iew System ❑Repair to Existing System ❑Expansion/Mod�cation of Existing System or Facility *"IMPORTAIVT"'THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billedsret}-$��,,.�a. , Contact Person ��ctt—$.,,..�eC� Billing Address�?�d--��wr�-- �� Home Phone City/State2IP`,�.x«.�1ro.i N�� 'a"T'25} Business Phone�'b ? � 1!i 4'1 Nazne on PermidATC if Different than Above_�i�1�d Ft-a+�N-+� MailingAddress N �- City/State2ipJ+40c.�CS..ltr N C Z7��} PROPERTY INFORMATION *Date House/Facili Comers Fl ed o• •!f NOTE: A survey plat or site plaa must accompany this application. Included:H'Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete piat) Owner's Nazne�T�..+� 'F're....—.�.� Phone Number ' Owner's Address h � � .. r City/Sta e2ip}�►o cKs�+-�l� N t Z'l0't� PropertyAddress'�di 3qoaKS A� City YqivLs. LotSize '_pt� Ae. T�PIN#5$S';SOS22? Subdivision Name(if applicable) Section/Lot# D'uections To Site: �S9 (1.] Rat.Jb.a (t.d 1�,.:l�-� 5��•Ic} R�{ T�-�.-•.:�`� i4-3ul If the answer to any of the following questions is"yes",supporting documentation must be attached. '�f,• Are there any existing wastewater systems on the site? �'i'es❑I�o , Does the site contain jurisdictional wedands7 ❑Yes�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❑� Wilt wastewater other than domestic sewage be generated? ❑YesXINo IF RESIDENCE FILL OUT TF�BOX BELOW #People #Bedrooms �_ #Bathrooms 'Z Gazden Tub/Whirlpool OYes B�Io Basement: ❑Yes o BasementPlumbing: OYes2iFio IF NON-RESIDENCE FILL OUT TI-IE BOX BELOW Type ofFacilityBusiness Total Squaze Footage ofBuilding #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similaz facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: P'f�.onventional ❑Accepted ❑Innovative ❑Altemative ❑Other WaYer Supply Type:❑County/City Water �w Well ❑Existing Well ❑Commwity Well Do you anticipate additions or expansions of the facility this system is intended to senre?0 Yes .�7No If yes,what type7 This is to certify that the infomiation provided on this application is true and correct to the best of my]rnowledge. 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 gant 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 respons�ble for the proper identification and labeling of property lines and comers and locating and flag ing or staking the house/facility locadon,proposed well location and the tocation of any other amenities. 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' �;: .. 5 ��.�,. �`� � x �' f ` I � �4 7 M) � k` �'Y �y �. � . � e .: �, j � � _ . � ' , ��. _ .� ,_ �y a �K �� M'' ��j�\ A ♦ _ . }.�['� �Y'�}'� ��/��l�+ ;� i . � h �„�,` �y�, � -� :. :::�� , _`�t �I i x � I .� � �Y� �� , +S� - � i kI � � � w. ��:, � ir,> .xyb�. ° ...,�y . ;� � �� - ` • i � � ,. .,_ .:�. , • , - ,`,�: = ,�� , �M.� :,� >yP� r ��`i, ` " 4} • ;��z� :° :, `v� � j *�j� : _ � � � y. k �� > � � .y . 'S K cP } T i 5 �. . . � . •��, „ � �ti � �, `5 '4,, : � `�.,� � ..s '� � r� -a.��t t ' si '�` . .r , " . ,,�T. �'�5,� . ' } .�',i �'t. k`" �,�� `�.`,; ' ♦ � ,}'�' .., �}i � `� O�'��F l �'�' ��•�,r: �N.� � Printed:Oct 04, 2015 All da�a is provided as is wilhout warranty or guarantee of any kind either ezpressed or implied including bu[no[limi[etl to the Implietl warranties o!merchantability o�fitness for a particular use. All users of Davie County's GIS websi[e shall hold harmless the County of Davie,North Carolina, its aqents,<onsWtants,contracrors or employees from any an0 all claims or causes of action due ro or arising out of the use or inahility to use �he GIS data UrovideA bythis website. ` -' ' For Otfice Use Oniv . � IMPROV�MENT PERMIT •CDP File Number �s�s2� - � �w"� Davie County Health Department � � 1 �� County ID Number:os-000-00-023-02 �% �� 210 Hospital Street �;,�'� P.O. Box 848 Evaluated For: NEW �� Mocksville NC 27028 Township: Phone:336•753-6780 Fax:336-753-1680 PERt.l1T VALID UtJTIL: 'I1I'I4/ZO'I9 "NOTE TO INSPECTIONS DIVISION: Buiiding Permits cannot be Issued with this Improvement Permit. Applicant: Richard Staley Property Owner: Sha Dunnuger Address: 335 Speaks Rd Address: 301 Speaks Rd City: Advance �rtY� Advance State2ip: NC 27006 State2ip: MT 27006 Phone::: (336)909-2707 Phone::: Pro ert Location 8 Site Information Address/Road ::: Subdivision: Phase: Lot: 301 Speaks Rd Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 158 to Rainbow Rd. left. go 1.2 Miles Speaks �of Bedrooms: 2 on Left, house 1/2 mife on left � ;:of People: 'Water Supply: NEW wELL ` S stem S ecifications Initial S stem 'Sit2 2SS1 �C8ti0t1: ProvisionallySuitable Minimum Trench Depth: 1 8 Inches Saprolite System? �Yes QNo �vtaximum Trench Depth: a 4 Inches Design Flotiv: a 4 g Septic Tank: 1 � � � Gallons Soil Application Rate: 0 , a 5 1-Piece: QYes QNo `—" Pump Required: QYes QNo Otvtay Be Required 'System ClassificationlDescription: TYPE II A.CONV SYSTEM(S►NGLE-FAMILY OR 480 GPD OR Pum p Tank: G allons LESSI 'Proposed System: 25%REDUCTION 1-Piece: QYes QNo Repair System Required:OY2S ONo ONo, but has Available Space Repair Svstem 'SItB C18SSIfiCeti0I1: PSShallo�vPlacement F.9inimum Trench Depth: 1 a Inches Soil Application Rate: � . a trlaximum Trench Depth: ], 8 Inches *System Classification/Description: Pump Required: QYes QNo Q F:tay be Required TYPE II A.CONV SYSTEM(StNGLE-FAMILY OR d80 GPD OR LESS) YProposed System: 25°!o REDUCTION Page 1 of 3 CDP File Number a61521 -•a � County ID Number: D6-000-00-023-02 ' �Site Modifications p Open Fiil Sheet No grading or constnaction activity is allowed in areas designated fo�system and repair�vithout approval of Health Department. �:_ 7: *Permit Conditions The issuance of this permit by the Health Department in no�vay guarantees the issuance of other permits.The permit holder is responsibte for checking�vith appropriate governing bodies in meeting their requirements. `'' ... 7: Site Plan The Improvement Permit shall be vatid for 5 y�rs irom date of issue wfth a slte plan(means a drawing not necessarily drawn to O scale that shovrs the existing and{xoposed property lines with dimensions,the Ixation of the facility and appuRenances,the site forthe proposed Wastewatersystem,and the Ixation otwater suppltes and surtace�vaters). Plat rne Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drav+n to a scale of one inch equals no morethan 60 fee�that includes:the specific Ixation of the proposed facitity and appurtenances,the site for the proposed Wastewater syste�m,and the location of water supplles and surtacewaters. Plat also means,for 5ubdivision lots approved by the Ixal ptanning authority and recorded v�ith the county register of deeds,a copy of the recorded subdivisions plat that is accompanled by a site plan that is drawn to scale). The Departrnent and local Health Departrnent may impose conditions on the issuance and may rewke the pertnits for faiture of the system to satisfy the conditions,the rutes,or this article This pertnit is subject to rewcation if the site plan,plat,or intended use changes(NCGS 130A�35(�).The person owning orcontrotling thesystem 5ha11 be respon5ibleforassuring compliance with the laws,rutes,and pernfit conditions regarding system Ixation,installatton,operation,maintenance,monitoring, reporting,and repair(.1938(b)). ApplicanULegal Reps. Signature Required? OYes �NO AppticanULegal Reps. Signature: Date: � � 'IssUed By: 2�40-Nations,Rober� Date of Issue: 1 1 � 1 4 � a 0 1 4 Authorized state Agent: �Valid witho�t Expiration? OCreate CA. OHand Drawing Olmport Drawing �`*Site P1an/Drawing attached.** , Page 2 of 3 • • IMPROVEMENT PERMIT 161521 - 1 . • . ' Davie Cout�ty Heaith Department CDP File Number: • 210 Hospital Street D6-000-00-023-02 P.o.eoxaas County File Number: Mocksville rvc 2�ozs Date: l / � Qinch Dra�vina Drawing Type: improvement Permit Scale: . . . QBtoctc _ QN�a �ft. ��.___�___,__-_T_—�--�_---.----i---------�-- -�--.___'�. -----,---�--�� _.,._ �.�:_j__ i ; i j { ; ! � � � � � ► ; ; � I � ; � I ; f j i � , , , : __ _ _. _ --- , , , , ;- , ` _, I_ � ! ; 1 �__. , __ ; _ ; _ i____; , _�o; '��,� ,;✓ _ 1_. � : , � � .__ �—.-' i_.---.1 �_.__l--_!_ ! _—:-� - -% -�_��_ 1.►�'� � _ _+ .._.�__� 11?__ 1 i i l i I � � I �` ..�$Gt l�+ S �i � '— i d(+, � . � 1 ; �._ . _..._ __...;. . _ _ __. . _. . _ � _.. . f ` � _ _ � i ( I i� � i ' i I j i I i I I i � � � I � � I i � � ___ G ___ .!..__ ..__.., .__. .,--_ ._ , , � . '_._.. ,_ . _ .._ _.. . _.,--�_ ,__ ,_� .____. _.__- ;.� i.. .. � . ,. �._ � � i i i i ___ -- � ' i j � � , .__ � 1 'r ._ . ..,_._ . �_- . ; t � ___.�._. k � i ; ..._ _......... ....__ _...._ .. _.__ _. . ; ..._ �. _._ _.__. _. ..._ ___ � ; ; ; � i ; , � )_�� _�_ _�.. _�_ _�_ _ � � 4 � � � � � I � _� � i t � � I `� _ _ __ __ - - . __ _. _ __ ! _ �I i _ _ � _... i � ; ; , ' _ __. _..__ _ _-- ' ' � i , a' , i ' � i , , i , _ , , . � ; i f' � ' ' ^i, ! i __ --_ -----.. �__ __�_. ..__._ � -. _ - - ..- --. ; - -- --, .— � '_ . � �� _ , � , � , �, _� ' _ _--- - , '-- --- - _- -_.- _ - , '__ __ _ __ _ - _ _ � : ✓ ..��J__� _ i ; , ; r � ; � i � � ; E � ; , , , � , i � ; , , � � � � � j � � ; ( ; ; ,! � � � i + { � . � --_ � _.. _�__ . __. ._ .____ . _ - , ---- - - -- -__ __ I-- : • , , � , I __ , ; ; `�n�� d��' ; , ' - .�` ; , ' '. ' i � � i � � : ` � � _._, ,_ , _ . , ___ .__ _.. .. _ , _ _ _�___. . __ __ __ _-- --- ,_._ ,- -_ _. , _ : � ,_ : , , . , _ _i ,_ ; � ; i 1 f � � � ! � ; I I ? ! i t i I f , . � � , ; ; ; � � � � , , ; ; , , ; � , ; , _. _ ____ '. _ .. . . _ ... . _--` � _ . _ �-� � _.._. ...._: , � � 1 ! '� y • � ; • _ __- ___ __ - _. _. - ,._ .__.__ __ . ___.__. _ .___- --. ._ ��y , ` i , , ; � , � � , , , � __ ; _ � , , �- , ; , . � , , � . , , � , . ' . : i � � � , , , _ __ _. ,_ _ __ _ < < _. _ _ ; � ; ' � ' ; � � � j ' � � i , ; ; � i i � � � � , , � i � � I r � I I ' ' " .__ � ._. . ..._.. ...._ ...__ . _ ._.. _ . .. ... _ ' '__' . ...._.. -_ "' _ _.' i t ' � �. ,. I i . ,. � : � . . . ; : � �:� � . � i � � . � i � . �' .._ .. " _...... ._..___ _'._. . _ _.'_..._. .._ ... . .. .._._ _. .._... --. .. .,.. ' ' 1 � � 1 � i �\A\\\\ t . . 4 I : ... �^ i' 1 4 � � � i � i 1 i ' . .. , _ __ .. __ _ ��►. ' v�`�G_,. _ _ _ _. __. � , -- _ _ _ , � 'C� � : ; . , , � , ; , � . . . � : , , : , , , � _ ___ _ __ �. __.._ ._- - , -- .. _. __._ _. ; � � ; ��- ��- , , , � . _ _ __ __ . _ . _ _� _ ,__ _� _ - _ _� ; � : ; ,, � ' ` 4 , �� t ;�:. . ; . : � _ ___ � _ ._ � _ _ _. _ _.__. . __ �_ _ -- __ , , : , _ , : , i y� � ; ! i.. ,- � ! � . i ' - . ' , . .--- --- - -.... ,__�._ . `__ ..-.___ . . ' -... ._.._.. �_. - -- -_ -___.. , � . �`1 `� �, ..� ' . '-_ .---� -- �-� --_., . r � � • c ; , t � � : � ` � I � � � ` _ _ _ ' ._' _'____ ' _ ;..._ .._... . . _...__ ._. . .__..._. ........ ... .. ..... � -_ .._.__ . A , ! � arr � � f i i �� , ; ' ; I i I i.. .� '...v V f� . �c_.'_...;....... ..,_....��._. -._. .�'.--.__ '_._._..___ ._ '__. _ i_._.. ._..: _ -- ._.__._ . ___ _ , ..._. . _ _, . � __. . � � � v _:. _ _ ___ i � � � ! , i ; i i � , ,' ; � _ ... . _ _._ . _. _.__._.. _ _ _ _.__ _ : :_ _ ` _. f i t ' I i `_. ` _. . _ -- . _ _.. �_. . _ __.. . . _. , , , � j i , ! I i I i I t ' r i ; I , � � ; !. j � ; � ': ; ... ' � _. ._. _... .� _ ....__. _._. . .. __.__.. .. . ._.... _ .... .__.__ _....._ , _ ,. _._, .._. ._.. . __ _. _._ _, _J, ' - ' S.. � � : � s i , ., .._ . ; . . __ i �_ , ;_ . __ __._. - _,. . , _ ; _... , <. _;..... . ; � , � � � i , , , � , � � , , t � ; i i i f I 1 i � i f � t i i , ; ; j i i � � � � , I ! � i , , i t ` _ _ —_ ._ __._ -- - ____._- --___.._ ____ ..._ _____ _ .___ . _._.__ _._ --- .___.. _ . ....__ _ _.__ _ _ Page 3 of 3 • . . : . •' ' . , � C.a-� l b�r� o� � : _ � 9 ' . . � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC ^� _.__._.___________ _,...._:� _...,_,___.�.DavieCountyEnyironmentalHealth .,...�. .�_�.::. '' _,.,_...` _____� ---- ��T— -y P.O.Box 848/210 Hospital Street ' .�. (, ✓ _ Mocksville,NC 27028 �.�UI; : � v ` (336)753-6780/Fax(336)753-1680 � Application For. ❑Site Evalua6on/Improvement Permit ❑Authorization To Construct(ATC) . ❑BoUi , ' Type of Application: ❑New System ORepair to Existing System ❑Expansion/Modification of Existing System or Facility . ••�IMPORTAN7**•THIS APPLICATION CANNOTBEPROCESSEDUNLESS ALL OF TI-IE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION A�I� Name to be Billed .� ' *� f �'JY'+/�� Contact Person So`^"� Billing Address • Home Phone 33 6 D�/^ 7D 7 City/State/ZIP /� c,�.�� N� ,'�7o�usiness Phone Nazne on PermidATC if D�erent than Above Mailing Address City/State/Zip PROPERT'Y INFORMATION *Date House/Facili Comers Fla ed�e ei T101�s NOTE: A survey plat or site plan must accompany this application. Included:�9.Site Plan ❑Plat(to scale) (Permit is valid for 60 mon�with site plan,no expiration with complete plat) Owner's Name s/t c� /l U n�r fc� Phone Number Owner's Address � City/State/Zip Property Address�0 r. ,� cC��S Ciry �r�ck��- /� 0 -�Q � Lot Sizey,��t Tax PIN# Subdivision Name(if applicable) Section/Lot# � D'uections Tq Site: ff$" fo �:�!h.v�.J _ l�2__�.� k�� vn � �9.-t.S G r 7. h. � On �� If the answer to any of the following questions is`�es",supporting docunylntarion must be attached. -. Are there any existing wastewater systems on the sitc? 5�`Yes�No Does the sitc contain jurisdictional weUands7 OYe o Are there any easements or right-of-ways on the site7 ❑Yes�o Is the site subject to approval by another pgblic�ency? ❑Y�o `1� �O�.1/y�Q O TO� +�y Will wastewater other than domestic sewa e be enerated? ❑Ye o `J(O ll U �; IF RESIDENCE FILL OUT THE BOX BELOW #People � #Bedrooms `Z #Bathrooms Gazden Tub/Whirlpool❑Yes o Basement:� es�Q10 Basement Plumbing: ❑Yes Q�No IF NON-RESIDENCE FILL OUT TI�BOX BELOW - Type of FacilityBusiness Total Square Footage of BuildinR #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similaz facility water consumption) " FOODSERVICE ONLY: #Seats Type system requested:�flConven6onal ❑Accepted ❑Innovative OAltemative ❑Other Water Supply Type:�County/City Water �New Well ❑Existing Well 0 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 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 aze 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 alth Department to conduct necessary inspections to determine compliance with applicable la d rules. I understand that I responsible for the proper identification and labeling of property lines and comers and ng a d aggin ing o se/facility location,proposed well location and the location of any other amenities. ' � Site Revisit Charge Property owner's or owner's leg representative signature Date(s): , !0�� '�� Client Notification Date: Date EHS: Sign given ❑Yes ONo Account# Y� V L.� r Revised 11/06 Invoice# i , , ' .. . , ' ' � � � � . . _ � DAVIE COUNTY HEALTH DEPAR NT ! ' � Environmental Heaith SectiTon� � i Soil/Site Evaluation ; I APPLI ANT FORMATION � � RO RTY INF RMATI N j , � � - -- _- __ _ . i __ _ - i _ _- -�_ __ � ! Richard Staley � _ � 301 Speaks Road i 336 909-2707 � � 1.070 Acres ' � � D6-000-00-023-02 , � — - --- -- -- -- - ------- ---_ __ ; -- ---_ _ _ _ j � --� ` J" ` a- �� \ � . . i : ' . � Water Supply: On- ite Well � Community � blic � Evaluation By: Aug r Boring Pit � �ut � ; � FACTORS � 1 2 3 � j 5 6 7 : Landsca e sition i L � � ; . Slope% ]; � i � � ' HORLZON I DEPTH _ _ � � � Texture grou }.� � L� � Consistence ' i r-- � � Structure ' �� .� 1 � � Mineralo � ; HORIZON II DF�'TH � _ I � : Texture u r •G F � � Consistence .j i • � S tructtue ' . . .� ! � . Mineralo ►, � ! • I . � HORIZON III DEPTH � � � ! � Texture ou � ! ! . Consistence [ ,r/� j � Structure • ' I � ; Mineralo �• . � j � HORIZON IV DEPTH � � � • Texture ou : Consistence E � � � • Structure �� j Mineralo k � i � SOII.WETNESS � I ; ; . RESTRICTNE HORIZON f � ; � SAPROLITE j I ! � CLASSIFICATION k 5 a' I . LONG-TERM ACCEPTANCE RATE d, ; � SITE CLASSIFICATION: � EVALUATI� N BY: � l � � Q � � , ( LONG-TERM ACCEPTANC .�RATE: OTHER(S)PRESENT: ✓ ; � � � . `�Q��o� ; � � .. { � xEENra�s: LEGEND � . 7.andscane Position ; • � • . . , R-Ridge S-Shoulder � L-Lineaz slope FS -Foot slope N-Nose slope; ' � CC-Concave slope CV- onvex slope T-Terrace FP-Flood plain H i Head slope � . � S-�S�and LS-Loam san � SL-Sand loam L-Loam SI-Silt ' ' � y c� y �� ; SICL-Silry clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay lqam .; SC-Sandy clay SIC-Silty clay C-Clay '� � (''ONSIS .N . . � . a'IQI�t �, , V�'R-Very friable FR-F�'able FT-Firm VFI-Very firm EFI-Extremely firm � . �'�.t � . � � • NS-Non sticky SS-Slig�idy sticky S-Sticky VS-Very Sticky � , i � NP-Non plastic SP-Slig�tly plastic P-Plastic VP-Very plastic � � � ' i _ StrLctLre �� . . � SC-Single grain M-Massive CR-Crumb GR-Granular . ABK-Angular blocky� . SBK-Subangulaz blocky ' L-Platy PR-Prismatic � Mineralo� • ' 1:1,2:1,Mixed . � ; �s � Horizon depth-In inches • � • � � � . Depth of fill -In inches . � Restrictive horizon-Thiclmess and inches from land surface � ; Saprolite-S(suitable),U(unsui�table) � � ' � 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 rovisionally suitable),U(unsuitable) _ . ` � '` � , . , ; � I : rm�n r --_ "— '----`^---�•_ __�e�---rc.n � � ,..._�.. .._.'- •- . . . . . �� - ,. r � �� ,; ,' / �' , , ,- , � ��, i /,� � �;� .- ,� „ �io�� . � , �� ^ � , `�'• / a / ��G �'�( t� ' "r A � u✓ 7�� .,. _ i� � .� C�,, �� I� L ;.�� ' �o. .� '\ � � / �, � �,a �� r�� .' �`%' /F /� '_,i��`�`,\ i-.J c�(l �,,� ��i i r � � 1 i ,!i .�..�.�"�.G..eLA �� I i j , _ . � �..`% . '�`%.T�.�r� i ,� �S.p�,a,�c"�� , � ;! ��o,q �� =`,. / � �.. �,.:x� ; � ; � __. %�/ � �dV'� i� ,i �% `1 57 rr: - ' ,�, . � i � / � / � .� � �� , � �i �� ' � i`� ��\ >._.�,,p_�__ �.,�'�.....,.�su:�..:1 (� o�bv,lF All data is provided as ia wkhout wamMy or puanrrtee o}any kind ekher exprossed or Implied Includiny but not Iimited to the Implied �'� ��' � wartantles of inerchantabflity or fdness for a paRicular use.All users of Davia County's GIS website shall hoid harmless the County of fl U N� ' ' Davie,North Carolina,its agents,consuttarHs,eoMradors or employees irom any and all claims or causes ot aetton due to or arlsiny out pri nted:Oct 17, 2014 S of the use or Inabiiity to use the GIS daW provided by this rvebske. � . , , . .- , , . , . • , • �. . - �-- -- ----- � .' . ��s� �� . . :. _=��o a�d�Lpao�Bl� �. � . _ . .... _._ . ._ � ��..�.. � � ,.NAARAK[Y DtED-lee�W�OI • frl�W r/fx rM h I�w�'��!C�..�W Yrkii�.N.G STATE OF NORTH CAIROUNA; � •�+�� Count�r, . . � .THIS DEED,wa.a�r 9 ,.�.� Nno.mt,.r .a_Z3�..b+r`- v�t t�.�n Y. Y�Cht� . �nd vlfw� ['�wrin � A_ �rf�w �t � f1av�� p�� I ,,,�,y��y�,.�,,,y��a,,,,.�..,j William J. Eiertleq (Sin�],e) ' � i1wv1. � Ceoey ad sur�[Na�Crau�Y�nlrhs MflNESSE7f4'i1�e tM C�tx.ix�1�a�iirub��f de w�d Anw Htmdrwd p�� f.�I w.wr�.r.a..r�oew�a.dw a ri.�r..� Md�.cs.c...a.r.�d�.ru..r r�r �..d....onw�.Ms.r.+..da �rl�d.a�t b tiat�nrw ioa dR./�t.�iil.sens�a�eo.6�.w tM Gt�M.M fd�rdn •woc.rw.r%�wlPa�r Fat1R�a$rnn 'f��rNP-n43L�� Ceref.l6ttiC+dl�qinv�rfolwu � � FIRST TItACT: BEGIIdNING at a aton�, Ben Boyles' cbrner in C. S. D�mn's liitr; .•�.I � tTianct R.70 degs. H. 5.00 chs. to a atone�• C. S. D�am's cornari thence ' '' S. 15 liaks to stona, ,C. S. Dutm'i coraar� thanca N. 86 dags. 45' �I. 16.53 � ciu. to Sy�camoxe, Flossie Smith Beauchamp s cornar; thenca S. 54 dags. .22' I � E. 13.88 cha. to an iron atake, Plossie Smith B�auchamp's coraar; thence � . S. 17 dags. 30' ii. 10.32 ctu. to post oak� Flossis Smith Beauchamp'i corneri . thsnce S. 49 degs. 30• E. 4.35 ctu. to stona, V. V. Spaaic coraer; theac� S. � � . 8S� dtgs. B. 8.19 chs. to an iron �taka Bea Boyles' corner in V. V. 5peak's ,� line= th�Aca N. S deg�. 40 E. 19.26 c�is. TO THE BE+GINrIING, containing 25 ' uras, mon or lass. For refar�nce aaa d��d recosded in Book'S3, page 306� �;; � � D�vi� County itegisery. • • • • SECOND TRACTt BEGINI�TING at s po�t oak, Rata Smith Dunn�s corAer; thanc� N. eS7�'gs. 38T' E. 10.32 cha. to sn iron, tlate S�itih D�um'a 'eorneri th�ace N. • 54 dags. 22' W. 13.86 chs. to Sycamor�, Kata Smirh Dunn's corner� thence S. 55 d�gs. W. 1.30 ch�. to an iran Grady Smith's aorner; thenca 1�. 85 de e. � W. 1.13 chs. to an ash, Grady Sm�th's corner; thance S. 30 degs. W. 10.�5 S� ' chs. to iroa ata1ce, Grady Sm3th=• corner= thanca N. 50 degs. W. 21.83 chs. ' • ' ' to iran staka; tha�cs N. 57 dagi. 30' W. 6.31 chs. to atons; th�nce S. 38 � � degs. W. 5.93 cha. in Boas ArmsMorthy's linei the�a S. 47 degb. 15'•E: � . 26.10 cha. to an iron stak�, Bota Aras*rorthy s cornar thanca N: 88 degs. _ � E. 17.24 chs. to atous, V. V. Speak's corneri thenca �. 49'degs. 30' E. '• ' S.96 chs. TO TFIE $ECINNING, contsin� 40 acraa mor� or le=�. For ' • raferenca ssa Daad r�corded in Book S , pag� 303. � ' � The doregoing descr3bed tract�iiae° tbs ideatical ' � propart� set forth ia th� ;� I afore�oiag desigaatrd deeds aad said d�scriptions.ar.e, set�o�t� thi � dats o! aaid d�ede. ---_.__. �.,...._. , dd�`��3� � ��-�, ` -'.��- � � ' � NORTF�CAI:�LI'1A ` p7��ATt � ATL e' ��%:�7C ' � 1•L Gyq�At ,p'r?, •. . �� ' �•- � 'l.�v..'.�x ' {/� . ��t�Y1��J/CMR�tJpCAMMOf� ��.�O.00 ��C.00 �f' •��J.QO �•r 1�0 FIAY!/1!m TO IIDLD'ff��bOw laR11d�ee�Ya.wk��II t�Q tppad�uea t�etueo Mlo�,w in�� a�eeq hY L�tld/x srearaa ri�wipn fae� � . •r 1W Me Qawee s��r4 dw M 4 rfa��f rY pe�Ya Y fn.r/Mr dr t te e�nq tM�w M fa iyLi dre rH/ra�W w i«fio�s s��irr��a(�rhi�em�eler�Le�wee/.I[a�):u/Wt M w�i��r r��t��efitl t�s rid tlW�e d�s ra��irt Nt Mwtd sMia otr pn�a+ j 1MM.wfe.wer Y.oir a W Cwitor ar Cwa�ae.�Ye ialr i.ti i�dod�d��unl�si eM wundiM�Yil dr w dw�ncer. ia��rrn��s rraasoe.n.c.,.�«w.r.�...�..�r��.e.w.d.�r�d�.a.�..+� . (3!A/,) (SEALJ . �" ls�l .Ss�I' , iSA7E OP�'�t CAlO{.INA OOUN'[Y. ' �r'.O�,,,...:.•��ss . �� j�L••� �. �tlatar�hlik of rY C.o�nq'.daM�i1 owtlfl M�e�• -,r ,r ��'ti.,`r: Llilliem K nschat �*+d_ Charlotte A. Kanachat `�..1��,��-'��s Ci1M��/�MY>��l�ONMt��IVq�OAO�{�It ��{. ' :N ' \� 1. ��• . � i.-{�...� . }:• � �oe..�tW..i,,�/L4Y'�'S� / S' M°f :~sL ..��'k��.: t;' . .wrco..rr.. �ti• .� . .„� :f srers ot�t+on'n�cwua.uu aourn'r. ' , '%•,;;,,��'`3N..r.: . 1, ,�None�sri&et rw Ce�ts.�e Mte6�owdfs�Ye 'i � • •��MMr�M�ORMtb{JtTM+w.+..�iVQWt10��IV�01h011�JM/. . . . :'I . , Mlewi h ti.d�.1�ewi�►wr.tli.dn �of • .1�—. ::i ' �y.ca.t.p.�rwu, .u.r.[�1 . � 91'A77 OM IWLYH CA�QIJNA. . • . I " ,es,• • •� '•�,r � • (� � 7y T . . •-+-�----•.-w-�---^r�� p �(s)o�bi»M.m.a.�Ai�Y�a�..n pasmJ i�,ql.aado.tW�1_+q of n� • •-- �'- . .11� . � �/A�O A.M..�Q`I.riMlyaeaei�lYtlregia�teMlte�4at�[DuM�! � i r•--••t :,.,.� Na�Crall�.i�iak �` ��• i 'AiFIM�' ' uw�h"�..�=..�'�:�.A.D.1l�. . (� c /� � ' j �d�• � ' U �_ '��r....7[:1.� �, Nd�SZ d d. li.�L4a._.� I R�r�tD�eA� ArYrtiap+h MIW�t ot '; .'i „�.�.�.�.�. : : . �. , . _ . . �::1 . , � . � �::... �`�;! {,;� .�,�:�' �...�.:�-�..�,. � �_ _ �'' �.�" 'i . ...... . _ _ . _ '�,. .. � .�. . .. �i �_.�.:_.:�,...:.•_ . _ ... . ... .. . .. . .. ... , . . . . • , . � • �,.:...._.._.:_... • ._;.:_..�.::. . -.-.-:-..-,:._...T-. - --- � r . - .,.__.. ..r.,.--s..,---:-.=.---_ . _...:-�--�_--r� ;,....�-.__..----.--..�,-_. ,._ .. _,.. ,-.�.... . . . . . � t�,n ro:�L��9" ' ' OFED BOOK�.��Ac.�� .� . A��.�.��..,�. ��.� • WARRAN7'Y DEED—Form WD-601 trlsad u�d(ar u6 b�Jame�Will'um�dt Co.,Ine.�Y�dk4iville,N.C. . . . � ' • STATE OF NORTH CAROtIN�1, Davie County, THIS �EED,MadethL 29th d,rnt MAY ,ts 81 ,b�a�eb«.+s, Curtis W. Webb and . • wife,�Victoria Y. Webb ' � o� Davia �� ' andna[eafNonhCarolW,hereinaRercalledCnnca,u�d TientoD 0. lIs11 iEd V1fe. Blanche R.'Rall ' � . � • • ' � ' �.,� Devie Counry and Sau of Nonh Cardiu�,hersinafcer � ealled Crantee,who�e permanent maiing addreu u � • • . WITNESSETM:Thit the Ctantot.fu and fn eomideation of ehe wm of*'�*************�E HUNDRED**�#�**A*1FieklFk*fFA�� ' � . and other`ood�nd tilwbk consideptions to him fn hand paW by tht Gnntee,the rceeiy[wAn'co(is hersb�uknowledeed,has pvsn,aanteQ,b�rpined,wid ' and conveyed,�nd br�be�e pretsnb does�fve,pant.4arpin.�ell.convry aad eonfvm unto t6e Cr�ntfe,Ab Aein and�m sucuuots and aui�nf�pnm4n in . Fa:min ton � � ' Davie . � .. . . _...� . . 'TowmAiP. CoawtY.Nonh Cuolin+.de�uibed a folloMns �� • • BEGINNINC on a aeq 1/2" iron pipe in the southern right-of-vay lina of State � . Rnad 1440. �eaid•iron being located.south 07 dnge. 00 nin. 00 aec. Fiest 76.84 ' feet from an old iron� corner of the property described ae Tract 1 in Dead Sook 91 at Page 814 of the Davie County RegieCry. esid begim�iug point aleo ' � beiag a�corner'of the property of Jake Long; thence from said beginning point . ' • • along Long's•line.•South 07 dega. 00 min. 00 sec. West 1189.11 feat to an oid • .. iron..corner of Long; thence along the line of Loag. South 85 dege. 16 min. 59 . sec. Esat 355.30 feat to an axle. corner of Long and Ba►det�; thencn along � • Bovden's� lian;'South 84 dege.41 min. 31 sec. Rast 165.05 feet to a pine stuaip; i. � , • corner aF Bovden and Smith; theace South�06 dega. 56 c�in. 29 eec. Weet 387.43 ' • feet.to a nex 1/2" iron pipe; thence Noreh 80 dega. 35 mia. 14 sec. West 558.57 ' feet to a new 1/2" iron pipe; thence North 49 deYe. 50 min. 15 sec. l�ieat 200 � , ' ' feet.to.a ne�,� 1/2" iron pipe; thence North 57 degs. SS min. 13 sec. West 990.86 � � '. � 'feat to a nev 1/2" iron pipe in the rightrof-vay liae of Stata Road 1440� thenca • : along the rlght-of-way lina of State Road 1440 the follwaing eight courses and distancee: North 52 degs. 21 min. 13 sec. Eaat 180 feet; North 52 dega. 21 min. • '. �, � 13 sec. East 201.35.feat; North 48 degs. 58 nin. 00 aec. Eset 115.24 feet; North � , .44 dege. 56•min. 14 sec. Eaet 153.35 feet; North 52 degs. 40 min. 22 ecc. Paet � ; � . 163.36 feet; North 54 degs. 45 min. 03 sec. Easc 536.99 feet; along a curve co ' , � the,tight a chord diatance $nd bearing of North 74'dege. 17 min. 48 aec. Haet , ' ' . . . 145.89 feet; and South 75 degs. 33 min. 48 aec. East 10.12 feet to tha poinE aad : • place of Seginning and being a portion of the property deecribed as Tract 1 in ' � . , deed recorded in Deed Book 91.at page 814 and a'portion of Che property deacrlbed , - . .in deed recorded in Deed Book 103 at page 840 ia tha offi,ce of Regietar of Deeds � �� • o£ Davie County� North Caroliaa. all according to aurvey of Francie Bryeon Creena � �, • , dated September 8, 1978. and containing 25 acre�, more or lesa. , � • ' 'The above lud wn conrryed�o Graneor by .Sn Eook Na ,lap 70 HAV2 ANP TO HOLD The abort daeribed prcmi�ea�wit6 all the appu�tewncs�therouato bslonjin�,or in�nr wiu�ppertaWe�,unto tht CrMw.6Y . he4�andlor sucteswn and�uiQm forever. ' � And ihe Cnntor covenantt.that he B uued o(aa�id premius ln ke,and hu the ri�t to coavey the�ame in fcs dmp{e;that uW prwbn ut tns Gar ek � eumbnncet(with the eacep[iom above tqted,i(�nX);and shu he will warra n t aod de&ed ehe uid tiW to the.ame a�.aina ehe l�wfW elsim�of aU ptrwns � Whomwevsr. ' ' an � • � When rcferrnee ia made to the Grawtor w Cnn�ee,tha dn[ulu�daU include du plunl aad[he�cW' e d �t e fyii {ne a muwr. � . - � IN WITNESS WHEREOF,The Cnnmt hu hercunto tet 6L hand and mal,the d,r a�a.ra. abo n. • ' �'� . (S6AL) (SEAL) ' (SEAL) � (SEAL) � � STATE OF NORTH CAROLINA D8V1C C�N�y • .'\ '�� l l f . . �, SYlvld E. LeRle . a Nutarr Publk o[dd County.do keroby eertifj tj�it,,� ' C�rtie W. Webb and vife, Victoria Y. Webb = 9 '•: � r Gnntw,,perwnally appeued be[we me thb day and aeknowkdQed�he execution of tht[aetofn�deed. . , :W�..�� '�'_ a -J - Witneu my hand and autuW�eil,il��the 29th day of �a.�•`19 $i, �= � ' My COmm{KI00 E�plfMt .T11IS@ 2�1� 1983 .��iSEAL}`• � �A,..".��..—�—.� .,.�. �. .... . .. . � S1'ATE OF NORTH CAROLINA_ + �,r � � � . � � y.�., � � . '• . . �"��A�+ •' '��`� ��p�L, A � '+ ."••. �G�� tir�`c� . R � �4 �.ry,� Cwn[or, no�ull i�td At�OfC 11'� ,�i - ''{�+t Y1,:��z AY . P� Y►PP� �s x ' .r /a r �x Witnn�my 6dnd and notuial ieal. .S 100.00 1 " +� `K O .(y� ;10.00 A ,19_. . Mr Comm{uion E:pircc �� -- - . _. .�iQA�1�57�AYMC+3 ' .N.P.(SEAL) SfATE OF NORTH CAROLINA, Davie . rpV�y, , � . Tue tore`uN�ceRilka�e(gaf � $Yly.1a_pLLagle NntAr��l i,� of Davie_,(',�}��y � s 1+(axs)eenitied to be eomct.7L'u inurummt w�a preuoted for re�4tntkn thit � �J�_dar of �3L ,19_$] Y� ' � at .2iJ�L_Y70.1:.P.M..md duly'rcqcoerded in�he oltke of eht Re�feter o(Desd�of DaV1H Co�n,� � `� � North Carcilipa{�n 9ook 113MP$a�e�. . . . � ` f� 7Lis the Z J h d.r of Y .A.D..19 81 � � � . . J. K. Smith er � . � Aegister of Deed� j��,pcpuq Re�uter o( � ' Tn�ti«aar,wnbr E. Edward VoAler. Jr.. Attornev at1,� ' ; � �. . ' . . , : y . . . �.........._._....�_...._ ._._..... ..... .....__..____._.�_._._.__._.__...___ � � , . >—��. �. • . . " . ' .. ;:i• , . ; • -- M,u ra: Rt. 1 .Box 253 Advanca NC 27006 ��3 WAK0.ANTY 1)E8P-Form W0.601 � Printed�nd fw uie b�)ame�W81um�6 Co.,Ine.,Yadtinvilk,N.C ' �STATE�Of NORTH CAROLINA, Davis County. THIS DEED,Madeth4�_d�yof Ca�amh,�`��q 89 �br�� TRRNTON O_ HALT. anrt vife� BLANCHE R. HALL ot � Counsr . and eute of Nnnh Cuolin+,hereinafom cilled Gnntor,�nd SOSAN P. KRENAC�ht�and� OHE T H. ILRENACH � of Counry and S�au of North Cuolina,hcrc:u(ur c�lled Gnniec,whore petmonent moUin�addren is WITNESSETH:Tha[the Gnntw,fw and in conttdoration ofl0 I.OVE AND �,Q ` , and Othct Kood and valuabk tonsidcntiom to him in hand�aW by�he Cuntta�he recdpt whereo(u hercby�ctnowledgcd,hq�irsn,�nnrod,bupined,wW and convcyed,aud by�Lck proscnp doei�ive,{rmt,baqam.�cll,conrcy and confvm unto the Graotee,hb Aein ond�ot wcccaon and ascgnb prcAYa ie __ .Farmington Township,__D$1C�8 County,NonhCarolina,desaribcdasfollow�: ' BEGINNYNC at an iron atake oa the aonthecn cdga of tLe rightrof-ua� of 5.�. 14d0, • ' said iron stak.e beiag Sonth 59 degs. 07 sin. 24 sec. West 722.62 feet froa thn ' . Northeast coscer of the lands described in Deed Boot 113, Page 729, =nas thence a • ' ' eev line South 18 degs. 51 d.a. 26 eec. Eaat T31.02 feet to an iroa stake; tLe�ce • South 07 degs. 38 aia. 26 sec. Enat 51.64 Leet to an iron atate; theace Sauth 16 • � � ' degs. 47 siu. 59 aec. Vest 42.96 leet to an iron atake; thence Sonth 87 dags. 54 � • � . . �ta. 34 see. fieat 52.19 feet to aa iron stakei thmca contianiag a nev line 17orth � .SS �deEa. 41 sin. 10 sec. Yeat 253.99 feat to aa iroa ataka at ths edas of tLe , ' : 'right-ot-na� ot S.g. 1440; runs t2►eoca+rith t6� edga of ssid riaLtrof-tia� Borth 44 ' dags. 36 ain. 14 sx. East 133.58 Eeet to an iron staks aad lbrth 32 degs. 40 at�1. . . , • 22 sec. East 123.84 lasi to t1,� Eeal�ins. conuinin= 1.0422 acr�� as ans�s��d b� .. • �tCLalcd Ho�pu[dr Re8lat�iad Snnhos• in8nat� 1989. . , . . � . . . ' . . . � .' � NO 7AXABLE COhSlCERATION STATED � . . .. � , , : .l . . . . T�o.bo.e la�d.ss con�ed�o cr.n�or br .Sts 600k Na ,Page � T�)HAVE ANP TO HOLD The a6ove dcfcri6cd prcm&sf,w�ii6 all ehe appunen�an thercunw bclonsin�,a in mr wbe�pperuinin�,unto t6e Gnnece,6b ' Ac'v�andfu�wcceuon�and�»nn�.forcvcr. ' - And�he Cnntw corcnann thal hc b uized of�a{d prcml�c�M fee,and h�t the t w comcy the aame in fee Ample;that qW ptam6n aa Gee lrom em . cumbrancet(with the e�ccp[bns above�u[ed.i(anYl:ind th�t Ae wiil wa t r�n t�de(end the said tit1�to the�ame�{ainu ehe lawful e1aLa�of all penonf. whomwever, � . , Wlwn rekicnce It eiadc to the Cnntot or Cnntec,the an[ular thatl fndude tAe plura!and the mauuline tluq Include the fcmhqfe oc Ne Muter. IN W ITNESS WHEREOF,The Grmto�Iw hereunto set 6h�and�nd teal,tha day and�/p�ar fr:t abm wrinen. ', I ' - - (SEALj . rL." d/•�_/�.�_� • � (SEAL) . (SEAL) �__�a�.��l�� ' (SEAL). SfATE OF NORTH CAROLINA D3V1e� L�ryTy, , • . ' ' . � �. � � ,a Notur hblk olald Countr,do ertifr that Trentoa 0. Hall aad wife. Blanche R. Hail ��F�� ' � Crantw.DuwnaUY appeued be(orc me th4 dar�nd ukoowled{ed tAe taecutbn o[the fore`oin�deed, ' ��AWlfe. �. � ' W itnea mj hand and notulal�eal,thb tAe /�, aar of . P�sY �I . � A�i. My Commluton Fxp'rei:g'�6�$1 �MK�r� xia � . � SfATE UF NORTH CAROLINA �Vie COUlRY. . . • . ' � � . I: .a Nonry Fu61ia of uid Coune�.do hereb�eertify�Aa� • � • � . . � . 's Gran[or,rcranallr appeared befom me eh0 day�nd�cknowkd`sd tM s:ecwbn of�M fae{oin�deed. . � , " . . � Witncu m�hai�d and�wnrfal real,[hb the d�r of � .19_. . , Mr Caomission Eapiru: � . . � . . �,N.P.4SEAL� .' _ z ' ..STAiE OF NOItTH CAROLINA,' nsV1,C �C�UMY, . . . � , 'ITe(orqoln�eertifiute(�of ��peQQy J Rlataen � Netaro Fu1+liC ef baviw Ce��n�� , b(&)centGed m be iorte�e,Thb inurummt w»prckaced fu rs`bauba th6 12 � d,�of September ,19 89, a[��.,P.M.,�nd duly rccaded h tM otfta of tht Re�Lter of Deedr of— �1 e � Couary, • • ' Nonh carouro.ie aook 150 p,j� 553, . � • . . • . ' � ' 12 '• September 89 • ' 7bb thi day of .A.D..19_.' � Henrv L. Shore ' • ay ,�(�Cl. �,�� ' � nKw�arn«a, �.P�ti��orn.ea, � Ta�o..d dr..n 6y Willism E. flall. ALtotaeY at Law. ' • / �-=" • `- . : . . . �. . . , . . . � . . . . . . . � � � ' � • _,�...._.._.._. . . .. . .._._.___..._.__..-:•-..:--�...-..-:-.:::.�--.- ----.. x._—�.-:,-a,,:,..�- r - - , �..._,._..._.r._..�....r. ,..�.-..,_.._:.,.,,�:,.,...._ ..._.. .. __ ' ;�+.�To�..;�.l��/ /�s.��- � . � � - o�a e°°rcL(�r� , � ' WARRANTY DEED—Form WD601 Prinad u�d for tab bT)uno WiR'um��Co.,Ine.,Y�dkiriWllt,N.C. � ' • STATE OF NORTH,�CAROLIN{4, Davie County. THIS DEED,Made�h4 29tb d,yn[- '�Y ,if 81 ,b�ndbn.�s■ Curtis il. Webb and . • . wife,•Victoria Y. Webb ' e� Davia ��, ' ond nace of North Carollna,hercinaftet alled Cnntor,u�d Tre[tton 0. tlall and wife, B1anCh8 R.'Adll ' . � • • ' � ' •.,� Davie co�q,.a sna orNonh c.�di.,,e«sr�afur � calkd Cuntee.whwe permanrnt malin{�ddreu u • � • . wrrraessetti:�m.�eheCr;neor.fuandintoroldentionofthewmof*'�**'�`******��**'�E H��' ***tRAAAAklt1F#t*t*�� ' and other sood and rdwbk conaideptiau to him in hand psW 6y�hs Cnnue,�Ae neeip�wAereof u Aerebr ukaowledtcd,lw prea,�naud,b�ryiMd,wld ' and tonveyed,and by�h'e�e pracnb doet�{ve,p�et,bupin,KII,eonvey and eonfvm unw�As Gnnete,Ad hein adlor wcee.wn and aukm,pnmbn in � '' � . •.. . . '. . . . A . Faniin ton Davie .... pi 'Town�ip. Cwnry.Nonh C�tdin+.de,ctibed as follovn� �� • BECIIiNINC on a nev 1/2" iron pipa ia the eouthern right-of-vay line of State � . Rnad 1440, �eaid.iron being located.South 07 dnge. 00 min. 00 eec.�West 76.84 • ' feet from an old iron. coraer�qf the property described ne Tract 1 in Dead Book 91 at Paga 814 of the Davie County Regietry. eaid begisming poiat also ' � being a'corner'of the property of Jake Long; thence from aaid beginaing poiat . ' • • along Long'e�line.•South 07 dega. 00 mia. 00 eec. West 1189.11 fent to an old .. iron,.corner of Long; thence along the line of Long. South 85 degs. 16 min. 59 . eec. Eaet 35S.30 feet to an axle. corner of Long and BoVden; thence along � • Bovden'e liae;�South 84 dega.41 min. 31 sec. East 165.05 feet to a piae at�p; r , • corner af Boeden and SAith; thence South�06 degs. 56 min. 29 sec. West 387.49 ' • feeC.to a new 1/2" iron pipe; thence North 80 dega. 35 min. 14 sec. fiest 558.57 ' •feet to a neir 1/2" irat pipe; thence North 49 deYe. SO min. 15 sac. West 200 , ' �� ' feet.to:a new 1/2" iroa pipe; thence North 57 dega. 55 min. 13 eec. S1eat 990.86 �� • �. � feat to a nev 1/2" iron pipe in the right-of-vay line of State Road 1440; thenca • : alcng the right-of�vay linc of State Road 1440 tha following eight aouraes and diatancea: North 52 degs. 21 min. 13 eec. Faat 180 feet; North 52 degs. 21 mi.n. ' . '. �, • 13 aec. East 201.35.teat; North 48 degs. 58 wia. 00 aec. Eaet 115.24 feet; North • , �.44 dege. 56•min. 14 aec. Eaet 153.35 feet; North 52 degs. 40 min. 22 aec. East � � • . 163.36 feet;.North 54 degs. 45 min. 03 aec. East 536.99 feet; along a curve to ' . � the.tight a chord diaCaace and bearing of North 74'dega. 17 min. 48 sec. Haat , ' ' , . . 145.89 faet; aad South 75 dega. 33 min. 48 sec. East 10.12 feet to the po1nE aad : • place of Heginniag and being a portion of the proparty deecribed ae Tract 1 in ' ' . deed recorded in peed Book 91.at page 814 and a'portioa of the property deecribed . . - . .in deed recorded ia Deed Book 103 at page 840 1n tha office of Eegister of Deedi �• • o£ Davie County� North Caroliaa� all according to ourvey o£ Francie Bryson Creens • •, � , 'dated Septeoober 8. 1978, and containing 25 acsea. more or lese. , . • ' The abme land wu conreyed to Cnntor by .Su 600k No. ,►ap . 70 HAVH AND TO HOLD Yhe abore deuribed premi�n,wi�h�11 the appur[emnce�thercuato brlaK6y,u!n�ny wifs appenaWn�,un�o tht Ctanta,6� : heh andlur sucteuun and�uiyn�forever. . And the Cnnwr covenanu.ehat Ae i�seaed o(aaid prcmi�e�!n fee.and Au the t to conrey the ume in fee dmple:that Wd premha u�Use Gm er • eumpnncet(with the euep[ioro above tpted,if anz);and thu Le wiU wa rt a n t aa�defeed cAe uid dda W tAe ume apinu tM lawful t6ima of all per�om Whomwerer. � ' . . . MAen rc&rence i�madt to iht C�antor w Cnn[ee�th�dn�u1u�haU Include Ju lun!and the�f�ccul' e d •t e fywjtdae e mutet � . IN WITNESS WHEREOF,The Cr�nror hu hereun[o wt fi6 hand and�eal,the�r,aa,y�u 4Xabo r' n, � • ' �` . (SeAL) (SE/►L) ' (SEAL) � (SEAL) � � SfATE OF HORTH CAROLINA D8V18 �My � ?.•�;.'\ ��1�� . � �� SylVlA E. I.BRle a Nutary Publk ef dd Counqr,do heraby eertilr tEat�'�.:�.T + ' C�rtit W. Wabb and W fe. Victoria Y. Webb r '�A; ��+ � r CnntW..pcno�aUr apptued befwe ma thb day and acknowledQed the taecution of tlu fat�oln�deed. . , _W �.�� :.` �,.;..:;: � Wi�neu my hand�nd nomrW�eal.tL�e4e 29th dsy ot b�. 19 81. = ' My Canmlubn Eip4et: JUIIe 24. 1983 , .�:�iseeL}' A ' .�� i -rw�.��.....�.��,-.� ..��, \/�� . ' S7';TE OF NORTH GROLINA_.�jR� _ _ �A� ��T o�`' ,�T'�j�,,OF 1 ' �+ ...• '�� . . . ��ST�T$�QR�// �KC. �t6L A � Rf2A Clt� A E ��,(1 J'r�!�7[�."W OAY ' Cnmor,personallY appeared befue�r. �a x • ,)ir 'ci ' wz '�t•t.. ' Witno�m hand a�notuisl�eil. ,'�%`� �k"�,'•� . Y a 100.00 1 310.00 ,19_. . Mr Canmiuion Eapinr . �,:... .N.P.(38AL� ��: — � -------- — S'fATE OF NORTH CAROLINA, Davie . rpV�y , �� . T1�e foro`uinrcerd(icue(go! $Ylyi.a_fLll$gle Nn a y��13 r p£ DBV�� COU�y ' i+(axe)eenified to be eerrect.'Ibu ieurumsat wu prcsented(or re�4trodon thb � 29 rh day of Z�,� ,19� r: . � at .-2i��X7M:,P.M.,ond duly recorded in�hi otfiu ot tht Re�lster of Decdi of b9V18 C�h,� =' � Nonh Cuglipo{{n a�►� 113Ma i��. . . . � � ` 4 7Li+the 1� h daY of y .A.P..19 81 ' � . :{ J�K. Smith ar � . � Aepseer o[Deed� j��,Depury Re�utu ot � � ThuDeeddnwnby E. Edward VoAler, Jr.._Attornev at Lav ' ; � . ' ' ; . t • . �.,........_._.....__...._ ... . ------.-_- � _ ' IMPI�OV�MENT PERMIT *CDP File Numbef.16 521�1v. ••�� Davie County Health Department � ''`� �s-ooaoaoz�-o2 210 Hospital Street County ID Number '� � P.O.Box 848 Evaluated For �NEVN� �aw✓` Mocksville NC 27028 Township: ,.. . -� -, ., Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL: 11/14/2019 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permi� Applicant: Richard Staley Property Owner. Sha Dunnuger a � Address: 335 Speaks Rd Address: 301 Speaks Rd �t,� � City: Advance City: Advance p�� State2ip: NC 27006 State/Zip: MT 27006 Phone#: (336)909-2707 Phone#: Pro e Location & Site Information Address/Road#: Subdivision: . Phase: Lot: 301 Speaks Rd Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 158 to Rainbow Rd. left. go 1.2 Miles Speaks #of Bedrooms: 2 on Left, house 1/2 mile on left � #of People: *Water Supply: N�►v wELL S stem S ecifications Initial S stem 'Slt@ 8SS1 ICa lOfl: Provisionally Suitable Minimum Trench Depth: 1 8 �nches Saprolite System? O Yes �No Maximum Trench Depth: a 4 Inches Design Flow: a 4 0 ' Septic Tank: 1 0 0 0 Gallons Soil Application Rate: � . a 5 1-Piece: �Yes �No `r Pump Required: OYes �No �May Be Required "System Classification/Description: TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons *Proposed System: 25°io REoucTiotv 1-Piece: O Yes �No Repair System Required:�Yes O No ONo, but has Available Space Repair Svstem '`Site Classification: Ps Shauow Placement ' Minimum Trench Depth: 1 a Inches Soil Application Rate: � , a Maximum Trench Depth: ]. $ Inches "System Classification/Description: Pump Required: QYes �No �May be Required TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *P�OPOS2d SySteftl: 25%REDUCTION Page 1 of 3 161521 -.1 os-ooaoaozs-oz CDP File I�umber ` County ID Number. ' *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. R� 750 *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. R�,� . 750 SitePlan The Improvement Pertnit shall be vatid for 5 years from date of issue with a site plan(means a drawing not necessarily drawn to � scale that shows the exlsting and proposed property Itnes with dimensions,the location of the facllity and appurtenances,the slte for the proposed Wastewater system,and the locat(on of water supplles and surface waters). Plat The Improvement Pertnit shall be valld without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drawn to a scale of one Inch equals no more than 60 feet,that Includes:the speclflc IocaUon of the proposed faclllty and appurtenances,the stte tor the proposed Wastewater system,and the locatlon of water suppltes and surtace waters. Plat also means,for subdivlsion lots approved by the local planning authority and recorded wlth the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that ls drawn to scale). The Department and Local Health Department may impose conditions on the issuance and may revoke the pertnits for failure of the system to satisfy the condttlons,the rules,or thls arUcle.Thls permit is subject to revocation If the slte plan,plat,or tntended use changes(NCGS 130A-335(�).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installatton,operation,maintenance,monitoring, reporting,and repatr(.1938(b)). Applicant/Legal Reps.Signature Required? O Yes �NO Applicant/Legal Reps.Signature• _ Date: � � *lssued By: 2�40-Nations,Robert Date of Issue: 1 �- � �- '4 / a 0 1 4 OValid without Expiration? Authorized State Agent: O Create CA? �Hand Drawing O Import Drawing � �:; .n:v, **Site Plan/Drawing attached.** Page2of3 IMPROVEMENT PERMIT 161521 - 1 � bavie County Health Department CDP File Number: ' 210 Hospital Street D6-000-00-023-02 P.o.Box sas County File Number: Mocksville rvc z7o2s Date: / / O inch Drawin� Drawing Type: Improvement Permit Scale: , . , O Block ;; 0 N/A J ft. �'.` e�. : . . /�� 'a,�i�,� 1��../ s � a l� � � .�-� , _� n, �f , , �F� . I . , . � . I 1 ( , , : : � ( Q4� � , �� ) r : �' �a : a.r: "'. . � : . �� _J s� : - � `'�.,,'�.�` �-C��- � ( . . ; . . .�-� . , : Ql��h , : : I � , � � : �L : : `S�' ,� ,�o��c a-� , : , o `� : r � � �,� . : . . �9 �� ' . : 6 � : .�.� vJ �- r� �� ad . : . . �� Page 3 of 3 P1 P2 � . IMPROVEMENT PERMIT � . Davie County Health Department � j 210 Hospital SVeet CDP File Number: 161521 - 1 P.O.Box s48 �s-ooaoo-o23-02 Mocksville tvc 27o2s County File Number: Date: .1.1./.1.4_/_a.0_1.4. Cilck below to import an image from an extemal location:Drawing Type: Improvement Permit Page 3 of 3 p1 P2