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184 Fostall Drive Lot 3 + 17t Davie County, NC Tax Parcel Report Wednesday. December 28, 2016 WARNING: THIS 1S NOTA SURVEY Parcel Information Parcel Number: C300000096 A Township: Clarksville NCPIN Number: 5822180085 Municipality: Account Number: 29665000 Census Tract: 37059-801 Listed Owner 1: GODBEY ROGER DALE Voting Precinct: CLARKSVILLE Mailing Address 1: 184 FOSTALL DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 3 + 17 FOSTALL SECTION 1 Fire Response District: WILLIAM R. DAVIE Assessed Acreage: 1.12 Elementary School Zone: WILLIAM R DAVIE Deed Date: 9/1994 Middle School Zone: NORTH DAVIE Deed Book / Page: 001760373 Soil Types: MnC2,MnB2 Plat Book: 0004 Flood Zone: Plat Page: 127 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: 101 j� All data Is provided as Is without warranty or guarantee of any kind either expressed or implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and al claims or causes of action due to ' ` C or arising out of the use or inability to use the GIS data provided by this website. CERTIFICATE OF COMPLETION By— (8/16/73) *Construction.must LOT AREA fg� X al g 1 rel; 16 11 t 06 Date r• / 3 "''� DAVIE COUNTY HEALTH DEPARTMENT ll aother applicable ., (Septic Tank),, Improvements Permit and .Certificate.of Completion (Groun4;;.A6"' Vn-'Sewage<.b .sposal' S ,stem' '-'G- S. Chao tei `- 130 Artie le 3Cl OWNER OR CONTRACTOR DATE, PERMIT „'.. �.t..t�..••� ,- N° 340 LOCATION. '.+�'-! S.R. NO. 133n SUBDIVISION NAME LOT NO. SECTION OR W or BLOCK NO. ''HOUSE MOBILE HOME Ej BUSINESS ❑ �- House Trailer 800 Gal. 400 Sq. Ft. NO. BE OOMS NO. BATHROOMS . Two Bedroom House 800 Gal. 60 g� Ft - GARBAGE GARBAGE DISPOSAL UNIT YES ElNO Lam- Three Bedroom House al. 900. Sq. Ft. AUTO. DISHWASHER. YES NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES G;<,,NO ❑ SSE SUITABLE YES [3-' NO ❑ SIZE OF TANK 240 gal. NITRIFICATION FIELD, sq. ft. DEPTH OF STONE IN. 'LINES : _3,0 WATER SUPPLY: Individualg bli"r�li op IMPROVEMENTS' PERMIT BY INSTALLED BY r ^ r CERTIFICATE OF COMPLETION By— (8/16/73) *Construction.must LOT AREA fg� X al g 1 rel; 16 11 t 06 Date r• / 3 "''� wit ll aother applicable State and local regulations -t t AVTHORIZATiCIN,NO: 14 6 DAVIE COUNTY HEALTH DEPARTMENT -� Environmental Health Section PROPERTY INFORMATION Permittee's '� P.O. Box 848 Name: Mocksville, NC 27028 Subdivision Name: —, Phone #: 704-634-8760 Directions to property:!.,,E� ' Section: Lot: AUTHORIZATION FOR i,:•! j j, l%°r' t; < �` ! WASTEWATER Tax Office PIN:# v SYSTEM CONSTRUCTION Road Name: lWan Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEA TH SPE IALIST DATE ISSUED �i DAVIE COUNTY HEALTH DEPARTMENT ,.. IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee's } Name:—` Subdivision Name: a9' w V Directions to property: r` 'r�"-''Uj " Section: Lot: IMPROVEMENT r, «°.,j J, ; ,: Y.f t" r PERMIT Tax Office PIN:# Road Name: 54-S"ta l Zip: e.1111-767 t **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ° f ;A"i K ✓ ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMSr .L _ # BATHS _ # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY i DESIGN WASTEWATER FLOW (GPD NEW SITE r, REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE e &. GAL. PUMP TANK GAL. TRENCH WIDTH +' r r ROCK DEPTH LINEAR FT; *7 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. ✓ O(ERATIjN PERMIT BY: f�C�CA DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05ft (Revised) • APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE Davie County Health Department Environmental Health Section oil P.O. Box 848 — 3 k� te Mocksville, NC 27028 f 8. • r� (704) 634-8760 �`�,,,f t' i^LEa.. . ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. aw 1. Name to be Billed . Contact Person R IjG,Q p` O r S LAI -1 GCC. lt!a Mailing Address K_Home Phone 3 3 G f �/ City/State/Zip MX �SV I ) l C , f 1c -10 c Business Phone ®6 3 t - LocS � — 6 `1 o V ` 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip ?1 3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC Both 4. System to Serve: [ ] House IV40bile Home [ ] Business [ ] I dus [ ] Other l COON 5. If Residence: # People_ # Bedroomsor _# Bathroom [ ]Dishwasher [ ]Garbage Disposal `•Z y [Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: L.Jeounty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **VRR T OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: u WRITE DIRECTIONS (from Mocksville) TO PRO] Tax Office PIN: #- —1� - 60 �'I? �r(t)C� i0'5 Property Address: Road 1` amee���C,�Si-0.S Q �IZ an �Q 1- � 3 PW b r i cl City/ZiP(`_)v1 Y' 1 J1 �>�I oU� If in Subdivision s� provide information, as follows: Name: �O,`7 I I D d- - Section: Lot #• This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative ( `off the Davie County H}�alth Department to enter upon above described property located in Davie County and owned by f, 6, Gw&_ , - to conduct all testipg procgdures as necessary to determine the site suitability. DATE - _z� 9 Revised DCHD (06-96) U THIS AREA MAY BE USEb FOR bRAIVINC YOUR SITE PLAN: � �'����� i�ro NO/( 7N,97- kW, /iI( ere - 7ah :::::::::::::::::::::::::::::::::::::::::::.::::::::::::.:::::::::: :::::::::::: ::::::::::::: .::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::: ::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::: ............. ::::::::::::: :::::::::::::::::::::,:::::::::::::::::::::::::::::::::::::::::::::�::::::::::::::::::,::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::: `:: 4: ::: :::::::::::::::::::::::.::::::..:.:.::.:..:..:.............:.. :::: :::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�: :::::::::::::::::::::�:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::: :::::�::::::. ,....,..,.............;;.:...,...,................... . . ... .. ............. . ... ... ................... ....... ::::::::::: :::::....:::.::..:.::.:.....:........................................................................................................................................................................... ............. ::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::: :�::� :::: :::[:::i ::::::::::::::::::::::::::::::::::::: : ::::::::::': ::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::s::::: :::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::: ::::::: :�:::: :::::::::: :: ::::::::::�:�::::::: :::: :::::::: . ::::::::::::: .::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :............ ::�:::::: ::: .....:.......:.:....:..........:..:..........:.:.......:.... ........� ::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::: ... ..... ..........:...::....................................... :::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::: :::::::::: :::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::: ...... ...... ....................................................... . . ::::::: :::::::::::::::::::::::::::::::::::::�::::::::::::::::: :::::::� :::::::::::::::::::�:::::::::::::::::::::::::::: ::::::::v :::::::::::::::::::::::::::::::::::::::::::::::::::::�::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::�:::�:::::::::::::::::::::::::::::::::::::::::::�::::::::::::::::::::::::::::::::::::::::::::::::::: ::............................................................._. .. ........................................................... ........ . .............. ..................... ..................:.................................................................... ........................................................... ........ . .............. .:......................................................................... ......:.... „ _ ..................................:...................................... . ................................ .............. � .......... ..... . .... ..... . ..... ......... ....: : .................................................... . rt� w� ................. .. ... .. .. .... ........ ... ... .... ........ . .. ....... ................................... ..... ...... .. ......... .......... ......................... ............. . ...:.. .. ... . . .............. �,, ��,j ........................ ...... . .. . . ...... . ............ � ,, � _ ........ ........ ................ ... . : ��, ....... . ........ _ � ................................... ,. r. :�: ., .......... .. ....... ..a � <, . a � :j ._ ; . ............. ................................................ ....... ...........� .. , . ......................,:� ......... .................... ....... .. . 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C . R AY C AT ES certify that on S e p t. 15 19 9 4 1 surveyed the property shown on this plat; that the property lines and location of all structures are accurately shown hereon; that no structure located on this property encroaches on any adjacent street or properly, and that no structure on adjacent property encroaches on the premises surveyed." NORTH P.B.4-127 \�o,etaeeeeoo�Qo N CAR I fess ° FOSTALL DRIVE S. R.1349, ?•4�;G,ST�9�:o?9 _ SEAL N 02°- 501- 20 E r L-2623 j 1 ' •�y O: -L o° found I _ 125.00 placed %,�• ...... G°�iq , I V wR�n 19/1 1 C r'' ' \\\ LOT 16 LOT 4 lfi � d' ti rn T 23.4 I (V ( (D � 00 N Z 23.e ti (D N v� 1 I I 1 1 9.! 46� xport X12. 1 story brick 58.5; I � I I � I I o I i 0a � LOT 17 It (_n N rron 1 rrcn foundJL6.93 _ _ _ _ _ icund( rron S03R- 07 W found to N I N O r 0 03 mo 1 ran fow LOT 3 overhead power 114.7 01 S 0 4°- 30 tV U-1 0 r7 _r� 1 0 (D 00 IN L>5�mt:� NO3°--4$IE 16.23 iron — — — found W '1n LOT 2 IT d• 0 0 a) V) tine 218'.t to iron Jock 800e Rd. found S . R. 1330 / U.S. 601 PROPERTY OF GARY FINCH and BILLI E PARCEL 96 D AVIE COUNTY TAX 1`1AP C-3 LOT NO. 3 E 17 MAP OF FOSTALL DEVELOPMENT BLOCK NO. DEED BOOK 138 PAGE 320 CLARKSVILLE TOWNSHIP PLAT BOOK 4 PAGE _ 127 D AV I E COUNTY, N: C. SCALE: 1 INCH = 60 FEEL JOB No 3289 SOUTH[RN PHOTO PRINT • SUPPLY CO: WIN°TON.SALLN N50999 0 1 DAVIE COUNTY HEALTH DEPARTMENT APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Environmental Health Section SECTION LOT Soil/Site Evaluation Community Evaluation By: Auger Boring Pit DATE EVALUATED <?/02?/PV PROPERTY SIZE �. ROAD NAME��%/f1/ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position 4, Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence �- Structure / ,e Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ti , SITE CLASSIFICATION: ,oY� LONG-TERM ACCEPTANCE RATE: (� REMARKS: 6L-) 0 DCHD (01-90) Landscape Position or LEGEND EVALUATION BY: _111 OTHER(S) PRESENT: R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet 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 Mineralogy 1:1, 2:1, Mixed Notes 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) LTAR - Long-term acceptance rate - gal/day/ft2 ■■EM■■■ ■■ME■M■ ■EME■■■ ■■■E■E■ ■■■ ■■■SME■ ■■■EME■ ■E■■■■■■■■■■■■ ■■■■M■■■E■■E■■ ■■■E■■U■■■E■■ ■■MMES ■■MM■■ ■■■■■■EM■■■■■■ ■■M■■ME■■■■■■■ ■wM■■■E■■E■■■■ ■■M■E■E■■E■■M■ ■EM■■■■■■■EM■ME■■■ ■■■■■ME■MEME■■■■■■ ■■■■■■■■■■■E■■■■M■ ■■■■M■■■■■■■MM■M■■ ■E■■M■■■■■E■■E■ME■ ■■■■E■■M■■■■■■■ME■ ■E■■M■■E■■■M■MM■■■ ■■■EMEME■■■MEM■M■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■E■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■E■■E■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ma■■■■■■■■■■■■■■M■ ■■M■■■■■■■■■■■M■M■ ■■M■■■■■■ME■■■E■E■ ■■M■■■M■EME■■■■■■■ ■EM■■■■■■E■■■■■ME■ ■M■M■■■■■■■■M■■M■■ ■E■■■M■MEM■■■M■MM■ ■E■■M■MMEM■■M■■E■■ ■E■■M■■EM■■■M■■E■■ ■E■■E■■M■■■■M■■E■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ LA■■■■■■■■■■■ ■■■■■■■■■■■■■ ■EME■■■■■■■■■ ■■M■■■■■REM■■ ■E■■■ME■!;ENNE ■■■■M■■■■EM■■ ■■■■■■■■E■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■EEE■ ■■■EE■EEE■■■■■■■■■■■■EEE■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■EEE■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■EEE■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■www■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■EE■■E■■■■■■■■EEE■■■ ■■■■EEE!1!■■■■■■■■■■■EEE■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■EEE■■■■■■■■■EE■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County Heafth Department NE NUM22� �a and Home Health .Agency N0 V MP�B' o Environmenta(Health Section '6FF�G�`,53151511 P.O. sox COURIER 2 09oOP06 STREET MOCKSVIUE, N.C. 27028 PHONE: (704) 634-8760 March 24, 1998 Roger D. Godbey 184 Fostall Dr. Mocksville, NC 27028 Re: Site Evaluation Fostall Drive Tax PIH: #5822-18-0085 Dear Client(s): As requested, a representative from this office visited the aforementioned site on March 23, 1998. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for installation of an on-site sewage disposal system in the front only. If you have any questions, please feel free to contact this office. Sincerely, '��e zw kc Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/wd Enclosure(e) i CRESCENT ELECTRIC MEMBERSHIP CORPORATION I ? 42A� , ZyL0 VA. have requested Crescent Electric Cof�ora'tion granVme 13(drmission to Yocate my septic tank and lines to extend onto CEME transmission right-of-way easement that is recorded on my deed. I fully understand that CEMC may need to use this right-of-way to maintain their power lines at any given time. I also understand that I must assume full responsibility for any damage that might occur to my tank or lines due to their right-of-way. I also must assume the understanding that CEMC may leave tracks on this right-of-way that they cannot be responsible for. Q, _-also know that when I sign this form I urYderkand thaf Cr6cent Electr' s not liable for any damage that might occur on this right-of-way. - �► a ., ri� , 7 ..�r. - • Date STATE OF NORTH CAROLINA, COUNTY OF I, nA,,o Elie (2., !ka aA_ a Notrary Public for County, State of North Carolina, do hereby certify that Tc,,4 s4 t?ro d be-, .4 ;`�c�� ,• (7 . Goa((�eY personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal, this I9 f` day of 619_, 19�. My commission expires S- OFFICIAL SEAL S Notary Public S Notary Pvblo Norlh Carolina S IREDELL COUNTY ---- MICHELLE G. SH RP My Gemmission Expires S