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126 Sunny Meadows Trail Lot 121 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900640 Tax PIN/EH M 5735-38-0207 Billed To: Bruce Anderson Subdivision Info: /Z(c 5uiviv /Vlecacdotzks Reference Name: Stacee Wyrick Location/Address: Junction Road -27028 Proposed Facility: Residence Property Size: 150 X 300 ATC Number: 2088 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type AC O _ #People #Bedrooms_ #Baths _ Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #Peopl Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _ c l_ Design Wastewater Flow (GPD) ,320- Site: New 04 Repair ❑ '�I I System Specifications: Tank Size Ia�o GAL. Pump Tank nGAL. Trench Width 1 c> Rock Depth Linear Ft. t r - I} �=fes' � Yii4,n.�/S'�Y>�,� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m.l or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** F I Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900640 Tax PIN/EH #: 5735-38-0207 Billed To: Bruce Anderson Subdivision Info: Reference Name: Stacee Wyrick Location/Address: Junction Road -27028 Proposed Facility: Residence Property Size: 150 X 300 ATC Number: 2088 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER"NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION Date: **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage 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. Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) Jpp e,W4 Date: !� APPLICATION FOR SITE EV AWATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Meath Sechion P.O. Box 848/210 Hospital Street Mocksville, NC 27028 1336)751-8760 JIAV 2 4 1999 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. i. Name to be Billed fyuA CL�,( , /� x1 Contact Person� aU- (AIM . Hailing Address al 1) �ah (),(j(-�. Q( j� Home Phone ,Q .4111) City/state/ZIP "At &H ,e,( t %v' Business Phone 2. Name on Permit/ATC if Different than Above Nailing Address City/State/Zip 3. Application For: U Site Evaluation ❑ Improvement Permit/ATC oth 4. System to service: ❑ House obile Home ❑ Business 0 Industry ❑ Other S. If Residence: # People— # Bedrooms # Bathrooms O Dishwasher O Garbage Disposal 0 -Washing Nachine 0 Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/other: Specify type # a # People # Sims # Showers # Urinals # hater Coolers IF FOODSERVICE: 1 Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City 44611 ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yeses If yes, what type? I ***IMPORTANT ** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED j BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. I Property Dimensions Sem Tax Office PIN: #� 35 - 3 8 Q 7 Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY- (-,tc PROPERTY- ( -, ROSS rh o Ckwj r IL .1 1! ll/ WAY � 1 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 frons this application. I, hereby, give consent to the Authorized Representat, f the avie Coun Health Department to enter upon above described property located in Davie County and n d by 1�� to conduct all testing procedures as necessary to determine the site i ility. nu DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclndfall of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. C 7 Revised DCHD (07/98) Invoice No. 2 J>0� S�\ �r DW I GH. -T CAMPBELL D.B. i 156 PG. 9 1 9 y OD Y t S 560 17' 16" E 2 19. 66' five l I \ t CURVE D A R = 2691.63' \ T =' {� \ L = 794.1994.19'' `\ .S 610 Q= 16.5420" �Q \` • F� 2,16 ACRES± o .\` \3s•F \'� rlr p. i,-� 9 DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900640 Tax PIN/EH #: 5735-38-0207 Billed To: Bruce Anderson Subdivision Info: Reference Name: Stacee Wyrick Location/Address: Junction Road -27028 p Proposed Facility: Residence Property Size: 360(,L' /5"0 Date Evaluated: 7-1 / 9 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut HORIZON I DEPTH row.&A Me MIX mr.29M Consistencei�1.D' ►� �� e . ROO 132MFAConsistence Texture ffoup MW2I= �� M-17- MConsistence HORIZON III DEPTH OREM HORIZON IV DEPTH ConsistenceSAPROLITE Mineralogy CLASSIFICATION • SITE CLASSIFICATION: f J LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY OTHER(S) PRESENT: LEGEND Landscape Position 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/112 DCHD (Revised 05/99) Record Boole ALL— pap $,sfaA,_ Mail To: c nr e WARRANTY DEED -Form WD -601 Printed and for sale by James Williams & Co., Inc., Yadlibiville, N. C. STATE OF NORTH CAROLINA, Davie County. THIS DEED, Made this l th day of Sgyltember 1999, by and between Perry Bruce Anderson, unmarried of Davie County and state of North Carolina, hereinafter called Grantor, and Peggy L. Menken, individually of Davie_ County and State of North Carolina, hereinafter called Grantee, whose permanent mailins address is P.O. Box 207, Mocksville, 27028 WITNESSETH: That the Grantor, for and inconsideration of the sure of Ten and 1101190 -----------------tip ---- —__� and other good and valuable considerations to him in hand Raid by the Grantee, the receipt whereof Is hereby acknowledged, has given. Ranted, bargained, sold and conveyed, and by these presents dos give, grant, bargain, sell, convey and confirm unto the Grantee, his heirs and/or successors and assigns, premises in .ieruaal em - Township, DBVieCounty, North Carolina, described u follows: LYING AND BEING a tract of land in Jerusalem Township, Davie County, North Carolina being more particularly described in Exhibit "A" which is attached hereto and incorporated by refer* as if fully set out herein. Wig COUNTY i SB -35-99 STATE OF $70.00 Real Estate Excise Tax .Not 08115 0 The above land was conveyed to Grantor by . See Book No. , Page TO HAVE AND TO HOLD The above described premises, with all the appurtenances thereunto belonging, or in any wise appertaining, unto the Grantee, his heirs and/or succeoan and assigns forever. And the Grantor covenants that he is seized of said premisas in fee, and has the right to convey the some in fee simple; that said premises are free from en- cumbrances (with the exceptions above stated, if any); and that he will war r a n t and defend the said title to the same against the lawful claims of all persons wbjkmsoever- on reference is made to the Grantor or Grantee, the angular shall include the plural and the masculine than include the feminine or the neuter. N WITNE WHEREOF(�/7ite ntor has hereunto get his hand and seal, the day and year t&tt above written. d k� K ~9 (_"", ._ (SEAL) (SEAL) 3ierry ruce Anderson (SEAL) _ (SEAL) STATE OF NORTH CAROLINA Davidson COUNTY. 1, the undersigned , a Notary Public of said County, do Grantor, personally appeared before me this day and acknowledged the execution of the foregoing deed. a • ..e,,. i 1 =v n......c. Witness my hand and notarial seal, this thsJ' day o tl s !�q - ' (3-'—• My Commission Expire" l-t5��•b.Jn�4$�•fS`��,_yp�g�AL] STATE OF NORTH CAROLINA COUNTY. �e a Notary Public of said County, do hereby certify Grantor, personally appeared before me this day and acknowledged the execution of the foregoing deed. Witness my hand and notarial teal, this the day of— My f My Commission Expires: , N. P. (SEAL) STATE OF NORTH CAROLINA, Davie COUNTY. The foregoingctrtiGcxt,M of Melissa, G. York. Notary Public of Davidson County, NC, Is (19) certified to be correct. This instrument was presented for registration this is day of October, 1999 at 1:10 WX, P, M., and duly recorded in the office of the Register of Deeds of D8V le County, North Carolina, in Book 316 page 860 This the 15 day of October A. p., 1999 HENRY L. SHORE By Register of Deeds , Deputy Register of Deeds Thi.Dceddrawnby Scott Y, Curry, Attorney, 111 West Center Street, Lexington, NC 27292