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274 Elm Street Lot 124-127Applicant: Jackie H. Hall Address: 200 Castlewood Drive Apt. 826 city Salisbury State2ip: NC 28147 Phone #: (704) 920-2428 *CDP File Number 136331-1 H5-150-60-016 County ID Number: Evaluated For: NEW �ownship: Property Owner: Jackie H. Hall Address: 200 Castlewood Drive Apt. 826 City Salisbury State2ip: NC 28147 Phone #: (704) 920-2428 Property Location & Site Information Address/Road #: Subdivision: Woodland Phase: Elm Street Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 2 *Water Supply: PUBLIC *IP Issued by. 2140 -Nations, Robert *CA issued by: 2140- Nations, Robert Design Flow: 3 6 0 Soil Application Rate: 0 3 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Lot: 116+ Directions Hwy 158 To right on Dogwood To stop sign to right lot on left. Past Brown Stroage Building *System Classification/Description: TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) SaproliteSystem? QYes QNo *Distribution Type: GRAVITY- SERIAL Pump Required? QYes QNo *Pre Treatment: Drain field 1 .1 0 0 Sq. ft 4 3 0 0 ft 9 Inches O.C. Feet O.C. 3 Inches Feet inches Minimum Trench Depth: 3 6 Minimum Soil Cover. a 4 Maximum Trench Depth: 3 6 Maximum Soil Cover: a 4 Inches Inches Inches Inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Randy Miller Certification #: *EH S: 2140 - Nations, Robert Date: 0 8/ 2 7 /.2 0 1 4 Approval Status D Approved ❑ Disapproved OPERATION PERMIT Q To Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Jackie H. Hall Address: 200 Castlewood Drive Apt. 826 city Salisbury State2ip: NC 28147 Phone #: (704) 920-2428 *CDP File Number 136331-1 H5-150-60-016 County ID Number: Evaluated For: NEW �ownship: Property Owner: Jackie H. Hall Address: 200 Castlewood Drive Apt. 826 City Salisbury State2ip: NC 28147 Phone #: (704) 920-2428 Property Location & Site Information Address/Road #: Subdivision: Woodland Phase: Elm Street Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 2 *Water Supply: PUBLIC *IP Issued by. 2140 -Nations, Robert *CA issued by: 2140- Nations, Robert Design Flow: 3 6 0 Soil Application Rate: 0 3 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Lot: 116+ Directions Hwy 158 To right on Dogwood To stop sign to right lot on left. Past Brown Stroage Building *System Classification/Description: TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) SaproliteSystem? QYes QNo *Distribution Type: GRAVITY- SERIAL Pump Required? QYes QNo *Pre Treatment: Drain field 1 .1 0 0 Sq. ft 4 3 0 0 ft 9 Inches O.C. Feet O.C. 3 Inches Feet inches Minimum Trench Depth: 3 6 Minimum Soil Cover. a 4 Maximum Trench Depth: 3 6 Maximum Soil Cover: a 4 Inches Inches Inches Inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Randy Miller Certification #: *EH S: 2140 - Nations, Robert Date: 0 8/ 2 7 /.2 0 1 4 Approval Status D Approved ❑ Disapproved 'CDP File Number 136331 - 1 County ID Number: Hs -iso -e0-0'6 .septic TanK Manufacturer. Shoaf Lat. STB: 760 Long: Gallons: 1000 Installer: Randy Miner Date: 04/ ❑ .17 / a 0 1 4 Certification #: ❑ No 'EH S: 2140- Nations, Robert 'Filter Brand: ST Marker: El Yes ❑ NO Date: 0 8/ 2 7/.2 0 1 4 Reinforced Tank: ❑ Yes ❑ No Approval Status 1\ 0 Approved ❑ Disapproved ,Piece Tank: ❑ Yes [R No Pump Tank Manufacturer. Installer: PT: Certification #: Gallons: *EHS: Date: / Riser Sealed ❑ Yes Riser Height: ❑ Yes nforced Tank: ❑ Yes 1 Piece Tank: ❑ Yes ❑ No ❑ No (Min.6 in.) ❑ No ❑ No Pipe Size: inch diameter Pipe Length: feet 'Schedule: Pressure Rated ❑ Yes ❑ No approved fittings ❑ Yes ❑ No Date: Approval Status ❑ Approved ❑ Disapproved upply Line Installer: Certification #: 'EH S: Date: Approval Status ❑ Approved ❑ Disapproved / Pump Type:_ Installer: f/ Dosing Volume: Gal Certification #: Draw Down: Inches 'EH S: =Chain: Date. Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check -valve ❑ Yes ❑ NO Approval Status PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes 0 No CDP Fife Number 136331 - 1 County ID Number: 145-150-130-016 Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer: Box 12 inches Above Grade ❑ Yes ❑ NO Certification #: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ NO *Activation Method: Date: Approval Status Alarm Audible ❑ Yes ❑ NO El Approved ElDisapproved Alarm Visible E3 Yes E] NO 2140 - Nations, Robert *Operation Permit completed by: Authorized State Agent: Date of Issue: 0 8/ a 7 l a 0 1 4 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A.1900 et Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 11 A. sewage septic system. Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria: Minimum System Review By The Local Health Department: N/A Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator: N/A Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. 01 -land Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 136331 - 1 Davie County Health Department CDP File Number: 210 Hospital Street H5 -150 -BO -016 P.O. Box 848 County File Number: Mocksville NC 27028 Date: / / CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 136331-1 Davie County Health Department County ID Number: H5 -150 -BO -016 t $ 210 Hospital Street Evaluated For: NEW •;�.' P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 6/ 3 0/ a 0 1 9 Applicant: Jackie H. Hall Address: 200 Castlewood Drive Apt. 826 City: Salisbury State/Zip: NC 28147 Phone #: (704) 920-2428 Address/Road #: Subd Elm Street Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 2 *Water Supply: PUBLIC Property Owner: Jackie H. Hall Address: 200 Castlewood Drive Apt. 826 City: Salisbury State/Zip: NC 28147 Phone #: (704) 920-2428 Phase: Lot:'Z5 Directions Hwy 158 To right on Dogwood To stop sign to right lot on left . Past Brown Stroage Building ification Page 1 of 3 Trench Depth: a 4 Inches \Site Classification: ProvisionallyMinimum suitable Saprolite System? O Yes (� No Minimum Soil Cover: 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY -SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25% REDUCTION 1 -Piece: 0 Yes ® No Pump Required: O Yes (& No O May Be Required Nitrification Field 1 a 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 1 -Piece: OYes ONo Total Trench Length: 3 0 0 GPM --vs-- ft. TDH ft Trench Spacing:Inches _ 9 O.C. Feet O.C. Dosing Volume: _ Gallons Trench Width: 3 0Inches _ ® Feet Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: O NSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: O 1 011 0111 ON / Page 1 of 3 CDP File Number 136331 - 1 *Site Classification: Provisionally Suitable Design Flow: 3 6 0 Soil Application Rate: 0 3 County ID Number: H5 -150 -BO -016 ired:®Yes O No O No, but has Available *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines 1 a 0 0 Sq. ft. Total Trench Length: 3 0 0 ft. ❑ Open Pump System Sheet Trench Spacing: 9 O Inches O.( ® Feet O.C. Trench Width:® — 3 O Inches Feet Aggregate Depth: inches Minimum Trench Depth: a 4 Inches Minimum Soil Cover: 1 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches *Distribution Type: GRAVITY -SERIAL Pump Required: OYes (8)No O May Be Required Pre -Treatment: O NSF OTS -1 OTS -11 *Site Modifications araclem 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. ch -1— ; 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be issued at the same time the Improvement Permit issued (NCGS 130A336(b)). If the Installation has not been completed during the period of validity of the Construction Permit, the Information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140 - Nations, Roberti �Date of Issue: 0 6 / 3 0 / a 0 1 4 y� Authorized State Agent: ''A/-' I/ � ' !i Malfunction Log OYes ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 136331 - 1 County File Number: H5-150-130-016 Date: 06/30/a014 O Inch Scale: O Block O N/A Page 3 of 3 P1 P2 ' CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 136331 - 1 P.O. Box 848 H5 -150 -BO -016 Mocksville NC 27028 County File Number: Date: .0.6./ 3 0/. 0 14 Click below to import an image from an external location: Drawing Type: Construction Authorization Page 3 of 3 P1 P2 Davie County Vnvij-onmeintal Health r � �� Q � A �7 P.O. Box 8481210 Hospiral Street Mocksville, Nth 27028 � J (336)753-67801 i'ax (336)753-1680 IMP ROVE -ME' -N7 PERMIT Account #: 990006171 Tax PINIEH #: H5 -150 -Bt? -016 Billed To:. Jackie Hall Subdivision Info: Woodland Lot # 125-127 Address: 200 Castlewood Drive, Apt 826 Location/Address: Elm Street -27028 City, Salisbury Properly Size: 200x240 Reference Name. Pro Po§l TliRimprovepmnt Perttiit DOI S NOT 3titnori c: the constniction of a wastewater system. ,fin Authortration To C'onsrruct a wa tewater system must he obtained from th is offi c:: prior to the construction/installation of a wastewater system or Clic issuance of a building permit(in compliance with Article I I of G.S. Chapter 130A. Wastewater .System,). This Improvement Permit is subject to revocation if site plains, plat or the intended use change. Pcmnt Tync: L:w nRLpair '11FxpLmsion Pennit N ahid for. LYcar> I-jNo Expiration Residential Specifications: k lkdw mis 3 8 i3athroonis —_ People r+�.� tia�cmc►�r, srrncnt l�hitn6iii Non -Residential Speciricalions: I'LelliLy Type A, Pec.Nple P ,'Seat!_ Scltjare rootage(or Dimensions of Facility) _ Design Flow(GPD) (c[) Tylae of Miter Si:pply:t ,( untyXity :J'4 eel 7iCommunity Well Sita Mndiiications/Nmi't Conditions: t�Plz� i t System Type L'I't1R I Initial tD Envirournental'Health Specialist Date �` t APPLICATION FOR SITE. EVALUATIONAMPROVEMENT P.EI�MIT & ATC Davie County Environmetttal Health P.O. Box 8481210 Hospital Strcet to i! ocksville, NC 27028 (336)753-67801 Fax (336)753-1680 Application Pur: '..I Sitc F.valLriltiatulmprovement Permit Authorization To Construct (ATC) Rath Type of Application: '>04ew System f Repair to Existing. System L-ExpansiotL':ModifiCfltiori ol'Existing System or Facility *6*1.tfPORT,,IN7**; '1'IIIS APPT.TCATIO Ctl Nr.-VUT'11L; f']?OCL''SSEL) UNLESS ALL OF THF. REQUIRED INI,`01;LN1JATTON IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICA"N7T INFORMATION Name fi } r7 - Contact Per on .Address .. (. Home Phone�r- � �5- 3� rie City/StatvJZTP .. `i_. Business Phone q-04 96—,;q Email 2C ice, l c w2T_ Name on PunniVATC if Different tha Above _ �. .,_ N' jailing A idreS8, CitylStatelLip PROPERTY TNFORMATIGN *Date House/Facility Comers Flagged a_ f i hif NOTE: A survey plat or site plan must accompany this application. Included: [ Site Plaut 7 Plat(tcs scale) (Permit is valid for 6{1 months with site }clan. no expiration with complete plat.) Owner's !\time 4JK11 Plione NUMl er a --,,%--6f, _ j j Owner's Address - T't'4'C'itylState!Lip Property Acldrr:ss t City— 11��?s i�� iL'a 9 T.ot Size_apju)C, afjoi Tax PIN# - 1 Ulla t Subdivision Name(ifapplicable) L-<&�� r � �Soc ficin+'Lot�� k. � �c� + CAM. To Site: 'S :1 L ci_% I Directiutts .. _ Specify Problem 0 cueing: -13 IF RESMENCE FILL 017 THE BOX BELOW 1" People 12A, 11 Bedrooms 4 Bathrooms _ Gardcn lubl4VhirIpool I Yes I3219enient: i es IVa Basemertt Phimbin : T 4 es Ilio F IF NON-RESYDENCE FILL QUIT THE BOX BELOW Type of.Facility/Business Total Square Footage of Building 4 People 4 ...,. Sinks # commodes ft Showers # [Jrittals, Estimtttul Water Usage, (gallons per day) � �{Attach documentation of similar facility water consumption) .-FOODSERVICE ONLY: # Seats 'I'ypest''KtCRln:ClLLC3ted:�Gonventitmal I -Accepted I"lnrtovative 7Alternative -Other Water SupplY T)pe*Iountyd(:ity Water .I New Well HExisting Well 1.1 Conununity Well Do you anticipate additions car cxpancions of the facility this s}stern is intended to serve? i_ Yes if ycs, what type? _... q No This is to Certify that the information proi,ided on this application is true and correct to the best of my knowledge. l understand that any pennit(s) or .MfC(s) issued hereafter are subject to suspension or revocation ifthe site is altered, the inteaded use changes, or if the infonnation :submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative 150 - rs 6 ~ 01 x 77 H5150A 12 H5150 00104 H51 OA0013 N515QA0011 H5150B0002 �' H5150B0003 N 1: 1�c� p M IV, urT .3fli 'tw sW3 rn tt,.. �idiw fBFIX CS IQI 25 200 r"p Yt„ 1S.."R1 Fr I�JfJ er `�� ,". 200 ': 20 350 ,Jgln as ,t.3.l59:'4Jrlbt!!Wre<0!Slwl)Ji e�rove,r-�In;,t't n hz W r, 1�. n2•.r,.t.ri.� F00 G:sear;n a Ita•1., Faetwe. l"Jea rve tu;iJ:rlei la �.._.. _ DOGWOOD LN ._.....__. _.._.._._ w __.__.-._.__.._.._. . H5151 001_ Davie 1 NC H5150A0018 k 201 201 151 N1 H5150BOO 1601 O H515080009 s- H5150130015 zoa 50 1�0 � 200 v 2ao 150B0010 4 H5150BOO16 H5150130014 0 H5150BOD18 ¢ H5150BOO17 r $ W to p n Nt 200 H51 11 H51 OBDD1801 ' $ H515QB001401 200 ►s 230 30 v w H51508001702 H5150Bf1f113 � H5150B001701 rn 290 230 249 239 326 15020BD007 1502050006 "' 15020600Q8 -"Y�=BOGU901 150 0019 1T SUNSET -DR 427 1: 1�c� p M IV, urT .3fli 'tw sW3 rn tt,.. �idiw fBFIX CS IQI 4' C "" 77 Tax Parcel: r"p Yt„ 1S.."R1 Fr I�JfJ er `�� ,". Cwv a,nl.• La caJv"I tu: mrr Lan .,,w: H'5150BU01 6 ,Jgln as ,t.3.l59:'4Jrlbt!!Wre<0!Slwl)Ji e�rove,r-�In;,t't n hz W r, 1�. n2•.r,.t.ri.� F00 G:sear;n a Ita•1., Faetwe. l"Jea rve tu;iJ:rlei la County 7 loth n 704'rret Davie 1 NC v Davie County Environmental Health /� P.O. Box 848/210 Hospital Street Jere 9 Mocksville, NC 27028 V 6; (336)753-6780 / Fax (336)753-1680 v IMPROVEMENT PERMIT Account #: 990006171 Tax PIN/EH #: 1-15-150-130-016 Billed To:. Jackie Hall Subdivision Info: Woodland Lot # 125-127 Address: 200 Castlewood Drive, Apt 826 Location/Address: Elm Street -27028 City: Salisbury Property Size: 200x200 Reference Name: Propo 8 I Thies improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G. S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration — Residential Specifications: # Bedrooms 3 # Bathrooms w'l.. # People :L Basement Fl asement plumbing Non -Residential Specifications: Facility Type # People _# Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): 3 (0c) Type of Water Supply: ?Zo--unty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: Site Plan System Type LTAR Initial . Repair CA t Environmental Health Specialist i.p. 11-06 / M Me Date APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health f''L`,k+ jV VD P.O. Box 848/210 Hospital Street Aa (� Mocksville, NC 27028 Q ed ' (336)753-6780/ Fax (336)75371680 Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct (ATC) Both Type of Application: 1>04ew System ❑ Repair to Existing System ❑ Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. A DDT TO A ATT TATT7nD A d A TTnXT Name A Contact Person i Address Home Phone City/State/ZIP Mc,, QKlql Business Phone Email '— i , C Name on Permit/ATC if Different tha Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 0 /111 NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name Phone Numberb_ - �( Owner's Address City/State/Zip i. I y Property Address City 5LdL 15-76,59 Lot Sizer'� 01D x a00 Tax PIN# - - 1. - 0- ol(o Subdivision Name(if applicable) l Section/Lot# t-4`6 laq� lQS.10A, QrJ Directions To Site: S Y\ S Specifv Problem O curring: IF RESIDENCE FILL OUT THE BOX BELOW # People A #Bedrooms ;:�S— # Bathrooms C Garden Tub/Whirlpool ❑Yes o Basement: es ❑No Basement Plumbing: []Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business- Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:'�Conventional []Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type)wf�- ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? No This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging sta 'g the hous facili to ion, proposed well location and the location of any other amenities. P perty owner's or owner's legal representative signature Site Revisit Charge Date(s): a , W Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # Invoice # o H5150A 012 N H5150E 0004 H51 OA0013 H5150j5O H5150B0002 p H5150B0003 N 50 25 200 200 201 350 � N Ln O H51 OB001801 0 0 o H51506001401 } 200 a 199 _2_0 0 230 30 30 CP H5150BOO13 w w H5150BOO1702 H5150BOO1701 rn 15020B000502 I H5 290 230 326 249 239 CA 15020B0007 1502080006 `n 15020B0008 00191 N Jouh— M -p p. t d Feb.." 5, 7011 So — ESTI A.G4S 10.1 Msana6.tC 2If9 -� DOGWON OD LN ��Hi'I''rV Dia Source L—CouxyG15 Tax Parcel: `.�'ti•-d—'�•`a S H5150c enures make noinfad ei or 45 0 45 90 180 ,jadudaim; eaprmsed or implied ro Earl win law, including without edo H515060016 H515OA001 limteims the implied wwrmnes ofinemhmmbihty and Feet 2201 201 151 I Inch - 100 feat Davie County t m th.t w,redmne wo b e so.de is bees eprmn.gs. O H5150B0009 j96H5150BOO1601 20 N cr, H5150BOO15 Z l 200150 03 150 200 O 200 Z 4 150BOO10 m0 H5150BOO16 o H5150BOO14 0 H5150B0018 s. H5150B0017 r- o C) o U% -i 900 � N Ln O H51 OB001801 0 0 o H51506001401 } 200 a 199 _2_0 0 230 30 30 CP H5150BOO13 w w H5150BOO1702 H5150BOO1701 rn 15020B000502 I H5 290 230 326 249 239 CA 15020B0007 1502080006 `n 15020B0008 00191 N Jouh— M -p p. t d Feb.." 5, 7011 So — ESTI A.G4S 10.1 Msana6.tC 2If9 W E DennyNA Mtie Hae Feet (iie )53®50 ��Hi'I''rV Dia Source L—CouxyG15 Tax Parcel: `.�'ti•-d—'�•`a S D—. county has compded this map &® annus enures make noinfad ei or 45 0 45 90 180 ,jadudaim; eaprmsed or implied ro Earl win law, including without edo H515060016 MMM135 limteims the implied wwrmnes ofinemhmmbihty and Feet fimea for apaniculas purpose. thersammcwngedm NC nae fythe GISDepartmeatufinwmtsmmamthemep I Inch - 100 feat Davie County t m th.t w,redmne wo b e so.de is bees eprmn.gs. scs a(ea Ta i WAUANiY DUD --ilio WD401 ...�.w...rw..... 3TATZ OF N6KM CARMNA, DAVE COUNTY. TH13 DIiD. mfade x,r. lt3th d.y of August ..� 19.13-. by sad l"ftnm E. C. Norris arA w ft Dorotby 0. Morris Of Dario Conn b ad wm of North Choline, herebtafter CWW Cantor, Sd Clyde L. Reavis and wife Billie D. Reavis „.. _ of ____ _ Da vii! _ ._ _ Comty sad Stele d North Cuolioa, hereisatter called OraNee. WITNESSETH: That the Orej or, for and i 000iderafi n of the Sam of Ten Dollgrs Sad other pod sed rebubie aooddetad oe a him In hood pad by We Oran1a, do -919 whereof Y bey ackwwkdpd. ba dyew Fang bupbw4 nod sod omnled, nod by than preuofe don Sloe, Fact, bawK Sell, come, sod —&m cob dr Ormalm, hi bels and/or • eaoomem sod asdps, promise 6, MckmrL• Township, Dade Co®ty, Nosh Carouse, doctibod a follows: Bei Lot )lumber One Hundred Twenty -Four (124), of Wood -Land Snbd vision, as per surrey and plat made by W. 0. Dorsett Surveyor, Ma 1967• And said Plat recorded in Map Book., Page Number Tbis the Register of Deeds Office of Davie County, North 6arolina. To which reference is hereby made for a more particular description. "But these lota'are sold subject to certain restrictions, as to the use thereof, running with said lands by whomsoever owned, said restrictions, which are •zpregalr assent6d to by the party of the aecoad part la accepting this deed, beings as follows: Said lots shell be used for residental purposes only, and no residence of a size less -than fourteen hundred square feet area, not counting bresseway or garage shall be erected thereon, and said dwelling must be erected az ranch as fifty feet from the front of the property line of said lots, nor closer than fifteen feet to side line of said lots and no Trailers of any kind are to be parked on said Tota." STAMPS PAID $1.00 12/19/72 • The above hood was coo—, to Onww by _ See Rook Na ... Page._ TO HAVE AND TO HOLD The above deeeibedy,a with ell the apperrssoaS Wstemb bdfaptug, or is any wins epperudoing unto the Grantee, his bda sdoor a—MM sod SNIPSfiaawr. And the Greater coveneate ea wtthath MMVIM sued ofaid pseulus in fee, and hie the d& to coom the aloe to tee aiu>nie Wet ad ptemhee ere the bwtul deem= of au pens i whameoeArption aboro sling, It my); sad that he VM Warner and ddead the odd MIS to the ams Spinet When r Juana is ride Io We Orator or Oemt* the dnpder Shull Mode the Abad and the mumline shall h+ctude the feminine or 60 awter. IN WITNES8 WHEREOF, The Grantor hu bamoto set ha hand asd wall, the day nod year fret above wriem. (SEA) E. C. Morris ---.-(SEAL) (SEAL) D C.by Bsr-g,.�es •a-i�acz-8: a: Mmi4�L) STATE OF NORTH CAROLIIIA_ Davis COUNTY, 4 Jane Johnson a Notary Pathic of add Cbsoty, do busby outhy the E.C. Morris and wife, Dorothy 0. Morris (By her Attorney in Tact) Z. C. Morris Orator. pen002ly We -ed before sw this day and aebfdpd We aasatlm d the loeepoisa deed Whew my hand sod madsl sed, this t>� lA*h day of - Auffust_ . 19-7? My Cfamlrloo E -pi.: 'LIA/25 _ Jane Johnson N. P. (SEAL) • STATE OF NORTH CARDIANA. DAVIE COUNTY. The faepoiSS cowd"160e) of Jan& Jah"Ann- NotarsPublic of h yin -Co Lor IS JSW ardGed to be cortecL This hotrummt was Presented for mpfsaddon tu, 19 _ _ dq d Deoember _ 19_72 At 1:9__*M P.M, sod d* rSeorded m the offs of WS Register of Dods of Dade Camty, Nath CaroSoe, in Boot___ 0 ..._, yap.- 59 - Thi, tb&__7q____dey of December A. D. i9 72 L IL Sahli R�her Register of DSeds TLS Deed dawn by _ APPLICANT INFORMATION PAcoaabt0; 990006171 E[Bllddr0o: Jackie Hall RUfMMXNftM: R lW: Residence Water Supply: Evaluation By: i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION_ TbxfNMcHffYt#: H5-150-130=016- 8SbbldMkionl9to: Woodland Lot # 125-127 t iooNAdIdwss: Elm Street -27028 i' FRt 200x200 Itki: a —d7 , 1 4 On -Site Well Community Auger Boring Pit Public FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH 67 Texture group G SG e -Consistence 5Pf Structure Mineralogy HORIZON H DEPTH 5 7 — Texture group j Consistence i. Structure k Mineralogy C HORIZON III DEPTH Texture groupi Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 6, SITE CLASSIFICATION: l �J LONG-TERM ACCEPTANCE RATE: V 7-5 REMARKS: EVALUATION BY: �JP/U 2)'/d,,'7 S 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 Moist VFR - Very friable FR - Friable FI - Firm VFI = Very firm Ek - Extremely firm 3�'et 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 Mineralog 1:1, 2:1, Mixed LYates 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 - Lone -term accentance rate - nal/davM2 noun nrIinc M -. —AN I