1181 Calahaln Rd. , DAVIE COUNTY HEALTH DEPARTMENT
;.. , _ - : • Environmentai Health Section
� P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990000968
Billed To: Craig Cartner
Reference Name: Craig Cartner
Proposed Facility: Residence
IMPROVEMENT/OPERATION PERMIT
I''��9 `2-/� �'�
Tax PIN/EH #: 5800-45-0933
Subdivision Info:
Location/Address: Calahaln Road-2702$
Property Size: 19.8 Acres
**NOTE'�* Ttii bgmprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AiTTHORIZATION 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERNIIT 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 f �/' �u(� #People _� #Bedrooms �� #Baths �_
Dishwasher: � Garbage Disposal: 0 Washing Machine: �� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size �� C Type Water Supply �� Design Wastewater Flow (GPD) �6� Site: New��Repair ❑
System Specifications: Tank Siz%�'d GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width � Rock Depth %�. � Linear Ft�DI%
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. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature:
DCHD OS/99 (Revised)
Prop°��`�
�
' � �5 N,
�
Date: ���% �d
Account #: 990000968
Billed To: Craig Cartner
Reference Name: Craig Cattner
Proposed Facility: Residence
ATC Number: 2327
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(33G)751-8760
Tax PIN/EH #: 5800-45-0933
Subdivision Info:
Location/Address: Calahaln Road-27028
Property Size: 19.8 Acres
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). T'his 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: ��%f� �,� Date: �� / 7�
CERTIFICATE OF COMPLETION
**NOTE** T'he 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.
%h A�n��'
Septic System Installed By:
Environmental Health Specialist's Signatwe :
DCHD OS/99 (Revised)
�
Date: D� 'o�%� ���
. ' � � n �2, ��j i5� Q
U
� APPLICAT10�11��i R SITE EVALUATION/IMPROVEMENT PERMIT & ATC
.lAN 2$ 20G0 V avie County Health Departmeht
„�_t,' nvironmenta/Hea/thSe�cGion �/// -
�,..-..----�-�---�---' .O Box 848/210 Hospital Street �//" � . �
Et�lVlRu�d����:.r�TAI HEALTH ��snille, NC 27028 �
D�VIE COUNTY , �
(336) 751-8760 a
***II�ORTANT*** THIS APPLICATION C�INNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BTJI�LETIN for instructions.
1. Name to be Billed �� %�`�.'� IL, •T'7 hiP �� Contact Person .! �� Q A�� �T !1U L
���ng �eee I 1 �31 i'��.� ��� �� �..
City/$tate/ZIP
Home Phone
Businesa Phone J li?E
2. Name on Permi.t/ATC if Different than Above �i'a{i�(�..-
Mailinq Addresa _ �'J-�'�.�_ City/State/2ip s �.r:� ��
3. Appiication For: � Site Evaluation ❑ Improvement Permit/ATC Both
� system to ser,.iae: 0�' House 6�' Mobile Home ❑ Business 0 Industxy ❑ Other
s. �f esidence: � People �_ : Bedrooms � � Bathrooms �
Dishwasher ❑ Gasbage Disposal ashinq Machine f7 Basement/Plumbing ❑ Sasement/No Plumbing
6. If Businaaa/Induatxy/Other: SpeciPy type # People � 3inks
# Commodea � Shoxera # Urinala # Water Coolera
IF FOODSERVICE: # S@at3 Estimated Water UsSge (gallona par day)
7. Type of water supply: County/City ❑ Well ❑ Community
e. Do you anticipate additions or eapansions of the facility this system is intended to serve? ❑ Yes �.AFt�
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. EitLer a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: ��' �/7���.5 WRITE DIRECTIONS (from Mocksville) to PROPERTY:
TaaOfiicePIN: # .SRoo-y5-o933 Go �y �•k� �-o ���e.��-�� �r� t��'�
Property Address: Road Name � ti� � � i�t.,..1r'tx�; �._��� � `l�4-�-- (Q� ���-5�.�� � �,� �`�t"� ��
�7 �+ j� ,} t /� -: t/'��r j� �y r. + p / ^j�;� „„�' �} ; • �
CIty�L.�p t, t1 C%`� _�c ,`}:,/ t��� S; :�,'. *tt ,+t7�G � f 1Z i��`t fi,�`! �` �¢" f%_ f A? s' ". S`�i i.-��� �2� 5" '� �
��.r�''� ��x��'c`'? i���..� i'�fyaC�l�';.
If in a Subdivision provide informallon, as follows: �,
Name:
Section: Block: Lot: Date Property Flagged: �—�� G U
This is to certify that the information provided is correct to the best of my knowledge. I understand t6at any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if t6e information
submitted in this apptication is falsified or changed I, also, understand that I am responsible for all charges incurred jrom
this application. I, hereby, give consent to the Authorized Representative of the Davie County Hfalth De� ar� �ent
to enter upon above described property located in Davie County and owned by �PAiC ���rc�4 G�C/'�'�rr^
to conduct all testing procedures as necessary to determine the site suitability.
DATE l �- � �Q "'� � SIGNATURE • . /1�
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Eaisting and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
' �6
Site Revisit Charge
Date(s):
I Client NoHfication Date:
I EHS•
Account No. [JO
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Maii allcr recording to Andrcw White (nttomey's Dox)
This instrument preparcd by Andrew White, Mocksville, NC
0 t� � 3 ( i
(NO T17LE SEARGf REQUESTED OR PERFORMEDf
WARRANTY DEED
This Warranty Deed is made this 4'h day of SeptemUer 1998, by and between J.C. Cleary
and wife, Gwendolyn L. Cleary (hereinafier "Grantors") of Davie County, North
Cazolina, and Rodney Craig Cartner and wife, Wanda G. Cartner (hereinafter "Grantees")
of Davie County, North Carolina.
In consideration of certain valuable consideration by Grantees, the receipt and sufficiency
of wl�ich is hereby acknowledged, Grantors l�ave and by these presents do grant a�id
convey to Grantees in fee simple all rigl�t, title, claim, and interest of Grantors to that
certain lot or parccl of land, and all improvements thereto, situaled in Davie County,
North Carolina, described in the attached Legal Description. -
Grantors hereby warrant and covenant witli Grazitees that Grantors are seized of the
above-described property in fee simpie, have the right to convey the above-described
property in fee simple, that title to the above-described property is marketable and free
and clear of all encumUrances, that Grantors have done nothing to impair such title as
Grantors received to the above-described property, and that Grantors will wanant and
defend the title to the above-described property against the claims of all persons.
In witness whereof, Grantors set their signatures below, this 4`h day of September 1998,
Grantors: � . � �./..(
�
J. . Cleary Gwendolyn L Cleary �
+kti�t#**t*#!#4t*#4Mtt�Rtt#t�**�*tM#tt#4**#4t##f�ftf*4*t4Mt##t4��tt*+M4t*#�4ftt+MtR**rtrtt�#•
STATE OF NORTH CAROLINA
COUNTY Or DAVIE
.�I,�p��ci��Qt' 1„ �c��►Q�C' , a Notary Public of Davie County, North Carolina, do
'•���;,•�`"H�l��'��tY�►���C,ertify that J.C. Cleary and wife, Gwendolyn L. Cleary did personally appear
,.�° ' k.�ba�"or���_[']'�e�•.this day and acknowledged the execution of the foregoing Warranty Deed as
�.�� :.•' .nyrr...,, ., i' � .
��: � � C-� r� n � t�; s:�j tness my han d an d o f f icia l sea Us tamp, t his 4' h day o f Sep tem ber 1 9 9 8,
E tu J ���u�'�;K� =' ; : :�z= �---�
� Q •ti� u � i ; - - —, -
'''��Gi.''Metr liF``� .
' `•�;'�C,���}��iission expires:
► << v .
[SEALJ
..,,� ,.-;:
.**.«**.*.*.*.�*..*.*......*..«*.:....*.**.:**.**«**+..*.*.�.*..:.*.�*.*.M�*:.*........
STATE OF NORTH CAROLINA
COUNTY OF DAVIE
The foregoing certificate of Jennifer L. Deeker , Notary Public of Davie
County, North Carolina, is hereby certified to be correct. This Warranty Deed and this
certificate are duly registered and recorded this 10 day of��'g�98, at 11:14
A. m., in Book 205 at Page 644
Henry L. Shore, Register of Deeds, Davie County, North Carolina
By: /t� � y� ��.-„�L1 � [DrputYl
UHVIE COUIITY
sra ORTH
NpRouNA
G �
N9-10-98
��.Z4� _ C�i�
�'. i, � Real Estate
��•" � Excise Tax
APPLICANT INFORMATION
Account #: 990000968
Billed To: Craig Cartner
Reference Name: Craig Cartner
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Heaith Section
Soil/Site Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 5800-45-0933
Subdivision Info:
Location/Address: Calahaln Road-27028
Property Size: 19.8 Acres Date Evaluated: '�/� ���
Water Supply: On-Site Well Community
Evaluation By: Auger Boring e/ Pit
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
SWcture
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SIT'E CLASSIFICATION:
s
LONG-TERM ACCEPTANCE R�TE
REMARKS:
LEGEND
Public
Cut
EVALUATION BY:
OTHER(S) PRESENT:
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
Wet
NS - Non sticky
NP - Non plastic
FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
SS - Slightly sticky S- Sticky VS - Very Sticky
SP - Slightly plastic P- Plastic VP - Very plastic
tructure
SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralo�v
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 - gaUday/ft2
DCHD OS/39 (Revised)
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