303 Cardinal Hill LnDav
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Ag. District:
'.016
Shady Grove
37059-804
FULTON
Davie County
DAVIE COUNTY R -A
54.75 AC OFF FORK BIXBY Fire Response District: FORK,ADVANCE
43.74 Elementary School Zone: CORNATZER
12/1998 Middle School Zone: WILLIAM ELLIS
002080207 Soil Types: PaD,PcB2,PcC2,ChA
Land Value: 162420.00 Total Market Value:
Total Assessed Value: 259710.00
WARNING: THIS IS NOT A SURVEY
Parcel Information
1800000002 Township:
5778495427 Municipality:
82524236 Census Tract:
TKACH RENAE JONES Voting Precinct:
303 CARDINAL HILL LANE Planning Jurisdiction:
ADVANCE Zoning Class:
NC Zoning Overlay:
27006-0000 Voluntary
DAVIE COUNTY
22160.00
381900.00
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County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due
No
to
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AUTHORIZATION NO: Q 6 81 DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section PROPERTY INFORMATION
Permitiee's r� �� f P.O. Box 848
Name:'''1�fir �'�, r'r",.'.! std>� Mocksville, NC 27028 Subdivision Name:
/ Phone #: 704-634-8760
Directions to property: , r>
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#�r
SYSTEM CONSTRUCTION
Road Name: �'� 19 Cd Pip— :'g -v dd e')
**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
�� /'l� 'r ✓ / . e �1i c:.! �''i ` IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
\ 11X0
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
PerinifYee`'s
Name:
Directions to property:
Subdivision Name:
Section: Lot:
IMPROVEMENT
,Tax Office PIN:#--'
Road Name: " ,ip:
**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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***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 # BEDROOMS ._ S # BATHS_7— # OCCUPANTS ,_? GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE -2 TYPE WATER SUPPLY 414 41 DESIGN WASTEWATER FLOW (GPDZ�✓h_ NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE ely / h GAL. PUMP TANK GAL. TRENCH WIDTH ;Fl ' ROCK DEPTH Z2-� LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
JMPROVEMENT PERMIT LAYOUT
i
"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: ,alq SGV
/II
AUTHORIZATION NO.OW19V OPERATION PERMIT BY: � DATE:1/,0�
"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 05/96 (Revised)
P�,1i rte' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT
LS O V
Davie County Health Department
5 Environmental Health Section FEB 1 7 j997
P. O. Box 848
Mocksville, NC 27028
(704)634-8760 j
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
1_� u �^ f ALL THE REQUIRED INFORMATION IS PROVIDED. 11-
1. Name to be Billed a [ t� i:. 1 S C til �� D l�j� Contact Person tx Ialkk'
Mailing Address 26y lriAQSKy LA 1l e Home Phone ����' to l ) 7
City/State/Zip A -d .i Ay\ C C- , Y) . C . Business Phone 1911 'e
2. Name on ,Permit/ATC if Different than Above
Mailing Address
3. Application For:
4. System to Serve:
5. If Residence:
❑ Dishwasher
(X" Site Evaluation
3' -House B"'Mobile Home
# People
City/State/Zip
Ef Improvement Permit & ATC
❑ Business ❑ Industry
# Bedrooms_
2"Both
❑ Other
# Bathrooms a
❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other: Specify type
# Commodes
If Foodservice:
7. Type of water supply:
# Showers
# Urinals
# People # Sinks
# Seats Estimated Water Usage (gallons per day)
❑ County/City 0 -Well
# Water Coolers
❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? Cl Yes 9 -No
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: s5
� I
Tax Office PIN: # �T % -7 5' - - c7 q 97
J I
Property Address: Road Name
n I
City/Zip AddAylLC-L ',170a
If in Subdivision provide information, as follows:
Name:
Section:
Lot #:
WRITE DIRECTIONS (from
Mocksville) TO PROPERTY-
-- L-1
ROPERTY:iV ...r 1 Y-J,A
10f' h.11 i-1 "'Rn Lem' &- 9 1 � I
MAJb6y -41pran A t' -
,J�a M- l e d ,'Qt Re-)_
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 of the Davie County Health Department to enter upon above described property located in Davie County
and owned b L £- -9 L o L ZN, n e — to conduct all testing procedures
as necessary to determine the site suitability.
DATE Q — % Z ` 7 % SIGNATURE
Revised DCHD (06-96)
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME a /" DATE EVALUATED
PROPOSED FACILITY /7- PROPERTY SIZE j
SUBDIVISION ROAD NAME .C_.�-eIA '20' d
Water Supply:
On -Site Well Community
Evaluation By: Auger Boring 6/ Pit
Public
FACTORS
1
2
3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
4�0
Texture groupGj
Consistence
r -
Structure
MineralogyL—
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture roup
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
,
SITE CLASSIFICATION: EVALUATION BY:/
11(°/%
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS:
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/ft2
DCHD (01-90)
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