253 Cedar Grove Church Rd Davie County, NC Tax Parcel Report ` r Monday, September 26, 2016
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WARNING: THIS IS NOT A SURVEY
.,_:.. Parcel Information
Parcel Number: J70000010304 Township: Fulton
NCPIN Number: 5777166271 Municipality:
Account Number: 67000000 Census Tract: 37059-804
Listed Owner 1: SMITH DONALD W Voting Precinct: FULTON
Mailing Address 1: 251 CEDAR GROVE CHURCH ROAD Planning Jurisdiction: Davie County
City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay:
Zip Code: 27028-7113 Voluntary Ag.District: No
Legal Description: 5.05 AC OFF HWY 801 Fire Response District: FORK
Assessed Acreage: 5.10 Elementary School Zone: CORNATZER `
Deed Date: 7/1981 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 001140365 Soil Types: PaD,PcB2,PcC2
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 30970.00 Outbuilding&Extra 5800.00
Freatures Value:
Land Value: 29650.00 Total Market Value: 66420.00
Total Assessed Value: 66420.00
161
Alldataisprovided 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 orfitness 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 all claims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
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DAVIE COUNTY HEALTH DEPARTMENT 16o.ooJ
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems " Permit Number
Name � 1 'cDate I s J N2 7 12 3
Location - �,_ , :•r. �,� VC11
Subdivision Name Lot No. Sec. or Block No.
Lot Size ` House Mobile Home — Business _ Industry
No. Bedro-Qms No. Baths e-a No. in Family _ Public Assembly Other
GarbaO Disposal YES ❑ NO El", Specifications for. System:
Auto Dish Washer YES E] NO 0 0 0 C..) . ak
Auto Wash Ma:hive YES, 13' NO ❑
Type Water Supply
'This permit-Void if sewage system described below is not installed within 5 years from,date of issue.
This permit is subject to revocation if site plans or the intended use change.
B l
Improvements permit by 7
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
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f
Certificate of Completion `'+ Date 14 7:?z
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
• APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
-- Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
1. Application/Permit Requested By '
��7
����s �.�oJ G(� �_ Home Phone
Mailing Address �1 // �/�/
Business Phone�/�7 �/7"
2. Name on Permit if Different than Above CU 1 f-- S M
3. Application for: ❑General Evaluation ❑Septic Tank Installation Permit
4. System to Serve: ❑ House obile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home:Subdivision Section Lot #
❑ Basement/Plumbing
No.of People �2 ❑ Basement/No Plumbing
No. of Bedrooms ` , ❑ Washing Machine
No.of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No.of Lavatories No. of Water Coolers
No.of Showers Water Usage Figures
7. Type of water supply: ❑ Public Private ❑ Community
8. Property Dimensions Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No
If yes,what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property: S e V E 1�` ��S GS—� d (Q q ee o-r
C -
,,� "I/e- 0/, C-
0
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this ap lication.
DATE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: J 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner:
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 by
to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment
and disposal system.
DATE SIGNATURE
DCHD(1/93)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Q Soil/Site Evaluation q q
NAME �? + �-�-� tc� DATE EVALUATED
ADDRESS PROPERTY SIZE ? \
PROPOSED FACIILTY �' LOCATION OF SITi��_Sl a \\l
Water Supply: On-Site Well Community Public
Evaluation By:t'%L Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Slope
HORIZON I DEPTH
Texture group <I--ICl C L-
Consistence � -
Structure Q__ RL C_� J
Mineralogy \
HORIZON II DEPTH 516 7o
Texture groupC
Consistence
Structure C K
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON _ — --
SAPROLITE
CLASSIFICATION ,S
LONG-TERM ACCEPTANCE RATE y V
SITE CLASSIFICATION: EVALUATED BY:
LONG-TERM CC�� NCE RATE:
1"l, OTHER(_ S) PR SENT: b__
REMARKS:
LtGEND
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(01-901
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