197 Cedar Ridge Road Lot 3 Box PropertyDavie County, NC Tax Parcel Report Tuesday, January 24, 2017
WARNING: THIS 1S NOT A SURVEY
Parcel Information
Parcel Number:
J6060A0009
Township:
Fulton
NCPIN Number:
5757799833
Municipality:
Freatures Value:
Account Number:
82526597
Census Tract:
37059-804
Listed Owner 1:
GREEMANN KENNETH R
Voting Precinct:
FULTON
Mailing Address 1:
197 CEDAR RIDGE ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
2.795 AC CEDAR RIDGE RD
Fire Response District:
FORK
Assessed Acreage:
2.79
Elementary School Zone:
CORNATZER
Deed Date:
6/2006
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
006670594
Soil Types: GnB2,EnB,ChA,MsD
Plat Book:
Flood Zone:
Plat Page:
Watershed Overlay: DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
All data is provided as is without warranty or guarantee of any ldnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS webslte shalt 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
F-O7
NCor arising out of the use or Inability to use the GIS data provided by this website.
Directions to property: yr
Section: J Lot: 62
AUTHORIZATION FOR f
WASTEWATER Tax Office PIN:#�
SYSTEM CONSTRUCTION
Road Name: a:6�' g�1/—)=Zip d
**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
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
AUTHORi,ATION
r�10: 0 8 9 5
DAVIE COUNTY HEALTH DEPARTMENT
•
Environmental Health Section
PROPERTY INFORMATION
Permittees ('��
—"'
P.O. Box 848j.
Name:
Mocksville, NC 27028 Subdivision
Name:
Phone #: 704-634-8760
Directions to property: yr
Section: J Lot: 62
AUTHORIZATION FOR f
WASTEWATER Tax Office PIN:#�
SYSTEM CONSTRUCTION
Road Name: a:6�' g�1/—)=Zip d
**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
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
it W �'. i : • , np
F y k DAVIE COM-Ty TY LTH DEPARTMENT
IMPROVEMENT AND OPERATION_ PERMITS -PROPERTY INFORMATION
Subdivision Na
•
D ti s to property: 1" �� , ^ ' ' 4 "'Section: Lot:
h.fflmQVEM ENTn
F. i�.,t... �""�.�; �t} ^J �' hPERM1T .Tax Office PIN•# -
-
Road Name: 1t.Zip:
. - y
**NOTE**This Improvement Permit DOESNOT authorize the construcon or installation off a septic tank system or any wastewater system. An-.
•AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION mu be obtainefrom this Department prior to the
' constiuction/installation of a .s stem or the issuance of a bu�ldin permit,
Y gpe i..
(Incompliance with Article 11 of G.S: Chapter 130A, Wastewater Systems,-Section1900 Sewage Treatment.and Disposal Systems)
L
^, ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION•IF SITE
PLANSOR THE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM' CONTRACTOR MUST SEE THIS PERMIT BEFORE '
ENVIRONMENTAL HEALTH SP �CIAI:,IST •: DATE'ISSUED � h -
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS " . # OCCUPANTS GARBAGE DISPOSAL: Yes or No `
COMMERCIAL SPECIFICATION` FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No .
LOT SIZEL2 ; -TYPE WATER SUPPLY f DESIGN WASTEWATER FLOW (GPD)NEW SITE� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE_ /-;rx GAL, : PUMP TANK' GAL.: TRENCH WIDTH;,,Pg;r' ROCK DEPTH /ni LINEAR FT. IOG
OTHER
REQUIRED SITE MODIFICATIONS/CONDTTIONSs
•**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 TIS DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760.
r'�dt a6 qA/� ; S "/iii 7 , —11 �O ? %h qrs,
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
y ' ' Davie County Health Department n
lt ' Environmental Health Section D V
P.O. Box 848
Mocksville, NC 27028 APR 1
(704) 634-8760
►� M 1, J
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED 1
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed S i A g .X Contact Person
Mailing Address 14111 /4/7Home Phone q I fl '44
City/State/ZipW/ti b/ — N.,—,-, V%/w Business Phone
2. Name on Permit/ATC if Different than Above 4y14
Mailing Address kvA
L % City/State/Zip
IV
3. Application For � Site 4tl uation L4mprovement Permit & ATC [ ] Both
4. System to Serve: [✓)'Hous Mobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People # Bedrooms # Bathrooms. 3 [gishwasher [•TG'-arbage Disposal
[gashing Machine [Ll'gasement/Plumbing [ ] Basement/No Plumbing
6. If Business/Other: Specify type �%�q # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
If Foodservice. eats Estimated Water Usage (gallons per day)
7. Type of water supply: [ County/City [ ell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [0 -No
If yes, what type?
EITHER A PLAT OR SITE PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE
SUBMITTED WITH TIM APPLICATION.
Property Dimensions: WRITE DIRECTIONS (fromksville) TO PROPERTY:
C
Tax Office PIN: # S %%'
Property Address: Road Name DA r , .` t-'e'—E
City/Zip j( n c ,-►
If in Subdivision provide information, as follows:
Name:
Section: Lot #: '
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
by '7 �0 G76nC66 15 to d gyl to g pro dures as necessary to determine the site suitability.
DATE'' 9 7 SIGNATURE
Revised DCHD (06-96)
THIS AREA MAY $E USED FOR DRAWINCI YOUR SITE PLAN:
LA�� ,���o�� Go/r✓�
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, NC 27028
(704)634-8760
****IMPORTANT****
1. Nam to be Billed
fyC/j,q i�P,eOA /di�ti0
I I
THIS APPLICATION CANNO BE PROCESSED UNLESS ALL
THE REQUIRED INFORMA ON IS PROVIDED.
.:e4 -h le, ��O.J
ntact Person A-1
Home Phone 9/0 - 74(vD- Aa /6
a
Al 6.usiness Phone ,—:::�.4ZM e-
2.
2. Name on Permit/AT if Different than Above
Mailing Address
3. Application For: [(Site valuation [ ] Improvement Pc
4. System to Serve: [dHous [ ] Mobile Home [ ] Business [ ]
5. If Residence: # People # Bedrooms # Bathroo
[Washing Machine [� Base ent/Plumbing [ ] Basement/No/
6. If Business/Other: Specify type
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimat Water Usage (galloc
7. Type of water supply: [4ounty/City [ ]� ell [ ] Commu
8. Do you anticipate additions or expansions of t facility this s
If yes, what type?
PROPERTY INFORMATION REQUIR]
I i
Property Dimensions: dmt 62
Tax Office PIN: #' -5- ;7,:Jr, �
//,,
-11,,
Property Address: Road Name; i
City/Zip
If in Subdivision provide information, as follows:
Name: �_/
Section: i�!��1 Lot #:
& ATC VBoth
istry [ ] Other
C 11 [✓fDishwasher [/Garbage Disposal
#Sinks # Commodes
per day)
is intended to serve? [ ] Yes [vf No
EITHER A PLAT OR SITE PLAN
** IMPORTANT *** AJDW COF THE PROPERTY MUST BE
SUBMITTED WITH rS APPLICATION.
;WRITE DIRECTIONS (fromcksville) TO PROPERTY:
,Z f> /✓ _
5r .
This is to certify that the information provided is co ect to the best of my know tbhe
subject to suspension or revocation, if the site plans or intended use change, or if
changed. I, also, understand that I am responsible for all charges incurred from this
Representa 've of the Davie County Healtb De artmentt t nter upon above des
b ry ond_
conduct procedure
Y
DATE ,;7 'd�A'�% SIGNATUR
Revised DCHD (06-96)
THIS AREA MAY BE USED FOR DI J WING YOUR SITE PLAN:
or
I understand that any permit(s) issued hereafter are
ormation submitted in this application is falsified or
lication. I, hereby, give consent to the Authorized
De property located in Davie County and owned
s nec ssary to determine the site suitability.
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
3
Environmental Health Section0�
P. O. Box 665
V Mocksville, NC 27028
1. Application/Permit Requested By � c
/ r%J -�, �� - - -70,- - = �- V 1 �r f J , %- t t
Mailing Address %2 .� k
3 y /2 - I Home Phone
• + >
/J - S Business Phone
2. Name on Permit if Different than Above
3. Application for: ❑ General Evaluationoptic Tank Installation Permit
4. System to Serve: ase
❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry
❑ Other ❑ Unknown
5. If house, mobile home: Subdivision
Section Lot #^-V
Qosr; d le �' la s -
O Basement/Plumbing
No. of People
❑ Basement/No Plumbing
No. of Bedrooms 3
m. Wtrashing Machine
No. of Bathrooms 2
ishwasher
Dwelling Dimensions a �_ r s
_1 ❑�rbage 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: 6-15ublic
❑ Private ❑ Community
8. Property Dimensions s- /q I I 1 11
Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility
this sytem is intended to serve? C Yes ®-fro
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:
.tE- - , -F— ; -7-, , - )- , S ` �- p n
S /P
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 application.
Z % `/ 1--�14
DTE SIGNATURE
CONSENT FOR SITE EVALUATION TQ BE DONE QN ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: fit�" 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
Dcr+D tiros)
SIGNATURE
V DAVIE COUNTY HEALTH DEPARTMENT } o -
Environmental Health Section 1�
Soil/Site Evaluation
NAME � DATE EVALUATED s�-� Z-57
ADDRESS
PROPOSED FACIILTY
PROPERTY SIZE
LOCATION OF SITE
Water Supply: On -Site Well Community Public z--
Evaluation
/Evaluation By: Auger Boring Pit Cut
FACTORS
1
2
3 4
Landscape position
-�
Slope %
-
-
HORIZON I DEPTH
`>"
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH/�'
�" -may
Texture group
Consistence
Structure
Alv
MineralogyP
.
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATIONS
[-=
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: G/_ EVALUATED BY: 'A/x
LONG-TERM ACCEPTANCE RA �E: OTHER(S) PRESENT:
REMARKS: Z T V -
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
3C -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
MEN M.■:C:::::::_::::
.....................
.....................
.....................
.....................
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
Mailing Address 1164- 1 61, y Home Phone 3 /
0 fl) - S 22 O Z K Business Phone
2. Name on Permit if Different than Above
3. Application for: ❑ General Evaluation eptic Tank Installation Permit
4. System to Serve: Oilouse ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
Qosr; 6 !e la s
❑ Basement/Plumbing
No. of People
N
No. of Bedrooms
1z
No. of Bathrooms
Dwelling Dimensions
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Showers
No. of Sinks
No. of Urinals
No. of Water Coolers
Water Usage Figures
7. Type of water supply: Eq-<blic ❑ Private
8. Property Dimensions .s— Iq c - t 5 Sewage Disposal Contractor
❑ Basement/No Plumbing
M. -Washing Machine
ishwasher
garbage Disposal
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes &<O
If yes, what type?
❑ Community
*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:
C� y
+-; `---- _1 `)- - s 4- 0
a e S i ..., t :, — L 2 �-- *i
(_ D o
4 -
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 application.
2 Z 9
v
DTE SIGNATURE
CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: I 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
If
disposal system.
DATE SIGNATURE
DCHD (193)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section lam'
Soil/Site Evaluation
NAMEA10, DATE EVALUATED
ADDRESS PROPERTY SIZE 45SX.335
PROPOSED FACIILTY / ���S�O LOCATION OF SITE'/i�/�
Water Supply: On -Site Well Community Publicy
Evaluation By: Auger Boring f Pit Cut
FACTORS
1
2
3
4
Landscape positionSlope
%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
'!''
Texture group
C
Consistence
77177—
7
Structure
14 /(
Mineralogy,
-
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
(l
VS
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS: l�ry,�1 'e, �iC �o '�� �o G,Ci 7�
`a r
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
3C -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
Davie County AealtFr 'Vepartment
and .dome NealtFi gyency
210 HOSPITAL STREET/ P.O. BOX 665
MOCKSVILLE, N.C. 27028
PHONE: (704) 634.5985
March 18, 1994
Shelton Congtruction Svcs.
;fit. 1, Box 34A-1
'11 NC 2708
MOCK sVl t:
Re: 4 Site Evaluations
Adjoining Hickory Hill I/!ots 1-4
Filed Hickory Hill I Addition
Dear Mr. Shelton:
On March 15, 1994,
this office evaluated 4 lots adjoining Hickory Hill I. f=
The first two lots
on the left side of the gravel road are provisioryally
suitable for one septic
tank system on `,each lot. {
The third and fourth
lots are unsuitable; however, if combined into one is
lot, the classification
may change to --provisionally suitable.
If you have questions,•feel
free to call.
Sincerely,
i
Robert B. Hall, Jr., R. S.
Environmental Health Section f
RH/wd
r
e
Enclosure
cc: Jesse Boyce, Zoning
Officer
•
J•
s
F;
F
F.
F'
e,
i=
t
1 1�
� �+rt
I _
' I I 2 I,
I a
Total 600 60'occess' case. N •730-58-`JO„�—~ ' � ` R `
r 7 :CEDAR..-RIDGE . _
121 o
i 327 48104 _ ,
_— e. (0 I
r r? M L
O N 0
(o I
co I44
i0 !rg r O co
t- n
r
z i = -3 1.2 57 -3 -�
i r 8 AC S q- M 1.007 o I
2.7 Mo Mme;
AC. U_ :F
AC . w
o o (D 01 _ i in -
—D o
0_jJ
— CE) J 2
r r- (0T F-
01
-O1 (p c - N
3 ; of I
1 u
i r 357.43, 1 152' 121 Y
r S 740 - 5.7s- 50.'W Total 630.43 tr-
r
' S I
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002566
Billed To: David Lee
Reference Name: Richard Hendricks
Proposed Facility: Residence
ATC Number: 3375
Tax PIN/EH #: 5757-79-9833
Subdivision Info: Hickory Hill Lot # 9
Location/Address: Cedar Ridge Rd -27028
Property Size: see map
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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: c:21J91es
q -
CERTIFICATE OF COMPLETION
**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)
Date:
APPLICANT INFORMATION
Account #: 990002566
Billed To: David Lee
Reference Name:
Proposed Facility: Residence
Water Supply: On -Site Well
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 5757-79-9833
Subdivision Info: Hickory Hill Lot # 9
Location/Address: Cedar Ridge Rd -27028
Property Size: see map Date Evaluated: /—V '(Z3
Community
Evaluation By: Auger Boring Pit
Public I/
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L L
Sloe %
L
HORIZON I DEPTH
ov�'
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
<
Texture group
Consistence
"I
Structure
Mineralogyi
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
a
SITE CLASSIFICATION:
EVALUATION BY: / O G/
C�
LONG-TERM ACCEPTANCE RATE: ) OTHER(S) PRESENT:
REMARKS: _ S�j
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 05/99 (Revised)
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January 8, 2003
David E. Lee
P.O. Box 3066
Kingsport, TN 37664
Re: Site Evaluation/ Cedar Ridge Road
Tax Office Pin : #5757-79-9833
Dear Client(s):
As requested, a representative from this office visited the aforementioned site on
January8, 2003. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
provisionally suitable for the installation of an on-site sewage system.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
xoea& 6_:;VO4Q'1A- -
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/df