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106 Falling Creek Drive Lot 33Davie County, NC Tax Parcel Report Wednesday, December 21. 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: 91 H908OA0033 Township: Shady Grove NCPIN Number: 5789624533 Municipality: Account Number: 72718000 Census Tract: 37059-804 Listed Owner 1: TAYLOR JOHN R JR Voting Precinct: EAST SHADY GROVE Mailing Address 1: 106 FALLINGCREEK DRIVE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: LOT 33 FALLINGCREEK FARM PHASE I Fin: Response District: ADVANCE Assessed Acreage: 0.84 Elementary School Zone: SHADY GROVE Deed Date: 6/2014 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 009600750 Soil Types: Pc132 Plat Book: 0007 Flood Zone: Plat Page: 049 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: All data is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Davie County, Implied wanantlas of merchantability or fitness for a particular use. All users of Davie Countys GIS website shall hold harmless the �T County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to l� C or arising out of the use or Inability to use the GIS data provided by this website. HEALTH DEPARTMENT RELEASE For Office Use'Only ''CDP:File (dumber 197350-1 Davie County Health Department - 210 Hospital Street County ID Number: P.O. Box 848 Evaluated For HDR/WWC Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID 1 0/ 0 1/ a 0 a 0 t I NT11 Applicant: Justin Decker Address: 201 Prospect St City: Lexington State0p: NC Phone #: (336) 309-0565 27292 'Property Owner: John and Tamra Taylor Address: 106 Fallingcreek Dr City: Advance State2ip: NC 27006 `Phone #: Property Location & Site Information t1-- ddress106 Falling Creek Drive Subdivision: Failing Creek Phase: Lot: 33 Road# Advance NC 27006 SINGLE FAMILY Township: 'Structure: Dimcdons # of Bedrooms: d # of People: Hwy 64 East left on Hwy 801 got to Peoples Creek Rd. right Failing Creek on left 'Water Supply: PUBLIC Type of Business: Basement: F] Yes ❑ No Total sq. Footage: No. Of Employees: "Proposed Improvement: Detached Garage Maintain a 5 foot setback to nay portion of the septic system This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? 4Yes 4No Applicant)Legai Reps. Signature: 'Date: / * 2140 - Nations, Robert + Issued By: Date of Issue: l 0 0 a x 0 1 5 Authorized State Agen _^ "Sitel"Plan/Drawing attached." ' )Hand Drawing QlmportDrawing, Drawing Type: HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release CDPFile Number: 197350-1 County File Number: Date: 1 0/ 0 a/ a 0 1 5 Olnch Scale: OBlock ":..ft. O N/A rage c or w_- t . j I •! t I` � { I I � _ ._.. rage c or Davie County Health Department Environmental Health SofIVED P.O. Box 848 210 Hospital Street Date: Cj-%lis' Courier #: 09-40-06 1 C111 1 Mocksville, NC 27028 Phone: (336) - 753 - 6780 Fax: (336) - 753-1680 ON-SITE WASTEWATE + ICATION (Check One) Replacement Reconnection Name: A'11 c Phone Number 73�- 3�t 'o��� s (Home) Mailing Address: 2-01 0(b5p cSAK 33 - 2qg - Z q q Y (Work) Email Address: Detailed Directions To Site: Property Address: 106 feAl 1:. e ©r V �c e— , . L, Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Lin le- S Type Of Facility: 6U S (2, Date System Installed (Month/Date/Year): Number Of Bedrooms:__�— Number Of People: Is The Facility Currently Vacant? Yes If Yes, For How Long?, Any Known Problems? Yes &-> If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: �2 h� 6-cl-rCL e- Number Of Bedrooms: — Number of People 5030 Pool Size: Garage Size: 11C0 Other: Requested By:� ,G�-t Date Requested: q 2� Zv i S For Environmental Health Office Use Only Approved Disapproved Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Check Money Order # Amount:$ &0,00 Date:. Paid By: l Received By; Account #: 1 Invoice t rQ 645 C3`I X15 P B11--GP21--- T�P to 92 35r _ j V 4533 i PB07_PG 49 33 PB06 PG183 1 ti _1 ` W+1 ., oU�� s Printed:Sep 21, 2015 All data is provided as is without warranty or guarantee of any kind either expressed or implied Including but not limited to the 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 or arising out of the use or inability to use the GIS data provided by this website. y 1 2607 ,,� =845 C S7 r , r n;32r 4 85'18 ` L'4cts, 4N f� 4533 1 GG I -J s 57 '. o r 272 '3 123 19 541 All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the implied tw % warranties of merchantability or fitness 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 or arising out of the use or Inability to use the GIS data provided by this website. pri nted: Sep 21+ 2015 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 D / (336)751-8760 / V% Account #: 990002625 Billed To: Jeff Hayes Contracting Reference Name: Proposed Facility: Residence ATC Number: 3377 Q� Tax PIN/EH #: 5789-62-4533 Subdivision Info: Falling Creek Lot # 33 Location/Address: Falling Creek Drive -27006 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 Tr tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT ON ON IS ALID FOR A PERIOD 9F FIVEYEARS. Environmental Health Specialist's Signature: Date:��n 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. CA 00 Septic System Installed By Environmental Health Specialist's Signature LO- DCHD 05/99 (Revised) . r DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section ~' P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002625 Billed To: Jeff Hayes Contracting Reference Name: Proposed Facility: Residence ATC Number: 3377 Tax PIN/EH #: 5789-62-4533 Subdivision Info: Falling Creek Lot # 33 Location/Address: Falling Creek Drive -27006 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 Tr tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT ON ON IS ALID FOR A PERIOD F FI YEARS. Environmental Health Specialist's Signature: Date: ��lin 606M I 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: If DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT • +.' Environmental Health Section P. O. Boz 848/210 Hospital Street t Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002625 Billed To: Jeff Hayes Contracting Reference Name: Proposed Facility: Residence ?04- 3 -1/ 7- 0'3 --c�l� G vim•.. % Tax PIN/EH #: 5789-62-4533 Subdivision Info: Falling Creek Lot # 33 Location/Address: Falling Creek Drive -27006 Property Size: see map ATC Number: 3377 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT 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 fiDosz#People #Bedrooms LA #Baths Z) Dishwasher: 113"' Garbage Disposal: 0 ", Washing Machine: E!r Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift ##Seeattss Industrial Waste: ❑ Lot Size .867 A�' 2'�Type Water Supply &Design Wastewater Flow (GPD) 4�✓ Site: New u Repair ❑ System Specifications: Tank SizeICDC�' GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. Other: ��,ST�i%i?fitO� I�Xs . � S 151 V 1.1��?- a(f 0 .C_ . ' Required Site Modifications/Conditions: 1P'y'--'TALL er') C-O'jTo-dQ �S�DPP aka F 16 OR= f� � 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.**** -t & R OX. VC; • 4 ISO; Environmental Health Sp st'ss Signature: vJ DCHD 05/99 (Revised) H00E a N _x �9 ri,,4' Date: D •� 99.1 1 26 00' 26.. 0'� CC�, 00 0.694 Ac.± co N 0.705 Ac. 10 0 -P� C 0.807 Ac.± r, -0' CD 0 Ln• C) LC) cy) 00 m > -` i\., 6 1 �rl r7l > MZ Orr 1 5' LA Ln EXISTINGEXISTINGEASE ENT /--'ro BE CLOS 0 08.52' —29 .......... Cr— 3C .......... ....... ............ ...... -Z -I <<, 7 afi 3— • � FE" �2 J DR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davle County Health Department Envlionmentel Health Seddon 1. Box 868/210 Hospital Street Mockaville, NC 27028 (336) 731-8760 * *IMpORUNT",.L;OTHIS�WAVION CANNOT BB PR=SSED UNLESS ALL THE REQUIRED 6N-IIDED. Refer to the IMRMATION BULLETIN for / instructions. 1. Name to be Billed V �n� JF A40 Y i2omrmC7—IN ' contact v rsony e- F Ajak/ c Mailing Address PO 4� a) 3 g� nos» Phone City/state/LIP a L..,Zn M ONJ. -, N C- Z% 0 / Z Rosins., Phone 3 9 04 01r 2. Nage on Permit/ATC it Different than Above Mailing Address City/State/Lip 3. Application For: ❑ Site Evaluation 0 Improvement Permit/ATC Both t. system to servioes House 0 Mobile Home ❑ Business ❑ Industry ❑ Other 3. If Residence: # People Bedrooms T # Bathrooms 3 P'Dishwasher (1► C Ztb Disposal F(washing Machine O Basement/Plumbing O Basement/No Plumbing C If Business/Industry/others specify type # commodes i showers M urinals i people f sinks Water Coolers Ir rOODSERVICE: g Seats ' Estimated hater Usage (gallons per day) 7. 'Type of water supply: County/City 0 Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes AO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTEU by the client with THIS APPLICATION. Property Dimensions: �0. F7)< 3-30, d-7;< iZy. q X WRITE DIRECTIONS (from MockrAlle) to PROPERTY: Tax office PIN: I! S� 8% 6 Z-�i�S3 3 /�wY /�8 T 8 0 I S -to- Property Property Address: Road Name T �' L4WlrekjaDrL. Av V(A�G4iex CA -k 9-1t> -7-'7A44 ".l City/Zip 4PV A N t- 5 iJ t- Z7) 0 ob Prr o P fT-y 44 GES- j sT td—, i If in a S.u�-bddivvision provide information, as follows: O/`� �lC:-NT �A�C-��"�I�-dd��r .►�,s' Name: "�A�1►�Cr^�' et�l� -� r—✓>� S Section: is R Block: 0 Lot: -3-3 Date Property Flagged: Z �/y� 03 This 6 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 pians or Intended use change, or if the Information submitted in this application Is falsified or changed 1, 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 MET' -i//L--W to conduct all testing procedures as necessary to determine the site suitability. DATE /� �v 3 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SPIE P ( c ode all oft a following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge D Date(s): Revised DCHD (07/99) Client Notification Date: EAS: Account No. 0-'), S Invoice No. b1ar,;lanC , Bailey's \ / \ Chapel Rd Parcel 40.01 \ William S. Crews \ DB 163, Pg 777 I NOTES: N80'24;00 �� ( \ 98.12' EXISTING 2. TOTAL L 0 T:F3Wk73. TOTAL L074. \TOTAL ACF N78° 3' „�5. AVE 00 W RAGE 1/ 9.30' � ���� � ' / DOE NOT ! Parcel 40 6. WATE, S U P John Alby� P De 76, Pg 371 i \WATER DEP N84�17'15"W 7• EACH L °J \ � T � 7a S TIC a 82.51 ' ; YS °' /o �A j ° S01 °17'35"W' 8• > L ING �E � S01 19 Ob W ---- 368.22`7 _ 1'51.60' / R—A ZONI� �3f 126.00',/ 126.00' 125.61' 124.90' WZOO SORVE. 1� WW(o � >wQo V) �N U N .CO,' W 1 0_ w JO cD • °0/ I N � 3 o L ZW WQ \ 9Ol O 32 W C� r O G �cY00 ;,4c 0;ich Calc, O �� Q�� y0J JN 33 1 o O N`�l 'See r�.,,�.a c iT' o_ ' O Z OQ ARC \ N � O v J `"'x'126.00' A. _ Chpc \ -I SS APPLICATION FOR SITE EVAtUATiON/IMPRWEMFM PERMIT & `Q Davie County Health Department Environmental Health SL -Won ,. P.O. Box 848/210 Hospital Street Mockoville, NC 27028 (336) 751-8760 _F JUL 20 1999 ENUlltill!i.11:r!'!, IIAUIE i;0lfl!!1 j ***rWCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the iNrORMATION BULLETIN for instructions. 1. Name to be Billed Wi SZNAE-3 bC1JEL40)"`E JV CLN1()A.1J/ Contact person Nailing Address 2 b 11 PW NM -04 + ZAV am* phone X 3 6 City/state/EIV WWSieN� Ci��C's"1 � )JC_ 21w Business phone 3 3E ' 17.7 2. Name on Permit/ATC it Different then Above Nailing Address City/state/sip 3. Application For: Site Evaluation 0 Improvement Permit/ATC ❑ Both 4. systen to 6ervioes E House 0 Mobile Home 0 Business ❑ Industry ❑ Other 5. If Residence: i People i Bedrooms -5-- ' 4 Bathrooms E(Dishwasher d Garbage Disposal O(Washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Isutustry/others specify type i Commodes # shovers Urinals # people f Sinks / Water Coolers Ir 100DSERVICE: # Seats Estimated Nater Usage 6gallons per day) 7. Type of Water supply: ® County/City 0 Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes CINo If yes. what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUES":'E') BELOW. Either a PLAT or SITE PLAN MUST BESUBSU 7TED by the client with THIS APPLICATION. ,pw-w Property Dimensions: -N:444 ',J 2-,(ALu,u cnifK (0-4cu'Eo) WRITE DIRECTIONS (from MockrAlle) to PROPERTY: A00 Lc Tax OMeePIN: # 5'7&`x-44•,z4?L J-19771-"-46��wy' 6-1t SI ,LEf� a►.! �ej(I It Property Address: Road Name `/uAwzp 4t Dim 0.1i RIIFLJ�j Ci -.W -C4, city/zip AovA-t,.,t/c 27-c;; If In a Subdivision provide information, as foil Name: FALU 4-Rtf- 7q G Lh I & PN►�c,�n L) �1 - Sectiov: Block: A U Lot: Date Property Flagged: 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 ibis application is falsified or changed 1, 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 to conduct all testing procedures as necessary to determine the site suitability. DATE '7 bq I0,9 SIGNATURE %� t THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the f awing: Existing and groposed property lines and dimensions, structures, setbacks, and septic locations). 0/a/ S -le— � �bllI- /1 5 �/-a--- Ile --C/ Site Revisit Charge J Date(s)• _ I Client Notification Date: I EHS• Account No. -y� Revised DCHD (07/99) invoice No.Ile) 7 Morhland Crews' 6Q0 Bailey's \ / Chapel Rd L( / Parcel 40.01 r William S. Crews � � NOTES: � DB 163, Pg 777 \� �, / � � N80°24;00"w� EXISTING 98.12' �/ / 2. TOTAL LOT; S��NNd?d / 3. TOTAL LOT 4. `O U \TTAL ACR A5. AVERAGE N78°53'00"W 7/19-3 0' \\ / DO NOT 6 • WA TE� S U P aZ�bQ / Parcel 40 DB 76John IPg 371 < / \WATE� DEP�N,�o� N84°17'15"W \\ 7. EACH L T �� 7a° S TIC YS bbd 92.51 S01 °1735" �I 8. L ING. SE a S01'19'O W 368 �- 151.60' _ / R --A ZONII1 ,26.00' 126.00' 125.81' 124.90' S L `R VE �o V) L) V) 1 a'w ON c° ^ • 00/ N c��irm 90 o v V Lj V) M (O O G� Qy 47! v Off' I O30 3 32 I W! W o G� �C►Q,ao� O a N ; a dc Di}ch Calc, ►� int 100 O Q 1 33 .SCC flIAiAo! CC.�, AR \ I C z ARC A N heck 1I t 7 126.00' 2 °` r)h I-1 + 100.00' --mm" - ARC a ,v 121.23• N R — ?S3 �• 99. �00, Fez\ @p4m5 Check ICS I .Stone wtlet srr?ucTURE IS'Lx 8'wx I --r / CLA55 .0 STaIIE 1 ��J N54°11'15"W ^ 49.09' T¢mp. s -time Const. N57°13'45"W 99.99' DAVI'E COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5787-62-4533.33 Subdivision Info: Falling Creek Sec.1 Lot # 33 Location/Address: Falling Creek Drive -27006 See Map Date Evaluated: Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: 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) 1. 2. ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE ALL THE REQUIRED INFORMATION IS PROVIDED. - Name to be Billed W .es� U /e tc> �ey2�o�x awl`. Contact Person G t- 1q Mailing Address --f-2-2 tS S.ctVA S- 4� AGrd uJ Home Phone ??r-64/'02 City/State/Zip U; ws i o d Si44 AIL", r271,93 Business Phone 9 99'-116- % 99�=a iaO Name on Permit/ATC if Different than Above Soo rrm.e-- Mailing Address City/State/Zip 3. Application For: 4. System to Serve: O' Site Evaluation ❑ Improvement Permit & ATC O House ❑ Mobile Home ❑ Business ❑ Industry 5. If Residence: # People # Bedrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing 6. If'3usiness/Other: Specify type # People _ #. Commodes # Showers # Urinals Both ❑ Other # Bathrooms ❑ Basement/No Plumbing _ # Sinks # Water Coolers. i . ;4€ If :Foodservice: # Seats Estimated Water Usage (gallons per day) 7. 1` -pe of water supply: ❑ County/City ❑ Well ❑ Community A. 8. Lo you anticipate additions or expansions of the facility this system is intended to serve? O Yes O No `z IIf yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST: BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: q9, � 74 1t Ne -S 1 Tax Office PIN: # 5 7 9i- G 3 -S703 Property Address: Road Name 5L2�- • 1 /r 1 City/Zip Ajyan/'-!� NG' 1 1 If in Subdivisionp�de orm`�t�rn, as follows: M 'N; me: //Qh//11 L f Cts/(" 1 Section: �� Lot #• J ' 1 WRITE DIRECTIONS (from Mocksville) TO PROPERTY: . This ,:; to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter , are sul: ject 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 D Ae County and owned by daz to conduct all testing prc,cedures as necessary to determine the site suitability. DATE g-fo-cl2 SIGNATURE Revised DCHD (06-96) C iad �� �r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department. D Environmental Health Section P O. Box 848 AUG - 6 1997 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE ALL THE REQUIRED INFORMATION IS PROVIDED. - Name to be Billed W .es� U /e tc> �ey2�o�x awl`. Contact Person G t- 1q Mailing Address --f-2-2 tS S.ctVA S- 4� AGrd uJ Home Phone ??r-64/'02 City/State/Zip U; ws i o d Si44 AIL", r271,93 Business Phone 9 99'-116- % 99�=a iaO Name on Permit/ATC if Different than Above Soo rrm.e-- Mailing Address City/State/Zip 3. Application For: 4. System to Serve: O' Site Evaluation ❑ Improvement Permit & ATC O House ❑ Mobile Home ❑ Business ❑ Industry 5. If Residence: # People # Bedrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing 6. If'3usiness/Other: Specify type # People _ #. Commodes # Showers # Urinals Both ❑ Other # Bathrooms ❑ Basement/No Plumbing _ # Sinks # Water Coolers. i . ;4€ If :Foodservice: # Seats Estimated Water Usage (gallons per day) 7. 1` -pe of water supply: ❑ County/City ❑ Well ❑ Community A. 8. Lo you anticipate additions or expansions of the facility this system is intended to serve? O Yes O No `z IIf yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST: BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: q9, � 74 1t Ne -S 1 Tax Office PIN: # 5 7 9i- G 3 -S703 Property Address: Road Name 5L2�- • 1 /r 1 City/Zip Ajyan/'-!� NG' 1 1 If in Subdivisionp�de orm`�t�rn, as follows: M 'N; me: //Qh//11 L f Cts/(" 1 Section: �� Lot #• J ' 1 WRITE DIRECTIONS (from Mocksville) TO PROPERTY: . This ,:; to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter , are sul: ject 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 D Ae County and owned by daz to conduct all testing prc,cedures as necessary to determine the site suitability. DATE g-fo-cl2 SIGNATURE Revised DCHD (06-96) C iad �� ` 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME G�C%3`/�i�GG� DATE EVALUATED" 4;�1�1'v 2 PROPOSED FACILITY PROPERTY SIZE <;ryAC SUBDIVISION ROAD NAME Water Supply Evaluation By: On -Site Well Auger Boring Community Public Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH ' Texture group Consistence Structure Mineralogy HORIZON II DEPTHp�- Texture group Consistence Structure Mineralogy 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 SITE CLASSIFICATION: tl)<� LONG-TERM ACCEPTANCE RATE: r K REMARKS: LEGEND DCHD (01-90) Landscape Position EVALUATION BY: 2 � OTHER(S) PRESENT: 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