126 West Rolling Meadow Road Lot 11Davie Countv. NC
Tax Parcel Renort Wednesday December 21- 2016
WARNING: `1'IUS 1S NOT A SURVEY
Parcel Information
Parcel Number:
H9080A0011
Township:
Shady Grove
NCPIN Number:
5789539306
Municipality:
Account Number:
82517151
Census Tract:
37059-804
Listed Owner 1:
STIMSON GARY M
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
118 WEST ROLLINGMEADOW ROAD
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 11 FALLINGCREEK FARM PHASE I
Fire Response District:
ADVANCE
Assessed Acreage:
0.68
Elementary School Zone: SHADY GROVE
Deed Date:
10/2002
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
004430967
Soil Types:
PcC2,WATER
Plat Book:
0007
Flood Zone:
Plat Page:
048
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Building Value:
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
161
1�T 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 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
l� C or arising out of the use or inability to use the GIS data provided by this websIte.
Davie County Wealth Department
Environmental Wealth Section
Po sox 848 / 210 Hospital street
Mocksville, NC 27028
Phone: (336)751-8760
July 6, 1999
David M. Hanes Contracting, Inc.
Attn: David Hanes
301 Hanes Trail
Advance, NC 27006
Re: Falling Creek Farm -
Section H/Block 9 -Lot #11
Tax PIN: 5789-53-9306
Dear Mr. Hanes:
As requested, a representative from this office visited the aforementioned site(s) on
June 29, 1999. The purpose of this evaluation was to determine the soil/site suitability for
the installation of an on-site sewage system Based on the information provided on the
Application for Site Evaluation and after the evaluation was completed, this tract was
found to be unsuitable for the installation of an on-site sewage system for the following
reason(s):
Rule .1940(d) — Topography/Landscape Position;
Rule .1945 — Available Space.
Due to the limitation(s) on these sites, this office is not aware of modifications or
alternative measures that can be implemented at the present time to upgrade the
classification from "unsuitable" to "provisionally suitable." Your application for
Improvement Permits must, therefore, be denied.
You have the right to an informal review of this decision by the Environmental
Health Director of this office and also by the regional staff of the Department of
Environment and Natural Resources. You should contact this office to arrange for this
further review.
You may also wish to obtain the services of a private consultant to collect site-
specific data and submit such data and a system design to this office for technical review.
A site may be reclassified to provisionally suitable provided written documentation,
including engineering, hydrogeologic, geologic or soil studies indicates to this office that a
proposed on-site sewage system or a proposed alternative system can reasonably be
expected to function satisfactorily. The substantiating data from these studies must
indicate that:
A) The effluent(wastewater) will receive adequate treatment;
13) The effluent(wastewater) will not contaminate any ground water or surface
water; and
C) The effluent(wastewater) will not be exposed on the ground surface or be
discharged to surface waters where it could come into contact with people,
animals or vectors.
Finally, you have the right to a formal appeal of this decision if you file a petition
for a contested case hearing with the Office of Administrative Hearings, PO Drawer
27447, Raleigh, NC 27611-7447. A copy of a petition form can be provided to you on
request. The petition must be received by the Offipe of Administrative Hearings within
thirty(30) days of the date of this notice. The hearing may be held in Davie County.
If you file a petition for a hearing, you must send a copy of the petition to Mr.
Richard Whisnant, J)ENR, Office if General Counsel, PO Box 27687, Raleigh, NC 27611-
7687.
If you have any questions, feel free to contact this office at (336)751-8760.
Sincerely,
Jeff G. Beauchamp, R.S.
Environmental Health Section
enc(s)
APPLICATION FOR SrrE EvAmATiowiMPROvmw PERMIT &
Davie County Health Department
CCeI� �lwlEnvironmentafi
/Heal Seddon
P.O. Box 848/210 Hospital Street
�Ei✓t�".�9 Mocksville, NC 27028
-r6 (336) 751-8760
1.
2
D L9c5t9uvLig
.0 2 4 ImL.D
***1HPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
Name to be Billed �Aylea tYl. Ar.Zt .rA,,e,4)24
Mailing Address
city/state/z=p\ ps O Uo-hL h 1. C. -7-220C.
Name on Permit/ATC\if Different than Above
Mailing Address
3. Application For: ^ite Evaluation
4. system to service: D House ❑ Mobile Home
5. If Residence:
dishwasher
# People
J
Contact Person
Some Phone
Business Phone
3
C
Ci to/Sip
LQ�Xrovement Permit/ATC ❑ Both
❑ Business ❑ Industry ❑ Other
t Bedrooms 3 # Bathrooms
J�KG&Xbage Disposal Dashing Machine ❑ Basement/Plumbing aasemsnt/No Plumbing
6. If Business/Industry/other: Specify type
# Commodes i Showers
f Urinals
6 People # Sinks
t Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of Water supply: 36ounty/City ❑ Well ❑ Community
9. Do you anticipa4e additions or expansions of the facility this system is intended to serve? ❑ Yes [ -
N -0 -
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: % d x 1(2 �' G 92�WRITE DIRECTIONS (from Mochsville) to PROPERTY:
Tax Office PIN: # J.�— / �e i.,ci kO "1 +a Pohle t
Property Address: Road Name&� l �li'Vti e off A 0-J Cr e-rk 1301-1 To r Pa
City/Zip n VLH ce, -J• L. a?ooc-
If in a Subdivision provide information, as follows: n e4j o 'J
Name:�u��c.re2/+_
Section: �t Block: i Lot: I I Date Property Flagged: 6 12 � l91
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
to conduct all testing procedures as necessary to determine the site suV*bktty. A
DATE—1 I ,L' A-11 SIGNATURE ,ILS L�,- 4- \ - '
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
T evised DCHD (07/99)
Site Revisit Charge
Date(s):
I Client Notification Date:
I EHS:
Account No.
Invoice No. ND .-4-5'1y`
AVATM CAROLINA DSPARTNSNT OP TRANSPORTATION PLAMW DSPART1rSA7/MY/S► OPP/CSR SUAYS"AS CZATI1/ MON L- .fir. �Wrnr.r r•rpn w.r..lyL.rwyy r w. DAPI! COUNTY AWISfSR OP DSSAT
DIVISION OP NXNrATS PINAL SUSDNISION PLT APPAOYAI, LJ r R. W — Mr ... r... rr,. .L • '(���'' rr r y • •+.gii.i ..r• • •mwwa y rr ra r r, •„• /6Af RIC/ST14flON_
�.r� �r i.r .r •'^+ r r.... wywwr• .�. rr.M a •�•wrw W r w•rr W /u•r• y rr'
rr..r r•r� w�irrr �'•�� •• � �^• 1W 4 � A Yr Y W 4 err• a wV
lR01M0 MMIwlM !41 AI�/M.TNYr �•� �� ..p.• Iy�� �y Mw�+�� - ^. _ `� . . ..N
ATIMAUIr iRA1ACIrwN 1.r r.y W M. w�i i Ir4r+ •. rww� W L �M•�M r w•�..^� - �. �I r+4 A4 w�y,wr •L]Ct�1�tL •�Jtrr
r pkyr,Waazr � ...wr".r�w.. �/ r+. rr• N w,.�Ycyarvlvr•n+ a awr..w u. _ fir r y • w..r V w rrWwryr/r4w�� +r++. rr`�. y r,a ff -'
•!/II•I . r r .�Mrr• r Y�•+ rY �I •L6IC! L0.r~1w ar•w t Art rY ►rr.r� •7 •.fry r w wrwrWrw y •wMW
~ • +�r 'ii.�M..rrr+ .""'rir w r�Y �• r r rP+.r. •1 • www�wa Rr 7
•wr•r r wM W r .. •..r. r r.r •
.rP.r _ rrwarr• r r• an v ar P./rrr rw• r r �.•rw .•r•r a Jl. �...
f Aaeumr1! wit1•w ra V �LirHr.s � � r� —L
I /'�� r �� !ra• lw wlt �iy�
ArAf IWYIT IwLI NIwYIY -!I•ff OepAr CRAM -POAWM OIIYJT W.r �(e� - �� I r • ',I
tri. b•.s : �.�� � �.�.."r '
w. urr•A' c �,.• v �
►•sue •z: ��
C, ' ,p
tq•7t H SITE
MwfrMh�• f{Iw4yT (rMAMV
0
\\�QF
L.—
��Gir, --- — � �' FALLINGCREEK DRIVE--Am�o'ost �-�_ �� r ':-•r M �?��
seat — o —. �..< .T�e,�— 505M
0 703 Ac
235 C", u
V 12
0 713 he !
. d
100 350 c�
' r
t
pot 11• . ,
" ' A
10
06#2 Al'A"J
dW
r 1S1 11'
'r N NO 3'31.35*1
010
J 6e0 Ac
as$ 42• tolAt
—el
/ti
(op
F.4cuN�c e c F•a AtM
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
• Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900641 Tax PIN/EH #: 5789-53-9306
Billed To: David M. Hanes Contracting Inc. Subdivision Info: Fallling Creek Farm H/9 Lot # 11
Reference Name: David Hanes Location/Address: Rolling Meadow Ro d- 006
Proposed Facility: Residence Property Size: 15 (X9 0 Date Evaluated: S
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1 2 .3 4 5 6 7
Landscape position
Slope %
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 1A'CCEPTANCE RATE:
REMARKS: _ITIS `rR ISS�t,
Landscaue Positio
EVALUATION BY:
OTHER(S) PRESENT:
Die P'�T 'Paw--, I -
LEGEND
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
Mois
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
ICHD (Revised 05/99)
■■■■■■■■■■■■■■■■■■■■■■■■
■/NOON■■/■■■/■■/■/NOON■■
■M■MMM■MM■■■MM■■■ ■ENE■
■/■■■/■/NOON/■■/■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
NONE
■■N■
■E■■
MONO
NONE
MONO
MEMO
■■N■
NONE
■M■■
OMEN
■■■
■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
IMEMEME MEMEMM MEMNON� ' MOMMEN0
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■
■
■
■
■
■
■
■NEEM■■■
■■■E■■■■
■■■■■■E■
■E■■E■E■
■■■■■■■/■■■
■■■■■E■■■■■
■■■■■■■■■■■
■■■■■■■■■■■
■■■■■■■■■■■
■■■y■■■■■■
■E■■■■■■/■■■■■■■
■■■■■■■■■■■■■■■■
■■■■■N■■■N■■■■N■
■■■■■■■■■■■■■■■■
■■■■■■ ■■■■■■
■■■■■N�MEMNON
■■■■■■■■■■■■■■■■
■■■■■■■■U■■■■■■■
■■■■■■■■M■■■■M■■
■M■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■U■■■■
■■■■■■■■■■■■M■■■■
■
■■■MEMO■■■■
■■■■■■■■■■■
■■■■M■■■■■■
■■■■■■■■■■■
■■■■■■■■■■■
■■■■■■MENU■
■O■■M■■■■■■
■■
i
■
i
' - .4 • APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT 'I)IQ? n :
- Davie County Health Department EF Environmental Health Section
P O. Box 848 G — 6 1997 ,
Mocksville, NC 27028
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE
ALL THE REQUIRED INFORMATION IS PROVIDED.
•i ' / � P�or�C Contact Person G V IA
1. Name to be Billed W �s // %c ul �iey n,
''wiling Address 22,5- .s% P b � 6z,- ZL Home Phone
E City/State/Zip ��� +vs �N �i4 nI LO , " Q 770 3 Business Phone
2. I` :me on Permit/ATC if Different than Above 500 m -e—
Mailing Address City/State/Zip
3 Application For: Site Evaluation ❑ Improvement Permit & ATC ❑ Both
.l
4. System to Serve: ❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: #People # Bedrooms
# Bathrooms
❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
i
j 6. If Business/Other: Specify type # People # Sinks
# Commodes # Showers `' # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: ❑ County/City ❑ Well Cl Community
3 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes f ❑ No'
If yes, what types {
•i
s
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUSYBF,
SUBMITTED WITH THIS APPLICATION.
p D' C%q Z 7d ko- e, WRITE DIRECTIONS (from
.•rty tMUM tons. I •
Mocksville) TO PROPERTY:
'fax Office PIN: # �5 7 gJ
L iG
Prop: rty Address: Road Name -F-a-�o GLw-k CL
�/� t d P;A
City/Zip / JV I4W
to
If in Subdivisionprovide inform tion, as follows:4)0
t
Y6 QA -1
{ Name:
f y.<
Section:
Lot #•
I
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 { ^° to conduct all testing procedures
as necessary to determine the site suitability.
DAT:: V -6 •' S 7 SIGNATURE
RevLad DCHD (06-96)
�.�C�
-1A,S
f
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION__ LOTS
Soil/Site Evaluation
APPLICANT'S NAMEzv-
PROPOSED FACILITY �►
SUBDIVISION y (/ e .0 h
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit 41----
DATEEVALUATED
PROPERTY SIZE ����"C
ROAD NAME
Public
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH �- F
Texture group'
Consistence .�
Structure l
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:
DCHD (01.90)
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
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