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118 West Rolling Meadow Road Lot 12a Davie Countv. NC Tax Parcel Report Wednesdav, December 21, 2016 I r 188 I 181 I fr r >-------^ 11 II r_. 176 r Z I �•I • r m m ' x I � I ~118 166 126 I I I i 15 E ROLL INGMEADOoIq `',,,W ROLLINGMEADO' W RD RD I — `' If 152 i WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H908OA0012 Township: Shady Grove NCPIN Number: 5789630346 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 12 FALLINGCREEK FARM PHASE I Fire Response District: ADVANCE Assessed Acreage: 0.73 Elementary School Zone: SHADY GROVE Deed Date: 6/2001 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 003760892 Soil Types: PcC2,WATER Plat Book: 0007 Flood Zone: Plat Page: 048 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 91 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 NCor arising out of the use or inability to use the GIS data provided by this website. I 512A AUTHORIZ4TION NO: DAVIE COUNTY `HEALTH DEPARTMENT t y.� Environmental Health Section PROPERTY, INFORMATION Permittee l`)� ji W�G1 /�f'J� P.O. Box 848 Name Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 `Directions to property: Section: Lot: AUTHORIZATION FOR s -`ti �1 �✓� �7J"Y� WASTEWATER Tax Office PIN: SYSTEM CONSTRUCTION . 7 Road Name: a Zip **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/Authonzation' Number should be presented to the Davie County Building Inspections Office when applying for Building PemttfS.' (ln co m liance;with Article'I I of G.S. Chapter 130A, Wastewater Systems, Section..1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION v . IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST BATE ISSUED . a^ �f k+�=.w* 3p AS:.: a--i':iT .wa u'6 t...wv i �.vY.� 3+��*"_-.t eiYw.x s+.• -.-..tea. .,,.._ .o.....'/y_ . . _ ..t. t /AIIDAVIE COUNTY. HEALTH DEPARTMENT u IMPROVEMENT AND. OPERATION PERMITS PROPERTY INFORMATION m _lame" t •.. %�% T t' :1 / Subdivision Name: r' Dire"c itihs to'prope�y: +� �' Section: Lot:dl•�' IMPROVEMENT PERMIT Tax Office PIN:# Road Name. , sff Zip ti **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.1 I of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems) i ***NOTICE***.THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ,PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST BATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE , INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS s'� # BATHS -'7. •S'�# OCCUPANTS 4/_ GARBAGE DISPOSALS Yes or No COMMERCIAL SPECIFICATION: FACILTTYTYPE- # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZES!) O TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) y� NEW SITE !!� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE/ODD GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH/V LINEAR FT)_ OTHER 'REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT &APPROVED EFFL E LTER+ &RISER(S) IF 6' ' B€WV F'^INISIIED GRADE& . l rnu�I t P C 40K V r - **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 7 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHOK # IS FMT r 5)751-675I6 OPERATION PERMIT % SYSTEM INSTALLED BY: / i 75 AUTHORIZATION NO. v OPERATION PERMIT BY: - - DATE: 2 Y Gd 1-�— **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) ` t APPU(ATION FOR SITE EVAUlAT1UN/IMPROVEMENT PERMIT do AT Davie County Health Department Environmental Kealth Se�cdon D P.O. Box 848/210 Hospital Street /�p� Mockaville, NC 27028 APR - 7 1999 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. name to be sided / r /► \ Contact Person 1Ja1*e"eA'Jt3or W'a V1 le/ Mailing Address �J�c3J l`1l � U.�`1 oe- Home Phone �"3�[, 7�0 city/State/zIP (,I parr/mlJ r,_/yC Business Phone P" 2. hams on Pe=lt/ATC if Different than Above Nailing Address City/State/Lip 3. Application for: U Site Evaluation X Improvement Permit/ATC 0 Both 4. system to Service: "ouse 0 Mobile Home 0 Business 0 Industry 0 Other a. If Residence: # People # Bedrooms 3 i Bathrooms 2—. 5 . N'Dishwashes D'Garbage Disposal E(Washing Naehine 0 Basement/Plumbing 0 Basement/no Plunbing 6. It Business/Industry/other: Specify type # Commodes # Showers IF FOODSERVICE: 11 Seats 7. Type of water supply: # People # Sinks # Urinals # Rater Coolers Estimated Nater Usage (gallons per day) ®'County/city 0 Well S. Do you anticipate additions or expansions of the facility this system is intended to serve! U yes, what type! 0 commmity 0 Yes B19-0 * "IMPORTANT v" CLIENTS DIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PIAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Su mPps 44"cS Tax Oflice PIN: # ,-%e 9 - /' -?— D 3 se, Property Address: Road Name PIS , Ri City/Zip Ad U • If in a Subdivision provide information, as follows: Name: _Fe. -111.14 Oretz-/L Faria WRITE DIRECTIONS (from MockrAlle) to PROPERTY: 6 O -Leff'Poi-1/ - Al '*1 / r i- P,ez�&. (/tA Rd - 9,ropy rn... LF {- Section: Block: Lot: /2 Date Property Flagged: `% 7— f% This is to certify that the information provided is correct to the best of my knowledge. 1 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 falsilled or changed. I, also, understand that I am nspondble for all cha ges incurred from this application. 1, hereby, give consent to the Authorized Representative or 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 the suitability. DATE �/ 7 /9g SIGNATURE.�.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). �D Account No. v, Revised DCHD (07/98) Invoice No. 6 �� 1. 15 --- NO 03'20"E 1 s z I crCe, 4t. Rcymond C 1.4,ers CB 97, Pq 904 703 "9 'dC2'C3'20"F 896.49' TC'AL RADIUS LENGTH 300.00 134 70' -- 560.00 144.76-T 500.00 9'— 32 V- 500.00 6^ 5.6'r� TANGENT 68 �2 89--, - ..� -- 45 79 +~ --!- ?.2BE -�^ - CHORD BEARING DELTA 33.57 514'10 52 w 25'x3'3 5 !44.25 N07'40 55 E 16-3596" 9' 19 N21''2 29 E X0'27 52 - 65.62 S86-13'057 07'31 31 ' - - -- �- 9?C OG' a, 62 is . ..,- - _._a' 51_� ---T-�- - S87 5 08 E -_i- ----T--�- 5-5 72- 27 F `O 5.58 ;3..- - - 530.00' _-- N00'36 43 �_----- _ 134.64' C-33 - c5 oe• 220 27 .64—, C-15 C -1a C-13 C-12 A 1 16 co 3 703'Ac .z t, 860 Ac.t ZP) k 235.09' 0.820 A- t s o 11 U _ ---- N0N07-32-40"E C-10 f (, n 3.' 0.970 Ac.t LO °' m h00 1 z 0 723 Ac.f 1 —9 c. G z a 200.35'_. :v N05'23'27"E n ^ cc s 1 - ExIST,NG poN ' uj �. j i C 0.692 Act rn W A N 252 3" sv V) _ _ Nc-;3'39' 5"E 70, z 3 68C 1. 15 --- NO 03'20"E 1 s z I crCe, 4t. Rcymond C 1.4,ers CB 97, Pq 904 703 "9 'dC2'C3'20"F 896.49' TC'AL RADIUS LENGTH 300.00 134 70' -- 560.00 144.76-T 500.00 9'— 32 V- 500.00 6^ 5.6'r� TANGENT 68 �2 89--, - ..� -- 45 79 +~ --!- ?.2BE -�^ - CHORD BEARING DELTA 33.57 514'10 52 w 25'x3'3 5 !44.25 N07'40 55 E 16-3596" 9' 19 N21''2 29 E X0'27 52 - 65.62 S86-13'057 07'31 31 ' - - -- �- 9?C OG' a, 62 _3 83 -_._ . ..,- - _._a' 51_� ---T-�- - S87 5 08 E -_i- ----T--�- 5-5 72- 27 ---- ----Rlw CURvE TABLE CURVE _ j RAD_ Ii_ L.ENG'H C-' `�_ 270 00 - _ '21 23' _ C-2 530.00 69.6' C-3 I 35.-00-- 05500 C-12 530.00' --55 �0 7— 6269+ r _s rS nn - c5 oe• 7-6- 55.00 30.39 C-7 {- C-8 I 55.00' 73 71' _ 44,08' 55.00 !- C-9 35.00 -_ �26.73' C-10 470.00' 8.44 C-11 470.00'53 2 9 C-12 530.00' _ 38 92 C-13 530.00'104.88' _-- ,-___ --9 ...- C -IL 530.00 .64—, C-15 53C T _ _ 95.46• ~- APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department ' Environmental Health Section P. 0. Box 848 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEILi7NL ALL THE REQUIRED INFORMATION IS PROVIDED. 1 �! 1. Name to be Billed V,es !/ /e uJ �iey Contact Person y off' �r�. . � Mailing Address �1 q.� I r oC � — 5",VA S�N b 1'G �'d �l Home Phone 9q1 r— g416 9 ! City/State/Zip h%i ,ys iN it/ .54 fes+ At e , Q 7/0 3 Business Phone 9 9 I -116 7 O 2. Name on Permit/ATC if Different than Above SoG m Mailing Address City/State/Zip 3. 1 Application For: a Site Evaluation ❑ Improvement Permit & ATC ❑ Both 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 6. If Business/Other: Specify type i # People # Sinks j t° Commodes #. Showers t # Urinals # Water Coolers ; day) It Foodservice: # Seats Estimated Water Usage (gallons per 7. Type of water supply: ❑ County/City ❑ Well ❑ Community , 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ 'Yes ❑ ,No If yes, what type? I _. PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: q9, 7� AtNis WRITE. DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # 77 g� 3 -- J% 0 3 j Property Address: Road Name �� V , CL • c .�L G 10/yd O1-/ City/Zip AJUi4Wee .� ff If in Subdivisionprovide inform tion, as follows: yn / ;2— Section: y� Lot #: This :a to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are srt ject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this appli..!tion is falsified or changed. I, also, understand that I am responsible f6i"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 8 as necessary to determine the site suitability. DATE g —� c/ % SIGNATURE - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME " %�� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE �9 SUBDIVISION [ /L 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 .2- Slope LSlo e % 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: EVALUATION BY: (G LONG-TERM ACCEPTANCE RATE: / OTHER(S) PRESENT: REMARKS: -/9,40, 4/e /1�� �% ��✓� Landscaue 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)