118 West Rolling Meadow Road Lot 12a
Davie Countv. NC
Tax Parcel Report
Wednesdav, December 21, 2016
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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.
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CB 97, Pq 904
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RADIUS LENGTH
300.00 134 70'
--
560.00 144.76-T
500.00 9'— 32 V-
500.00 6^ 5.6'r�
TANGENT
68
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45 79 +~
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CHORD BEARING DELTA
33.57 514'10 52 w 25'x3'3 5
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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
'
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9?C OG' a, 62
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CURvE TABLE
CURVE
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L.ENG'H
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270 00
-
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530.00
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55.00
30.39
C-7
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_ 44,08'
55.00
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35.00
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C-10
470.00'
8.44
C-11
470.00'53
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C-12
530.00'
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C-13
530.00'104.88'
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530.00
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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)