122 Falling Creek Drive Lot 31Dav;P ('r%1i1M tr urs
Trn D. -I D----+
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Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
WARNILV(T: THIS 1h .N0T A SURVEY
Parcel Information
H9080A0031 Township: Shady Grove
5789624747 Municipality:
82523682 Census Tract: 37059-804
HUBBARD JOHN R Voting Precinct: EAST SHADY GROVE
122 FALLINGCREEK DRIVE Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
NC
Zoning Overlay:
27006-7655
Voluntary Ag. District:
LOT 31 FALLINCREEK FARM PHASE I
Fire Response District:
0.69
Elementary School Zone:
12/2004
Middle School Zone:
005860838
Soil Types:
0007
Flood Zone:
049
Watershed Overlay:
Outbuilding & Extra
Freatures Value:
Total Market Value:
No
ADVANCE
SHADY GROVE
WILLIAM ELLIS
PcB2
DAVIE COUNTY
M 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
NC or arising out of the use or Inability to use the GIS data provided by this website
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173'8 DAVIE COUNTY HEALTH DEPARTMENT
,. ,�..
Environmental Health'Section PROPERTY INFORMATION
Permittee's
Name: ,%�
/���l#f� P.O. Box 848 6,;/
Mocksville, NC 27028Subdivision Name:
' Phone # 336-751-8760
Directions to property: /_ +'.1%� .. �" �r f/ Section: Lot:i
�-% AUTHORIZATION FOR
WASTEWATER"
-SYSTEM CONSTRUCTION Tax Office PIN:#—�f7w- 469 -5 �+ �G,
kA
Road Name:* 2&71Q p. -
**NOTE** This Authorization for Wastewater System Constriction 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 I I of G.S. Chapter 130A, Wastewater Systems, Section .]900 Sewage Treatment and Disposal Systems)
/ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
'IS VALID FOR A PERIOD OF FIVE. YEARS.
ENVIRONMENTAL HEALYHA SPECIALIST DATE ISSUED
i+�716
Z1°rwy q."'?5'c`�"•'+Y.°""°'.•'y t ",�r• . L'^+'Y—^.:"''F"` �T'
s17
$ DAVIE OUNTY HEALTH DEPARTMENT
. IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
P.
� Namt Subdivision Name:.
•
birections to property:`� • �` J'`f ' Section: —..Lot: , /r
�-' IMPROVEMENT '
PERMIT Tax Office PIN.# '7y-
�- Road Na e.
*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 11 of G.S.Chapter.130A,Wastewater Systems,Section:1900 Sewage Treatment and Disposal Systems)_
/ ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
�• . !
PLANS OR THE INTENDED USE CHANGE:YOUR WASTEWATER '
ENVIRONMENTAL.HEALTH SPECIALIST DATE ISSUED . SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICAT
ION:BUILDING TYPE #BEDROOMS -' #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION; FACILITY TYPE
/� #PEOPLE #PEOPLFISHIFT #SEATS ' INDUSTRIAL WASTE:Yes or No
LOT SIZE/ TYPE WATER SUPPLY_4 1 DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK �
SIZE dGAL. PUMP TANK 'GAL. TRENCH WIDTH 3�+ NROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
. r
IMPROVEMENT PERMITLAYOUT
**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 THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760:
OPERATION PERMIT
SYSTEM ITA B
AUTHORIZATION NO.
_ OPERATION PERMIT BY: . DATE:
**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 NOWAY BETAKEN ASA
GUARANTEE THAT THE SYSTEM WELL FUNCTION SATISFACTORILY.FOR ANY GIVEN PERIOD,OF TIME.
DCHD 051%(Revised)
A.PPUCAlION FOR entPERMIT & ATI
.. Davie County Health Department R R M R
Environmental Hea/tb SmWw
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 [NOV - 6
(336)751-8760
***II►PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
INFORMATION IS PROVIDED. Refer t�oy�the
>INFORMATION BULLETIN for instructions.
1. Name to be Billed (LR 1/, w Contact person
Nailing Address /-042 /���'.�-��; ./lar 7`o:'� �,/� Home phone
City/state/ZIP ,,, aw : S l� i /� / / �L' Business phone
Z. Name on Permit/ATC if Different than Above
Hailing Address City/State/Zip
3. Application For:
U Site Evaluation
;Improvement Permit/ATC
❑ Both
6. system to service:
(W House ❑ Mobile Home
❑ Business 0 Industry 0 Other
❑ Couaaunity
5. If Residence:
# People
# Bedrooms # Bathrooms
6.
A Dishwasher 0 Garbage Disposal )(Washing Machine
If Business/Industry/Other: Specify type
# Commodes # shavers
0 Basement/Plumbing
# Urinals
# People
Basement/Ho Plumbing
# Sinks
# hater Coolers
IF FOODSERVICE: # Seats
Estimated Water Usage
(gallons per day)
7. Type of water supply:
County/City 0 well
❑ Couaaunity
e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes -"0
If yes, what type?
***IMPORTANT•** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: ,I �0x r 5 Z 1� �' WRITE DIRECTIONS (from Mocluville) to PROPERTY:
Tax Office PIN: " ��-
a��/ ;6y��� 77,3\ 4 TCS
Property Address: Road Name 1/" % o &&,, Cf2 P -7—LI
City/Zip�iJ ��� % C ,-g/-1 (�ezo fl
If in a Subdivision provide information, as follows:: d!7
Name://`� C/e�,� �/r��/�?-�
Section: Block: Lot: Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
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 responsiblefor 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 thesiteZ-eo�
DATE J SIGNATU' -
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).
Revised DCHD (07/98)
Account No. q
Invoice No. 1
' 7. Type of water supply: ❑ County/City
El Well ❑ Community
j� 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No`'.
If yes, what type?
*** IMPORTANT *** A PLAT OF THE PROPERTY MUST ':1E
SUBMITTED WITH THIS APPLICA' )N.
Property Dimensions: % 9, 74 AtNe_S 1 WRITE DIRECTIONS (from
Mocksville) TO PROPERTY
Tax Office PIN: # 63 - .. J % o 3
Pro- _ rty Address: Road Name
City/Zip _AJyd4wee, /4G' . we //
i D D Lem
If it :subdivision provide inform tion, as follows: 1
Name:
� � 1
Section: �� Lot #: 1
1
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 pal< to conduct all testing procedures
I
as necessary to determine the site suitability.
DATE 9-6-97 SIGNATURE
Revised DCHD (06-96)
gC ��� .
'
APPLICATION FOR SITE EVALUATIONIIMPROVEMENT PERMIT
Davie County Health Department6�7_ a
D
Environmental Health Section
P 0. Box 848 AUG - 6<1997
Mocksville, NC 27028
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEV UNLESS -----------------
ALL THE REQUIRED INFORMATION IS PROVIDED.
1.
Name to be Billed
�f�s !/ %e uJn ..
� Contact Person G V 1A
n.
!
Mailing Address
Lev
II SrQct�T� S�"r a FG rd �G/ Home Phone �1 �i' 9 �/Z j ,
City/State/Zip
W i a/I iN A/ Ji4Ln, At e , Q 7/2 3 Business Phone 9 91l-116-
1'/162.
2.
Name on Permit/ATC if Different than Above Soo &Le-
1!'uiling Address
City/State/Zip
'
3.
Application For:
y
(a Site Evaluation ❑ Improvement Permit & ATC ❑ Both
4.
S1 -stem to Serve:
❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5.
Ifltesidence: -
# People # Bedrooms # Bathrooms
❑ Dishwasher
❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6.
If Business/Other:
Specify type #People #Sinks
# Commodes
# Showers # Urinals # Water Ccolers
If Foodservice:
# Seats Estimated Water Usage (gallons per day)
' 7. Type of water supply: ❑ County/City
El Well ❑ Community
j� 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No`'.
If yes, what type?
*** IMPORTANT *** A PLAT OF THE PROPERTY MUST ':1E
SUBMITTED WITH THIS APPLICA' )N.
Property Dimensions: % 9, 74 AtNe_S 1 WRITE DIRECTIONS (from
Mocksville) TO PROPERTY
Tax Office PIN: # 63 - .. J % o 3
Pro- _ rty Address: Road Name
City/Zip _AJyd4wee, /4G' . we //
i D D Lem
If it :subdivision provide inform tion, as follows: 1
Name:
� � 1
Section: �� Lot #: 1
1
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 pal< to conduct all testing procedures
I
as necessary to determine the site suitability.
DATE 9-6-97 SIGNATURE
Revised DCHD (06-96)
gC ��� .
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT'S NAME
PROPOSED FACILITY
SUBDIVISION
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit
L/
SECTION ---k— LOT,
DATE EVALUATED ZZ��2 G `Z�
PROPERTY SIZE
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
Texture group
Consistence l
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: _�P� /g Y2
DCHD (01.90)
Landscape Position
EVALUATIONBY:
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
•''�• `sem.
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24
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