166 Falling Creek Drive Lot 20Davie County, NC Tax Parcel Report Wednesday, December 21, 2016
WAKN1[f4 T: TMS 1S 14U'1' A SURVEY
Parcel Information
Parcel Number:
H9080A0020
Township:
Shady Grove
NCPIN Number:
5789634313
Municipality:
Account Number:
8305985
Census Tract:
37059-804
Listed Owner 1:
WILLIAMS TRAVIS M
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
166 FALLINGCREEK DRIVE
Planning Jurisdiction:
Davie County
City:
ADVANCE
Zoning Class: DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
No
Legal Description:
LOT 20 FALLINGCREEK FARM PHASE I
Fire Response District:
ADVANCE
Assessed Acreage:
0.67
Elementary School Zone: SHADY GROVE
Deed Date:
1/2016
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
010100592
Soil Types:
PcB2
Plat Book:
0007
Flood Zone:
Plat Page:
049
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Building Value:
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
F-a
All datais 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 theCounty of Davie, North Carolina, its agents, consultants, contractors or employees from any and ail claims or causes of action due to
NCor arising out of the use or inability to use the GIS data provided by this websIte.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990000757
Billed To: Kellogg Construction Company
Reference Name: Ted Kellogg
Proposed Facility: Residence
ATC Number: 2159
Tax PIN/EH #: 5789-63-4313
Subdivision Info: Falling Creek Sec. 1 Lot # 20
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 WASTEWA C UCTION VALID FOR A PERIOD OF FI YEARS.
Environmental Health Specialist's Signatur :- — 4,:2
Date:
%0
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:
DCHD 05/99 (Revised)
Date: %/ `-- `/ -4
DAVIE COUNTY HEALTH DEPARTMENT
' r Environmental Health Section Y/
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000757 Tax PIN/EH #: 5789.83-4313
Billed To: Kellogg Construction Company Subdivision Info: Falling Creek Sec. 1 Lot # 20
Reference Name: Ted Kellogg Location/Address: Failing Creek Drive -27006
Proposed Facility: Residence Property Size: See map
ATC Number: 2159
**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 A W5L= #People #Bedrooms 3 #Baths 2 • }
Dishwasher: Z Garbage Disposal: El"' Washing Machine: Ml"" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size 12-61 Type Water Supply CZVA// T Design Wastewater Flow (GPD) �J Site: New Repair ❑
System Specifications: Tank Size IOCOGAL. Pump Tank GAL. Trench Width Rock Depth 1,2 Linear Ft.:30ct
Other:
1 i ,
Required Site Modifications/Conditions: Ft1�gLL p� c4a) Og, 19 OF,-b�tr,,ZX OAF
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.****
A PPe nV, I I I
� o �
To
i
Environmental Health Specialist's Signature: Date: Likk
�DCHD 05/99 (Revised)
V
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC += v U v
Davie County Health DepartmRnt
Envimnmental Health Sermon AUG 3 01999
P.O. Box 848/210 Hospital Street
Mockaville, NC 27028
(336) 751-8760
***IMPORTANT*** THIS APPLICATION CAIUINOT B>!: PROCESSJW UNLESS ALL THE REQUIRED
nVORMIITION IS PROV
�I
%DED. Refer+ to the INSORHM1= BULLETIN for
�i—n�stt=ot�i%ons.l
L. Name to be Billed 1'� e i t4Q ( Ti , CO. Contact Parson . 1 cf— e i t) col
Mailing Address — � o eons Phone
City/state/LIP '1/Cl/VI Business Phone C1 •"l U" — SO I
Z. Name on permit/ATC it Different than Above
Hailing Address '5oiewae GS C4 190 [/C City/stats/zip
3. Application YorW"ite Evaluation ' 4rovemeat Permit/ATC ❑ Both
a. system to service: J�ouse 0 Mobile Home 0 Bnsinens 0 Industry 0 Other
s. if Residence: # People # Bedrooms Z # Bathrooms 2-•S"
�ishssasher �eazbage Disposal ,Mashing Machina O Basement/Plusibing 13 Basement/No plumbing
S. tf Business/Industry/Others specify type # People # sinks
# Commodes # 91mmers # Urinals # Mater Coolers
I! a'OODSERVICE: # Seats Eatimated Water Usage (gallons Pw day)
I. 27pe of Mater supply: lecounty/City 0 Well 0 Community
e. Do you anticipate additions or expansions of the faculty this System Is intended to serve? 0 Yes R14
H yes, what type?
***IMPORTANT"** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBIWIM by the client with THIS APPLICATION.
Property Dimensions: 1 Za X "2 -3a X 12.a A 2-3
Tax O®ce PIN: # .- : q 4 3 - 1-31,3
Property Address: Road Name _Fa I ( I ✓lA Cxea 17r'-
H
City/Zip C I a-t4CJ , jJC Z WX
If in a Subdivision provide information, as follows:
Name: 6irC e k
Section: _� Block: Lot:
WRITE DIRECTIONS (from Mock"le) to PROPERTY:
W.
L64 t' is r. lK Greer a
Ld '4-2,o i.B C,4- 11 rc%s'Sec� &^
of l2cQ. oN )el,?kl
Date Property Fogged:813,1 I 9q
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 falsifled or changed 1, also, understand that I ane responsible for all charges incurred frons
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
61
g d I qcl SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all, of the following: Existing and proposed
property Imes and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
I Date(s):
Client Notification Date:
I EHS:
Revised DCHD (07/99)
Account No. 73—Z
Invoice No. �2;2
4406
PcB2
0
This map is for PERC TEST
and BUILDING PERMIT purposes
only. The Davie County
Tax Administrator's Office
assumes no liability for any
information contained on this me
COUNTYID:H9080A0020
August 30,199912:21 PM
Parcel Identification Number
5789-63-4313
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED
WITH THIS APPLICATION.
Propzrty Dimensions: q9. 7� YDS
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
n �/7
t_�, l I L/
63 _-5 7 o 3
:.
Property Address: Road Name _F-�
V ci- .
Davie County Health Department
D
//
City/Zip Ayxwe!e .
144L-, '1Q7DB 6
icy 96 / 0
1 .�
Environmental Health Section
O n Gem
If�Subdivision or
p� �)g ytasfollows:/��S
1
1 QV V- -
•
Cto
P o. Box 848
AUG — 61997
Lot #: D
1 ..
,�
Mocksville, NC 27028
1
(704)634-8760
2J
6N
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEJ
ALL THE REQUIRED INFORMATION IS PROVIDED.
1. 'Name to be Billed
We-s� Contact Person 61"4
P t ailing Address
d t� J��t�f� sth Home Phone 99�i'' gyC�g
" City/State/Zip
P/i +✓s � t/ Jr4 k, A(e , 1971,93 Business Phone 9 9 �' - 6 7
2. Name on Permit/ATC if Different than Above _ 5*4 m 9—
M;Ailing Address
City/State/Zip
3. Application For:
W Site Evaluation ❑ Improvement Permit & ATC ❑ ^ Both
'
- 4. System to Serve:
❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
P
5. If Residence:
# People # Bedrooms # Bathrooms
❑ Dishwasher
❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/N.- P.umbing
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 ❑ . Community
'
i
8. Do you anticipate
additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ ', No .
i
If /es, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED
WITH THIS APPLICATION.
Propzrty Dimensions: q9. 7� YDS
1 WRITE.DIRECTIONS (from
Th xOffice PIN: # 5 7 g! -
63 _-5 7 o 3
Mocksville) TO PROPERTY -
ROPERTY:Thx
1
Property Address: Road Name _F-�
V ci- .
1 c t
1 *
//
City/Zip Ayxwe!e .
144L-, '1Q7DB 6
icy 96 / 0
1 .�
O n Gem
If�Subdivision or
p� �)g ytasfollows:/��S
1
1 QV V- -
Name: Jr/
Cto
1
Section:
Lot #: D
1 ..
,�
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 ;00 4k e-1 l f to conduct all testing procedures
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME sL ice/
PROPOSED FACILITY
SUBDIVISION /A-//�
Water Supply:
Evaluation By
On -Site Well Community
Auger Boring Pit
DATE EVALUATED
PROPERTY SIZE
ROAD NAME
Public
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope % 69
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH B /`
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 1 c
SITE CLASSIFICATION: UJ
LONG-TERM ACCEPTANCE RATE: oc
REMARKS:
DCHD (01-90)
EVALUATION BY:l/
OTHER(S) PRESENT:
V V LEGEND
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