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222 Falling Creek Drive Lot 34Davie County, NC Tax Parcel Report Wednesday. December 21. 2016 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: WA UNINU: 1-Ull 1J 1V V-1 A bUKV.LY Parcel Information H9080A0034 Township: Shady Grove 5789636617 Municipality: 8301399 Census Tract: 37059-804 DARNELL MICHAEL D Voting Precinct: EAST SHADY GROVE 222 FALLINGCREEK DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006 Voluntary Ag. District: No LOT 34 FALLINGCREEK FARM PHASE II Fire Response District: ADVANCE 0.71 Elementary School Zone: SHADY GROVE 9/2012 Middle School Zone: WILLIAM ELLIS 009020778 Soil Types: PCB2 0007 Flood Zone: 0189 Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Freatures Value: Total Market Value: 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 �7 l� C or arising out of the use or Inability to use the GIS data provided by this webs e. _ 1J111v1L' \,VV1V11 L'1Vv1AVIliv11S1V1M.,nnl-ii,1ri P.O. Box 848/210 Hospital Street K •- - Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 REPAIR OPERATION PERMIT �F Account #: 990005808 Tax PIN,EH #: H9080A0034 Billed To: Brain Journey Subdivision Info: FallingCreek Farm Phase II Lot # 34 Reference Name: REPAIR PERMIT Location/Address:.222 Falling Creek Drive -27006 Proposed Facility: Residential Repair Property Size" .'-0:71 ATC *WLui * J%tjuance of this Operation Permit.shall indicate the system described on the ATC has been installed in comp iance wit 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. System Type: S.T. ManufacturerVIQ Tank Date Tank Size Pump Tank Size �1� System Installed By: .J 001 iIf- �Q�rn.�� E.H. Specialist:{ A) te: o / d GPS Coordinate: DCHD 11/06 (Revised) fid6p-# ���g DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005808 Tax PIN!EH #: H908OA0034 Billed To: Brain Journey Subdivision Info: FallingCreek Farm Phase II Lot #.34 Reference Narne: REPAIR PERMIT . Locatitin/Address:', 222 Falling Creek Drive -27006.. Proposed Facility: Residential Repair;'PEtsp(9tte$r� -❑HIM IXRepair ❑Expansion AfMM691-ThiS66i4horization to Construct (ATC) MUST BE ISSUED,;by the Davie County Environmental Health Section prior to.issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms 3 # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size %_767 0.L Type of Water Supply: County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) _Tank Size GAL. Pump Tank / GAL. Trench Width 31 Max. Trench Depth" Rock Depth Linear Ft.176 Site Modifications/Conditions/Other:�� Contact the Davie County Environmental Heilth Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. t I Col%J - 57o-Fpeea Iev'elCnr I 66res /,p new, N xl. I I i 7 Ake, 1^e a� Environmental Health SpecialistDate: /130xv2- DCHD 11/06 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002128 Billed To: Phase IV Realty Reference Name: - Proposed Facility: Residence ATC Number: 3633 Tax PIN/EH #: 5789-63-6617.PR Subdivision Info: Falling Creek Lot # 34 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONST R CTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 16 6,:S 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. "] I I Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 't • (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002128 Billed To: Phase IV Realty Reference Name: Proposed Facility: Residence /1 ce 004117- 0 �/ Tax PIN/EH #: 5789-63-6617.PR Subdivision Info: Falling Creek Lot # 34 Location/Address: Falling Creek Drive -27006 Property Size: see map ATC Number: 3633 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of aseptic 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 jq #People #Bedrooms IS #Baths :� Dishwasher: K1 Garbage Disposal: e Washing Machine: e Basement w/Plumbing: 0"' Basement/No Plumbing: Cl Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) %,—r:7a 0 Site: NewZ-*'Repair ❑ System Specifications: Tank Size W eGAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Widthy�Rock Depth 1��Linear Ft QZ IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** Environmental Health Specialist's Signature:4) Date: IC2 — 1A -03 DCHD 05/99 (Revised) APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental MeaM Seciitm P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPQRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED n=RMATION IS PROVIDED. Refer to the nUUMATION BULLETIN for instructions. 1. Name to be Billed Contact Person �1,11Q/1/p�/Opa� Mailing Address cJ ear Phon. 7y�^ q q9z City/state/LIP )& '�VC . �� /D� _ - Business Phone 2. dame on Permit/ATC if Different than Above Mailing Address City/ state/sip 3. Application For: (a Site. Evaluation B'Improvement Permit/ATC. .._ 91'30th 4. system to servios: a" House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms # Bathrooms W166ishwasher U -Garbage Disposal G -1h thing 11aehine 6-s"ament/Plumbing ❑ assemrnt/No Plumbing 6. If Business/Industry/Other: speoify type # People # sinks # Commodes # showers # Urinals # Yater Coolers IF I'OODSERVICE: # Seats /" Estimated .hater Usage (gallons Par day) 7. Type of Mater supply: 8'County/City ❑ Nell ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 944Z! If yes, what typeT ***IMPORTANT*** CLIENTS MUST COMPLMETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax OMce PIN: # Property Address: Road Name `rU if City/Zip If In'a Subdivision provide information, as follows:. Name: i y S Section: _ Block: Lot: 3 WRITE DIRECTIONS (from Mocknille) to PROPERTY: 2 r1� Date Property Flagged: 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 we change, or U 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 th site suits flity. DATE ZIv) SIGNATUR THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations)., C., l C2�s 1II1Rtt►eubrRte etrtrrtRt7rt or tRtwsrt/Rrtrrow 1110112100 or OWNPAn nuvwrRe acrtRrptwr�Rnrrr orrrct* r/w.t SUe0r►IJlew parr tprRsrt6 I _ ter..••. wr+w.ri��rr Y. �.. 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OI.P....._—..w.- r..w n.. e 31...._.._...11... n..l.q • n......•^—../..1^t w 1M e...ne/.1 �O ........... Carw.r ® .._...._.�.C..lw,1.. C.— t.r.6.. 2 —rtoo —.,.tan lw< nroe U.. �- — -- — `0.000 ---...._.ae.� r•rn.w....1. LN.INw) 100 000 e ScoIA 1 1- 100 (1 /.<hHne i\.•.le7.w.w7 C wl7w ny tw /IffwM D.Pl.fww•w! CPpt.wfl.w 1.1.. wr, rl.. r."'t c y­,Irwl 1w -Not M.G t .w.n+. .w..0..... nEEr71n EncinEEnlnR InC :r.ry.f rti. S A• ` JAN 2 4 2000 � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT 7 y Davie County Health Department Environmental Health Se+clion ENVI DONNE . ANTIEALTIi P.O. Box 848/210 Hospital Street Mocksville, NC 27028 _ (336)751-8760 ***ZMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed '(UIC�)�C�4t�oMCrtT (Wakw Contact Person &ANT 6dnf0XY Mailing Address 2631 lkyriei.OA ReAD Home Phone .334-7&--1008 City/State/ZIP Wwsry1F--5,dLEvvt , IIIc 111a Business Phone �� �-']"I l •De7B 2. Name on E�ermit/ATC if Different than Above Mailing Address 3. Application For: Site Evaluation 4. system to Service: eHouse ❑ Mobile Home 5. If Residence: # People City/State/Zip n Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms 3 # Bathrooms 0 Dishwasher 11 Garbage Disposal ❑ washing Machine 11 Basement/Plumbing CI Basement/No Plumbing 6. If Business/Industry/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 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes EI NO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Ofliice PIN: # Property Address: Road Name FALUW64AEC,K-NIv4 city/zip A piwcE. at 11A If in a Subdivision provide information, as follows: Name: FALUA44 t.EFI< 1%krt 4 Section: 7---' Block: Lot: Lorf 17 4 3 q -'q I WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: /1' Z8' q`f 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 WKMW--W L"XMcIM6n;i & mOA-N to conduct all /testing procedures as necessary to determine the site suitability. DATE (! Z310d SIGNATURE 4"&AL� T� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all oft o owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). N�uS µof y� I? Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: I EHS• Account No. Invoice No. �� %� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnYlivnmental Heath SL-cftn P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 N D JUL 2 0 1999 ENVIRD VIE COUNTY HEALTH ***II4PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS 1PROVIDED. Refer to the INFORMATION BULLETIN ford instructions. 1. Name to be Billed ESl�n �EyErl.u�J`^EN; C `^� '/ Contact person IJzati7 G*army Mailing Address Some Phone D6-760 '2�-8 city/state/sxP WWS tcM--111 C-. CA , IX %1\cL Business Phone _33?e 17-7 - ooh$ 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Sip 3. Application For: t Site Evaluation Improvement Permit/ATC 0 Both e. system to service: House 0 Mobile Home ❑ Business 0 Industry 0 Other 3. If Residence: # People # Bedrooms -5-t # Bathrooms 2+may' d Dishwasher dGarbage Disposal O/ washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/industry/other: Specify type # People # Commodes # showers # Urinals # Sinks # water Coolers IF FOODSERVICE: # Seats Estimated (Pater Usage (gallons per day) 7. Type of Mater supply: or-county/city ❑ Well ❑ Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes P"No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BE:MV,. Elther a FLAT or SITE PLAN MUST SESUB-MIiau by the client with THIS APPLICATION. at - Property Dimensions: >c4VKIJ 1, (AWAKcRC-c-K (A'T4c", O) WRITE DIRECTIONS (from Mocksville) to PROPERTY: NO Lcr 13{�v„u,)G�S�fti1C1 r= Tax Office PIN: # 5185-0•R0l, a-S7f!I-Iz.-4533 ffi4y 6`r 6AST , Lf--, a ci 8�(� Ri4-T Property Address: Road Name f-AUvJ,,-eA<- 4t DRAW c"i f OPLf s Z:zCC-i, city/zip Q vA.,tE , i/t -27oc-4 If in a Subdivision provide information, as foil: Name: F L N 4n(<- JCOC2 71q Section: 1 Block: A O Lot: Date Property Flagged: 7.1 .51 49 This is to certify that the information provided Its 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. DATE :1 19I qq SIGNATURE—::Ze- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the f awing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: I EAS• Revised DCHD (07/99) Account No. -?� Invoice No. U r ' i INN\ I Sharnrock Acres I _ \ TAMA M. O'MARA _� \ PB 6 Pg 183 & 184 \ DB 157, PG 69Z I I \ y\ 14 I 13 • 2238.60' �I N \ 4\\ \ 7-20 730 �6�— \ -�.\ \ a 740 / 6?s• , X10 _. 1 w 40 75 92' 223.59- 'r- 23.5•io 5e ``r`�. R¢mOvad Const. 210 ►+ase ]Z J u \ I r I^ \ \ j 150. 237.6V 1 6 ` \ \ \ 140.43' 97.16 / yr Y ; 110.00' • Q ,\� \ yy / ate•/ R = 150 q ` 1 x st��9 s 'Id,,�s \ N - O i n be reswemov 4i ed ^i� \ h \ g Mat pnt iT ) —Ph45z II _ % M \ n 9 i Const. CTYP,) \ h' N05 3 20"E / - \ s0.58 84.08• W 6 4s.70' °' 6� a1• ,� 5 dlmenty ©� -'' R = >'76' ' :: STONi UTLET STRUCTURE`` 9.64' }0) •�J \ TfOP / •.�y:�'• 1 !�� 1 O'llic JZ, x 1 f04.88� 2 i R= 500' �16v 15 APPROxINL4TE LI MIT5 OK N nlsrURBEO -..� — 14 \ ,p \ Q 165 \ ro 130, Iti V EXISTING LAKE Parcel 42.05 Wanda Gaye Hoots / DB 138, Pg 288 C), DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account M 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5789-64-7482o3'f Subdivision Info: Falling Creek Sec. 2(Blk AO Lot # 34 Location/Address: Falling Creek Drive -27006 226x480x108x Date Evaluated: Community Evaluation By: Auger Boring a Pit („_�-' Public Cut • .• vo©aova • • •. ren-M��VAMMWA��HORIZON I DEPTH ���� Texture group___Consistence —NKM'I / / Mineralogy --- HORIZON II DEPTH Consistence Texture group HORIZON III DEPTH ConsistenceHORIZON IV DEPTH Texture grou ConsistenceMineralogy • R-121 N -.191110 CLASSIFICATION SITE CLASSIFICATION: 1%� LONG-TERM ACCEPTANCE RATE: REMARKS: .11 LEGEND EVALUATION BY: eC f2/ 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 DCHD 05/99 (Revised) x APPLICATION FOR SITE EVAIIJATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital street Mockaville, NC 27028 (336)751-8760 1. JUL 2 D 1999 _1 ENVIRONNIENTAL HEALTH nmtm (In[IMTV ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INIrORMATION BULLETIN for instructions. 1� Name to be Billed WESi�F•�.� 1�E�1E��P� �E1JT 4m�P�1J`/ Contact Person 2r.►tT �rc4FnEY Nailing Address 2 b31 RC^�tyaz(Je 1ZcAL` Rome Phone 36- NO '1�8 city/state/zxv WWI .,Ix 2:1kQL Business rhono 3&,-17-7-0r174 Z. Name on Permit/DTC if Different than Above Nailing Address City/state/Sip 3. Application Por: site Evaluation ❑ Improvement Permit/ATC ❑ Both e. system to Services I(House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People # Bedrooms �5-'V # Bathrooms 1-24' dDishwasher d Oarbaga Disposal O/ Washing Machine 0 Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: specify type # Commodes # showers # Urinals # people # sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: Q County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes d" o If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE RBQUIXED PROPERTY INFORMATION R(;QUESTED BELOW. Either a PLAT or SITE FLAN MUST BESUBMI- TED by the client with THIS APPLICATION. 'N'IsF- Property Dimensions: �I 2_, (A�.u,KCatEK (/tOACIWO) r.00 L,*r 33 ��v.Wr-aE6fc� CL Tax OMcePIN: # 5781-0• gOL �- S7£ i Gc•4533 Property Address: Road Name ` eJW<4c 0R W WRITE DIRECTIONS (from Mockwille) to PROPERTY: LL �fwY 41 MS -1 , LEfT. wJ V4(% R i6AT City/Zip ,AO uA-M ,lie 27rCti If in a Subdivision provide information, as foil�i ` Name: F LZi cTtEE-K 71"1 dV %S5 p Section: �,r Block% R U Lot: -�- Date Property Flagged: 7 .81 rt -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 informatien submitted in this application is falsified or changed I, also, understand that I am responsible for all charges Incurred f-ont 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 :191q`i SIGNATURE r /� THIS AREA MAY BE USED FOR DRAWING YO AN (Include all of the f awing: Existing and proposed property lines a ens ons, structures, set a , septic 1&400s). New fnaP I Revised DCHD (07/99) Site Revisit Charge I Date(s): I Client Notification Date: I EAS: Account No. 4?4� Invoice No. 1101-2 Shamrock Acres _ \ T B 1 7, G 697 I_ 1 PB 6 Pg 183 & 184 I \ OB 157, RG 697 � \ 1 y I 14 I 13 2238.60' 710 ..� • .� 1` pp / i '�` \ \ N O ^°' / /• 42 � / � \� 5 �730 /133. pyo �a, — '� � � \ �, e \ / - --, y 740 ja 92 _ I c 223.59' Rembv0d�on5t. 21o. �ha be jI u 1$0' t , 140.43• 97.18• f i 11o.ou �I ti 1 C, R O = 150' � 19 f Pl,o;sejj $i e Pltch Le reMoved�^�� \\ \ d ,,,+i, Phase II �h \ Matting (TY ^) 1 .04Const. (TYR) N05 3 20"E M 0 1 TirnpofOPy © J R Q 4�. it SedimP,tlt ,t: 1 /`J {,TONT 'ouTLET STRucTURB'��9.84• - •� .� }rn ��3 6' \ Tro� / . + �rQ 104-H8'..� 3 T..�f 1 Ky 1CgA. 12'wx 1 ! �i e{sss "A^ s ohs `e R 500' V 15 APPR&AIMATE1.1ml,175 or: N 'V 4 -- P1STUR15EIP *ft*. w) — 14 lbs' - 130, 467- EXISTING 6jEXISTING LAKE Parcel 42.05 I ( \ I o Wanda Gaye Hoots 'o DB 138' Pg____ 288 A60 �f� 0 �� \ J 1 J • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5789-64-7482.47 Subdivision Info: Falling Creek Sed21Blk AO Lot #47 Location/Address: Falling Creek Drive -27006 See Map Date Evaluated: //-/0- Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public &I Cut FACTORS 1 2 3 4 5 6 7 Landscape position 'L_ L Slope % HORIZON I DEPTH ci i Texture group Consistence Structure Mineralogy HORIZON II DEPTH <le Texture group Consistence �Y Structure i L Mineralogy A' 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 c SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: 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 DCHD 05/99 (Revised)