257 Peoples Creek Road Lot 2Davie County, NC Tax Parcel Report Wednesday. December 21. 2016
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
H908OA0002
Township:
Shady Grove
NCPIN Number:
5789529767
Municipality:
Account Number:
8301437
Census Tract:
37059-804
Listed Owner 1:
MYERS TIMOTHY L
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
257 PEOPLES CREEK ROAD
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 2 FALLINGCREEK FARM PHASE I
Fire Response District:
ADVANCE
Assessed Acreage:
0.68
Elementary School Zone: SHADY GROVE
Deed Date:
10/2012
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
009030991
Soil Types:
PcB2
Plat Book:
0007
Flood Zone:
Plat Page:
048
Watershed Overlay:
DAVIE COUNTY
Building Value: Outbuilding & Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed 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 wan-Antles of merchantability or Iftness 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 websfte.
FO
HEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Kimberly S. Myers
-� ic
ApIpIlress: 257 Peoples Creek Rd
City: Advance
StatefZiP: NC 27006
Phone #: (336) 414-6984
r. For Office Use Only
*CDP File Number 202111 - 1
County ID Number.
����HDIRMWC
PERMIT VAUD 0 4 / 0 5 / 2 0 .1 1
UNTIL - -
Property owner: Kimberly S. Myers
Address: 257 Peoples Creek Rd
City: Advance
State0p: NC 27006
Phone #: (336) 414-6984
I'—
Property Location & Site Inform atlon
Address257 Peoples Creek Road Subdivision: Fallingcreek Phase: Lot 2
Road# Advance NC 27006
SINGLE FAMILY Township:
'Structure: Diroctlons
4 of Bedrooms: 9 of People: Hwy 64 east, left on Hwy 801 right onto Peoples Creek Rd at the
church. Home on the left
'Water Supply: PUBLIC
Basement: FlyesnNo
*Proposed Improvement:
Metal Building on conrete slab
Type of Business:
Total sq. Footage: No. Of Employees:
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? OYes ONo
Applicant/Legal Reps. Signature; *Date:— / — /
*Issued By.* 2140 - Nations, Robert Tate of Issue: 0 4 / 0 5 0 1 6
Authorized State Agent:
**Site Plan/Drawing attached.**
01-landDrawing OlmportDrawing
Drawing Type:
HEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Health Department Release
CDP File,Number: 202111 - 1
County File Number:
Date: 04 /05/ 2016
0 Inch
Scale: _. 0131ock ":..ft.
ON/A
Page 2 of 2
Phone: (336) - 753 - 6780
.'%,2
ly 690 kin, (53)ON-0911
Davie County Health Departmer±--
i romuental Health Section
ror
P.O. Box 848
210 Hospital Street 0_11 I
Courier # : 09-40-06
Mocksville, NC 27028
Fax: (336) - 751 - 8786
ON-SITE WASTEWATER CERTIFICATION FOR DWELLING
(Check One) Replacement Remodeling Reconnection
Name: 911-Abe�,u S. MLAOXS Phone Number 9,t, 4 bq ?4
MailingAddress; e5q':=)P1 P -P -00Q c�lez'y_ 60,6( (Work)
Email Q(Y)S4 Sil C 10 �Iahfp- C.,e)m
Detailed Directions To Site: it) L4 E -/b SD I S e 44 ovi 90) , r 10 pq-� "-)v-)
Property Address: r] ve-ek e—pa d
Please Fill In The Following Informati bout The ST#YG Facility:
Name System Installed Under: D, :7 A4 4 If /V ___jype Of Facility:
Date System Installed (Month/Date/Year): C;;? -16 -a00a. Number Of Bedrooms: Number Of People:
Is The Facility Currently Vacant? Yes �p If Yes, For How Long?
Any Known Problems? Yes (9 If Yes, Explain:
Please Fill In The F 11 informatign About The NEW. Fa !!ligto
- w tIq 60a -
ZT0 gu 0� _11ber Of Bedrooms:
Type Of Facility- Number of People
,3 -C-;7
Date Requested: 3 -le
Requested B
(Signature)
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time. -
Payment: Cash Check Money Order # Amount:$ tOO -00 —Date:,
Paid BY: Received By:
Account Invoice #: &at MA __� 13 0
PE-tq c,,-,
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DAVIE COUNTY 111EALTH DEPARTMENT
Environmental -Health Section
P. 0. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 2 9'
IMPROVEMENT(OPERATION PERMIT
Account #: 989900259 Tax PIN/EH #: 5789-52-9767
Billed To: David Mallard Subdivision Info: Falling Creek Farms Lot # Lot 2
Reference Name: David Mallard Location/Address: Peoples Creek Road -27006
Proposed Facility: Residence Property Size: 134x264x180
ATC Number: 2136
**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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment an&Disposal Systems). THIS
PERMI'T 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 #People #Bedrooms #Baths
Dishwasher: 171"" Garbage Disposal: r2-' Washing Machine: Cy"_ Basement w/Plumbing: 0'*' Basement/No Plumbing: 173
Commercial Specification: Facility Type #People _ #People/Shift #Seats Industrial Waste: El
Lot Size qgo, iovo�t`r.4 ,,,Type Water Supply C-40 Design Wastewater Flow (GPD) Z-) Site: New2o"""Repair C,
System Specifications: Tank Size le0b GAL. Pump Tank GAL. Trench Width Rock Depth /j Linear FtZf"4W'
Other:
Required Site Modifications/Conditions:
k
IMPROVEMENTIOPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTEIL 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.****
L---
1
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #:
989900259
Tax PIN/EH #:
5789-52-9767
Billed To:
David Mallard
Subdivision Info:
Failing Creek Farms Lot # Lot 2
Reference Name:
David Mallard
Location/Address:
Peoples Creek Road -27006
Proposed Facility:
Residence
Property Size:
134x264x180
ATC Number: 2136
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUC71ON
**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 I I of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWAVR CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
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 I I 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-afti-me.
N- D
Septic System Installed By:
Environmental Health Sp�ta S Signature: Date:
DCHD 05/99 (Revised)
APPU ON FOR SITE EVAURTION/lIMPRO1 IT& ATC U
Davie County Health Department
77 -6 1999
1 Ae� Envirvnmenfal Health S&Won AUG
P.O. Box 848/210 Pospital street
Mockaville, NC 27028 ENVIRONMENTAL HEALTH
(336)751-8760 DAVIE COUNTY
***ZXP0RTANT*** THIS APPLICATION CAMOT BE PROCESSED MMESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFOM&TION BULLETIN for instructions.
1. Name to be 811164 �d Contact Person
Mailing Address Rome Phoneq 4- 791 -7 -7
CLty/State/ZXP "/I Z et?02"ss Phone
2. Name On PG=it/ATC it Different than Above
Mailing Address
city/state/zip
3. Application For: J"ite Evaluation 1XImprovement Permit/ATC
4. system to Servicat V House 0 Mobile Home 0 Business 0 Industry
5. If Residence:
XDishwasher
# People 17— # Bedrooms --S*
11 Garbage Disposal 'A Washing Machine Bassmant/Pil—bing
6. Xf Business/Xndustry/other: Specify type
# Commode* # Showers
# Urinals
0 Both
0 Other
# Bathrooms -5
a Basement/No Plumbing
# People # Sinks
# Water Coolers
IF FOODSERVICZ: # Seats Estimated Water Usage (gallons per day)
7. Type of water Supply: County/City 0 Well 0 Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 yes 0
If yes, what type?
'IMPORTANT"* CLIENTS MUSTCOMPLETETHE RE9117RED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUSTBESUBAHTIED by the client with THIS APPLICATION.
Property Dimensions: -31 'Oor '5;-eu V Z I IgbR
Tax Offlce PIN:
Property Address: Road Name
City/Zip
U In a Subdivision provide Information, as follows:
WRITE DIRECTIONS (from MockrAlle) to PROPERTY:
(:7�e 1Z
Name: C/14ee
0
Section: Block: ilot�-5—� Date Property Flogged:
This 497to ce4 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 changedL I, afto, understand that I am responsiblefor all charges Incurredfrom
this amlication. 1, 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 Sul ' )
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SM PLAN (include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Zov
jc-
HD 0
Site Revisit Charge
I Date(s):
I Client Notification Date:
IERS:
Account No.
Invoice No.
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
Davie County Health Department
Environmental Health Section
UG
P. 0. Box 848 AUG 6 1997
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed klla5� I/ Zy, Contact Person 6;,)4
Mailing Address 5_62JV� .5 til )a Ayr 6/ Home Phone
9 9g,-116-7
City/State/Zip U;111�yd Q Z/V,3 Business Phone
2. Name on Permit/ATC if Different than Above 54mie_
I'viailing Address City/State/Zip
3. Application For: 2 ---Site Evaluation El Improvement Permit & ATC
4. System to Serve: 0 House 0 Mobile Home Q Business 13 Industry
5. If Residence: # People # Bedrooms
Q Dishwasher El Garbage Disposal 0 Washing Machine 0 Basement/Plumbing
6. If Business/Other: Specify type # People
# Commodes # Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimaked Water Usage (gallons per day)
7 7ype of water supply: El County/City El Well El (ommunity
-8. Do you anticipate additions or expansions of the facility this system is intended to serve? El' Yes C3 116.
If yes, what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** A PLAT OF THE PROPERTY MUST BE
' i
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: qq, 7q Atte--s WRITE DIRECTIONS (from .:.- - --
Mocksville) TO PROPERTY.
'I -ix Office PIN: # �5 7 99 63 _�s7o3
e-
Pr.op. rty Address: RoadName
ow 9161
City/Zip Admnld�=q / 0-:
41 Ae
If in Subdivision de information, as follows:
;3 ycr
7,4 PP. JQ
Name: �Zllg eel?" tp
Section: Lot #:
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. 1, also, understand that I am responsible f6r all charges incurred from this application. I, hereby, give ci. isent to
W,- 1
the Authorized Representative of the Davie County Health Department to enter upon above described property located in D_ v1-- County
and,owned by a to conduct all testing,,,procedures
as necessary to determine the site suitability.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION--/ LOT-�2
Soil/Site Evaluation
APPLICANT'S NAME DATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION ROAD NAME
Water Supply:
Evaluation By:
On -Site Well
Auger Boring
Community
Pit
Public �
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON 11 DEPTH
Texture group
Consistence
77 -
Structure
5:� -t
V A
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: A�
LONG-TERM ACCEPTANCE RATE: j
REMARKS:
DCHD (0 1 -90)
EVALUATION BY: Al Z'
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 Sl - 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 F1 - 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 AB K - 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
j -4T
31C.A.
NOI-19'05"E
505-11'
p7w
00.0c,
T '126 Lr)
-0c
6
L692 Ac.= c,
J� 1-301
:3.3-
Dote �Dwner s 5.quorur
6010 0—er's Signewro
9-18-78 -
Dots Owner s Signature
VJCIrViQW 060kWAk" T COMOA 4y
6-59,
59
I"
0 , d,
t4 18'
3:
. zi
77
2 6 3 B
------ 67 BO'
'3'
L
—693 Ac.t.
I../ (CI
'9 <".6a
. C
'8-.34'
61.52'
N04*16'0C"F
cZ A
7-
M Parce 44
oficcte
B ' 7 3, g 8 Cd er' C1 App -ova, ry P Z—ir� Board
-Ie D(2,,e Cou,,Ty Pio—r; SocrC lereoy opD,c,,es the
(J/ Record Plot for roll,nqCreek �orn- SuDd;vi3ior
Ric,or- Y Toitert .0
Date Cr'c-'rmc 'Ity P,
ann,nq Boa,c
C
mar. 0,
L OCA TIO
N
NOTE
Me �wy is r
ducLosed by a ttU
furrAshed rrto as o
.Wrn%*�Jx. �Vhgs
assesr,nengs. V an
"cord tn Ch. Offsc
of Cou�t. rown or
have bem acquired
NOTES
I All distances Sho,4
ground distances.
2 All boarLngs sha
deed or
tj,l,at,,b an?
3 Iran s 3 ot at
patnts, unless not
4 There are NO N C
of Project
5 Total Area - 34 1'
6 Total Number of 1,
7 Average Lot S%xG
8 Existed Zontnq -
9 Minimum Building
Front
sute
Rear
Side Street
10 Utilities
Public water %
Pmvat, septic
All utilities "
Pavement vAdt
I KrKNn
ZIP ..... . . Zxteftng
NfP .......... Vs— 3�14
st�. - . Old Pta"t
,REBA R..... Zww ting
found u,
pt ..... ... P&tnt c,n
found or
FALLINCC
PHA�
0 WNERIDI
WESTVIEW DEVELOI
TAITTINCER DEVELOI
2631 REY!
WIAISTON-SAL
50 16o'
KT/CJ
U)
7 C) 4 .4
Cc.
z
I
N
5J
(10
99,
692
F
QQ
3,6921 AC.±
S 5 TC
�0
7
I"
0 , d,
t4 18'
3:
. zi
77
2 6 3 B
------ 67 BO'
'3'
L
—693 Ac.t.
I../ (CI
'9 <".6a
. C
'8-.34'
61.52'
N04*16'0C"F
cZ A
7-
M Parce 44
oficcte
B ' 7 3, g 8 Cd er' C1 App -ova, ry P Z—ir� Board
-Ie D(2,,e Cou,,Ty Pio—r; SocrC lereoy opD,c,,es the
(J/ Record Plot for roll,nqCreek �orn- SuDd;vi3ior
Ric,or- Y Toitert .0
Date Cr'c-'rmc 'Ity P,
ann,nq Boa,c
C
mar. 0,
L OCA TIO
N
NOTE
Me �wy is r
ducLosed by a ttU
furrAshed rrto as o
.Wrn%*�Jx. �Vhgs
assesr,nengs. V an
"cord tn Ch. Offsc
of Cou�t. rown or
have bem acquired
NOTES
I All distances Sho,4
ground distances.
2 All boarLngs sha
deed or
tj,l,at,,b an?
3 Iran s 3 ot at
patnts, unless not
4 There are NO N C
of Project
5 Total Area - 34 1'
6 Total Number of 1,
7 Average Lot S%xG
8 Existed Zontnq -
9 Minimum Building
Front
sute
Rear
Side Street
10 Utilities
Public water %
Pmvat, septic
All utilities "
Pavement vAdt
I KrKNn
ZIP ..... . . Zxteftng
NfP .......... Vs— 3�14
st�. - . Old Pta"t
,REBA R..... Zww ting
found u,
pt ..... ... P&tnt c,n
found or
FALLINCC
PHA�
0 WNERIDI
WESTVIEW DEVELOI
TAITTINCER DEVELOI
2631 REY!
WIAISTON-SAL
50 16o'
KT/CJ
Cc.
z
I
I"
0 , d,
t4 18'
3:
. zi
77
2 6 3 B
------ 67 BO'
'3'
L
—693 Ac.t.
I../ (CI
'9 <".6a
. C
'8-.34'
61.52'
N04*16'0C"F
cZ A
7-
M Parce 44
oficcte
B ' 7 3, g 8 Cd er' C1 App -ova, ry P Z—ir� Board
-Ie D(2,,e Cou,,Ty Pio—r; SocrC lereoy opD,c,,es the
(J/ Record Plot for roll,nqCreek �orn- SuDd;vi3ior
Ric,or- Y Toitert .0
Date Cr'c-'rmc 'Ity P,
ann,nq Boa,c
C
mar. 0,
L OCA TIO
N
NOTE
Me �wy is r
ducLosed by a ttU
furrAshed rrto as o
.Wrn%*�Jx. �Vhgs
assesr,nengs. V an
"cord tn Ch. Offsc
of Cou�t. rown or
have bem acquired
NOTES
I All distances Sho,4
ground distances.
2 All boarLngs sha
deed or
tj,l,at,,b an?
3 Iran s 3 ot at
patnts, unless not
4 There are NO N C
of Project
5 Total Area - 34 1'
6 Total Number of 1,
7 Average Lot S%xG
8 Existed Zontnq -
9 Minimum Building
Front
sute
Rear
Side Street
10 Utilities
Public water %
Pmvat, septic
All utilities "
Pavement vAdt
I KrKNn
ZIP ..... . . Zxteftng
NfP .......... Vs— 3�14
st�. - . Old Pta"t
,REBA R..... Zww ting
found u,
pt ..... ... P&tnt c,n
found or
FALLINCC
PHA�
0 WNERIDI
WESTVIEW DEVELOI
TAITTINCER DEVELOI
2631 REY!
WIAISTON-SAL
50 16o'
KT/CJ