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126 West Rolling Meadow Road Lot 11Davie Countv. NC Tax Parcel Renort Wednesday December 21- 2016 WARNING: `1'IUS 1S NOT A SURVEY Parcel Information Parcel Number: H9080A0011 Township: Shady Grove NCPIN Number: 5789539306 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 11 FALLINGCREEK FARM PHASE I Fire Response District: ADVANCE Assessed Acreage: 0.68 Elementary School Zone: SHADY GROVE Deed Date: 10/2002 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 004430967 Soil Types: PcC2,WATER Plat Book: 0007 Flood Zone: Plat Page: 048 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Building Value: Freatures Value: Land Value: Total Market Value: Total Assessed Value: 161 1�T 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 l� C or arising out of the use or inability to use the GIS data provided by this websIte. Davie County Wealth Department Environmental Wealth Section Po sox 848 / 210 Hospital street Mocksville, NC 27028 Phone: (336)751-8760 July 6, 1999 David M. Hanes Contracting, Inc. Attn: David Hanes 301 Hanes Trail Advance, NC 27006 Re: Falling Creek Farm - Section H/Block 9 -Lot #11 Tax PIN: 5789-53-9306 Dear Mr. Hanes: As requested, a representative from this office visited the aforementioned site(s) on June 29, 1999. The purpose of this evaluation was to determine the soil/site suitability for the installation of an on-site sewage system Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, this tract was found to be unsuitable for the installation of an on-site sewage system for the following reason(s): Rule .1940(d) — Topography/Landscape Position; Rule .1945 — Available Space. Due to the limitation(s) on these sites, this office is not aware of modifications or alternative measures that can be implemented at the present time to upgrade the classification from "unsuitable" to "provisionally suitable." Your application for Improvement Permits must, therefore, be denied. You have the right to an informal review of this decision by the Environmental Health Director of this office and also by the regional staff of the Department of Environment and Natural Resources. You should contact this office to arrange for this further review. You may also wish to obtain the services of a private consultant to collect site- specific data and submit such data and a system design to this office for technical review. A site may be reclassified to provisionally suitable provided written documentation, including engineering, hydrogeologic, geologic or soil studies indicates to this office that a proposed on-site sewage system or a proposed alternative system can reasonably be expected to function satisfactorily. The substantiating data from these studies must indicate that: A) The effluent(wastewater) will receive adequate treatment; 13) The effluent(wastewater) will not contaminate any ground water or surface water; and C) The effluent(wastewater) will not be exposed on the ground surface or be discharged to surface waters where it could come into contact with people, animals or vectors. Finally, you have the right to a formal appeal of this decision if you file a petition for a contested case hearing with the Office of Administrative Hearings, PO Drawer 27447, Raleigh, NC 27611-7447. A copy of a petition form can be provided to you on request. The petition must be received by the Offipe of Administrative Hearings within thirty(30) days of the date of this notice. The hearing may be held in Davie County. If you file a petition for a hearing, you must send a copy of the petition to Mr. Richard Whisnant, J)ENR, Office if General Counsel, PO Box 27687, Raleigh, NC 27611- 7687. If you have any questions, feel free to contact this office at (336)751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section enc(s) APPLICATION FOR SrrE EvAmATiowiMPROvmw PERMIT & Davie County Health Department CCeI� �lwlEnvironmentafi /Heal Seddon P.O. Box 848/210 Hospital Street �Ei✓t�".�9 Mocksville, NC 27028 -r6 (336) 751-8760 1. 2 D L9c5t9uvLig .0 2 4 ImL.D ***1HPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed �Aylea tYl. Ar.Zt .rA,,e,4)24 Mailing Address city/state/z=p\ ps O Uo-hL h 1. C. -7-220C. Name on Permit/ATC\if Different than Above Mailing Address 3. Application For: ^ite Evaluation 4. system to service: D House ❑ Mobile Home 5. If Residence: dishwasher # People J Contact Person Some Phone Business Phone 3 C Ci to/Sip LQ�Xrovement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other t Bedrooms 3 # Bathrooms J�KG&Xbage Disposal Dashing Machine ❑ Basement/Plumbing aasemsnt/No Plumbing 6. If Business/Industry/other: Specify type # Commodes i Showers f Urinals 6 People # Sinks t Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: 36ounty/City ❑ Well ❑ Community 9. Do you anticipa4e additions or expansions of the facility this system is intended to serve? ❑ Yes [ - N -0 - If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: % d x 1(2 �' G 92�WRITE DIRECTIONS (from Mochsville) to PROPERTY: Tax Office PIN: # J.�— / �e i.,ci kO "1 +a Pohle t Property Address: Road Name&� l �li'Vti e off A 0-J Cr e-rk 1301-1 To r Pa City/Zip n VLH ce, -J• L. a?ooc- If in a Subdivision provide information, as follows: n e4j o 'J Name:�u��c.re2/+_ Section: �t Block: i Lot: I I Date Property Flagged: 6 12 � l91 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 to conduct all testing procedures as necessary to determine the site suV*bktty. A DATE—1 I ,L' A-11 SIGNATURE ,ILS L�,- 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). T evised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EHS: Account No. Invoice No. ND .-4-5'1y` AVATM CAROLINA DSPARTNSNT OP TRANSPORTATION PLAMW DSPART1rSA7/MY/S► OPP/CSR SUAYS"AS CZATI1/ MON L- .fir. �Wrnr.r r•rpn w.r..lyL.rwyy r w. DAPI! COUNTY AWISfSR OP DSSAT DIVISION OP NXNrATS PINAL SUSDNISION PLT APPAOYAI, LJ r R. 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L0.r~1w ar•w t Art rY ►rr.r� •7 •.fry r w wrwrWrw y •wMW ~ • +�r 'ii.�M..rrr+ .""'rir w r�Y �• r r rP+.r. •1 • www�wa Rr 7 •wr•r r wM W r .. •..r. r r.r • .rP.r _ rrwarr• r r• an v ar P./rrr rw• r r �.•rw .•r•r a Jl. �... f Aaeumr1! wit1•w ra V �LirHr.s � � r� —L I /'�� r �� !ra• lw wlt �iy� ArAf IWYIT IwLI NIwYIY -!I•ff OepAr CRAM -POAWM OIIYJT W.r �(e� - �� I r • ',I tri. b•.s : �.�� � �.�.."r ' w. urr•A' c �,.• v � ►•sue •z: �� C, ' ,p tq•7t H SITE MwfrMh�• f{Iw4yT (rMAMV 0 \\�QF L.— ��Gir, --- — � �' FALLINGCREEK DRIVE--Am�o'ost �-�_ �� r ':-•r M �?�� seat — o —. �..< .T�e,�— 505M 0 703 Ac 235 C", u V 12 0 713 he ! . d 100 350 c� ' r t pot 11• . , " ' A 10 06#2 Al'A"J dW r 1S1 11' 'r N NO 3'31.35*1 010 J 6e0 Ac as$ 42• tolAt —el /ti (op F.4cuN�c e c F•a AtM DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900641 Tax PIN/EH #: 5789-53-9306 Billed To: David M. Hanes Contracting Inc. Subdivision Info: Fallling Creek Farm H/9 Lot # 11 Reference Name: David Hanes Location/Address: Rolling Meadow Ro d- 006 Proposed Facility: Residence Property Size: 15 (X9 0 Date Evaluated: S Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 .3 4 5 6 7 Landscape position Slope % 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: LONG-TERM 1A'CCEPTANCE RATE: REMARKS: _ITIS `rR ISS�t, Landscaue Positio EVALUATION BY: OTHER(S) PRESENT: Die P'�T 'Paw--, I - LEGEND 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 Mois 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 ICHD (Revised 05/99) ■■■■■■■■■■■■■■■■■■■■■■■■ ■/NOON■■/■■■/■■/■/NOON■■ ■M■MMM■MM■■■MM■■■ ■ENE■ ■/■■■/■/NOON/■■/■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NONE ■■N■ ■E■■ MONO NONE MONO MEMO ■■N■ NONE ■M■■ OMEN ■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ IMEMEME MEMEMM MEMNON� ' MOMMEN0 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■NEEM■■■ ■■■E■■■■ ■■■■■■E■ ■E■■E■E■ ■■■■■■■/■■■ ■■■■■E■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■y■■■■■■ ■E■■■■■■/■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■N■■■N■■■■N■ ■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■ ■■■■■N�MEMNON ■■■■■■■■■■■■■■■■ ■■■■■■■■U■■■■■■■ ■■■■■■■■M■■■■M■■ ■M■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■U■■■■ ■■■■■■■■■■■■M■■■■ ■ ■■■MEMO■■■■ ■■■■■■■■■■■ ■■■■M■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■MENU■ ■O■■M■■■■■■ ■■ i ■ i ' - .4 • APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT 'I)IQ? n : - Davie County Health Department EF Environmental Health Section P O. Box 848 G — 6 1997 , Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE ALL THE REQUIRED INFORMATION IS PROVIDED. •i ' / � P�or�C Contact Person G V IA 1. Name to be Billed W �s // %c ul �iey n, ''wiling Address 22,5- .s% P b � 6z,- ZL Home Phone E City/State/Zip ��� +vs �N �i4 nI LO , " Q 770 3 Business Phone 2. I` :me on Permit/ATC if Different than Above 500 m -e— Mailing Address City/State/Zip 3 Application For: Site Evaluation ❑ Improvement Permit & ATC ❑ Both .l 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 i j 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 Cl Community 3 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes f ❑ No' If yes, what types { •i s PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUSYBF, SUBMITTED WITH THIS APPLICATION. p D' C%q Z 7d ko- e, WRITE DIRECTIONS (from .•rty tMUM tons. I • Mocksville) TO PROPERTY: 'fax Office PIN: # �5 7 gJ L iG Prop: rty Address: Road Name -F-a-�o GLw-k CL �/� t d P;A City/Zip / JV I4W to If in Subdivisionprovide inform tion, as follows:4)0 t Y6 QA -1 { Name: f y.< Section: Lot #• I 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 { ^° to conduct all testing procedures as necessary to determine the site suitability. DAT:: V -6 •' S 7 SIGNATURE RevLad DCHD (06-96) �.�C� -1A,S f • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION__ LOTS Soil/Site Evaluation APPLICANT'S NAMEzv- PROPOSED FACILITY �► SUBDIVISION y (/ e .0 h Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit 41---- DATEEVALUATED PROPERTY SIZE ����"C 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 �- F Texture group' Consistence .� Structure l 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: DCHD (01.90) EVALUATION BY: 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