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131 Falling Creek Drive Lot 5DaV;A rn„n4cr 'NT(' 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: WARNEN T: '1'Mb 1J P (Y]L' A bUKVhY Parcel Information H9080A0005 Township: Shady Grove 5789621848 Municipality: 82513293 Census Tract: 37059-804 HENDRIX RONALD DAVID Voting Precinct: EAST SHADY GROVE 131 FALLINGCREEK DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006-7655 Voluntary Ag. District: LOT 5 FALLINGCREEK FARM PHASE I Fire Response District: 0.68 Elementary School Zone: 11/1999 Middle School Zone: 003190835 Soil Types: 0007 Flood Zone: 048 Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: No ADVANCE SHADY GROVE WILLIAM ELLIS PcB2 DAVIE COUNTY 9� rap N �L Davie County, NC All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the 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 or arising out of the use or Inability to use the GIS data provided by this website. F .� i 7 1 eA :t`4 it I'•i. �� aw y-.,. 1 � ; y� r A1W4b0kATI6N N6:1''� 6 7 8 DAVIE C LINTY HEALTH DEPARTMENT . Environmental Health_ Section PROPERTY INFORMATION Permittee's ., ► P.O. Box 848 Name: - "� Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: " ' i� r �" �fr� Section: AUTHORIZATION FOR WASTEWATER Tax Office PIN: #4C?940 - SYSTEM CONSTRUCTION Road Name: .► p: `/� l%tO **NOTE**This Authorization for Wastewater System Construction 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 l l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH S ECIALIST DATE ISSUED DCHD 0996 (Revised) If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ` p ❑ Well ❑ Community 8. ho you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes } ;❑ No u If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. " APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT y Davie County Health Department p Tax Office PIN: # ? 63 __5703 Environmental Health Section Property Address: Road Name-�'L.a./ CJ1:e2��ei.• P 0. Box 848 AUG — 61997 City/Zip AdUi4Wee Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE If in Subdivision provide inform tion, as follows: ALL THE REQUIRED INFORMATION IS PROVIDED. : 1 ' 1. Name to be Billed // / U�s� !/ %e teJ �eyP�ox '�n, Contact Person G �,a 1 Nailing Address e2R tS 5LaJVA Home Phone 4 City/State/Zip i +�/s �N d/ -5044 Ate, Q 749 3 Business Phone 9 9 6 7 1 .. 1 2. Name on Permit/ATC if Different than Above 54 m 6_ Mailing Address City/State/Zip 3. Application For: OSite Evaluation ❑ Improvement Permit & ATC ❑ Both 4. System to Serve: ❑ House ❑ Mobile Home ❑ Business ❑ Industry Cl Other—, -:" s 5. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washiri4Machine ❑ Basement/Plumbing ❑ Basement/N F'umbing ;1 6. If Business/Other: Specify type # People # Sinks j y.. # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ` p ❑ Well ❑ Community 8. ho you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes } ;❑ No u If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: q9, � 7q Ax ee•S 1 WRITE DIRECTIONS (from Tax Office PIN: # ? 63 __5703 Mocksville) TO PROPERTY: T j / Property Address: Road Name-�'L.a./ CJ1:e2��ei.• 1 t City/Zip AdUi4Wee . , If in 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 9 are s bject 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 Al,.thorized Representative of the Davie County Health Department to enter upon above described property located in, Davie County . . and owned by m to conduct all testing procedures 1 YI j1: as necessary to determine the site suitability. DATE .1-6-97 SIGNATURE Revised DCHD (06-96) A ".. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME�j PROPOSED FACILITY ,�/v SUBDIVISION �A (Ir' le Water Supply: On -Site Well Community SECTION 1 LOT S' DATE EVALUATED PROPERTY SIZE I A e ROAD NAME �C /��' �( Public Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 5 6 7 Landscape position 14, Sloe % .� HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH a- Q r 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: 45�� LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01.90) EVALUATION BY: 4Z OTHER(S) PRESENT: C `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 ty APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC )lv -Qju Davie County Health Department n 0 W E-Wronmenfal f/ea/th Section �4..1l�� fi P.O. Box 848/210 Hospital Street SEP 2 5 10 ty�R Mocksville, NC 27028 \` � (336) 751-8760 ENVIRONMENTAL HEAL' D 1' it l/ii MII.I ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for ^�instructions. 1. Name to be Billed J 2^ r y �%%l , t % Contact person Mailing Address �/ S"� e'7ea;L f?d Home Phone city/State/Zip /.p x�%A/ /V ,e. 2 72q.0 Business phone 33G- Z.7S' =62-6-0 2. Name on Permit/ATC if Different than Above $jE}i/7 Mailing Address City/State/Zip 3. Application For: 0 Site Evaluation G-Qrovement Permit/ATC 0 Both 4. system to service: 2' House 0 Mobile Home 0 Business 0 Industry 0 other s. If Residence: # People # Bedrooms #Bathrooms 4kishwasher 0 Garbage Disposal B-taaashing Machine 0 Basement/Plumbing Isasement/No Plumbing 6. If Business/Industry/other: Specify type # People # sinks # Commodes # showers # (Urinals # Nater Coolers IF FOODSERVICE: ii Seats Estimated slater Usage (gallons per day) 7. Type of water supply: BKCounty/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes If yes, what type? •"IMPORTANP" CLIENTS 11IUST COMPLETE TINE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the dient with THIS APPLICATION. Property Dimensions: pf IZA' A -aV 2?-/ 26 R -442- WR DIRECTIONS (from Mocksville) to PROPERTY: l'0 Tax Office PIN: # --'r :Z $'9 6 S % 63 Lf 5 1 on1 6q )-e J=7- o �U go FC - Property Address: Road Name ,l'o p�1 `R - .:ml �S City/Zip Z 7 () 0„L If in a Subdivision provide Information, as follows: Name: r:,241,wN Qr-ee i{ - - Section: Block: Lot: L" Orr 1' /7� /U t} N 1--P F Date Property Flagged: 9 - 2c, - ,Z_ 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 responsiblefor all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Heap epartment to enter upon above described property located in Davie County and owned bu I P_/.J to V. Co to conduct all testing procedures as necessary to determine the site suitability DATE 9 , -'Z5 - i I? SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclfide all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. I 9'- 07ZIInvoice No. CK Pb b. kg Ib3 t Ib4 — UOSTM POND �4\ Parod L \ / Do 162. Po Gw ,b �j a lu io m\\` s 240 / \ sp`-26 6� ~ F. © H \\\ 151.9.0' \ SW4rw'w— I SM,#,CD'w — 3'11' 23a9S i2LW ".11. \ /26 00