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191 Falling Creek Drive Lot 15Davie County, NC r Tax Parcel Report Wednesday, December 21, 2016 WAKNINU: 'Yfflb 1, 1VU1' A bUKVEY Parcel Information Parcel Number: H9080A0015 Township: Shady Grove NCPIN Number: 5789631628 Municipality: Account Number: 82513201 Census Tract: 37059-804 Listed Owner 1: HORNE JASON SCOTT Voting Precinct: EAST SHADY GROVE Mailing Address 1: 191 FALLINGCREEK DRIVE 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 15 FALLINGCREEK FARM PHASE I Fire Response District: ADVANCE Assessed Acreage: 0.82 Elementary School Zone: SHADY GROVE Deed Date: 10/1999 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 003160525 Soil Types: PcB2,PcC2,WATER Plat Book: 0007 Flood Zone: Plat Page: 048 Watershed Overlay: DAVIE COUNTY & Extra Building Value: FOreatuires Value: Land Value: Total Market Value: Total Assessed Value: 9p �O ti p'C4 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. u� . . 21 °L, rtUTIRIZATION NO: 155 6A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's" - j� P.O. Box 848 (' Name: Yi �l (!J n(�.- Q Mocksville, NC 27028 Subdivision Name: � AL' -ftJV L , Phone # 336-751-8760 / Directions to property: �`� '�`�- �� Section: Lot: c- f , AUTHORIZATION FOR r C N.1 1 ! U: S 64' /aNn WASTEWATER -+ SYSTF. CONSTRUCTION Tax Office PIN:# Jp ! Cn Road Nam e:[;('C **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 complialfc r' ith,Article 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) II�f `/ .^^+ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS, ENVI OrfMLiNTAL HEALTH S CJALIST DATE SSUED +F :,g,,, F y rt.: a.-� .S_ --;I` _ n `-rrrw,., ..i' F y w � Y. rjr „ ,:c„J . s . �.c, -F4. ,V. ,.: •. : .rp ` r -r w ;��..bp-1t° �J DAVIE COUNTY HEALTH DEPARTMENT «,r*+r• '" Y��' TMPROVEIIENT AND OPERATION PERMITS PROPERTY INFORMATION •»•*� j' Name:` � >i Subdivision Name: Directions to property: .. % Section: Lot: IMPROVEMENT f • Er.'�"'PERMIT' 1; +' r3 is f !VC awt a Tax Office PIN:# - �' j I f •' R L. I ,� '{" �~ �k� i t �7f_.� ' `, .,.: f Road Name: s ` Zip: rr t **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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 II of G.S.Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems) { I ..�.•---- ***NOTICE*** THIS PERMrr IS SUBJECT TO REVOCATION IF SITE. _.. _ , • ", �• e/%v PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST, ' DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE# BEDROOMS_ # BATHS C• #OCCUPANTS GARBAGE DISPOSAL: Yesr No COMMERCIAL SPECIFICATION:. FACILITY TYPE / : # PEOPLE # PEOPLE/SHIFT ^ # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE` PE WATER SUPPLE " ' ' 'DESIGN WASTEWATER FLOW (GPD) ~ y NEW SITE � REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE I M GAL. PUMP TANK - GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT:.-ao OTHER &X1 0i I, REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 Vow od CVdTW, 121 r' k ' ©6t— " "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M: ON THE DAY OF INSTALLATION. TELEPHONE # ISX=)Mjdit$ tMS) 75JL-8760 DCHD 05/96 (Revised) t - APPLICATION FOR SIZE EVALUATION/IMPROVEMENT PERMIT & ATC t5 Davie County Health Department Envirvamenfaif/ea/fh Sbciion APR 3 0 1999 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 113361751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IIWORTANT*** THIS APPLICATION CANNOT IM PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Dame to be Billed 7kq y d s. Igo Contact Person Mailing Address, z(i!^l��1 nn Bcme Phone City/state/ZIPS6, ; j �% I► ` �70 Z3 Business Phone 336 9 7 s 7 g Z. Dame on Permit/ATC if Different than Above !tailing Address City/state/Zip 3. Application For: U Site Evaluation T`Improvement Permit/ATC 0 Both a. system to service: House ❑ Mobile Home 0 Business 0 Industry 0 Other a. If Residence: 9 People 4 Bedro���oms - • Bathrooms XDishwasher O garbage Disposal 'XWashing Machine p Basement/Plusbing U Basement/Do plumbing S. If Business/Industry/Other: specify type / ' / People / sinks # Commodes # showers # Urinals i water Coolers IF FOODSERVICE: # Seats Estimated crater Usage (gallons per day) 7. Type of water supply: County/City ❑ well ❑ Concrunity e. Do you anticipate additions or expansions of the facility this system Is Intended to serve! 0 Yes ,N No If yes, what type.' ***IMIaORTANP**CLIENTS MUSTCODIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBA11ZTED by the client with THIS APPLICATION. Property Dimensions: � �5 X/ e, -UO 4 `� WRrM DIRECTIONS(from Mocluvtlle) to PROPERTY: TaxOfncePlN: #�7 '�`Ct?r�LC /tom Vol (+PEZ--' Property Address: Road Name DD ��-2af-��{'S- 4�1-e421�' City/Zip if in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: .This is to certiry that the information provided is correct to the best army knowledge. 1 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 al/ charges Incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Depagiment to enter upon above described property located in Davie County and owned by �`� Ze �<--t !L �IA��rr�/ to conduct all testing procedures as necessary to determine the site sur .•.01 DATEr�� '�SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN property lines and dimensions, structures, setbacks, and se c los C Revised DCHD (07/98) (include all of the following: Existing and proposed ! , enAccount No. S a s 9 Invoice No. �� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department IN' L5 Environmental Health Section P O. Box 848 AUG - 6 1997 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEd UN ESS ' W / sALL/o�.,THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed e� // %c u.) �ie✓2�ox � �,y, Contact Person G PA =E5-— .4 p�J / cam% Mailing Address 2 ,STs -5-A5- h a � 6 rd 2e Home Phone 'r City/State/Zip U; 1V -5 �V rt/ -5,4ke-, /fit e . Q 749 3 Business Phone 2. Name on Permit/ATC if Different than Above 5S 4 mg— Mailing Address City/State/Zip 3. Application For. a 63' Site Evaluation ❑ Improvement Permit & ATC . 4. System to Serve: j ❑ House ❑ Mobile Home ❑ Business ❑ Industry 5. If Residence: # People # Bedrooms '6 >1 G Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing 6. If 1.3usiness/Other: Specify type # People _ # Commodes # Showers # Urinals ❑ Both ❑ Other # Bathrooms ❑ Basement/No Plumbing # Sinks # Water Coolers Y If :7oodservice: # Seats Estima.ted Water Usage (gallons per day) a 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ .Yes " - ❑ No' If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE -- SUBMITTED WITH THIS APPLICATION. Property Dimensions: qq, 7q jooz,,-e 5 Tax Office PIN: # 7 g!j - 63 _ --7o3 Property Address: Road Name -F-"=&a=/ � CL - City/Zip 4;4we If in;Suivision provide inform tion, as follows: bd ..,dip A)6:'- ,t1R»j�A }��"o" /� 03 i / 7.5 Name: Section: Lot #: S� WRITE DIRECTIONS (from Mocksville) TO PROPERTY: This to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 afalsified 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 iri Davie County ' and owned by C 4j to conduct all testing procedures as necessary to determine the site suitability. r., 'A" DATE SIGNATURE _ r Revised DCHD (06-96) L Ck y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME 111nr PROPOSED FACILITY SUBDIVISION r C �e e Water Supply: Evaluation By On -Site Well Community / Auger Boring Pit ✓ SECTION_ LOT DATE EVALUATED d ��//�% PROPERTY SIZE / ?��C ROAD NAME Xt Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure le - 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 c SITE CLASSIFICATION: /'*_1 LONG-TERM ACCEPTANCE RA REMARKS: DCHD (01-90) LEGEND Landscaue Position EVALUATION BY: JAI. `Z/1 OTHER(S) PRESENT: 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 NOC 36'43""1 C, ''34 64' C-33 22C.�� _ o`o 1254 4 r "' v' Z ` 7 0 703 Ac.s ^. r 860 Ac.t 3;'� 235.09' u N er °23 f s c ["Y� 69P � NO -3"40"E z� oa 3 _ 0.970 Ac.t -(D° co U' /^ (N 64 Do It Z C-9 cv N 0 723 A.c.r 00 CO z 200.35' PL � N05'23'27"t In \ � c' - EX'S' NG pONO - Q�. \ ---jC-6 LP 0.692 Ac x C�� N o' NC3'39'35"E oc C 089 O� 3 680 Ac 1 \ 0�Q 0 `-- ti02'C3'2C"_ 896.4 Parce 4`_ Rcympr:: 1.4yer5 DB 97, 904 R/W CJRVE 'ABLE rCuRVE i RADIUS i �-ENG'H CHC C—' 27000 i 21 C-2 530.00' 69.61' r 69. C-3 35.00' 26.73' 26. C-4 55.00 62.69' 59. C-5 55.00' 45.94 44. C-6 55.00 30.39' 30. C-7 55.00 73.71' 68. C-8 1-9 j 55.00 35.00`— y 44.08' 26.73 42 26. C-10 470.00' 8.44' 8. C-11 470.00' —� 53.29 ! 53. C-12 530.00 36.92 '. 38 530.00' 104.88' 104 C� 14 i 530.0Or 9.64' i 9. C- 15 53C.C^ 95.4F' 95. Lt) `. 1 123 1 N N 2g Njr OAB '00a 'CB) 1 Y ao • 125 Y i N N N fk 0 28 � vy 124 l' ° pROp0 EO + 0 65 0 6 94'�2 = 1 59 76' 61• 0 N tl N O o• ^? W 94 21' 123 CPROPOS 9� 40• 13� J, O12,W Z �(' ( is 1 e✓L // 0; �N 23g. y N 16 15 Yti o 12.ro . -A 2 N X a)O 60 \ V N YTrI 00 165 ?71' 130' 00� 11 • 467' 172 Go �- %J.✓o 1 � t • EXISTING �-p,KE o 252 w a5 ' 760f -Q. '0 �� ^o No2•o�' � Z .. 104 SEP i 2010 Inty Health Department rental Health Section P.O. Bot 848 210 Hospital Street Courier # : 09-40-06 locks,,ille, NC 27028 Plione: (336) - 753'- 678 Fac: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: ���( r Gn�erp�; vs 5ryc. Phone Number -33 to 3 `i ,S oq un (Home) Mailing Address: q' -j-1 a 4 ., C�_ f t rc f cL (Work) M d O ­.\y \t WC 2 -7 0? S Detailed Directions To Site: (-( To got -no Pe 0; (. g Cree- it Pel 7D F4 1). nr Cres ic Or- oil cor Property Address: U Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: _) rn soy, Obrrn(_ Type Of Facility: Date System Installed (Month/Date/Year): Number Of Bedrooms: 3 Number Of People: Is The Facility Currently Vacant? Yes 0 Any Known Problems? Yes & If Yes, If Yes, For How Long? Please Fill In The Following Information About The NEW Facility: Type Of Facility: Two Jury Ad d ,'t-vh &_nraorn c 0 FIC; 4 i Number Of Bedrooms:Number of People Pool Size: Garage Size: Other: / X zy (. // -dose AAo1oer A� `1 C -e Requested By: WV1a Date Requested: 9-)3-)?) ignature) For Environmental Health Office Use Only Approved, Disapproved Comments: Environmental Health Specialist1, &C /, ��..Date:��'` U/ *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: CashChec Money Order # Paid By: Q Ayi/,-1cher Account #: .12(01A Amount:$ Received By: Invoice #: �% 7 7 Z- Date: �7