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211 Falling Creek Drive Lot 40Davie Countv. NC Tax Parcel Report Wednesday, December 21, 2016 2,1b ?f 232 `-214 230 231-- 233 211 .,235 232 199 198 -222 j 228 131 191 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 Courdy'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 161 NC or arising out of the use or Inability to use the GIS data provided by this website. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H908OA0040 Township: Shady Grove NCPIN Number: 5789642074 Municipality: Account Number: 82523034 Census Tract: 37059-804 Listed Owner 1: MONROE JAMES Voting Precinct: EAST SHADY GROVE Mailing Address 1: 211 FALLINGCREEK DRIVE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-7659 Voluntary Ag. District: No Legal Description: LOT 40 FALLINGCREEK FARM PHASE 11 Fire Response District: ADVANCE Assessed Acreage: 4.02 Elementary School Zone: SHADY GROVE Deed Date: 7/2004 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 005600052 Soil Types: PaD,PcB2,PcC2 Plat Book: 0007 Flood Zone: Plat Page: 0189 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 warranties of merchantability or fitness for a particular use. All users of Davie Courdy'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 161 NC or arising out of the use or Inability to use the GIS data provided by this website. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Envir»nmenta/HealthSoc ion P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 Dr �t OMR JAN 2 4 2000 ENVIRONMENTAL HEALTH DAVIE COUNTY ***SMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �MWbCyt-LOOMWI �(kY1MIJ1/ Contact Person &ANT GdaMCY Nailing Address 7A31 AYNswA NAP Home PhoneX793/,-760-2408 city/state/ZIP Mg$rC/V�LEWI , MC `�I Q� Business Phone 3��•1-t-t'oe7a 2. Name on Permit/ATC if Different than Above Nailing Address / City/state/Zip 3. Application For: Vsite Evaluation .,'Improvement Permit/ATC ❑ Both 4. system to service: eHouse ❑ Mobile Home 0 Business ❑ Industry ❑ Other 5. If Residence: #People #Bedrooms 3 # Bathrooms 1 O Dishwasher 17 Garbage Disposal ❑ Washing Machine (] Basement/Plumbing ❑ 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: ta'County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B'No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # 5789 " 64 --74 $-1---. Property Address: Road Name FALUNeWoc-N1v4 City/Zip A OOAVGE .,NLy7aX If in a Subdivision provide information, as follows: Name: FA LUN6Gt1.EC—f< Z.// Section: Block: Lot: cors 1713 q-41 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: /2- Z8- cl 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 % &TWO J QMc— M6W1 6 mQ IMI to conduct all %testing procedures as necessary to determine the site suitability. DATE l l Z3 Jia SIGNATURE 4" "A3� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of tob ifflowing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. f� Invoice No. 1.2- 2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002954 Tax PIN/EH #: 5789-64-2074.AR Billed To: Alex Rhodes Subdivision Info: Falling Creek 2 Lot # 40 Reference Name: Location/Address: 211 Falling Creek Drive -27006 Proposed Facility: Residence Property Size: 3.972 acres ATC Number: 3597 �3li:�Th�_I� C�.� Ci T[4Z93�>3�_ 001139) **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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: //f �� 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 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. Septic System Installed Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) •' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 - _ IMPROVEMENT/OPERATION PERMIT Account #: 990002954 Tax PIN/EH #: 5789-64-2074.AR Billed To: Alex Rhodes Subdivision Info: Falling Creek 2 Lot # 40 Reference Name: Location/Address: 211 Falling Creek Drive -27006 Proposed Facility: Residence Property. Size: 3.972 acres ATC Number: 3597 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS Olt THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths Dishwasher: K Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machinee Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) _�-?4ZL Site: New Repair ❑ System Specifications: Tank Size%[ GAL. Pump Tank GAL. Trench Width n�-Rock Depth, Linear Ft,3X Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYO - ' F ENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Conta prese vie unty Health Department for final inspection of this system between 8: 0 a.m. to 9:30 a.m. or 1:00 6 :30 p n. on the da tallation. Telephone # is (336)751-8760.**** eIv- / o o Q Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVAIIATION/IMPROVEMENT PERMR A ATC Davie County Health Department Environments/ Health Section P.O. Box 648/210 Hospital Street Mookoville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCIISSED UNLESS ALL THE REQUIRED Ih'MRMATION IS PROVIDED. Refer to the INSORt+S1TION BULLETIN for instructions. 1. Hams to be billed ^A OLVi-1 /t od Pis Contact person sL�Yittli Mailing Address �S o! / to ;n/sO�1/U �" some phone 2/04- �h /1900 e�� City/state/ZIP `��. �_�, n[- / Cy business phone _e&L_- / 2. Mame on Permit/ATC if Different than Abom Mailing Address City/state/sip "th 3. Application For: 0 Site Evaluation ❑ Improvement Permit/ATC 4. system to aerviee: 0 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. -If Residence: People Bedrooms I Bedroom�j # Bathrooms Y 3v garbage /age M Disposal .d Mashing Machine B'basemsnt/plumbing ❑ buement/Ho Plumbing 6. If Business/Industry/Other: specify type # People # Sinks # Commodes # Showers # Urinals # Mater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 6-County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facWty this system IS intended to serve? ❑ Yes ffNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 3, t p Tax Office FiN., // 751 - 6 Y�WZ7 - PR Property Address: Road Name `+v I 10me�Pr City/zip__AyAweP_ Ate 9 76,6 If in a Subdivision provide information, as follows: Name: _kg : ry iv 6 A4 Section: Black: Lot: WRITE DIRECTIONS (from MocksAlle) to PROPERTY: Cy Date Property Fagged: /0 -13 -a 3 - 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 if the information submitted in this application is falsified or changed 1, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie C Health Department to evter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine theite sultab ty. DATE 10 �� D3 SIGNATURE__ HIS AREA MAYBE USED FOR DRAWMG YOUR STTE PLAN(Include Il of the following: 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. g Invoice No. '� RFA CAROLINA DEPARTMENT OF TRANSPORTATION DIVISION OF HICNIFAFS P/tlr. IMA AU6p/y/paN QMt/KAfRIAD CaMrr#YIC'"`u` ' rfrlWRar /ON r A T :Sw.er.°ci:.« all, .y..Q-Sk�L+.__ not M IM tma.nynw h«eby e.•111y nkat W me !w own«. or the prop«t Owalbed kFlw4 .hob It meal.' w"'N 1M twaMuw Aw4aki of De14 County,' and that We -.by .dol this Nbd.4kwh Non wllh aw hw t=ut and wldhfM mhhnYm Wed" wlbech Fnw. and dedicate al slrwls. aleye, rola; .abs and H _ plc. and ees•mw t to P blk be private .s. as M.4. 7aittinper Devetoomenl Corporation by John T. U-,, e C y* qwa s!tvies, Devellonnmenl Company by CLee y ' 4.fA _ B•7,/ / dgne iVl� PLANNING DEPARTMENF/RSVIEV OFFICER SURVEYORS CERTIFICATION;.= N.r FINAL SUBDIVISION PLAT APPROVAL I John r Re -ji, Intl Iw jH war dwew w+4r k a YYN 1� yw 1: i1 i .�.+1 1111 Y h wwyy W M y.I ..hrN W M yIy ,wN,lr Y •hhPwYhw /,rn ew Mrl wear Yw4r ±hy pw.ylw. r.WY « s n ;.= MI ►whaw•. Ml.wwn hr rlw hry.lh. Pr /lrw*Irr4w wrMN Iw bN Me M1w--JJIIL- nN MI A rNr IY4 NH b �r IYpwli�h. w(IHNN Wae1H Ilrl �a 1 µ N/N S. .w f' l A,I,w d� 1 IrIi41y1.1 p•rew[ /n •wwdaww YW Gl. a Aa Y4 ) h •�1/ a M`. h r w••,Nin�MYw.W w N •N YM IA4 Y.'rj %�wJ rI G. /OM�� � � 4 r•�,rNq. w�irr`w. . AwwIIhrw Mrw1, Ila, am WRN CA b-LTINi4 7L-Ww 7Y.Glr =a" >w�-ra+e�i." A •- YdR tIMLIM - NrrN LWNly neAT CIAO 1 - /aRTrrl/ Centerline Curve Data calm have I Radius Della l7oncentl Are Length Beorin Chord CA Ct 198.48 73'10'33" 14), 4' 253.49' 552'33'49"W 6.61' _- +nitsFlj w, it Tax Mop H-9 O •r 1 i ?• Part of Palest 42 pt s,�•ELM 7.i?i�yV lA Now or loan«I John E.C-varier, Jr; & �WARD Q�• OWife Undo C. sera f (DB -197, PQ -157) tt per PRa'ERiy LIN PI. IERL SOS. PI. Po I. L13 PL Ile Alit 710EIV "CA OF S/NE OF CREEk ! 7n+ Ps 1, � ... ... l lic Pt. - NIP •!d'• ' Pae.1 42.03 pf' Wando Cay. Hoot, Ngo h3 _. t00. DB 138, Pg 288 /„ 20.cd (lo PtPt. oreexi N dislonces shoan an this Nal ve haitanld dlslonces. 100,423 Sa- Ft. ' 2.305 Acrwt 4, � l,s e0• 40 5�0 kO 173.026 Ser. Ft. 7.972 A­*Pte- s 7P;- Non /101 m Pt. 42.91' 14__41 PI. g PI. LPI-�4y NIP 20.00' to ° PtPt. CL Creak)-". N dislonces shoan an this Nal ve haitanld dlslonces. 100,423 Sa- Ft. ' 2.305 Acrwt �Ll a10' Public D7 Z70. 83}2.76 Eosemenl to1p6A41319AereSo Fl. h off' 1 j,.3 � V �y ho E S. N gu h 8 - / \ 498, 641 Sa.Ft. of former ye, R/W to be dosed vn total Control Corner r4LLINGCREEK FARM PHASE 1 PB 7. Pg. 49 c` O' 'S_a,G9 \/\/�^' 11 74,59• 7o.6J, I 74 D`,27 W ' m 1O FALLINGCREEK FARM I P' / PHASE I. �_ I PB 7, Pg. 49 /151 -• a EXISTING LAkE ' / � Aaw4 e,wwar. xh hvA-1A2e rewlly N .we 1. • -d-- .! /..4 ".lw w •- awa. aew .NI,Ywa Ih•1 wwlwra wwwb N 1•e1: �4 I,evN /w •.eY pw4wy • ewhu• N •w .Nh.w rk11 wewla pwN..1 Nw1: :ewbems rw4 « Plwm el I.w: uIA.. w..e'e •h.A u w ,.welw4w .y Ne'/y NM •.e.elhw N IAr MAwbM ./ • eW1w..hw IAY •r.wyw N eastIMI I ew whr1N N wN e wA.- •wllr as N rwN.N+e aN•tw w nMY Pl. tea Q Pt. LS rI 73.76' NI� o m Pt. 42.91' 14__41 PI. g PI. LPI-�4y NIP 20.00' to ° PtPt. CL Creak)-". N dislonces shoan an this Nal ve haitanld dlslonces. 100,423 Sa- Ft. ' 2.305 Acrwt • 39 3 a plat Bearings to1p6A41319AereSo Fl. h off' 1 j,.3 � V �y ho ) (- I S. N gu h 8 Q ., e N y ry, Jl• 0 /7 �r m / � 1 207,7 F1. 9 4.769 Acec, d: I f l 1 1 ' - I `191 FALLINGCREEK ' IW tis �°� � W I • I= q,� J n I I to p �+ � n m n egW7,C�I f .._ Ng�'O6olMcl S 66'25'30" W 114.02' �P•Il 568.17 I; I �qtj V9'O6 f, Sg�"W . y, Rodi" g_.N 10• Public Utilities FAAggN CWK DRIVE N22'S8'53'E Easement ' rusllc / I. / 50.91'(Cn 0 V 5489.09'06"E-' t 7.80 52.Tr(hrt)) d�• 48.59' 110.25 J8.96'yZa�' I /� !•LCx, •sea � +76 9 So. FI. 1.d�3 Aareft In Rte. d�t7 ^' •-.I I �,a Nis 0.. 0.b21 Acre,ll 9.73 N48.201 1410 21 IY Ser. Ft. 1 i<_ ul i 1.+07 Aae,t 249.79' : t506 N 85.06•+7' W Can X131 60957 / Cor. C«11lneate e• ApPrmA ewa (m she) Sge Dhpo•a system .o05'01•r�' I9 E . Nx •e1 .ae�.Y UW e.e.ee, 14rMeb•4 Y. n H /W 4,Y, her wwJ w wgreeve l t• .areYnnw, r4hN-a-wT- .ew»tub.. tt 7 1 ee w«wY t 11111 that the Dade Cexhl. Health DeParlmenl hes •mooed IM N dislonces shoan an this Nal ve haitanld dlslonces. 97 16• • _ a plat Bearings aued'wN4r enINlW _ idG Ce.k Fa Pae. ) (- I -` _ 7 98'58 09 1V survey Yanlmenls nlhn 2.000 Feel of this site .nh Iwp•cl t0 aa«b a�.d tandHmne IeoGMtte by 9lal• Lo+ m pearnuyoted 11hereuwde, and the wane h wand 1e Comply eM •ueh aN•rN ons tenANbns erteot w band N -ch .,.aa.Ha. Far W.M. e th4 erolvelbn w' Mnllalbns sw tic• wRlw repot en Nr M the OeW Calmly Healk Cwalmenl. 1 ' - I `191 FALLINGCREEK ' 221.2Y I FALLMCCREEK FARM �3) Important NeUa: I FARM APq•149 _ 1211 `22) PHASE I PB 7. Pg. 49 / J �ieflHlealf 11nes_ent oanflllulf a Permll al appro.a el 100 0 100 Pg I r Scale 1" = 100 ft ,Node YrfbalNyn /a Nal.ka Tan of aewge /aNRbs' UNE un'4 .sal k!1' ]tr/f l{ s'f✓T s : '; ^�'/ UNE LCNO)H %. - / n • ll lel - t 5th :«1114.1. at AWo,7 by Ml Ing B.ad l• 51 the Durk CeunlY Plwnmg Board hereby worevew the renrd 0101 L5 r •a -E Me�G.,e�Ie ?�It 2--d- L4 lee L1 2.4 DAVIE COUNTY P.ECISrER OP DEEDS PLAT AITISTRAFION r.N 11'r wrW.el Nw N �alwk jr N nN w�wy • - tsi.wr waw Iw M wee7 .rear row rw nita�.�- RnuT51h,AFAaYnr a/erre ' h / 1Vf.f�e �•u�7 -s•Mr � wi 1 - • LTJI .wrw M wb1rN Y w/ IaY U•1 �n .. 4nwna,4 7Y ISystems. . Nx •e1 .ae�.Y UW e.e.ee, 14rMeb•4 Y. n H /W 4,Y, her wwJ w wgreeve l t• .areYnnw, r4hN-a-wT- .ew»tub.. 1 PI. <•` iu rywrawnl.. k Y ear• a lb• aY. Yw1 Me4s. Cwt arra . IM arae H the ..11. m N M. H Cott, Tire « [wnlr Tn Ilee w .Mak Mer fl0lp. hob. bse. • "." y I.-Pthe Ya. L27 Pt' bd N dislonces shoan an this Nal ve haitanld dlslonces. zn All Bearings shown an this plot we based M Deed _ a plat Bearings 0 3/4• hon Pipes of all earners unless otherwise noted. 1 There we no N.CC.S., U.S.C& C., a other Ceodelie survey Yanlmenls nlhn 2.000 Feel of this site N3 Rot depicts Falling Creek farm, Phase 2 (8 tots told), rr \ ° n and Revised Lots 17 of Falling Creek Farms, Phase I n............ Told Area this Phase is 24.117 AOesi. (1,050.579 Son.) - ;n Told Area IN Righl-of-Way this phase 0.837 Aeres4, v 138,454 Sal.Ft.) - -- PubrK Skeels. Publp Water System. 0.4 Ph'ole Septic ISystems. 20' Ribbon Paving AN UlTties und«ground. y Properly shown is toned R -A - <� kfin;mum Building Selbodr. front.. 40'15de-15/Rear...30'/Side SO -el -.257 IILLa ..Ae Yr LMK,r1 .Y a.ernus - :rs ld:uSits If -� �- fw)0 FJP..............8.laling Iran Pipe 1 Ri Nip..;..........Mer Inn PIP. .6 St. .......... Stan* (found) • Pt................Point on the ground/at Centerline of Creek rr \ ° n OQ C.0.............Control Caner - n............ Centerline Cune Number 5 - F100 -...-100 Yw. Flood U. o , (.pproslma. meati.) in 100 0 100 Scale 1" = 100 ft - -- Wesivi.ew Development Company o Taifttnper Development Cajvomfi.n w� P.a.ea Ins, - <� ./wnwh-SJehn AC 27,11 l3r41 m -ors IILLa ..Ae Yr LMK,r1 .Y a.ernus - :rs � m If -� �- rIr Y•R IrIK41^ h. A-• w .J Yf a rorrsxrr clrr torn: Mrt 1 em j MCI` _wA r[ l Adlw­ I of BEE300 EOOIOEEO108 IOC. crixc[.ea .mxrrroxs ntxrrAs Nr wNx srxxrr rla7rp.. s,Iur. x -r. ror rrrnrner Ix•r. ••e-eo•• • 'u • 62.11A '16e • e6ee ». A) T ty n ;>'e Dean a s eaw `. 9 p 1 Nw 20 � `o � row sr � 8 10 ^ iet7 91 ¢ (10eA) arw m Via.( 311 esu •� �", 1, mA) (tt � f 61,261 '6' 1 e,m 238 ' 157 1 183 1 P -A) eeu mt, �'A 1 'e)t -- ------------ R0 1 '1 ` ' 1 Ya„ _---236 32 -- eeeo neeA� aim wN C2 SM m,e aaa 1WA Ia6eA1 wn ou, 'sae Q 20 e .., KP lOfA 231 � 33' 'nA � e O , a, ♦ 1 s aeu ♦ 'wA 8 ' m Ness - f1 O)ae a+N ;, 3 b e 1 _ ten IMA .17mn a a6w wea P eeez "12 m,i (e.'aA, est) j ',' � �' � a•� . road es. 12 orA, �/ 1 181 ♦e 'fi761?e5135. 9 n.eA aide 1 3 18 3M 128 35 i ("'IA, 231 .., • '1142_ . °, ; 54 p 7325a, - 2867 un, 4122 16 1 a,. 14 Dose 06 's J do `% ,anA,120 S �. (a,al I (6.aeA) mno n,e (27—) ,est 365 (,..,?A) nm 461 € uw "''1111 r 392 1 a 1 , (142 It i 1 11 1 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & .Davie County Health Department Environmental Health SeWon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 D � M � 0 W R JUL 2 0 1999 ENVIRONMENTAL HEALTH ***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 WESrnF•.-3 DiVEL445MENV C4mMP,kjJ'l Mailing tee.. 20611 +iV Contact Parson Smn.or C,*nFr cy Se Phone s36- N( om•u=se City/state/BIP WWI , �X i1lCb Business Phone 336 -37-) -007,q 2. Name on Permit/ATC if Different than Above Mailing Address City/stag/Sip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC ❑ Both s. system to Services d(House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 3. If Residence: i People # Bedrooms -'� i Bathrooms EI(Dishwasher d/Garbage Disposal O washing Machine O Basement/Plumbing O Basement/No Plumbing 6. If Business/industry/Others specify type # Commodes # People # sinks t# shovers i Urinals i water Coolers IF FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: t County/City ❑ Well ❑ Community 9. 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 COMPLETE THE REQUIRED PROPERTY INFORMATION RIFQUESTED BELOW. El.her a PLAT or SITE FLAN MUST BESUBMi —SED by the client with THIS APPLICATION. 'PWS( -- Property Dimensions: w5�4-w-Q 2--, (ALu we ns c K (!m'-401(0) WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax O ice PIN: # 5"7811-G4•-j4&L -S�t�i Gz•�IS33 _ ��wY 4-1S► LEf�' �.►.! ��iI 1LIGui Property Address: Road Name � �RC�-►c �It�u CW PrOP L-( C %W-C4e, City/Zip AOue-tV.,AIC ..27'CX; If in a Subdivision provide information, as follows: Name: F LL' 04<-X ()q Section: Block: Ay Lot: �1/0 — Date Property Flagged: �81 �trj 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 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 SIGNATURE r a THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the f owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations. Site Revisit Charge Date(s): I Client Notification Date: 1 EHS• Revised DCHD (07/99) Account No. 3 Invoice No. 161- Shamrock Acres I \\ TAMA M. O'MARA j': B 6 pg 183 & 184D8 157, PG 69Z14 132238.60' 710 ••� \42 �/ � � � \ \ 5 -- � 730 / / Q ><- 76-0 740 —770 r 5 2j6. 92" I � 223.59'\, .` 2j.5. exist. Bldg. Ta 5e i �—:44, 21o, —'` ` , , )I con5t. _ i 750, M 237.81' / 140.43• 97.18' - I 110.0C 3 1 \ \ PT . t*53•�� 17 I o \\a \ a`/ R = 150' 19 Exiytinc, B �3 \\ .n Pik, Iiw• a 3 / b" Side DitG1� 6e removed iT •i i Q Ph45e ]1 \ � roy \ r 9 % \ R 1 .04' Const. (TYR) e7 a N05 3 20"E / \ so.3s M84.08, �, as.70. 90.3 i'�!a' - Q 6 Tempa aCy r .�� (� R =)500 1 1-.a �� ' Sedim¢.11f . ,;;f-, s70Ni auTLET ST:tUCTURe�9.6a' 104.88' 6 \ Tra� Ky: ` , 10 ✓ I Z'w x 1 Q Cj s6s'A" s oNE �R = 500' 3aQ4'. 16 v'. 0 15 APPROXIMATE N JQ L161ITS at: 14 / N ¢ 1 \ \ PI5TURI3Et2 "�'� _% J N xw C w �. rn \ \ \ Q \ 16S - L", L+ \ \ 730. 467, ry EXISTING LAKE Parcel 42.05 I I \ Wanda Gaye Hoots / DB 138, Pg 288 X60 1 ' 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: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5789-64-7482.40 Subdivision Info: Falling Creek Sec.2(Blk AO Lot # 40 Location/Address: Falling Creek Drive -27006 See Map Date Evaluated: 4 _/ -?)-VL% ©�2 -zx -ai) 4771 v �/�A. S-C'lxPti ins Community Evaluation By: Auger Boring Pit L1____ i Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position _L. Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r i Structure l /i Mineralogyl ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION:�f LONG-TERM ACCEPTANCE RA REMARKS: 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 DCHD 05/99 (Revised) Davie Countv. NC` Tax Parr.Pl R Pnnrt Tuesday. October 4. 201 f 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: WARNING: 'PHIS I5 NUT A SURVEY Davie County, 1�T 1� C Parcel Information------------ H908OA0040 Township: Shady Grove 5789642074 Municipality: 82523034 Census Tract: 37059-804 MONROE JAMES Voting Precinct: EAST SHADY GROVE 211 FALLINGCREEK DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006-7659 Voluntary Ag. District: No LOT 40 FALLINGCREEK FARM PHASE II Fire Response District: ADVANCE 4.02 Elementary School Zone: SHADY GROVE 7/2004 Middle School Zone: WILLIAM ELLIS 005600052 Soil Types: PaD,PcB2,PcC2 0007 Flood Zone: 0189 Watershed Overlay: DAVIE COUNTY 243240.00 Outbuilding & Extra 31260.00 Freatures Value: 57100.00 Total Market Value: 331600.00 331600.00 t,V 1,,F 9 A' Davie County, 1�T 1� C All data Is provided as Is without warranty or guarantee of any kind 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. r, t Phone: (336) - 753 - 6780 Davie County Health Department _ Environmental Health Section , P.O. Box 848 210 Hospital Street II Courier # : 09-40-06 P, 1 9 11 Mocksville, NC 27028 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Name: -i fW(�s /V16 Fax: (336) - 753-1680 Phone Number (Home) Mailing Address: 21f til ArW (;See&,)X - (Work) 4 /( /e RZd'0 P Email Address: Detailed Directions To Site: Property Address: Please Fill In The Following Information Abo t The EXISTING Facility: Name System Installed Under: LL— Date T e Of Facili S�Y 4 Yr tY System Installed (Month/Date/Year): l0 ' '" 0 Number Of Bedrooms:_Number Of People: Is The Facility Currently Vacant? 'Yes No If Yes, For How Long? Any Known Problems? Yes (Z If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: Ad T O V15YL kWS- ff ((�e, .ber(CNumber Of Bedrooms: Number of People. Pool Size: ,1equested Garage Size: Ot r: ate Requested: r7 t D 11 For Environmental Health Office Use Only Approved Disapproved p y� Comments: I�j/�ltS�dye-� G/�-/�S !f. Mav no �- 4-7-r e x s-h-na oli "-x i U✓1 Environmental Health Speciali Date: 7 l (! *The signing of this form by the Environmental alth 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 Paid By:_ Account #: Money Order # Amount:$ Date: Received By: Invoice #: