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228 Falling Creek Drive Lot 3511 Davie Countv. NC ' Tov 'Dat -,-A 1?Pnnrh 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: WA" 1NU: "l'tllN ll PIV-1 A b U X V E Y Parcel Information H9080A0035 Township: Shady Grove 5789637647 Municipality: 82525253 Census Tract: 37059-804 ACKERSON KRIS G Voting Precinct: EAST SHADY GROVE 228 FALLING CREEK DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC 27006-7659 LOT 35 FALLINGCREEK FARM PHASE II 1.10 10/2005 006300367 0007 189 Zoning Overlay: Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: PcB2,PcC2 Flood Zone: Watershed Overlay: DAME COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 101 1�TAll data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to theDavie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the l�County of Davie, North Carolina, Its agents, consultands, contractors or employees from anyandalldaimsorcausesofactiondueto 1\ C or arising out of the use or inability to use the GIS data provided by this website. 0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001825 Tax PIN/EH #: 5789-63-7647 Billed To: Mike Hester Subdivision Info: Falling Creek Lot # 35 Reference Name: Location/Address: Falling Creek Drive -27006 Proposed Facility: Residence Property Size: 3/4 acre **N O4qiIs�Tmprovegmlent/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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT 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 hOOSC #People #Bedrooms #Baths 2. Dishwasher: 21"— Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size I- ( A� Type Water Supply QP Wastewater Flow (GPD) `f— Site: New Repair ❑ ►► i1 � System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth j 2 Linear Ft.�� Other: '�.5� Qv Tion tzS _ 1(0)YALL, (jn) eS A., Required Site Modifications/Conditions: I', STALL_ W I 10'tPfiC IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED &FF'1.UENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative o Davie County Health Dep ent for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 on the day of installation. Telephdne # is (336)751-8760.**** / 9( --D ue0c-'sIPj 0'O too \ TT 17— T I L I � I l Environmental Health Specialist's Signature: / Date: DCHD 05/99 (Revised) a • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001825 Tax PIN/EH #: 5789-63-7647 Billed To: Mike Hester Subdivision Info: Falling Creek Lot # 35 Reference Name: Location/Address: Falling Creek Drive -27006 /:"I Pro osed Facility: Residence r 1upalLy ATC Number: 3101 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **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 InspectionsjOffice 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 WAST ERC S V D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu 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. i /pp � S lam, to q' �- l/o O -btJr-- Septic System Installed By: Environmental Health Specialist's SignaturDate. DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & C� C 9 W Davie County Health Department Environmental Health Section 2 O 2-119 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 E14V1 O%DAVE NTAL HEALTHY ***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 �(L ��/�� (� L�j� 4f9ontact Person •-/ �iL�p, �� I F� Mailing Address �, S ; 5 &J�► CwT'y&—i L �. Home Phone J Q S OVo /('►� City/State/ZIP V7-0 V't �'1 C P 'v. 1 G� Business Phone �9j ry7 / Vo— �� l 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Site Evaluation WOImprovement Permit/ATC ❑ Both 4. System to Service: 6 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms , Gl'Dishwasher ❑ Garbage Disposal thing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers IF FOODSERVICE: # Seats # People # Sinks # Urinals # Water Coolers Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes -8 Pqo— ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPEWfY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: � %�-C WRITE DIRECTIONS (from Mocksville) to PROPERTY: / Tax Office PIN: # S �% �' `7 3 " 7 to ^% 7 P Ce Property Address: Road Name FCi v-eepe le 5 C t? c/. City/Zip /,CJ vest -i f h kJ Fg l/ / >t S C K. If in a Subdivision provide information, as follows: / Name: -Ci / /1-'1 S C /2 P -P/(' OLS`11 Section: Block: Lot: 3 r Date Property Flagged: J /"d1 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. „s DATE G SIGNATURE 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). Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. / 1�- Z' 5 Revised DCHD (07/99) Invoice No. f •�C4rb11_i 1rs.4�Ir.� q rr cr r�4..�, • •p a% -•i ( (i t'1 (�, 9 \ n1 I't ►11 13 47 �1• 14.41 r. �; i`1 � , �1 HIP 70.00' 10 I ��• (10 (,.T. r- c� . Cl Creek) Pi P!, E (7 i.�•, Ion 423 Sa rt IIN• 'rt <<'l 7.3nS Actsti hP t y Gq 7rlrl 1• t 349 a II ► n ill Ir$.t•t- • q. (. ,T j Ci.i ,r r^ �~ 707 713 Sn rt { 1 r`' ry �, 191•. � / 1� t ,A9 Ir.t•f 1 / \\ 0. 61 1.1.)r rid ) ,7r.r. r•1 i, vN fl, to c f` tn' f ub+k UInIU. �9i\39� ••`• ti1 41 • 558 ll J 6 / ( _ f �1 tiq r 1 nt L•.,mr. I�r'� 06"r(Rodivf� ' `� _ 10' wblic 0111 let °CG P/K In t,r c10i1'd.\ .�`t.3 ,1,1 `._.-�- $% .otlt'menl-• �kF.IC) "Fig r',iCc �[g�K DRIv� 50.9tiCn1[ P,�� � . N 7� _ 1 7.80 � t 09 i6"E >!t rj; a1 z� r .,i,.,c::r,cc , ..:,, jU�;- -• R'S9' iTo.25 .F9 .0 36 j8.4° c-., <<r ' l fi l • t <• Lf �. �: .� `� cr R. + 7ti.o Sa F1 / rq , n� to Y?'/�4 `� �1p• �•�� .c;l _ 1(, Ir•.•} i I i Ali t4, ���� (1 ',r ,, , •,o s r'n^X, z� a•=4�//1(at�1~*�,._. �_. ^i� i (.34) tP1 -4 T t� �• / r 11 I rlCrn( r r A `=0 9 nu r •33-E• 0 b2( Acre (" c;g � rowr 1 1it5 © 1 r, 4n.204 Sn r( 249 79 (rr. N )1-�l 1 rr• lf. 1 107 Arrest 0 1 2. w 7" w 74 CA I ' r R7 1•-01 M Dn,It Co.ntp) nt-<tlw P.rr l...rl �•r. ...+,•.r.r 1••. I I I I � _ 7 i [tB•5[1 !)q - r� r vltry fr,d tCndlllo,/ tt+ot,itntd E7 S+tlt It- lrr,It_ rd t%v jo f h fo,rr,d to r/„••r1/ -'•I• ^I'ti I I /i t11 - -�� Se^f t•cml o+ frvd ►, wrc� •.Nar•Il— rc. ,+tlo•• L _-_ rll[NGIA!;F ►�prl- 0� [t,-t(cAla,t •re Itit _"Ir rt"Ml ..., n. nl Iti• - - - r11 IRILCOC[v rinlr. -'•' FI11 $f t � tw Mc.r(..1 rNIS[ t r - /221 rA 7' ro 49 r[I 7 ro .o I 1211 QIIi1151 cr•r.,••t, .. +.r,., ,, 1,1.,. ;.� .. _ - - .-_ .. - - -- - .. -_---- �b'tdd •uc11'^- I- 1. Otp•l - - .-� r � -• -:.- i in nr• A �Zi i11LItJ[ TAlFLC I lCHH -- ZP' Ki K A PING -- t9- - [ It)[ TABLE 1iy/ APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMFF & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 ID JUL 2 0 19;j � ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED IMMPMATION IS PROVIDED. Refer to the IMMPMATION BULLETIN for instructions. 1. us=e to be Billed WESTnF-,J DL�IELGY�^EN� (:ScWoAJJ`1 )!sailing Address 2L-11 Re-Imal-04 RrAv City/state/SI? )JC 2MUL Z. Naso on >Pezait/ATC if Different than Above Nailing Address 3. Application For: Id Site Evaluation Contact Person 13Rrrrr G�AFriEY Boma Phone --,36-110 `2A8 Business phone 33b - 37.7 - u!) 7j� City/state/81p ❑ Improvement Permit/ATC ❑ Both e. system to service: i(House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: t People f Bedrooms -5-1v i Bathrooms [7 Dishwasher E(Garbage Disposal O / hashing Machine a Basement/plumbing O Bassmant/No plumbing 6. If Business/Zndustzy/other: specify type i Commodes # showers # Urinals f people # sinks # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) f7/ 7. Type of water supply: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Id'No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST SESUBM:1irri by the client with THIS APPLICATION. , WIC Property Dimensions: —5�4'j 2--, (A ftccn (0-4c;,co) x`.00 tCP' -�3 tZ Tax 08icePIN: # 9185-44—igRL J-- S7Fii-IL"1533 Property Address: Road Name City/Zip ,AlDvAvIC,:(c 227,X;; If in a Subdivision provide information, as follows: Name:' LL f 5 liZfE� .r ft. J%."(/) L) ��CJ Section: _ Block: A U Lot:_ WRITE DIRECTIONS (from MockrAlle) to PROPERTY: ffWV 44 (AS?, itfT �.�/ ��I I--- ' Date Property Flagged: 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. DATE i II % 125 SIGNATURE / &VII 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). N�w "p 100T 35 - Revised DCHD (07/99) Site Revisit Charge 1 Date(s): Client Notification Date: I EHS• Account No. Invoice No. &�z \ \ I I Shamrock Acres \ � TAMA M. O'MARA 1 PB 6 Pg 183 & 184 I \ DB 157, RG 697 I 14 \ 13 I \ \ _ I — 2238.60' 1` 81\ 710 I• / i � ry N \ \ _ \ \ N 1\ �— / \ — 720 \ , 730 15z '760, 740 / 710 u� 1 1 _ o � w 40 S 92'—z I '; --223. 9' � , — N To $e Ca 5t. 210 \ / Aase � � B \ \\\ I 1 \ 3@7 r� ` \\ PT •13 txi9t��g B 'Id?+�s ; n Pho e it w, 3 h i 6e removed 'H.;4,� Phase II 1 .04Const. CTYR) N05 3 1 0e i M Ternorory M Q Seel Irn It ^s�Iu 7 6' \ Trop j� •KZ?::. /�� 3 47 I N o v ♦, I I 237.67' / 1 � 140.43' 97.18' ;o m 1 m o 110.00, 17 1Fi � ,s I �R = 150' SIdeuch D ► N 1\ 1 \Quay (rr 45,70' _ 99.37 R = 0 � 113.61. _ .. ,6"1 UTLET STRUCTURE 9.64' .� 1Vii 12,wx 1 0' •104.88 3 2'i C� a69'A" 5 DNE R = 500' F� 16 APPROxIMATE LIMITS 01= IDI STUR5EO \�REA 01 0. \\ \ 7\ \(3\ V-:,. \ \ Q : ry � I65 Parcel 42.05 Wanda Gaye Hoots DB 138, Pg 288 \ ` — 0)0, I I 1 � � N f u C u _ �. rn N 130, EXISTING LAKE V 3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` Soil/Site Evaluation APPLICANT INFORMATION Account M 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey Proposed Facility: Residence Property Size: Water Supply: Evaluation By: On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5789-64-7482.46 Subdivision Info: Falling Creek Sec./Blk AO Lot # 46 Location/Address: Falling Creek Drive -27006 See map Date Evaluated: 60 d -/V eV Community Pit �— Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position �S S Sloe % HORIZON I DEPTH / d Texture group1 5C Consistence Structure Mineralogy HORIZON II DEPTH Q " 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: 0 L LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscaue Position EVALUATION BY: 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 DCHD 05/99 (Revised) l APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC D C Davie County Health Department JAN 2 4 2000 f Environmental Heaft S;aWon P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONNIENTAL HEALTH,t, (336) 751-8760 DAVIE COUNTY ***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 �PJJC6A �C%Awmwj rc)(V1(iAw Contact Person 1]RANT 6dr) V Mailing Address 2431 RICY04WA AOAP Home Phone R34-760-2408 City/state/ZIP WwsrCH f5ALEWI. IVC II) Business Phone .3AM-7-ona 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: Site Evaluation Improvement Permit/ATC ❑ Both 4. system to service: eHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. if Residence: # People # Bedrooms 3 # Bathrooms O Dishwasher 0 Garbage Disposal Li washing Machine fl 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: e"County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ErNo 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: Tax Office PIN: Property Address: Road Name lALUM4QW —N1vG city/zip A nuwcc. at Vat If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Name: FA lUN14U't -K Yib)cr / Section: �� Block: Lot:10r11? t 3g-41 Date Property Flagged: 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 6/CT(l/lFu)Lt�t clMQrl eow)Rf1vl to conduct all %testing procedures as necessary to determine the site suitability. DATE I l 7,3 %oa SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR'STT'E PLAN (Include all oft o owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. X,? Invoice No. 1°22 APPLICATION FOR SITE EVALUATION/IMPROVEMEM' PERMIT & Davie County Health Department Environmental Heallfi Section P.O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 JUL Z 0 1999 ENVIRONMENTAL HEALTH fl111,IC /SAI l►IN ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Hama to be Billed WES��M1�C� �iyELt�iP�^EIJ�' C[AwA-P-j Nailing Address Zb3� R<'^Jl�lat_ga Z.^Fl2` city/state/ZIP 2. Nage on Permit/ATC if Different than ]Above Contact Person �J�C�J1' �j�4FnEY Home Phone ,, — No '1,alR Business Phone Jab -1 %' - 0,17' 2. ,17' Nailing Address City/state/Sip 3. Application For: trSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: E(House 0 Mobile Home 0 Business ❑ Industry ❑ Other S. It Residence: # People # Bedrooms 15- 1� # Bathrooms U Dishwasher d Garbage Disposal E/ Mashing Machine 0 Basement/Plumbing D Basement/No 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 rater supply: ['1 County/City ❑ Well 0 Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes d"No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION Rf QUESTED BEIDW. El.uer a PLAT or SITE PLAN MUST BESu AH771 D by the client with THIS APPLICATION. Property Dimensions: .w :SAI 2-, (/1w,u c nCEtC (O-IC,+EO) ,n,.)q to 33 ` tU.W:=aECx► Cit Tax OMcePIN: # 9"7H5-44•R4RL --L-S1PI-tL"1533 Property Address: Road Name rAa-AAfl.1W<4t DR.W City/zip hove -'r -,Kc 2711%; If in a Subdivision provide information, as foll: Name: F- Tq � J5 -i S Section: % Block: Ry Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: c.,J J-rop L (j c iLC-o" Date Property Flagged: 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 1 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 i 691 q i SIGNATURE e c 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 1 Date(s): I Client Notification Date: 1 EAS: Revised DCHD (07/99) Account No. Invoice No. �� 77 rock ck Ac \ \ \ TAMA M. O'MARA I PBh6mPg 183 &s 184 \ DB 157, PG 697 I 14 ' 13 I 2238.60' . 81 / 710 I• �, � b _ \ `N N \ \ — ! 4 Q, �. �.—_ Geo / f ti _ 720 \ \ / 42 �� 5 X30 /15Q 76-0 710 \ \ \ d ED\ , V UN.i S � 40 92'—L � 223.59''\ 2j4' Ex;st. Bid,, To 5e -•�, ���` r I Rhase~ I[ Co 51:. 2j0 i � N t e /--�---\ 150• I s 47 `O c� 237.e1' 140.43' 97.18' / 1 m f 1 e I 110.00' \ \ ♦ er -a 17 18 o Ovy. \ �\ 4 •', Pc � R = 150' '1 19 n ry Exi9tiny B P•Id,�s P;, w, 3 h`' Side p. -V) N 1 be removed ^� \ \\ \ w;H Phase in9 (Ty •) a 1 .04' const, CTYP,) 1 N05 3 0"E \ \ \ \ 8?4 ►•� sos`s• M _ / 0 84.08- � 1\ 6 45.70•Li 90.3 o 6�Ell Tem cPo�Y t .i� 1 `p • 3.81 • _ ,°�' 0 �6, s .� sed,mellf 1 r� oN/ 6UTOT STAUCTURE�9.84 �\ i'fOP / bjy.`•'• 10'Lx 12'W x 1 704.886— 2i � R = 500' �F 16 15 \ TE 125' _ L MIT5APPROx1 CP \ N 1 \ �M,qISTUR»EV 14 .\ C w Ln \ \\ Q �. \ 165' 0D" = \ 130• \ \ � Iry � •• 1j?• I \ O" / EXISTING LAKE v Parcel 42.05 I I Wanda Goye Hoots DB 138, Pg 288 I1 I \ 2 \ OS I I \, 0. I I ` 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 Water Supply: On -Site Well Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5789-64-7482.35 Subdivision Info: Falling Creek Sec. I/Blk AO Lot # 35 Location/Address: Falling Creek Drive -27006 359x79x379xU$—Date Evaluated: //A?/o Community Evaluation By: Auger Boring Pit / Public 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 ACCEPTANCE RATE: REMARKS: EVALUATION BY: A01111 OTHER(S) PRESENT: 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 DCHD 05/99 (Revised)