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232 Falling Creek Drive Lot 36Davie County, NC _ 1 Tax Parcel Report Wednesday. December 21. 2016 231 233 275 ` 211 .= 235 ; r-- -- r.' -- --- - _ I x 270 t t t 232 �J 263 t 199 ��� s5 '{�' Q 198 25 6 222' 22+8 253 - ----' -�f :D — — 191tr - --- �- 244 188 j -z 139-, 241 176 -._-- 107 127 j ---- ---------------------- ------ --- —�_ _�--------------'—r!---------- ------ 229 - - — --------'-----55'�-----� 1:01 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 Illness 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 NCor 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: H908OA0036 Township: Shady Grove NCPIN Number: 5789730738 Municipality: Account Number: 82525584 Census Tract: 37059-804 Listed Owner 1: ALLEN JEFFREY Voting Precinct: EAST SHADY GROVE Mailing Address 1: 232 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 36 FALLINGCREEK FARM PHASE II Fire Response District: ADVANCE Assessed Acreage: 4.06 Elementary School Zone: SHADY GROVE Deed Date: 12/2005 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 006410219 Soil Types: PaD,PcB2,PcC2,ChA WATER 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: 1:01 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 Illness 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 NCor arising out of the use or inability to use the GIS data provided by this website. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATLr R k Davie County Health Department 2 0 ���9 J . Environmental Health Section /- P.O. Box 848/210 Hospital Street ;i_il;;;j'ii�ElTi! Mockaville, NC 27028 E n)1.1fm, ; (336) 751-8760 ^� ***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 1,Q E SWq,,J b CQ EL,. ' ME JJ; • CIL7110 C 1J l Mailing Address Z -11 City/State/ZIP WIAJ5iaNl 2. Name on Permit/ATC if Different than Above Mailing Address Contact ?arson 3Qr.��'. G:l1l nEY Rome phone 33%•- No `2-?,,' Business Phone J3(, - 17-) -u,I7r-, City/state/Zip 3. Application For: e8ite Evaluation ❑ Improvement Permit/ATC ❑ Both s. system to service: [(House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 3•. # Bathrooms 2- �— dDishwasher C( Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Others Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 0/`County/City ❑ Well ❑ Community a. 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 REQUESTED BEIACW. Either a PLAT or SITE PLAN MUST BE SUBU17 IED by the client with THIS APPLICATION. �IdiE Property Dimensions: Tax Office PIN: # 5'7�'�-G'i-�4<L S7F: G�•15i3 Property Address: Road Name `AL W e1W-0t DRAK City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: A O Lot: WRITEDIRECTIONS(from Mocksville) to PROPERTY: 'T4Jy 6-1 E�1� i ` i.CfT• cJJ 1(1J'(1 R 14- rw R-"rL-c; c:ue 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 % 11 2`i SIGNATURE 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): Client Notification Date: EHS: Revised DCHD (07199) Account No. Invoice No. U Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit t/f Cut FACTORS 1 2 3 DAVIE COUNTY HEALTH DEPARTMENT '' `".' (` Landscape position iC J_ Environmental Health Section Sloe % Cr Soil/Site Evaluation ,ANT INFORMATION Texture group PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5789-64-7482.36 Billed To: Westview Development Co. Subdivision Info: Falling Creek Sec. J(Blk AO Lot # 36 reference Name: Brant Godfrey Location/Address: Falling Creek Drive -27006 Proposed Facility: Residence Pr6perty Size:. See Map Date Evaluated: ca- C' Consistence Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit t/f Cut FACTORS 1 2 3 4 5 6 7 Landscape position iC J_ Sloe % Cr HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH !i 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 i SITE CLASSIFICATION: a_ j6,22 LONG-TERM ACCEPTANCE RATE: 21 REMARKS: 111r tA C �/Yld�/i� y EVALUATION BY: 1! OTHER(S) PRESENT: /�i J))e !p J4l -, '-4 "4 / d 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) DAVIE COUNTY HEALTH DEPARTMENT A—/ �' J - 0/ Environmental Health Section P. O. Boa 848/210 Hospital Street ' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001896 Tax PIN/EH #: 5789-65-3355.MR Billed To: Mark Reed, - Subdivision Info: Falling Creek Two Lot # 36 Reference Name: Mark Reed, Location/Address: Falling Creek Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2995 **NOTE** This Improvement/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 jArjo*c #People �_ #Bedrooms 3 #Baths 2. Dishwasher: Garbage Disposal: M"" Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 4.04 40kc-S Type Water Supply (1047y Design Wastewater flow (GPD) <!(OD_ Site: New Er Repair ❑ I " System Specifications: Tank Size/000GAL. Pump Tank GAL. Trench Width Rock Depth V— Linear Ft. �XJ Other: l dip �dlJ Oni Tqu- U4,5 S l0• a. W'1. Required Site Modifications/Conditions: L CEJ UrJIWQ 1CI:P 10, �F R&. 1-1 s � - Y / IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** cam,-�o'1r►�►.t. p20P. u1.>zz PPQo f k. O 721 4ESZ-P D(.)T of Health Specialist's Sf ature: Date: �1 D DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001896 Tax PIN/EH #: 5789-65.3355.MR Billed To: Mark Reedy Subdivision Info: Falling Creek Two Lot # 36 Reference Name: Mark Reedy Location/Address: Failing Creek Drive -27006 Facia ATC Number: 2995 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 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 VAL)b FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: /D CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compl' r cle 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall ' taken as a guarantee that the system will function satisfactorily for any given period of tiril. F Septic System Installed By: Environmental Health Specialist's Signature: /'4 r G'V� Date: Z �/nL� DCHD 05/99 (Revised) 100.413 54. f1 r 7.3(15 Acre+ft m t, 1 - (3- • -4- / t0349 5a. FI 21,i!t Arrtl7t rn v+ ► ,ti � t 7w 74-1 sn FI P., ) } Lei � N m N 0 r �4 X1%56 fR 'r n. •ri n to J -86'25 �• l l.;per 114.07.\ 55fl 17' _.--- sag*oq Rodiux. `( 1 4 t11r• Gh ---- }��K 5 im 10' Public titgtt+eiFt 1t--11 k"URlyl%27'S6';53' aia�ment _ i`��'Niif�C 7.80' ' 50.91'(Ch t" ` rn }c- r �.C� N89'09'06"E 1 >f? 7( rc) / n .S9'_ 3lf.98' 0.2525��QD 36 �-, n �N,1 < s �> ch ,� 1 e.o. t 76, 30 Sq Ft.co 3S I��ti` r. YE o.b21 Al e'lFit ' M, og 7 it / ^ s lA 0 / ' N 4n204 Sq r1 i er 74Y11 27 K I 1 (17 Arrest 249 79' --- -- — N 85'06'17" W r7n1►n1 r 6w E.1 g 7 r ciR OQ W r 1 APPLlCA _ U ALTH IN 1`011 SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Eadmnmenta/ Health SaWon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***-nWORTANT*** THIS APPLICATION CANNOT BE PROCE'BBED UNLESS ALL THE REQUIRED I INH"ORMATION IS PROVIDED./Refer to the INSORMATION BULLETIN for in�stmations. 1. Name to be Billed iM,4Q�' A. QEE6 Contact person Y 4AP-1GEED Nailing Address d . 0 �( 22cm 51 am* phone , (3 &.\ 14 -.3424- city/state/213? An YA /SCS NC, 0760(p business phone ,L33(el 830 - 16 9 (a 2. Name on permit/ATC if Different than Above-Samri¢- Nailing Address _ �s ArY`2 City/state/sip Sc1m2. 3. Application ror: 0 Site Evaluation t9'Improvement Permit/ATC ❑ Both 4. system to servio.: R House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other "jvt 5. if Residence: I People Q- I Bedrooms 3 1 Bathrooms 2.5 R"bishvasher B"Oarbage Disposal R Naahinq Machine ❑ Basement/plumbing ❑ sasemant/No Plumbing 6. If Business/Industry/Other: specify type # Commodes i shovers -� ! Urinals • people f sinks i Nater Coolor■ Ir FOODSERVICE: # Seats - Estimated hater Usage (gallons per day) 7. Type of Nater supply: [}'County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes [moo 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: 56A I >< St -8. iri x 3r6 -33x 249.79 x tsb m WRITE DIRECTIONS (from MockrAlle) to PROPERTY: _ 339.88 Tax Office PIN: # Property Address: Road Name FC -t)1;' C'(eXX or;4e- City/zip Aa�larcz, 12rlw& If In a Subdivision provide information, as follows: Name: 1 �� nq Crae.k F:Wm Section: T- Block: Lot: 36 Q- Eu5-f- Le'1'r - Cor,, ,+z.,e. r' /cc.. nn n }�,, . go I saw -H., r n i Te - 1...41 eat s oa Le -T4- - / o � I c(p1 Ohs( Lc+ cilJasaG. «1-Ghd Of S ec" (- Date Property Flagged: 1011401 This is to certify that the information provided Is correct to the beat 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 falsifled or changed. 1, also, understand that I am responsible for all charges Incurred front this appllcadom 1, 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 j'y%REE0 to conduct all testing /procedures as necessary to determine the site suitability. DATE �0 �'Z/ a 1 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 249.79 �6o L� Date(s): l,/ r Client Notification Date: w EIIS: 0 5'� Account No. URevbeiDCHD(07/99) 0`� Invoice No. yt IL, APPLICATION FOR SITE EVAtIJATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section P.O. Bos 848/210 Hospital street Mockoville, NC 27028 (336)751-8760 a JUL 20 1999 ENVIRO,NME,TAL HEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nasty to be Billed �ESCVIE� DEl)ELaPr^EM' �crnnP�la►`/ Contact Person 3Rr.�tr ��F1tiEY Nailing Address so" none 336-11(-) -Iv58 city/state/zxv WWI , Lic- Business Phone _336 -17-7 -0414 2. Nam• on permit/ATC it Different than Above Nailing Address City/state/Sip 9. Application For: dSite Evaluation 0 Improvement Permit/ATC 0 Both t, system to service: J(House 0 Mobile Home 0 Business 0 Industry ❑ Other 5. It Residence: # People # Bedrooms -5- I # Bathrooms O�Dishwasher [Garbage Disposal O/ washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. It Business/industry/others specify type # People #Sinks ' # Commodes # showers # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: d County/City 0 Well 0 Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes J7 No If yes, what type? ***IMPORTANT*** CLIENTS MAST COMPLBTETHE REQUIRED PROPERTY INFORMATION RIEQUESTED BELOW. E311uer a PLAT or SITE PLAN MUST BESuvM7TED by the client with THIS APPLICATION. klfc- Property Dimensions: -5�"4&4 2-, (Au AgcnifK (}ti *i—tEo) WR('TE DIRECTIONS (from Mocksville) to PROPERTY: Tax08icePIN: # 5-7h`i-44•g4r>>� a S7�'�•IL•+15J3 ITwY �� (QST , LC -91- W./ e6(ti R.,tuT' Property Address: Road Name rALV-ye lw4c DR -W cw Rc.P L.0 j c i c-(, City/Zip ,AtlueNtc.,:{c 27'C%; If in a Subdivision provide information, as follows: Il Name: F LL1c'R(<-k Section: Z Block: AO Lot: Date Property Flagged: `i 181 ro 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 ane 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% II % h 2q SIGNATURE 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). T1.11E v) r&AtP LOT"- 3(0 Revised DCHD (07/99) Site Revisit Charge I Date(s): I Client Notification Date: I EHS: Account No. 3,� Invoice No. D \ I \ Shamrock Acres TAMA M. O'MARA 1 PB 6 Pg 183 & 184 \ DB 157, PG 69Z 3-3 \ I 14 \ \ 1 I 13 --2238.60' 41sT � - 710 _�►) . i N 7220 ; \ 730 740 / �/ � 8 T / X10 ` `\ \ 1`� — — lash` 0" \ • 40 s \ 92' _13 223.59' \ 2J4' Ex"St. Bid , To ge RemDved CDnSt. 210 —�Ke asI[ -- — --� iso• (� s 47 .,� \ \ \ 1 I 237.61' / 97.18' / I 1 1 61 \ \ rn t m IR I1t0.0 C� PT . �r5�jj3 17 18 a h I R = 150' ` O191 txi5t;r9 8 'Idl+53 be Matting (Tr .) \ 1.0 14' Const. CTYR% a N05 3 0"E ^/ 7 84.08' 45.70. 90.3 C) 69` Tem orOCy 076,11 a sed merit 6 e,' • %6+. �• �I ' r STONi uTLE T ST.NUC{•{,1Rg�9.64' 104.88 3 2'i 1 3 Trap •Ki: 1 o'✓x 12'w x 1 = 500 C;;A48'A" 9 ONE R ' F 16 15 I `\ O APPROXIMATE �Q LIMITS GK N 14 N 40 L4G \ m I 130• ' EXISTING LAKE Parcel 42.05 Wanda Gaye Hoots DB 138, Pg 288 \ i \ '�0• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5789-64-7482.44 Billed To: Westview Development Co. Subdivision Info: Falling Creek Sec. i/Blk AO Lot # 44 Reference Name: Brant Godfrey Location/Address: Falling Creek Drive -27006 �q Proposed Facility: Residence Property Size: See Map Date Evaluated: 1C% ` of Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit V Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position 2— Slope % I IQ HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH A1 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: EVALUATION BY: LONG-TERM ACCEPTANCE RATE:OTHER(S) PRESENT: REMARKS: z.G/ V '�s' TJ,,�� 7X,/, %2 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) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environment/ Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 JUL 2 0 1999 J L) ENVIRDAV EECOUNTI�LTH ***ne0RTA1M** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. liana to be Billed VJEmWQ%--3'b�VEL4�A40JT' CcW(3A0J11 Mailing Address 2.bsl RA-q� city/state/SIP NWS 2. Nana on pernit/ATC it Different than Above Mailing Address 3. Application For: Site Evaluation Contact person Ilzr T 67ZAFMCy sone phone D6-- 7&7 Iazf Business phone Jab -17-)-OrJ?4 City/State/Sip 0 Improvement Permit/ATC ❑ Both e. system to Service: E House ❑ Mobile Home 0 Business 0 Industry 0 Other 5. If Residence: # People # Bedrooms 15-1� # Bathrooms 2��►� dDishwasher d Garbage Disposal O / washing Machine O Basement/plumbing O Basement/No plumbing 6. Zf Business/Industry/others specify type # Commodes # showers # Urinals # people # sinks # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: d County/City 0 Well ❑ Community S. 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 COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. El"her a PLAT or SITE PLAN MUST BESUSSMITTED by the client with THIS APPLICATION. ,TwtSsF- Property Dimensions: L, (Au+Wene frc (s ITAcrtcc) Tax OfllcePIN: # 5"78�-�4•a4k� �S7t�� Gz-W833 Property Address: Road Name f4-UW1( CC4C OR:K city/zip AOua-lrt,i(e 27'r%; If in a Subdivision provide Information, as foil: Name: F LLs ciiiEX 71 6 Prv►�;En L) Section: Block: A U Lot: - WRITE DIRECTIONS (from MockrAlle) to PROPERTY: !fw y 6-1 ms7—(, Lc -,PT' w.r �� t, ri i cuT- CW Prop L(; C %Wcii� Date Property Flagged: 81 ct `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 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 mored by to conduct all testing procedures as necessary to determine the site suitability. JJ DATE '�' g l q --i SIGNATURE I c THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the 061 coring: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge I Date(e): Client Notification Date: `EHS: Revised DCHD (07/99) Account No. -jv Invoice No. //07 \ \ 1 I ShamrockA es I \ TAMA M. O'MARA { \ PB 6 g184 \ DB 157, PG 697 I 14 \ I 1 ( 13 2238.60' 11 !\5 710 -. l �°\\�4`\ 9 —72_0 i \\ h' 42 ' — — �� \ 5 730 740 D- \� 1 ,. 46� � , 1 1 S I o \\ J•e 40 92. 223.59' w 2.4' exist. Bldy. Ta Be \ i R¢mDved Ca 5't. 210 hose. rl N 47 \ ( \ \ 1 I 150, 237.61' 6 \ \ 140.43' 97.18' 3 1 \\\\� 7TH„ 18 I 17 \\ h I F R = 150' 19 Exi9t,�g 8 Idt,�3 � ¢ n H c., Pho1`e �' w' • J 3 / \ h"' d D�teti N 1 be removed roa \\ h \ Mat -ins (Ti 1!{ Phase \ 1 04 Const. CTYR) . N05 3 0" E 84.08, ; \ °8 as.70 � _ 90.37 � I Tem orofy 1 � R = �Or °' 47• Sediment 1 `�� �` 6r -X9.64' - .. % STONi buTLET STRUCTURE Q 104.88• 3 2'i I\ \ \�Qz ss pW^ 51 DN6 R = 500' `6 �Q7 L MITS ROxIMATE v '\ OP PISTUR»EIP 1N — 14 \ O ``4RE�h \ rn \ \ \ Q j• \ 165, 730• in EXISTING LAKE v Parcel 42.05 I I Wanda Gaye Hoots �r DB 138. Pg 288 I I /ice `�� \_ ` r'o• � 11 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 #: 5789-64-7482.45 Subdivision Info: Falling Creek Sec2ABlk AO Lot #45 Location/Address: Falling Creek Drive -27006 See Map Date Evaluated: 4ZI, /8`Z%9 Community. Evaluation By: Auger Boring Pit Public Cut FACTORS 1 4r2 3 4 5 6 7 Landsca a osition 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: l/S LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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)