Loading...
233 Falling Creek Drive Lot 38a Davie County. NC Tnv PnrrPl R Pnnrt Wednesday, December 21, 2016 WARNING: Tt11S 1S NOTA SURVEY Parcel Information Parcel Number. H9080A0038 Township: Shady Grove NCPIN Number: 5789647245 Municipality: Account Number: 40103650 Census Tract: 37059-804 Listed Owner 1: JOHNSON CHRISTOPHER K Voting Precinct: EAST SHADY GROVE Mailing Address 1: 233 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 38 FALLING CREEK FARMPHASE 11 Fire Response District: ADVANCE Assessed Acreage: 2.30 Elementary School Zone: SHADY GROVE Deed Date: 2/2002 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 004090096 Soil Types: PaD,PcB2,PcC2,ChA 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: q t'iwlt�`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 County's GIS webslte 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 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 Environmental Health SCction P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 JAN 2 4 2000 �VIRONh1ENTAL,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 �zftgdd bCq4L0MQJJ ((itY1i1AM/ Contact Person !]RANT 6dnMV Mailing Address 2131 &Yoot.DA AgAO Home Phone 3347760-2408 City/state/ZIP W1ffl9T;M& 5ALEWl. NC 17),a Business Phone .134-117-00,8 2. Name on Permit/ATC if Different than Above Mailing Address ^ity/State/Zip 3. Application For: E7 Site Evaluation l Improvement Permit/ATC ❑ Both 4. system to service: eHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: #People #Bedrooms 3 # Bathrooms 1-- 11 Dishwasher ❑ 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: @'County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ErNo If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE 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: # Jr78� " 6� -'14 $y - 7 Property Address: Road Name FAl.UtJ401(0,-NlvC city/zip A pvavcc . /arc 1104 If in a Subdivision provide information, as follows: Name: fALUN6cE-K/1 7?�►crs Section: 7---' Block: Lot: Lorfl7 t 3�f-41 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: i2' Z8- 51 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 WCT1L C -W L"1WAg M6Wi 6;mOAAi to conduct all/testing procedures as necessary to determine the site suitability. DATE l ! Z3 kc) SIGNATURE 40'A" THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all oft o lowing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 1,1EvJ MAP WT M Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: EHS• Account No. fC Invoice No. .2— % Account #: 090002197 Billed To: Chris Johnson Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT 5789-64-72459 Falling Creek Lot # 38 Felling Creek Drive -27006 see map Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: ATC Number. 3091 **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 #People J #Bedrooms 7 #Baths Dishwasher: X Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine:Z" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size j4AP, Type Water Supply_ Design Wastewater Flow (GPD) '/W Site: NewO Repair ❑ i �bD System Specifications: Tank Size /000 GAL. Pump Tank GAL. Trench Width S14�C' Rock Depth �Linear Ft Other: Required Site Modifications/Conditions: 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.**** i44V Environmental Health Specialists Signature: Date: !� DCHD 05/99 (Revised) Account #: 990002197 Billed To: Chris Johnson Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5789-64-7245 Subdivision Info: Falling Creek Lot # 38 Location/Address: Falling Creek Drive -27006 Pro osed Facility: Residence Property Size: see map ATC Number: 3091 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 WASTE WA NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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, S ion .1900 "Sewage Treatment and Disposal Systems," but shall in NOWAY betaken as a guarantee that t s em will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: , U IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnvirvnmenW Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (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 C�/R / S 1� JD t -IN o A4 Contact Person Mailing Address 6 ✓ -3 `17Fo Re-, F -S 6PFEit RV, Home Phone �'¢O � 7 8 City/State/ZIP 4DOAMCE ,AIC 2'700(, Businesss Phone 'f 27— Zoe Z C.YH 2. Name on Permit/ATC if Different than Above ( `/k `3 o (a y F"� Mailing Address City/State/Zip 3. Application For: i'Site EvaluationImprovement Permit/ATC Both 4. System to Service: W -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People_ # Bedrooms _ # Bathrooms Z• k-1 Dishwasher ❑ Garbage Disposal "ashing 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: W-County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 No If yes, what type? /V or 0 ***IMPORTANT*** CLIENTS MUNTCOMPLETETHE REQUIRED PROPERI-V INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. ,— "/ _ bE-5,4C & T Property Dimensions: 6PeEF7 GINE 43 R. G /A1/E 53 Z oA) Tax Office PIN: # 5 -?e"-2 h4 7045 - Property Address: Road Name F4-leIA)(, 62FEe- Pk- City/Zip ,4byAAX-F, N C Z70CC If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: /5'R -ro Rt e-wr aA.) 80 1 S, , ZEPT PEO&Ers eREE/c X17, LEFT FALC/,t1G C•A1=6K FARM .5 . 1A57- /-PT oA.,) ZEFT � aT A 3R Name: FA,,- / zou t lI2EFe FARI-1 S H -9 Section: %9-A Block: _ Lot: Date Property Flagged: o 10,90 a MAPA 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 falsiCed 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 Couiity:Health Department to enter upon above described property located in Davie County and owned by C4,2/!5 k , 5 O'YN Se w to conduct all testing procedures as necessary to determine the site suitability. DATE U 3�/�o Z SIGNATUR_ c /- 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). SFE 4 i 1/Vcmr,—P Revised DCHD (07/99) C"t L Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. 11?� .L) t I L L muuceiiia Bf1s339' l Z JO [ Vrm:. m..: ....! �•a..0 I � � W YrM• wp • v.. wof 3 .•... yvlNt•tw+y nwr:[sist7 :MS:)♦af R•.K•.te� frw.I..Y,r. �.� �..� vxiel i�u.^��• :! Opt R 4 :JDDg i w xrr•i « •wr✓» V »/weA til r «».' • •• •, V . �; ru .M lmteR O•....^ O .SC'1•rHS w'CJ,K"w+b T"w5r7/'•tVUJ 'fwWl� 1•+Yr'v w,nyp t-6— wv. N �.A. «vi'tl 06 ."WS &-,,, "" r. •raW& rilr +Ila w.rY, rru ( u'+ t4W+'A ryewY 4i'ri . fw! rw I'll PR t wy'r j 0',4 -so a -1 twi W (x101 w0! Ii t Iw'•V'wll »•D 1'•t•! li+A. Fq 4C +vl •w N W! OCO': +VIr tWw^•.F /rMt MI•/Wj IAO P'+r 17:'1 1114 as u iw\ rode„ w+Iv« prF Iw,:ws Ip N NaA «n ,Y; S 04 ,A w r:rN rywaw: N wR tM .�. —".WW !•' .1. ~••�rV � W i M�rI. ",R r�i �.w� ri W.wYww• w.r IM +ww «r w«.w M•.lw w .yr W • +wp Ma «I ail� � seri n•««r«��w .e. r„ .. w�u I`LL j wt b.w.~ J M ww•r • •w.+m w � i.; w y Y ,rrnCv! 10Lcunv! w « w...«� w r x•ww+0 .M.+•wro .w• rM.IrdA.9«0001 � trr.wy N •y«w• M n { •w mew. rr.. r h•r « t«w. w�yr r a••.w (� 4. 1 � J w «"i: wwf :•� H `"' M rr •wYn YI u..w I I J » «.+. rn t»ryefr! r«w fl.ro ...s %`w� •w� +0 ".r 1 1 I wMlf r•r+• r..s Pr •N'+rw rwsrnr. ��� f Ft 1 t9� •� �I•,x� ^ 1 P •G � ' s �a * f 11A1 7. c. , I ��,,,,rna rt..aM°i«n.f f ! F y� !d •--nl.e-=..IY w w �•wv .�•• w... v«..Ir« « rx�rr .w � ..www •Iwr• w .• www rrn w.rlpr. l,M �r •.0w Y YW N.alw• W « M.i.Ar wVr• ,w., rr+w.•0. y r a..•.A rr Hr.r. w.r .. N. w.lQ®�w�wrraf �•Ywr iiYAtialY {p e110/wM aattrJ.••+sew•r �'� law�ey/e r»!xn I/J DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account M 990002197 Billed To: Chris Johnson Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH M 5789-64-7245 Subdivision Info: Falling Creek Lot # 38 Location/Address: Falling Creek Drive -27006 Property Size: see map Date Evaluated: Water Supply: On -Site Well 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: LEGEND Landscane 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) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5789-64-7482.38 Billed To: Westview Development Co. Subdivision Info: Falling Creek Sec_TBlk. AO Lot # 38 Reference Name: Brant Godfrey Location/Address: Falling Creek Drive -27006 Proposed Facility: Residence Property Size: See Map Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit L/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % Ij I HORIZON I DEPTH . v 4 - " r Texture groupc -re L f Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence , Structure k/- /-Mineralo Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE j CLASSIFICATION i LONG-TERM ACCEPTANCE RATE G SITE CLASSIFICATION: P EVALUATION BY: /,Z LONG-TERM ACCEPTANCE RATE: < % OTHER(S) PRESENT: REMARKS: ?� /� YO �//�/!4 f S1 -e;.- 9 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) r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC JAN 2 4 2000 Davie County Health Department Environmental Health SL -Won P.O. Box 848/210 Hospital Street ENVIRONN ENTAL HEALTH Mocksville, NC 27028 DAVIE COUNTY (336)751-8760 ***IMPORTANT*** THIS APPLICATION CAMOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. � Refer to the INFORMATION BULLETIN for instructions. Ham 1. Hato be Billed �EJJMICAA UCt�4Lo0MNST (/_OMi I J�/ contact Person (.ANT (3 DRUCy Mailing Address 2.631 &y0*LoA koAP Some Phone 33OU-2408 City/State/ZIP Wit+sraN S&LHM , me ll'Q& Business Phone 3A-11-1-oa-7a 2. Name on Permit/ATC if Different than Above Mailing Address / City/State/Zip 3. Application For: H Site Evaluation Improvement Permit/ATC ❑ Both 4. system to Service: eHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 3 # Bathrooms 1 n Dishwasher 11 Garbage Disposal 11 Washing Machine 11 Basement/Plumbing H 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: fa'County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes E(No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE 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: # 5-781 - 64 -14 8-2-- - 3cY Property Address: Road Name FAL.UN6ULf4fc. N1vC- City/Zip A pv wcc .jet. 11A If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Name: rAu1N6ct1,t:E� Jr7 Ort Section: ?� Block: Lot: Leri17 f 3`l -Y1 Date Property Flagged: /1- 28' `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 owned by bJcTfI/lC-uJ �'?�r1Ee cIM6Ni fnw►QA1y1 to conduct all testing procedures as necessary to determine the site suitability. DATE r l Z3 ko SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of th& 10owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge I Date(s): I Client Notification Date: EHS• Revised DCHD (07/99) Account No. jt Invoice No. 12 —.-> Y APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Secdon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 JUL 2 0 1999 AL 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 VJESMF.O hF-UEL<j0- ^ENV CcmAPA.)Jl Contact Person 11QWJ1' 6•:Armey Nailing Add,*s• Zbsl RC/lUa1-Qa Z^qL� acme Phone City/state/zxv WWi:�nr�ciA�C-r� � 1.1c 2'l�v� Business Phone -a'36 X17-1 -067,- 2. Name on Permit/ATC if Different than Above Nailing Address 3. Application for: Site Evaluation City/stag/Lip ❑ Improvement Permit/ATC ❑ Both s. system to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People # Bedrooms 15 -IV # Bathrooms / doishvasher [(Garbage Disposal 1] washing Machine ❑ Basement/Plumbing ❑ Ba.amant/No Plumbing 6. if Business/Industry/others specify type # People # sinks # Commodes # shovers # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated stater Usage (gallons per day) 7. Type of water supply: d County/City ❑ Well ❑ Community 0. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes d"N' o If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE FLAN MUS. BESiiaKHTEEr.D by the client with THIS APPLICATION. I Property Dimensions: � 'j 2--,(A uy;,cft"K l a`►,�n} P:10 ui i1�.Wc-r.<Ctc1 �L Tax OMcePIN: # 5" 781-44•-i4ftL 4- S7£"7-GL•g533 Property Address: Road Name rAU4 -(AC<4t DIMIC City/Zip /4t1 ve,M , i/c 2%Y%4 If in a Subdivision provide information, as foil Name:' LL c'RfE� Section: Block: A U Lot: a WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1t1,Jy' C`� (4Si' LC -VT' <,J (I /L IGuT' <W R:oP L-(; C' %WC+; Date Property Flagged: 8 ctc1 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 1 am responsible for all charges incurred from this applleation. 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 '7IIr-?12q SIGNATURE -A" THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the fdIawing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): I Client Notification Date: I EHS: Revised DCHD (07/99) Account No. Invoice No. -//6)17 \ \ I Sharprock Acres \ TAMA M. O'MARA PB 6 Pg 183 & 184 \ DB 157, PG 697 I 14 ' .� 13 1 I 2238.'0' ` \\ \ 4.1,5E �� / \ —� \ \ \ \\ �\ _--- — X32" K7. \ 81 710 LO o c'4 --' \4 0, 720 730 74 / J 6�6 / 770 C 0- 1 1 ; , c I O \\ �•l y, 40 J s2' 2 223.59' ¢d w;+A21 0• �r` 4' �ha1e Const. i 150• s 47 237.61' / PT 17 \ 4` °•Ba ' (� R = 150' Eai9t�n9 a 'Id;4� � ry c. Phv Q ri 9 3 \ 7 d ,t N 5; e P� ch 6e removed ; h M'-win (T ) \ w;� P1,4re II _ ._, \ 9 r \ Coq St. CTYP,) Illy 1 .04 1 e,,�\ • � N05 3 20"E y\ \ 5p56' M �� I� �B 4s.7o LL, 9�.3 6�• p I Tent po�ory ©� � R 41 ,I Sedimefl,f gT0.1c ZLET STRUCTLR8�9-64' 361 \ Troia •Ky: 1, Z I o'" 12'w >< 1 R = 500' F� 3 16 15 —� APPROKIMATE N ��A �► \ 125 \ P, STUR5Efl 14 cly 765• 3p 46). EXISTING LAKE v Parcel 42.05 I I \\ b Wanda Goye Hoots / DB 138, Pg 288 1 . grru (4ROL/v 04/ARI e'f /+7 9r rRARSmRryrION I-/4A:•/N' C'[rAfl7YEA•T,AEVI(V O/!/CER - - -'-_-_---_-^--' DIVISION OF II):N1I,trJ .tURrrreRS CCRTIi/CAfION 1_.kba_L�f -�-y,Y�ww.4 I,V r....r.. _.-.:167/_....,,.. .. ,,• MAL SIIRn/Y/SION vlAr APIRAVAL /..M., f e Y.r .u,r+ n. ,w. OArir Cdrkrr Rrc,irrR cr Crrer rrMIOA1rrqII�ItI�K f•Y per M . Y ..•r yr• - wr •w.w.+.l. •,q••or•1•,II•+, .. r7r1 .rY rrw-v­ 1.0/ lnR..'P'ari QIIRrIr rlM ""'10M Y••.••• r'w,.,Ju r'�i•M�.u, t♦ww•r, t /Ii•w,/Yw ••e,nlN M ISN A•f ,�, RN A•1yylll�y r •r YrWYY/ IV W •. «I•v,u IYr wrrr•• r+.0 •J N.. rl.Ar Rre/t ro r/nv r IAN IY w,u •1 rM�, rY,J,IM r1Y / •.•„•Y IV Y 4,IN M r,u\ rwuw ,/ • uwl� i T t IAV---AgeM •MrNO IM Y wwrlNN r u •w IW wwr.r•• r w. •/ u.I rn.I F n I Iwrl. N t� • 7_ n _E_'�t•'_"" nw Itl N•1 w TMM M � l r4,1 qY Y •t ` •`n'I N .+ „YrM lI � r[�/ � wl Y on'~ - _-_ 1,r r•11 ICY w+l rrrylA. INr41 Yw rrr.,e« rrr••Y •! 1wNA« ••f.� •..e IY `•l.....Ii,N1., •/ •rNly h4 ,•._ X.I.1 N__ tr w4�/�i�,�rrl (..� +•,. Irh�r1�-�1 LLjC MrY. Y N`r. My �./ r - •�I wM� Yw`il.M wwyr « rM ••wr Yw Y h. 4/MYY+ •/ • •N«w.••. M nN I..1 -'T p� rr S'+�!^'••,Y SQL• r !` 114�,M•rnrW .ra,W Y qY r,n„Y„ N •r• rV 1 ,w w,N a .,•N • �-�.Mr•�_1L�_ ■■Lf �!-�•CTC��''l[�-��.•�•..-'mow/"+�: Mw.11,,rYw Y /Y Mr N N T/•uM�l •1 •Ilr •• w r„y,.w wNNw1 r. r••;l.Al.. rl_.. A���31.___. M_� I._ hY IYN row Iw �rV1�^1_ h(21_ r• "jlV7T1.. A'T: 1 ""A �`>�SLYf .�+rti �rw •J w -r _ �Rlr+ tl+ryw.1 . fr•r e4ar1+ .,ran r •rurr . um roam r uAeur ArnR twrn ^--�-�1L YOM cmo AI°R . rrrK(wv" Cpnlerlmt Curve Dolo +�-' -•• «v►-«-nI•..r« Cu. re 1 No4wf Dello lon0enl Are Length Bearin Chord LSA A' M M Iwe+pwN ew.b. w." Iwr •1 , •n n.w.q n' ur IS7..i1' ,_ 253.40' S59'33'40'w j 1' Qtl ii��:�liy Z".r. �or I1014r Co-ly we IMI F M• -r •4nOI 1-�.a•wet• ••N -101"1 rYe yn b0dwp rNen-• Tnr NOII H-9 1 HnlgrMe•Mr-"we wawN, INMa O•+•.t• s- e• MH r;Pn•1 nl ParaN 42 A + !r•w•11n.• M 1n "Iyl.hn E O.rnla..1,wur Llndo CPLt/t711461_D2VdQOR?MLC4waay_ - 4 PI � rl 113 PI AS / NrfgM O rl (/r PND1xA rs • Swllia_� •. ___ d Lrl /, ted' .1 1 r ...r . •rer1.• . 1 / �;f: Oi ?0• ri PI PI. 15 l /6 f e _ i1.Yi N. . rvYW �.�ii.'Uw ( ( PI fJ Ir PI. L ...• PLPI. 7 l3 PI 1 v r / • tl�n. •• r' w..,., rl. t qY y1J.11• SJI' o m (/1 rl ,e �.n,N w n.. r+•_.yN«M �.i: PI 2 1, `a\ g r rl. PI •1 t w:wir` r r.,-+�i.• em.• w .w.. J NIP PI l7f rI w x1,1.1 .., «r .. .• ....•... • ,r. 70.00' le � _ PI L7D Cyw� CL Cree4 ,"(7 n / L7' 1 t1 Aslrw n • n.w m 1� I . .i i� rt'l y �, r / 7 � - II.,•iy, ,4,ww ••r 1•'t ?'^f •.. h,..• n. f1..A 31 Ni ".r R" IOn.473 S0. rl / ^q+ bA \ 7.303 Ae.rr, : o 14' r nr1 rsr• nl nw .n -e•+ .w+�...1•...:.. ,, •r,0 f.,r• NwM, rl .O•,- - it 1 • A«. a .n }s ((.r.5" re HI qt ),. 7000 11°_ I d n h 3 Ox •7 Yrrw .nit •:Iwo 7mn h.l , - Y) O J49's. II f. Mme. Mw _ ca carr 7 u+ . , ,t fi, � o e Iw;, n,l A o a v - �-' ng J7 and P.d,.d lnh 17 M ryf lwl°'. Iwu). J• J ; 1 f .WL510 �;,. •„ ^' '.h Br.. �-,. ii a ti~ �_� J = ',.la Yarn hi. ren.. Ia 71 N7 rw.• I h 707 )43 Sn fI - I,Ir 1•rn :. P: AI_n,-1r,r ley r•,,. 11011 ..,i1. li, d• . r_ ^ Q • dat An.r,I [!j'` 1 '/' { ep`+ A7 '77.074 Sq !1 a r.w':. ;1•r.I. P,K+ .,•« ;r,N- .., r._r. •.« •, 3912 Ar•e•, •o to', G Zo N � J, fb. ''rr.•.P. n I. � _ f.'� r.rcn•ly .ww.+ if r1,wrA P-. - :.. J��Y367 •.I.r r/ == n R V..^,ww Rr- p 41-j4I A ,1 3 IO rubor Ulegle .n g1 DJJ�� j� /-' ! IS/P.- \n .: A. o 4- 710 (".6J.0Z I f e,.menl 4}ia ! �SsObOI� 66'2 ' M r.n,.I 40 ,.f Ltiend _02' 111. N S1 Ott 56617 ! Ort^ ►.nuq'L,- nr. 441 sort n/ f­­trl J' 1 ^� E•41••p / rg67t. P/w In br 0"'d,•���L�� SBO'090E• Rodfvr. I 1 1 OKir tt�� e S ' 10' roblic 111101142 / ASInw.. Sl,rr ft,.rn41 EPnI•e •101 7d.°;I H\�OSI f11'wivi �t�EE DRIVE .N22'56'53' a0rrn0 t _ r ..� • r\ PM.1 nn Ih. pwnw,lwr f•wlnbn• . Ce•,r 1 zeo• so.9r//cel ? 141 MGCr((r r•qr �,-- � � N69'09'06 -E --'" _ Nr('li.el /•/ 1 �Ak1 een+rwl Own•.. 1++45f I / - t)•� It0.73' 36.96' t°, '�_'� o /k i e,nlr.nw. nr... N.,•,w.. i6.S9' yb o3 V� 107 o. ~' 171. �a._.50fi r inn Ino Y"'n-4IJ•,. rS`d k.N n• N k 1� ll�•`,-. _ �, 3� _ T- t OpPrw•rmN• In•N hnl 4 - c Inn n •nr. )1Dt'7i .N- .aAl-_ rq / �Pti4' NR 1 `� W_� nUrtrcot Fr r•au !ill' rW 7, rp 1e rl I I q+ci "irr]In 1 . - rn•;t 1 _ N15.S�6'33-C 0171 o$ z ,7, /• �.. /191 v +� 9.73 E �'.._- �= I bx N ?"1 4. 48. 07 Se r/ f•'$IINr; L r - o`t 0171 W IIO) •rrtl, u % 249 79' - I ,wV.•.s�,.. M/wln I rnwr i s 1 1, 2 tw p Ir N B5tl6'I7' W r°,1•M T,Irl to r• �'� M^`• i r n, Iwf Ce•P+nliwn 7\� S7l�s _ .••�.+.. er...•.e (w- .R•1 s--eo, oYee.el s,,.«- n ,Oleg• � �' wn..r ...7. Ie •w1a• erl■ I.01 M D.+. Cwnly Nreu lYrwl-•r-1 wro •.An,rrl r+• _ _ N 9 �6 ).1 6n a 1 •w.. rr r.q h•Y4« Ins I o.+ r n1... 7 I 1 11 ' ___. 7 • / C r.rr •-•-ww.• —�� P6'SP Oq W •• •r•s•11 to sena w1 seMtrw• 0,1.•O.,N ey SIN, le. r 1 771.77 ��A101N 1hOrw14► wO M IAMt M ,1rr1d la 7 - or •"w wrt+1 1 I . _ _ n ••nw ,,.• 1r r.rr.lr r — rb ON eMlw/ r Vtl - r—it 6 .Nn •M,eVnn Iw r11.,. ... `9•I T }1 r m n,~�'•• _ ---- . • Pi wd,011r M FAlOnwt •M M ••alr rgrl w ••. wI u• rAp ♦ •NfwbllrMr 141,Dwwwl fAIIMCCPI IK (ARV .^ rRP)11APS0 LqRMe• _211 ,=YkN, 001r9—/f-�,` r _._ In- , --• • _.—i.. .. --- ...�Ir._•v__n_w. T - _.•Fa.. . .•" - A 1w • _ �r1 r �'+�rwl1." )' r,•rl'" _LINE TAPI.E _ ----_LINC IABIC _— _—_LINC —TABLE i .. _ ZINC `I tCY(;IN tt;IND _LINO L(NGIN ---RAVING - N(1N e(Yr IN4 ' �r T .••... lIM LC rr I r •r• r •. to I- _ Ti -�_3 t! _. I r —_ _– � i ' _ �+er w. a' i ^tn 4/+o •y11±U1 il� Ij7p )meet .. .... ern• nhsl• r yr -wee nv..A., r_.. Lit Ire _ s.t-• --i -- g;-- `.. -• PwAr E1,.17 r.,- t -r, • . + ..... - ---- -----------}�: — �17-gin —E-1-1-351'_ die ira .•., r .,.. .. � rally ti 1 • , _ 2_ 2 _ _ -- 1-•!�13) .. _ t -t 1 ----Tl is t� rpt tse a 1a na Yxl.aat its $u n...�tit ii n:. r..»ui flEEUOfI EI10111EEi11fIR IOC n 1 _ - .filet w wi ilowiii - Iti ?e• - w7liirii - .. r - ' �P•f� day; �y£ �/ �ws� �k ,�&k M{�F$, � 'S2 `� .H� i ' ,Y w W � � v NEW a ✓r M' �xa�. � ��" �;, af" �� ,a; $ � ,'' •.� " "� f y,2.aq,.��:� �`?.;u�� 'd �1 4 � "� //x r ww x.. `�'P �e fi" hh �i'/ �4 ' df /5 ,"9'x / &' x� �9.•Y 3 ' �,k �pM, j �T.,. 'uq .a :. _r" � ,�"• w ,w t Zx `k`e' v € " a.v awm �,.,�'%w � •✓�ffi« tSJ"w�a�a " � �` s �'� a w'.�£p, # �t x �n'E � �y` w�" � `;%+ a 'Y ::� lit PON x+a" VM) ,` = a ,, %'q�',J x„ •« X wZ 1 "k r " M 4 3 g xt Ag,Oj '4 M C y A a a W + : a &�+fig "x; ^�£ °�' .,w�ew F� 'a�,.di"`y4�°� �w� �x, i� .�S P d'�,�" N3%i fA MOM 1 mid out- 2 � ��� ��,� > �'��� �;� eas4 tib � � `' � � � d � � „�. ��;' ,�A���,4��� •