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257 Peoples Creek Road Lot 2Davie County, NC Tax Parcel Report Wednesday. December 21. 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: H908OA0002 Township: Shady Grove NCPIN Number: 5789529767 Municipality: Account Number: 8301437 Census Tract: 37059-804 Listed Owner 1: MYERS TIMOTHY L Voting Precinct: EAST SHADY GROVE Mailing Address 1: 257 PEOPLES CREEK ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006 Voluntary Ag. District: No Legal Description: LOT 2 FALLINGCREEK FARM PHASE I Fire Response District: ADVANCE Assessed Acreage: 0.68 Elementary School Zone: SHADY GROVE Deed Date: 10/2012 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 009030991 Soil Types: PcB2 Plat Book: 0007 Flood Zone: Plat Page: 048 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 wan-Antles of merchantability or Iftness 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 NC or arising out of the use or Inability to use the GIS data provided by this websfte. FO HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Kimberly S. Myers -� ic ApIpIlress: 257 Peoples Creek Rd City: Advance StatefZiP: NC 27006 Phone #: (336) 414-6984 r. For Office Use Only *CDP File Number 202111 - 1 County ID Number. ����HDIRMWC PERMIT VAUD 0 4 / 0 5 / 2 0 .1 1 UNTIL - - Property owner: Kimberly S. Myers Address: 257 Peoples Creek Rd City: Advance State0p: NC 27006 Phone #: (336) 414-6984 I'— Property Location & Site Inform atlon Address257 Peoples Creek Road Subdivision: Fallingcreek Phase: Lot 2 Road# Advance NC 27006 SINGLE FAMILY Township: 'Structure: Diroctlons 4 of Bedrooms: 9 of People: Hwy 64 east, left on Hwy 801 right onto Peoples Creek Rd at the church. Home on the left 'Water Supply: PUBLIC Basement: FlyesnNo *Proposed Improvement: Metal Building on conrete slab Type of Business: Total sq. Footage: No. Of Employees: This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature; *Date:— / — / *Issued By.* 2140 - Nations, Robert Tate of Issue: 0 4 / 0 5 0 1 6 Authorized State Agent: **Site Plan/Drawing attached.** 01-landDrawing OlmportDrawing Drawing Type: HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release CDP File,Number: 202111 - 1 County File Number: Date: 04 /05/ 2016 0 Inch Scale: _. 0131ock ":..ft. ON/A Page 2 of 2 Phone: (336) - 753 - 6780 .'%,2 ly 690 kin, (53)ON-0911 Davie County Health Departmer±-- i romuental Health Section ror P.O. Box 848 210 Hospital Street 0_11 I Courier # : 09-40-06 Mocksville, NC 27028 Fax: (336) - 751 - 8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: 911-Abe�,u S. MLAOXS Phone Number 9,t, 4 bq ?4 MailingAddress; e5q':=)P1 P -P -00Q c�lez'y_ 60,6( (Work) Email Q(Y)S4 Sil C 10 �Iahfp- C.,e)m Detailed Directions To Site: it) L4 E -/b SD I S e 44 ovi 90) , r 10 pq-� "-)v-) Property Address: r] ve-ek e—pa d Please Fill In The Following Informati bout The ST#YG Facility: Name System Installed Under: D, :7 A4 4 If /V ___jype Of Facility: Date System Installed (Month/Date/Year): C;;? -16 -a00a. Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes �p If Yes, For How Long? Any Known Problems? Yes (9 If Yes, Explain: Please Fill In The F 11 informatign About The NEW. Fa !!ligto - w tIq 60a - ZT0 gu 0� _11ber Of Bedrooms: Type Of Facility- Number of People ,3 -C-;7 Date Requested: 3 -le Requested B (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist Date: *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. - Payment: Cash Check Money Order # Amount:$ tOO -00 —Date:, Paid BY: Received By: Account Invoice #: &at MA __� 13 0 PE-tq c,,-, d4l CA 0i ot, t)Ay �D L- i ,) es sef 'h C- A 5 1 fEnce- �6u-se- Te-- o ol4e S rE, n C- DAVIE COUNTY 111EALTH DEPARTMENT Environmental -Health Section P. 0. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 2 9' IMPROVEMENT(OPERATION PERMIT Account #: 989900259 Tax PIN/EH #: 5789-52-9767 Billed To: David Mallard Subdivision Info: Falling Creek Farms Lot # Lot 2 Reference Name: David Mallard Location/Address: Peoples Creek Road -27006 Proposed Facility: Residence Property Size: 134x264x180 ATC Number: 2136 **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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment an&Disposal Systems). THIS PERMI'T 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 #Bedrooms #Baths Dishwasher: 171"" Garbage Disposal: r2-' Washing Machine: Cy"_ Basement w/Plumbing: 0'*' Basement/No Plumbing: 173 Commercial Specification: Facility Type #People _ #People/Shift #Seats Industrial Waste: El Lot Size qgo, iovo�t`r.4 ,,,Type Water Supply C-40 Design Wastewater Flow (GPD) Z-) Site: New2o"""Repair C, System Specifications: Tank Size le0b GAL. Pump Tank GAL. Trench Width Rock Depth /j Linear FtZf"4W' Other: Required Site Modifications/Conditions: k IMPROVEMENTIOPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTEIL 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.**** L--- 1 Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Tax PIN/EH #: 5789-52-9767 Billed To: David Mallard Subdivision Info: Failing Creek Farms Lot # Lot 2 Reference Name: David Mallard Location/Address: Peoples Creek Road -27006 Proposed Facility: Residence Property Size: 134x264x180 ATC Number: 2136 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUC71ON **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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAVR CONSTRUCTION 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 I I 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-afti-me. N- D Septic System Installed By: Environmental Health Sp�ta S Signature: Date: DCHD 05/99 (Revised) APPU ON FOR SITE EVAURTION/lIMPRO1 IT& ATC U Davie County Health Department 77 -6 1999 1 Ae� Envirvnmenfal Health S&Won AUG P.O. Box 848/210 Pospital street Mockaville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAVIE COUNTY ***ZXP0RTANT*** THIS APPLICATION CAMOT BE PROCESSED MMESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFOM&TION BULLETIN for instructions. 1. Name to be 811164 �d Contact Person Mailing Address Rome Phoneq 4- 791 -7 -7 CLty/State/ZXP "/I Z et?02"ss Phone 2. Name On PG=it/ATC it Different than Above Mailing Address city/state/zip 3. Application For: J"ite Evaluation 1XImprovement Permit/ATC 4. system to Servicat V House 0 Mobile Home 0 Business 0 Industry 5. If Residence: XDishwasher # People 17— # Bedrooms --S* 11 Garbage Disposal 'A Washing Machine Bassmant/Pil—bing 6. Xf Business/Xndustry/other: Specify type # Commode* # Showers # Urinals 0 Both 0 Other # Bathrooms -5 a Basement/No Plumbing # People # Sinks # Water Coolers IF FOODSERVICZ: # Seats Estimated Water Usage (gallons per day) 7. Type of water Supply: County/City 0 Well 0 Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 yes 0 If yes, what type? 'IMPORTANT"* CLIENTS MUSTCOMPLETETHE RE9117RED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBAHTIED by the client with THIS APPLICATION. Property Dimensions: -31 'Oor '5;-eu V Z I IgbR Tax Offlce PIN: Property Address: Road Name City/Zip U In a Subdivision provide Information, as follows: WRITE DIRECTIONS (from MockrAlle) to PROPERTY: (:7�e 1Z Name: C/14ee 0 Section: Block: ilot�-5—� Date Property Flogged: This 497to ce4 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 changedL I, afto, understand that I am responsiblefor all charges Incurredfrom this amlication. 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 to conduct all testing procedures as necessary to determine the site Sul ' ) DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SM PLAN (include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Zov jc- HD 0 Site Revisit Charge I Date(s): I Client Notification Date: IERS: Account No. Invoice No. APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section UG P. 0. Box 848 AUG 6 1997 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed klla5� I/ Zy, Contact Person 6;,)4 Mailing Address 5_62JV� .5 til )a Ayr 6/ Home Phone 9 9g,-116-7 City/State/Zip U;111�yd Q Z/V,3 Business Phone 2. Name on Permit/ATC if Different than Above 54mie_ I'viailing Address City/State/Zip 3. Application For: 2 ---Site Evaluation El Improvement Permit & ATC 4. System to Serve: 0 House 0 Mobile Home Q Business 13 Industry 5. If Residence: # People # Bedrooms Q Dishwasher El Garbage Disposal 0 Washing Machine 0 Basement/Plumbing 6. If Business/Other: Specify type # People # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimaked Water Usage (gallons per day) 7 7ype of water supply: El County/City El Well El (ommunity -8. Do you anticipate additions or expansions of the facility this system is intended to serve? El' Yes C3 116. If yes, what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** A PLAT OF THE PROPERTY MUST BE ' i SUBMITTED WITH THIS APPLICATION. Property Dimensions: qq, 7q Atte--s WRITE DIRECTIONS (from .:.- - -- Mocksville) TO PROPERTY. 'I -ix Office PIN: # �5 7 99 63 _�s7o3 e- Pr.op. rty Address: RoadName ow 9161 City/Zip Admnld�=q / 0-: 41 Ae If in Subdivision de information, as follows: ;3 ycr 7,4 PP. JQ Name: �Zllg eel?" tp Section: Lot #: 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 f6r all charges incurred from this application. I, hereby, give ci. isent to W,- 1 the Authorized Representative of the Davie County Health Department to enter upon above described property located in D_ v1-- County and,owned by a to conduct all testing,,,procedures as necessary to determine the site suitability. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION--/ LOT-�2 Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME Water Supply: Evaluation By: On -Site Well Auger Boring Community Pit Public � Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH Texture group Consistence 77 - Structure 5:� -t V A 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: A� LONG-TERM ACCEPTANCE RATE: j REMARKS: DCHD (0 1 -90) EVALUATION BY: Al Z' 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 Sl - 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 F1 - 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 AB K - 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 j -4T 31C.A. NOI-19'05"E 505-11' p7w 00.0c, T '126 Lr) -0c 6 L692 Ac.= c, J� 1-301 :3.3- Dote �Dwner s 5.quorur 6010 0—er's Signewro 9-18-78 - Dots Owner s Signature VJCIrViQW 060kWAk" T COMOA 4y 6-59, 59 I" 0 , d, t4 18' 3: . zi 77 2 6 3 B ------ 67 BO' '3' L —693 Ac.t. I../ (CI '9 <".6a . C '8-.34' 61.52' N04*16'0C"F cZ A 7- M Parce 44 oficcte B ' 7 3, g 8 Cd er' C1 App -ova, ry P Z—ir� Board -Ie D(2,,e Cou,,Ty Pio—r; SocrC lereoy opD,c,,es the (J/ Record Plot for roll,nqCreek �orn- SuDd;vi3ior Ric,or- Y Toitert .0 Date Cr'c-'rmc 'Ity P, ann,nq Boa,c C mar. 0, L OCA TIO N NOTE Me �wy is r ducLosed by a ttU furrAshed rrto as o .Wrn%*�Jx. �Vhgs assesr,nengs. V an "cord tn Ch. Offsc of Cou�t. rown or have bem acquired NOTES I All distances Sho,4 ground distances. 2 All boarLngs sha deed or tj,l,at,,b an? 3 Iran s 3 ot at patnts, unless not 4 There are NO N C of Project 5 Total Area - 34 1' 6 Total Number of 1, 7 Average Lot S%xG 8 Existed Zontnq - 9 Minimum Building Front sute Rear Side Street 10 Utilities Public water % Pmvat, septic All utilities " Pavement vAdt I KrKNn ZIP ..... . . Zxteftng NfP .......... Vs— 3�14 st�. - . Old Pta"t ,REBA R..... Zww ting found u, pt ..... ... P&tnt c,n found or FALLINCC PHA� 0 WNERIDI WESTVIEW DEVELOI TAITTINCER DEVELOI 2631 REY! WIAISTON-SAL 50 16o' KT/CJ U) 7 C) 4 .4 Cc. z I N 5J (10 99, 692 F QQ 3,6921 AC.± S 5 TC �0 7 I" 0 , d, t4 18' 3: . zi 77 2 6 3 B ------ 67 BO' '3' L —693 Ac.t. I../ (CI '9 <".6a . C '8-.34' 61.52' N04*16'0C"F cZ A 7- M Parce 44 oficcte B ' 7 3, g 8 Cd er' C1 App -ova, ry P Z—ir� Board -Ie D(2,,e Cou,,Ty Pio—r; SocrC lereoy opD,c,,es the (J/ Record Plot for roll,nqCreek �orn- SuDd;vi3ior Ric,or- Y Toitert .0 Date Cr'c-'rmc 'Ity P, ann,nq Boa,c C mar. 0, L OCA TIO N NOTE Me �wy is r ducLosed by a ttU furrAshed rrto as o .Wrn%*�Jx. �Vhgs assesr,nengs. V an "cord tn Ch. Offsc of Cou�t. rown or have bem acquired NOTES I All distances Sho,4 ground distances. 2 All boarLngs sha deed or tj,l,at,,b an? 3 Iran s 3 ot at patnts, unless not 4 There are NO N C of Project 5 Total Area - 34 1' 6 Total Number of 1, 7 Average Lot S%xG 8 Existed Zontnq - 9 Minimum Building Front sute Rear Side Street 10 Utilities Public water % Pmvat, septic All utilities " Pavement vAdt I KrKNn ZIP ..... . . Zxteftng NfP .......... Vs— 3�14 st�. - . Old Pta"t ,REBA R..... Zww ting found u, pt ..... ... P&tnt c,n found or FALLINCC PHA� 0 WNERIDI WESTVIEW DEVELOI TAITTINCER DEVELOI 2631 REY! WIAISTON-SAL 50 16o' KT/CJ Cc. z I I" 0 , d, t4 18' 3: . zi 77 2 6 3 B ------ 67 BO' '3' L —693 Ac.t. I../ (CI '9 <".6a . C '8-.34' 61.52' N04*16'0C"F cZ A 7- M Parce 44 oficcte B ' 7 3, g 8 Cd er' C1 App -ova, ry P Z—ir� Board -Ie D(2,,e Cou,,Ty Pio—r; SocrC lereoy opD,c,,es the (J/ Record Plot for roll,nqCreek �orn- SuDd;vi3ior Ric,or- Y Toitert .0 Date Cr'c-'rmc 'Ity P, ann,nq Boa,c C mar. 0, L OCA TIO N NOTE Me �wy is r ducLosed by a ttU furrAshed rrto as o .Wrn%*�Jx. �Vhgs assesr,nengs. V an "cord tn Ch. Offsc of Cou�t. rown or have bem acquired NOTES I All distances Sho,4 ground distances. 2 All boarLngs sha deed or tj,l,at,,b an? 3 Iran s 3 ot at patnts, unless not 4 There are NO N C of Project 5 Total Area - 34 1' 6 Total Number of 1, 7 Average Lot S%xG 8 Existed Zontnq - 9 Minimum Building Front sute Rear Side Street 10 Utilities Public water % Pmvat, septic All utilities " Pavement vAdt I KrKNn ZIP ..... . . Zxteftng NfP .......... Vs— 3�14 st�. - . Old Pta"t ,REBA R..... Zww ting found u, pt ..... ... P&tnt c,n found or FALLINCC PHA� 0 WNERIDI WESTVIEW DEVELOI TAITTINCER DEVELOI 2631 REY! WIAISTON-SAL 50 16o' KT/CJ