267 Peoples Creek Road Lot 3Davie County, NC' Tax Parcel Report Wednesday, December 21, 2016
WARNING:1111S IS INU'I'A SURVEY
Parcel Information
Parcel Number:
H908OA0003
Township:
Shady Grove
NCPIN Number:
5789620771
Municipality:
Account Number:
8302427
Census Tract:
37059-804
Listed Owner 1:
COX ANDREA B
Voting Precinct:
EAST SHADY GROVE
Mailing Address 1:
267 PEOPLES CREEK ROAD
Planning Jurisdiction:
Davie County
Citv:
ADVANCE
Zonina Class:
DAVIE COUNTY R -A
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 website shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees fion anyand all claims orcauses of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website,
State:
NC
Zoning Overlay:
Zip Code:
27006
Voluntary Ag. District:
No
Legal Description:
LOT 3 FALLINGCREEK FARM PHASE I
Fire Response District:
ADVANCE
Assessed Acreage:
0.69
Elementary School Zone:
SHADY GROVE
Deed Date:
712013
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
009330061
Soil Types:
Pc132
Plat Book:
0007
Flood Zone:
Plat Page:
048
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Building Value:
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees fion anyand all claims orcauses of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website,
DAVIE COLTNTY BEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 989900228
Billed To: Castlegate Construction, Inc.
Reference Name: Marshall Horton
Proposed Facility: Residence
ATC Number: 2224
Tax PIN/EH #: 5789-62-0771
Subdivision Info: Falling Creek Sec.1 Lot # 3
Location/Address: Peoples Creek Road -27006
Property Size: 110 x 300
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 I I of
G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWA S IS VZAD FOR I 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
hasbeen installed in compliance with Article 11 ofG.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. 1!�D- I X. -TI - "
.o
i
Aar'
V
I P-2 (F, 114 V 7-
A17- /&1SP6Cric,3
C-�o evc,,r�-)
Septic System Installed By:
Environmental Health Specialist's Signature - Date: 1-7 )00
'A5' 7
DCHD 05/99 (Revised)
DAVIE COVNTY HEALTH DEPARTMENT 0 C:�
Envir4mental Health Section
P. 0. Box 848/210 Hospital Street
Mockwille, NC 27028
(336)751-8760
IMPROVEMENTIOPERATION PERMIT
Account #: 989900228 Tax PINIEH M 5789-62-0771
Billed To: Castlegate Construction, Inc. Subdivision Info: Failing Creek Sec.1 Lot# 3
Reference Name: *Marshall Horton LoGation/Address: Peoples Creek Road -27006 1-4190
Proposed Facility: Residence Property Size: 110 x 300
ATC Number. 2224
**NOTE** This Improvernent/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 13 OA, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SM PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type H006c, #People #Bedrooms #13aths 7—
Dishwasher: 0"' Garbage Disposal: 17 Washing Machine: ffr-- Basement w/Plumbing: 0 Basement/No Plumbing: El
Commercial Specification: Facility Type #People _ #People/Shift #Seats Industrial Waste: 11
Lot Size 0.02 Afk6 Type Water Supply Design Wastewater Flow (GPD)_]�&D Site: New ET"'itepair 13
/? .0
System Specifications: Tank Size 1C)ODGAL. Pump Tank GAL. Trench Width 3, Rock Depth /Z: Linear Ft.��O
Other: TA�S-1(24WTIO,375� L, fQes '9' C> -c-
/o
Required Site Modifications/Conditions: YA--ea 1VC)Fj: FaoP-L-1-1iS
IMPROVEMENT/OPERATION PERMIT LAYOUT ) ROVED EFFLUENT FILTER. RISER(S) IF 6 - BELOW
FINISHED GRADE. ****NOTICE: Contact a reprZ�i2th of the Davie County Health Department for final inspection of this
1:30 p.m. n the day of installation. Telephone # is (�36)751-876O.""
system between 8:30 a.m. to 9:30 a.m. or 1:00 p n� I
Im"'to
0.
Z
2&
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
APPUCATION FOR SFFE EVAMTION/IMPROVEMENT PERMff & ATC
Davie County Health Departihent
En vimnmentill Hesith Sedfan
P.O. Box 849/210 Hospital 8t;reot AUG 3 1 19N
Mockaviller VC 27026
(336)731-8760
***1W09TU THIS AVPLXChTI0X CAMWT BX PJW=SBZD UMSS WZ THE RZQUXRZD
XMMMWXOH IS RqVXDZD. Referto the XNFCRt=XOH BULLZTIK for instructions.
1. name to be SLIled contact Person ldleswf"�
WALUng Address Nomis Phon
Utl/stats/srp C,,e5 ShoLness Phone
2. Vaiss on Pezait/ATC it DUterent than Above
Wailing Address ip
3. A"lication ror: 0 Sit* Rvaluation Zrov'Lt Vemitl= 0 Soth
4. Systan to services A-18"Ouse D Mobile Home 13 Business 13 Indust" 13 Other
7
S. If Residence% # People # Bedroom 66.3 # Bathroms '97—
/DLehmasher 'bave OLD"sal Wi;wUng WaahLna 13 Bas—t/Plubing 0 Namesent/no Plumbing
4. ZZ Musivess/Xud"tZT/otheal specift two
# Conoodes
# People _ # Unks
0 showers # VrLnals # Water Coolers
X1r N=SZRVICZ: # Seats Zatimated Water Usage 19atons per day)
7. Type of water supply: la/c'cunty/city a Well a coumni ty
9. Do yon anticipate additions or expauslous of the facility this system is Intended to serve? 11 yes O/No
If yes, what ty"?
***JMPORT4NT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTE1D
BELOW. Either a PLAT or SITE PLAN MINTBESUDMITED by the client with THE APPLICATION.
Property Dimensions: I 10 )� -:�ZC)
Tax OMce PIN: # 5-7 ?7 4 Z,6 -7 -7 1
Prop" Address: Road Nnme/'e�'6y
City/ZIp
H In a Subdivision provide Information, as follows:
Name:
Section: Block: IAU
WR17M DIRECTIONS Ohm Macknille) to PROPERTY:
I -A 125: —r - 7 2 � - ed / A /
Ae- Z1k-4"-4ZZS-
Date Property Flagged: I Idel 7
This Is to certify that the Information provided Is correct to the best of my knowledge. I anderst2nd that any permit(s)
Issued hereafter are subject to suspension or revocations If the site plans or Intended use change, or If the Information
submitted In this application Is hisilled, or changed. 1, also, understand that I am w1blefor all charges Incurredftom
this appUcation. 1, hereby, give consent to the Authorized Representative of the 1 0 Hawuh D)*rtment
to enter upon above described property located In Davie County and owsed by
to conduct all g procedures as necessary to determine the site qdtability.
DATE :7 SIGNATURE Y
IM AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacluN and septic locstlons�
Revised DCHD (07M)
,��r 3
D
FO CT 2 .2 19 - 99
Site Revisit Charge
Date(s):
Client Nodfication Date:
EHS: J-;,�
Account No. 1 01;
Invoice No.
El Dishwasher El Garbage Disposal 0 Washing Machine El Basement/Plumbing El Basement.06 Plumbmg�,
6. If Business/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
J
If Foodservice: # Seats Estimlit6d Water Usage (gallons per day9)
7. T. pe of water supply: El Count ity El Well E) community',
Y/C
8.
Do you anticipate additions or expansions of the facility this system is intended to serve? El, Yes E) No
It yes, what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** A PLAT OF THE PROPERTY MUSTIBE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: qq, � 7q
WRITE DIRECTIONS (from
Tax Office PIN: # 5 7 99
63 1'r,-�5703
Mocksville) TO PROPERTY.
Property Address: Road Name
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
(r. -I
I Wt/ to -54 e -
I
City/Zip Adv;4We!�—,
Davie County Health Department
CA) AIPJS-)� 4
Environmental Health Section
eJ9
If in Subdivision provide information, as follows:
81 ye
P. 0. Box 848
AUG - 6 1997
tlrle
Mocksville, NC 27028
Lot #:
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSEII UN�ESS
ALL THE REQUIRED INFORMATION IS PROVIDED.
I
Name to be Billed
ljla:s� Ld Z01144A
Contact Person 6;"4
Mailing Address
2 .5 VA 5-t,,o� rf;"al
Home Phone
City/State/Zip
�I;JV'5�4111 514IL4"% At ie, Q 749 3
Business Phone 9 9�? 6-
2.
Name on Permit/ATC if Different than Above 5�4me—
Mailing Address
City/State/Zip
3.
Application For:
Gr Site Evaluation 0 Improvement Permit & ATC I Both, %
4.
System to Serve:
13 House El Mobile Home El Business
El Industry C3 Other
5.
If Residence:
# People # Bedrooms
# Bathrooms
El Dishwasher El Garbage Disposal 0 Washing Machine El Basement/Plumbing El Basement.06 Plumbmg�,
6. If Business/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
J
If Foodservice: # Seats Estimlit6d Water Usage (gallons per day9)
7. T. pe of water supply: El Count ity El Well E) community',
Y/C
8.
Do you anticipate additions or expansions of the facility this system is intended to serve? El, Yes E) No
It yes, what type?
PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** A PLAT OF THE PROPERTY MUSTIBE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: qq, � 7q
WRITE DIRECTIONS (from
Tax Office PIN: # 5 7 99
63 1'r,-�5703
Mocksville) TO PROPERTY.
Property Address: Road Name
CL -
I Wt/ to -54 e -
I
City/Zip Adv;4We!�—,
CA) AIPJS-)� 4
eJ9
If in Subdivision provide information, as follows:
81 ye
r
Ap. a QAJ
Name:
tlrle
Section:
Lot #:
This z 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
falsificd or changed. 1, also, understand that I am responsible f6r all charges incurred from this application. 1, hereby, give consent to
County
the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie
-;.vned by to conduct all testing., procedures,
and.o 0
;A I
as necessary to determine the site suitability.
DATE. 1? -6- 9 7 SIGNATURE
Revised DCHD (06-96)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION---/ LOT -f
Soil/Site Evaluation
APPLICANT'S NAME
PROPOSED FACILITY
SUBDIVISION
Water Supply: On -Site Well
DATE EVALUATED
PROPERTY SIZE
ROAD NAME X),2
Community ' Public /
Evaluation By: Auger Boring t,-' — pit
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
AW
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
r's
LONG-TERM ACCEPTANCE RATE
/ -/
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (0 1 -90)
EVALUATION BY: A��
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 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
N 0 1 ", 9'0 5 E
505. 11
P'UBLIC R W
126.00' CN 100.00, C_ 1 02"
T 123.00' in 0 'k,
06
V_ I
CN
R
U-)
C14
0.692 Ac.± '
CN
00
z
!23.3-17'
250 . 00'
S01*21'01"E
OD
0.700 Ac.= in
z
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t 0111 U�
74.18 U-)
0
c?1110�;�� z
Pa"Ce
RiCha
D8 I
§'E- A _Rl N G
4'10'52 "W
6 3 05
W
239 9
�'l 3 0 5
4 E
3*26'02 W
6'5
09,
Ln (9-
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0.704 Ac.±
ILD
U0
cy,
0
(S) N
LD Co
n z 99,
-0. 692- Ac, 011 r
:10
z
00 .692 Ac. S59*d',
0:11 4-Z
CN 99 b'6
51 79'
26.38'
3
16-7.BO'
(0.
011111W
N01'21'
0'
U')
0.693 A c.
(2
Q)
Q,
�b
.'.�."4 It.
0 30
14*- 0
3 0
0.707 AC.±
a) Ln
CIO
C C7)0
187.34'
261.52' 3 3. 13
N04*16'00"E
S89*1 4'041W
44
J M. Talbert 0 7T
Certificate Of Approvoi t) P:jr'g Board:
Pg 853 Cd
The Davie County Planning SOWC hereby approves
Record Plot for FollingCreek Parm subdivision
0
427 Date Chairman, u'ty Planning Board
C)
('0 zCertification of Approval of Private (on site) Se*oge Disposal S
ystem,
hereby certify that the Davis County Health Department has ev , 6uated
subdivision entitled FallingCreek Form with respect tO'critflirio (Ind condit
established Dy state !aw or promulgated thereunder Pnj the same is fo
to COMPIY with such criteria on PTw0q