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1340 Baltimore Rd Davie County,NC Tax Parcel Report Tuesday, February 21, 2017 .t 1332 '1339 I 13 401 7{_ 1415 - I 1410 r 5 t �Yt 5 ....1...... .......................................1................._..................................1,5Y.................... _~._.r....~..`.."-.._ir......................._...._1........................................................._................_................................................................................................................................... . WARNING: THIS IS NOT A SURVEY ��" Parcel Information , ��� Parcel Number: G70000006805 Township: Shady Grove NCPIN Number: 5860821535 Municipality: Account Number: 57074500 Census Tract: 37059-803 Listed.Owner 1: PLITT CHARLES W Voting Precinct: WEST SHADY GROVE Mailing Address 1: 1416 BALTIMORE ROAD 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: 6.838 AC BALTIMORE RD Fire Response District: CORNATZER-DULIN Assessed Acreage: 6.96 Elementary School Zone: SHADY GROVE Deed Date: 9/2016 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 010291052 Soil Types: GnB2,RnD Plat Book: 12 Flood Zone: Plat Page: 233 Watershed Overlay: DAVIE COUNTY Building Value: 109880.00 Outbuilding&Extra 0.00 Freatures Value: Land Value: 56020.00 Total Market Value: 165900.00 Total Assessed Value: 165900.00 O uV 11' All data Is provided as Is without warranty or guarantee of any kind 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 Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to r'p NC or arising out of the use or Inability to use the GIS data provided by this website. 1 OPERATION PERMIT or ice se nry * Davie County Health Department *CDP File Number 218623-1 210 Hospital Street P.O. Box 848 County ID Number.-'` ''' Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Will Plitt Property Owner: David Paul Folmar Address: 1102 S Hawthorne Rd !Address: 1410 Baltimore Road City: Winston-Salem Cly Advance State/Zip: NC 27103 State2ip: NC 27006 - - Phone#: (919)9173291 Phone#: (336)817-7133 . Property Location & Site Information Address/Road #: Subdivision: Phase: Lot: Baltimore Road Advance NC 27006 Directions Structure SINGLE FAMILY Hwy;158, right on Baltimore Rd. beside#1332 On the right #of Bedrooms: 4 i #of People: g *Water Supply: PuaLtc *IP Issued by- ' 2140-NaOons,Robert 'System Classiiicatan/Description: - = TYPE III G.OTHER NON-CONN,TRENCH SYSTEMS *CA issued by: 2140-Nations,Robert SaproliteSystem? OYes QNo Design Flow: -- 3 6 0 *Distribution Type: GRAVITY-SERIAL Pump Required? OYes ONo Soil Application Rate: 0 3 *Pre Treatment: Drain field rNoNk(ification Field 1 - 6 0 0Sp•ft• *System Type; INFILTRATOROUICK4STANDARD rain Lines 7 Installer: William Rueben Clayton III Total Trench Length: 4 0 0 8 Certification#: 2694 Trench Spacing: 9 Inches O.C. — &Feet O.C. *EHS: 2140-Nations,Robert Trench Width: — 3 Inches &Feet Date: 1 1 / 0 2 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover a q Inches Approvaistatus Maximum Trench Depth: 3 6 Inches ® Appr=oved D Disapproved Maximum Soil Cover: 2 4 Inches CDP Fite Number 218623 - 1 Septic Tank County ID Number: ' Manufacturer Shoat Lat. STB: 760 Lang: Installer Rueben Clayton III Gallons: 1000 Certification 9: 2694 Date: 0 8 / 0 9 / 2 0 1 6 ` *EH S: 2140-Mations.Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter Date: 1 1 / 0 1 / .2 0 1 6 ST Marker: ❑ Yes 0 No " Reinforced Tank. ❑ 'YesEl NO Approval Status ® Approved❑ Disapproved 1 Piece Tank: ❑ -Yes �-'No _ Pump Tank rnufacturer. Installer.PT: Certification;9: Gallons: *EH S: Date: / / Date: Riser Sealed ❑ Yes ❑ N o RiserHeght: ❑ Yes ❑ No (M in.6.in.) Uk Approval Status Reinforced Tank: [J .Yes ❑ No ❑ Approved❑ Disapp`rovecl 1 Piece Tank:_0 W.Yes-__.__ ❑._.NO - _ Supply Line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: *Schedule: *ENS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings [I Yes ❑ No a Approval Status ❑ Aloved❑==Dlsa 'roved p pPi? Pump e u e e Pump Type: Installer: Dosing Volume: — Gal Certification#: Draw Down: Inches *EHS. *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check-valve ❑ Yes ❑ No Approval Status PVC unions ❑ Yes ❑ No ❑,Approved E] Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No I CDP Fite r Number 218623 1 County ID Number: Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ NO Conduit Sealed ElYes ❑ No *EHS: - Pump Manually0perabte ❑ Yes ❑ No *Activation Method: Date: Alarm Audible ❑ Yes ❑ No /�f APPrtntat Status � x ❑Approved❑ Dtsapproyed .:. .__Alarm Visible ❑ Yes ❑ No 2140-Nat' ns,Robert *Operation Permit completed by: 00 _Authorized State Agent Date of Issue: 1 1 / 0 a f a 0 1 6 Owner/Applicant Signature: "This system has been installed in compliance with applicable NC General Statutes:Article 11,Chapter 130A, Rules for Sewage Treatment and Disposal,15A NCAC 18A .1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE III G. sewage septic system. Rule:1961 requires that a Type TYPE III G. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: wit Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: NCA Reporting Frequency By Certified Operator: NfA Rule.1961 requires that aType IV and V septic systems designed fora hometbusiness owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. _ Rule.1961 requires that Type VI septic systems designed far a homelbusiness owner must maintain a valid contract with a public management entitywith a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity,unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as tong as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. C Hand Drawing 01mport Drawing **Site Plan/Drawing attached.** . OPERATION PERMIT 218623 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksv►lle NC 27028 Date: a Inch Scale: . Oslocic D -*vin Drawing Type: Operation Permit ON/A I r � � 1-7 a _ 1 - I � I z I I W CONSTRUCTION For office Use Only d AUTHORIZATION *CDP File Number 218623- 1 su- - Davie County Health Department County IDNumber: 210 Hospital StreetEvaluated For: NEW P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 9 / 0 6 a 0 a 1 Applicant: Will Plitt Property Owner: David Paul Folmar Address: 1102 S Hawthorne Rd Address: 1410 Baltimore Road City: Winston-Salem City: Advance State/Zip: NC 27103 State/Zip: NC 27006 Phone#: (919)917-3291 Phone#: (336)817-7133 Property Location & Site Information Address/Road M Subdivision: Phase: Lot: Baltimore Road - Advance NC 27006 Directions Structure:` ` ' SINGLE FAMILY - Hwy 158, right on Baltimore Rd. beside#1332 On the right #of Bedrooms: 4 #of People: 5 *Water Supply: PUBLIC System Specifications 11 Minimum Trench Depth: a 4 Site Classification: Provisionally suitable Inches Minimum Soil Cover: Saprolite System? O Yes 9 No - 1 a Inches Design Flow: Maximum Trench Depth: 3 6 -.- 4.-- 8 0 Inches Soil Application Rate: 3 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field 1 6 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 4 1-Piece: OYes ONo Total Trench Length: 4 0 0 ft GPM--vs- ft. TDH Trench Spacing: 9 ®_ O Inches O.C. Feet O.C. Dosing Volume: _ Gallons Trench Width: _ 3 O Inches ®Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: O NSF OTS-1 O TS-11 Septic Tank Installer Grade Level Required: 01011 O 111 01V Page 1 of 3 f: CDP File Number 218623 - 1 County ID Number: ~ ❑ Open Pump System Sheet Repair System Required:®Yes O No O No, but has Available Space rDesignFlow: System Trench Spacing: 9 O Inches O. . ification: Provisionally suitable — ®Feet O.C. 4 $ Trench Width: _ 3 Feet Inches Soil Application Rate: 0 3 Aggregate Depth: inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: LESS) 1 Inches Maximum Trench Depth: 3 6 Inches *Proposed System: 25%REDUCTION Maximum Soil Cover: a 4 Nitrification Field 1 6 0 0Sq.ft. Inches No. Drain Lines 4 *Distribution Type: GRAVITY-SERIAL --Total Trench Length: 4 0 0 ;Pump Required: OYes O No O May Be Required ft. Pre-Treatment: O NSF TS-I TS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. cRh=a-1nti 750 *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. R�,�g 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been completed during the period of validity of the Construction Permit,the information submitted in the application for a permit or Construction Authorization is found to have been incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? O Yes O No Applicant/Legal Reps. Signature• Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 9 0 6 a 0 1 6 Authorized State Agent: Malfunction Log OYes ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 218623 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville -NC .27028 Date: 09 / 06 / ,2016 0 Inch Drawing Drawing Type: Construction Authorization Scale: 0 Block 0 N/A i..._............................ ........................... ..................... . .......... ................................... ................................................... .................................- . .. ................... ... .............. 2. ........ -'- -"--T'­"' I................. .............. ................ ........ ........... ..................................... ................................................... ........................................ ... .............................. ......... .............. ......................... .........................................................................................................l ................................................................ ........... ............... ........ ........... .......... ............ .............................................................. ................................................................................................................ ............................... ........... ...................................... .......................... .................................................................. .......... ............... .......... ... ..............................................J._.............. ..... ........................................ .................... ........... .............. ......... .... . ...... ............. ............. .. ................... 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I j.................... .............. .... ............... ................ ............................ ............................. .................................. ................................................... ............. ............................................... ...... ........................................... ................. ............ . . . .......... .................. .......... ............... ...... .... ............................... ... ........ .... ............. ........... i �............................... ..... .......... .... ............................................................ . ........... ................ ............................. .............. . . ................. ................ .......... ......................... ... ..................... . ....................... ................ ................ ........................................................................ ................ ........... . . .. ...... ................................ ................ ....................- .......... ......... ............. ............. .................. .............................. ............... ............ . ................................................... ............. .............. .......................................................... ....................... ............................................................. ...................................................... ................................................- Page 3 of 3 Pi P2 v CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 218623 - 1 P.O.Box 848 MCounty File Number: ocksville NC 27028 coo d(tv, (o�� � g / .0.6. / a0 16 Click below to import an image from an external location: Drawing Type: Construction Authorization o�6 _. ,A 5J - 2b r � 0� 1 � Page 3 of 3 P1 P2 1-e