1340 Baltimore Rd Davie County,NC Tax Parcel Report Tuesday, February 21, 2017
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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
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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
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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
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