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170 Montclair Drive Lot 11Davie County, NC I I I Tax Parcel Report Wednesday, October 19, 2016 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: NCPIN Number: Account Number: Listed Owner 1: Mailing Address 1: City: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: F712OA0011 Township: 5860951389 Municipality: Shady Grove 82515608 Census Tract: 37059-803 DOWNEN RICHARD R Voting Precinct: WEST SHADY GROVE 170 MONTCLAIR DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006-0000 Voluntary Ag. District: LOT 11 BALTIMORE HEIGHTS Fire Response District: Land Value: Total Assessed Value: 1.01 Elementary School Zone: 8/2000 Middle School Zone: 003430450 Soil Types: 0006 Flood Zone: 076 Watershed Overlay: 196700.00 Outbuilding G Extra Freatures Value: 36000.00 Total Market Value: 236420.00 ADVANCE SHADY GROVE WILLIAM ELLIS SeB, MrB2 DAVIE COUNTY 3720.00 236420.00 No 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 �T/-r County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to no�N 1\ L or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001652 Tax PIN/EH #: 5860-95-1389 Billed To: Richard Downen Subdivision Info: Baltimore Heights 1 Lot # 11 Reference Name: Location/Address: Montclair Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2765 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 WASTEWATER.69NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 9 GY�i! 71 J� Date:4" L3 MW M5 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, 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. PT- DA Ta cc—t8 R,O-3 - pr'►'I,wer-rloa X120' Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) 5. .75, M,C-DA,I t1z>_ DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001652 Tax PIN/EH #: 5860-95-1389 Billed To: Richard Downen Subdivision Info: Baltimore Heights 1 Lot# 11 Reference Name: Location/Address: Montclair Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2765 **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. �j i Residential Specification: Building Type // #People �,T— #Bedrooms sT #Baths 1..5 Dishwasher: YS Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply (?,i Design Wastewater Flow (GPD) -4 Site: New V� Repair ❑ System Specifications: Tank Sized GALL..' Pump Tank �Q(j�I GAL. Trench Width�6 „ Rock Depth A5 'Of Linear Ft.�b Other: �rar -r e- /'Z4 ` -?-A ` f 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 a.m. or 1:0Q�mD. IoZgQ p.m. on the day of installation. Telephone # is (336)751-8760.**** kav jD t°X /,'Niw ° alp 0 - Environmental Health Specialist's Signature:e- 2 2r Date: DCHD 05/99 (Revised) '. APPUCATION FOR SITE EVALUATION/IMPROVEMFM PERMIT & ATC Davie County Health Department 3 EnkivnmenW Health SLac on P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336) 751-8760 DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer tq-he INFORMATION BULLETIN for instrnctions. 1. Hems to be Billed G Ti C/�/a /f l `O w / IA Contact Parson Mailing Address�/2 Home Phone city/state/ZIP `�!� /�/,l n�Gi� /J C o� %y u (' Business Phone /VO IV 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both t. system to service: >rHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 12� # Bedrooms '-33 # Bathrooms �' S X, Dishwasher n Garbage Disposal Mashing Machine ❑ Basement/Plumbing U Basement/No Plumbing 6. If Business/Industry/Other: specify type # People # sinks # Commodes # showers # Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Mater supply: � County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XV0 If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: -i 9-%q K Tax Office PIN: I, �So j� 1 Property Address: Road Name City/Zip %O✓P 0 Gi 76 G If in a Subdivision provide Information, as follows: Name: � Section: Block: Lot: WRITE DIRECTIONS (from Mocksvilllee�) to PROPERTY: Date Property Flagged: �5 - G/ 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 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 to conduct all testing procedures as necessary to determine the site sultabil DATE 2 �- �� SIGNATURE 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). Site Revisit Charge Revised DCHD (07/99) 0 Ji Date(s): I Client Notification Date: I EHS: Account No. A 5-�' Invoice No. 1 g r HEIG14TS with respect to ertt4no end eendtigsws - 6stabks,ied by stere low or promulgated thoraandu 066 the soma ,s foe" to comply with Svc% cr,ter,a sod comdgtioas EXCEPT as tea"• 10 such eveloottoes. For details *Of Isis 41"61.411.6 wd few limitations sea the wrttte6 rapid 06 11141 t the sold Oepoll menf. IMPORATANT NOTICE :THIS CERTIFICATE DOES NOT CONSTITUTE A PERMIT OR APPROVAL OF INOIVIOU'AL LOTS IN SAID SUOOlvIS10N. FOR INSTALLATION OF SEWAGE FACILITIES GATEdhjjHTr HEALTH OFFICIAL PARCEL 18.05 - PARCEL 18-03 STACY CORNATZER et of ppm OF PARCEL 18.04 0.8.163-762 I CARL W. GUITON STACY LEE MYERS 0.8.151-TS3 • I O. B. 151- 779 .- -- -� - - -- _ -' Total 1,58 S 89 =50 -50 �.E-- - - 1.64 198.05 138.26 --ToR 59.79 137.63 gram found •-_--- ------ -•--198.05 "-- -"-` -198 05 - " found 175.41 ' - _ _ " 198.05 "198.05 3 ; ~ 4106 19.99 3� 1 - ; 5'n6gettva drtvawey sosarmant in g c -� - frl E -Q °'1 L� ' .a 4 g m o: O I I fT • -0 01 .O Qt iu Cl E e' I o► v 2 of t N °I . O N � I O �N o 0 N TWO ACRES c Two Al � OI Z C I ' , 10' attltty � aos4n«N D7o'tlo' soot edu� -J---- - --- -- -- --- - - - 198.08 - ----- - - 98.05 ---- - a 200.69 1 198.05 _ i98.05� _ - -' N 89%50 -25 W Total 1,586.93 • 60 PubhC Street �oio Total 1.585.76 S 89•-50-25�E-�' • -3�-------296.10------ - 3 100-- - --198.05 ---- 198.OS -" -"" - -� � - 199.41 ----- "-- 70'alp'sggkt 6osa 3 3 ti 3 ' 3 orn o e? rn -� 3 179.36 ap �) M of Q z _ -0 'at 8 m .�. �- �� _ N89•-50-25 W �O M 0 _ O 1 C { 7 �so - _ $Y O O ono to al - er6s /or 0 O C-4 O a 3 %e O N O N seti saw O� N sem. 0 t O in �+ to drags r - dram field N N O to 1,4114 O , 7 o G 44.70 116.74 w - -- - - - - �79.3fi - - - - ---- Dtz - - -- '--- -- - - 198.05 - - - - - - --- "R�R mem ta.sfi moa teamll �--- N 89. 50 - 30;� W Total 1.58. 0• control corner~ I . PARCEL 23 -` PARCEL 22 I j's:_GUY J. CORNATZER, JR 1 HILARY C. WILSON D.B.153-098 ti w RAY CKA, V' -6J rfr--- Re juver of Deeds 13ij rn mteby earkly that the subdivision plot shown bonen hoe bean lou" 10 comply wglb the County Subdivision Regde11ons. with the except*^ of such variances. of any. as en 00144 to Ike istautas of the PloOotag eoord God that it boa been approved for reeo"gng to the office of the Register of Deeds. It is busby meted that sad approval ler rtceedaba" does reel loclado approval t0 1n4I011 664 oldita so0atary facilities nor does it tncbtde approval for conk -Eywo6 or oeevpeneriot Outidgng4- ttrodo- . oal5z- 706 . MONTCLAIK m SITES O: CE a a � 6P LOCATION MAP PARCEL IS-- STACY LEE III/r D. B. 151-• 7 S aw.50'- 3CP E- 21'5.,6' PAr- GUY J. 0-F- S _E S O2--3S-4.d' i 60.08 76416 porer� lobe 0sod $a PARCEL 23.03 GLENOA C. MILLIS D. 8.152- TI I PLAT FOR HE OWNER LIFESTYLE MR. RICK APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address / L9 !.}�'7�.�'��cl�!? CGC.��-'-1 •(�(/.??/Ccs_ ti's Z•7,' t: Home Phone ( ".c Business Phone 1 i/6-- -- —:7 2. Name on Permit if Different than Above 3. Application/Permit for: ❑ General Evaluation ❑ Septic Tank Installation 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision 15/, 2Z110,6k-2— Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Sinks _ No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: R Public ❑ Private 8. Property Dimensions co'c/c A /2-67- Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If vac what tvna? ER-N'o' ❑ Community `NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: This is to certify that the information provided is correct to the -best f my knowledge, annc, incurred from this application. DATE _�- rstand I am responsible for all charges f TURE CONSENT FOR SITE EVALUATION TO BEVONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ©--� I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative Af 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 a ermine "said , ite's suitability Dorm d absorption sewage treatment and disposal syst m. ✓ i ,,�- ,7 ATEA` f----4SIG ATURE DCHD (12.90) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY Water Supply: On -Site Well DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Community Public A,-'- Evaluation / Evaluation By: Auger Boring Pit ll_� Cut FACTORS 1 2 3 4 Landscape position S Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupJ Consistence Structure All i o` 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: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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 Mineraloey 1:1, 2:1, Mixed Notes liorizon 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 (01-901 y CCCCCCCCCCCCCCCCCCCCCC�■CCCCCCCCCCCCCCCCC'MESEMMINMEMME MENEM= NN ■■■...■..■.■■■■.■■...■.....■..■■.■■■■■.■■C■■.eeee■■■■■■■■■■■CC■■ ■.ecce.■■■■■■■■■■■■■.■■■......■■■.■.■■■■..■.■■...■.■■■■...■.....■■ ■� ■■.■■■..■■■■■■.■■■■■.■....■..■■ .■■■■■■eoeeeeee.■ee■eeeeeeeeeee■ ■e■■■■■■■■■■■■■■■.■■■..■..■...■ ■■■■■■■...■■....■■■■■.■..■..■.■■ ■...■...■■■...............■■■.■■■■■■■see■■■■■■■..■■e.eeeneeeeeee■ ■■■.■■...■.■■■■■....■.....■.■....■.■■.■■■■■■.■■see ■e■eooeeo..■e■C ■■.■■■■■■ee■o.e■■eee■■■■■.■■■■■■.■C■■..■■■■■■■■u.■■.....■■....■■ ■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■ ■■■■u■■■■■■■■■■■■ ■■■ .................................................. ............... ................................................■......■■�■....■■ ■■■■■.ee■■■■eee■ee■■■e��e■e■eeo■.eee■eC■ecce■e��e■■eessCeeeeoee■ON CCCCCC�CCCCCC�CC�.CC�CCCCCC CCCCCC�CCCCCC -m IMMMEMEM NECU .......■........................................ �. ■O■MO■ME■EM■■■ .......CCCCCCCCCCCCCCCCCC� .... 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