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300 Montclair Drive Lot 12Davie County, NTC Tax Parcel Report Thursday, October 20, 2016 t I'arC% yum:.be::r: NCPIN Number: Account Number: 1-13tcd O.:ncr 1: Mailing Address 1: City: State. Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Goof / Page: Plat Book: Plat Page: Sullding Value. L::nd Value-. Total Assessed Value: WAR-NINC-:THIS 1S NOTA SURVEY Tl_ l T. 1• 1 Ul �. 1.1 1111V1113UL1t111 F71200"0012 To :nsttlp: Sh-dy Grove 5870062363 Municipality: 82527405 Census Tract: 37059-803 COCKERHA".a, HAL PHILLIPS Voting Precinct: ."JEST SHADY GROVE 300 MONTCLAIR DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC 27006-0000 LOT 12 BALTIMORE HEIGHTS FHASE 2 0.99 12/2006 006930009 0008 016 191150.00 3500.00 239080.00 Zoning Oveeln,,: � All data Is provided as is without warranty or nuarantee of any kind either exnrrssed or Implied including but not limbed to the i F Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE Middle School Zone: WILLIAM ELLIS Soil Types: IvirC2,ChA Flood Zone: Watershed Overlay: DAVIE COUNTY Ostb iI'd iz g & E::: . 11930.00 Freatures Value: Total &M rr: tifalu : 23C00.0.00 Davie noun Ey, } implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the i G�- 1 + Cour:Yy of Davie, t3_rt'., CaroLns, its agents, eunse.'1ar1�, cor.Latinrs er emp:oyees fro,ti airy and 2;I ci=;ms er causes cf action hue [o j r'p t ITC I or arising out of the use or Inability to use the GIS data provided by this website. Phone: (336) - 753 - 6780 Davie County Health Department Environmental Health Section P.O. Box 848 C71!' 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection Fax: (336) - 753-1680 NA L P. C0 C l< E 12 I d 4 m '33 6 " f VO 3 3 `f Name: Phone Number 77 (Home) Mailing Address:. .3 U U I%ONTC t // / P 0/ - 5 3 6 - r7 Lf y- 5-4 4 uyANcl , IV C 7 uv6 #10Ckiv/c 16 —>/�&/y Detailed Directions To Site: 15- C T 6 r rY10 K p %1 J I U Rx� 121,11-17' R+ c *X %V 0/1., lex-r, /i✓ 0.3 ,i4ises 7'U1tA-, zz,. r L/iST HottSE OAl X lelyr ,4r 71.1 3errezP, of T/lF - Property Address: 30d {/%ie A17 e 2,, / /? /)e , W i1x NC e Q_ /I✓ C -Z 7 10 C9! Please Fill In The Following Information About The EXISTING Facility: IJftft 1 � � 1161 Name System Installed Under:-, �Anj 66-d o-14 Type Of Facility: Ause, Date System Installed (Month/Date/Year): // Q Number Of Bedrooms: 3 Number Of People: Is The Facility Currently Vacant? Yes 6 If Yes, For How Long? Any Known Problems? Yes (S)If Yes, Explain: Please Fill In The Following Information About The NEW Facility: h1 DO1r7aA-- Type Of Facility: ClWe- /I t re 5W6 a- D i OF w * tf Number Of Bedrooms: Number of People Pool Size: nn / Garage Size: Other: Requested By: 147-T • c fce..-- Date Requested: (Signature) For Environmental Health Office Use Only Approved Disapproved Environmental Health *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 Payment: Cash Check Money Order Paid By: Received By:_ Account #: �,�� Invoice #: for any given period of time. Date: Bnrrowr.NClient Hal P- COckerham Property Address 300 Montclair Drive ccs Advance Lender No AMC PLAT MAP ADDENDUM Count D8v'e State NC 2. Ccxie 27005-7332 Y .�F 88 & T Mortgage �l G 7b a � _y t f e i Fila No Ncntctair300 '- t ..,i'q;w A.: •masn4Ft..µ.'... •;1tht "t' i P11^ (.Ll• i „ 'A Vea V . A 4 - ,V.� D x f , t. _,• �• t.. i •1 � a•-Jt'k, �, .1 t1 •r— -'+.M - +. •��• a :... • a_t N 'Z �xY •- a ... . .� I.x 1- '. 1!ea� ... :. ...r. .....:ft ..o 1'w . �:. Jr:i ...t...0 tt.. t♦....a.. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section K P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002736 Tax PIN/EH #: 5870-06-2363 Billed To: David Gordon Subdivision Info: Baltimore Heights II Lot # 12 Reference Name: Location/Address: Montclair Drive -27006 Proposed Facility Residence Property Size: 100 x 365 **NO`$1Q*1WM%rdOrP &/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. Residential Specification: Building Type _ #People #Bedrooms #Baths _ Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD)�d 'Waste: Site: Newt Repair ❑ System Specifications: Tank Size/ GAL. Pump Tank Other: Reouired Site Modifications/Conditions: GAL. Trench Width �Rock Depth,/(5 Linear FL92FO IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED/E"" L ENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the avi C untyHealth 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 thepay f i stallation. Telephone # is (336)751-8760.**** i Environmental Health Specialist's Signature: 4Z Date: �s DCHD 05/99 (Revised) Account #: 990002736 Billed To: David Gordon Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section U P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5870-06-2363 Subdivision Info: Baltimore Heights II Lot # 12 Location/Address: Montclair Drive -27006 Proposed Facility Residence Property Size: 100 x 365 ATC Number: 3783 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 CONSTRU TION 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 11 of G.S. Chapter 30A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarant t at he system will function satisfactorily for any given period of time. o Septic System Installed By: j D Environmental Health Specialist's Signature : 4/R-/ / Date: Z2 —Z/—P DCHD 05/99 (Revised) to ' PLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department J Environmental Health Section / P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 GE� Uu 6 �1AY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �l. Name to be Billed o r6Q Contact Person Mailing Address ill , `Q'e. r(( nro ¢-`%) ,Lc>i �/�. Q � Home Phone -3 36- [ � � �� � z City/State/ZIP ((vVt l C y�J . �. 27�1-18usiness Phone 374� ` :)!�t C1 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip Ill Improvement Permit/ATC ❑ Both 4. System to Service: ® House 11 Mobile Home 11 Business 11 Industry El Other S. Type system requested: LSA Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People 2— # Bedrooms 1�3 # Bathrooms '2 7. ®Dishwasher ❑Garbage Disposal ®Washing Machine ❑Basement/Plumbing RlBasement/No Plumbing If Business/Industry /Other: verify type # Commodes # Showers IF FOODSERVICE: # Seats # Urinals # People # Sinks # Water Coolers Estimated Water Usage (gallons per day) 8. Type of water supply: ® County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Z No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: too )(-5 le )54 Tax Office PIN: # 7i D O 6� "' 3 Property Address: Road Name 6 I CI C% I r City/Zip AA VQ c WRITE DIRECTIONS (from Mocksville) to PROPERTY: If in a Subdivision provide information,, as folojwV` s: (� Name: ( Q 'r e 1' 1 e Section: Block: Lot: � ate home corners flagged: This is to certify that the information provided is correct to the best 0�'2tn�acnowled�e I understand that any er Y 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 I am responsible for all charges incurred fi'oln 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 1procedures ' as necessary to determine the site suitabilit . DATE t I — V SIGNATURE Gv" �f (M Z�� 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). Sign given Revised DCHD (05/03 C l� �s 2 - Jb ° 0 C Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. U 1. Name to be Billed ('7 4.t y (o ! /l- J2 • Contact Person Mailing Address d� / /� o AJ •Lc / C4-, i/C �2 Home Phone �/ cj —S V C. 33 City/State/ZIP ��t �/r� /►-i G Q / , . 2 � UC3 Business Phone y I/ V ---U 3 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: a --Site Evaluation ❑ Improvement Permit/ATC Il Both a. System to service: ((.Yliouse ❑ Mobile Home ❑ Business ❑ Industry 1.1 Other 5. If sidence: tt People ;i Bedrooms # Bathrooms Dishwasher CI Garbage Disposal ashing Machine LI Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks D Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: O-County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes )) No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB,UTTED by tl►c client with THIS APPLICATION. Property Dimensions: Tax OfficeIN: # 'V" . T 6 6 -C/ S / 5 C/3 Property Address: Road Name DhAn u« Dr , ✓ � City/'Lip 22ooG If in a Subdivision provide information, as follows: Name: Section: Block:��-- WRITE DIRECI'IONS (from Mocksville) to PROPER'11': Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permits) 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 for all charges incurred from this application. 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 suitability. DATE 2- - G SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the foil 111- Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Rcvisit Charge ✓r� � it �' a :.-t. 'r �-..) r 4•r Revised DCHD (07/99) Datc(s Client Notification Date: EHS: Account No. �Z Invoice No. �� b .� DAME COUNTY HEALTH DEPARTMENT 4 Environmental Health Section t Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002232 Tax PIN/EH #: 5860-95-1543.12 Billed To: Guy Cornatzer Subdivision Info: Baltimore Heights Lot # 12 Reference Name: Location/Address: ' Montclair Drive -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 4/. Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % a 6 HORIZON I DEPTH Texture group 15 C < Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r - Structure 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: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: )THER(S) PRESENT: REMARKS: % /, < C//s'��/✓lav �'' /V 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 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 DCHD 05/99 (Revised) ■ ■■ ME ME ■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■Mil■■i�fiii■■■■■■■/.�■ MEMOMEMEMNMEMENN 2MMMMM ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■M■ ■■■■■■■■■■■■■■■■■■■■■■ No ME No ME ■■ ■■■E■■■■ ■■■MM■■■ ■■■■■■■■ ■E■■■■M■ ■■MENU■ ■E■E■ ■ ■M■■■■M■ ■EMME■O■ ■E■■M■■■ ■EM■■M■■ ■MEMS■■■ ■E■■MME■ ■EM■■E■■ ■EM■EME■ ■E■■ME■■ ■M■■ME■■ ■M■■ME■■ ■■E■■ME■ ■EMEMEM■ ■EM■■ME■ ■■M■MME■ ■EMM■E■■ ■E■■MM■■ ■■■■■E■■ ■■M■■E■■ ■M■■E■■■ ■■■■ME■■ ■■■■MEM■ ■E■ME■■■ ■EMM■■M■ ■EMM■■E■ ■■■MEMS■ ■E■■E■E■ ■■E■■■E■