300 Montclair Drive Lot 12Davie County, NTC Tax Parcel Report Thursday, October 20, 2016
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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
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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 "
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Name:
Phone Number
77 (Home)
Mailing Address:. .3 U U
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Detailed Directions To Site: 15- C T
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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
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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)
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