109 East Valley View Rd Lot 22 (2) Davie County,NC r Tax Parcel Report Wednesday, February 15, 2017
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WARNING: THIS IS NOT A SURVEY
iarcel'Infonnation
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Parcel Number: E8070B0006 Township: Shady Grove
NCPIN Number: 5871962709 Municipality:
Account Number: 8306468 Census Tract: 37059-803
Listed Owner 1: KELLOGG THEODORE GLEASON JR Voting Precinct: EAST SHADY GROVE
Mailing Address 1: 109 EAST VALLEY VIEW ROAD Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-20
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27006 Voluntary Ag.District: No
Legal Description: LOT 23 4.97 ac GREENWOOD LAKE Fire Response District: ADVANCE
Assessed Acreage: 4.97 Elementary School Zone: SHADY GROVE
Deed Date: 6/2016 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 010210066 Soil Types: GnB2,GnC2,GaD,RvA,ChA,WATER
Plat Book: 0003 Flood Zone:
Plat Page: 053 Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding&Extra 1250.00
Freatures Value:
Land Value: 93000.00 Total Market Value: 94250.00
Total Assessed Value: 94250.00
IN
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/� County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
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• IMPROVEMENT PERMIT For office Use Only
*CDP File Number 218881- 1
a � Davie County Health Department
210 Hospital Street County ID Number:
P.O. Box 848 Evaluated For. NEW
Mocksville NC 27028 Township:
Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 5/24I2021
*NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit.
Applicant: Ted Kellogg Property Owner: Virginal Burton
Address: 109 East Valley View Rd Address: 341 South Westview Dr
City: Advance City: Advance
State/Zip: NC 27006 State/Zip: NC 27006
Phone#: (336)998-5466 Phone##:
Prol2erty Location & Site Information
AddressJRoad#: Subdivision:,-_Greenwood.Lekes Phase: Lot723^
Valley View
Advance NC 27006 Directions
Structure: - SINGLE FAMILY Hwy 801 South off of 140 left on Underpass Rd. on
#of Bedrooms: 3 the left
#of People:
*Water Supply: PUBLIC
System Specifications
nitial System
*Site ��mcafp :_
Provisionally Suitable
Minimum Trench Depth: a 4 Inches
Seprolite System? QYes ®No Maximum Trench Depth: 3 6 Inches
Design Flow: 3 6 - 0 Septic Tank:
1 0 0 0 Gallons
Soil Application Rate: 0 . 2 7 5 1-Piece:
QYes QNo
*System Class ificatanJDescription: Pump Required: QYes QNo OMay Be Required
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons
LESS)
*Proposed System: 25%REDUCTION 1-Piece: QYes QNO
Repair System Required:QYes ONO ONO, but has Available Space
Repair System
*Site Classification: Provisionally Suitable Minimum Trench Depth: 2 4
Inches
Soil Application Rate: 0 2 7 5 Maximum Trench Depth: 3 6 Inches
*System Classification/Description: Pump Required: QYes Q No Q May be Required
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR
LESS)
:Proposed System: 25%REDUCTION
Pagel of 3
CDP File Number 218881 - 1 County ID Number:
"Site Modifications ❑ Open Fill Sheet
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. r
"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
Site Plan The knprovement Permit shag be valid for 6years from date of Issue with a site plan(means a drawing not necessarily drawn to
scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the
g site for the proposed wastewater system,and the location of water supplies and surface waters).
Plat The knprovement Permit shag be valid without expiration with plat(means a property surveyed prepared by a registered land
O surveyor,drawn to a scale of one inch equals no more than 60 feet,that Includes:the specific location of the proposed facility
and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat
also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy
of the recorded subdivisions plat that is accompanied by a site plan that is drawn to scale).
The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of
the system to satisfy the conditions,the rules,or this article.This permit Is subject to revocation if the site plan,plat,or intended
use changes(NCGS 130A335(f)).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? Oyes ONO
Applicant/Legal Reps.Signature; Date:
'Issued By: 2140-Nabons,Robert Date of Issue: 0 5 / a 4 / a 0 1 6
Authorized state OValid without Expiration?
OCreate CA.
01-land Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
IMPROVEMENT PERMIT 218881 - 1
Davie County Health Department CDP File Number:
210 Hospital Street
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: %/ /
Q Inch
Drawing Drawing Type: Improvement Permit Scale: pBlock
QN/A ft.
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I I i __ _____ __ _ ___ .I �' I ►�
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IMPROVEMENT PERMIT ,
Davie County Health Department
210 Hospital Street CDP File Number: 218881 - 1
P.O.Box 848
Mocksville NC 27028 County File Number:
Date: 05 / 24 / 016
Click below to import an image from an extemal location:Drawing Type: Improvement Permit
NCDENR '
Division of Environmental Health
On-Site Wastewater Section 'Date: o s / a / e 1 6
Soil/Site Evaluation *File#: a 1 s 8 s 1
For On-Site Wastewater System PIN #:
*OwnerVirgina Burton Proposed Facility SINGLE FAMILY
Proposed Design Flow (.1949) 3 6 o Location of Site Valley View
Property Size Water Supply PUBLIC Evaluation Method Pit
1940 Horizon SOIL MORPHOLOGY
Lan scape .1941 Other Profile
Profile# Depth
Slope% (IN) Texture Structure Mineralogy
nce Color Color Factors
1 L 0-3 SL 3-Stng gr efi ns np .1942 W et.
4 o/0 3-56 C 3-Stng sbk fi s p .1943 Depth
GPS Saprolite:(in) .1944,Rest.
Hodzon
EHS .1947 Class PS
Nations, beF-71 Profile
RoAR 0 7 5
LT _,
2 L 0.61 C 3-Stng sbk fi Is p .1942 Wet.
3 % .1943 Depth
GPS Saprolde:M) .1944 Rest.
Hodzon
.1947 Class Ps
EHS
Cop rotile Nations,Robe P °fi1e 0 2 7 5
LTAR—
3 L 0-59 C 3-Stng sbk fi s P .1942 Wet.
3 % .1943 Depth
GPS Saprolite:iin) .1944 Rest.
Horizon
EHS 1947 Class Ps
Copy rotile Nations,Robe Profile 0 2 7 5
LTAR._
4 L 0-51 C 3-Stng sbk fi s p .1942 W et.
4 % .1943 Depth
GPS Saprolite:00 ,1944 Rest.
Hodzon
EHS .1947 Class Ps
Copy rotile El Nations,Robe LTAR 0 • 2 2 7
1942 Wet.
% .1943 Depth
GPS Saproldcon) .1944 Rest.
Horizon
EHS .1947 Class
Copy otDe Profile
LTAR
Available Space(.1945) PS OtherFactors(.1946) Site Classification (.1948)Ps
Initial LTAR: o . 2 7 5 Repair LTAR: o . .1 7 5 Others Present:
Comments:
Evaluated By. Nations,Robert
NCDENR . ' .
Division of Environmental Health
On-Site Wastewater Section Date: ® s ,� a `�+e 1 6
Soil/Site Evaluation Fie#: 2 1 8 8 6 1
For On-Site Wastewater System PIN #:
14940 Horizon SOIL MORPHOLOGY
Lan scape .1941 Other Profile
Profile# POS Depth Factors
Slope% (IN) Mineralogy Matrix Mottle
Texture Structure Consistence Color Color
1942 Wet
ala .1943 Depth
GPS Saprolde:pn) .1944 Rest.
Horizon
1947 Class
my EHS
Copy�rofil Profile
LIAR", • .
.1942 Wet.
% .1943 Depth
Saprolde:(in) .1944 Rest.
GPS Horizon
1947 Class
EHHSS
Copy,P—roril Profile
LJ LTAR
.1942 Wet.
ado .1943 Depth
Saprolde:00 .1944 Rest.
GPS Horizon
1947 Class
EHS
Copy rapl Profile
LTAR. • ,,�._ ..
.1942 Wet.
.1943 Depth
GPS Saprolde:(in) .1944 Rest.
Horizon
.1947 Class
EHSS
Copy.Profil LTAR
.1942 Wet.
o� .1943 Depth
GPS Saprolde:(in) 1
oifR t.
.1947 Class
EHS
copy, fil Profile
— LTAR
Comments:
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The "Import"button, attaches the drawing, or other Image Into the space below.
Open Drawing Farm
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Profile: 1 }( Y Z
Profile: 2 X Y Z
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A APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
Da-,ie Count} Environmental Health
DOM P.O.Box 848/210 Hospital Street
b I%Iocksville,NC 27028
ecawed (336)753-6780/Faa(336)753-1680
Application For: ❑Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) ❑Both
Type of Application: ❑New System ❑Repair to Existing System GExpansion/Modification of Existing System or Facility
***IMPORTANT***THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed d 'e,LL oqq Contact Person w
Billing Address l 6 Home Phone
City/State/ZIP A CAAICA44 Le Business Phone
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION S 1 L *Date House/Facility Flagged
NOTE: A survey plat or site plan must accompany this application. Included: Site Plan GPlat(to scale)
(Permit is valid for 60 pmonths with site plan,no expiration with complete plat.)
Owner's Name t tN�tv Phone Number
Owner's Address i . City/State/Zip W tbiSfyice Z"j d4
Property Address 1_o City �1�-LP__
Lot Size Tax PIN# gt
Subdivision Name(if applicable) Secti�ot# �3
Directions To Site:
If the answer to any of the following questions is"yes",supporting documentatio giust be attached.
Are there any existing wastewater systems on the site? Dyes TWINy�
Does the site contain jurisdictional wetlands? Dyes L�'l1oo
Are there any easements or right-of-ways on the site? GYes COQ
Is the site subject to approval by another public agency? Dyes Cis 0
Will wastewater other than domestic sewage be generated? Dyes Y1Qo
IF RESIDENCE FILL OUT THE BOX BELOW
#People #Bedrooms #Bathrgams 2. Garden Tub/Whirlpool❑Yes a<
Basement: ❑Yeso Basement Plumbing: Dyes Lrr1Qo
IF NON-RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building #People
#Sinks #Commodes #Showers #Urinals
Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY:#Seats
Type system requested: C.. 0. entional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: 'County/City Water ❑New Well ❑Existing Well ❑Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve?G Yes [moo
If yes,what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand
that any permits)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use
changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized
Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I understand tht I a risible for the proper identification and labeling of property lines and comers and
locatin"— agd •ei sta]iq� ou respoa/facility location,proposed well location and the location of any other amenities.
Property owner's or owner1 legal represent i e lure Site Revisit Charge
Date(s):
S 1 Client Notification Date:
.Date EHS:
Sign given Dyes GNo Account#
Revised 11/06 Invoice#
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NLDENR '
Division of Environmental Health
On-Site Wastewater Section *Date: e s 1 4 / a e i 6
Soil/Site Evaluation "File#: a 1 8 8 8
For On-Site Wastewater System PIN #:
,owner Virgina Burton Proposed Facility SINGLE FAMILY
•Proposed Design Flows(..1949) Location of Site Valley View
Property Size '. Water Supply PUBLIC Evaluation Method
1940 Horizon SOIL MORPHOLOGY
Profile,,. Landscape Depth •1941 Other Profile
Oe°lo IN Mineralogy Matrix Mottle Factors
Slope ( ) Texture Structure 1J,5
f Consistence Color Color
L 9— .3 S fJ5
L C (�AJIi° If d` r .1942 Wet.
H ox) 5 5 C r .1943 Depth
GPS Saprolite:(in) .1944 Rest.
Horizon
EHS .1947 Class
Pronle —7
LTAR Or
0-60) G S 03 b- S P -fir .1942 Wet.
3 % .1943 Depth
GPS Saprolite:Qn) .1944 Rest.
Horizon
EHS .1947 Class 5
Co otile
Profile
LTAR
.1942 Wet.
3 °f° .1943 Depth
GPS Saprolite:Qn) .1944 Rest.
Horizon
EHS .1947 Class JT!
Copy rofile Profile
El
LTAR D• X77
.1942 Wet.
°fo .1943 Depth
GPS Saprolite:Qn) .1944 Rest.
Horizon
EHS 1947 Class
Copy rofile Pronle ^s�
LTAR� • -O"''Z
.1942 Wet.
% .1943 Depth
GPS Saprolite:(n) .1944 Rest.
Horizon
EHS 1947 Class
Copy ofile Profile
LTAR,_ -
Available Space(.1945) Other Factors(.1946) Sete Classification (.1948) 1" S
Initial LTAR: . 7� Repair LTAR:D . a 7 Others Present: j&M e`
Comments:
Evaluated By. \`
NCDENR Y
Division of Environmental Health
On-Site Wastewater Section Date: ® s `� 4 0 1 6
Soil/Site Evaluation Fie#: a 1 a a s 1
For On-Site Wastewater System PIN 9:
1940 Horizon SOIL MORPHOLOGY
Lan scape .1941 Other Profile
Profile# Depth
Sbpe 9`a (IN) Mineralogy Matrix Mottle Factors
Texture Structure Consistence Color Color
1942 Wet.
% 1943 Depth
GPS Saprolite:(in) .1944 Rest.
Horizon
EHS .1947 Class
Copy�rotii Profile
LTAR • .
.1942 Wet.
% .1943 Depth
GPS Saproincon) .1944 Rest.
Horizon
EHS 1947 Class
Copy�rafil Profile
LJ LTAR
.1942 Wet.
% .1943 Depth
GPS Saproldcon) .1944 Rest.
Horizon
1947 Class
EHS
Copy rofil Profile
LTAR - ,
.1942 Wet.
% .1943 Depth
GPS Saprolite:00 .1944 Rest.
Horizon
EHS .1947 Class
Copy-Erofl Profile
LTAR
.1942 Wet.
% .1943 Depth
GPS Saprolite:(in) AH 4 Rest'
EHS 1947 Class
COpy,.L,rotil Profile
(_J LTAR
Comments:
�. Attach Image
The "Open Drawing Form"button, opens the the drawing form.
The "Import"button,attaches the drawing,or other image Into the space below. ;P3,
Open Drawing Form
Profile: X Y Z
Profile: X Y Z
Profile: X Y Z
Profile: X Y Z
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