1340 Baltimore Rd (2) Davie Coulity,NC Tax Parcel Report Tuesday,November 1, 2016
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WARNING: THIS IS NOT A SURVEY
�� � A Parcel,Information �_ _ ._�
Parcel Number: _-G70000006802 Township: Shady Grove
NCPIN Number: 5860823510 Municipality:
Account Number: 25700000 Census Tract: 37059-803
Listed Owner 1: FOLMAR D P Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 1410 BALTIMORE ROAD Planning Jurisdiction: Davie County
City: ADVANCE Zoning Class: DAVIE COUNTY R-A,R-20
State: NC Zoning Overlay:
Zip Code: .. 27006-0000 Voluntary Ag.District: No
Legal Description: 15.830 AC BALTIMORE RD Fire Response District: CORNATZER-DULIN
Assessed Acreage: 15.73 Elementary School Zone: SHADY GROVE
Deed Date: 12/2009 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 008150513 Soil Types: GnB2,RnD
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: DAVIE COUNTY
Building Value: 0.00 Outbuilding&Extra 0.00
Freatures Value:
Land Value: 176990.00 Total Market Value: 176990.00
Total Assessed Value: 6690.00
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 Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
nOUty4 NC or arising out of the use or Inability to use the GIS data provided by this website.
' CONSTRUCTION For.Office use Only
•
' AUTHORIZATION *CDP File Number 218623`- 1
Davie County Health Department County ID Number:
- 210 Hospital Street Evaluated For. NEW-
P.O.Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax:336-753-1680 0 6 / 1 0 / a 0 a 1
Applicant: Will Plitt Property Owner: David Paul Folmar
Address: 1102 S Hawthorne Rd Address: 1410 Baltimore Road
- Cky: Winston-Salem Cily: Advance
StatefZip: NC 27103 StatefZip: NC 27006
Phone#: (919)917-3291 Phone#: (336)817-7133
Property Location & Site Information
r- Advance
dress/Road #: Subdivision: Phase: Lot:
altimore Road
NC 27006 Directions
Structure: SINGLE FAMILY Hwy 158, right on Baltimore Rd. beside.#1332 On the
�-
#of Bedrooms: 3 right
#of People: 5
"Water Supply: PuguC
System Specifications
Minimum Trench Depth: a 4
rSitessification: Provisionally Suitable Inches
S stem? Minimum Soil Caver. 1 ay OYes (iNo Inches
glow: 3 6 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 . 3 Maximum Soil Cover: a 4 Inches
"System Classification/Description: 'Distribution Type: GRAVITY-SERIAL
TYPE II A CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
_ 1 0 0 0 _ Gallons
"Proposed System: 25%REDUCTION 1-Piece: OYes ®No
Pump Required: OYes @No OMay Be Required
N krification Field l a 0 0
Sq.ft. Pump Tank: Gallons
No. Drain Lines 3 1-Piece: OYes ONo
Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH
Trench Spacing: 9 Weet
O.C.nches O.C.— Dosing Volume: / Gallons
Trench Width: — @Inches
3 Feet Grease Trap: Gallons
Aggregate Depth: inches 1 TS-II
Pre-Treatment: ONSF OTS- O
Septic Tank Installer Grade Level Required: OI OII 0111 OIV
Donn 1 of Z
CDP File Number 218623 - 1 County ID Number: ,
❑ Open Pump System-Sheet
Repair System Required:Wes ONO ONo, but has Available Space
rDesign
System
Trench Spacing: 9 Q Inches O.0
ification: Provisionally Suitable ®Feet O.C.
Trench Width: Inches
w: 3 6 0 - ` . 3 @ Feet
Soil Application Rate: 0 - 3 Aggregate Depth: inches
Minimum Trench Depth: 2 4
"System Classification/Description: Inches
TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover. 1 2 Inches
Maximum Trench Depth: 3 6 Inches
*Proposed System: 25%REDUCTION
Maximum Soil Cover a 4
Nitrification Field 1 2 0 0 Sq.ft.
Inches
No. Drain Lines 3 *Distribution Type: GRAVITY-SERIAL
Total Trench Length: 3 -0 0 ft Pump Required: QYes UNo May Be Required
Pre Treatment: ONSF OTS-1 OTS-11
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
*Permit Conditions
The issuance of this permit by the Health Department in noway guarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements. ;
This Authorization for wastewater system Construction shall bevalid fora person equal to the period of validity of the Improvement Permit,not
to exceed five years,and may be Issued atthe same time the Improvement Permit Issued(NCGS 130A-336(b)).If the installation has not been
completed during the period of validity ofthe 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? Oyes ONO
Applicant/Legal Reps. Signature* Date:, / Jr
*Issued By: 2140-Nations,Robert Date of Issue: . 0 6 / 1 0 / x 0 1 6
Authorized State Agent:'
Malfunction Log Oyes
@Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
• CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number:
210 Hospital Street
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 0 6 / 1 0 / .1 0 1 6
Q Inch
Drawing Drawing Type: Construction Authorization Scale: 0Block
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CONSTRUCTION AUTHORIZATION
Davie County Health Department '
210 Hospital Street CDP File Number:
P.O.Box 848
Mocksville NC 27028 County File Number:
Date: 06 / 1 0 / 2 0 1 6
Click below to Import an Image from an extemal location: Drawing Type:Construction Authorization
IMPROVEMENT PERMIT For office Use Only
'CDP File Number 218623-1
Davie County Health Department
210 Hospital Street County ID Number.
P.O. Box 84$ Evaluated For. NEW
Mocksville NC 27028 Township:
Phone: 336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL' 6/10/2021
*NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit.
Applicant: Will Plitt Propertyowner. David Paul Folmar
Address: 1102 S Hawthorne Rd Address: 1410 Baltimore Road
City: Winston-Salem City: Advance
State/Zip: NC 27103 State0p: NC 27006
Phone#: (919)917-3291 Phone#: (336)817-7133
Property Location 8 Site Information
Address/Road 4: Subdivision: Phase: Lot:
Baltimore Road
Advance NC 27006 Directions
Structure: SINGLE FAMILY - Hwy.158, right on Baltimore Rd. beside #1332 On the
#of Bedrooms: 3 right
#of People: 5
*Water Supply: PUBLIC
System Specifications
nitial S stem
,bite Classification:ion: Provisionally Suitable
Minimum Trench Depth: .2 4 Inches
Saprolite System? OYes QNo Maximum Trench Depth: 3 6
Inches
Design Flow: 3 6 0 Septic Tank:
1 0 0 0 Gallons
Soil Application Rate: 0 _ 3 1-Piece: OYes QNo
Pump Required: OYes QNo OMay Be Required
'System Classification/Description:
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons
LESS)
'Proposed System: 25%REDUCTION 1-Piece: OYes ONo
Repair System Required:@Yes ONo ONO, but has Available Space
CS
Repair System
e Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inches
l Application Rate: 0 3 Maximum Trench Depth: 3 6 Inches
u
*System Classification/Description: Pump Required: OYes QNo O Maybe Required
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR
LESS)
'Proposed System: 25%REDUCTION
Pagel of 3
CDP File Number 218623 - 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.
"Permit Conditions
The issuance ofthis permit bythe 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. ;
Site Plan The Improvement Permit shag be valid for 5 years from date of issue with a site plan(means a drawing not necessarily drawn to
O scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the
site for the proposed Wastewater system,and the location of water supplies and surface waters).
Plat The Improvement 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 sitefor 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 rewcatlor 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-Nations,Robert Date of Issue: 0 6 / 1 0 / .1 0 1 6
Authorized State Agen . OValid without Expiration?
—,&Create CA?
el-land Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
. iMPROVEM ENT PERMIT 218623 - 1
Davie County Health Department CDP File Number:
210 Hospital Street
P.O.sox 848 County File Number:
Mocksville NC 27028 Date:
OInch
Drawing Drawing Type: Improvement Permit Scate: . OON/A k
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IMPROVEMENT PERMIT
Davie County Health Department
210 Hospital street CDP File Number: 218623'- 1
P.O.Box 848
Mocksvilie NC 27028 County File Number:
Date: ,0 6 / 1-4-0-1/ 2 0 1 6
Click below to Import an Image from an external location:Drawing Type: Improvement Permit
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
RECEIVED Davie County Environmental Health PAID
P.O.Box 848/210 Hospital Street
Date: 2 I Mocksville,NC 27028 Date:
(336)753-6780/Fax(336)753-1680 RaCelveA by; ?!6 MI "
Application For. 9 Site Evaluation/improvement Permit ❑Authorization To Construct(ATC) ❑Both
Type of Application:XNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
•**IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED 4uAVNfiS 1b
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
be t\A,*--rhere
APPLICANT INFORMATION 01'a C X10Cfv -e
Name ��_p I` Contact Person pl t � q 0
Address Home Phone q/q ql? 3Lgt V
City/State/ZIP -9 Business Phone
Email wal. i -64fm Email i i :r(a,_
Name on Pemut/ATC if Lt&er nt tha Above
Mailing Address 0?- Gtf� City/State/zip US AL2 Z710a�
PROPERTY INFORMATION *Date House/Facifity Comers Flagged
NOTE: A survey plat or site plan must accompany this application. Included: ❑Site Plan ❑Plat(to scale)
(Permit is valid fief 0 m the with site 1 no expiration with complete plat.) 7/3
Owner's Name A.V Phone umber
Owner's Address l) City/State/Zip t� Vail Le NL 2
Property Address City ifAyIGC/
Lot Size �X 8,0 Tax PIN#
Subdivision Name(if applicable) Section/Lot#
Directions To Site:
If the answer to any of the following questions is"Yes",supporting documentation must be attached:
Are there any existing wastewater systems on the site? Yes-kNo
Does the site contain jurisdictional wetlands? _Yes 1 No
Are there any easements or right-of-ways on the site? Yes 2No
Is the site subject to approval by another public agency? Yes No
Will wastewater other than domestic sewage be generated? _Yess/�J No c�
IF RESIDENCE FILL OUT THE BOX BELOW
#People _ #Bedrooms #Bathrooms ZA Garden Tub/Whirlpool❑Yes o
Basement:AYes ❑No Basement Plumbing: KYes ❑No
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: Xconventional ❑Accepted ❑Innovative ❑Altemative ❑Other
Water Supply Type:XCounty/City Water ❑New Well ❑Existing Well ❑Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes i(No
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.
and tand that I am responsi a the proper identification and labeling of property lines and comers,and locating and flagging
r in`g the he ty 1 c d well location and the location of any other amenities.
r perty owner' oro er s le representative signature Site Revisit Charge
Date(s):
Client Notification Date:
Date EHS:
Sign given ❑Yes IJNo Account#
8b23
Revised 11/06 Invoice#
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All data is provided as is without warranty or guarantee of any kind either expressed or Implied inducing but not limited to the Implied
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