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109 Baltimore Downs Rd Lot 12 Davie County,STC Tax Parcel Report Wednesday, February 15, 2017 116 9 1181 BALTIMOREZ ' rTRAILS U —-- - ��p\ � 12 21110 `l�3- \ 'ti F 1205 lf, 170 109 0190"/ A --- ` ! .� .1 16 3 Il ' _ Q? O ` 12 49 t 2 06 '©� 18 3 '-- ` � .---1263 T- 199 !Y'''omJ 1_267 � X10 'y 109 119 129141 ;`_129 2 08�118-132144" 1156 169 - tit ti I, IRS!'L'N-1- -- — ' ' 112' 1318 1323 1•� WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: G701OA0012 Township: Shady Grove NCPIN Number: 5860842100 Municipality: Account Number: 8306165 Census Tract: 37059-803 Listed Owner 1: SIMMONS KRISTIN A Voting Precinct: WEST SHADY GROVE Mailing Address 1: 4504 EAGLE ROCK ROAD Planning Jurisdiction: Davie County City: GREENSBORO Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27410 Voluntary Ag.District: No Legal Description: LOT 12 BALTIMORE DOWNS Fire Response District: CORNATZER-DULIN Assessed Acreage: 5.76 Elementary School Zone: SHADY GROVE Deed Date: 3/2016 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 010140480 Soil Types: GnB2,RnD Plat Book: 0008 Flood Zone: Plat Page: 150 Watershed Overlay: DAVIE COUNTY Building Value: 219420.00 Outbuilding&Extra 4320.00 Freatures Value: Land Value: 61080.00 Total Market Value: 284820.00 Total Assessed Value: 284820.00 161 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 merchantablilty 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 NCor arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT or ice use Only Davie County Health Department *CDP File Number 201975-1 210 Hospital Street - P.O:Box 848 County ID Number, Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Schumacher HomesProperty owner: Austin and Kristen Simmons Address: 6349 Bueno Poplar Rd Address: 400 Cameronden Courts City: Greensboro• COY: Kemersville _�.:-State2ip: NC- 27409 �State2ip: NC Phone#: -(336)793-4796 Phone#: (336)327-5840 - ------ Property Location Site Information C. Address/Road Subdivision:` Baltimore Oowns Phase: lot: 12g 1 V9 Baltimore Downs Advance NC 27006 Directions "Structure .` U p `SINGLE FAMILY i40 West to exit 162, turn Left, Left on Campground Rd. go to 4110 of mile, 190 on right #of Bedrooms: 3 #of People: *Water Supply: PUBLIC `*IP Issued by ` 2140 Matrons Robert *System Classification/Description: TYPE III G.OTHER NON-CONN,TRENCH SYSTEMS *CA issued by: 2140.Nations,Robert - Seprolite System? OYes ( No Design Flow: SERIAL Pump Required? , Y_3 0 *Dist ributionType: GRAVITYY O)Na .Soil Application Rate: 0 a *Pre Treatment: Drain field 1 8.. 0 0._: Sq.ft. Nrification Field *System Type: INFILTRATOR QUICK 4 STANDARD No. Drain Lines 4 Installer: Tim Beeson Total Trench Length: 4 5 .2 ft. Certification#: 3018 Trench Spacing: 9 Inches O.C. Feet O.C. *EH S: 2140-Nations.Robert Trench Width: _ 3� Oinches Date: 1 0 / 2 7 / .2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 °Approval,Status; Inches Maximum TrenchDepth: 3 6 Inches ® ApprovedO`D�sapproued; Maximum Soil Cover. 2 4 Inches CDP File Number 201975 - 1 Septic Tank County ID Number: • ' Manufacturer. Sh°at Lat. Long: STB: 760 Gallons: 1000 :Installer. Tim Beeson Date: 0 7 / 1 9 / 2 0 1 6 Certification#: *EH S: 2140-Nations.Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker:_❑ Yes E N o Date: 1 . 1l0a / 2016 Reinforced Tank: ❑ Yes ® No AppVl rovaCStatus Piece Tank: ❑ Yes ® No Approvtl Disapproved - Pump Tank Manufacturer. Installer PT: Certification#: Gallons: *EH S: Date: I / Date: RiserSealed ❑ Yes ❑ No RiserFieight: ❑ Yes ❑. Nb (Min.6 in.) . =� APPrava!Status Reinforced Tank: ❑ Yes O Na Q 'Approvee[❑'Disapproved 1 Piece Tank: ❑ YeS_., ❑_No__ �,� Supply Line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: 'ENS: *Schedule: Pressure Rated [IYes _ ❑ No Date: Approved fittings [I Yes ❑ NO Approval Status Approved b, Disapproved u p Requirement Pump Type: Installer: Dosing Volume: Gal Certification#: Draw Down: Inches 'EHS: *Chain: / f Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Status .: A PVC unions ❑ Yes ❑ No ❑ proved El Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole F1 Yes ❑ No 'CDP File Nurdber 201975- 1 County ID Number: Electric Equipment NEMA 4X Box or Equivalent p Yes ❑ No Installer: Box 12 inches Above Grade El Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ NO = 'Conduit Sealed 1:1Yes El No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Approval Status " - Alarm.Audible ❑ Yes _ 0. No -- = ❑ Approved ❑ Disapproved Alarm Visible ❑ Yes ❑ No = _ 2140-Nations,Robert *Operation Permit_completed by: Authorized'State Agent: Date of Issue: 1 1 / 0 a / a 0 1 6 Owner/Applicant Signature: This system has-been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules'for - �Sewage Treatment and Disposal,15A NCAC 18A-.1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization This property Is served by a TYPE III G. sewage septic system. Rule=.1961 requires that a Type .TYPE III G. septic system meet the following criteria: i - Matimum_System Review_ByThe Local Health Department: NIA ____. ....._Management Entity: OWNER � -- Minimum-System InspectionNeintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator. NIA -Rule .1961 requires that a Type1V and V septic systems designed fora homethusiness owner must maintain a valid contract wih a public management entitywith a certified operatoror a private certified operator forthe Life of the septic system. _ Rule,1961 requires that Type VI septic systems designed fora homelbusiness owner must maintain a valid contract with a public m ana gem ent e ntity with a certified operator for the life of the septic system. = Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity,unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** �;` OPERATION PERMIT ' Davie County Health Department CDP File Number: •201975- 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Scale: . pBtock Drawn_ Drawing Type:-Operation Permit - ON/A r ✓Vl CJ �" 00, - b V 111 ; l I � I y ' . CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 201975- 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 3 / 3 1 a 0 a 1 Applicant: Schumacher Homes Property Owner: Austin and Kristen Simmons Address: 6349 Bueno Poplar Rd Address: 400 Cameronden Courts City: Greensboro City: Kernersville State/Zip: NC 27409 State/Zip: NC Phone#: (336)793-4796 Phone M (336)327-5840 Property Location & Site Information Address/Road M Subdivision:, Baltimore Downs Phase: Lot: 12B 119 Baltimore Downs Advance NC 27006 Directions 1-40 West to exit 162, turn Left, Left on Campground Rd. Structure: SINGLE FAMILY go to 4/10 of mile, 190 on right #of Bedrooms: 3 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 (Saprolite te Classification: Provisionally suitable Inches -- - Minimum Soil Cover: System? 9Yes ONo Inchesesign Flow: Maximum Trench Depth: 3 6 3 6 0 Inches Soil Application Rate: _ a Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL SS) Septic Tank: 1 0 0 0 Gallons TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LE *Proposed System: 25%REDUCTION 1-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field 1 8 0 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 4 1-Piece: OYes ONo Total Trench Length: 4 5 0 ft. GPM--vs— ft. TDH Trench Spacing: - 9 ®O Inches O.C. — Feet O.C. Dosing Volume: Gallons Trench Width: — 3 j Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: O NSF OTS-1 O TS-II Septic Tank Installer Grade Level Required: 01011 OIII 01V Page 1 of 3 r CDP File Number 201975 - 1 County ID Number: ❑ Open Pump System Sheet Repair System Required:®Yes ONO ONO, but has Available Space CDesign System Trench Spacing: Q Inches O. . fication: Provisionally suitable — 9 Q9 Feet O.C. Trench Width: Inches w: 1 8 0 0 — 3 Feet Aggregate Depth: Soil Application Rate: 0 .1 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: 1 a LESS) Inches Maximum Trench Depth: 3 6 Inches *Proposed System: 25%e REDUCTION Maximum Soil Cover: a 4 Nitrification Field 1 8 0 0 Inches Sq.ft. No: Drain"Lines 4 *Distribution Type: GRAVITY-SERIAL - ..Total Trench Length: 4 5 ,ft. Pump Required: OYes ®No O May Be Required _ Pre-Treatment: O NSF OTS-I OTS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Reme s 750 *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. Rmain�s Remaining 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been completed during the period of validity of the 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? O Yes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 3 / 3 1 / .2 0 1 6 Authorized State Agent: Malfunction Log OYes 0 Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2of3 z CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 3 / 3 1 / 2 0 1 6 O Inch Drawing Drawing Type: Construction Authorization Scale: , O Block ft. Q N/A ............. .......... ...,....................._.................._........._............,............................_...._._........................_.,....._... ......... ._ ......... . ......... ......... i I i f � I i.... _ I .. ... .':wr t 1 I . �..... i. .. ................ ................... ...... icy .. ............... ..... �......... ..... .................i .......... .....> ...._... ............... ._ i........ ! ....... ..'� ...... 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' I.. i.. ! .... .. . .... . ............ . ............. ............. .................................................................. ................................................................................................................................ Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION µ Davie County Health Department 210 Hospital street CDP File Number: P.O.Box 848 (gyp Mocksville NC 27028 County File Number: 7 -�Cf ( � S Date: .0.3./ .3 1 /.a.0.1.6. Click below to import an image from a external location: Drawing Type:Construction Authorization 45 Fq 3 � 4-4 � r Page 3of3 P1 P2