122 Baltimore Downs Rd Lot 2 Davie County,NC Tax Parcel Report Wednesday, October 19, 2016
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: G701OA0002 Township: Shady Grove
NCPIN Number: 5860748821 Municipality:
Account Number: 8304668 Census Tract: 37059-803
Listed Owner 1: ALEXANDER KENNETH Voting Precinct: WEST SHADY GROVE
Mailing Address 1: 122 BALTIMORE DOWNS ROAD Planning Jurisdiction: Davie County
City: Advance Zoning Class: DAVIE COUNTY R-A
State: NC Zoning Overlay: DAVIE COUNTY QD
Zip Code: 27006 Voluntary Ag.District: No
Legal Description: LOT 2 BALTIMORE DOWNS Fire Response District: CORNATZER-DULIN
Assessed Acreage: 5.25 Elementary School Zone: SHADY GROVE
Deed Date: 1/2015 Middle School Zone: WILLIAM ELLIS
Deed Book/Page: 009770924 Soil Types: MrB2,GnB2,EnB,MsC
Plat Book: 0008 Flood Zone:
Plat Page: 150 Watershed Overlay: DAVIE COUNTY
Building Value: 310320.00 Outbuilding 84 Extra 4030.00
Freatures Value:
Land Value: 61260.00 Total Market Value: 375610.00
Total Assessed Value: 375610.00
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 merchantability or fitness for a particular use.All users of Davie County's GIS websfte shall hold harmless the
County of Davie,North Carolina,its agents,consultants,contractors or employees from any and allclaims or causes of action due to
NC or arising out of the use or Inability to use the GIS data provided by this website.
vim . DAVIE COUNTY ENVIRONMENTAL HEALTH `
P.O.Box 848/210 Hospital Street 1�107
Mocksville,NC 27028
(336)751-8760 Fax#(336)751-8786
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
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Account #: 990003057 Tax PIN/EH#: 5860-74-5687.02
Billed To: R.B.Hope Contracting Subdivision Info: Balitmore Downs Lot#2
Reference Name: Location/Address: Baltimore Road-27006
Proposed Facility: Residence Property Size: 5.25
ATC Number: 4578
**NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD FIVE YEARS. This ATC is subject to revocation if site plans,plat or
the intended use change.
Residential Specification:Building Type n.• #People #Bedrooms �[ #Baths 3 7
Basement w/Plumbing:T Basement/No Plumbing
Commercial Specification:Facility Type #People #People/Shift #Seats
Lot Size Type Water Supply Design Wastewater Flow(GPD) Site:New Repair
System Specifications:Tank SizeJ r oGAL.Pump Tank—GAL.Trench Width 3t"'Trench Depths%4 o r-
Rock Depth_IaL Linear Ft._ 1.
Other:
As stated in 1511 NCAC )
Required Site Modifications/Conditions: Anf=tFd Sy-tees wa also h, user
Contact the Davie County Environmental Health Section for final iinspection of this system between
8:30–9:30a.m.on the day of installation. Telephone#(336)751-8760.
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1cC�cxlCJo{/e QjS�l. Do`C I
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Environmental Health Specialist Date:
DCHD 11/06(Revised)
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V" AI' CAT N I:011 SITC L'VALUATION/1h1P1iOVEAIIWF 1'Ltir1• 'C R fir' �r s f,,-+ •
0 G Davie County Health Department
Enviroiunenta/Healf/�Section
P.O. Box 848/210 Hospital Street r, l
ROPy�� Nockaville, NC 27028
(336)751-8760
***IMPORTANT*** TIiIS APPLICATION CANNOT FSE PROCESSED U14LESS ALL THE rr.QUI1tLD
-INFORMATION IS PROVIDED. ��yyRefer to the INFORMATION BULLETIN for instiuctioa.j.
1. Name to be Billed p ( 'o514rn d-k Contact Person
Mailing Address klia2smdl
��JJ n lIoure Phone g9�-
City/State/ZIP • j&y4A/d,__ , /l/d j 2DDla Dusinass Phone _.3Z3_��SI "•.•
2. Name on Permit/ATC if Different than Above ________...._. ........
Mailing Address City/state/'Lip �•__•___•___•._,_•,_._._
3. Application For: Ie Site Evaluation ❑ Improvement- Permit/ATC Doth
4. Syr;tem to Service: 19 House ❑ Mobile Home ❑ nusinetn ❑ Industry ❑ OL•llcr
5. Type system requested: (Conventional 11 conventional modi ❑ innovative,
L46. If Residence: 1t People U Bedrooms Il Batt! oolluj
L'1Disltwasher 13Garbagc Disposal 014a1hing Machine ement/Pltunbinga:eicnL•/No Plumbing
7. If Business/Industry /Other: verify type It People Il Sinha
8 Commodes 11 showers 1t Urinals 11 Watur Coolers
IF FOODSERVICE: 11 Seats Estimated Water Usage (gallons per day) ___,____•'
8. Type of water supply: ET"Count-y/City ❑ Well ❑ Conuuunity
9. Do you anticipate additions or expansions of we facility this sysicii,is illtelide(1 to sel•ve? Ales ntr
If yes,what type?
***1A11'0RTANT***.CLIENTS i)1UST COA11'LBTL•THE 11iQUJR.GD PROPERTY INFORMATION It1iQl11iS'1'l;l)
BELOW. R111ier a PLAT orSITE//PLAN MUSTBE-SUIIAH776D by the client )ti,itli'1'Id1S APPI,ICA'I'ION.
1'roperl}'Dimensions: —S-1 ,
1 `T7 `6,2 WRITE lllltM1OlNS(f-om Muclisville) to I'1ZU1'l;lt'1'Y:
ax OfficcPIN: tf
Property Address: Road Nalne 1' 14AT Q3 K R Q iJ ?41 -'Wo CQ
City/Zip V i • J�• m/' / li O r\
If ill a Subdivision provide information,as Follows:
Nalllc:
Section: Block: Lot: Date Monte corners!lagged:.
/ZW/' �
This is to certify that the information provided is correct to the best oflny knowledge. I understand that any perulit(s)
issued hereafter are subject to suspension or revocation,if tile site plans or intended use cliange,or if the i ifor►uatiou
submitted ill this applica tion is falsified or changed. 1,also,understand 11ra1I a/a,'pl,ousible for all chai-gas hicul•rrd front
!Iris(II)INCatioa. I,hereby,givc consent to the Authorized Representative of the Davie CU(nity I1cal UID elm N11lei)
to enter upon above described property located in Davie County and omied by _
to conduct all testing procedures as necessary to detcruline(lie site suitability.
DATE SICNATURI;
-0 CO
THIS AREA.MAY BE USED I+OR DRAWING YOUR SITE;PLAN(Include all of the follolYing: Existing alld proposed
property lines and dimensions, structures, setbacks, and septic locations).
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k4LS � Site Revisit charge
hvDate(,):C • Client Notification Date:
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• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003057 Tax PIN/EH#: 5860-74-5687.02
Billed To: R.B.Hope Contracting Subdivision Info: Balitmore Downs Lot#2
Reference Name: Location/Address: Baltimore Road-27006
Proposed Facility: Residence Property Size: 5.25 Date Evaluated: 1-7 JC.tvt Q
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring I--,' Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position 0,777
Sloe % 2 2 3
HORIZON I DEPTH p-'y — —/ —�.
Texture group G= C_ t— C.- C C
Consistence R 17 , f i V
Structure K e..
Mineralogy 1: l 1' (: I I; I :'1 C l
HORIZON R DEPTH I&1/
Texture group C_
Consistence U W& !/
Structure k rf "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: n QCt�i
LONG-TERM ACCEPTANCE RATE: C�•a7 OTHER(S)PRESENT:
REMARKS:
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
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
lYQte�
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 05105(Revised)
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. Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760/Fax(336)751-8786
IMPROVEMENT PERMIT
Account #: 990003057 Tax PIN/EH#: 5860-74-5687.02
Billed To: R.B.Hope Contracting Subdivision Info: Balitmore Downs Lot#2
Address: 342 Kingsmill Drive Location/Address: Baltimore Road-27006
City: Advance
Property Size: 5.25
Reference Name:
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to
revocation if site plans,plat or the intended use change.
Permit Type: ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration
Residential Specifications: #Bedrooms 14 #Bathrooms#People Basement❑ Basement plumbing❑
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facciility)
Design Flow(GPD):�g� Type of Water Supply: 516ounty/City ❑Well ❑Community Well
Site Modifications/Permit Conditions:
System Type LTAR
Initial i,e cel O.a-7
Repair
4L
Site Plan
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Environmental
Environmental Health Specialist Date L: 0
i.p.11-06
Davie County Environmental Health
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760/Fax(336)751-8786
IMPROVEMENT PERMIT
Account #: 990003057 Tax PIN/EH M 5860-74-5687.02
Billed To: R.B.Hope Contracting Subdivision Info: Balitmore Downs Lot#2
Address: 342 Kingsmill Drive Location/Address: Baltimore Road-27006
City: Advance Property Size: 5.25
Reference Name:
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
constructionlinstallation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to
revocation if site plans,plat or the intended use change.
Permit Type: ZNew ❑Repair ❑Expansion Permit Valid for: 195 Years ❑No Expiration
Residential Specifications: #Bedrooms y #Bathrooms 3.< #People Basement❑ Basement plumbing[]
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Faccility)
Design Flow(GPD): �l�� Type of Water Supply: 5 ounty/City ❑Well ❑Community Well
Site Modifications/Permit Conditions:
S stem Type LTAR
Initial ,.%-_ �y'�.. r ,4. 6•a,�
Repair
Site Plan
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Environmental Health Specialis Date_
i.p.l 1-06
DAF T SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
C P.O.Box 848/210 Hospital Street
tl Mocksville,NC 27028
�Z �}-6 6 (336)751-8760/Fax(336)751-8786
�..�..._.�_....._..._.-....
luationIpplication'For::r Sitb� ''aprovement Permit ❑ Authorization To Construct(ATC) ❑ Both
YPe 61ASlicafioniLJKewS ste ❑Repair to Existing System ❑Ex ansion/Modification of Existing System
or Facility
***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed /�/ape— n 1-aa, Contact Person
Billing Address3y kl n cSi►'�:// D� Home Phone
City/State/ZIP jf% C ,—,W a2�DD Co Business Phone _3 99—DS/S
Name on Permit/ATC.if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan,no expiration with complete plat.)
Owner's Name SfdIV71r-- /n(/P_ Phone Number
Owner's Address City/State/Zip
Property Addressf� /,►%oe-e- t`��rt s City A1110 A) -e—
Lot Size _ f}�r Tax PIN# 2
Subdivision Name(if applicable) Ao It. r,6' re— &-)ALJS Section/Lot#
Directions To Site: /SS 7G 43n &2gte: Rd- &- n rJ Bak V. P L B.D. D t) +V2
If ffe answer to any of the following questions is"yes",supporting documentation must be attached.
Are there any existing wastewater systems on the site? ❑Yes [9'l leo
Does the site contain jurisdictional wetlands? ❑Yes B<o
Are there any easements or right-of-ways on the site? ❑Yes eo
Is the site subject to approval by another public agency? ❑Yes iso
Will wastewater other than domestic sewage be generated? ❑Yes 211o'-
IF RESIDENCE FILL OUT THE BOX BELOW
#People #Bedrooms #Bathrooms 3 Yz Garden Tub/Whirlpooles ❑No
Basement: ❑Yes 8<o Basement Plumbing: ❑Yes Cho
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: &eonventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: V115ounty/City Water ❑New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Cho'
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 permit(s)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 that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging
or staking the house/facility location,proposed well location and the location of any other amenities.
Site Revisit Charge
Property dwner'so6r owner's legal representative signature
Date(s):
An) Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account#
Revised 11/06 Invoice#
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DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003057 Tax PIN/EH#: 5860-74-5687.02
Billed To: R.B.Hope Contracting Subdivision Info: Balitmore Downs Lot#2
Reference Name: Location/Address: Baltimore Road-27006
Proposed Facility: Residence Property Size: 5.25 Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring t'-' Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape positionSlope
HORIZON I DEPTH — 0 -31 f)—q0 16 - 6 G _
Texture group G C G 5 C_L" ZY C
Consistence P,J .5r r TV IT
Structure k
Mineralogy VI ' I 1 1.
HORIZON H DEPTH 3k-K$ Q K - 2 6—
Texture group G C_ IL c
Consistence e 4;r N V
Structure 4 Ak K '5 J-Ab le- A A K
Mineralogy 12
HORIZON III DEPTH
Texture group..
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESSkf 7 _
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE -r 5 p.:)7t 0.1
SITE CLASSIFICATION: (� Sl�c� �`P EVALUATION BY: I n - �I I Qc IGS 5
LONG-TERM ACCEPTANCE RATE: Q 2-7 OTHER(S)PRESENT:
REMARKS: <A-e <<G/ /tocfd NGS ��rcztnS�l�d� lJeIn75 /cJ/Yl� G�Sa��
LEGEND 7 c
Landscape Position
R-Ridge , S-Shoulder L-Linear slope FS -Foot slope N-Nose slope u
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
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
LYQtes
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 05105(Revised)
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DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760 Fax#(336)751-8786
OPERATION PERMIT �2 Z
Account #: 990003057 Tax PIN/EH#: 5860-74-5687.02
Billed To: R.B.Hope Contracting Subdivision Info: Balitmore Downs Lot#2
Reference Name: Location/Address: Baltimore Road-27006
Proposed Facility: Residence Property Size: 5.25
ATC Number: 4578
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S. Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"
but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of
time. �/j,c,�,,
System Type: S.T.Manufacturer. d Tank Date 5 Z--7
w"Tank Size O
Pump Tank Size
System Installed By: � lG E.H. Special a
(DLJ
ow
$ 2 (IZ
q
70-
DCHD 11/06(Revised)