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220 Baltimore Trails Lane Lot 2Davie County. NC I Tax Parcel Renort Wednesday. October 19. 2016 W11.11N.11'"U: THIS IS NUFA SURVEY r i 4 f• Y :1 T'(•f-` 1 1 Tit, l4TT 1'.t 11! ITl Parcel Number: G707OA0002 Township: Shady Grove NCPIN Number: 5860549986 f 0unicipality: Account P:umber: 82527140 Census Trct: 37059-803 Listed Owner 1: NANCE BOBBY CUNDIFF Voting Precinct: WEST SHADY GROVE Mailing Address 1: 113 WELLSBOROUGH RD. Planning Jurisdiction: Davie County City: WINSTON SALEP I Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27104-0000 Voluntary fig. District: No Legal Description: LOT 2 BALTIMORE TRAILS Fire Response District: CORNATZER - DULIN Assessed Acreage: 10.16 Elementary School Zone: SHADY GROVE Deed Date: 812008 rViiddle School Zone: WiLLIANI ELLIS Deed Book I Page: 007690922 Soil Types: EnB,MsC,ChA Plat Book: 0008 Flood Lone: Plat Page: 277 V atershed Overlay: DAVIE COUNTY Buildiria Valise: - 0.00 Outbuiiding & Extra Freatures Value: 0.00 Land Value: 71220.00 Total Market Value: 71220.00 Total Assessed Value: 71220.00 E01I T��TAli Baia is provided as is without warraartr or guarantee of any kind either expressed or implied induding tut nat limited to the &3a ie Count , implied warrai.'ies of merchardaUity or fits;ess for a particular use. Ali users of Davie County's GIs we;:site shall hold harmless the p ,f� County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to 1 `T'` or anGi:i3 out of i;^,cuss or inab;l'sry is use the CIS data provided by this wcbs:te CONSTRUCTION For office Use only AUTHORIZATION *CDP Fite Number 219061-1 Davie County Health Department County ID Number: f`_ { 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/ 0 9/ 2 0 2 1 Applicant: Jonathan Johnson Address: 130 Hidden Creek Dr City: Advance State/Zip: NC 27006 Phone #: (336) 970-1065 (Address/Road #: Baltimore Trails Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 6 # of People: *Water Supply: NEW WELL Property Owner: Bobby Nance Address: City: State/Zip: Phone #: Subdivision: Baltimore Trails Phase: Lot: 2 Directions Hwy 158 east, right on Baltimore Rd. on the Right System Specifications Dann I ^f'2 Minimum Trench Depth: 3 6 Pump Required: @Yes ONo OMay Be Required Site Classification: Provisionally Suitable 3 6 0 0 Inches No. Drain Lines Minimum Soil Covet a 4 1 -Piece: @Yes ONo Seprolite System? OYes ONo 9 0 0 ft Inches Design Flow: 7 2 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 2 Maximum Soil Cover: 1 4 Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 5 0 0 Pre Treatment: ONSF OTS -1 OTS -II _ Septic Tank Installer Grade Level Required: OI Oil 0111 OIV _Gallons *Proposed System: 25% REDUCTION 1 -Piece: OYes ONo Dann I ^f'2 Pump Required: @Yes ONo OMay Be Required Nitrification Field 3 6 0 0 5q. ft. Pump Tank: 1 5 0 0 Gallons No. Drain Lines 6 1 -Piece: @Yes ONo Total Trench Length: 9 0 0 ft GPM vs— ft. TDH Trench Spacing: _ 9 0Inches O.C. Dosing Volume: _ Gallons Feet O.C. Trench Width: 3 8Feet Inches _ Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: OI Oil 0111 OIV Dann I ^f'2 CDP File Number 219061 - 1 County ID Number: ' ❑ Open Pump System Sheet Repairbvstem Requireo:vteb vrvu urvu, uu1 nabHvanaole space *Site Classification: Provisionally Suitable Design Flow: 7 a 0 Soil Application Rate: 0 a *System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: 3 6 0 0____ Sq. ft. 6 9 Inches 0. — Feet O.C. 9 0 0 ft. Trench Spacing: 9 Inches 0. — Feet O.C. Trench Width: 3 Inches 2 Feet Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover. a 4 Inches *Distribution Type: PUMP TO GRAVITY Pump Required: QYes ONo OMay Be Required Pre Treatment: ONSF OTS -1 OTS -II "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 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. 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 maybe issued at the sametime 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 pernit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). 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/ 0 9/ 2 0 1 6 Authorized State Agent: MatfuncWn Log Oyes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization C `t CDP File Number: 219061 -1 County File Number: Date: 06/09/2016 Q Inch Scale: OBlock QN/A 5 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 219061 -1 County File Number: Date: .0 6/ 0 9/ 2 0 1 6 Click below to Import an Image from an external location: Drawing Type: Construction Authorization APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC •`` (� Davie County Environmental Health P.O. Box 8-48/210 Hospital Street 7j Alocksvillc, NC 27028 DAtO' - (336)753-6780/ Tai 6)753-1680 pplication For: ❑ Site Evaluation/Improvement Permit Authorization To Construct (ATC) ❑ Both Type of Application: B'&ew System ❑Repair to Existing System :]Expansion/Modification of Existing System or Facility ***IiIIP0RTAN7*** THIS APPLICATION CAAXOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Names Jnvt a r_r.— c� o v�.soy-- Contact Person . l ohCLAC_&. Address J3 p }��1 d{„ r r e e_, nr` Home Phone y2109- City/State/ZIP /4ci " I-- " I' 4 Business Phone Email ; a" Email: /,i mar, 2ca2 as lYs•��.•'/.cc.. Name on Permit/ATC if Different t an Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 6_12-3 /P NOTE: A survey plat or site plan must accompany this application. Included: U Site Plan UPlat(to scale) (Permit istd fp r,6(0 mo'}�h�with site Ian, no expiration with complete plat.) Owner's Name �O L) 7q / y ... Phone Ntmiber Owner's Address City/State/Zip Property Address 114 I& Vtt,- l S City Lot Size Tax PIN# Subdivision Name(if a plicable) Section/Lot# t�rr etion To.Site: Awlwq l5 irYlOr� �/' N ��lirfYl(ji 114115 - 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 ANO Does the site contain jurisdictional wetlands? No Are there any easements or right-of-ways on the site? Yes Is the site subject to approval by another public agency? es o Will wastewater other than domestic sewage be generated? Yes No W RESIDENCE FILL OUT THE BOX BELOW # People# Bedrooms &— # Bathrooms 3— Garden Tub/Whirlpool I es INo Basement: ❑Yes o Basement Plumbing: 7Yes 311fo 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: Iil'Conventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: C County/City Water t3 New Well ❑Existing Well 7 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes ❑ 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 permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or. if oal4fa n submitted ' pplication is falsified or changed. I hereby grant right of entry to the Authorized Representative ep ment to conduct necessary inspections to determine compliance with applicable laws and rules. sponsi a for the proper identification and labeling of property lines and corners and locating and flagging iIi cation sed well location and the location of any other amenities. r's or owner's legal representative signature Site Revisit Charge Date(s): 5 a % Client Notification Date: Date EHS: Sign given I Yes ❑No Account# Revised 11/06 Invoice # � � �� ��� o'� � � �� �� ��` � ,, � �� 4 �o�� l o-�s o vs� ,k� �� U� �` � a �° a�� W, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P O Box 848/210 Hospital Street Mocksville NC X27028�.AMRr "i(336)751-8760/Fax (336)751'8786, ' Application For. to provcment Permit Authorization To Construct(ATC) Both Type of Application: ew System Repair to Existing System Expansion/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 O{1 e , ontact Person 09adfiV4_ Billing Addresso Home Phone City/State/ZIP Business Phon 2 .`L Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged 7-61-019 NOTE: A survey plat or site plan must accompany this application. Included: Site Plan Plat(to scale) (Permit ivalid for 60 months with site plan o exp. ation with complete plat.) 9�ry/� Owner's Name ✓llrZb - K S Phone Number 4 ll�j' Owner's Address 64 Al e.0 W 4r,1 f City/State/Zip ADVIV-55. VC, ; PropertyAddress fJAA7jh,0,dc lZkfa C J Lot Size Tax PIN# `J Subdivision Name(if applicable) GznMa ection/Lot# 7 Directions To Site: r_ / _ ., _ -6 If the answer to any of the following questions is "yes", supporting documentaIN ust be attached. Are there any existing wastewater systems on the site? Yes 1,;N I L Does the site contain jurisdictional wetlands? Yds r /�� Are there any easements or right-of-ways on the site? Yes Is the site subject to approval by another public agency? Yes Will wastewater other than domestic sewage be generated? Yes IF RESIDENCE FILL OUT THE BOX BELOW # People# Bedrooms # Bathrooms. Garden Tub/Whirlpoo Yes No Basement: Yes N Basement PI bins: Yes 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: ConventionaD Accepted Innovative Alternative Other Water Supply Type: County/City Water Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes 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 comers and locating and (}agging or staking thihouse/facility location, proposed well location and the location of any other amenities. Site Revisit Charge roperty owne or owner's legal representative signature Date(s): 10 Client Notification Date: Date EHS: Sign given Yes No Account # I Revised 11/06 Invoice # ^4,.,,A_reA 4b C,nMnnc CUR Page I of 8 http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=24432&CFTOKEN=38508700 7/29/2008 Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Improvement Permit Sam Ballas 520 Cherbourg Avenue Winston-Salem, NC 27103 Re: 10.132 Acre Tract Baltimore Trails -Lot 2 Tax MAP# G707OA0002 Dear Client(s): o -C 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 or the intended use change. System To Serve:Re5lltal) .AVastewater Design Flow(GPD): 7W Valid: Years ❑No Expiration System Type: ❑Conventional Accepted ❑Innovative ❑Alternative ❑Other. Site Modifications/Permit Conditions: rwld ✓A-I_yl= '2z�� Cdi�l Plan 'AN F129F 1--1 Q0 . eco ,ateQ �. Z I J Iy i.p.letter 7/06 Date '44, C 15 06 .09:01p** davie county envhealth 336 751 8766 p.2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 106(f Davie County Health Department n Environmental Health .Seeiione 5 ee 11 P.O. Box 8481210 Hospita I Street v1ch1 b DMocksville, NC 27028 11f+ 200c (336)751-8760/ Fax (336)7:51-8786 AUG 3Apphcation Fo Site valuation/hitprovement Permit n Authorization To Construct(Al Q O Both t TAN7"" APS APPLICATION CUNNOT BE PROCESSED UNLESS ALL OF THE REQUIRED ENV1RDt�h� Ji T10N I AIDED. Refer to the INFORMATION BULLETIN for instructions. ppV1E �" APPLICANT INFORMATION Name to be Billed SA M 6- f� A \ X A- Contact Person }rh C - 34l \ h5 Billing Address «bowel g1ve-Home Phone 316 - 76o-61-2'7 City/State/ZIP �A s Aza - A- t yr , N t. -LI 103 Business Phone _'06-760--71/Z Name on Pere it/ATC if Different tLan Above Mailing Address City/State/Zin PROPERTY INFORMATION NOTE: A surveyplat or site plan must accompany this application (Permit is valid for 60 months with site plan, no expiration with cotYplete plat) © 7 o600 Z Street Address CityTax PIN# Subdivision Name Section/Lot# -.2- rLot size /o- 13Z 4C.Directions To Site: 14 u 'f ),f ,Q 40 R, I-{ wtcr a RA. , En.i'-4-- A. -J -Li r,rre— Date Hous Tacility Corners Flagged K -, 3 U - QV If the answer to any of the following quntions is "yes", supporting documentation must be attached. Are there any existing wastewsder systems on the site? ❑Yes *qo Does the site contain jurisdictional wetlands? ayes *0 Are there any easements or right-of-ways on the site? OYes ONo Is the site subject to approval by another public agency? ayes W40 Will wastewater other than domestic sewage be generated? O Yes )640 IF RESIDENCE FILL OUT THE BOX BELOW # People ,# BcMioms # Bathrooms 157_ Garden Tub/Whirlpool*Yes []No Basement: es ONo Basetttent Plumbing: {yes ❑No 313 01 a10gty110i!to] 9l Sa1�1�1.�.. 110MOPKam 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 systemrequested: OConventions.l ❑Accepted Olnnovative ❑Alternative Miller �+lC, ? Water Supply Type: O County/City W.tter )(New Well rlExisting Well O Community Well Do you anticipate additions or If yes, what type? f this system is intended to serve?XYes ❑ No This is to certify that the information provided on this application is tete ant: correct to the best of my knowledge. 1 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 arntlkation is falsified or changed. I understand that I am resp msVe for all charges incurred from this application. I hereby grant right of entry to the Authorized Repre;.entative of the Davie County Health Department to conduct inspections to deter= cc Ppliance g ' licablc law : and nilw on the above desei-bed property located in Davie Coun�wned rU1• �' (-ldtt ei legal representative signature 4 Sign given OYes ONo Revised 2/06 Site Revisit Charge Date(s):_ Client Notification Date: ER& Account# �v0 Invoice # -D.B, t 1018.01 'AUJ' - 0.0 ACRF6z', f 13.97 LOT i � AREA - -�I 10-00+ ACE'S LOT '3 AREA -- M 10.0 0 A CRE'��' m �— ICY A�3 Al LOT ARFA b�' _ -40T p t 1 w a AJ J -,,,j, — � � � u ?x'•53 F 22:x, 96 s ' 1D11:.01 J ` LOT 2 � '7j=f 10.00 ACRES LOT I T t e r 10.00+Z- A CRY'S ACRES •� i ; t E 10.00-,',-/- A ES - AZ r _ AREA L.O T . c; Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Improvement Permit Sam Ballas 520 Cherbourg Avenue Winston-Salem, NC 27103 Re: 10.132 Acre Tract Baltimore Trails -Lot 2 Tax MAP# G707OA0002 Dear Client(s): 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 or the intended use change. System To Serve:RE�5111balx Vastewater Design Flow(GPD): 72-0 Valid: Years ❑No Expiration System Type: ❑Conventional Z'Accepted ❑Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions: "IRM0 nwvv ✓�.L�i: i.p.letter 7/06 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004100 Tax PIN/EH #: 5860-33-5745-02 B Billed To: Sam Ballas Subdivision Info: Baltimore Trails Lot # 2 Reference Name: Location/Address: Baltimore Road -27 6/� Proposed Facility: Residence Property Size: 10 ac. Date Evaluated: tJ g( Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH p - t Z Texture group G Consistence Structure Mineralogy HORIZON II DEPTH - Zv Texture group C _ Consistence Structure MineralogyM1- HORIZON III DEPTH Texture group Consistence Structure t� Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE �. SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: � T �C l�'r1 OTHER(S) PRESENT: 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 )�Q1Si VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm }fit 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 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) ■■..■.■■■.■..■..��/.■■■■■..■.■■■..■■.■...■■■■.■..■.■...■.1.3`1....■■■ ■.■■■■■■■■■■.■■■.■■■■■■■\■■..■■■■■■■moi■■..■■.■■■■■■■.■■..■■■■.■■■■ MENNEN ::::::i�::::::MENNEN iMEMNON i ■■■■■■■■■■■■■■■■■■ �• 697 moo- AW fu 10.225A, 4628 Ant �010 r, MINIM q � X k i Q n b C A MS C �V4 _ lot VA h Q MSDlow s , 63 Z2 1 MEA r � 9241 f COME., MCI 55 Wan o fill Um a f � a. NOT 14296A MS LJ 0910 ` . . �` a l ,r