352 Baltimore Trails Lane Lot 5Davie County, NC Tax Parcel Report Wednesday, October 19, 2016
State:
e IS1 • 77 `I
It 2 1a .r 114-
Zoning Overlay:
DAVIE COUNTY QD
rgart�rt LT111))'TT1:111r)TI
27006-0000
Parcel Number:
G707OA0005
Township:
Farmington
IICPIN Number:
586034890
Municipality:
18.70
Account Number:
82527042
Census Tract:
37059-803
Listed Owner 1:
KOHL RICHARD G
Voting Precinct:
WEST SHADY GROVE
;ailing Address 1:
352 BALTIMORE TRAILS LN
Planning Jurisdiction:
Davie County
C's by:
ADVANCE
Zoning Class:
DAVIE COUNTY R .A
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27006-0000
Voluntary big. District:
No
Legal Description:
LOT 5 BALTIMORE TP.AILS
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
18.70
Elementary School Zone:
SHADY GROVE
Deed Date:
1012006
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
006820453
Soil Types: MrC2,SeB,MrB2,EnB,RnD,EnC,MsC,ChA,MsB
Plat Book:
0008
Flood Zone:
Plat Page:
278
Yfatershev Overlay:
DAVIE COUNTY
Build'ina Value:
638060.00
Guiiding & Ex
Freatures Value:
266360.00
Land Value:
116200.00
Total Market Value:
1020620.00
Total Assessed Value:
1020620.00
� All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limned to the
TT
L.ia—Vic Ci unity, implied v;arra+sties of merchantability or fitness for a particular use- All users of Davie County's GIG wel:site 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
��r
L., or arising out of the use or inability to use the GIS data provided by this wcbsitc.
Y DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990004149 Tax PIN/EH #: 5860-33-5745.05
Billed To: Roger Lawson Subdivision Info: Baltimore Trails Lot # 05
Reference Name: Location/Address: Baltimore Trails -27006
Proposed Facility: Residence Property Size: 18.6 acres
ATC Number: 4532
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permits) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Sectio e e t and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER T CTI V LID A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: to 06
i
0
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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. ,
be/
�O�I �,C��l eu`A I
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street P
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990004149 Tax PIN/EH #: 5860-33-5745.05
Billed To: Roger Lawson Subdivision Info: Baltimore Trails Lot # 05
Reference Name: Location/Address: Baltimore Trails -27006
Proposed Facility: Residence Property Size: 18.6 acres
ATC Number: 4532
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type / #Peoples #Bedrooms #Baths `Pk
Dishwasher: 2< Garbage Disposal: 711" Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type 13/#People #People/Shift #Seats Industrial Waste:
Lot Size L'' Type Water Supply Z06 Design Wastewater Flow (GPD) !Ce o! Site: New Repair ❑
pz
System Specifications: Tank Siz/dDy GAL. Pump Tank GAL. Trench Width � Rock Depth. � Linear FtC1)
As stat ;d in 15A NCAC 18A.3.969(;� l
Other: a-ccerited Sv,ternc rinv mcn hm
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Environ
DCHD 05/99 (Revised)
Date: /45 16', A41
Oct 23 06 04:22p
APPLI1cA, I,
.,o r:at'1t`d4AFA$ni�ii'For: 0 Site E
davie county envhealth 336 751 8786
FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Ilealth Department
Environfnental Health LI ecdon A10
�P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax 6)7:;1-8786
tion/lmp Dement Permit Authcrizat.on To Construct(ATC) U Both
"a*IMPORTANP' -- THIS APPLICKRON CANNOT BE PROCESSED MILESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Re rr to the INFORMATION BULLET.N for instructions.
APPLICANT INFORMATION
p.2
Zd-,4FaYd
3Yq -903
oR
Name lobe Billed 6�o '�� _ Cortact Person 0411 1!z �-1 �r
Billing Address _5 ,IQ, Hume Phone 33(n1-2,11-02PU
City/State/ZIP Lexi n (�r� '7-1q5 BusinessPhone��
Name on Permit/ATC if Different &an Above
Mailing Address _
PROPERTY INFORMATION
NOTE: A survey plat or site plan must accompany this application.
(Permit is v for 60 monthsf� ate p no expiration wit corrnletlt•�P)
Street Address Alfimo r. S City (% Tax PIN#
Subdivision Name }+ i M;,r e- n/Lot# Lot Size 19. (, Al re C
Directions To Site: ��y �(D�,l� �4 A -+6,r I� —
(1-�l l niil --hr�ql
1 :!a lob s
Date House/Facility Comers•r'iaggr IUla(o In/a .
If the answer to any of the following qu estions is "yes' , supporting g doctunen:adon must be attached.
Are there any existing wastcw.,ter systems on the site? DYrs kNo
Does the site contain jurisdictional wetlands? OYes'CNo
Are there any easements or ri€ ht -of -ways on the site? DYc:s.RNo
Is the site subject to approval ay another public agency? DYts.&'No
Will wastewater other than domestic sewage be gcizeratcd? OY,:s ANO
IF RESIDENCE FILL OUT TE! i BOX BELOW
# People _�'i__ t/# Bedr_wms q 4 Bathrooms= Garden Tub/Whirlpool Wes mNo
Basement: CIYes 4allo Basement Plumbing: []Yes „I�No
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business _ Total Square Footage of Building_ # People
# Sinks # Commodes # Showcrs _ # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: Wonventional DAccepted Olnnovative OAlutmative F]Other
Water Supply Type: D County/City Water g New Well DEiisting Well O Community Well
Do you anticipate additions or expansions of the facility this system is inter ded to serve? 0 Yes R No
If yes, what type? _ _
This is to certify that the infomnation .irovided on this application is true ar d correct to the best of my knowledge. I understand that
any permit(s) or ATC(s) issued Berea Ier 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 understand that 1 am responsible for all charges incurred
from this application. I hereby grant right of entry to the Authorized Reprsentative of the Davie County Health Dcpartment to
conduct necessary inspections toAderrninc compliance with applicable laws and rules on the above described property located in
Davie County and owned by Gi• �n h
k---)
Property o 's or owner's legal [e-,resentative signature
/e
0
Dati
Sign given OYes ONo
Revised 2106
Site Revisit Charge
Date(s):_
Client Notification Date:
EHS:_
Account #
Invoice #
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
IMPROVEMENT PERMIT
Account #: 990004149 Tax PIN/EH #: 5860-33-5745.05 Barn
Billed To: Roger Lawson Subdivision Info: Baltimore Trails Lot # 5
Address: 554 Pine Ridge Road Location/Address: Baltimore Road -27006
City: Lexington
Property Size:
Reference Name:
Proposed Facility: Barn
**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: E?1ew ❑Repair ❑Expansion Permit Valid for: R5Years ❑No Expiration
Residential Specifications: # Bedrooms # Bathrooms 6.7 # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)—i4-
Design
acility)i4
Design Flow(GPD):
Site Modifications/Permit Conditions:
Type of Water Supply: ❑County/City ❑Well ❑Community Well
As stated in 15A NCAC 18A.1969(5
accepted Systems may also be use
System Type LTAR
Initial �.
Repair ret. y d 2
Environmental Health Specialist
i.p. 11-06
Date 1-a 3—L� %
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990004149 Tax PIN/EH #: 5860-33-5745.05 Barn
Billed To: Roger Lawson Subdivision Info: Baltimore Trails Lot # 5
Reference Name: Location/Address: Baltimore Road -27006
Proposed Facility: Barn Property Size: Date Evaluated: / — '�''a — Q
Water Supply:
Evaluation By:
On -Site Well '� Community
Auger Boring d'� Pit
Public
Cut
FACTORS
1
2
3 4 5 6 7
Landscape position
G L
L
Slope %
L
lr
HORIZON I DEPTH
r_
,
Texture grow
L
L
Consistence
Structure
4L-
Mineralo
I
l; rvt,
/: ( G;
HORIZON H DEPTH
91 —jig
IT VI
Texture group1
c. l_
Consistence
5fS
Structure
5Sk Ciw
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
2
L.
LONG-TERM ACCEPTANCE TE
SITE CLASSIFICATION:�d r1 r . cap+ /i s c� • 7m� l -f
LONG-TERM ACCEPTANCE RATE: �-
REMARKS:
LEGEND
EVALUATION BY: �C n!>e/(1 �ukt S
OTHER(S) PRESENT:
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
u.
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
1`io>t�
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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MENNENiiiiiiMENNENiiiiiiMENNEN i
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
• P. 0. Boz 848/210 Hospital Street `
Mocksville, NC 27028 Z�J4
(336)751-8760 lf'
IMPROVEMENT/OPERATION PERMIT
Account #: 990004149 Tax PIN/EH #: 5860-33-5745.05
Billed To: Roger Lawson . Subdivision Info: Baltimore Trails Lot # 05
Reference Name: Location/Address: Baltimore Trails -27006
Proposed Facility: Residence- Property Size: 18.6 acres
ATC Number: 4532
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type ` #People �_ #Bedrooms #Baths
Dishwasher: 2< Garbage Disposal: Washing Machine: lr1 Basement w/Plumbing: Basement/No Plumbing: El
Commercial Specification: Facility Type #People #People/Shift /#Seats Industrial Waste:
Lot Size Type Water Supply I�` Design Wastewater Flow (GPD).. fa Site: New Repair El
System Specifications: Tank Siz/400 GAL. Pump Tank GAL. Trench Width 0 �Rock Depth./(>z Linear Ftyw�
As stated ii) 15A NCAC 1BA.:inc� ) 1`
Other: acceLited Svsterns n,av nit -.n nn ite-
Required Site Modifications/Conditions: .=, � 2 d -9�� 4 // A, 1/�e
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system be V.30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
Coe liw
t�
sr
r
Environmental Health Specialists Signature: Date. 1phj f
DCHD 05/99 (Revised)
690.3E
550. �9
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y't1 yY 2-1.46
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DEC 2 7 200
bfdVlROII�EAl
EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
a uation/Improvement Permit ❑ Authorization To Construct(ATC) oth
❑New 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 Contact Person�1
Billing Address Are-, Adie, 0, Home Phone S --%'o Z7,0
City/State/ZIP Lhbiq i0ki272 S Business Phone M 7-114-39 75
Name on Permit/ATC if Different than Above �jty7�i
Mailing Address City/State/Zip
PROPERTY INFORMATION
*Date House/Facility Corners Flagged /dV�29JO&
NOTE: A survey plat or site plan must accompany this application. Included: Nolite Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name Phone Number
Owner's Address �. lqW, _ City/State/Zip
Property Address City I/
Lot Size R, le AAo-� , Tax PIN# 0'; - ' 51 4Y.0S ,q/ -
Subdivision Name(if applical
Directions To Site: 1941 E
Section/Lot#
' / / /W-1 V V u
the answer to any of the following questions is "yes", supporting docur&ntation must be attached.
Are there any existing wastewater systems on the site? ❑Yes ❑No
Does the site contain jurisdictional wetlands? ❑Yes ❑No
Are there any easements or right-of-ways on the site? ❑Yes ❑No
Is the site subject to approval by another public agency? ❑Yes ❑No
Will wastewater other than domestic sewage be generated? ❑Yes ❑No
IF RESIDENCE FILL OUT THE BOX BELOW
# People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No
Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of FacilityBusiness�i✓ Total Square Footage of Building L5& 6il P # People
# Sinks �_ # Commodes �_ # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats //Z kd&
Type system requested;, 2 onventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: ❑ County/City Water J�Wew Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ 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
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 tha responsible for the proper identification and labeling of property lines and corners and locating and flagging
or staking theJ}ouse/ cilialocation, proposed wgll location and the location of any other amenities.
��
Site Revisit Charge
y oners r ovum ' 1 epresentative signature
rtw
Date(s):
12, L7 6
Client Notification Date:
Date
EHS:
Account # t�
Sign given ❑Yes ❑No
Revised 11/06
Invoice #
Jul eu ub ue:uup davie county envhealth 336 751 8786 p.3
All
No
< -.:;�
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t
J ,
f .
1 62 OSS
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3E'D69
i.OE,6t.'�• .•
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990004149
Billed To: Roger Lawson
Reference Name:
Proposed Facility: Barn
ATC Number: 4576
Tax PIN/EH #: 5860-33-5745.05 Barn
Subdivision Info: Baltimore Trails Lot # 5
Location/Address: Baltimore Road -27006
Property Size:
**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 �� #People #Bedrooms ¢ #Bathsd.
Basement w/Plumbing: _ Basement/No Plumbing _
Commercial Specification: Facility Type #People #People/ShiR #Seats
Lot Size t C .4 4' Type Water Supply `" Design Wastewater Flow (GPD) 25-- Site: New Repair
System Specifications: Tank Size I-" GAL. Pump Tank T GAL. Trench Width 3b "Trench Trench Depth 3 4 -'^—e
Rock Depth Linear Ft. 1 o o 7, 4 " 04 '.It
Other:
As stat -:d in 25;-N NC^,C !SA.J960(5)
Required Site Modifications/Conditions:— ircceptect 5y�tr »� nl v ,if- ti-, uspdd
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760.
DCHD 11/06 (Revised)
S
Account #: 990004149
Billed To: Roger Lawson
Reference Name:
Proposed Facility: Barn
ATC Number: 4576
DAVIE COUNTY ENVIRONNIENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
OPERATION PERMIT
Tax PIN/EH #: 5860-33-5745.05 Barn
Subdivision Info: Baltimore Trails Lot # 5
Location/Address: Baltimore Road -27006
Property Size:
**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.
System Type: S.T. Manufacturer Tank Date Tank Size
Pump Tank Size
System Installed By:
DCHD 11/06 (Revised)
E.H. Specialist: Date: