217 Montclair Drive Lot 6u
Davie County. NC
Tax Parcel Rennrt
Wednesday, October 19, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
WARNING:: ' HIS IS NOTA SURVEY
Parcel Information
F712OA0006
Township:
5860957675
Municipality:
8300440
Census Tract:
AGNER JAMES III
Voting Precinct:
217 MONTCLAIR DRIVE
Planning Jurisdiction:
ADVANCE
Zoning Class:
NC
Zoning Overlay:
27006-0000
Voluntary Ag. District:
LOT 6 BALTIMORE HEIGHTS
Fire Response District:
Land Value:
Total Assessed Value:
1.01
Elementary School Zone;
8/2005
Middle School Zone:
2005EO239
Soil Types:
0006
Flood Zone:
076
Watershed Overlay:
155920.00
Outbuilding u Extra
Freatures Value:
36000.00
Total Market Value:
195500.00
Shady Grove
37059-803
WEST SHADY GROVE
Davie County
DAVIE COUNTY R -A
ADVANCE
SHADY GROVE
WILLIAM ELLIS
GnB2
DAVIE COUNTY
3580.00
195500.00
l,r•.
Davie County,
All data is provided as is without warranty or guarantee of any Idnd either expressed or implied including but not limited to the
Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
j�(''
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
GIS by this
` `-�
or arising out of the use or inability to use the data provided website.
AUTHORIZATION NO: Q 5 9 O DAVIE COUNTY HEALTH DEPARTMENT
,/� Environmental Health Section PROPERTY INFORMATION /Z
Pe, mittee' s�/�Izfi' 4 fr'G'� P.O. Box 848
Name: Mocksville, NC 27028 Subdivision Name:/�� �� !•�
f-�/;far r / Phone #: 704-634-8760
Directions to property: Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
/SYSTEM CONSTRUCTION -
�I ! Road Name: /iizTT���! rrzip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. 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, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
t 4 DAVIE COUNTY HEALTH DEPARTMENT s
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION J�
PerWftee�Q, JJ
Subdivision Name:, 4 7,m% .
Directioni to property: " � / f Section: Lot: f.
" IMPROVEMENT
PERMIT
Tax Office PIN:#
Road Name: •Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An,.-,
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to die'
construction/mstallation of a system or the issuance of a building permit. ' v ".
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS r # BATHS j2Z&# OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE�% # PEOPLE # PEOPLE/SHIFT # SEATS /INDUSTRIAL WASTE: Yes or No
LOT SIZE -LZs� TYPE WATER SUPPLY / DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE-/ GAL. PUMP TANK GAL. TRENCH WIDTH s. ROCK DEPTH l2 LINEAR FT.,
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: �MI,C
AUTHORIZATION NO. os�v OPERATION PERMIT BY: 144e,
DATE: �-2/y /W
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 05/96 (Revised)
1
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section„Q
P. O. Box 848 f �'
Mocksville, NC 27028
(704)634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL THE REQUIRED INFORMATION IS PROVIDED.
'gy
Name to be Billed ✓m t1 J_ • / jk A., �"' Contact Person
If f
Mailing Address '7 mDA/T C 1fi irL � n Home Phone -9A) " 76 6 `/ %,P%
City/State/Zip %�1 %ice Svc L- A C -2 7,00 � Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For:
4. System to Serve:
5. If Residence:
O'Dishwasher
City/State/Zip
❑ Site Evaluation ❑ Improvement Permit & ATC ❑ Both
❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
# People # Bedrooms 3 # Bathrooms �a
❑ Garbage Disposal 2' -Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Other:
# Commodes
If Foodservice:
7. Type ofmater supply:
Specify type
# Showers
# Seats
&County/City
# People # Sinks
# Urinals
Estimated Water Usage (gallons per day)
❑ Well
# Water Coolers
8. Do you anticipate additions or expansions of the facility this system is intended to serve?
If yes, what type?
❑ Community
❑ Yes 9--'N-o
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: 9 7' g y 20-0,101
0-0,1 WRITE DIRECTIONS (from
- A Mocksville) TO PROPERTY.
Tax Office PIN: #
1
L=40 D
Property Address: Road Name o2 l mbNi cl ►��12 1
ko4- 41 1 /T�rno�Q
City/Zip /pct jZgyce_ o(/G '7.704) 1
1
If in Subdivision provide information, as follows:
Name: ���Ti mU 2 2
1
1
Section: Lot #: 1
1
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter
are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is
falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to
the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County
and owned by J t I n r^ 4 -T0 *4 iv Id tI d to conduct all testing procedures
as necessary to determine the site suitability.
c
DATE //-a I ! /S.0 SIGNATURE /—riry
Revised DCHD (06-96)
L. C . RAY C AT E S certify that on J U N E 13 , 19 9 4 , I surveyed the property shown on this plat;
that the property lines and location of all structures are accurately sho itshtWilzueAhat no structure located on this property
encroaches on any adjacent street or property, and that no air�
ogp4'tcrei�t' property a croaches on the premises
o .•G ST
surveyed." I
uo04 ,••�
r
SEAL
r -2623 •
�•
PARCEL 18.04
PARCEL 18.03 4,1111
,otiSTACY LEE MYERS
_
CARL W. GUITON i��9rf YC3
D:B. 151-783 D.B. 151- 779
O j i
2
ron i
i
placed' Total 197194' S 89°- ii 5����E iron placed
— N 5 negative driveway eoseraent 0
137.63 60.31 I
LOT 5 til
LOT
6
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1188.Sto BALTIMORE.
ROAD (S.R. 1630)
Temp. construction�Gnd
IFO—nplaced
10'utility easement /
maintenance easement
iron
placed
--�— N 890-50-25
rf
W
197.94��
Q-' Iz-
MONTCLAIR
DRIVE
(public)
I ,
LOT 13 1 LOT 14
PROPERTY OF
JOAN L. HOLYFI E LD
LOT NO. 6 MAP OF BALTIMORE HEIGHTS BLOCK NO.
SHADY GROVE TOWNSHIP,
PLAT BOOK 6 PAGE 76 D A-V I E : COUNTY, N. C.
SCALE:I INCH= 40 FEET 3195-6
JOB NO.�—
APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, NC 27028
i
1. Application/Permit Requested By
Mailing Address�2 �'�?cl���� C/Ll �it-y •��i/�s/C� ' Z- G
Home Phone Business Phone 7Sy69 0
2. Name on Permit if Different than Above
3. Application/Permit for: ❑ General Evaluation ❑ Septic Tank Installation
4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision �s/� /:�//��c�,�C%" cic'� r Section _� Lot #
❑ Basement/Plumbing
No. of People ❑ Basement/No Plumbing
No. of Bedrooms ❑ Washing Machine
No. of Bathrooms ❑ Dishwasher
Dwelling Dimensions ❑ Garbage Disposal r
6. If business, industry, place of public assembly, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers Water Usage Figures
7. Type of water supply: Public ❑ Private
8. Property Dimensions __— c',i/C A.(:�'-c% Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes
If yes, what type?
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property:
��-
This is to certify that the information provided is correct to the -best f my knowledge, anc
incurred from this application. ;
71Z 6
DATE
f
TURE
P'
I am responsible for all charges
CONSENT FOR SITE EVALUATION TO BE`DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 0"2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative f the Davie County Health Department to enter upon above described
property located in Davie County and owned by ?avS cam'
to conduct all testing procedures as necessary to a ermine -said ite's suitability,Jor d absorption sewage treatment
and disposal syst m.
ATE ,,,,,4StGNATURE
DCHD (12-90)
h -C c /2vss
��-
This is to certify that the information provided is correct to the -best f my knowledge, anc
incurred from this application. ;
71Z 6
DATE
f
TURE
P'
I am responsible for all charges
CONSENT FOR SITE EVALUATION TO BE`DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: ❑ 1. 1 OWN the property. 0"2. I DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I hereby give consent to the authorized representative f the Davie County Health Department to enter upon above described
property located in Davie County and owned by ?avS cam'
to conduct all testing procedures as necessary to a ermine -said ite's suitability,Jor d absorption sewage treatment
and disposal syst m.
ATE ,,,,,4StGNATURE
DCHD (12-90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME '� DATE EVALUATED
ADDRESS PROPERTY SIZE �/ 7CTr1_1 PROPOSED FACIILTY �� LOCATION OF SITE �l:J/{lyere
Water Supply: On -Site Well Community
Evaluation By: Auger Boring _ Pit
Public
Cut
FACTORS
1
2 3 4
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
D f
Texture group
Consistence
Structure
.kI
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
o
a
SITE CLASSIFICATION: — 10�_
LONG-TERM ACCEPTANCE RATE: 1 3
REMARKS:
DCHD(01-901
EVALUATED BY:
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
Moist
VFR-Very friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm
Wet
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
Notes
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
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