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284 Montclair Drive Lot 10Davie COL lty. NC T,iv Ppt -ol P, i-norl Thursday. October ?0.2016 Parcel liuilibsr. DCPID Dumber: Account Nurnbar: List --d 0nncr 1: G",ailing Address 1: City: State. Zip Codc: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: F712CO0010 Township: Shady Grove 5870062172 r4unicipality: 82528473 Ccr:sus Tract: 37059-803 VICK JANSEN PHIPPS `Doting Precinct: kNEST SHADY GROVE 284 MONTCLAIR DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Clzms: DAVIE COUNTY R -A NC 27006-0000 LOT 10 BALTIMORE HEIGHTS PHAISE 2 0.78 7/2007 007220+174 0008 016 169640.00 36000.00 209810.00 Zoning Overlay: Voluntary Ag. District: No Fire Response District: ADVANCE Elementary School Zone: SHADY GROVE !:Riddle School Zone: WILLIAM ELLIS Soil Types: RrlrC2,GnB2,Pc82 Flood Zone: Watershed Overlay: Outbu;!ding & Extra Freatures Value: Total Market VLIuc: DAVIE COUNTY 4170.00 209810.00 PY All data Is provided as is withoutwarranty or guarantee of any kind either expressed t r implied including but not limited to the hold harmless the � vu v i.. %— implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall Davie, floral Csre;;:,a, Us contractors or employees from any and a' claims or causes cf acticct due to hµ NC Coui::y of agents, consullants, or arising out of the use or Inab;iity to use the GIS data provided by this website. 0 r DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002260 Tax PIN/EH #: 5860-95-1543.10 Billed To: Allen Wayne Builders,LLC. Subdivision Info: Baltimore Heights Lot # 10 Reference Name: Location/Address: Montclair Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3545 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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�4— Res idential Specification: Building Type #People#Bedrooms � #BathsDishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply 6 Design Wastewater Flow (GPD) ,�d Site: New C?] -Repair ❑ System Specifications: Tank Size/e?,id GAL. Pump Tank Other: Required Site Modifications/Conditions: z :a 10 GAL. Trench Width,12 " Rock Depth' Linear Ft.2W IMPROVEMENT/OPERATION PERMIT LAYOUT - AV ED EFFLUENT FILTER. RISER(S) IF 6 "BELOW FINISHED GRADE. ****NOTICE: Contact a representative of theNday 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. o e installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002260 Billed To: Allen Wayne Builders,LLC. Reference Name: Tax PIN/EH M 5860-95-1543.10 Subdivision Info: Baltimore Heights Lot # 10 Location/Address: Montclair Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3545 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 permit(s) (in compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CO STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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. Paf q L4 KA I DOC Septic System Installed By: Environmental Health Specialist's Signature JL Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IhIP110VEAIENT PE►i�ti1 Davie County Health Department Eaviranmenta/Hea/t/1 Section P.O. Box 848/210 Hospital Street biocksville, NC 27028 (336)751-8760 Ei.ai g i'ErITAL fU- Jill ***XMPORTANT*** TIIIS APPLICATION CANNOT BE PROCESSL•'D UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions 1. Name to be Dilled %1/1/7 kilt "e &, Iders LG C, Contact Person j�({ % Q{�/11F.. Mailing Address 20f) ciownda l -L, a,,e 54. 1 (3 Itome Phone City/State/ZIP On5+Cn— ka7 &. e - 27103 Business Phone-f!O.S /7 2. Name on Permit/ATC if Different than Above Ains Mailing Address City/State/'Lip 3. Application For. ❑ Site Evaluation Improvement Perinit/A`1'C ❑ Both R 4. System to Service: y House ❑ Mobile Home ❑ Busine$s ❑ Industry ❑ Other S. Type system requested: Conventional ❑ conventional modified ❑ innovative 1 6. If Residence: It People .2- It Bedrooms_ It Bathroom:; tdDishwasher ❑Garbage Disposal VWashing MM►a'chine ❑Basement/Pliunbing ❑Basement/llo Pluming 7. If Business/Industry /other: verify type— _!, II People IIJinls 8 Commodes It Showers IF FOODSERVICE: It Seats 8. Type of water supply. County/City It Urinals U Water Coolcr:i Estimated Water Usage (gallons per day) _ ❑ Well ❑ Conununi ty 9. Do you anticipate additions or expansions of the facility this System is illtcll(1L`(1 to sel•ve? ❑ yes If yes, what type? ***1/1f1'0RTAjYP** CLIENTSil1UST COAIPLETE TILE REQUIRED PROPERTY 1NFORIYIATION RB011l?5'1'1sl) -- -f BELOW. Either a PLAT or SITE PLAN 111USTBESUISiVITTED by the client will, TIIIS APPLICATION. ` Pi-operty Dimensions: / 00 ' .' 139 Tax Office PIN: # 5,40 -01 S-- 1 S q 3 10 Properly Address: Road Nanlc Or - City/Zip AAUanbjJ _ Z l,oc4 If in a Subdivision provide information, as follows: Name: 94/1(1 Mere Ne,�A fs Section: �_ Block: Lot: WRITE DIRECTIONS (Cron, Alocicsville) to PRUI'I(ItTY: Date IIonic corners flagged: b' 9'D 3 This is to certify that the information provided is correct to the best of my knowledge. I understand that any per►Nit(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, ol• if the infoc•nlation submitted in this application is falsified or changed. 1,, also, understand that I nuc responsible for all chat-ges inccn•rctl front this application. I, hereby, give consent to elle Authorized Representative of the Davic County Ilealtl, Departlnc„t to enter upon above described property located in Davie County and owned by/ to conduct all testing procedures as necessary to deteraline the site suit4lwyty., llATi; SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PL (I do all oft following: Existing and proposed property lines and dimenlsions, structures, setbacks, and septic locations). Sign given Revised DCHD (05/03 Site Revisit Charge Dalc(s): ----- Client Notification Dale: EES: Account No.. Invoice No. S (r96'46' W 100.00' Lot 11 PB a pq 16 at 9 Lot 10 Baffimore Heights Phase Two PB a pq 16 hady Grove Township — Davie County. NC SeUmft as'per plot Side 15 feet front 40 Iled Tear 30 feet -------------------------- Moniclaw Drive 20 Paved — — — — — — — — — — — — — — — — — — — — — — — — — — Scale I Inch = 60 feet APPLICATION f OR SITE E1ALUA7I0N/IftlH10VEh1ENi EII,1IIi C Davie County Health Department Environmenta/Health SectionAl - P.O. Box 848/210 Hospital Street A"tt ' $ Mocksville, NC 27028 (336) 751-8760 UJAR:Qi' ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS P/ROVIDEDD. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person Mailing Address 09'3 M o A-1 --c /ct ,!� �/� Home Phone '5 3 _ City/State/ZIP %Vf C. Z 7 UU L/, Business Phone C% -/ -C1 3 -3 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Er ite Evaluation ❑ Improvement Permit/ATC 11 Both 4. System to Service: WYHouse ❑ Mobile Home ❑ Business ❑ Industry 1-1 Other 5. If sidence: # People ii Bedrooms # Bathrooms Dishwasher CI Garbage Disposal asking Machine LI Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ErCounty/City [I Well I] Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes )&NO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eithcr a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ' WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax OfficeO IN: # S 6 " q S / 5 C/3 ` ( u Property Address: Road Name /Y�0r-,k-(,A« Dr ,/t City/Zip /9a'UZ Tao G If in a Subdivision provide information, as follows: Name: Section: Block: Lot D Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. 1 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, itaderstand that I ran responsible for all charges incurred from this application. 1, hereby, give consent to the Authorized Representative of the Davie County Hcallli Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE — G SIGNATURE Z-2n::2:V THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. / DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' t Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002232 Billed To: Guy Cornatzer Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5860-95-1543.10 Subdivision Info: Baltimore Heights Lot # 10 Location/Address: Montclair Drive -27006 Property Size: see map Date Evaluated: �2 Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public C-1-11 Cut FACTORS 1 2 3 4 5 6 7 Landscape position .L Sloe % HORIZON I DEPTH Texture groupG Consistence Structure Mineralogy HORIZON II DEPTH Texture group C Consistence —/ Structure 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: fT� LONG-TERM ACCEPTANCE RATE: r REMARKS: EVALUATION BY: zlzG 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 Mineralog 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 DCHD 05/99 (Revised) ■E■EM■■ MEMO■■■ ■EMM■M■ ■■■■ME■ ■ME■ME■ ■■MEMS■ ■MEM■E■ MEM■■■■ ■■■■M■■ ■■■■■M■ ■MEMO■■ ■ESE■M■ ■ ■ SEEN MEMO ■E■■ SEEN MEMO moos moms SEEM ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■E■EE■N■■ ■E■MOMM■■ ■E■O■O■E■ ■■MEMEM■■ ■E■E■EME■ ■MEM■■M■■ MEMEMEMME ■■MMM■■E■ ■■EE■■■E■ ■■■M■■■■■ ■■E■■■■■■ ■■■■M■■■■ ■■E■■■■E■ ■■■M■■■M■ ■■■■M■■■■ ■■■M■■■M■ ■■E■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ MEMO■■■■■■■ ■■■■■■■■■■■ ■O■■■E■EEE■ ■O■■■MM■■E■ ■EE■■EM■■■■ ■■MESE■■■■■ ■■■■■EEE■■■ ■E■■■■■E■■■ ■■■■■E■E■■■ ■■■■■■■■■■■ ■■■EEE■■■■■ ■O■■■■■■■■■ ■ mmommon ■■■■■■ ■■■E■■EE■O■ ■■■■■■EE■■■ ■■■■■■■■■■■ ■■■EEE■■■M■ ■■■■O■■■■■■ ■■■■■■■■■E■ ■■E■■■■■■■■ ■E■■■■■■■■■ ■E■■■■■■■■■ ■■■■■MMES■■ ■OE■■■■■■■■ ■E■■■■■■■■■ ■E■■E■■■EE■ ■■■■NNE■■■■ ■■■■O■■■■■■ ■■MEMO■■E■E■■■■■■ ■■■■EEME■E■■■■■■■ ■EEE■■■■NEE■■■■■■ ■O■■■■■■■■■■■■M■■ ■O■■■■■■E■■■■■■■■ ■■■■■■EMM■■■■■■■■ ■■E■■■■■■■■■■■■■■ ■O■■■■E■■■■■■■■■■ ■■■■■■■■■■■E■EE■■ ■■MM■■■■EMM■■■■■■ ■■■■■■■■E■■■■■■■■ ■■■■E■■■■■■■■■E■■ ■■■■■■■E■■■■E■■■■ ■E■■■■■■■■■■■■OE■ ■E■■■■ME■■OE■■■■■ ■E■■■■■■■■■■■■■■■ ■O■■■NEE■■■■■■■■■ ■■■■O■■■O■■EOO■O■ ■■■■■■■■■■■E■■■■■