136 North Hazelwood Drive Lot 21Davie Countv. NC
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Tav Parr-pl R annr 1
Tuesdav, January 10. 2017
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:
WA"IIN is "I'HI, I, INU'I' A NUKVEY
Parcel Information
J7080B0021 Township: Fulton
5768117156 Municipality:
82513040 Census Tract: 37059-804
BURCH DAVID W Voting Precinct: FULTON
136 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County
MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
Land Value:
Total Assessed Value:
NC Zoning Overlay:
Davie County,
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27028-0000 Voluntary Ag. District:
No
LOT 21 HERITAGE OAKS PHASE ONE Fire Response District:
FORK
0.66 Elementary School Zone:
CORNATZER
/ Middle School Zone:
WILLIAM ELLIS
Soil Types:
GnB2,GnC2
0007 Flood Zone:
005 Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
F-O
Davie County,
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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 CounWs GIS website 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
or arising out of the use or inability to use the GIS data provided by this website.
DAME COUNTY HEALTH DEPARTMENT G�,;7
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900625 Tax PIN/EH #: 5768-11-7156
Billed To: David & Julie Burch Subdivision Info: Heritage Oaks Lot # 21
Reference Name: David Burch Location/Address: Hazelwood -27028
Proposed Facility: Residence Property Size: 3/4 Acre
ATC Number: 2059
**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 r✓ #People 2- #Bedrooms 3 #Baths 2
Dishwasher: &!�- Garbage Disposal: ❑ Washing Machine: 12� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industriall Waste: ❑
Lot Size �94 A(ee� Type Water Supply�^W Design Wastewater Flow (GPD) 3(60 Site: New 12 Repair ❑
System Specifications: Tank SizeIVOGAL. Pump Tank GAL. Trench Width Rock Depth If' Linear Ft.�`nl
Other: 2 :P1 :5. -MA 9c� 11 o z
I
Required Site Modifications/Conditions: 1N STb U- Cy -I C o- Tooaf 40 ":r-
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.****
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ental Health Sp iXlist's Signature: e
i
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 989900625 Tax PIN/EH #: 5768-11-7156
Billed To: David & Julie Burch Subdivision Info: Heritage Oaks Lot # 21
Reference Name: David Burch Location/Address: Hazelwood -27028
Proposed Facility: Residence Property Size: 3/4 Acre
ATC Number: 2059
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 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEW R NS CTIO S VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signa e: Date:
**NOTE** The issuance of this
has been installed in
Disposal Systems," b
given period of time.
.0
yr
CERTIFICATE OF COMPLETION
ite of Completion shall indicate the system described on Improvement/Operation Permit
nce with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
in NO WAY be taken as a guarantee that the system will function satisfactorily for any
Septic System Installed By:
Environmental Health Specialist's Signature :
DCHD 05/99 (Revised)
IV �--R.a,-jT
4s,3D&,,\A-J
Date: 2 //
APPLICATION FOR Oav � PERMIT &
e County Health m
lth Depaft
Environmental Health 5"Hon
P.O. Box 848/210 Hospital Street JW ' 8 M
Mockaville, NC 27028
1336)751-8760
ENVIRONMENTAL HEALTH
DME MINTY
***ZHPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS QOIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN fo instructions.
1. Name to be Billed �, t� ul�lc- Contact Person \�
Hailing Address Home Phone -%qy 37R c�
city/state/zip Z7 35-t Business Phone `Z�1R. 66yz
2. Name on Permit/ATC if Different than Above
Nailing Address
3. Application For: U Site Evaluation 0 Improvement Permit/ATCBoth
4. system to service: l ` ouse 0 Mobile Home 0 Business 0 Industry 0 other/
S. If Residence: # People Z- # Bedrooms # Bathrooms �.
dishwasher 0 Garbage Disposal �-Vashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/other: Specify type # People # sinks
# Commodes # showers # Urinals # Nater Coolers
IF FOODSERVICE: # Seats I Estimated Water Usage (gallons per day)
7. Type of water supply: "runty/City 0 Well 0 Comaaunity
9. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 No
If yes, what type' a, i 11 n S v�
***IMPORTANT'** CLIENTS AIUSTCOmpumTHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN AIUST BESUBAIITTED by the client with THIS APPLICATION.
c 1577fi.3.7(,1
Property Dimensions: �r,on'% ZOZ i L 14q .70 1
Tai Office PIN: #
Property Address: Road Name jf ' nn
City/Zip �oLCsv l'c; lI C'
If In a Subdivisionm
provide Information, as follows:
Name: p'f' � t eri^ It 6)a,k,5
Section: 1 Block: Lot:
WRITE Di tEUnONSr(rfrom M/ockrAlle) to PROPERTY:
l-o�- r rl Cvtiv-� On �� f t1
Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
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 t ani responsible for all charges i rcuffed from
this application. 1, hereby, give consent to the Authorized Representative of the Qavle a He th epartment
to enter upon above described property located in Davie County and owned by
to conduct all testingproceduresas necessary to determine the site itabiliq
It -vim
SiGmATUIRE
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).
E:
Account No.
Revised DCHD (07/98) Invoice No. �a
L.28
140.74
(D
If O
G � LOT 7
N/F
WILLIAM A. PURNET(E
DB. 187, PG. 426
N 02'28'52" W
1028.39'
_.... 136.10' 131.63'
170.55' 141.05' - - --
38.22' 63.28' -
zt
WOODS
M
N LOT 14 i
ry LOT 12 LOT 13 *
�r� O
LOT ' 11
Z Nto � LOT 10 �,.. 'a oe Ow�.f� oN
I m ►
i' 10' UTILITY EASEMENT m
LOT 9 �� ,_ 1
N
v yOp1 16' 140.82' 135.88'
6 131.43'
54.19'
.. N 00'43'36" - — 682.9 V -
�J!RQEOSM 20 - — 150.75'
2. 1.55' i 52
LOT 8 - -
WOODS
l \' LO 21 m
1 � o) LOT
18'FE.LOT 2 p
� Q
4 g
07.05' i 150 7S'I 151.56' ( 152.
ON K 1 I
x11
- 3A 106-65. j
4 �n
x
226.52 f N s 00' 19' �4, W
`O
!� = 09'59'48" 755.36' !
1.
I R = 1600.00' �
T = 13993- o p ( LOT 23 I
L = 279.16'
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' t DAVIE COUNTY HEALTH DEPARTMENT >
Environmental Health Section
Soil/Site Evaluation
NAME
f �
ADDRESS
PROPOSED FACIILTY
Water Supply: On -Site Well
Evaluation By: Auger Boring
DATE EVALUATED 21
PROPERTY SIZE
LOCATION OF SITE
Community_
Pit
Public C/
Cut
FACTORS
1 2 3 4
Landscape position
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
d�
Texture groupG
Consistence
r
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: ep—S
LONG-TERM ACCEPTANCE RATE: �I
REMARKS:
EVALUATED BY: .1)4 //
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 :lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V,2. -y 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
.3C --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/ftz
DCHD(01-901
1 �