150 North Hazelwood Drive Lot 20Davie County, NC Tax Parcel Report Tuesday, 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-RN11NG: '1'Hli lh NUT A 5UKVEY
Parcel Information
J7080B0020 Township: Fulton
5768117351 Municipality:
82517187 Census Tract: 37059-804
KIMBLE MELVIN L Voting Precinct: FULTON
150 N HAZELWOOD DRIVE Planning Jurisdiction: Davie County
MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
Land Value:
Total Assessed Value:
I[6.
27028-0000
LOT 20 HERITAGE OAKS PHASE ONE
0.68
7/2001
003770816
0007
005
Zoning Overlay:
Voluntary Ag. District:
No
Fire Response District:
FORK
Elementary School Zone:
CORNATZER
Middle School Zone:
WILLIAM ELLIS
Soil Types:
GnB2,GnC2
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
9 [I� All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
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County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
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r'OUty'C� 1\ C or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT e U
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 989900624 Tax PIN/EH M 5768-11-7351.20
Billed To: Lary Everhart Subdivision Info: Heritage Oaks Lot # 20
Reference Name: Larry Everhart Location/Address: Cedarwood Place -27028
Proposed Facility: Residence Property Size: 151 X 199
ATC Number: 2464
**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 1F SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type #People c�2 #Bedrooms #Baths_
Dishwasher: Garbage Disposal: ❑ Washing Machine.A Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size .s C 4 Type Water Supply Design Wastewater Flow (GPD) .., ?/� Site: New ®Repair ❑
System Specifications: Tank Size/AP!� GAL. Pump Tank GAL. Trench Width3w << Rock Depth /,8 << Linear Ft OM
Other: d %Ce f,& 1..2 c�
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICF,:--Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.ipr .to 9:30 a.m. or 1:607p-. to,\:30 p.m.. on the day of installation. Telephone # is (336)751-8760.****
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
19
Account #: 989900624
Billed To: Lary Everhart
Reference Name: Larry Everhart
DAVIE COUNTY HEALTH DEPARTMENT At---
Environmental
Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5768-11-7351.20
Subdivision Info: Heritage Oaks Lot # 20
Location/Address: Cedarwood Place -27028
Proposed Facility: Residence Property Size: 151 X 199
ATC Number: 2464
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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: 4 —�
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.
15
l
t tt�
Septic System Installed By: W r%'`
Environmental Health Specialist's Signature: «--- Date:
DCHD 05/99 (Revised)
4 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department
Environmental Health 8ec[ion
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed L,4 P, e y}} r--�1 '?J' Zxffjg �-/ Contact Person �j L�'►+6�(lA1 n
Mailing Address (o (V (,y .T , Home Phone 2S' 6 L 6 6 O T� /
City/State/ZIP IZ ft '! 6� Ci 2- Business Phones —r�
2. Name on Permit/ATC if Different than Above
Mailing Address C;m=eprov'ement
/Zip
3. Application For: E�tsite Evaluation Permit/ATC ^- h
4. System to Service: 0/douse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Resi
2nee: # People # Bedrooms # Bathrooms .�
.: her ❑ Garbage Disposal aj.Mashlng Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Vater Usage (gallons per day)
7. Type of water supply: County/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 1-5,� WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: 4 ��%'� X11 "73 6-1 20, "Z TIL �^
Property Address: Road Name c� �d Y-0 �` �.'��'1 ! L
A
City/Zip
If in a Subdivision provide information, as follows:
Name: 007#4—
Section: Block: Lot:
0
Date Property Flagged: U
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
to conduct all testing procedures as necessary to determine the site suitability. %�
DATE b --16) r C) v SIGNATURE (/ / / [.[./s(�I tC,4 �A
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).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS•
Revised DCHD (07/99)
Account No.
Invoice No.
r
,r STOKES
•i HAT HARRIS B.
r-RS,'.)NAU,Y
140ALEDGED THE
-i
4 3EAL THIS
N/F
:0i A. BURNElTE
: 87, PG. 426
REFERENCES:
1. PLAT ENTrnED " ROBERT NEI.SON JONES & wife JAKE S. JONES!'
AN UNRECORDED MAP BY GEORGE R. STONE, R.—TS. 3162, DATED
JANUARY 2, 1996.
I. PLAT ENTMZD " DALLAS WAYNE JONES & wife CONNIE LEE HENDRIX JONES'
AN UNRECORDED MAP BY GEORGE R. STONE, R.L.S. 3162, DATED
FEBUARY 1, 1996.
N --6-228'52" W
1028 39'
LOT I I
LOT 12
LOT 13
LOT 14
LOT
15
LOT 16
.0
oD
14082'
135.88--
131.43'
127.38'
127.54
0
0
0�
— ---
Un
N W43' -W f
ul
182.91'
150,75' 15155, 152.37'
15-1 20'
LOT Zi LU �:
I U LV; 19 LV 10 LOT I
22
75-'o.36'
S 0019'34"W
14 C GRID MAD 1983)
N 02*28'52"
--
10`+4.3 3'
REMAINING AREA
9.382 ACRES
N/F
ROBERT N. jo
IIII C; 11 DB. 185, PG.
S 00'37'14" E
k' ", 7 f-'
DAVIE COUNTY HEALTH DEPARTMENT�a
y Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS /
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Water Supply:
On -Site Well
_ Community
Public
Evaluation By:
Auger Boring
Pit L-1-1
Cut
FACTORS 1 2 3 4
Landscape position
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH D r"
Texture groupG�
Consistence
Structure /C
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: 0--5
EVALUATED BY: A/Z
LONG—TERM ACCEPTANCE RATE: / / OTHER(S) PRESENT:
REMARKS:
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 -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
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(01-901