162 North Hazelwood Drive Lot 19Davie County. NC
169
Tax Parcel Report
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WARNING: THIS IS NOT A SURVEY
Parcel Information
Tuesday, January 10, 2017
— --,
Parcel Number:
J7080B0019
Township:
Fulton
NCPIN Number:
5768117456
Municipality:
Account Number:
23562000
Census Tract:
37059-804
Listed Owner 1:
ECKENRODE BILLY A
Voting Precinct:
FULTON
Mailing Address 1:
162 NORTH HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 19 HERITAGE OAKS PHASE ONE
Fire Response District:
FORK
Assessed Acreage:
0.67
Elementary School Zone:
CORNATZER
Deed Date:
11/2004
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
005830501
Soil Types:
GnB2,GnC2
Plat Book:
0007
Flood Zone:
Plat Page:
005
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
pluValtAll data is prodded as Is without warranty or guarantee of any ldnd 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 Dade County's GIs website &hail hold harmless the
County of Dade, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
�NC or arising out of the use or Inability to use the GIS data prodded by this website. —
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section /
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028 /
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003236 Tax PIN/EH #: 5768-11-7456
Billed To: Jeffrey Raynor Subdivision Info: Heritage Oaks Lot # 19
Reference Name: Location/Address: 162 Hazelwood Drive -27028
Proposed Facility Residence Property Size: see map
ATC Number: 3781
**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 #Bathe
Dishwasher: 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 Design Wastewater Flow (GPD) .-,?z� Site: New Repair ❑
System Specifications: Tank Size GAL. Pump TanVodl? GAL. Trench Width b Rock Depth � Linear Ft,3�
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT F
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Hea
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
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
LTER. RISER(S) IF 6 " BELOW
th Department for final inspection of this
Telephone # is (336)751-8760.****
Date:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990003236
Tax PIN/EH #:
5768-11-7456
Billed To: Jeffrey Raynor
Subdivision Info:
Heritage Oaks Lot # 19
Reference Name:
Location/Address:
162 Hazelwood Drive -27028
Proposed Facility Residence
Property Size:
see map
ATC Number: 3781
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 CONSTIR%UCTI/O/N IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: ZZ 44
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.
Septic System Installed By:
Environmental Health Specialist's Signature : � ZZ Date:
DCHD 05/99 (Revised)
ly CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
D Davie County Health Department
IE
Environmental Health Section
i��►Y P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
�NVIRON�EtyIA�VIM (336) 751-8760
COIJO
* RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS P+'Ri�O-,V,,IDED. R(e�fer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed 5-4(4-y K PA�ion2 Contact Person
Mailing Address 92 r 1 ! i'Al-, b12 Home Phone 356- Z(, 0" UJ6+
City/State/ZIP L�Ilj wootj At(_ R7)eM Business Phone 33_ ' - 2,140-9 Oq (4
2. Name on Permit/ATC if Different than Above RS W0,40 '
Mailing Address <e*wc— City/State/Zip Smr c
3. Application For: ❑ Site Evaluation >IZ Improvement Permit/ATC ❑ Both
4. System to Service: W-'H�Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. Type system requested: L'7 Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People � # Bedrooms _3 #Ba�throoms
Mbishwasher ❑Garbage Disposal Ml aching Machine tilBasement/Plumbing Z<.ement/No Plumbing
7. If BXes ndustry /Other: verify type # People # Sinks
# Comm # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: t//County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C -K0
If yes, what type?
L_
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 161,Y196 y KI /' (17
Tax Office PIN: # S�r/p�L ZqQ
Property Address: Road Name 1 (' L --c 1"tJ lX
City/zip MbCfftJ(ti i4C
If in a Subdivision provide information, as follows:
Name: I F ii nwp n o t
o-
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
LIE -6 aFnarre'a
4yrM L4 go -fu cNia tvre,% 14
Lb -F o r4
Date home corners flagged:
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 ann 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 procedure] as necessary to determine the site suitabjlity. „
DATE J5— / A-0 Lf '%� SIGNATURE L./ X ' W/J- t Z101
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN Veldde all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
yy a m h 4--o C /\- a n. 8 -. -4-1..—
N/0
Sign given
Revised DCIID (05/03
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
/4077 Account No.
Invoice No. t /
C—
` DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME Z2�K�l h
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED 71
PROPERTY SIZE
LOCATION OF SITE 6�1 �-
Water Supply: On -Site Well _ Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1 2 3 4
Landscape position
Slope Z
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH
Texture groupz
Consistence
Structure
l
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
t
SITE CLASSIFICATION:
LONG-TERM ACCEPTA
REMARKS:
DCHD(01-901
EVALUATED BY: �Z
OTHER(S) PRESENT:
END
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- Vl�-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/ft2