174 North Hazelwood Drive Lot 18Davie County, NC Tax Parcel Report Tuesday, January 10, 2017
WARNING: THIS IS NOT A SURVEY
Parcel Information
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:
J7080B0018 Township: Fulton
5768117652 Municipality:
82526632 Census Tract: 37059-804
VIZCAINO RICHARD S Voting Precinct: FULTON
174 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County
MOCKSVILLE Zoning Class: DAVIE COUNTY R-20
Land Value:
Total Assessed Value:
NC
27028-0000
LOT 18 HERITAGE OAKS PHASE ONE
0.67
6/2006
006680524
0007
005
Zoning Overlay:
Voluntary Ag. District:
No
Fire Response District:
FORK
Elementary School Zone:
CORNATZER
Middle School Zone:
WILLIAM ELLIS
Soil Types:
GnC2
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
Outbuilding 8r Extra
Freatures Value:
Total Market Value:
Davie County,
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r'O� •�'�
NC
County of Dade, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001750
Billed To: Southland Construction, Inc.
Reference Name:
Proposed Facility Residence
ATC Number: 4120
Tax PIN/EH #:
5768-11-7652.18
Subdivision Info:
Heritage Oaks 1 Lot # 18
Location/Address:
N Hazelwood -27028
Property Size: see map
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 CO ST UCTION 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. ----I
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r
Septic System Installed By:
A,AJ 41,�I 0�,� )N V
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001750
Billed To: Southland Construction, Inc.
Reference Name:
Proposed Facility Residence
Tax PIN/EH #:
5768-11-7652.18
Subdivision Info:
Heritage Oaks 1 Lot # 18
Location/Address:
N Hazelwood -27028
Property Size: see map
ATC Number: 4120
**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 ---? #Baths _ V
Dishwasher: Garbage Disposal: ❑ Washing Machin Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply ec Design Wastewater Flow (GPD) � Site: New Repair ❑
System Specifications: Tank Size/,&,O GAL. Pump Tank,1AA GAL. Trench WidtlK�Y "'Rock Depth Linear Ff�?W
Other:
=vapted Syatoms may also .be use
Required Site Modifications/Conditions:
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. . or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
po
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F
Environmental Health Specialist's Signature: Date: !iS
DCHD 05/99 (Revised)
J F R SITE EVALUATION/IMPROVEAIENT PERMIT & ATC
avie County Health Department
0-4n virvamental Health Secdon
.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
***IMPC) TANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructons.
1. Name to be Billed
Mailing Address x/1,2 L&41ANuI v GC
City/State/ZIP L&)V&&4 /� 27aWjcdrr�l?.-11
Contact Person
Rome Phone .—&:3
Business Phone _ �JJ d`�W ccM
2. Name on Permit/ATC if Different than Above
Mailing Address C ty/State/Zip
3. Application For: 13 Site Evaluation Improvement Permit/ATC ❑ Both
t. system to Service: j Hyouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S. Type system requested: t)1 Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People # Bedrooms # Bathrooms_
shwasher ❑Garbage DisposalWashing Machine ❑Basement/Plumbing ❑Basoment/No Plumbing
T. If business/Industry /Other: verify type # People # Sinks
# Commodes # Showers
# Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
s. Type of water supply: County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facIlIty this system is intended to serve? ❑ Yes ] No
If yes, what type?
***1A1P0RTANT*** CLIENTS AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUAST BESURAfITI'ED by the client witil THIS APPLICATION.
Property Dimensions: 16� F�/I`Q7 ar 1VRITE DIRECTIONS (fromModaville) to BROPERT
Tax Office PIN: 1f fcj7f; 81766
Property Address: Road Name ,446 X
City/Zip
If in a Subdivision provide information, as follows
Name: (t4
f� /CAQYCj
Section: l Block: Lot:!
tftgi6q /,-
Ods
Date home corners flagged: O
This Is to certify that the information provided is correct to the best of my knowledge. I gpderstand that any permits)
Issued hereafter arc subject -to suspension or revocation, if the site plans or intended use nge, r if the information
submitted in this application is falsified or changed. I, also, understand that l an o a/1 charges incurred front
this application. I, hereby, give consent to the Authorized Representati le a Couut (Ii Department
to enter upon above described property located in Davic County an oivn
I VLYYt.• i/cw/u1 a:a as t1i7L1:JJilry /V (llllrlllllll 1110 31LC Si •-
�—
DATE SIGNATURE
� -- ....
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
4i'roperty lines and dimensions, structures, setba ks, a�spti locations).
Sign given
Revised DCHD (05103
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
.Account No.
7 So
L►voice No. r /'
rA•�I �'T
;.;'/ C 4`•.t 1••' .4• •.t� 1, .
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• ,' DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
• Soil/Site Evaluation
NAME &�
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE 15 yC-
Water Supply:
On -Site Well
_ Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS
1 2 3 4
Landscape position
Sloe Z
,
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
i N
Texture group'
Consistence
i
Structure
Mineralogy
1"
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
75
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: OSS EVALUATED BY: �CY��Z
LANG -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
Mineraloey
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