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179 North Hazelwood Drive Lot 15Davie County. NC I TaY Parr Pl R r nnrt 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 I Page: Plat Book: Plat Page: Building Value: WARNING: THIS IS NOT A SURVEY Parcel Information J7080B0015 Township: Fulton 5768114689 Municipality: CORNATZER 82525165 Census Tract: 37059-804 RESTIVO ROYCE S Voting Precinct: FULTON 179 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC 27028-7164 LOT 15 HERITAGE OAKS PHASE ONE 0.68 9/2005 006270200 0007 005 Zoning Overlay: Voluntary Ag. District: No Fire Response District: FORK Elementary School Zone: CORNATZER Middle School Zone: WILLIAM ELLIS Soil Types: Gn132,GnC2 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Freatures Value: Total Market Value: 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 County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to NCor arising out of the use or Inability to use the GIs data provided by this website. • _ ~. 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 #: 5768-10-9770.15 JR Billed To: Jeffrey Raynor Subdivision Info: Heritage Oaks Lot # 15 Reference Name: Location/Address: 179 N.Hazelwood Drive -27028 Proposed Facility Residence Property Size: see map ATC Number: 3955 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: ��A`� f 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 I 1 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. (� -lam 66 o iy Septic System Installed By: eP Environmental Health Specialist's Signature: Z-& Date: �` 5 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT " Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003236 Tax PIN/EH #: 5768-10-9770.15 JR Billed To: Jeffrey Raynor Subdivision Info: Heritage Oaks Lot # 15 Reference Name: Location/Address: 179 N.Hazelwood Drive -27028 Proposed Facility Residence Property Size: see map ATC Number: 3955 **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 1/ #People #Bedrooms ,—? #Baths_ Dishwasher Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: El Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: El Lot Size Type Water Supply �B Design Wastewater Flow (GPD) Site: New Repair 13 System Specifications: Tank Size/aop GAL. Pump Tank GAL. Trench Width,'�l Rock Depth Linear Ft.:?40 Other: 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.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** C/ Environmental Health Specialist's Signature: Date: C DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IAiPROVEAiENT PERMIT T JA Al Davie County Health Department 5 2005 Environmental Health Section P.O. Box 848/210 Hospital Street ENVIROPM ENTAL Mocksville, NC 27028 DAVIECONTY (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 -At-4r-e" l\ F. t lUeL Contact Person ile 4414L,/l%t-7 Mailing Address � Home Phone 3� 913 -6 77J City/State/ZIP �l /1lIf W /v &i .2%Z-! S Business Phone 334 -e-N-0-1905 C/ 2. Name on Permit/ATC if Different than Above — '54-'m C Mailing Address 5�71tF ittyy/State/Zip - St�3'►�E City/State/Zip- 3. 3. Application For: <,Site Evaluation 0 Improvement Permit/ATC ❑ Both 4. System to service: 19-50use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: M Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms 3 # Bathrooms 2- I I ODishwasher ❑Garbage Disposal Mashing Machine ❑Basement/Plumbing [Oasement/No Plumbing If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers— IF FOODSERVICE: I#�.Seeats Typo of water supply: M County/City Estimated Water Usage (gallons per day) ❑ Well ❑ Community 9. Do you anticipate additions or CXp211Si0ns of the facility this system is intended to serve? ❑ Yes l9'No If yes, what type? ***IMPORTANT'`** CLIENTS AfUST COAfPLETETIIE RL•QUIRED PROPERTY INFORMATION REQUESTED BELONV. Either a PLAT or SITE PLAN MUSTBESUBAIITTED by the client with THIS APPLICATION. Properly Dimensions: Tax Office PIN: # g— /0 " C7 -770 Property Address: Road Name _177 /�/ /�i9LFLl.�/✓dD ,0/Z City/Zip %YIOG/4i1/i/1r Ale If in a Subdivision provide information, as follows: Name: o z -s Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: `/, Iry /1FrtrT 4�li�,s 60 Date home corners Ragged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued 1lereafter are subject to suspension or revocation, if the site plans or intended use change, or if t11e information submitted in this application is falsified or changed. I, also, understand that l ani responsible for all charges inctured from this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth 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. n DATE /- 5-'O 's", SIGNATURE W. -?Y 4'k + TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAVnElfide all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). _L6�lC '7" Sign given_____ Revised DCIID (05/03 Site Revisit Charge Datc(s): Client Notification Date: EI;IS• Account No. �3� InvoiccNo. �� ,az I I • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ( k ADDRESS PROPOSED FACIILTY _# /s DATE EVALUATED PROPERTY SIZE LOCATION OF SITE i� Water Supply: On -Site Well _ Community Public L� Evaluation By: Auger Boring Pit �� Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 4- f Texture group pC 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: �/ LONG-TERM ACCEPTANCE RATE: 1 / REMARKS: DCHD(01-901 EVALUATED BY: 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- Vc.-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 , f ' DAVIE COUNTY HEALTH DEPARTMENT '- Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account M 990003236 Billed To: Jeffrey Raynor Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: On -Site Well Property Size PROPERTY INFORMATION Tax PIN/EH #: 5768-10-9770.15 JR Subdivision Info: Heritage Oaks Lot # 15 Location/Address: 179 N.Hazelwood Drive -27028 see map Date Evaluated: Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: 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 Mineralo�v 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)