186 North Hazelwood Drive Lot 17Davie Countv, NC
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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:
WAlZN1NG: TMS 1S NOT A SURVEY
Parcel Information
J7080B0017
Township:
Fulton
5768117768
Municipality:
CORNATZER
82526956
Census Tract:
37059-804
SILVERSTEIN PAUL D
Voting Precinct:
FULTON
186 NORTH HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
Land Value:
Total Assessed Value:
NC
27028-0000
LOT 17 HERITAGE OAKS PHASE ONE
0.83
9/2006
006790852
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 & Extra
Freatures Value:
Total Market Value:
�'
_.
Davie County,
�T
1\ C
----
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County of Dade, 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 prodded by this website.
- - _ .r
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
MoclkrAlle, NC 27028
(336)751-8760
Account #: 990001750
Billed To: Southland Construction, Inc.
Reference Name:
Proposed Facility Residence
ATC Number: 4121
Tax PIN/EH #: 5768-11-7768.17
Subdivision Info: Heritage Oaks 1 Lot # 17
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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: xLz Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of
has been installed in cow
Disposal Systems," but shall i
given period of time. _
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
shall indicate the system described on Improvement/Operation Permit
11 of . Chapter 130A, Section .1900 "Sewage Treatment and
uarantee that the system will function satisfactorily for any
T—
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 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 #:
5768-11-7768.17
Subdivision Info:
Heritage Oaks 1 Lot # 17
Location/Address:
N Hazelwood -27028
Property Size: see map
ATC Number: 4121
**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_
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) Site: Newtf� Repair ❑
System Specifications: Tank Size 1,06�GAL. Pump Tank GAL. Trench WidthRock Depth Linear FtSdD
As stated in 15A :CAC 1814.199(5)
Other: cecepted Systems t'OY a1S0 :Pc u
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.****
!v
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
• � r V
v
PgrAT10
ITE EVALUATION/IMP110VE61ENT PERMIT & ATC
Ne'County Health Department
ronmental Health Section
x 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
I ***IMPOR'T'ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed Dwrfj I Owl L -C /q_, . Contact Person 252-007
p�/�-�
Mailing Address _ -373 Wott �GiAA%!^ �7�1/�` Home Phone 330- /2U�,2-n0 / nom,/
City/State/ZIP _ Lwf en /V 1. /�►Y-+ Business Phone Z? -2 cu V 1 • y
2. Hams on Permit/ATC if Different than Above
Mailing Address ;ly /Sta/Zip3. Application For: ❑ Site Evaluation mprovte ement Permit/ATC ❑ Both
4. System to service: (� house ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
S. Type system requested: Conventional ❑ conventional modified ❑ innovative
X -1;(
6. If Residence: # People �- 5 # Bedrooms 3 # Bathrooms
*nhviasher ❑Darbage Disposal Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type # People # Sinks
# Commodas
# Showers
# Urinals
# Water Coolers
IF FOODSERVICE: #i�Seats Estimated Water Usage (gallons par day)
8. Type of water supply: L)Q County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNO
If yes, what type?
***IMPORTANT*** CLIENTS AI UST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLATU
or SITE PLAN AIUST BESUBA•11TTED by the client with THIS APPLICATION.
Property Dimensions: 163 ria 6 g 1VRITh DIRECTIONS (frons Mocksville) to PROPER'T'Y:
Tax Office PIN: it 6ATa776r
Property Address: Road Name IV440d
City/Zip
If in a Subdivision vide information, as follows:
Name: Meth
,�`N/
Section: L Block: Lot:
ow •6�0 �.. Tli ,nig h�,e�p at,r�
6h0 qv -7e
,aV a1 Sf&t T/t m 111��1004
W!� u6WA-4k-
Date home corners flagged: i7 S
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter arc 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 tarespfor all charges incurred from
this application. I, liereby, give consent to the Autliorized Represc itati IIeal1�iartmet
to enter upon above described property located in Davie County and oto conduct all test' ig pi cedures as necessary to determine the si uit
DATE S SIGNATU
TIIIS AREA MAY BE USED ICOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, sctac cs, . septic locations).
Sign given
Revised DCIID (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No. (
Invoice No.�/
jW4kT!
' DAVIE COUNTY HEALTH DEPARTMENT J
Environmental Health Section 7
- Soil/Site Evaluation
NAME
l'
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Water Supply: On -Site Well _ Community
Public
Evaluation By: Auger Boring Pit L'_�' Cut
FACTORS 1 2 3 4
Landscape position
Sloe
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogX
HORIZON II DEPTH /d
Texture groupC_-
Consistence
Structure
44 -
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 �c
SITE CLASSIFICATION: Ps
t
LONG-TERM ACCEPTANCE RATE:
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- 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
Mineralozy
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 watef 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