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131 North Hazelwood Drive Lot 10Davie 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: WARNING: THIS 1S NOTA SURVEY Parcel Information J7080B0010 Township: Fulton 5768115001 Municipality: 82523852 Census Tract: 37059-804 COHEN EVAN D Voting Precinct: FULTON 131 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC 27028-0000 LOT 10 HERITAGE OAKS PHASE ONE 0.68 1/2005 005890476 0007 005 Zoning Overlay: Voluntary Ag. District: No Fire Response District: FORK Elementary School Zone: CORNATZER Middle School Zone: WILLIAM ELLIS Soil Types: Gn132 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: 9[t� Davie County, All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the II! O U N NC I County of Davie, 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 provided by this website. I • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003285 Tax PIN/EH #: 5768-11-5001 Billed To: Jarvis -Kennedy Custom Homes,LLC Subdivision Info: Heritage Oaks Lot # 10 Reference Name: Proposed Facility Residence Location/Address: Hazelwood Drive -27028 Property Size: see map ATC Number: 3812 **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 I 1 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: RT" Garbage Disposal: ❑ Washing Machine: -2T Basement w/Plumbingle Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _ Design Wastewater Flow (GPD) 710) Site: New 0 Repair ❑ System Specifications: Tank Size ft GAL. Pump Tank GAL. Trench Width,?/ Rock Depth Linear Ft 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.jpn�he day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date:�� DCHD 05/99 (Revised) NAME ADDRESS PROPOSED FACIILTY r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation =I- DATE EVALUATED PROPERTY SIZE Z�We LOCATION OF SITE G '/,e' - Water Supply: On -Site Well _ Community Public !/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 1 Texture group ellG Consistence Structure Mineralogy/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFI ATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 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 -Finn 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 Account #: Billed To: Reference Name: Proposed Facility f4 7-13'Oy DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 990003285 Tax PIN/EH #: 5768-11-5001 Jarvis -Kennedy Custom Homes,LLC Subdivision Info: Heritage Oaks Lot # 10 Location/Address: Hazelwood Drive -27028 Residence Property Size: see map ATC Number: 3812 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 CONST UCTI N IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 7)2/d� 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 icle 1 0 S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in N WA t as uarantee that the system will function satisfactorily for any given period of time. � g Septic System Installed By: 1 '— Environmental Health Specialist's Signature :c / Date::) I' t DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnvironmentalHeaith Section 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 Ja�w.S `le, -,,-,i 6,s -i.. DSS L.L6 Contact Person t"/A0,1:w's Mailing Address 937S ,S}yc s E-1 1.7 Q Home Phone 336 `2/S 66 3 City/State/ZIP 4J:�S{�. Sa t..r. � /\L a11o� Business Phone c a'S'r 336 39 q 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. system to Service: /`❑ House 11Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: X Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms Dishwasher ❑Garbage Disposal Washing Machine ,Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # Commodes # Showers IF FOODSERVICE: # Seats 8. Type of water supply: County/City # Urinals # People # Sinks # Water Coolers Estimated Water Usage (gallons per day) ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes, what type? ***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: W X ;.i `i x1111T;r 041 Tax Office PIN: #14,966 11 5 OO l 131 ) tt Property Address: Road Name 1142 e,� &v:S d Ur City/Zip in'((� r If in a Subdivision provide information, as follows: Name: L1 en'4.3L OAks Section: ! Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 81,40"; Rill —T �•� �►, l � -6 11 si a�rrc1 �- I.,/�e 1-d1:1tit i ►,�� -Sy- I Date home corners flagged: 6 t This is to certify that the information provided is correct to the best of my.knowledge. I understand that any permits) 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 :) kv ti ^a to conduct all testing procedures as necessary to determine the site suitability. DATE �I I SIGNATURE IL" �"" '`^"` L "��c^ "��-�, �,►ws THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include al the following isting and proposed property lines and dimensions, struclsetbacks, and septic locations). `I Sign given Revised DCHD (05/03 �> Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. '3 O s L/ - -7 �- Invoice No. � s=- �_-__ _f -_- =_ -�-- -`�-__ -.• ---_ _- -- --- --_' -_-_'-_.,.-_ -_-� � -_ _ - --_--- -- -_ ._ _- - -•--- _-_ _-__--_ =ice`--- _ _-'` -- - �-_ --_~ -_-_ - _. - ___ _____ _r --_--_ __ - --- _ --__ _ - - _ . _.- -- _� g- i 1 W .