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143 South Hazelwood Drive Lot 27t Davie Countv. NC Tax Parcel Report Tuesday. January 10. 2017 233 75 1 115_ 125 133 143 ' 163 155 173 S I IAZt_L%'1vo0DDR ! --r w ' S FIA-[ L AJ0-7D DR i T 1 QC. WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: J7080B0027 Township: Fulton NCPIN Number: 5768214020 Municipality: Account Number: 8306910 Census Tract: 37059-804 Listed Owner 1: BRELIG WILLIAM D Voting Precinct: FULTON Mailing Address 1: 143 S HAZELWOOD DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: LOT 27 HERITAGE OAKS PHASE TWO Fire Response District: FORK Assessed Acreage: 0.68 Elementary School Zone: CORNATZER Deed Date: 9/2016 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 010300930 Soil Types: GnB2,GnC2 Plat Book: 0008 Flood Zone: Plat Page: 139 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: All data Is provided as is without warranty or guarantee of any kind 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 f'oD x.�4 NC or arising out of the use or Inability to use the GIS data provided by this website. r Account #: Billed To: Reference Name: Proposed Facility 990003441 Micah Stauffer Residence ATC Number: 3946 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5768-20-3337.27 MS (� 4s"— Heritage Oaks Lot # 27 / fr Hazelwood -27028 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 I VALID FOR A PERIOD OF FIVE YEARS. r Environmental Health Specialist's Signature: Date: h;v CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion sh in a system described on Improvement/Operation Permit has been installed in compliance with Article 11 f G. a er 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be t en a ar tee that the system will function satisfactorily for any given period of time. py Septic System Installed By: o /1 Environmental Health Specialist's Signature: / Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT + Environmental Health Section / J q' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990003441 Tax PIN/EH M 5768-20-3337.27 MS Billed To: Micah Stauffer Subdivision Info: Heritage Oaks Lot # 27 " Reference Name: Location/Address: Hazelwood -27028 TT_' Proposed Facility Residence Property Size: see map ATC Number: 3946 **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 C07OR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms',? #Baths Dishwasher Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machin Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPDO� Site: New Repair ❑ System Specifications: Tank Size ,&& GAL. Pump Tank GAL. Trench Width3�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: 0 .m. on the day of installation. Telephone # is (336)751-8760.**** II :ij Environmental Health Specialist's Signature: Date: &2 DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATI ON/lAlPROVEAl ENT PERMIT Davie County Health Department EnvironmentaiHeai i Section �`� 2 8 �Op4 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 <:NVIRpN (336) 751-8760IEEN>ALNfgLTy DAVfECDUNTY ***IMPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed / 1(,A 14 1 �>TAi) frex- Contact Person j(,dj4 '/>Tr ,L �(~F— Mailing Address Z -0-7`,1:L4 )Li AJ/ -i~ I , ,&- home Phone 3 7j- 6 -y / b 540 3 City/State/ZIP -Moltis m.c E , i✓C 7-731-0 "Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: E3 Site Evaluation tl-improvement Permit/ATC ❑ Both 4. System to Service: &--ff-ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: M -Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms 3 # Bathrooms Z-- Et5ishwasher ❑Garbago Disposal ashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business./Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats 8. Type of water supply: Nd' County/City Estimated Water Usage (gallons par day) ❑ Well ❑ Community 9. Do you anticipate additions or C%pallsiOns of the facility this system is intended to serve? ❑ Yes L -Vro If yes, what type? ***IMPORTANT*** CLIENTS MUST COBiPLETETHE IWQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST Br. SUBMITTED by the client ivitll THIS APPLICATION. Property Dimensions: I Z -0X L5 -o A tzo x LSo Tax Office PIN: 11 S16 6 Zvi 2531 Property Address: Road Name9-2—=1�J-0 01 Die. City/Zip If in a Subdivision provide itlfornlatioll, as follows: Nanic: N ee- ITA GE ©•4 KS Section: Block: Lot: z 7 WRITE DIRECTIONS (from A,locksville) to PROPERTY: Cil LEST 1 vT o.✓ Date Monne corners Ragged: This is to certify that the information provided is correct to the best of niy Iclloivledge. I understand that any perniit(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 oi• changed. I, also, understand that l ani responsible for all charges ince red 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 owlied by to conduct all testing procedures as necessary to determine the site suit ab' ity. DATE zed e 1114, SIGNATURE TRIS AREA MAY BE USED FOR DYOUR SITE PLAN (Include all o the following: Existing and proposed property lines and dimensioq:( ttlll` ,setbacks, and septic locations). SOW N a a -f- ZD -0 sign given teviscd DCI1D (05/03 Client Notification Date: EIIS: `/ Y / Account No.:;�- Invoice No. /� 54F G b -r Z,(O f, HF -ALT -P -OF--PT. 17-0.101 L -o -r 7-1 60� l 3o 0AzF-C_LOODD DekVF- O 0 N b (-5 AA,cpN 5T-A0FFErG y7g- 651 q f DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME /�G A Xvct� ADDRESS PROPOSED FACIILTY DATE EVALUATED Z/?S`Yl PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well _ Community, Public !� Evaluation By: Auger Boring Pit I Cut FACTORS 1 2 3 4 Landscape position 2— Slope Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 451 - Consistence Consistence r 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 c L SITE CLASSIFICATION: EVALUATED BY: LONG-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 'r—tol— 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 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 DCHD(01-901 rle." .,� .60 Voz I rdrw�a••rr� �� fig I 'oz �