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149 North Hazelwood Drive Lot 12Davie County. IVC Tax Parcel Renort 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 IS NOT A SURVEY Parcel Information J7080B0012 Township: Fulton 5768114289 Municipality: CORNATZER 82523432 Census Tract: 37059-804 BURNS RICHARD C Voting Precinct: FULTON 149 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC 27028-7164 LOT 12 HERITAGE OAKS PHASE ONE 0.67 10/2004 005760397 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 hiF 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 FDavfte 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. 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: M, I Tax PIN/EH #: 5768-11-4289 Subdivision Info: Heritage Oaks sec. 1 Lot # 12 Location/Address: N.Hazelwood Lane - Proposed Facility: Residence Property Size: 140 x 217 ATC Number: 2981 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 WASTE N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: —j-t2who i 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. %14 t_��ES ISO �3t;'%�IZ1% S t r &T -i-- j Ft Liu/2, `rA-N le- -:1>o x--12 Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) �An QDamjo �%49riC 0 )L Date: �� 1� �– Z •4O DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001750 Tax PIN/EH #: 5768-11-4289 Billed To: Southland Construction, Inc. Subdivision Info: Heritage Oaks sec. 1 Lot # 12 Reference Name: Location/Address: N.Hazelwood Lane - Proposed Facility: Residence Property Size: 140 x 217 ATC Number: 2981 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of aseptic 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 ot7z�c #People #Bedrooms 3 #Baths 2 I Dishwasher: GR`� Garbage Disposal: ❑ Washing Machine: L2r,", Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 14fi �2 t'7 I Type Water Supply pit' Design Wastewater Flow (GPD) 3000 Site: New 121"" Repair ❑ 1t to System Specifications: Tank Size1000 GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. � Other: I '0131b boll o t) t�� If-ISIulAe.s 9,04. t,&1r4 Required Site Modifications/Conditions: 1,,) -,TALL &-� co'JI-Ooa,, kr�- ow- 1400Sc_ veep 0 01:r_ PLOP 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 ,ystem between 8:3 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.**** TFIS 10-2L C. Unit l ►t) XN� rac)p L1r-ty flZ lamial Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ,XE LteJ6— rJC� L 00 �TrP�O�r1S f rJ��r,� lel v,��.u2 Date: to i2 fl APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC e I Davie County Health Department OCT 9 �6J� Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336) 751-8760 DAVIE COUN?Y ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVID ] . Refer to the INFORMATION BULLETIN for Anstruq4onp. 1. Name to be Billed Contact Person Mailing Address t % a ( Home Phone City/State/ZIP q !L 1'7d- Business Phone l&k 2. Name on Permit/ATC if Different than Mailing Address 3. Application For: ❑ Site Evaluation 4. System to Service: House ❑ Mobile Home 5. If Residence: # People`- Dishwasher EJGarbage 1 6. If Business/Industry/Other: # Commodes Ci /State/Zip provement Permit/ATC II Both) I Business n Industry II Other # Bedrooms # Bathrooms sposal <Washing Machine Specify type # Showers 11 Basement/Plumbing II Basement -/No Plumbing # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well 11 Community .ate 8. Do you anticipate additions or expansions of the facility this system is intended to serve? I-1 Yes No If yes, what type? ***Id1P0RTANT*** CLIENTS MUSTCOMPLCTETHE RCQUlRCD PROPERTY INFORMA'T'ION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUSTBCSUBMITTED by the client with THIS APPLICATION. Property Dimensions: 140 Y t 17 Tax Office PIN: # 5 -7(, Property Address: Road Name IV HdzCli,tadLi City/Zip If in a Subdivi ion provide information, as follows: Name: Section: I Block: Lot: %? WRITE DIRECI'IONS (fro 1 Mock sville) to 1'ltO1'Elt'1'1': 'IiA 64 - alb ,fi` 7/L -1w 07/ tylk .2 01 Date Property Flagged: 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 that I am responsible fur till charges incurred front this application. I, hereby, give consent to the Authorized Representative of the Davi rounty Ilealth Department to enter upon above d cri d property located in Davie County and owns to conduct all testing roc/dures as necessary to determine the site �J DATE V SIGNATU4 0" THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inc u� of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge atc(s): �t J I it Notification Date: 1 yf Account No. Invoice No. 5 lot r0. gtI* oars - Phan I N /F riLLiAM A. BURNETTE 3877 3 DB. 187, PG. 426' 373 &)"%wh( N 0202852 W • . 1028.39' 131.63'170.5' 127.58' 63.28' 1 WOODS LOT 11 LQT LOT 14 r LOT p LOT , 1 Cr. CN t r `T1 0. UTILITY . EA. SEMENT 14 2 1, 513 x (y QQ Ar 131.43' -- t�.�_ 131.43;-- --- 127_38'_ w w_ .. --- - 1�T . 00'43'3C .__E- . -- 582:91' .._. _.. _... _. ��. .�.. 202'.._ __ _ _ 150.75' -'- -- 1.55' -- --4- - - --- - --- R -Z-,x �;.. LOT __21 .. o WOODS LOT 20 1 (-)T 1 Q `, , NAMEn ADDRESS PROPOSED FACIILTY DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation DATE EVALUATED PROPERTY SIZE�� LOCATION OF SITE #/2 Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 Landscape position L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence i Structure C— 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: DCHD(01-901 EVALUATED BY:/X OTHER(S) PRESENT: LEGEND Landscape Position R -Ridge S. -Shoulder L -Linear slope FS -Foot slope N -Nose slope CC -Concave clone CV -Convex sloae 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 Mineraloty 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