155 South Hazelwood Drive Lot 28Davie County, NC I r
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Tax Parcel Report
Tuesday, January 10, 2017
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Oi wtt 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 ortitness 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
noUty�C
NC or arising out of the use or Inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number.
J7080B0028
Township:
Fulton
NCPIN Number:
5768205989
Municipality:
Account Number:
82532105
Census Tract:
37059-804
Listed Owner 1:
STEWART RICHARD G II
Voting Precinct:
FULTON
Mailing Address 1:
155 SOUTH HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 28 HERITAGE OAKS PHASE 3
Fire Response District:
FORK
Assessed Acreage:
0.68
Elementary School Zone:
CORNATZER
Deed Date:
7/2010
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
008310469
Soil Types:
GnI32
Plat Book:
0008
Flood Zone:
Plat Page:
334
Watershed Overlay:
DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
Oi wtt 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 ortitness 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
noUty�C
NC 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. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990004069 Tax PIN/EH #: 5768-20-3337.28
Billed To: Micah Stauffer Subdivision Info: Heritage Oaks Phase 3 Lot # 28
Reference Name: Location/Address: S. Hazelwood Dr. -27028
Proposed Facility: Residence Property Size: 3/4 ac.
ATC Number: 4477
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: Z" l Date:
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. z Sa
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Septic System Installed By: blah n USS eV
Environmental Health Specialist's Signa Date: 7, 0'S'0 4
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Q `6
V1
IMPROVEMENT/OPERATION PERMIT
Account #: 990004069 Tax PIN/EH #: 5768-20-3337.28
Billed To: Micah Stauffer Subdivision Info: Heritage Oaks Phase 3 Lot # 28
Reference Name:
Proposed Facility: Residence
Location/Address: S. Hazelwood Dr. -27028
Property Size: 3/4 ac.
ATC Number: 4477
**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 CO TOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type #People #Bedrooms c_?— #Baths
Dishwasher: Garbage Disposal: 121"' Washing Machine: K— Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply 1/0,
Design Wastewater Flow (GPD) r�-�t'3 Site: New 0`* Repair ❑
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System Specifications: Tank Size�%�AL. Pump Tank GAL. Trench Width Rock Depth a 0 Linear F&:De
Other: As stated in 15A NeAe 40A 40r,011;1
accepted Systems may also be use
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.****
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Environmental Health Specialist's Signature: /�l Date:
DCHD 05/99 (Revised)
2006
, AUG T 4 _
�tVIRO�M��FL HEALTH
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SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
Permit R'Authorization To Construct(ATC) ❑ Both
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed / v 1 t GA 0 S -MO FF eiL Contact Person ALA[) STAO FFEdI-
Billing Address 986 [LA v&tv.6w lZ n Home Phone _S36-109- 6S9 y
City/State/ZIP L&x tnn `ro+j , /y C 7-1 Li 7_ Business Phone AI/A-
J
Name on Permit/ATC if Different than Above Al lA
Mailing Address City/State/Zip
PROPERTY INFORMATION
NOTE: A survey plat or site plan must accompany this application.
(Permit is valid for 60 months with site plan, no expiration with complete plat.) x
Street Address ISS S. HAz6Lwoo,p �dLw& CityMoc_IISv1(.C� Tax PIN# ✓ 0 ZO 3337
Subdivision Name H yLi'rAG 6 0,%4s Section/Lot# Z$ Lot Size
Directions To Site: 6kF-,,-r�T ,g4zt-TAGS OAX5 fir QivnT12 670 S?,V ONT'o S 4AzEcwoo,O AL
_
Date House/Facility Corners Flagged SL/z16G
If the answer to any of the following questions is "yes", supporting documentation must be attached.
Are there any existing wastewater systems on the site?
❑Yes G+Ko
Does the site contain jurisdictional wetlands?
Dyes �o
Are there any easements or right-of-ways on the site?
Dyes PKo
Is the site subject to approval by another public agency?
❑Yes Colo
Will wastewater other than domestic sewage be generated?
Dyes LKo
IF RF,SIDF,NCE FILL OUT THE BOX BELOW
# People # Bedrooms 3 # Bathrooms Z, Garden Tub/Whirlpool es ❑No
Basement: Dyes CRo Basement Plumbing: ❑Yes 8'l_
IF NON-RESTDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested: [4 onventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: County/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes
If yes, what type?
M-!
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that
any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if
the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred
from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to
conduct necessary inspections too getermine compliance with applicable laws and rules on the above described property located in
Davie County and owned by /V I ICA N 5T -AU f FOUL
A --A ).
Property owner's or er's legal rep sentative signature
shoC
Date �---t
Sign given Dyes ❑No
Revised 2/06
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account #0�9
Invoice #
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336-y�j -659 y
s DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section )pC/3
Soil/Site Evaluation
NAME
ADDRESS J
PROPOSED FACIILTY juG9
Water Supply: On -Site Well
Community
Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1 2 3 4
DATE EVALUATED ze�
el
C�
PROPERTY SIZE
Texture group
LOCATION OF SITE-��
Structure
Community
Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1 2 3 4
Landscape position
el
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
40_e
Texture group
45 -
Consistence 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
,t
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD(01-901
EVALUATED BY: Wil/
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
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