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159 North Hazelwood Drive Lot 13Davie County. NC Tax Parry I R Pnnrt 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: WARNIN T: T1115 IS 1VUT A SURVEY Parcel Information J7080B0013 Township: Fulton 5768114483 Municipality: 82523191 Census Tract: 37059-804 BRAHIM EDRES Voting Precinct: FULTON 159 NORTH HAZELWOOD DRIVE Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC 27028-7164 LOT 13 HERITAGE OAKS PHASE ONE 0.68 8/2004 005650923 0007 005 Zoning Overlay: Voluntary Ag. District: No Fire Response District: FORK Elementary School Zone: CORNATZER Middle School Zone: WILLIAM ELLIS Soil Types: GnB2 Flood Zone: Watershed Overlay: DAVIE COUNTY Outbuilding 8t Extra Freatures Value: Total Market Value: F-9t.t�, Ag data Is prodded as Is without warranty or guarantee of any Idnd either expressed or Implied including but not limfted to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Dade County s GIS website shall hold haffnless the County of Dade, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to r'p UN.�'�` NC or arising out of the use or Inability to use the GIS data prodded by this website DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001750 Billed To: Southland Construction, Inc. Reference Name: Larry PottS Proposed Facility: Residence 114d- 4 ?,- o � Tax PIN/EH #: 5768-11-4483 Subdivision Info: Heritage Oaks Lot # 13 Location/Address: Hazelwood Lane -27028 Property Size: see map NC Ngvb?r: 2847 **N E** This mprovement/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 1 i V ose, #People #Bedrooms J #Baths 2— Dishwasher: 17"' Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size I3S �'- 22t /�� Type Water Supply l "rDesign Wastewater Flow (GPD) 3(CO Site: New Repair ❑ System Specifications: Tank SizeIC00 GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width 3[Z Rock Depth 12 Liar Ft Linear . M It,) . VMP l©t 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 8:30 a. . 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.**** 7©, ►.Sr- -A Z L 10 ,t',10 , Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: �s1,741d) P, - DAME COUNTY HEALTH DEPARTMENT . Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 - (336)751-8760 Account #: 990001750 Tax PIN/EH #: 5768-11-4483 Billed To: Southland Construction, Inc. Subdivision Info: Heritage Oaks Lot # 13 Reference Name: Larry PottS Location/Address: Hazelwood Lane -27028 Proposed Facility: Residence Property Size: see map ATC Number: 2847 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section,l. ewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT 01, TION VALID FOR A PERIODL10;E YEARS. Environmental Health Specialist's Signature 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. 3� y� 4>/So l 5. �3 �o �T l� Septic System Installed By: '6(2-r- � Qf Environmental Health Specialist's Signature: Date: 0 DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 1 MAY 15 2001 i L I ENVIRONMENTAL HEALTH ' DAVIEC0I1niry ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDW. Refer to the INFORMATION BULLETIN for. instrtdr-tions. 1. Name to be Billed ,/WWT11p/1Q( Lul —4-if—Contact Person Mailing Address 1 Home Phone City/State/ZIP;mq 7 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation 4. System to Service: '/ HOuse ❑ Mobile Home `- 9W 0336 Zace mo/ City/State/Zip RX 717— 56` Y V Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms 3 # Bathrooms X Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: Count /City ❑Well ❑Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes X90 If yes, what type? I***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITEr PLAN MUST BESUBMITTED by the client with THIS APPLICATION. J Property Dimension ��7J (� WRITE DIRECTIONS (fr Mocksville) to PR PEgTY: tyka Tax ce PIN: # �6o e �.yea? • �. {-- ,��/ — j n �.�i Property Address: Road Name /�( �� d %n� ! F! /f�' G1 City/zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: 4Z J-1jr ICU S! Qed l� f- ms7- 110- Aow of Date Property Flagged: 5" 1 al This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) 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 Pqvie County Health Department to enter upon abo dese 'bed property located in Davie County and o m to conduct all to g prXcedures as necessary to determine the sit _ DATE 51IJ SIGNA THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD J3 � ZS T9) (0la Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. t L Invoice No. / ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / Soil/Site Evaluation NAME l DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE 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 'f Texture group 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 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 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 Mineralo¢y 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 Z�r ti ,4u s�.e �".. * r.. y ��K:•� x '`R� ]� +. i`3' I.r�? �t 1�%� � i � <' _.' ` 'e` , :`� ;�,,, - .�'^" C `... , y, x. z�i �7 �e �•`S�� 4 r.. ) as {� 1 i -f .. �.�_ 'R t._M f < ' i 1 LOT 1 \ ; . 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