163 South Hazelwood Drive Lot 29fl
Davie Countv. NC
Tax PnrrPl RPnnrt
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:
Land Value:
Total Assessed Value:
WARNING:THIS 1S NUT A SURVEY
Parcel Information
J7080B0029
Township:
Fulton
5768206998
Municipality:
8302773
Census Tract:
37059-804
MCKENNEY MICHELLE ANN
Voting Precinct:
FULTON
163 SOUTH HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
NC
Zoning Overlay:
27028
Voluntary Ag. District:
No
LOT 29 HERITAGE OAKS PHASE 3
Fire Response District:
FORK
0.68
Elementary School Zone:
CORNATZER
11/2013
Middle School Zone:
WILLIAM ELLIS
009430341
Soil Types:
GnB2
0008
Flood Zone:
334
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
9rtA All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the f
Davie County, implied warranties of merchantability or Mness for a particular use. All users of Davie County's GIS websHe shall hold harmless the I
County of Davie, North Carolina, Its agents consultants, contractors or employees from any and all claims or causes of action due to
�ovrti NC or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
OPERATION PERMIT
Account M 990004086 Tax PIN/EH #: 5768-20-6998.29
Billed To: Glenn Hughes Subdivision Info: Heritage Oaks 3 Lot # 29
Reference Name: Location/Address: S. Hazelwood Dr. -27028
Proposed Facility: Residence Property Size: 12x250
ATC Number: 4570
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. 0 -/
System Type: S.T. Manufacturer Tank Date Tank
Size
Pump Tank Size
System Installed By: 9-34 00` E.H. Specialist: a Date:,(�A--v
DCHD 11/06 (Revised)
w
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990004086
Billed To: Glenn Hughes
Reference Name:
Proposed Facility: Residence
ATC Number: 4570
Tax PIN/EH #: 5768-20-6998.29
Subdivision Info: Heritage Oaks 3 Lot # 29
Location/Address: S. Hazelwood Dr. -27028
Property Size: 12x250
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD FIVE YEARS. This ATC is subject to revocation if site plans, plat or
the intended use change.
Residential Specification: Building Type,'jFJ6,,,-- #People q #Bedrooms 3 #Baths�'-)-
Basement w/Plumbing: _ Basement/No Plumbing
Commercial Specification: Facility Type #People #People/Shift #Seats
Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: New Repair
System Specifications: Tank Size II oo oGAL. Pump Tank _ GAL. Trench Width 34" Trench Depth 34'
Rock Depth_tXL Linear Ft. yo L) u �H
DAM;
sta cd in 35.A NCAC
Required Site Modifications/Conditions: As na <•„6f�-,C _ r.,�.,
Contact the Davie County Environmental Health 5ectton for final i ”"
8:30 — 9:30a.m. on the day of installation. Telephone # (:
,
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hcu ii5O
of this system between
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1
,74-5
Environmental Health
DCHD 11/06 (Revised)
y
l9 Q 7
SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
rovement Permit ❑ Authorization To Construct(ATC) /Both
]Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***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 C c.£w f-�, a. t(Qc.gtc.s Contact PersonC �,c,v a (�rtr5
Billing Address - 339 Siakoy LASE Home Phone Vo<t - -3Zo
City/State/ZIP Business Phone fix.- -764i-175'2
Cgs
Name on Permit/ATC if Different than Above
Mailing Address -N.&
PROPERTY INFORMATION
*Date House/Facility Corners
.Q
NOTE: A survey plat or site plan must accompany this application. Included:t.2'5ite Plancig'Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name e--cr.:o;,, A-►ZocytcS cc Phone Number. 4o cr- 5-52a
Owner's Address :53q 5 -44r),1 um.+G City/State/Zip 4j s :ic_ X-7io-7
Property Address 5,; j-rjk 14h--aeLLt ex:, � City 2.lpaR ;,,e cks:,XZZr.
Lot Size JgLo x -2-VO Tax PIN#rj 7toW a-(ogQK
Subdivision Name(if applicable) jjrca- etc, -c cgkSSection`/Lot#_ 2'/
Directions o Site: Gy Er45 r // - /Itre2�xc t «;!� c(p� G 7Ue<,t2/(L�JCi/I A)
N
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,HNo
Does the site contain jurisdictional wetlands? []Yes 2No
Are there any easements or right-of-ways on the site? ❑Yes P No
Is the site subject to approval by another public agency? ❑Yes 010
Will wastewater other than domestic sewage be generated? ❑Yes QNo
IF RESIDENCE FILL OUT THE BOX BELOW
# People I/ # Bedrooms 3 # Bathrooms ;L Garden Tub/WhirlpoolAes ❑No
Basement: ❑Yes �No Basement Plumbing: ❑Yes 2flo
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/BusinessTotal Square Footage of Building ,1 #People _
# Sinks # Commodes 1� # Showers Xi1,4 # Urinals ( A
Estimated Water Usage (gallons per day) ./ (Attach documentation of similar actlity water consumption)
FOODSERVICE ONLY: # Seats
Type system requested:,❑Conventional ❑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 X No
If yes, what type?
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 hereby grant right of entry to the Authorized Representative
of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules.
I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging
or staking the hguse/facility location, proposed well location and the location of any other amenities.
/l Site Revisit Charge
Property owner's or owner's legal representative signature
Date(s):
/._ 4Z... 0-7 Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account # 4d
Revised 11/06 Invoice #
�Vulkes
+ er140L�e �,�5 -T�F La��2`�
06
I p�5 &
. I • 3DAVIE COUNTY HEALTH DEPARTMEN c,�y
Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED��
PROPERTY SIZE
LOCATION OF SITE Lam"
Water Supply: On -Site Well _ Community /
/ Public J
Evaluation By: Auger Boring Pit L/ Cut
FACTORS 1 2 3 4
Landscape position L_
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
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: !/
LANG -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
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 wateP 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