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166 South Hazelwood Drive Lot 35Davie County, NC Tax Parcel Report Tuesday, January 10, 2017 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: J7080B0035 Township: Fulton NCPIN Number: 5768206682 Municipality: Account Number: 82529151 Census Tract: 37059-804 Listed Owner 1: LAUNZINGER DENNIS L Voting Precinct: FULTON Mailing Address 1: 166 SOUTH HAZELWOOD DR 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 35 HERITAGE OAKS PHASE 3 Fire Response District: FORK Assessed Acreage: 0.94 Elementary School Zone: CORNATZER Deed Date: 1/2008 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 007430438 Soil Types: GnB2 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: 9 Awlt� All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the e 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, tof the use Carolina, i its agents, a GIS ata r contractors by t or employees from any and all claims or causes of action due to Nl.. or arising out of the use or inability to use the GIS data provided by this website Account #: 990004086 Billed To: Glenn Hughes Reference Name: Proposed Facility: Residence ATC Number: 4740 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5768-20-6682 Subdivision Info: Heritage Oaks Phase 3 Lot # 35 Location/Address: S. Hazelwood Dr. -27028 Property Size: .938 **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. I d oc� System Type: S.T. Manufacturer l t Tank Date Tank Size r Pum Tank Size'' T System Installed By: �� E.H. Specialist: ,\a� ""��w Date: r 1 kz�� DCHD 11/06 (Revised) ~ DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 q0101 (336)751-8760 Fax #(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004086 Tax PIN/EH #: 5768-20-6682 Billed To: Glenn Hughes Subdivision Info: Heritage Oaks Phase 3 Lot # 35 Reference Name: Location/Address: S. Hazelwood Dr. -27028 Proposed Facility: Residence Property Size: .938 ATC Number: 4740 Site Type: ❑New ❑Repair ❑Expansion **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 OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms # People_ Basement❑ Basement plumbingO Non:Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size G • c13 Type of Water Supply: Pt ounty/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) C3 Tank Size Bou GAL. Pump Tank GAL. Trench Width 36 Max. Trench Depth 3 �� Rock Depth,/�� Lin ar Ft. � Site Modifications/Conditions/Other: As stated in 15A NCAC 18A.1969(5 A r_cerAnd Systems mai+ also bre use Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. /.T) 11/^n , JK 3o 5' Environmental Health Specialist-- ��/i/� �/ (_..�� Date: DCHD 11/06 (Revised) 0 i 0 3o 5' Environmental Health Specialist-- ��/i/� �/ (_..�� Date: DCHD 11/06 (Revised) SITE EVALUATION/IMPROVEMENT PERMIT & AT(( - i Davie County Environmental Health WW AUG 2 4 2007 P.O. Box 848/210 Hospital Street C Mocksville, NC 27028 ENVIPUTIENTAL I It-ALTH (336)751-8760/ Fax (336)751-8786 DAVIE COUi#'7 pp tca ton F or: u i eEvalua to mprovement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑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 ��9!/1'� �l �YJC�C ,> Contact Person S All) k Billing Address J,ge7v,&rJ, �i .A,61! _ Home Phone;1,54 City/State/ZIP /,y,.� Business Phone C��L Name on Permit/ATC if Different than Above, Mailing Address PROPERTY INFORMATION *Date House/Facility Corners Flagged $'24-01 NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name / C, 1? ' Phone Number 3.34'- �G 520 Owner's Address S Zcl 5/ - City/State/Zi.67/ 0 7 Property Address ' /'i Z—i MF g t (If ', v8AI "e -J3 x s�_ City.//Y�-mss V, LL•e! Lot Size �-S fi Qr_�Q Tax 1 �:� _f ,`709- 20- &&g7, Subdivision Name(if applicable) ? �h i'S' 4 Section/Lot# � Directions To Site: n ti -k & R: If the answer to an of following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? []Yes QNo Does the site contain jurisdictional wetlands? ❑Yes Ao Are there any easements or right-of-ways on the site? ❑Yes 04o Is the site subject to approval by another public agency? ❑Yes 01<o Will wastewater other than domestic sewage be generated? ❑Yes VKNo IF RFMDENCF. FILL OUT THE BOX BELOW # People # Bedrooms 3 # Bathrooms ✓( Garden Tub/Whirlpool es ❑No Basement: ❑Yes 21 o Basement Plumbing: ❑Yes E'flo IF NON -RESIDENCE 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:. dconventional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: O 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? SIKO 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 house/facility location, proposed well location and the location of any other amenities. ,��t�'/i✓ 7 a6, Site Revisit Charge Property owner's or owrg6ls legal representative signature Date Date(s). Client Notification Date: EHS: Sign given ❑Yes ❑No Account # L1096 Revised 11/06 Invoice # hi 7-/_ — DAVIE COUNTY HEALTH DEPARTMEN \ f . Environmental Health Section (� Soil/Site Evaluation -71 NAME Z / a ADDRESS Qq PROPOSED FACIILTY DATE EVALUATED 7'// -0 PROPERTY SIZE LOCATION OF SITE Gf�i Water Supply: On -Site Well _ Community Public /-' Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Ilk,L Consistence 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 i ", SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: .1 T REMARKS: DCHD (01-901 EVALUATED BY: F� 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 S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty clay 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 Mineralotty 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