169 Hazelwood Drive Lot 14Davie County NC , _ t
Tarr Part -PI R Pnnrt
Tuesday, January 10, 20,17
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:
WARNILN is TMS IS INU'1' A JUKVEY
Parcel Information
J7080B0014
Township:
Fulton
5768114586
Municipality:
CORNATZER
82522785
Census Tract:
37059-804
RAINEY CHAD
Voting Precinct:
FULTON
169 HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
MOCKSVILLE
Zoning Class: DAVIE
COUNTY R-20
Land Value:
Total Assessed Value:
NC
27028-0000
LOT 14 HERITAGE OAKS PHASE ONE
0.68
5/2004
005520926
0007
005
Zoning Overlay:
Voluntary Ag. District:
No
Fire Response District:
FORK
Elementary School Zone:
CORNATZER
Middle School Zone:
WILLIAM ELLIS
Soil Types:
Gn132,GnC2
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
9 hwy.�A 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 or fdness 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
nQ UNC NC or arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Sectioncn 6
1
< P. O. Boz 848/210 Hospital Street /x.2 V / ✓ U
Mocksville, NC 27028 7
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002859 Tax PIN/EH #: 5768-11-4586
Billed To: Titan Homes Subdivision Info: Heritage Oaks Lot # 14
Reference Name: Location/Address: Hazelwood -27028
Proposed Facility: Residence Property Size: see map
* * NO+F*NF0ffiprA?n%nt/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 #People V #Bedrooms 3 #Baths 2 ' S
Dishwasher Garbage Disposal: ❑ Washing Machine;. Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply CD Design Wastewater Flow (GPD) 6 d Site: New)6 Repair ❑
System Specifications: Tank Size f°U o GAL. Pump Tank GAL. Trench Width 3 6 Rock Depth/-)-" Linear Ft.3 o
Other:
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.****
Environmental Health Specialist's Signature: Date:
7—/'4-7— 10-3
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Bog 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002859 Tax PIN/EH #: 5768-11-4586
Billed To: Titan Homes Subdivision Info: Heritage Oaks Lot # 14
Reference Name: Location/Address: Hazelwood -27028
ATC Number: 3526
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 CO ST CTIO IS VALID FOR A PERIOD OF FIVE 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 I 1 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.
1v
Septic System Installed By: �r/ �'� / / l�
Ys
P )J)te`
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
015 vat, e, I4�
APPLICATION FOR SITE EVALUATI0N/IMPI10VBIE1%JT PERMIT
Davie County Health Department 2003
EnvironinentaiHeaith section JUL 2 9
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760 ENVIRpA�f(',&I-Il LTH
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TIIE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed
-�
� /-f"PI✓ �/�'��-S
Contact Person /I'I�P I ��
cTR r ✓�S
Mailing Address
T37 5 S TyERS FE/t(?t� /a
�
bA ,0 Home Phone
Bedrooms
City/State/ZIP
IJJ) ✓S 7y- 3Nte-A, /y, (-
71 b7 Business Phone S I t_ZSs9
1 -
2. Name on Permit/ATC
if Different than Above
It Sinks
# Commodes It Showers
Mailing Address
It WaLer Coolers
City/State/Zip
8. Type of water supply: A County/City
3. Application For:
❑ Site Evaluation
49, Improvement Permit/ATC
Oftoth
4. system to servicer House ❑ Mobile Home
❑ Business ❑ Industry ❑ Other
5. Type system requested: #N Conventional ❑ conventional modified ❑
innovaL-ive
3
7's
6. If Residence: It People_ #
Bedrooms
It Bathrooms
(Dishwasher []Garbage Disposal /Washing Machine
❑Basement/Plumbing
❑Basement/No Plumbing
7. If Business/Industry /Other: verify type
It People
It Sinks
# Commodes It Showers
It Urinals
It WaLer Coolers
IF FOODSERVICE: t# Seats Estimated Water Usage (gallons per day)
8. Type of water supply: A County/City
❑ Well
❑ Community
9. Do you anticipate additions or expaIIsions of the facility this systeni is in(ended to serve? ❑ Yes KNo
If yes, what type?
***IMPORTANT*** CLIENTS r1IUST COAIPLETETIIE REQUIRED PROPERTY INFORMATION REQ1JESTE'D
BELOW. Either a PLAT or SITE PLAN AIUST BESUBAfITTED by the client with'1111S APPLICATION.
Property Dimensions:
iI I )L 7..-2.-5' X X32-�-z3 Z
Tax Office PIN: # 57.6 S ! / YS0
Io�--#ly
Property Address: Road Namc !6 9 6,i zc utwvd p •
City/zip /�tG►cks y, c L�
If in a Subdivision provide information, as follows:
wizrrE DIRECTIONS (Il•om Mudisville) to PROPER Y:
�i✓'t � �' Fi.� s T � �F7"
Namc: 11FIC I rA 6'- DA ICS
Section: Block: Lot: Date home corners flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any pm•mit(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 tint responsible for all charges inctin-ed from
this application. I, hereby, give consent to the Authorized Representative of the Davie Comity Ifcaltli Departmicmt
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE SIGNATURE, Ay.
,A& Ali III/JZ1 :001
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).
Sign given
Revised DC11D (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EIIS:
Account No.5 /
Invoice No. �j
DAVIE COUNTY HEALTH DEPARTMENT70
• Environmental Health Section
Soil/Site Evaluation
NAME
ADDRESS
PROPOSED FACIILTY
Water Supply: On -Site Well
Evaluation By: Auger Boring
DATE EVALUATED Z
PROPERTY SIZE
LOCATION OF SITE �11�
Community
Pit C.;'�
FACTORS 1 2 3 4
Landscape position =L
Sloe %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH v?)
Texture group
Consistence r
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:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD(01-901
Public
Cut
EVALUATED BY:qC�Z
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
5C -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
(D
00
Ca
Ca
(9
(D
I -
(D
m
m
W
ff
In
0
Z
Q
J
W
J
J
Q
a
Ir
tl
Q
CD
m
G
m
N
1
LO
N
2
x
M GRAPHIC SCALE I
x o Lew ao a Fm NOTE -
SURVEYOR HAS NAZE NO INVESTIGATION OR IIIDEPENCfENT SEARCH FOR
EASEMENTS t3F' RECORD, tNCUHBRANCES, RESTRICTIVE lCOVENARIS,
OWNERSHIP, TITLE EVIDENCE, OR ANY OTHER FACTS THAT AN ACCLARATE
{ IN MT) AND CLN-RENT TITLE SEARCH MAY DISCLOSE, THIS Z4EY IS PEWORMED
l I Inch - 30 TL WITHOUI THE EENEFIT DF A TITLE SEARCH. 1
NOTICE:
MARK JARVIS HAS VERIFIED TO ALLIED LAND SURVEYING C[wANY,
P.A. THE EXTERIOR IIJSE DIMENSIONS FOR THIS EXISTING
HOUSE/STRUCTURE. HOUSE POINTS AND POSITDON SHDVN ON THIS NAF
REPRESENT THE POINTS TO BE PLACED ON THE PROPER7Y. THE
OVNER/CONTRACTOR RAS REVIEWED ALL HOUSE/STRUCTURE
DIHENSKINS, SETBACKS FROM PROPERTY LILIES, AND COMPLIANCE WITH
RESTRICTIVE COVENANTS AND/IIR LOCAL GOVERNMENTAL
REQUIREMENTS ON THIS DRAWING AND BY THEIR SIGNATURE
AUTHORIZES ALLIED LAND SLARVEYING COHPANY• P.A. TO PLACE THE
POINTS AS ACCURATELY AS IS REASONABLE (TYPICALLY 0r02.".
OVNER/CONTRACTOR TO VERIFY THE PLACENIENT OF POINTS SET IN
FIELD PRIOR TD AUTHORIZATION OF FOOTINGS/BRICK MASONS/
CONSTRUCTION TO PROCEED. BY SIGNING THIS' STATENENT tTWIJ'c.R/
CONTRACTOR FULLY ACCEPTS THEIR RESPONSIBILITY TO VERIFY
POINTS IN FIELD. THE HOUSE POINTS DENOTED -BY SOLID FILLED
CIRCLES ARE THE ONLY POINTS TO BE LUCATED IN THE FIELD. ALL
OTHER BUILDING CORNER LOCATIONS ARE TO BE THE RESPONSIBILITY
OF THE UNDERSIGNED CONTRACTOR/DEVELOPER. 1
ACKNDVLEDGNEtTTi _ DATE, _
O t /C R
FIELD REVISION- --------- ---------------- DATE- ________
DVNER/COt4TRACTOR/ALL)ED STAFF
PRELIMINARY LAYOUT
SOT 14 -
HERITAGE OAKS
PHASE ONE
Plat for, Mark Jarwls
ALS PROJECT ND 9397
NOTE:
THIS PLAT DOES NOT REPRESEtiT A CURRENT F1EID SURVEY. ALL LOT
DI4ENSIONS HAVE BEEN TAKEN FROM THE PLAT OF HERITAGC OAKS,
PHASE is LOCATED DI PLAT BOOK 7 PUCE S. AS RECORDED JULY 1997.
NO TITLE RESEARCH HAS BEEN PERFORMED OR REQUESTED fOR THE
BENEFIT OF THIS PLAT,
Allied Land Surveying Co., P.A.
47L3 KESTER MILL ROAD =ryea hy-
WOtST.IONS,+LrNf,NORTH CAROL INA 27MG - Pro.n 2;, XH
Phune: (336)765.2377 %% Fax: {136)760 -06Th P,.Jrct He. 9591
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