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173 South Hazelwood Drive Lot 30Davie County, NC ' Tax Parcel Report Tuesday, January 10, 2017 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: J7080B0030 Township: Fulton NCPIN Number: 5768208937 Municipality: Account Number: 82527756 Census Tract: 37059-804 Listed Owner 1: MUELLER WILLIAM JOHN Voting Precinct: FULTON Mailing Address 1: 173 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 30 HERITAGE OAKS PHASE 3 Fire Response District: FORK Assessed Acreage: 0.69 Elementary School Zone: CORNATZER Deed Date: 3/2007 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 007031054 Soil Types: Gn132 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: �oU NisCounty Davie County, NCor All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to arising out of the use or Inability to use the GIS data provided by this webslte. Account #: 990004086 Billed To: Glenn Hughes Reference Name: Proposed Facility Residence ATC Number: 4488 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5768-20-3337.30 Subdivision Info: Heritage Oaks Phase 3 Lot # 30 Location/Address: S. Hazelwood Drive -27028 Property Size: 3/4 ac 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 CONS RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: /r//d 4 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. I 2 -75 t� 75 is ' No�s� �i) SN '� Septic System Instal ed B Environmental Health Specialist's Signature: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section (9 ' P. O. Boz 848/210 Hospital Street 3a1� Mocksville, NC 27028 �1 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990004086 Tax PIN/EH #: 5768-20-3337.30 Billed To: Glenn Hughes Subdivision Info: Heritage Oaks Phase 3 Lot # 30 Reference Name: Location/Address: S. Hazelwood Drive -27028 1-73 Proposed Facility Residence Property Size: 3/4 ac ATC Number: 4488 **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 CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type TiT #People #Bedrooms #Baths Z Dishwasher: Z Garbage Disposal: 0 Washing Machine: Basement w/Plumbing: 0 Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13 Lot Size Type Water Supply Design Wastewater Flow (GPD) :28 Site: New Repair 0 System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width �L�Rock Depth _,e2� Linear FVIC60 As statad in 15A NCAC 18A.1939(:E) accepted Systems may also be used 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.**** _6 Environmental Health Specialist's Signature: /� Date: �G DCHD 05/99 (Revised) r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC E C H U E Davie County Health Department DEnvironmental Health Section P.O. Box 848/210 Hospital Street AUG 2 4 2006 Mocksville, NC 27028 (336)751-8760/ Fa (336)751-8786 � TIV, TI�I HEALTH pplicatig%l�Ay1E�09?X� Evaluati provement Permit 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 C #4Contact Person S- qme. Billing Address (S .Q Home Phone V6 171""- 11057, City/State/ZIP iN d 27/ Business Phone 336 Name on Permit/ATC if Different than Above 5km p Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A surveyplat or site plan must accompany this application. (Permit is valid for 60 mon with site plan, no expiration wit complete plat.) Street Address �7) . City i /2. Tax PIN# 677(-^ 9 Z6-3 Subdivision Name KS PAOpctipn/Lot# X30 Lot Size 3 Directions To Site: !t<W V &LI C /7x15 Ll;o- 1! v iA6 A] IET4 Date House/Facility Corners,Flagged If the answer to any of the following questions is "yes", supporting documentatioust be attached. Are there any existing wastewater systems on the site? ❑Yes No Does the site contain jurisdictional wetlands? ❑Yes CTlo Are there any easements or right-of-ways on the site? []Yes C?No Is the site subject to approval by another public agency? ❑Yes E31qo Will wastewater othet than domestic sewage be generated? ❑Yes 2<0 IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms 155?— Garden Tub/Whirlpool es ❑No Basement: ❑Yes Basement Plumbing: ❑Yes ❑No 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: �nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ►nty/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 ----,-a - ny permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if te 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 to d nninec mplianc with applicable laws and rules on the above described property located in Davie County and owned bye/V AL Cp lfa�� 11 r� Site Revisit Charge Lperty owner's or owner's legat' presentative signature Date(s): ��• - (7 Client Notification Date: V Date 1 �r EHS: Sign given ❑Yes ❑No 1= Account # b� Revised 2/06 Invoice #7�I' A DAVIE COUNTY HEALTH DEPARTMEN Environmental Health Section 3 Iff90 Soil/Site Evaluation NAME% ADDRESS PROPOSED FACIILTY Water Supply: On -Site Well DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Community Public L-111 Evaluation By: Auger Boring Pit_41 / Cut FACTORS 1 2 3 4 Landscape position Sloe % !v HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence i Structure /r' 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 ic/ SITE CLASSIFICATION: EVALUATED BY: _/` lad `'f LONG-TERM ACCEPTANCE RATE: r 7' 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 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