183 South Hazelwood Drive Lot 31f
I
Davie County. NC
Tax ParrPl 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: 'PHIS IN NOTA SURVEY
Parcel Information
J7080B0031
Township:
Fulton
5768209985
Municipality:
GnB2
82529596
Census Tract:
37059-804
MCCULLOUGH JERRY E
Voting Precinct:
FULTON
183 SOUTH HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
NC
Zoning Overlay:
27028-0000
Voluntary Ag. District:
No
LOT 31 HERITAGE OAKS PHASE 3
Fire Response District:
FORK
Land Value:
Total Assessed Value:
1.38 Elementary School Zone:
CORNATZER
4/2008 Middle School Zone:
WILLIAM ELLIS
007560049 Soil Types:
GnB2
0008 Flood Zone:
334 Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
Davie County,
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
F-7
NC
County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to
or arising out of the use or Inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
' Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001750
Billed To: Southland Construction, Inc.
Reference Name: Larry Potts
ATC Number: 4384
Tax PIN/EH #: 5768-20-3337
Subdivision Info: 6rdog e-OaAs Loi* 31'32-
Location/Address: S. Hazelwood -27028 Ph lis 6:77ff
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 WASTEWATERCON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: /9' 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.
Joe - e4e-Z
Z
Septic System Installed By:
Environmental Health Specialist's Signature : //la(.t Date:
DCHD 05/99 (Revised)
I
DAVIE COUNTY HEALTH DEPARTMENT
f. Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT VVV
Account #: 990001750 Tax PIN/EH #: 5768-20-3337
Billed To: Southland Construction, Inc. Subdivision Info: 9 f6is-
Reference Name: Larry Potts Location/Address: S. Hazelwood -27028
Proposed Facility: Residence Property Size: 154x250
**NOTE *This Improveme4i t/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 f I #People cV,— #Bedrooms (3" #Baths
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 Design Wastewater Flow (GPD) yed Site: Nevof:5 Repair ❑
System Specifications: Tank Size,/ GAL. Pump Tank GAL. Trench Width.3G Rock Depth /.7`f Linear Ft: Oh
Other:
accepted Systems may also be use
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) 1176 "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.****
F
1.
l
Environmental Health Specialist's Signature: Date:
e-1 C�r l
DCHD 05/99 (Revised)
I
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
APR 2 4
Zp06 D
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
p 'Qid41 � Site E on/Improvement Permit ❑ Authorization To Construct(ATC) Both
DAVIE
r
**IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
NFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
HYrLIUAN I IN P OKMA I ION
Name to be Billed G Contact Person _allfy %m
Billing Address Home Phone X36.7 T7- 46471
City/State/ZIP Business Phone
(1u- .23a -a.:) $v
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION
NOTE: A survey plat or site plan must accompany this application.
(Permit is lid fo 60 Mont wit site p n, no expiration with complete plat.)
Street Address City 5e C, _Tax PIN# S7W Z3n7
Subdivision Name_hWiftl 0JJr5 Section/Lot#Lots 31-.31, Lot Size I SLXQ60'
Directions T�u ire: ,
(c �nfv l t',iC's - a40WIlkV41
Date House/Facility Corners Flagged (, N Wiy
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 VNo
Does the site contain jurisdictional wetlands?
❑Yes p'No
Are there any easements or right-of-ways on the site?
❑Yes VNO
Is the site subject to approval by another public agency?
❑YesyNo
Will wastewater other than domestic sewage be generated?
❑Yes YNo
IF RESIDCE FILL OUT THE BOX BELOW
# People A # Bedrooms -3 # Bathrooms AST Garden Tub/Whirlpool ❑Yes1No
Basement: ❑Yes 1No Basement Plumbing: Oyes M40
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:Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: Cyounty/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or
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
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 understand that 1 am responsible for all charges incurred
from this appC ion. I hereby gra t right o entry to the Authorized Representative of the Davie County Health Department to
D�a duct n essary in ectibons �� to ' e 1' with applicable laws and rules on the above described property located in
0 eer's legal representative signature
G �Date
Sign given ❑Yes RNo v
Revised 2/06
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account # I
Invoice # /
' 1
N.� LOT 29 w
• N
10' UTILITY EASEMENT
-
�o LOT 30�,`
N I CAL r-
r-
250.00 x..
1 . ' 31
/��1f". '1� vt ,�. - (,� �..� � �. Pte•
•oo
VIC;;.
f4 �,LOT
X
x
►.47'
�8'S9'� �• t
3'. TOTAL.'
LOT 29
_..250,006
10' UTILITY
EASEMENT*
o
LOT- 30
It
.250.
01,
1110c,
2 .0ob
!" ~' i,
4t
Ir
�PLQT
mono
9.47.! J.
3B'59
,3,. TOTAL..
DAVIE COUNTY HEALTH DEPARTMENT j
Environmental Health Section
• Soil/Site Evaluation
NAME 61Z44 u� �'1 DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY
LOCATION OF SITE
Water Supply: On -Site Well _ Community Public L�
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4
Landscape position
Sloe Z
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH o
Texture group,
Consistence i
Structure S >
Mineralogy, 1
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 r
SITE CLASSIFICATION:_
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
EVALUATED BY: &. 4
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 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 -Finn 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
Mi neraloey
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 watef 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
• V P
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME 11 Gt! Z&A X
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE
Water Supply:
On -Site Well
_ Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1
2 3 4
Landscape position L
2—
Sloe Z 4
Slope
61
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH <
.�
Texture groupG
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:
LONG-TERM ACCEPTANCE RATE: 1 `�
REMARKS:
DCHD(01-901
EVALUATED BY: Al" //
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- Vl::-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
Mi neraloey
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