186 South Hazelwood Drive Lot 33Davie County, NC Tax Parcel Report Tuesday. January 10. 2017
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
J7080B0033
Township:
Fulton
NCPIN Number:
5768209781
Municipality:
NCor
Account Number:
82533092
Census Tract:
37059-804
Listed Owner 1:
GRISWOLD STACI WHITE
Voting Precinct:
FULTON
Mailing Address 1:
186 SOUTH HAZELWOOD DRIVE
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028
Voluntary Ag. District:
No
Legal Description:
LOT 33 HERITAGE OAKS PHASE 3
Fire Response District:
FORK
Assessed Acreage:
0.73
Elementary School Zone:
CORNATZER
Deed Date:
12/2012
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
009110135
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:
9l�F
Davie County,
All data is provided as Is without warranty or guarantee of any Idnd either expressed or implied inchrding 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
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
NCor
arising out of the use or Inability to use the GIS data provided by this website.
" V"
Account #: 990004069
Billed To: Micah Stauffer
Reference Name:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5768-20-3337.33
Subdivision Info: Heritage Oaks Phase 3 Lot # 33
Location/Address: S. Hazelwood Dr. -27028 11S(a
Proposed Facility: Residence Property Size: 3/4 ac
ATC Number: 4478
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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVES YEARS.
Environmental Health Specialist's Signature: i/&/-! jDate:
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.
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Septic System Installed By:
Environmental Health Specialist's Signature: D
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028 u(p
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990004069 Tax PIN/EH #: 5768-20-3337.33
Billed To: Micah Stauffer Subdivision Info: Heritage Oaks Phase 3 Lot # 33
Reference Name: Location/Address: S. Hazelwood Dr. -27028 gio
Proposed Facility: Residence Property Size: 3/4 ac
ATC Number: 4478
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 CON CTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type #People #Bedrooms #Baths
Dishwasher: Garbage Disposal: Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13Lot Size Type Water Supply GO Design Wastewater Flow (GPD) LUo O Site: New 23`� Repair ❑
System Specifications: Tank Size (deo GAL. Pump Tank- GAL. Trench Width t2j�f'Rock Depth dQ 0 Linear FtjtV
Other:
As stated in 15A NCAC 18A.1969(5
Required Site Modifications/Conditions: cvcmited Svatemc may alsobe- us -ed
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: � �1/ Date:
DCHD 05/99 (Revised)
J,/ Cir,// when reaJy
---��A�'kjl AM SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
AUG 1 4 2006 Environmental Health Section
P.O. Box 848/210 Hospital Street
E(VVIP,04d4J,ENTAtHEALTN Mocksville, NC 27028
pn�iEcou alv (336)751-8760/ Fax (336)751-8786
Application For: ❑ Site Evaluation/Improvement Permit uthorization 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 &CAN STAu FFkZ Contact Person / ica 14 jTAu FFGZ
Billing Address 7$6 io Home Phone 33&-479-(.594/
City/State/ZIP 4-Exi9tc ou, NC- 7-1ZL97- Business Phone A)JA
Name on Permit/ATC if Different than Above ,✓/4
Mailing Address City/State/Zip
PROPERTY INFORMATION
NOTE: A survey'plat or site plan must accompany this application.
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Street Address I8& S. t4Az.6tw000 L12, o& City AoC-03VIceE Tax PIN# Zo- 5337. 33
Subdivision Name nrjr-,TA0i E vRle-s Section/Lot# 33 Lot Size
Directions To Site: 6q C1, LtVT,NTc, N,cletiAmrarcc,IC5., 9T P, STao S.? ^j. L. 51 In 7- nN iZT :VT5 A
Coa^r-IL C -F
Date House/Facility Corners Flagged 8&- oL
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? Dyes RN -o
Does the site contain jurisdictional wetlands? Dyes CNb
Are there any easements or right-of-ways on the site? Dyes C�10
Is the site subject to approval by another public agency? Dyes [moo
Will wastewater- other than domestic sewage be generated? ❑Yes 2<0
IF RESIDENCE FILL OUT THE BOX BELOW
# People Z # Bedrooms 3 # Bathrooms Z- Garden Tub/Whirlpool Ceres ❑No
Basement: ❑Yes 14Ko Basement Plumbing: Dyes Wo
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: &,-onventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: E3'C.ounty/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?
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 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 determine compliance with applicable laws and rules on the above described property located in
Davie County and owned by /M ,CA N S. STAo FFF-2
Property owner's cyownerrs legal epresentative signature
06.
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Sign given Dyes ❑No Account #
Revised 2/06 Invoice #
e
s
DAVIE COUNTY HEALTH DEPARTM
Environmental Health Section fil
Soil/Site Evaluation
NAME 111711
ADDRESS
PROPOSED FACIILTY
DATE EVALUATED 7, a v
PROPERTY SIZE
LOCATION OF SITE
Water Supply: On -Site Well _ Community Public
Evaluation By: Auger Boring Pity Cut
FACTORS 1 2 3 4
Landscape position
Slope % y
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure S
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-Fimn 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
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