137 Austine Lane Lot 31I r
Davie Countv. NC
Tnv PnrrPl R Pnnrt
Friday. December 30. 2016
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:
WARNING: THIS IS NOT A SURVEY
Parcel Information
H7030A0023 Township: Shady Grove
5769960385 Municipality:
82517529 Census Tract: 37059-804
BEAN RONNIE ALLEN Voting Precinct: WEST SHADY GROVE
137 AUSTINE LANE Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R -A
Land Value:
Total Assessed Value:
NC
Zoning Overlay:
27006-0000
Voluntary Ag. District:
No
LOT 31 GREEN BRIER ACRES
Fire Response District:
ADVANCE
0.45
Elementary School Zone:
SHADY GROVE
9/2001
Middle School Zone:
WILLIAM ELLIS
003860602
Soil Types:
GnB2
0004
Flood Zone:
173
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
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, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to
noU tyc'� NC �.»� or arising out of the use or inability to use the GIS data provided by this website.
HEALTH DEPARTMENT RELEASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Clayton Homes
Address: 828 Piedcmont Dr
City: Lexington
State2ip: NC 27292
Phone. #: r336) 782-1647
% For Office Use Only
*CDP File Number 175997-1
5769-96-0385
County ID Number:
valuated For: HDR/WWC
PERMIT'VAUD l a/ 1 5/ a 0 1 9
UNTIL
Property OWner:Ronnie Beam
Address: 137 Austin Lane
City: Advance
State2ip: NC 27006
Phone #:
L
Property Locatlon & Site Information
Address 137 Austin Lane Subdivision: green Brier Acres Phase: Lot 31
Road N Advance NC 27006
Township:
'Structure: SINGLE FAMILY
Directions
# of Bedrooms: 3 # of People: Hwy 158 east, right on Baltimore, to end. left on Cornatzer Rd. Right or
Fork Bixby Rd. then left into Green Brier
'Water Supply: PUBLIC
Basement: n Yes ❑ No Type of Business:
Total sq. Footage: No. Of Employees:
"Proposed Improvement:
Replacing Home
J
This release in no way expresses or implies that the existing subsurface sewage treatment and disposal
system. serving the site will continue to function for any period of time.
Applicant/Legal Reps. Signature Required? OYes ONO
Applicant/Legal Reps. SignatureL
*Date: /
*Issued By: 2140- Nations, Robert *Date of Issue: 1 a 1 5 1 a 0 1 4
Authorized State Agent: _
**Site Plan/Drawing attached."*
OHand Drawing 01mportDrawing
Drawing Type:
I'
HEALTH DEPARTMENT REI -EASE
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 175997 1
County File Number: 5769-96-0385
Date: 12/ 15/ 2 0 1 4
Olnch
Scale: OBlock = ft.
Health Department Release ON/A
Page 2of2
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All data is provided as is without warranty or guarantee of any kind 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 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.
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All data is provided as is without warranty or guarantee of any kind 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 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.
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4TTFFVAITTATTC]l�/TTtdU72C11Tt7tr��.r�rnnn*`r•r o= �•rr._
Davie County Environmental Health PAID
\ ^ P.O. Boz 848/210 Hospital Street Date:
r V` Mocksville, NC 27028 `
(336)753-6780/ Fax (33 753-1680 Re�eNed b
Application For. ❑Site Evaluation/ImprovementPeimit Authorization To Construct(ATC) ❑Both
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***1MPORTAN7`** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed Q fDN -T Contact Person _ S r vtf-K-
Billing Address 1b Z r— Home Phone
City/State/ZIP 1. s. X1 12 ;k -Ml usiness Phone 33 4 • � fdr'it ' / b �I �
Name on Permit/ATC ifDierent than
Mailing Address 1_-k7 �*>W t L
PRUPERI Y INPUKMAI IlJN
NOTE: A survey plat or site plan must accompany this application. Included 4 -Site
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name • - 1
Owner's Address City S te/2
Property Address t Ci
Lot Size . k TaxPIN#.$7 JJ1e03
Subdivision Name(ifapplicable) i sp A e Section/Lot#
Directions To Site: &A 1 %i ...kd (%'-� rai ruezi,,' R (R) FJflC
r 7.•ru
Plan ❑Plat(to scale)
DDt/
If the answer to any of the following questions is "yes", supporting documexitahon must be attached.
Are there any existing wastewater systems on the site?
❑ryes ❑>°
Does the site contain jurisdictional wetlands?
Dyes In 8'
Are there any easements or right-of-ways on the site?
❑Yes,NN
Is the site subject to approval by another public agency?
❑Yes
90
Will wastewater other than domestic sewage be generated?
❑Yes
IF RESIDENCE FILL OUT THE BOX BELOW
# People 3 # Bedrooms _ # Bathrooms - Garden Tub/Whirlpool ❑Yes bio
Basement:. Dyes p o Basement Plumbing: ❑Yes/JNo
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:XConventional ❑Accepted ❑Innovative ❑Altemative ❑Other.
Water Supply Type:,0<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?
kNo
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 o£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 comers and
1 g and n r staking the house/facility location, proposed well location and the location of any other amenities.
Site Revisit Charge
'�'6operty owner's or owner's legal representative signature
Date(s):
12-C3.1 It Client Notification Date:
Date EHS:
Sign given ❑Yes❑No
Revised 11/06
Account #
Invoice #
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968), Permit Number
Name s, %i' /;�->^��, Date
Location
Subdivision Name > 1 r - :1 f .; - , Lot No. Sec. or Block No.
Lot Size House `"�- Mobile Home _ _ Business -- Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑- Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES p NO ❑ 1'' %;' �..
,,, � �.-.� rte;; • <, ,,..
Type Water Supply - __—
f� j� y
"This permit Void if sewage system described below is not installed within 36 months from date of ;issue. f'
' I
;f
f
r
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Improvements permit by --
'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
00
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
f✓
NOTE: Issued in Compliance witk&'G,S. of North Carolina Chapter 130 Article 13c
Sewage. Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name —�'�cy /,'/. i�rra Date �� �� M0 w4530
Location
Subdivision Name dree-0 fir Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. 'Baths No. in Family
Garbage Disposal YES fl NO Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine, YES NO D
Type Water Supply
*This permit Void if sewage system de cr'ed low is not installed within 36 months from date of 'ssue? /
F1
Improvements permit by
"Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion Date
"The signing of this certificate shall- indicate that the system described above has been installed in compliance with
the standards set forth in the -above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
i
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'*NOTE:"Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment -and Disposal Rules (10 NCAC 10A .1934-.1968) ; Permit Number
Name > Date 7'`-.•`,
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House `--`" Mobile Home _ Business -- Speculation
_ No. Bedrooms _ — No. Baths No. in Family
Garbage Disposal YES ❑ NO 0Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash. Machine YES 0 NO E]/ 16
Type Water Supply
'This permit Void if sewage system desdribed below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion Date _
*Tlhe signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
t Davie County Health Department
Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone ?5W -'?o go
1. Permit Requested Byl" A- c Q i a, k-1), I k �C)q Business Phone
2. Address tnute_ 3 lq4 I ne- a-7oa!�
3. Property Owner if Different than Above
Address
4. Permit To: a) lnstall$ . Alter Repair
b) Privy Conventional Other Type
Ground Absorption I o i$
c) Sub -Division &c �r•r'� rar MSec.� �nL No. S • q (�� C res
5. System used to serve what type facility: House Mobile Home Business
Industry Other
b) Number of people
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms— Bath Rooms_— Den w/Close
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes rl urinals garbage disposal
lavatory showers washing machine
dishwasher 1 sinks 1
8. a) Type water supply: Public— Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions 3�5 X (n9S
b) Land area designated to building site nSnO . l-
c) Sewage Disposal Contractor s_'�_km r, e Or r \c tf -t-r-
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? s_
What type? nmrh1:J e t S; ,,L S ksaoc r` i ,n Sc r cyi
This is to certify that the information is correct to the best of my knowledge.
S-1 5-
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property: t{
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af-ioQuo
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
PERCOLATION TEST RESULTS
` tks It *74
DATE 7-- aR,2—,go
NAME �AoQe 6,raLAtAt
LOCATION AC Ives — tm fkN.- Tmzr
FINDINGS: HOLE NO.
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COMMENTS
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BY: -- tppp. nam
z 10s
M 3 pd
DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. O. BOX 57
MOCKSVILLE, N.C. 27028-
(704)
7028(704) 634-5985
Statement for Septic Tank Improvements Permits and/or Site Evaluations
ADDRESS 15 5'P %Au,t
%�ake%u+ l It A f. 2l$b3i
DATE -1 -ll -to
PERrUT 140. 14 'r
EXPLA14ATION or CHARGE` OS;At V QCAe- "it
AMIOUNT DUE 1fl+ tSD SANITARIAN r '(if1Cl
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
Pp
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received....