147 Auburn Hill Lane Lot 4Davie County, NC Tax Parcel Report Thursday, December 29, 2016
WARNING: Tli1S 1S NOT A SURVEY
Parcel Information
Parcel Number: E60000002504 Township:
NCPIN Number: 5851735380 Municipality:
Farmington
Account Number:
8301824
Census Tract:
37059-802
Listed Owner 1:
STYERS THOMAS R JR
Voting Precinct:
SMITH GROVE
Mailing Address 1:
141 PRAGE CIRCLE
Planning Jurisdiction:
Davie County
City: WINSTON SALEM
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
DAVIE COUNTY QD
Zip Code:
27106
Voluntary Ag. District:
No
Legal Description:
LOT 4 FRYE ACRES PHASE II
Fire Response District:
SMITH GROVE
Assessed Acreage:
0.80
Elementary School Zone: PINEBROOK
Deed Date:
1/2013
Middle School Zone:
NORTH DAVIE
Deed Book! Page:
009140499
Soil Types:
MrB2,GnB2,PcB2
Plat Book:
0008 Flood Zone:
Plat Page:
159 Watershed Overlay: DAVIE COUNTY
Building Value:
Outbuilding & Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
161 �7 Ail 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 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
iN C 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. Boz 848/210 Hospital Street (-
Mocksville, NC 27028 Y'
(336)751-8760 I^
W�
IMPROVEMENT/OPERATION PERMIT W
Account #: 989900635 Tax PIN/EH #: 5251-73-5380
Billed To: Wayne Frye Subdivision Info: Frye Acres Lot # 4
Reference Name: Location/Address: Auburn Hills Lane -27028
Proposed Facility: Residence Property Size: .85 Acre
**NOTEq*7mprovem
%TTi seent/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 #Bedrooms #Baths
Dishwasher: 1� Garbage Disposal: Z Washing Machine: JQ 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) c l% Site: New Repair ❑
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width_ Rock Depth/ Linear Ft.�
Other: As stated 111 10A N AG
accepted Systems may also be used
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: 1,6111 Date: V 2 0
DCHD 05/99 (Revised)
May 18 06 04:04p
May 1U 06-03"43p daVie county envheeltri 336 751-8786-- p.-1...
APPLICATION FOR -;ITE VALUATION/IMPROV EMENT PERMIT & ATC
Davie County Health Dcpnrtment
Environmental Health .Section
P. -O. Box 54410 Hospits 1 Street
Maeksville. NC 27018
(336)751.876W. ruff (336)751-8786
Application For -((Site Ewluetionlhnprovement Fcmii rJ Aulhoriz& ion To Conwua(AI C) U Bob
•••IMPORTANIv•• T1I1S APPLI(Wl.'ION (:ANNOTAIi 1rR0CriSS•ED U•111SS ALL OF -ran R80U1Rpr)
aa
INFORATION B 1'140VIDED.:tcl'or to she INFORMATION DULLE'l IN for instructions.
APPLICANT INVORMATION
--
Nainc tobc Irillyd �%C. E f tii lacrPcrson
Billing Addrex,^ri`•n1c
City1$talefLrP.. ,rjC.e lift- inems Phane 5
Name. on PCrmiVA'VC if niffei-ew than Above___
NIsiling Address CityMmer7.ip. _
PROPERTY tNFORMATION
NOTE A wrvey plat of 0te plan mus accaupsny dtis application.
(Permit is v- id for 6U lots nth sitep plan. fro expitation WidjorrTletc p1111.)
Street Ackkess - _- Xlea• iGt!• City i( S cF 'fax VINN 7 —3 jx 0
Subdivision Name f_S CectionlLotN_ l.ot Size -----Oe
DIt'eO�UTI�ns•P_U Site: d, � yd/i!�^ t.f �• ��iuo .OG/ LE O47
r
DntcHouscll':wilily(:ornusfiig;cit
If the anrwer to any of the followins .pt.sGons is 'yes' , %Upportint. ttbenracil .firm nnalr heanacltc.t/ Are them any exuting wastewater systems on the site? civet 14"
Docs de site contain jurisdich•mal wrtlandi! OYc t l�th�
Are dxre any easements or t ig.:bof ways on the site? LI YC 1 L <--
Is dur site :llbjecl to appfoval ty another public agency'! LIYe i We
Will..vrostewatcrother than dontctacstwosebegencotedl ❑Yc. 0< —
1F RESmI:NC - FILI.. OUT TI lk. BOX BELOW
etPcople. NDturoonrc IlBathr ums. GardenTub/Whidpool es ri
basement, f� JNo Hascr.tent Plumbing: UYes 1 0
IF NON -RESIDENCE, FILL OUT THE BOX BELOW_ • _ . _ _
Type of Facility/Dusincss _Total Square roots gc of Ruilding^ rt People
V Sinks 0 Commode i. IF Shower __ _ A Urirwly _
retimnlcd Water tlsupo (gallons Per day) (Attach duct muntation of simiLtr facility water consumptiten)..
FOODSERVICE ONLY: ►i Seats-_.. _
Type systemicqucacd• onversdarial JAcceped Uhxtovative flAlresoative UONa
WaterSupply'1-ypc:ovmy/Ciry!vrm PNew Well (luxc.linGWall, !?Communitywst►.
Du yvu anticipate adilitimu or cxpaoiit ns of the facility this cystam is inteadod to serve? 1771 Yes 4sNo
if yc. »tut typel _ -
This is to certify daw flee information provided on this application is Inic and :affect to the bell of my knowledge. t underslaM that
any permit(l) or ATC 0 issued hertrfoa are subject to suspntsion or revoca Son if the silt is, alweLL the intended use changes; or tf
dta infomvili m subiniucd in this application is falsified or ehangrA I vndu.rand root I am rr pnnribte for nil charges wrurnM
from dO epplicariou. l busby grant sy ld of entryto dte Authorized )topres_nlative of the Usvie County llcalilt Deparmwi t W
canduc• necessary itupecttuns to det•rriae compliance with spplicablo laws and rules on the attuve described propctty totaren in.
Davie C minty and ow/ncd by
Site Revisit Charge
Property o to i n ow tee's legal re "VC ntative etgoature
Dom(s)r_
Client Notit kation Date:
Dale F.HS: .•_
tet n hirer UYes UNo Am -aunt 0 glG_..LD0 15✓
Rcv"lIf06 Invoice Ft `
P.2
31
DN FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department `
Environmenta/Health Section
P.O. Box 848/210 Hospital Street
Mocksville,•NC 27028
(336) 751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed1�iQ11idq. //"V.'4-' Contact Person Sm --
2.
3.
4.
5.
6.
7.
Mailing Address
[yV Z6-�-
Home Phone
19/` j9 oL3Y-2
City/State/ZIP
n��0,6
_ _/% PdA,IJCIEt. > /VJ��
/
��d Business Phone
S4.2 -gp J
Name on Permit/ATC
if Different than Above
Mailing Address
City/S�tat-ee/Zip
E
Application For:
Site Evaluation
❑ Imprdv-ement Permit/ATC
❑ Both
System to Service:
Douse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
Type system requested: IJ Conventional ❑
conventional modified ❑
innovative
If Residence:
# People
# Bedrooms 3
# Bathrooms 21
2 -Dishwasher ❑Garbage Disposal Mashing Machine
If Business/Industry /Other: verify type
# Commodes
# Showers
❑Basement/Plumbing
# People
# Urinals
❑Basement/No Plumbing
# Sinks
# water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: County/City ❑ Well ❑ Community
9. Do you anticipate additions or expallSiOnS of tile facility this System is intended to serve? ❑ Yes ❑ No
If yes, what type?
***1A1P0RTAN7*** CLIENTS MUST COMPLETE- TIIE REQUIRED PROPERTY INFORMATION REQUESTED
BELOIV. Either a PLAT or SITE PLAN MUSTBESUBMI7TED by the client with THIS APPLICATION.
Property Diniensions: /77co
Tax Office PIN: # JCA- 73 72- L7
Property Address: Road Name
City/Zip
If in a Subdivision provide information, as follows:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
AM'S
Name: /
Section: Block: Lot: Date home corners flagged: / .7y4j
This is to certify that the information provided is correct to the best of my knowledge. I understand that any perinit(s)
issued hereafter arc 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 l ain responsible for all charges incrured frons
this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth Department
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 %/�/d SIGNATURE
TIIIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic Iocations).
c�
Sign given
Revised DCIID (05/03 � �`��
Site Revisit Charge
Datc(s):
Client Notification Date:
EIIS:
Account No.
8'77ad -�
Invoice No. ��P��
PJ 4(o
t 0 " #, ' DAME COUNTY HEALTH DEPARTMENT 't 11
. Environmental Health Section 6
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 989900635 Tax PIN/EH #: 5251-73-5380
Billed To: Wayne Frye Subdivision Info: Frye Acres Lot # 4
Reference Name: Location/Address: Auburn Hills Lane -27028
ATC Number: 4413
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 FIVE YEARS.
Environmental Health Specialist's Signature: a" Date: 2 i�
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.
J(- &W, Qut'ck Ll elatl
. Stg - ShID4 100 ri
G-13
v
193111115
to par+tls�
(51
sti
N`
�Rontr
Septic System Installedt4, lhl"
'
Environmental Health Specialist's Signature: J1 IA41J
DCHD 05/99 (Revised) pow/
8c,
,7Z'
Date: //— 2,17-0&