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577 Cornatzer Rd HEALTH DEPARTMENT RELEASE For office useonly *CDP File Number 122334- 1 ` Davie County Health Department I6-000-00-076-04 210 Hospital Street County ID Number. <� P.O. Box 848 �'�••. �„, .,��` Evaluated For: HDR/VMC w; Mocksville NC 27028 Phone:336-753-6780 Fax:336-753-1680 PERMIT VAUD 0 7 / 2 3 / 2 0 1 3 UNTIL: Applicant: Michael Chamberlin Property Owner: Terry and Sandra Davis. Address: 2186 Milling Road Address: 577 Cornatzer City: Mocksville City: Mocksville State[Zip: NC 27028 State2ip: NC 27028 Phone#: (336) 399-3703 Phone#: Property Location 8.Site Information "^577 Comatzer Rd. Address-�- --� Subdivision: Phase: Lot Road# Mocksville NC 27028 SINGLE FAMILY Township: 'Structure: Directions #of Bedrooms: 3 #of People: Hwy 64 E,left on Comatzer Rd.Across from Cornatzer School 'Water Supply: NIA Basement: n Yes❑No Type of Business: Total sq.Footage: No.Of Employees: '_Proposed Improvement: Addition Garage 30x30 `Release Conditions It is the responsibility of the owner to maintain a 5'minimum setback between the wastewater system and any part of the structure foundation,including porches,decks,and any other appurtenances. If you are unsure as to the exact location of the septic system,please have a licensed installer or inspector locate the septic system for you. The local county health department in no way implies that the proposed construction meets the required setbacks from the septic system unless otherwise noted. This release only shows that this property has an approved wastewater system that appears to have met the permitting requirements at the time it was installed. EMAII.ED Ae n.W 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.Signature: *Date: j *Issued By: 2244-Daywalt.Andrew *Date of Issue:_ 0 7 / 2 3 2 0 1 3 Authorized State Agent **Site Plan/Drawing attached.** TotalTlme:(HH:MM) 0 1 Hours 0 0 Minutes O Hand Drawing OlmportDrawing Davie County Health Department 9 18 t� Environmental Health Section P.O. Box 848 1 • � 'MAILED 210 Hospital Street O 'S Courier# : 09-40-06 ZT D" & Mocksville, NC 27028 Phone:(336)-753-6780 Fax:(336)-751-8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: /'r {�li�'/Q//N � 1��+'���2/��� Phone Number .�gCJ-,3��� (Home) �M Mailing Address: ! .N 1�LQ (Work) /`/oLKJv� ,G G vZ� Email /Yln[ hct�14'( �-/i►�N►�Ua`'� Detailed Directions To Site: W` C`t4e&*OA)�,01,rtym�t, S Property Address: 577 69RAW�/L 2 Please Fill In The Following Information About The EXISTING Facili Name System Installed Under: / AL �'{'� Type Of Facility: Date System Installed(Month/Date/Year):_ a� Number Of Bedrooms: v Number Of People: J' Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any.Known Problems? Yes No If Yes,Explain: Please Fill In Th Following Information About The NEW Facility: Type Of Facility: 4i (SOIY436 Number Of Bedrooms: Number of People-4— R quested eopleRequested By: 1 C24 Date Requested: ✓� (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Specialist r Date: *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment Cas " Check Money Order # Amount:$ 1019. -'Date: Wo—,63 Paid By: 14fes Received By: Account#: Invoice#: Z C �Z� 33 . t X1144 � �/l J 5271 1 17J )36 172 (20)--- -_-- 3�13 J` 7 o z 197) N 21 G ---- ' � O -- 443 199 ------------t------- All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Implied �' VIL warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of G U N- 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. Pri nted:J u 116, 2013 octD soolJ�.►Aa� �._..._ _ _... . Al CORPORATION WARRANTY DEED—Poen CWD-402. nam Printed sad ter nY bP lama WMI&M t Ca.,,lac.,vadkelvmo N a . -- aawaseaaaelseaaa®.maaaawar� STATE OF NORTH CAROLINA, Davie County. THIS DEED,id.d. t_He7 .it_9i.btand a•* CAROLINA E. E Davie red State of Norte,Crrollee,Imakaf er aaW Gr,aato ma TERRY M. DAY I wife, of Davie ry sad sate of No"e carelktao hereinafter saWd Gerota. WITNES ETIHI The he creator. —k-of-%, ,of#*'�*AAA##AAAAA#pN- HUNDB [IAAAAAAAA####A###AA w i and others and Pal to Wren M Mand Peid►P tM Cnoue.the rccslpt whenot Y honer eck»wfsdtod,hat{fven,pemud.►agaNed.add teed colt..Prd, a teen prawn dote sM,Scant.Marp3a edl.tooreP and tontfno woo&*Grwtiq MY Mb Ior»aer»n wd Magee.r"kb"Mt • Tovaseip, Dav j,e Ceamr,N-dt Cerelba,doeco&od tee follawn •BEGINNING at a railroid spike in the center of S.R. 1605 (Cornatzer Road), a corner for Lot 1 and being 102.46 feet from the corner of T. Holt Naywood,.Jr. in-the center of said road, runs thence North 87' 321 15" West -233.39 feet to an iron stake; thence North 9' 4Se 10" West 101.56 feet to an iron stake in the line of Luther Potts; thence with the Potts line South 87' 321 15" East 172.43 feet to an iron and thence continuing North 870 32' 15" East with the Potts line 57457'feet to a railroad spike In the center of said S.R. 1605; thence,with the center of said S.A. 1605 South 11. 40' 22:' East 102.34,feet to the Beginning. containing 22,992 square feet* more or less, as surveyed by C. Ray Cates"and Associates. February. 198S. Subject to a 15-foot easement on the Souibo'irn boundary of said Lot for ingress and egress from Cornatzer Road to the properties iaaed- .•Lately to the West of the above described property. . STACQ� :'T. t t' ,T "...... STATE OF NOi6TM ►fS� '7�:. .. •. .. .>L: NC:i i'J-l�G?nnftt]CiF1A . a GWS XCIaIt TeX ;•' .•Y.; + •!„x 5 .i ` :� EXCIa;TAX 30.00 y .U3 .t'Q t: �''`: 50f i .. ; >• The Ae"hndw000...e,.d»Comment y .sa3e414whp TO HAva AND TO HOLD Teo Am daoDed peeashm vitt on do arprenlaaeee tear..ato Wonslm&ar w my win sprocul dq,em”doe Genal,eY wire adr-»mere.WA a.tyaa tNeva;. .. And de Orrtet ooeaeate toot tK Y aaMd o/eaY rnaaYn Y[a tad ems tae,�l.t M cw»r da ea�a Y Er riapiei that.aid rre�iw w Eos 6e.so• ,XW ewenacayMWlpp�ePtiou*be"tented.K sq)t sad that M narYt warrant sad datad tM aeW title»thoeatee spied the Mwfd daMoa*(an p woom t'eOO1wS StOt Catena-or organ.,tee nYlsoler nisIl 6t3nde ter ptaltal and tee aaaealMse aMatl Yclade tM EsaiaFne ter tee aaaas. tGreater Us Bawd dJ,deed to be eaksad by in ddp madmim"of mer sad Yr mal to be' d uml tei der rd r u. Horne�,�►�a, sraetur y pre Davis .. STATS nE N � /� rnWY.do hereby cats tMa�L0�tLs-7 plrat+allP pm[�ifj�o»e ddedar,aadaeknewWSeddiat Secretary d/Il� wig,. ` .•••• ••.;r sad teat,by mete-Nr ddr Swat sad u tet an of tla cotpatatYa,ter. nraiy YrtronLaq was @Wad is he aaaa by ke •'•~ President,MW WMM ite eatponra teal,and y MYuelf n in Saeretrr •�� ?! air Witmer rq bead Lad ofatlal ad t61a '� +.P of Z .1 85 a_. '�2/V1 ON . MP co.at6do.npir-: Ito—,—p lr Y l. !TATS OP moKTH CAROLR . Davie rwnrry �rpAurl"atu Haat TMfaresodaseat&NWP)of Peggy. Shelton, Notary Public of Davie Cotmhr. le Yom' adfYd a M eoatoct.TeY etsaorasat vas rmaated far tesisaatYa teY 5 dq of Juno o .3185_. at- 4:20 X K•i'.gM•a,teed deny ro ter' N the afte ottM RgMnr of Dwds ofDavie NottbCaroEaallnBook 85 Teo tM-5 ..r a f Jttxs .A.D,.It• . ' `.' J IC 31dth By "; Regiatet a Dade rogoomcDeptr Register of Doeda C! TMIa Dad dnera y William H.-Hall. Attorney at 1.av •. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION. 0 *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 �/ rt�al- Date 5VN2 3766 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 [:jNO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ �' �/ �!! Auto Wash Machine YES p NO C] T /Oav �`�-�-•� ype Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. L� 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 "-4 Y►t -'- . th w' Certificate of Completion Date`s *The signing of this certificate shall indicate that the system descri d 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. DAVIE COUNTY HEALTH DEPARTMENT 1 P.J 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 %%r ,''�� r— �/ r _ Date T, 6 d v 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 ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ r;-, �✓ , <;•' r Auto Wash Machine YES ❑ NO ❑ ���� ✓ r Type Water Supply *This permit Void if sewage system described 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 Vul r 1 1c t r s Certificate of Completioni' �'Z'i(t-- Date Sd *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. t � r DAVIE COUNTY HEALTH DEPARTMENT r r Y ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0 .NO 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 —��l'�`.��� ��."� 3766 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 ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES E] NO C] �xx/ Type Water Supply *This permit Void if sewage system described 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 ll_Y�n e e L) o - t �(N O Certificate of Completion< �� ����j?1.iE.> Date`5 A *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.