111 Tyler Court Lot 62Davie County, NC Tax Parcel Report Tuesday, December 20, 2016
A
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:
Land Value:
Total Assessed Value:
WAKNI-Nki: THIS IN 1VU'1' A JUKVEY
ADVANCE
Parcel Information
F8030A0062
Township:
Shady Grove
5870632690
Municipality:
8304118
Census Tract:
37059-803
SCHRADER MICHAEL JOSEPH
Voting Precinct: EAST SHADY GROVE
111 TYLER COURT
Planning Jurisdiction:
Davie County
Zoning Class: DAVIE
COUNTY R -A R-20
NC
Zoning Overlay:
27006
Voluntary Ag. District:
No
LOT 62 ESSEX FARM PHASE 1B
Fire Response District:
ADVANCE
0.69
Elementary School Zone:
SHADY GROVE
9/2014
Middle School Zone:
WILLIAM ELLIS
009680726
Soil Types:
Gn62
9
Flood Zone:
388
Watershed Overlay:
DAVIE COUNTY
Outbuilding & Extra
Freatures Value:
Total Market Value:
F-a
Ail 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, ifs 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.
f
OPERATION PERMIT
Davie County Health Department
t 210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: RS Parker Homes / Joy Springer
Address: PO Box 2567
City: High Point
State2ip: NC 27262
Phone #:
Pro
Address/Road #:
111 Tyler Court
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
*Water Supply: PUBLIC
*IP Issued by. 2140 -Nations, Robert
*CA issued by: 2140 -Nations, Robert
*CDP Fite Number 136568-1
F8030 -AO -062
County ID Number:
Evaluated For: NEW
�ownship:
("'Property Owner: RS Parker Homes / Joy Springer
Address: PO Box 2567
City: High Point
State2ip: NC 27262
Phone #:
lerty Location & Site Information
Subdivision: Essex Farm Phase: Lot: 62
Design Flow: 4 8 0
Soil Application Rate: 0 - a 7 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
Directions
Hwy 64 East, left on Cornatzer, then Left on Essex
Farm Rd. past Beauchamp Rd
*System Classification/Description:
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
SaproldeSystem? OYes QNo
*Distribution Type: GRAVITY -SERIAL Pump Required?
QYes (DNo
*Pre Treatment:
Drain field
1 7 4 5 Sq. ft.
4
4 3 6 ft.
9 (:)Inches O.C.
—
Feet O.C.
()Inches
— 3 � Feet
inches
Minimum Trench Depth: a
4
Minimum Soil Cover. 1
2
Maximum Trench Depth: 3
6
Maximum Soil Cover:1-1 a
4
*System Type: INFILTRATOR QUICK 4 STANDARD
Installer: Transou Septic
Certification #:
*EH S: 2140- Nations, Robert
Date: 0 7/ 0 8/ 2 0 1 4
Inches
Inches Approval Status
Inches ®Approved D Disapproved
Inches
CDP File Number 136568-1
Manufacturer. Shoaf
STB: 760
Gallons: 1000
Date:
03/
1 0/
2 0 1 4
*Filter Brand:
POLYLOK Dual PL -122 With Pipe Adapter
ST Marker:
❑
Yes
El
No
nforced Tank:
❑
Yes
El
No
1 Piece Tank:
❑
Yes
2
NO
❑
No
Flow Adjustment Valve
❑ Yes
Manufacturer
PT:
Gallons:
County ID Number: F8030-Ao-062
c Tank
Lat.
Long:
Installer: Transou Septic
Certification #:
*EHS: 2140- Nations, Robert
Date: 0 7/ 0 8/ 2 0 1 4
Approval Status
Approved ❑ Disapproved
Pump Tank
Date:
/
/
Riser Sealed ❑
Yes
❑
No
RiserHeight: ❑
Yes
❑
No (Min.6 in.)
nforced Tank: ❑
Yes
❑
No
1 Piece Tank: ❑
Yes
❑
No
Pipe Size: inch diameter
Pipe Length: feet
*Schedule:
Pressure Rated ❑ Yes ❑ No
Lpp roved fittings ❑ Yes ❑ No
Installer:
Certification #:
*EHS:
Date:
Approval Status
Approved ❑ Disapproved
upply Line
Installer.
Certification #:
*EHS:
Date:
Approval Status
Approved ❑ ` Disapproved
/ Pump Type:
Installer:
Dosing Volume:
—
Gal Certification #:
Draw Down:
Inches
*EHS:
*Chain:
Date:
Valves Accessible
❑ Yes
❑
No
Flow Adjustment Valve
❑ Yes
❑
No
Check valve
❑ Yes
❑
NO
Approval Status
PVC unions
❑ Yes
❑
No
❑ Approved ❑ Disapproved
Vent Hole
❑ Yes
❑
No
\ Anti -siphon Hole
❑ Yes
❑
NO
CDP File Number 136568-1
County ID Number: F8030 -AO -062
2140 - Nations, Robert
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 0 y/ 0 8/ a 0 1 4
This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE II A. sewage septic system.
Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: NIA
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed fora homelbusiness owner must maintain a valid contract
with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a
public management entitywith a certified operator for the life of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system ownerand a management entity priorto the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and
operation, responsibilities of the ownerand systems operator, provisions that the contract shall be in effect for as long as the
system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
OHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
c�c�u�� cyu�Nn�cn�
i
NEMA 4X Box or Equivalent
❑ Yes
❑
No
Installer:
Box 12 inches Above Grade
❑
Yes
D
NO
Certification #:
Box Adj. To Pump Tank
D
Yes
D
No
Conduit Sealed
❑
Yes
D
NO
*EHS:
Pump Manually Operable
❑
Yes
❑
No
*Activation Method:
Date:
Alarm Audible
13Yes
D
No
Approval Status
D ApprovedEl Disapproved
Alarm Visible
❑
Yes
D
No
2140 - Nations, Robert
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 0 y/ 0 8/ a 0 1 4
This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE II A. sewage septic system.
Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: NIA
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed fora homelbusiness owner must maintain a valid contract
with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a
public management entitywith a certified operator for the life of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system ownerand a management entity priorto the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and
operation, responsibilities of the ownerand systems operator, provisions that the contract shall be in effect for as long as the
system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
OHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Drawing D_ra;avt
OPERATIOMPERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
,type: Operation Permit
{
VI
j
• 1
,
i a ,
Y
j
41k,
�0
i
♦ 1-
CDP File Number: 136568 - 1
County File Number: F8030 -AO -062
Date: / /
O Inch
Scale: OBlock
ON/A
CONSTRUCTION For Office Use Only Ns
` A AUTHORIZATION 'CDP File Number 136568-1
Davie County Health Department F8030 -AO -062
tY P County ID Number.
' ca 210 Hospital Street Evaluated For: NEW
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 3/ 1 4/ 2 0 1 9
Applicant:
Address:
CRY:
State2ip
Phone #:
RS Parker Homes / Joy Springer
PO Box 2567
High Point
NC 27262
/Address/Road #:
111 Tyler Court
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
'Water Supply: PUBLIC
Property Owner: RS Parker Homes / Joy Springer
Address: PO Box 2567
CRY: High Point
State2ip: NC 27262
Phone #:
Subdivision: Essex Farm
Phase: Lot: 62
Directions
Hwy 64 East, left on Cornatzer, then Left on Essex Farm
Rd. past Beauchamp Rd
System Specifications
Page 1 of 3
Minimum Trench Depth:
a 4 Inches
Site Classification: Provisionally Suitable
Saprolite System? QYes QNo
Minimum Soil Cover.
1 a Inches
Design Flow: 4 8 0
Maximum Trench Depth:
3 6 Inches
Soil Application Rate: 0.2 7
5
Maximum Soil Cover:
a 4 Inches
'System Classification/Description:
'Distribution Type:
GRAVITY -SERIAL
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY
OR 480 GPD OR LESS) Septic Tank:
1 0 0 0 Gallons
'Proposed System: 25% REDUCTION
1 -Piece:
QYes QNo
Pump Required: QYes
QNo OMay Be Required
Nitrification Field 1 7
4
5 Sq. ft. Pump Tank:
Gallons
No. Drain Lines 4
1 -Piece:
QYes QNo
Total Trench Length: 4 3 6
ft
GPM—vs—
ft. TDH
Trench Spacing:
—
9
ches O.C.
DeetO.C. Dosing Volume:
—Gallons
Trench Width:
3
Inches
Feet
_
Grease Trap:
Gallons
Aggregate Depth:
inches
Pre Treatment: ONSF OTS -1 OTS -11
Septic Tank Installer Grade Level Required: 01
011 0111 OIV
Page 1 of 3
CDP File Number 136568-1
County ID Number: F8030 -AO -062
❑ Open Pump System Sheet
Repairbystem Regwreo:vTes vivo vivo, out na5 AvallaDle o
*Site
Trench Spacing:
QInches 0.
9
Classification:
Provisionally Suitable
— Feet O.C.
Design Flow:
Trench Width:
Q Inches
3 Feet
4 8 0
_
Aggregate Depth:
Soil Application Rate:
0 a 7 5
inches
.�
Minimum Trench Depth:
a 4
*System Classification/Description:
Inches
TYPE IIA. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover.
1 4
Inches
Maximum Trench Depth:
3 6
*Proposed System:
25% REDUCTION
Inches
Maximum Soil Cover:
a 4
Nitrification Field
1 7 4 5 Sq. ft.
Inches
No. Drain Lines
*Distribution Type:
GRAVITY -SERIAL
4
Total Trench Length:
4 3 6
Pump Required: OYes
(DNo
OMay Be Required
ft.
Pre Treatment: ONSF
OTS
-1 OTS -II ,
'Site Modifications
C.
No grading or constriction activity is allowed in areas designated for system and repair without approval of Health Department. 01,
7!
'Permit Conditions
The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
2(
This Authorization for Wastewater System Construction shalt be valid for a person equal to the period of validity of the Improvement Permit, not
to exceed five years, and maybe Issued at the same time the Improvement Permit Issued (NCGS 130A -336(b)} If the Installation has not been
completed during the period of validity of the Construction Permit, the information submitted in the application for a permit or Constriction
Authorization Is found to have been incorrect, falsified or changed, or the site Is altered. the permit or Construction Authorization shall become
Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature: Date:.
*Issued By: 2140 -Nations, Robert Date of Issue:. 0 3/ 1 4% a 0 1 4
Authorized State Agent: Malfunction Log Oyes
(2)Hand Drawing Oimport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 136568 -1
County File Number: F8030 -AO -062
Date: 03/14/2014
Olnch
Drawing Drawing Type: Construction Authorization Scale:. . . OBlock
ON/A
� I i
I
� I �
I
a
� I i
F
{
i
f
4 � i
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/ Fax(336)753-1680
Application For: /Site Ev luation/Improvement Permit VAuthorization To Construct(ATC) ✓Both
Type of Application: L! rew System Repair to Existing System Expansion/Modification of Existing System or Facility
***LbIPORTANP** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed Pay Contact Person o
Billing Address Home Phone
City/State/ZIP Business Phone S
Name on Permit/ATC if Different than Above lrl I c.
Mailing Address City/State/Zio
PROPERTY INFORMATION *Date House/Facility Corners Flagged
NOTE: A survey plat or site plan must accompany this application. Included: C Site Plan lat(to scale)
1� /�(Permit isali for 60 m PO the w ' site plan, no expiration with complete plat.)
1 Owner's Name 1 Phon Nu be Owner's Address City/State/Zip
Property Address Cityj4dvak
Lot Size . ax PIN#
Subdivision Name(if applicable) Section/Lot#(0 Z
Directions To Site: L46 w PD4, MA.,rurn I't 0 k%4 4 1;p SC
the answer to any of the following questions is "yes", supposing dofumentation must be attached! �
Are there any existing wastewater systems on the site? GYes11<0
Does the site contain jurisdictional wetlands? GYes !�No/
Are there any easements or right-of-ways on the site? GYes >O
Is the site subject to approval by another public agency? GYes j'S'A��� + (J^ -+ O�
Will wastewater other than domestic sewage be generated? . :Yes r o
IF RESIDENCE FILL OUT THE BOX BELOW
# People in I Ol # Bedrooms # Bathrooms Garden Tub/Whirlpool GYes 7—,No
Basement: 'Yes E]No Basement Plum ing: ❑Yes CNo
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: 4*Conventional EAccepted _Innovative EAltemative E -Other
Water Supply Type: YCounty/City Water New Well [Existing Well Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 'YIVo
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 hereby grant right of entry to the Authorized
Representative f the Davie County Health Department to conduct necessary inspections to determine compliance with applicable
la and rule understand that I am responsible for the proper identification and labeling of property lines and comers and
1 ca ' n fl "in or staking the house/facility location, proposed well location and the location of any other amenities.
Site Revisit Charge
Pr p wn iso owner's lega epreAntative signature
Date(s):
Pr
Client Notification Date:
Date � qEHS:
Sign given GYes --No Account #
Revised 11,06 Invoice #
r
R-20 SETBACKS:
FRONT; 45' x82.28' 00" W
SIDE: 15' f 00.00'
SIDE: 25'(STREE'o
REAR: 30'
PROPOSED
RESIDENCE
J210r 15.45'
. Lil
SETBACK
g
10' UTILITY EASEMENT
0' S82*28' 00"E
100.00'
TYLER COURT
50' R/W (PUBLIC)
GRAPHIC SCALE
40 0 20 40 eo
( IN FEET )
I Inch - 40 it
63
lo 14.42'
15.75'
22.67'
75'0.75'n RcoV
PROPOSED
ESIDENCE
24.08'
J!�!6.75 .75'13.17'
24.63' 1M
HOME DIMENSIONS
NTS
PRELIMINARY
PLOT PLAN FOR:
RSP BUILDERS
LOT 62 OF ESSEX FARMS, PHASE 1
P.B. 9 PC. 388
Rmial 6ginuAng, pec.
700 Ca ale Place Greensboro, NC 27409
Phone: 336 524797 , Fax: 33649.070
NCBEIS C-0950 DATE: 01-30-14
REF: PR0D\1831-01\dwg\ESSEXFARM.dwg
SETBACK
61
62
w
O
w
IOw
PROPOSED
RESIDENCE
J210r 15.45'
. Lil
SETBACK
g
10' UTILITY EASEMENT
0' S82*28' 00"E
100.00'
TYLER COURT
50' R/W (PUBLIC)
GRAPHIC SCALE
40 0 20 40 eo
( IN FEET )
I Inch - 40 it
63
lo 14.42'
15.75'
22.67'
75'0.75'n RcoV
PROPOSED
ESIDENCE
24.08'
J!�!6.75 .75'13.17'
24.63' 1M
HOME DIMENSIONS
NTS
PRELIMINARY
PLOT PLAN FOR:
RSP BUILDERS
LOT 62 OF ESSEX FARMS, PHASE 1
P.B. 9 PC. 388
Rmial 6ginuAng, pec.
700 Ca ale Place Greensboro, NC 27409
Phone: 336 524797 , Fax: 33649.070
NCBEIS C-0950 DATE: 01-30-14
REF: PR0D\1831-01\dwg\ESSEXFARM.dwg
LI, N FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
p�G P.O. Box 848/210 IIospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
Al
Ilp 1 t or. Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both
ype of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT"** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
-�� 73
Name to be Billed Asc /oc ✓6aoprtrNT 52% i^v-- Contact Person 72'ARY J8f v;X
Billing Address A-6 3./o Home Phone
City/State/ZIP_&Jocr='"d ' - Z got t3 Business Phone 7S/ - 790
Name on Permit/ATC if Different than
Mailing Address
PROPERTY INFORMATION *Date House/Facility Comers Flagged
NOTE: A survey plat or site plan must accompany this application.
Included: ❑ Site Plan R lat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name AO -_ An6reopr 4 -ii C% IeSG
Phone Number 7S/ - 73—
Owner's Address /°o doh 2
City/State/Zip /tfoct c �icc.r .VG 17oZs
Property Adcjlres
Lot Size �) Tax PIN#
Subdivision Name(if applicable) ES=
Directions To S C S
City �s
G q
Sectiioul ot# v
R <rT i ,e "T CVLi
S 4
f the answer to any of the following kiiestionslis "yes", supporting documentatio} must be a ched.
Are there any existing wastewater systems on the site? ❑Yes 2p1
Does the site contain jurisdictional wetlands? ❑Yes CPAP
Are there any easements or right-of-ways on the site? Bles ❑ o
L�
Is the site subject to approval by another public agency?
Will wastewater other than domestic sewage be generated?
❑Yes
Dyes LW
I y1111[il l046,.icf3i?:i70114112A
I# People # Bedrooms _16 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No
Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No
IF NON -RESIDENCE FILL OUT T14E 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: 6-6nventional ❑Accepted ❑Innovative ❑Altemative ❑Other
Water Supply Type: cKounty/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?
❑ No
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 of 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
locating an ging or staking the house/facility location, proposed well location and the location of any other amenities.
Site Revisit Charge
Prope r s or o rer's legal representa re
Date(s):
7 Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No Account #
Revised 11/06 Invoice #
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
Account #: 990004425 IMPROVEMENT PEIWJ'lf)IN/EH M 5870-64-2265.62
Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 62
Address: PO Box 340 Location/Address: Cornatzer Rd -27006
City: Mocksville Property Size: 0.689 acre
Reference Name: Brad Coe
Proposed Facility: Residence
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a was system must be obtained from this office prior to the
construction/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to
revocation if site plans, plat or the intended use change.
Pemut Type:,.21qew ❑Repair. ❑Expansion Permit Valid for: 05Years o Expiration
Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD):14&) Type of Water Supply;.,?rCounty/City OW ell ❑ Community Well
Site Modifications/Permit Conditions:
Site Plan
980
S sterq Type LTAR
Initial !
Repair 0
Environmental Health
St
a
t
an
Date