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112 Wyatt Drive Lot 59Davie County, NC Tax Parcel Report Tuesday, December 20, 2016 I WARNING: TMS IS NOT A SURVEY Parcel Information 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: F803OA0059 Township: Shady Grove 5870633848 Municipality: 8306613 Census Tract: 37059-803 GARCIA ERNESTO Voting Precinct: EAST SHADY GROVE 112 WYATT DRIVE Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R -A NC Zoning Overlay: 27006 Voluntary Ag. District: LOT 59 ESSEX FARM PHASE 1B Fire Response District: 0.69 Elementary School Zone: Land Value: Total Assessed Value: 7/2016 Middle School Zone: 010231023 Soil Types: 9 Flood Zone: 388 Watershed Overlay: Outbuilding & Extra Freatures Value: Total Market Value: 29 ADVANCE SHADY GROVE WILLIAM ELLIS GnB2 DAVIE COUNTY 9 tuv I� All 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 �ouK c� NC or arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT Davie County Health, Department +A 210 Hospital Street P.O. Box 848' •`a,.~'• Mocksville; NC 27'02& Phone: 336-753-6780 Fax: 336-753-1680 Applicant: RS Parker Homes Address: 502 Hickory Ridge CRY: Greensboro State/zip: NC 27409 Phone #: (336) 978-7120 Address/Road #: 112 Wyatt Drive Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC Property Owner: RS Parker Homes Address: 502 Hickory Ridge City: Greensboro statelzip: NC 27409 one #: (336) 978-7120 Subdivision: Essex Fane *IP Issued by. 2140- Nations. Robert *CA issued by: 2140- Nations. Robert Design Flow: 4 8 0 Soil Application Rate: 0 2 7 5 Nitrification Field No. Drain tines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Phase: trot: 59 directions Hwy 64 East left on Coimatzer Rd. past Beauchamp Rd. on left *System Classification/Description: ' TYPE III B. SYSTEM WtSINGLE EFFLUENT PUMP Saprolite System? 0Yes No "Distribution Type: PUMP TO GRAVITY Pump Required? Yes 0 No "Pre Treatment: 1 7 4 5 Sq. ft. 5 4 3 6 ft. a alnches O.C. iVFeet O.C. 3 Inches Feet inches Minimum Trench Depth: 3 Inches Minimum Soil Cover: 1 8 inches Maximum Trench Depth:'3 6 Inches Maximum Soil Cover: 4 Inches *System Type: INFILTRATOR OUICK 4 STANDARD Installer: Frank ransou Certification #: 2711 *EHS: 2140 - Nations. Robert Date: 0 2/ 1 1/.2 0 1 6 CDP Fite Number 196228 - 2 Countv ID Number: 5870633848 Manufacturer: Shoat STB: 760 Gallons: 1000 Date: 0 9/ a 6/ a 0 1 5 "Filter Brand: POLYLOK PL -122 With Ike Adapter ST Marker: ❑ Yes O No nforced Tank: ❑ Yes FOI No 1 Piece Tank: El Yes R1 No F Manufacturer. scat PT: 64 Gallons: 1250 Date: 1 2/ 0 5 /. 0 1 5 RiserSealed 0 Yes ❑ No RiserHeight: ® Yes ElNo (Min.6 in.) nforced Tank: ❑ Yes 0 No 1 Piece Tank: 51 Yes ElNo j Pipe Size: 2 inch diameter Pipe Length: 1 1 1 feet *Schedule: 40 Pressure Rated ral Yes 13No Approved fittings Q Yes ❑ No Lat. I Lung: Installer. Frank transou Certification #: 2771 THS: 2140 - Nations, Robert Date: 0 2/ 1 1/ 2 0 1 6 u mp Tank Installer Frank Transou Certification #: 2771 "EH S: 2140 - Nations, Robert Date: 0 2 / 1 1 / 2 0 1 6 ppty Line Installer Frank Transou Certification #: 2771 THS: 2140 - Nations. Robert Date: 0 2/ 1 1/ 2 0 1 6 ............ r Pump Type: Zoeter Installer. Frank Transou Dosing Volume: — Dat Certification #: 2771 Draw Down: Inches *EHS: 2140 - Nations, Robert *Chain: ROPE Date: 0 a/ 1 1/ a 0 1 6 Valves Accessible p Yes ❑ No Flow Adjustment valve W Yes ❑ No Check -valve❑ Yes ❑ N O W,050`119, �4t�� p �2 = YX PVC Unions ® Yes ❑ No. - ►p!ed E?sarptd went Hole ® Yes ❑ No]aab� Anti -siphon Hale ril Yes ❑ No j Pipe Size: 2 inch diameter Pipe Length: 1 1 1 feet *Schedule: 40 Pressure Rated ral Yes 13No Approved fittings Q Yes ❑ No Lat. I Lung: Installer. Frank transou Certification #: 2771 THS: 2140 - Nations, Robert Date: 0 2/ 1 1/ 2 0 1 6 u mp Tank Installer Frank Transou Certification #: 2771 "EH S: 2140 - Nations, Robert Date: 0 2 / 1 1 / 2 0 1 6 ppty Line Installer Frank Transou Certification #: 2771 THS: 2140 - Nations. Robert Date: 0 2/ 1 1/ 2 0 1 6 ............ r Pump Type: Zoeter Installer. Frank Transou Dosing Volume: — Dat Certification #: 2771 Draw Down: Inches *EHS: 2140 - Nations, Robert *Chain: ROPE Date: 0 a/ 1 1/ a 0 1 6 Valves Accessible p Yes ❑ No Flow Adjustment valve W Yes ❑ No Check -valve❑ Yes ❑ N O W,050`119, �4t�� p �2 = YX PVC Unions ® Yes ❑ No. - ►p!ed E?sarptd went Hole ® Yes ❑ No]aab� Anti -siphon Hale ril Yes ❑ No CDP File Number 196228 - 2 NEMA 4X Box or Equivalent ® yes Box 12 inches Above Grade ® Yes Box Adj.To Pump Tank ® Yes Conduit Sealed Q Yes Pump M anually 0 parable p Yes =ActivationMethod: PIGGYBACK' Alarm Audible ® Yes Alarm Visible R Yes 2140 • Nations. Robert "Operation Permit completed by: Authorized State Agent: Owner/Applicant Signature: County ID Number: 5870633848 mens Installer Frank Transou Certification #: 2771 " EH S: 2140- Nations, Robert Date s '2 / 1 1_/, a 0 1 6 Date of Issue: 0 2/ 1 1/ 2 9 1 6 This system has been installed in compliance with applicable NO General Statutes: Article 11, Chapter 130A, Rules for Sewage; Treatment and Disposal,15ANCAC 16A .1900 of Seq.,,and all conditions of the Improvement Permit and Construction Authorization. This property is served by.a TYPE In s. Sewage septic system. Rule .1961 requires that a Type TYPE Iii B• septic system meet the following criteria Minimum System Review ByThe Local Health Department: 5YRS. Management. Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator. NIA Reporting Frequency By Certified Operator. WA Rule .1.961 requires that a,Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entity with`a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entitywith a certified operator forthe life of the septi system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system, required to be maintained bya public orpnvate management entity, unless the system owne rand certified operator are the same'. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems, operator, provisions that the contract shalt be in effect for as long as the system is in use, and other requirements forthe:continued proper performance of the'system. Itshall also be a condlion of the Operation Permit that'subsequent`owners of the systems execute such a contract. @Hand Drawing (Import Drawing **Site Plan/Drawing attached.** �' OPERATION PERMIT 196228-2 Davie County Heath Department CDP File Number: 210 Hospital Street 5870633848 P.O. Box 848 County File Number: Mocksville NC 27028 Date: / O Inch Drawing Drawing Type: Operation Permit 9'r O Scale: , ONIA k ZI V, -------- - -�,o� e,-( 1 &01 i 0 ell I 17- -17- CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 196228 - 2 °: r. Davie County Health Department County ID'Number: 5870633848 >` 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 8/ 1 8/ a 0.1 0 Applicant: RS Parker Homes Address: 502 Hickory Ridge City: Greensboro State/Zip: NC 27409 Phone #: �(336)978-7120 Pro Address/Road #: 112 Wyatt Drive Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC Property Owner: RS Parker Homes Address: 502 Hickory Ridge City: Greensboro State/Zip: NC 27409 Phone #: (336) 978-7120 1� n Subdivision: Essex Farm Phase: Lot: 59 Directions Hwy 64 East left on Cornatzer Rd. past Beauchamp Rd. on left cificati Classification: Provisionally suitable Minimum Trench Depth: .1 4 Inches \Site Saprolite System? O Yes (9 No Minimum Soil Cover: 1 2 Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 , 2 7 5 Maximum Soil Cover: —.2 4 Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 0 0 0 Gallons *Proposed System: 25% REDUCTION 1 -Piece: O Yes ® No Pump Required: ®Yes 0 N O May Be Required Nitrification Field 1 3 4 5 Sq. ft. Pump Tank: 1 0 0 0 Gallons No. Drain Lines 5 1 -Piece: OYes ®No Total Trench Length: 4 3 6 GPM --vs-- ft. TDH ft. Trench Spacing: _ 9 O R Inches O.C. Feet O.C. Dosing Volume: Gallons Trench Width: 3 Olnches ® Feet _ Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: O NSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01011 O III 01V / Page 1 of 3 CDP File Number 196228 - 25870633848 County ID Number: , ❑ Open Pump System Sheet Kepalr System Kequlrea: v T es VINO V Ivo, Dui nas AvallaDle Space /Repair System Trench Spacing: 9 O Inches O. *Site Classification: Provisionally suitable — ® Feet 0. C. Trench Width: 3 O Inches Design Flow: 4 8 0 — ® Feet Soil Application Rate: 0 a 7 5 Aggregate Depth: inches *System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE 111 B. SYSTEM W/SINGLE EFFLUENT PUMP Minimum Soil Cover: 1 a Inches *Proposed System: 25% REDUCTION Nitrification Field 1 7 4 5 Sq. ft. No. Drain Lines 5 Total Trench Length: 4 3 6 ft. Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches *Distribution Type: PUMP TO GRAVITY Pump Required: ®Yes O No O May Be Required Pre -Treatment: O NSF OTS -I OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rema g 750 *Permit Conditions The issuance of this permit by the 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. Ceara tees ing 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be 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 Construction 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? O Yes O No Applicant/Legal Reps. Signature: Date: *Issued By: 2140 - Nations, Robert Date of Issue: 0 8 / 1 8 / a 0 1 5 Authorized Stat " fdhalfunction Log OYes ® Hand Drawing O Import 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 Drawing Drawing Type: Construction Authorization CDP File Number: 196228 - 2 County File Number: 5870633848 Date: 08/18 /.1015 O Inch Scale: O Block O N/A Page 3 of 3 P1 P2 r ` CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 196228 - 2 La I U �! l) P.O. Box 848 5870633848 Mocksville Nc 27028 County File Number: Date:A-8 / 18/ a 0 15 Click below to import an im�e from Jext�rrn�alplo/afeior: /erawing Type: Construction Authorization Ir Page 3 of 3 © q U G c 6 P1 P2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATRECEIVED Davie County Environmental Health P.O. Box 848/210 Hospital Street AUG 11 1015 Mocksville, NC 27028 (336)753-6780/ Fax (336) 753-1680 Application For: Site Evaluation/Improvement Permit authorization To Construct(ATC) ❑ Both �� ������ Type of Application: kew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***Ijb1PORTANT*** 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 S ?(Alitef OOnq -e-5 Contact Person 30Sp f 1 Billing Address Home Phone,33p • M , 7 C City/State/ZIP C Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPEKTY 1NFORMA ION *Date House/Facility Corners Flaeeed NOTE: A survey plat or site plan must accompany this application. Included:.K, Site Plan ❑Plat(to scale) (Permit is lid fo 60 months with site plan, no expiration with complete plat.) Owner's Name 5 1 T10S Phone Number?3V3'41,Wqq Owner's Address 1 City/State/ tp Of0 IJC. C Property Address city �Q rlcg _ Lot Size re Tax PIN# Subdivision Name(if a plicable) Section/I,ot# Directions To Site: ( 5 t'i t1Ct LGA } 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? ❑Yesto Does the site contain jurisdictional wetlands? ❑Yes Are there any easements or right-of-ways on the site? ❑Yes Is the site subject to approval by another public agency? Dyes, Will wastewater other than domestic sewage be generated? ❑Yes IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms L4 # Bat rooms Garden Tub/Whirlpool .,*es []NoBasement: ❑Yes o Basement Plum ine: ❑YesANo 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:Xonventional ❑Accepted ❑Innovative ❑Altemative EOther Water Supply Type:County/City Water ❑ New Well ❑Existing Well 0 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �No 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 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 corners and 19CN,ing an agging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge P1. o erI own is or owner)leg&I representative signature Date(s): 1 Client Notification Date: ate EHS: Sign given ❑Yes ENo Revised 11/06 Account #� Invoice # LOT 82 PB 12. Fr, 42 LOT 80 LOT 58 PROPOSED - --� PR�OSH HOM Dm�wAi `y C A CA v GRAPHIC SCALE Ym m so Rao 100 NOTE SURVEYOR HAS MADE NO INVESTIGATION OR INDEPENDENT SEARCH FOR EASEMENTS OF RECORD. ENCUMBRANCES, RESTRICTIVE COVENANTS. OWNERSHIP. TITLE EVIDENCE, OR ANY OTHER FACTS THAT AN ACCURATE AND CURRENT ( IN FI$P) TITLE SEARCH MAY DISCLOSE, THIS SURVEY IS PERFORMED WITHOUT THE 1 Leah 60 ft. EIMEFlT OF A TITLE SEARCH. NOTICE: RS PARKER HOMES HAS VERIFIED TO ALLIED LAND SURVEYING COMPANY, P.A. THE EX7ERIOR HOUSE DIMENSIONS FOR THIS E7aSTNG HOUSE/STRUCTURE. HOUSE POINTS AND POSITION SHOWN ON THIS MAP REPRESENT THE POINTS TO BE PLACED ON THE PROPERTY. THE OWNER/CONTRACTOR HAS RENEWED ALL HOUSE/STRUCTURE DIMENSIONS. SETBACKS FROM PROPERTY ONES, AND COMPLIANCE WITH RESTRICTIVE COVENANTS AND/OR LOCAL GOVERNMENTAL REQUIREMENTS ON TMS DRAWNG AND BY THEIR SIGNATURE AUTHORIZES AWED LAND SURVEYING COMPANY. P.A. TO PLACE THE POINTS AS.A000RATELY AS IS REASONABLE (TYPICALLY 0.OZ*t OWNER/CONTRACTOR TO VERIFY THE PLACEMENT OF POINTS SET IN FIELD PRIOR TO AUTHORIZATION OF FOOTINGS/BRICK MASONS/ CONSTRUCTION TO PROCEED. BY SIGNING THIS STATEMENT OWNER/ CONTRACTOR FULLY ACCEPTS THEIR RESPONSIBILM TO VERIFY POINTS IN FIELD. THE HOUSE POINTS DENOTED BY SOLID FLIED CIRCLES ARE THE ONLY POINTS TO BE LOCATED IN THE FEED. ALL 01HER BUILDING CORNER LOCATIONS ARE TO BE THE RESPONSIBILITY OF THE UNDERSIGNED CONTRACTOR/bEVELOPER. ACKNOWLEDGMENT- OWNER/CONTRACTOR DATE: FEED REVISION: OWNER/CONTRACTOR/AWED STAFF DATE PRELIMINARY LAYOUT LOT 59 "Essex Farm" Phase 1-13, revised Plat for. RS Parker ALS PROJECT NO. Esau Farm NOTE: THIS PLAT D06 NOT REPRESENT A CURRENT FIELD SURVEY. ALL LOT DIMENSIONS HAVE BEEN TAKEN FROM THE PLAT OF ESSEX FARM. PHASE 1-8, redeed. LOCATED IN PLAT BOOK 12 PAGE 42 NO TITLE RESEARCH HAS BEEN PERFORMED OR REQUESTED FOR THE BENEFIT OF TMS PLAT. QA&P� �D r S ite Eva] ❑New FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/Fax(336)751-8786 arovement Permit ❑ Authorization To Construct(ATC) ❑ Both ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility 1-ri* *THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMA Name to be Billed Contact Person %a'RRy .84764;X Billing Address A•o -li-.x 3f0 Home Phone City/State/ZIP 4629es ",< JC- 27028 Business Phone 7S/ 7300 Name on Permit/ATC if Different than Mailing Address PROPERTY 1NFOtC"AIION *Date House/Eacility Corners k1aggecl NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan lat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name D �Sc -y84oArr-ridi e% Phone Number 7S/ - 73-10Owner's Address /'odoX ?-r+.� City/State/Zip �/oun.+icc.r /�G_27oL8 Property Address City Lot Size o, Tax PIN# --6 - z tg - Subdivision Name(if app)icable) o�*Aej Sectiop/Lot# _ A 1f the answer to any of the following 4uestionstis "yes", supporting documentatio}� must be attAched. Are there any existing wastewater systems on the site? ❑Yes Rp, Does the site contain jurisdictional wetlands? ❑Yes DNo Are there any easements or right-of-ways on the site? Bles ❑No Is the site subject to approval by another public agency? oyes l 20 Will wastewater other than domestic sewage be generated? ❑Yes IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms _!;6 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No 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: ✓-Conventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: B County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No 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 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 locatin�anging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Prope r s or o er's legal representa re Date(s): 7 , Client Notification Date: Date—7--7—/ Sign given ❑Yes ❑No Account# 8 Revised 11/06 Invoice # -�� 73 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account #: 990004425 IMPROVEMENT PERf1dJ'PIN/EH #: 5870-64-2265.5q Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 51 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 wastewater 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. Permit Type: 9Kew ❑Repair. ❑Expansion Permit Valid for: M<Years ❑No Expiration Residential Specifications: # Bedrooms 'T # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): �0 Type of Water Supply: L<ounty/City ❑Well ❑Community Well AS stated in 15A NCAC 18A.1969(5) Site Modifications/Permit Conditions: ==Pled SystemsSL System Type LTAR Initial QfG t 4.pcj Q . 5 Re air I ry c c, y e ea m• a Environmental Health Specialist o. 0 Date /0—/7-0–(