417 Cornatzer Road Lot 3Davie County, NC r Tax Parcel Report Friday. November 18. 2016
WARNING: `1731515 NOT A SURVEY
Parcel Information
Parcel Number:
1615OA0003
Township:
Shady Grove
NCPIN Number:
5758730015
Municipality:
Account Number:
82523505
Census Tract
37059-804
Listed Owner 1:
BROWN PATRICIA ANN
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
417 CORNATZER ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class: DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 3 CORNATZER HEIGHTS
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
0.50
Elementary School Zone:
CORNATZER
Deed Date:
10/2004
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
005790001
Soil Types:
Gn82
Plat Book:
0005
Flood Zone:
Plat Page:
157
Watershed Overlay:
DAVIE COUNTY
Building Value:
67870.00
Outbuilding & Extra
Freatures Value:
90.00
Land Value:
14010.00
Total Market Value:
81970.00
Total Assessed Value:
81970.00
1:01
All data Is provided as is vNthout warranty or guarantee of any Idnd either expressed or implied Including but not limited to the
Davie County, Implied warrantles of merchantability or Rtness for a particular use. Ag users of Davie County's GIs website shall hold harmless the
County of Davie, North Carolina, Its agents, consuhants, contractors or employees from any and all claims or causes of action due to
NC or arising out of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Account #: 990005853 Tax PIN/EH #: 1615OA0003
Billed To: Trish Brown tSubdivision Info: Cornatzer Heights Lot # 3
Reference Name: REPAIR PERMIT ? LocationiAddress: 417 Comatzer Rd -27028
Proposed Facility: Residential Repair Property Sizel`- - 0.50 Acres
ATC Dumber: 5911
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 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.
System Type: S.T. Manufacturer Tank Date Tank Size
Pump Tank Size Bedrooms
System Installed By: Inspector#: Date:
GPS Coordinate:
Environmental Health Specialist:
DCHD 11/06 (Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210. Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
AT*�MW�hisMlhorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to.issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms -3_# Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: ®,County/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) 3GQ .Tank Sizeex S n GAL. Pump Tank oo GAL.
Trench Width 31t` Max. Trench Depth_3_GL Rock Depth Linear Ft -3b0' o?-S'Ao _
Site Modifications/Conditions/Other: %2CG(uGA6n
Contact the Davie County Environmental Health Section for final inspection of this system between
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990005853
Tax PIN/EH #:
1615OA0003
Bided To:
Trish Brown
Subdivision Info:
Cornatzer Heights Lot # 3
Reference Nanie:
REPAIR PERMIT
LocationlAddressi.
417 Comatzer Rd -27028
Proposed Facility:
Residential Repair
Praperty Size:
0.50 Acres
Site Type:
❑New kRepair ❑Expansion
AT*�MW�hisMlhorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to.issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms -3_# Bathrooms # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: ®,County/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow (GPD) 3GQ .Tank Sizeex S n GAL. Pump Tank oo GAL.
Trench Width 31t` Max. Trench Depth_3_GL Rock Depth Linear Ft -3b0' o?-S'Ao _
Site Modifications/Conditions/Other: %2CG(uGA6n
Contact the Davie County Environmental Health Section for final inspection of this system between
J DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION..
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) ��� •�
NAME PHONE NUMBER 3b(p-g72-%ySS_
ADDRESS 06Yrrl.a 7X4- SUBDIVISION NAME A 1
DIRECTIONS TO SITE & Ll 4-0
LOT #
S"h w 6 d- hdLAR— 0-1 0:
71'Orlj']w1 S 1�1 QGI� s�ir✓t��rf'S
DATE SYSTEM INSTALLED t �7 NAME SYSTEM INSTALLED UNDER ?
TYPE FACILITY NUMBER BEDROOMS —S NUMBER PEOPLE SERVED
TYPE WATER SUPPLY CQUbSPECIFY PROBLEM OCCURRING �� G I -CO '1
)
YAA r) V1 Inc( M4 1'" t/a
DATE REQUESTED a" 22-12 INFORMATION TAKEN BY Oh -Z irlq
This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT.
Rev. 1193
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se age Treatment and Disposal Rules (10 NCAC 10A .1934-1.96) Permit Number
�.•
Name �fisC�
it�o-� Date i �; 0
Location ��S!F '/
Subdivision Name `'�") �i i - ILJs Lot No. Sec. or Block No.
Lot Size, /'(-- /I House �~ Mobile Home _ Business Speculation
No. Bedrooms J No. Baths No. in Family
Garbage Disposal YES ,[:] NO �
Specifications for System:;
Auto Dish Washer YES p NO El re� 41)
,• j XI
Auto Wash Machine YES` ] NO .p CI (� y`S t/ J) !J
Type Water Supply __— 'C ✓t
"This permit Void if sewage system described below is not installed._ withiD–Z6 months from date of issue.
F
Improvements permit by 'Z '- ���5i
`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:
S tem stalled bye--� /21fes/
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.
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
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
1. Permit Requested By t�D�/!n/� �7�s Business Phone
2. Address Tom` -
3. Property Owner if Different than Above
Address
4. Permit To: a) Install Alter Repair
b) Privy Conventional Other Type
Ground Absorption oAr2
C) Sub-Divisioor* 77__47-X � Sec. Lot No.�
5. System used to serve what type facility: House_i::: lobile Home Business
Industry Other
b) Number of people ?5Z�
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions
Bed Rooms_ , Bath Rooms I Den w/Closet
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 /
lavatory
dishwasher
urinals garbage disposal
showers washing machine
sinks
8. a) Type water supply: Publics Private Commynity
b) Has the water supply system been approved? Yes it No
9. a) Property Dimensions—,Z o d I 9 �2_ 0 O
b) Land area designated to building site _
C) Sewage Disposal Contractor it u� R �SG--,�T % —� /�� tl" C C-
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? AV"/ -2
What type?
This is to certify that the information is correct to the best of my knowledge.
I
uw
Date Owner Sign ure
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
DCHD (6-82)