1393 Cornatzer RdDo --7kuR
DAVIE COUNTY HEALTH DEPARTMENT ov-xo
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
--*NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
IMS 60rA(dn0_
Sanitary Sewage Systems Permit Number
Name Date N2 7007
Location V, 'K '-'
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 Spec . ifications for System:
Auto Dish Washer YES ❑ NO fD
Auto Wash Ma thine YES p NO,[-]
A F
Type Water Supply
*This permit Void if sewage -System described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
�, QA
-.5
,�
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 704-634-59
Final Installation -Diagram: System Installed by
-----------
/06'
mo
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, NC 27028
1. Application/Permit Requested By. 24 11 A Ct1
Mailing Address R n ctte_ :r3, 0 �C d i%%o cJ S l/i / e_ Z2, Gt 02 70,9Y
Home Phone Business Phone 3 6f : % �S
2. Name on Permit if Different than Above e:�e O n to 11% �a.n
3. Application/Permit for: ❑ General Evaluation V Septic Tank Installation
4. System to Serve: IH'House ❑ Mobile Home ❑ Place of Public Assembly
❑ Business ❑ Industry ❑ Other ❑ Unknown
5. If house, mobile home: Subdivision Section Lot #
❑ Basement/Plumbing
No. of People asement/No Plumbing
No. of Bedrooms P plashing Machine
No. of Bathrooms
❑Dishwasher
Dwelling Dimensions X 0. ❑ Garbage Disposal
6. If business, industry, place of public assembly, other: Specify type
No. of People Served
No. of Commodes
No. of Lavatories
No. of Sinks
No. of Urinals
No. of Water Coolers
No. of Showers Water Usage Figures _
7. Type of water supply: [ Public ❑ Private
8. Property Dimensions a -V 'a Sewage Disposal Contractor
9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes E(No
If yes, what type?
❑ Community
'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to
revocation, if site plans or the intended use change. Effective October 1, 1989.
Directions to Property: %K e. ) 5 $ &L. - !� r n (`, the o r.. M I i1'% h� R o J +Lt -r t' C" n 4 o s-,
Corn%:�--2'e-(- kio&. 5b 1)-D 4'.- 3rd Cock A0%veLJALy 0-hyowr r�5b —1
%.s e�; ��- ► -� ra r`� aG roSs �o cd rn ti+�-�6V� l �J- 67 tw�,
This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges
incurred from this application.
DATE SIGNATURE
CONSENT FOR SITE EVALUA ION TO BE DONE ON ABOVE DESCRIBED PROPERTY
MUST CHECK ONE: P,16 OWN the property. ❑ 2. 1 DO NOT OWN the property.
If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner:
I herebygive consent to the authorized re resentat• of the Davie ourr��ty Health Depa ent to nter u_p0n above described
propertocated in Davie County and owned by C&Ola nam d �; 1, �', m` �c n c� c�!'.
to conduct all testing procedures as necessary to determine said site's suitability for a ground abs rption sewage treatment
and disposal system.
/
M A a� DATE �SIGNATURE
DCHD (12.90)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME b N A �c DATE EVALUATED _
- 9s�
ADDRESS S p PROPERTY SIZE Z'A 4�
PROPOSED FACIILTY V\ o e, sg LOCATION OF SITE Lam' R�
Water Supply: On -Site Well Community Public
Evaluation ByO k Auger Boring Pit Cut
FACTORS
1
2
3
4
Landscape position
5
Sloe Z
&'15
HORIZON I DEPTH
2`
2
Texture group
CD—
Consistence
Structure
Mineralogy
'.1
1 ',
HORIZON II DEPTH
Texture groupC
Consistence
7 7
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
S
_75
RESTRICTIVE HORIZON
--�
SAPROLITE
-�
—
CLASSIFICATION
3
LONG-TERM ACCEPTANCE RATEI
i
�-t
SITE CLASSIFICATION: �'X -.7,>
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD(01-901
EVALUATED BY:
OTHER(S) PRE S NT:
> — V
END
Landscape Position
R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope
CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope
Texture
S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt
SICL-Silty clay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR-Very friable FR -Friable FI -Firm VFI-Very firm EFI-Extremely firm
Wet
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic
Structure
SC -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky
SBK-Subangular blocky PL -Platy PR -Prismatic
Mineralogy
1:1, 2:1, Mixed
Notes
Horizon depth - In' inches
Depth of fill - In inches
Restrictive horizon Thickness and inches from land surface
Saprolite - S(suitable), U(unsuitable)
Soil wetness - Inches from land surface to free water or inches from land surface to soil colors
with chroma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
■E■
■E■
■E■
Davie County, NC Tax Parcel Report Tuesday, September 27, 2016
I
. . .........
126
MILLING RD
. . .. ..........
(290)
z
UI
1359
(238) 176.32 52 72 12 90
7 6 735 3235
2_
Pia f In
Parcel Number:
72 (89)
Township:
Shady Grove
NCPIN Number.
5769147291
'2548
CC
J;
Census Tract:
c.
c
Listed Owner 1:
HORTON DAVID CHRISTOPHER
Voting Precinct:
WEST SHADY GROVE
W
L9285
g285
co
Planning Jurisdiction:
10
U
1400
MOCKSVILLE
Zoning Class:
C-0
C%j
Lo N
C'4 C14
7291-
NC
Zoning Overlay:
Zip Code:
27028-7137
Voluntary Ag. District:
No
(342)
1.2 AC CORNATZER RD
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
0.94
FRANK ...... l—IRL
CORNATZER
190.79
_190.79
1/2001
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
2001 E0275
Soil Types:
PcB2,GnB2,RnD
Plat Book:
Flood Zone:
x
Plat Page:
.... .... .......
�1390—
65660.00
Outbuilding & Extra
10.00
4008
Freatures Value:
Land Value:
24090.00
1381
<
Cc)
1004
Total Assessed Value:
CN
t 7061: ,
gn4
52
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, NC
implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold
harmless the Countyof Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
vivre
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.
WARNING: THIS IS NOT A SURVEY
Pia f In
Parcel Number:
H600000064
Township:
Shady Grove
NCPIN Number.
5769147291
Municipality:
Account Number:
82518268
Census Tract:
37059-804
Listed Owner 1:
HORTON DAVID CHRISTOPHER
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
1393 CORNATZER ROAD
Planning Jurisdiction:
Davie County
City:
MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-7137
Voluntary Ag. District:
No
Legal Description:
1.2 AC CORNATZER RD
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
0.94
Elementary School Zone:
CORNATZER
Deed Date:
1/2001
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
2001 E0275
Soil Types:
PcB2,GnB2,RnD
Plat Book:
Flood Zone:
x
Plat Page:
Watershed Overlay:
Building Value:
65660.00
Outbuilding & Extra
10.00
Freatures Value:
Land Value:
24090.00
Total Market Value:
89760.00
Total Assessed Value:
89760.00
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, NC
implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold
harmless the Countyof Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or
vivre
causes of action due to or arising out of the use or inability to use the GIS data provided by this website.