1975 Cornatzer Rd (3) DAVIE COUNTY HEALTH DEPARTMENT
`-" 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 '(/,erf �d '.57�3r' Date � �/r� '� N2 6741
Location ,���G i ',,'r`i7
�GG� � / �l,'i'S";''� i1•-'� /F'�/ � ���')•- % �: ,r %� ,,fir° ' — .r..- s;�"`
.Subdivision Name Lot No. - Sec. or Block No.
Lot Size 7 House Mobile Home Business Speculation
No. Bedrooms No. Baths No.,in Family
Garbage Disposal YES .-] NO p' Specifications for System: o
Auto Dish Washer YES NO
Auto Wash Machine YES T NO fl /(Ti'G�4 J� ✓"
Type Water Supply t4d _
�Q
*This permit Void if sewage system described below is not installed within 3G months from date of issue.
L�
Improvements permit byZ�Z
*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 combletion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
11U
b ,
�Dr
Certificate of Completion Date.—S)//S
t
*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.
i ,
` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
Davie County Health Department
` Environmental Health Section / q
P. 0. Box 665
I D Mocksville, N.C.27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
Home Phone
1. Permit Requested By D i 4 Business Phone
2. Address r--
3. Property Owner if Different than Above
Address
4. Permit To: a) Install �!-_'ZIter Repair
b) Privy Conventlonal ✓Other Type—
Ground
ype Ground Absorption �--
c) Sub-Division Sec. Lot No._ 6 ( O
5. System used to serve what type facility: House Mobile Home Business
IndustryOther
b) Number of people
6. a1 If house or mobile home, state size of h e and number of rooms.
House Dimensions /Ve O
Bed Rooms 3 Bath Rooms 2— 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) 1
7. Number and type of water-using fixtures:
commodes urinals garbage disposal
lavatory o2 showers Z washing machine
dishwasher sinks
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved?Yes_A�fNo
9. a) Property Dimensions L _
b) Land area designated to building site .3 X r cx /qG 'e�,} -
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is corr the best of my knowledge.
/ f9
DateOwner Signature
PO
OWNER IS SOLELY RE NSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
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' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
/ SOIL/SITE EVALUATION
Name �✓ Date
Address Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position (:i) (5� -WS
PS PS PS S
U U U U
2) Soil Texture (12-36 in.) Sandy, �S
Loamy, Clayey, (note 2:1 Clay) t7
U
3) Soil Structure (12-36 in.) S S
Clayey Soils ( t� J3/ t-s)
''�Cjj
4) Soil Depth (inches) NO S, S SS
U - dup
5) Soil Drainage: Internal CPS k
PS
U U U
External S S S S
PS PS PS S
U U U U
6) Restrictive Horizons
7) Available Space
PS PS PS PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U . U
9) Site Classification '-S- I J`te )1? S—
U—UNSUITABLE S—SUITABLE -PS...Provisionally Suitable
Recommendations/Comments: c,?'qaO'Q1 r-Z2Ze
Described by Title Date
SITE DIAGRAM
�l
,wood
2 .
Dade County Nealti rDe ar&nent
and .glome Aealtli envy
210 HOSPITAL STRLLT P.O.BOX Oas
MOCKSVILLi,N.C. 27026
PHONY(704)694.5986
April 19, 1989
Roy Potts .
P. 0. Box 11 a
Advance, NC 27006 � .
Re: Site Evaluations/Cornatzer Road
Across from Hickory. Hill II/
Tracts 1, 2, & 3 ;
Dear Mr. Pottac
On April 19, 1989, as .you requested a representative from this office
visited the above mentioned sites. The soil on these three tracts was found
provisionally suitable for the installation of a ground absorption sewage
system. .
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure
. r .