1568 Cornatzer Rd t
DAVIE COUNTY' HEALTH DEPARTMENT
T
j t .IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION . r
4 , cJv
*NOTE:Issued.in Compliance With Article II of G.S.Chapter 130a }'
Sanitary Sewage Systems Permit+Number
Name Date �'1 N4
64 73
Location a'�f .'S � ;s v i 1 .�, :�?U.�: t'll.:,(;
Subdivision Name F\T
Lot No.
Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedroomst• —
--•J .NO. Baths ? No. in Family
Garbage Disposal YES ❑ NO Q' Specifications for System:
Auto Dish Washer YES-E] NO e-'
Auto Wash Ma,hine YES U', NO ❑
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 uusCe�change.
QD
y _t
d
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 704-634-5985.
Final Installation Diagram: System Installed by
Q
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.
�" • j APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT
t� Davie County Health Department
Environmental Health Section
P. 0. Box 665
Mocksville, NC 27028
I, �s1 . Application/Permit Requested By �pp A fy
Mailing Addresser;
Home Phone ??9Business Phone
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: 0 General Evaluation 0 S/Tank Installation
S. System to Serve: 0 House Plr�Mobile Home 0 Business
0 Industry u Other 0 Unknown
6. If house,,:`mobile home: Subdivision Sec. Lot#
No. of People Dwelling Dimensions
No. of Bedrooms Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
%0,, shing Machine rj Dishwasher 0 Garbage Disposai
04
7. If business, industry, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
8. Type of water supply: ublic 0 Private 0 Community
9. Property Dimensions S.
10. Sewage Disposal Contractor
11 . Do you anticipate additions/e�xpa cions of the facility this system is
intended to serve? 0 Yes � ` o
If yes, what type?
*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.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
chargers incurred from this apple ation.
J
U to Signature
Directions to Property :
C%o ep
1
DCHD (10-89)
A P
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME P cct.e s a N c DATE EVALUATED S -
ADDRESS \\ PROPERTY SIZED
PROPOSED FACIILTY LOCATION OF SITE Z
Water Supply: On-Site Well Community Public
Evaluation ByC'E-L Auger Boring `/ Pit Cut
FACTORS 1 2 3 4
Landscape position S
Slope % 0- 711, o-$6
HORIZON I DEPTH (D
Texture group CL
Consistence F= VT -T
Structure C P_
Mineralogy '
HORIZON I.I. DEPTH 6 2 ' 4,
Texture groupS `}
Consistence
Structure a.
Mineralogy ►t,I l i r S o i a
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS SS S S
RESTRICTIVE HORIZON
SAPROLITE — V
CLASSIFICATION S 5 S
LONG-TERM ACCEPTANCE RATE -.yo ;3;-i O
SITE CLASSIFICATION: .S EVALUATED BY:
LONG-TERM ACCEPTANCE RATE: '3 `y OTHER(S) PRESENT: <' C_--:;x-
REMARKS: -ko - �*� " R-s*c-
LEG ND
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 plait; ' 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
DCHD(01-901
I
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Davie County .71ealK Dye
and .�fome .1�ea'ltFr yency
210 HOSPITAL STREET/P.O. BOX 665
MOCKSVILLE.N.C. 27028
PHONE:(704)634.5985
May 13, 1991
James E. Nance
Rt. 31 Sox 545
Mocksville, NC .27028
Re: Site Evaluation
Cornatzer Road 5.2 Acres
Dear Mr. Nance:
As requested, a representative from this office visited the aforementioned
site on May 9, 1991. The site 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,
Charles E.' `Li'ttle, R.S.
Environmental Health Section
CL/wd
Enclosure