451 Cornatzer Rd (2) i. �....w....w+cV".r�'rwau•.u.'S'4s..1.-,f v.. .4-..'.. �..r«. -wM»v`'a`.r..F`�Y- .i -. _•_- Y.r.ra.'i`... -,.,.1"_. ..4;_•.c... _....,.,. �. ._ ... -...__..
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 cin, 11 r•.it, : r Date —x- 2 3 - $Ir
Location Inq f , E. It D (4 j ?t_ � .�., t. ; + �� t'L t r. i I.I 1 7
Subdivision Name Lot No. - Sec. or Block No.
Lot Size—?1 rf• House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES 0` NO ❑
Auto Dish Washer YES p NO E] Specifications for System: I dui ice'"- +•�-k'
1 %?``'�
Auto Wash Machine YES p NO ❑
Type Water Supply ---
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
t
h
13v �
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 t,
17
r
/AV_
r i i Completion /� ��
e t f cate of Co p _� Date
C f
"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.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
- A"es "t,-�,�, Date x 2 —/j
Name \
Address L�y�-u �� '�� ) Lot Size
FACTORS AREA 1 AREA 2 AREA 3 AREA 4
1) Topography/Landscape Position S S S S
ag:� ® PS
U U U U
2) Soil Texture (12-36 in.) Sandy, S S S S
Loamy, Clayey, (note 2:1 Clay) 4:1. CfFM--> PS
U U U U
3) Soil Structure (12-36 in.) S S S S
Clayey Soils �� ® PS
U U U U
4) Soil Depth (inches) 30 �� Gly 30�� 30" <::!!� PS
U U U U
5) Soil Drainage: Internal S S S S
2E> C±9:> PS
U U U U
External e5&5:> <n�� S
PS PS PS PS
U U U U
6) Restrictive Horizons
7) Available Space � S S
PS
U U U U
8) Other (Specify) S S S S
PS PS PS PS
U U U U
9) Site Classification �� _ 6
U—UNSUITABLE S—SUITABLE SPS—Provisionally Suitable
Recommendations/Comments: CA
,�,.C�� w.�, f?ow.� t.-��.- .�auc1�- •3- S� ,vo r,�
- 1U14 u l.•/ 4WD s ti r/ S" F h Al.—.-
Described by Title A Date Z-16-
.SITE DIAGRAM
InAW,�f; rt C,
z 70
s'
fl I
icy 9iS- S7L7- V7/7
DCHD(6-82)
APPLICATION FOR SITE EV/%LU,4T ION/IMPROVEMENTS PERMIJ
Davie County Health D,rpartmem Z�I
Environrnental Hoalfh Section �Q,t
P. 0. Ekix 665
Alocl(sville, N.C. 27028.
CONSTRUCTION SMALL.NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS 84iF.N I&WfiIa
• Home Qpone
1. Permit Requested Ely JAMOZ �L=.tel �,U L Husineas Ph6ne 99 PM,/00
2. Address O / d �!_�Q � - l� z
3. Property Owner If Different than Above
_ Address
4. Permit To: a)Instsfl.L�Alter Repeir__-
b) Privy Conventional-ef'otlter Type___
M A P (around Absorplion TrAcT
�-
& System used to serve what type facility: House-r Mobile Herne Elusine$s._.
Industry_—Other.__
b) Number of people
f3. a) If hol.se or mobile home,state size of home and number of rooms.
House Dimensions 3X0
Bed Rooms ,f 3 Bath Rooms..3 -Den w/Closet. ._
b) " Business, Industry or Other. State: Number of persons served
What type business, --
Estimate amount of waste daily (2-4 hours)-----.--..-
7.
ours)_-_ _.—_..-7. Number and type of wager-using lixtures:
commodes 3 �_. urinalsgarbage disposal —..
lavatory -� __ showers 1-7 .washing mwhlne_/ _
dishwasber sinks.—J_;..__....
8. a)Type water supply. Public_L�___F'rivaje-_—_—Community
b) Has the water supply system been approved? Yes o_.._._.
9. a) Property Dimensions
b) Land area designated to building sit:i .�.��
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of (tie facility this sewalte system is Intended to serve?
What type?
This is to cortity that the.information if. correct to the best of my knowledge.
Owner Si natu �L
Date g
OWNER 11; SOLELY RESPONSIBLE FOR COMPLIAN:'E WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property.
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pavie ( auntu; Health pepar#men#. _
ana Home Health '�genty
P. O. BOX 665
�flocksuffle, North Carolina 27028
OFFICE OF THE DIRECTOR - TELEPHONE
17041 634-5985
February 19, 1985
Mr. Roy Potts
Potts Realty
P.O. Box 11
Advance, N.C. 27006
Re: Property Evaluation, Cornatzer Rd.
James E. Hendrix, Buyer
Dear Mr. Potts:
As per your request the aforementioned property was evaluated by this
office on February 15, 1985 for the purpose of determining the soil/site
suitability for the installation of an on—site sewage system. After said
evaluation was completed and all necessary information was gathered from
the prospective buyer, this office can forsee no problems in issuing the
Improvements Permit to install a sewage system.
Should this office be of further assistance to you concerning this
matter, please advise.
Ie
cerely,m ,Mando, R.S.
Environmental Health Coordinator
Davie County Health Department