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P82393 Howardtown Rd APPLICATION FOR SITE EVALUATIONAMPROVEMENTS PERMIT i� f O Davie County Health Department AU6 2 3 1993 1� D Environmental Health Section P. O. Box 665 �j ✓ Mocksville, NC 27028 1. Application/Permit Requested By ZI J• {{{ Mailing Address n Home Phone Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: general Evaluation ❑ Septic Tank Installation 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown :!!!�1 4Q- 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, 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 Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private ❑ Community 8. Property Dimensions—Z,1/ hewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No - ��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. Directions to Property: 2 �� - 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 EVALUATION TO BE DONE ON ABOVE DESCRIBE PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. I 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 hereby give consent to the authorized representative of the Davie C98nty Health Deportment to enter upon above described property located in Davie County and owned by.--45K¢l ,t 4 / to conduct all testing procedures as necessary to determine said site's sLMability for a ground absorption sewage treatment and disposal system. DATE SIGNAT — DCHD(12.90) • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED v<--?z ADDRESS 1. PROPERTY SIZE PROPOSED FACIILTY z 1 , LOCATION OF SITE . Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �� Pit Cut FACTORS 1 2 3 4 Landscape position L L A- L .4— Slope C._-Slo e % 2 HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texture group f1l; V4--j' S'9'1C Consistence Structure Mineralogy - HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: !;de )c- '"' EVALUATED BY: '& LONG-TERM ACCEPTANCE RATE: aC22 OTHER(S) PRESENT: REMARKS: LEGEND 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-Finn 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 watef 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 ■■/.■t;%■■.■��\■■/■.///.■■■■.■./.�.■.■.■■■.lei/iC�■■■■■.■..■■.■■/■ ■../■■.■■■■■■\�\.■■■■■.■■.■■■■■■.■■■■■EEE.%■■■■■.■\`\■■..■..■■■■■.■ ■.11..■■■■.■.■■■■.\■■■■■■■...■.■■.e.■■/.%..■■■...■■.t\'q■■■.■■..OMEN■ ■■1/■E■■■■EMM.■.■.■\E■■■E■■■O■■■■■■.EI.■■■...■M..e■■OM■\.■MMM■■■■Ee■ ■IIO■.t.■t�EEM■■■■■■■..EE■■■■M■e..■�..EM.E■MME■.�tEEOEEEE�E�IEEENEEt■ ■11■■■■E■■ ..■t■■M■rJ■■■■■■■.■■■■■■�1.■..... ■Me/ ■ ■ ■■.■ ■■■■■■MO ■ale■■■■M■ ■■.■■■■■► ■■■■■.■.■■■.■...■.■M..1�■.eui�t■�.C■■■■E■■.■EM..t■ ■.�1.■■■■■■■■■■■.I/EEO■■■■EEE■■■■O�\�■■■■■■■■■■■■t■■■■■■■■■/O.i■■.■■ ■■■e►wE■...wwe.■.■.■■■MEM.■M...■■.=.M►t■.■■...Et■■.■E■►.i■■eM■.M..■� ■■■■■■■■■■.■.■■■■■■■.N.M■■■■.■■■■■NO■■■■■.■■.■■■.■O ■OMEN.■E... ..................................................C■■EMMEMME...... ■■■■■es.■■M.■■..■■.■■■■.■■.■■■.. .■..M.■■E■■■.E■NEM■■■■■.■..OMEN ■■..■■.■■■■■se.E.M■E.■E■s■.■■.■■l�i■.■.e■■e■.t.■IE..■M■Ee.Et.■t■■.■ ■■sMM■MMM.■M.EM■■..■■M■M■■.■■MM■M■■■■■e■M.■■■■.■■.■.M■■■E ■■.■..■■ iii■iiiiiiio■iioiiiiii�■iiiiiiii=iiiiiei.�iiiiii�i.■■.e■■..■t■■M■.M■ I■..■■.EE■■eE.e..■EM.■.t■EEE■EE..■■■EEE�E■E■t.E■■■MME■EE= �.EOE..E.■■ ■��iiiiiii■�=iiiiiii■�;iiiiiii■��iiiiiiil.iiiiiiiiNimiiii.�ENNEN iiiiiii.�i ■■■■o■■■■■■■■■■■■■■■■■■■■■■■■■■■.■..■■ MEMO- ■EMEMMM■■MENE.E■ MEMO ME 0 ME MENNEN ■M■■.■.MMM■.■■.■■M■a■■.■.M■..■.■■MMeMM ■ ■■M■■ .� ■.E..■..■M■IEMEN MMMMMMMMMMMM ■■E■ ............................................ .= EEOEE.■C.■.E■MMMMMMMMMMMMMMEMMMom I mom =Nmmmnm. ■■..■■.MM■.■M.■.....■e■.t■■.MMM■■■ ■■Mu ■ OMEN ■ C��. ■■..M■■E ■■.■..E■.■.■.E..■■■■se■.e..MM.M■ �e.nM■�u.M■ .�. ef■M.aw■E■E■■■■ ■■E■M■■M■■.■■■■■.■■M■■■■■■■■M.■■�ME■EMn■..■ r■■■■■.■EM.MME■■M■ ■..■.E.et.■■■E■E.NE...E..E.E..EEEE.. ■EM■ . eEE.■t\lmom►SMEmom . ■■.■MME ■■M■E.N■■■■�eu■.EUM.■E■u ■tl��■�i,M. ■E.1•■.■.■■■a.�...� M.e.■ ■.■■■.. ...C............................... i.. .........► .. ........................■............ .■. �...■�NiMMMMMMMM."■■MMM .................■.............■......M..r,.��....■MMMMM■JMMM■II1 ■■■■NE■■■■■■E■■■.■E.■■.O.■.■■E. ■■■■■I1■�■■■■■n■■■■■■■■M.■■■■■E■ ■.■■O■M.M■..MM■■.■■.G�:�:��aiaRii■M..■■./IM no SOME ME MMWSIMMMMMMMMMMMNMMMM M.■.M■■NM■.EMM■■.■■ .......n■■■■■■M■■M.,,..■a"ae: -nit......■■■.. .n. n■r;t..t.E ■■..■■.. ■E■■■■■M■■■E■■■■■■■■ ■■■■■�■■.■■■■■■■■■1\■■■■E■M■■O%�■■ENE■■■II■■■E■ MOEN ■■■■■E■M.■■■■■■■E■■E�■■■O■E■.■■E�■■EEE\�■■■ME■M■E■■■■■■■EME■IlE■■A■ ■M■■■■■■■■.■■■■■■■■■■■■E■EM■■■EN■■E■■■■ .��awma M■■■t►%■■■■■■E■ Y{�; . ,-. / � • � $err •�` ~ ' 432.3 f d r �� ' , • 225 @ 779.97., 5 .19 At. ,. ..�`• m « 450 76.6 405.a7 133s 3 44lJI � e � � • `�� ;.,� � :. t, .. I Ar, .4 I r '� w.. ss i. •, N fit, i.4 . � �' �• 1411 4 r ` q• . , t,N a A1431. ..`f 8 £ '.9 7Ae it �I. 37,9 ` � ► ,�j��y` ti 1188 . !!r4 I99Ac 1 '; 80203 �4 '''" (p �'' '" •d' 'r431.3 �. 55,- A, 5 A, 1104 3 3Ac , • �. wo�v+t KT .. �� r + s, •a 02so z r LR py �� r �81-!•A d I J�aa ;t•• ' 637.15 ♦ je;. .w;� r '059 ( ts.ls 17•47Ac 40 Daae Counly Yleall§i Deparbnenl and .1 'ame Yieall§ Myency ; v s 6i . C 210 HOSPITAL STREET P.O. BOX 665 , ;y? Sr , MOCKSVILLE.N.C. 27028 s `' PHONE:(704) 634.5985 September 1, 1993 , "l7 Elmer W. Day , Rt. 3, Box 404 ft Mocksville, NC 27028 Re: 3 Site Evaluations Howardtown Road/Approx. 14 Acres ` E' a Dear Mr. Day: : f As requested, a representative from this office visited the aforementioned sites on September 1, 1993. Based upon the information provided on the application for a site evaluation and after evaluations were completed, the '. . sites were found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system on each site. 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 cc: Jesse Boyce (given 2nd copy of ;letter w/1st Permit/ATC 0524- on 10-03-96) cc: Maxine $oger 09-10-93 i