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251 Marchmont Dr Lot 4 (I� APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI & ATC f Davie County Health Department Environmental Health Section , Y P.O. Box 848 ?, �J� --. /3',' Mocksville, NC 27028 v` i (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed �Ld Contact Person l� C � VV-51,7 Mailing Address /�3 R Home Phone 9 q City/State/Zip Business Phone 910 76 0 M3 1 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: bq Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: ,House [ ]Mobile Home [ ]Business [ ]Industry [ ] Other 5. If Residence: #People_L___ #Bedrooms #Bathrooms-q- [ ishwasher[ I'Varbage Disposal LJ'Washing Machine [ asement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other: Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: [ County/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [eNo If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***XA?U=OF THE PROPERTY MUST BE ^� 6--9 '( trcel q4 SUBMITTED WITH APPLICATION. Property Dimensions: �J� ��e47e. WRITE DIRECTIONS(fr i ocksville)TO PROPERTY: Tax Office PIN: #�-�- ; t ?01 S Property Address: Road Name C \tR . ; on, Le �► �S City/Zip ; If4indivision rovi nformation,as fo lows:P , Go N l Section: Lot#: t S This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Re rie tative[ of the Davie County Health Department to enter upon above described property located in Davie County and owned by �� �� \ to c " duct a testitcedu=resasnecessary to determine the site suitability. DATE I SIGNATURE L Revised DCH (06-96 THIS AREA MAY $E USED FOR DRAIVING YOUR SITE PLAN: C- (C'(ice L V V ' QN , N 0 CD 142 • . . 15.64 Ac 3 � 4) 43 n /� 99 6.76 m j i 5 5.3 Ac , CIO � n v Cl - t Nui 14 . (5) (3 44 h 3.4 5 . ro !1 40 >s3, 51.15 Ac t 5. g5 q " s4 h ( 123.52 Ac) 607°42 (5A) "' 39 8.7—j o ` "�,.____... v rh 485,04 10 O��.P 230 3$ 3930.93 'gym rw CQ to15°22Ac c 32 °" ° �• IsaS. 8.75 A N a) 3 8 48 to3`r (6) 36 m 10 0A 5.62 Ac s °D f.27 n 4 \3 m H47 s vbo a 34 , w 5.65Ac w (2) g 60 cn (15.57AC) 6.51 Ac 6 W 31 u (3) 500 O 9 " 0 Iry 17.02AG 5(�9Ar 1 v 1 j.01 �\ cp `° to 60 60 , ( 5) V 30 1145_ �8) 675' w >. \ I C.10 Ac 13. 5 C0 2a �� ( pry -''� 4 r i 5 Ac eN u' _�v 9,� �/' I 13-10 70.5 351 (14) a ,5.26Ac 2 �ti g.tl � 9° � c 2.64 Ac 0 0 1 24 2.63 235• Ac o 'p9 2.79 Ar- , I 1 .� �o � 1� $ 13.05_ ; 3s3 g �T{15) �r Ar ¢ 2�69Ac °`� �� 20 1307 31.32 Acres o 7 s x(17, 6 �°�� , 215 00 a. r (1 2) 51 609 6.61 Ac 99 ll ��g} v�p G` 13.06 ' o p M 171 3 Vy08 6.6I Ac ---- L'-- 5 5 Ac e. ` 7 13-08 1`, 13- 8 3 8 Acs 2i7.22Ac 6 Ac _ 5 A 2� � 6 0 / I6°02 �' m N 51 14 15� 0 a. "� 07 _� ►o0 1480 — 6.5 Ac � 0Co O t46 I'J9.9 113 I00 M - ri t M M O M (o O- o� t(3� ^Q �� 109 10 5 f 5 710 a PHOTOGRAPHY BY F - 8 F - 9 N ALSTER & ASSOCIATES, INC. COLUMBIA, SOUTH CAROLINA G 8 G - 9 DATE OF PHOTOGRAPHY: MARCH 28, 1976 H - 8 H - 9 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME—� ��'C1i O 10 DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE ��•�� SUBDIVISION ,2A,0& �r. � i�. /� i7i�iTtO✓✓` ROAD NAMECY C /'DSrGsifirllf Water Supply: On-Site Well Community Public L� Evaluation By: Auger Boring i"-, Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH (o r Texture groupC G 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: EVALUATION BY: _ 6 LONG-TERM ACCEPTANCE RATE: 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-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(01.90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■/■////■■■■///■■■■■■■■■■■■///■■■■■/NOON■■/////■///NOON■■/■//NOON■■ ■■/■■■■■■■■■■E■■E■■■■E■■■■■■M■■■�■■■■■■■■■■/■■■■■■■■■■/NOON■/NOON ■NOON/■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■//■/■■E■E/MM■■■■E■MM■■MM/E■■■MMM■■■■■//■■■■■■■■■■■■■■■■■■■■■■■■■ NOON■ME■■■■■■■■■■■■EEE■■■■■■■■■■■E■■■■■■■■■■■■■■■■■■■■s�■■■■/■■/■■ ■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■E\■■■NONE MEMMEMMEMMEMEMEMENEMEMEMMERNMEMENNENMilmosi ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NE■EN■■■■■■■■■■■EEE■■■■■ ■■■■■■■■■■■■■■■■EE■E■■■■■■■■■■■■■■■■NOON■■■■■EE■■■■■■■■■NE■■��■■■■■ ■■■■/�,i�nO■�■■■■/■■/■■/■■■■■■/■■/■■■■■O■OOOOOO■OO■■■OOOOOOOOE■ONOO■ ■res►.��■/■■■/�■■■■■■■■■■■/■■/■■■■■/■■/■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■ ■C: ■■/■■■■■■i1■■■M■M■M■MMMM■■■■//■■/■/■■■■■■■■/■■/■//■■/■■/■/■/MEMO ■■■■■■/■■■/■u/■EE■EM■■M■■■■EEMEM�■■■■■■M■■MME■■E■■■/■E■■/■■MOM■■■ noun ■■M■ME■MOEM/u■MM■■MMM/■MOO■MOMM■ ■M■MMOOMO■■■■/OM/O■■■■MOM■■■■■■■ ■/■■■■/■■■M■■/■■■■■/■E■■■■E■M■■ME■■■ENE■■■■■E■■■■EM■■■■■■■E■■OE■■■ ' Davie County Health Department and Home Health Agency Environmenta(Health Section P.O.Box 848/ 210 HOSPITAL STREET COURIER#09-4.06 MOCKSVILLE,N.C.27028 PHONE:(704)634-8760 August 6, 1997 David A. 'Macaione 1348 Westgate Ctr. Dr. Winston-Salem, NC 27103 Re:. Site Evaluation/240 Crosswinds Dr. Marchmont Acres/Lot 4 TAX PIN: 45880-91-8106 I . 1 Dear Mr. Macaione: As requested, a representative from this office visited the aforementioned site on July 28, 1997. Based upon the information �. provided on the application for si(O evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. 1 If you have any questions, please feel free to contact this office. 'j i 1 I Sincerely, Robert B. Hall, Jr., R.S. a Environmental Health Specialist A RH/wd Enclosure(s) .1 i