Howell Rd Lot 6 (^ { APPLICATION FOB S1TE EVALUATION/IMPROVEMENT PERMR&ATC
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Davie County Health Department
NOV f 7 1999 i ' j Envilm menbi HMIM SWUM -v 4 /•
P.O. Box 869/210 Hospital Street
i Mookaville, KC 27028
Li�UfiDN111E C014NlYALM (836)761-9740
***ZWCRT71I V** THIS APitLICA21= C=WT ER rRo=Sm D mmige ALL TSE RZQUnM
=9==210H IS PRO=ZD. Rotor to the Ili1'OIMION BULLZTIH for instructions.
L. Mane to be Billed/0,&-y BcG JC eF-S- Coataot person C-kr 1 S 6 vo GC, V,kdk��rv►'�
:,aili•nq address rote Beck 707-1 some shone 336— 4b8-461) N/G 7.701
City/state/s:s Z x �V l_ / ot,+Eav, 1, ,,.tie.. a//home � 3 6- 6�
a. ttw an pazml Uc is Siffasent thaq Shore A �Ue c lc �5-A'Ar_.
�iinq�addrers �`s ��/
X21 gvatuation 0 Igprovommt Permit/ATC 0 Both
a. "etas to serrioat "9 House Mobile Home 0 Business 0 Industry 0 other
a. It Residenoet I People i Bedrooms 70l 3 r Batbroome
O Disbussher a earba" Disposal q Washing Waobine O asaement/pludAng O Basemant/Wo slumbiaq
S. If Business/Indust T/others Specify type t scopic t sinks
Commodes # Showers i Urinals f Water Coolers
IT 1=811AVItat d seats ..r� Zstioated hater Osage tgalions per day)
7. Type of water supply: County/Cit, a V,' A well 0 Commuaitp
s. Do you anticipate additions or expansions of the beWty this system Is Intended to serve? Oyu ArNo
If yes,what type?
*"IMPORTANTP"CLiE M UWCOMPLMTHE REQUIRED PROPERTY INFORMATION REQUESTED
BELAW. Either a PLAT or SITE PLAN MAST1WSUBMITTED by the client wit4'H19 APP1./C,kT!0N. ,
Property Dlmensionst .SGc._ /���` FrYh3'':E«:1eZE,Ci1t3N)i(room idoek:vitle)to PROPLRTYs
Ta:O®ce PINs 8 mclt SUL �1
Property Addreas Road Name wd C-4- ,G 4
��.V C4 14 J-1 GP
City/Zlp
It In a Subdivision provide Information,as follows: A w"u
Names
Section Blocks Lots Date Property Fiaggeds t .W
This is to certik that the la brmation provided Is correct to the bat of my knowledge. I understand that any permits)
issued bereaAer are subject to suspension or revocstioa,It the site plans or Intended ase change,or It the information
submitted in this application Is Milled or changed 1,also,asderstand that I am respoo to for alt charga Incurred jhons
tib appltcadon. I,hereby,give consent to the Authorized Represents"of the Davie County Health pa nen
to enter upon above described property located in Davie County and owned by, k�T
to conduct A testing procedures as necessary to determine the site suitability.
DK-iE f '"� �clSIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(include all of the followings 'Isting and proposed
property Lina and dimensions, structures, setbacks, and septic locations).
Site Revhit Charge
Please complete the highlighted area(s)and
Dais(e)s
return. Client Notification Dates
EAS:
Account No.
Revised DCHD(07M) Invoice No. lo r-3
S 84'25'45' E446.59-
I'
446.69'
1' Square Iron 343.10' 48.
CA .2
7,128 sq.ft.
_ 0.1638 ocre
ki,e. 56,227 sq.tt �, c
'L 1.2408 acres
pDBCES BECK
40 PG 376 ti S 66'24'21' E i
0 370.42' I
5 �
� O
1.3456 acres 1 28
58,613 sq.ft.
S 86'24'21' E n
427.01' 1 WILL
_
DB
O " 03'38' w
57,071 sq.ft. _
1.3102 acres n
2ps�
TI•1 1,44-
w
.38-91, E
94.82'
iipike �z N 42,560 sq.tt
0.9770 acres O
ST\ SJ /�� 044,120 sq.ft
X 22` f 1.01.29 acres S 8535VT E
O [] 250.00.
ry `
57,488 sq.fL
\ = 1.3198 acres
\ 49,409 s
1.1363 0
Lmam
PROPERn uNE �I `�
RIGN1 Of WAY LWE Q014
uNE fTtDu NEED oR Put \ 224.64•
NNW NR FDR11ERtr 2t?dl�,• / ' 3
DEFD BOOK
Pur WOK
DOOBIE M 90m DISTANCE b2;T0.
,CE?1rC"E w
.PROPERTY UNE U
RIGHT NF WAY
k SER EATON CHURCH ROAD � �a�. Spike
.uRB \
1116NED ELDOR c>.t_Wnh SR 1415
P ( DUSTuG KION rwm �
P ( NEW IRON SET )
on ( NO MONWEIlwlm SEI )
GS CONTlux MOM1M[NT
STING PK NAR
NAR SEI
R, PREUMIAMRY PLA TWO Fn ' '
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000872 Tax PIN/EH#: 5822-62-1818.06
Billed To: Grady Beck Subdivision Info: Mary Beck Estates Lot#6
Reference Name: Grady Beck, Executor Location/Address: Howell Road-27028
Proposed Facility: Residence Property Size: 1.29 Acre Date Evaluated:
Water Supply: On-Site Well Community / Public
Evaluation By: Auger Boring Pity Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupG
Consistence i
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION Y
LONG-TERM ACCEPTANCE RATE C t
SITE CLASSIFICATION: J EVALUATION BY:
C
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
Mineralog
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 05/99(Revised)