Loading...
183 Princeton Ct Lot 9 DAVIE COUNTY HEALTH DEPARTMENT pet 60/ `o • Environmental Health Section • P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001261 Tax PIN/EH#: 5860-81-3295.09 Billed To: Stone Hinge LLC Subdivision Info: Princeton Lot#9 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC IV, 2898 **NOTE** is mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type (' #People 4 #Bedrooms 3 #Baths Z Dishwasher: 111"' Garbage Disposal: ❑ Washing Machine: 62"" Basement w/Plumbing: Q" Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size 4 Z-?q ACOLS Type Water Supply Lwr' Design Wastewater Flow(GPD) 73o O Site: New 0" Repair System Specifications: Tank SizelQCV GAL. Pump Tank GAL. Trench Width31��' Rock Depth 12+ LinearFt.:F,�. Other: 3 s wiles.) -S � '�sT�,t t_ 6A^3e;5 9 O.e. /'lit,"j. Required Site Modifications/Conditions: k -&L- 2n1 r01JI-AQ_ kxa�p Isp�r 'O'ca: 0,40 IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FIL PER. RISER(S)JT-6j OW FINISHED GRADE. ****NOTICE: Contact a representati4e of the Davie County Health Pepartiffent for final inspection his_ system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.io 1.30 p.m.on the da lation. lephone#is(336)751-8760.**** Mill � IS? 100' Ot�S� I oo 10 -� 1_I��� Environmental Health Specialist's Signature Date:00's l9 `/ DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001261 Tax PIN/EH M 5860-81-3295.09 Billed To: Stone Hinge LLC Subdivision Info: Princeton Lot#9 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 2898 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.L9OO Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE O N IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa re: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. i)4t- . /Yo I 'Yt1T1✓ t-z s- 'T Septic System Installed By: 4T Environmental Health Specialist's Signature: Date: 'C DCHD 05/99(Revised) • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department 0 •d EliWimmentai Health Section P.O. Box 848/210 Hospital Street EJUN 1520701JUN 1 5 2001 Mocksville, NC 27028 (336)751-8760 f v r *;Tjyplj ** T IS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED HVIr U Uw ORMAT �—IS—PROVIDED. Refer to the INFORMATION BULLETIN for instructions. I 1. Name to be Billed s4 n P �t"rwr L Contact Person J���+K^e�F Mailing Address of Q Lyy on i n C �Q 2p�, Home Phone City/State/ZIP �,LL18r ki I,'11 e JVC— 2?0 9n S Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: it:e Evaluation L.0'Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry 1-1 Other 5. If Residence: I # People _ d # Bedrooms _ # Bathrooms H'Dishwasher U Garbage Disposal 44-Washing Machine W<sement/Plumbing II Basement/No'Plumbing 6. If Business/Industry/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 H Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes tTqo-- if yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client with THIS APPLICATION. Property Dimensions: C WRITE DIRECTIONS(from rM/ocksville)to PROPERTY: Tax Office PIN: # 5Z60 O � � f S� --lb & fl—d' Property Address: Road Name Z M r pert,Com, C y- t' 1 0 City/Zip Lam- G n Ica If in a Subdivision provide information,as follows: Name: e. n`Ie% e C 4 n CO-4144- Section: p-41 / *Section: Block: Lot: / Date Property Flagged: n(., ^( 0 I 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 inncnnrred frons this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitabi ' y. DATE 06� ^(''-O j SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(In de all following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). r7�- Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Revised DCHD(07/99) Invoice No. <; �/ I ; • _ r CATION-PO- _ %avie County Walth Department - Environmental Health SectionP.O. Box 8482Mocksville NC 27028Re111 RITAL HEALTH (704) 634-8760 D1IItE.fdl=tTlf ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. /� 1. Name to be Billed � I —T S Contact Person �rs�' ���1 a/ I Mailing Address /Q. TD [��s,�n �<s /?a� Home Phone City/State/Zip A Q ,we�Tr, C` . Z 7U U G Business Phone ::5A vf4 2. Name on Permit/ATC if Different than Above Mailing Address !724rrI L- City/StateMp 3. Application For: [,%XSite Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: P4 House [ ]Mobile Home [ ]Business [ ]Industry [ )Other 5. If Residence: #People #Bedrooms #Bathrooms ( ]Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/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 [ ]No If yes,what type? L111111% -1 l'1.-11 OR SHL PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***,AFLOAT OF THE PROPERTY MUST BE > SUBMITTED WITH THIS APPLICATION. Property Dimensions: c 1,9e"4-- 66 "Z�;WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 5"66 D - 01 Property Address: Road I ame g A L 7* nut r /.>a A t Zl 2Z0'f' � Cit /zi A . Alec . . �'• ; 7o!2 ' lik),r4-A u % �Cr4le 49 ?Z&�A - y P 2�/ y If in Subdivisionrovide information,as follow-4 - / El c,4-� c� n/ G./ S 7- p (( �/ Ge�0 Name: , Section: Lot#• LoT S 1 72p J n'►4 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 Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 7- / Z -�2 `Z___ SIGNATURE Revised DCHD(06-96) THIS Al,'E,I A1.111 19E 11SEb F01t WMIVINcI /0111,' SITE PLAN.-(I/V, r -'ata Pirocior. &)ovio _ounry . tanning u*porvm*ni I i I � Parcel 65 ° James Mayhew I oD.B. 071-392 � m VU " U Y 231.02'am o 83°51'35"E N . 150.08' 150.08' 150.08' t w m r i ;n tr? 12 ) C" ° 4 . 13 L 1 / C) WU IO N Z CVVV/ d o N 556-36'35"E 25.00' �y 209-01' 148.69' 15().00' ' EiP 499.94' �N° 5°44'i YW Providence 1'S0N 31.62' —� Prot�idence N 84°14' 0"W �� N 14 10'2 31. 2' �o -CIO 62-A 01 __g CN 85° 150.00' N 47°05' 'VvS5.00' ' h� ti� �' N/ rp ° 03Z n } ON� Cu Qo r"'OCb n I N05 ; „ 150.0 7' 150 - 150.07' 258.03' N 87o32'15' 7 63 DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH M 5860-81-3295.09 Billed To: Gray Potts Subdivision Info: Princeton Lot#9 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 150 x 277 Date Evaluated: Water Supply: On-Site Well Community Public ✓ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position =-S Slope% Z. HORIZON I DEPTH 0 —Co Texture group 6L- Consistence Structure IL Mineralogy HORIZON II DEPTH Texture group G Consistence 'S Structure L Mineralogy HORIZON III DEPTH L Texture group Consistence r Structure Mineralogyl: HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION t)S LONG-TERM ACCEPTANCE RATE b. SITE CLASSIFICATION: EVALUATION BY: �►'�`+ LONG-TERM ACCEPTANCE RATE. O• OTHER(S)PRESENT: I Q 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 05/99(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■e■ess■■■e■sere■s■■■■■■■ee■■■■■■■■■■ee■ceecs■■■■■■■ee■ ■■■■■■■■■■■■■■■■■■■e■■ace■■e■■®■■■■■ace■■■■■e■■■■ecce■■■■■s■■e■se■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ec■■e■■■■■■■■■■■■e■■■■■■■■■■■■■■e■e■■■■■■■■■■e■■■■eee■ ■■e■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■e■■e■■■■■■■■■■e■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■e■■■■■■■■■■■■ee■■■■■■■■■■eeeee■ ■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■■■■e■■■■■■■■■■■eee■■■■■■■■■■e■ecce■■■■■■■e■■■■■■■■■■■■■■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMNONMEMNONMONSONMEMNONiiiiii ■■■■■■■■■■■e■■■■■e■■■■■■■■■■ece■■■■■■■■■■■■■■eeeee■eeeeeeeeeeee■■■ ■■■■■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■c■■■■■■■■■■■■■■■■■■■■■■eeeee■■ ■e■■■■■■■■c■■■■■■e■■■■■■■■■ecce■■■■■■■■s■■■■■■■eee■■■eeeee■■■■■■■■ ■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ee■■■■■■■ ■ecce■c■■c■■ee■eeeee■eeeee■■■■ee■■■ecce■■eeeeeee■■e■■■ee■■■■■■■■■■ ■■■■■■e■■■■■■■■■e■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ccee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■e■■■■■■ecce■■■■■■■■■■■■■■■■e■ee■eeee■c■■e■■ee■eee■■eeeee■■ece■ ■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■ ■■■■■■e■■■■■■■■eeeeee■■e■■■eee■■ ■■■eee■■e■■■■■■■■■■■■■■■■eeeeeeee■■e■■■■e■eee■eeee■■ecce■■■■■e■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ee■■■■■eee■ ■■■■e■■■■ee■■■■ce■eeeeeee■■ee■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■ecce■■■■■■■■■cc■■■■■■■■eee■■ ■■e■■■■■■■■■■■■■■■■■■■■e■■■■■ee■ ► RUGATION-EO TE EVALUATIONAMPR OVEM ENT PERMIT&ATC _. ? ±1tavie Count Health Department Environmental Health Section n P.O. Box 848 ��r✓` ' , 2 ' Mocksville,NC 27028 n Ltv lam' • E1IYIRUGtlEl1TALkiIALTN (704)634-8760 acrlf call.m ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C- I � 7 S Contact Person e,— Mailing Address J 7n (� '4jZ�?P,4_s s i?O� Home Phone ���/.— City/State0p A 0%&2 Az�T, C` . , Z 70 U G Business Phone :5A vfL 2. Name on Permit/ATC if Different than Above Arlt Mailing Address �7Arr! L` City/State0p 3. Application For. [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: P4 House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms [ ]Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/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 [ ]No If yes,what type? E I THh1C A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***,X-nAr1T OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: C f- �� �6>� �WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: #_-L& b 0. /�'P X74 S-7- Property Property Address: Road If lame a 4 L Tirrlu c gr 17,0 � _ ASA t it a9Qv,14 Ci !Li .4 .4.c,�f C it/ tY P 21� �' ; 72oU ' /1/c,,,r•!-A 01-7 Cr4 {,1¢7Zd�-.t— 42 If in Subdivision provide information,as follows ��` �� � /I/ G. �P S- 7' S/AD 4.:— Name: ; Section: Lot#: 7- 9 :DA! AIW M A � 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 Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 7- / Z :�2 y SIGNATURE Revised DCHD(06-96) THIS AREA ,11.11] 13E USED rOR DRAlVINC 1/0118 SITE PLAN: /f f�" r / Date Director, Davie County Plonnlny Deportment II i o Parcel 65 F / James Mayhew o D.B. 071-392 n J NN 231.02' 150.08' 150.08' S 83°51'35"E I_ N 150.08' 150.08' L U U7 nlo_ Z W� � � i lam ) a0 U+ U)LLJ n . I r0 I\ I O <L 01 ° r, I IXlrl\J rTt .n LAJ C-2 r*i c d � o N 55°36'35"E 25.00' 209.01' �� — A 148.69' 150.00' E,, 499.94' X44'15"W a ° 1'5(3:'E 31.62' J U� N�8_4°14'50"W N 14 10'2 01 31. 2'`� ��5� Providence 0 A. N 850 1 g � / `. � � 150.00' N 47°05'83"W 5.00' ,�, o 1 rL ,� N N z a� 3 3 �� o w `t 0 LO N � i .j O WP 150.0 7' 258.03' 150 50.07' r•` �� ,I' N 87°32'15"1 i �z - `-, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH#: 5860-81-3295.19 Billed To: Gray Potts Subdivision Info: Princeton Lot#19 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-2706 Proposed Facility: Residence Property Size: 150 x 259 Date Evaluated: Zo Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH p- O-L.- Texture group PIG Ct- Consistence Structure IL Mineralogy ; HORIZON II DEPTH - Z2 Texture group (11 Consistence Structure Mineralogy HORIZON III DEPTH 2 - Texture group C tS4 G+ Consistence Pr $ Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE D• o SITE CLASSIFICATION: P5 EVALUATION BY: 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 05/99(Revised) bIGATI0A1-I+6 TE EVALUATIONAMPROVEMENT PERMIT&ATC avie County Health Department Environmental Health Section 1999 P.O.Box 848 2 ' Mocksville,NC 27028 ttlrtRoll�t�rrr�11E1,1r11 (704)634-8760 a�wl`ontrmr ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C- � —r-5 Contact Person S.gi�L— Mailing Address /Q.7n u,4./i2 c s- i?df, Home Phone :5t-4 .w City/StateMp 4 p%14wr�T 6 , C` . -Z 70 U G Business Phone :5 A vfL 2. Name on Permit/ATC if Different than Above Mailing Address 5,4,w L- '— City/State/Zip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: P4 House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms [ ]Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/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 [ ]No If yes,what type? EIT11E1( .t PLAT 01%' SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**CXFI.1�`�I'OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �6T3 "'2� WRITE DIRECTIONS(from Mocksville)TO PROPERTY: r � Tax Office PIN: #_S$� O - L-_- 5� ; _ [J. S /SP G— S'T Property Address: Road Dame B A e- 7"/n ,r- 17,0 A t lliVorl em7 2Q�d4 City/Zip —A a VA"e c;, Al. �'• ; 7003� /1/01t 4-11 y l- 4,,r 424 Z Z—A— If in Subdivision provide information,as f ll ws- �� c� �7 ,�l c Anp c>/1./ G.r-e S ? S/AD L;— Name: — ; Section: Lot#: �20 ('LUT- 0^J AAA ,,J MAP) This is to certify that the information provided is correct to the best of my knowledge.I understand that any permit(s)issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 2. / Z - . SIGNATURE Revised DCHD(06-96) THIS AI?E,1 ALtll 13E 11SEI) J=01t DRAIVINC 1/0111? SITE PLAN: 1- r I ^— / Date Director, Davy County Planning Ospartnenl I o Parcel 65 / James Mayhew a D.B. 071-392 �� u.'O " v —a o'er c 231.02' 150.08' S 83051'35"E 150.08 150.08' 150.08' � W C? IST a ^ in LO o I C C14 CO z n1b ? _ (n u., t, W .rn a, o 00(n 0 n 1 (o p LAJ r,Gn ! b W U Q N \ 0 r I, o V �� S, �9, , N N 55036'35"E 25.00' 209.01' ��-° �. 148.69' 150.00' 1" Eli' �N 5944'15"W 499.94' 2° 1'S0'E 31.62'-� Providence N 84 14'5011 W O N 14 10'2 0t 31. 2'� ��5 LA 85°a.'-VVS5.00 1 t � � 150.00' r � • N 47°05' ' fV N N A C6 Cf- P$ CO CO 05 N150.07' 50.07' �J.;i1' 258.03' 150 7 7Z N 87032'15"\ - _» DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section - Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH M 5860-81-3295.20 Billed To: Gray Potts Subdivision Info: Princeton Lot#20 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-270Q Proposed Facility: Residence Property Size: 150 x 255 Date Evaluated: D Z 2 'Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% 1 HORIZON I DEPTH 0 - 12-- Texture - ZTexture rou GL G Consistence 555r G:s P Structure Mineralogyl;'I HORIZON II DEPTH — AD ! Texture group 0— Consistence Consistence / - Structure Mineralogy t HORIZON III DEPTH 4. Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 11 SITE CLASSIFICATION: V� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: [ISM ,a� yJl LOTg Ial 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 oist 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 05/99(Revised)