286-296 Swicegood Street Lots 2A & 2B5'1�.�-,DAV
IM]
A A
!*NOTE** This Improvement Pemrit DOES NOT authoriie the
or
Davie County Health Department �.le.lm qua
EnvffvamentalReafthSecdOn ��
+ n� P.O. Box 848/210 Hospital Street
' 1Y/ Moakeville, HC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT pE pROCES= UNLESS ALL THE
INFORMATION IS PROVIDED, Refer to the INFORMATION BULLETIN for inn
1. nam to be milled ` t
contact Person
Mailing Address
[) some M
City/ate/rIP ��CI�1L Phone Business Phone
a. nam on Pewit/ATC if Different than Above
Mailing Address
3. Application For: U Site Evaluation
4. System to Service: 11 House B'Mobile Home
S. If Residence: / People
D Dishwasher 0 garbage Disposal
Ul.LS_�
NOV 2 5 1998
City/stale/rip
0 Improvement Permit/ATCX4 ro th
0 Business ❑ Industry 0 Other
/ Bedrooms .1?_
0 Washing Machine
s. If Business/Industry/other: Specify type
f Ce®odes i Showers
IF FOODSERVICE: / Seats
7. Typs of Mater supply:
D Baseaent/Plumbing
tl Bathrooms �_
0 Basement/Wo Pluabing
/ People f sinks
/ Urinals i Water Coolers
Estimated Aater Usage (gallons per day)
59 C unty/City avwell ❑ C..-ity
s. Do you anticipate additions or expansions of the facility this system is intended to serve! 11 yes
0 No
H yes, what type?
* **IMPORTANT•** CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Elt6er, a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION
Property Dimensions: WRITE DIRECTIONS (from MocksAlle) to PROPERTY:
Tax Oifice PIN: a 57� 5- -1�y R/aa)kl o l s y1 g p /s
Property Address: Road Name1MIL � 1e ,F74 00
City/Zip eQ m Lo L
If in a Subdivision provide (uformalion, es follows: 701 •
Name: _-il,(11 I d I— -
Section: Block:Lot: �� Date Property Flagged: ,2
This is to certify that the information provided is correct to the bat of my knowledge. 1 understand that any permtl(s)
issued hereafter are subject 10 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, anderstandthat) am raponslblejor S# charges incurred from
this appRcatPon. I, hereby, give consent to the Authorized Representative of the Dsvjp County Health Departmen
to cuter upon above described property located in Davie County and owned by L U 4 e I - — f rn �t[,Or) Q
to conduct all tesding procedures as necessary to determine the site suitsli r�
DATE -- y 9 SIGNATURE 1 i"/i7i�n J.
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (inciuddfdl of the follo ing: Existing and proposed
Property lines and dimensions, structures, setbacks,and septic loations).
Account No. --�-L_
Revised DCHD (07/98)
invoice Na _ 9j'
� �p i fT}ibf.IZ�ATION
f
Pernii[tee s�
..Name:
*NOTE**7
[c
�c
An compliarii
onzation for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
of any Building-P.ermics: This Form/Authorization Numbershould be presented to the Davie CountyBuilding Inspections ;
-�aPPlyJ' g for Building.Petmits .. >
�ticle,
Fog .S:.Chapter130A,Wastewater.,Systems;.Section 1900$ewageTreatmen[and.DtsposafSys[ems)
iz GNOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTTON
`1 IS VALID FORA PERIOD OFTWE YEARS
LTH,SP LIST DATE lSS D
. ., ....
APPLICANT'S NAME
PROPOSED FACILITY ? �✓
SUBDIVISION
Water Supply'
Evaluation By:
On -Site Well Community /
Auger Boring Pit (/
DATE EVALUATED
PROPERTY SIZE Jam• b l i� E% C.
ROAD NAMEZ�__44=0
Public i/
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON H DEPTH
Texture groupG.
C
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: A S EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: r / OTHER(S) PRESENT:
REMARKS:
LEGEND
Landscape Position
R - Ride S - Shoulder L Linear
' g 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 SII, - Silty loam CL - Clay loam SCL - Sandy clay loam
SC 7 Sandy clay SIC - Silty clay C - Clay
CONSISTENCE
Mo st
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
truct r
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)
a
No
■t■■
■■■Y
■
0■■■■
0■■■■
■■■■■
77
�AUTIiORIZ 719N NO: DAME CLINTY HEALTH DEPARTMENT
ff E nvironmental Health Section PROPERTY INFORMATION
Permittee is' tI tC1 , ..P.O.B,
Name: ksville'N-C 27028 Subdivision Name.-
Phone
ame:Phone #,336-751-8760
Directions to property: C6.0 IS
_TL) Section: Logi Z�
AUTHORIZATION FOR
"TWASTEWATER
064 . ` ' Oa GcG=c�o SYSTEM CONSTRUCTION Tax Office PIN:#
Road Name: �G`tXJd� Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County. Environmental Health Section prior
to.issuance of any Building-Pemiits. This Fomi/Authorization Number should be presented to the Davie County' Building Inspections,
Office when applying focBuilding Permits.
(In compliance with Article I l f G.S. Chapter 130A, Wastewater Systems, Section .1900Sewage Treatment'and Disposal Systems) .
`) ***NOTICE**.* THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS
..a; ENVIRON AL HEALTH EC ST DAT ISSU D
Davie County Health Department
� 5. *g �.,..
nn % Env/ronmenfal Mealo Se 0,1
P.O. Box 848/210 Hospital Street
f ! Moaksville, NC 27028
(336)751-8760
+++2ll�ORTAItT+++ THIS APPLICATION CANNOT Er p1tOMSrt'p gNLE39 ALL Tl
INFORMATION IS PROVIDED, Refer to the INFORMATION BULLETIN for is
1. Name to be Billed
Mailing Address
City/state/rip
2. Name on pewit/A2C If Different than
Mailing Address
3. Application For: U Site Evaluation
4. system to service: ❑ House td'Robile Home
s. If Residence: # People I
D Dishwasher D Garbage Disposal
Contact Person
nl Boma Phone
1�1 Business phone
fZ NUp.c
NOV 2 5 1998
City/stale/Lip
11Improvement Permit/ATC6th
0 Business ❑ Industry 11 other
# Bedrooms -L # Bathrooms
D Mashing Machine
6. If Business/Industry/other: specify type
# CoMmcdes # showers
D Basement/pls*bing
# Urinals
# people
D Basement/Bo Plumbing
# sinks
# Mater Coolers
IF FOODSERVICE: % Seats Estimated Nater `Daa�ge (gallon per day)
7. Type of water supply: ,f�County/City tlFNell
0 Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve! ❑ Yes 0 No
If yes, what type!
***IMP0RTANT*** CLIENTS AIUSTCOMPLETE THE REQ111"D PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN AIUST RESUBMITTED b the client with THIS APPLICATION.
Property Dimensions: WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: a 1 74 — —,�4 �� O�g) s 7164'
Property Address: Road NamerJ�
Gf/ICBQU�
City/Zip 2217, L C tit
If in a Subdiviissi�ion provide Informatloa, as follows:Name: _ x-.17 62 iy 1—
Section: Block: Lot:.7� Date Property Flagged: �/ „Zrj --9W
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 rrsponsibfejor all charges Incurred f vm
this apPBcntion. 1, hereby, give consent to the Authorized Representative of the DaVIP .C^ounty Health Department,
to enter upon above described property located In Davie County and owned by r2 ev- — fr — N) i c�ar� S
to conduct all testing procedures as necessary to determine the site suite 711DATE1-2- 9 SIGNAT7i�n
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include4l of the folling: Existing and proposed
Property lines and dimensions, structures, setbacks, and septic locations).
Account No.
Revised DCHD (07/98) luvoice No. �%�
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section. _, SECTION LOT��
-Cnil/.CitaFvalnatinn - - '
Water Supply: On -Site Well Community
Evaluation By: Augei Boring Pit -
Public' L�
Cut
Cc L4
HORIZON I DEPTH
. • .
�®e-®tea
SITE CLASSIFICATION: ;� EVALUATION BY
LONG-TERM ACCEPTANCE RATE:/ OTHER(S) PRESENT:
REMARKS:
LEGEND
` Landscape Position'
R - Ride S - Shoulder L - Linear slope pe 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
,
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
MineraloPy
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) .