Loading...
287-297 Swicegood Street Lots 21A & 21B_..., • •r.M'", vwparunenl �� Env/ronmenfal Health SeWon P.O. Box 848/210 Hospital Street r NOcksville, NC 27028 13361751-8760 •••IWORTANT►w THIS APPLICATION CANNOT HE PROCE33SD INFORMATION IS PROVIDED. Refer to the UNMSS ALL TINS TION BULLETIN for ins l • sans to be Billed t . • Contact Parson nailing Address �'1 some Phone City/state/ZIP l t .,Y ry .•) ,M :Y li 00 - ' 1 rl A111- 7��•� t. saes on Peradt/ATC 11 Different than Above '— Walling Address r•. Application For: U Site Evaluation I' system to service: 17 House Wlgobile Home L If Residence: I People D Dishwasher D garbage Disposal 6. If Business/Industry/other: / Commodes '107 FOODSERVICE: a3 nosiness U Improvement Permit/ATC NOV 2 5 1998 . xa " 11 Business U Industry O Other I Bedrooms_ / Bathrooms -:;7_ D Hashing Maohlne specify two / showers D Basement/Pluabing H Bast/Mo Pluabing / People / sifts I Urinals f Nater Coolers Bata Basement/Mo Estimated Nater Usa e . 4 (gallons per day) 7. Type of water supply: W oun `��• tY/City Community s. Do you anticipate additions or elpanstoss of the facility tits system is Intended le serve? a Yes 11 No If yes, what type? BEXLOWOBTAN"s PI.ACLIENT A/USPCVA(pig>� 1NE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either s PLAT or SITE PLAN MUST BESUBMITTM:.., e._ Properly Dimessioon . G, 3 � a Ta:Olitce PIN: Property Address: Road Name tiv/ City/zlp ee.YnLo If in a Subdivision provide Information, as follows:`� Name: Q• -u )/t I () ►— - Section: V M-1. DIRECTIONS (from Morlwllle) to PROPERTY. 7o s �o Is n" .Ji t/Ite90ed ac . tut: 2 I tt Date Pru egg Property Flogged; I — f .1 Phis is to certify that the information provided is correct to the best of my knowledge, I understand Thal any perIIn ' slued hereafier.are subject to suspension or revocallos, If the Bite plans or inlesded use change, or if fbe information ub gFfte in this , her2PPIIby g Is cofalnsfiedent or th Huth I, alro, andmwdnd that 1 am rerponslb/e for all charges Incurrad fnv,n D enter application. 1, hereby, give roperty to the AIn D rized Representative of the Dsvjq Counly Heaitb DepartmeB s nupon above described property located iB Davie County and owned by __LIQS 4 e1,— s conduct all testing procedures as necessary to determlDe the aIle alta li / IATE � — � � •� 9 ,Fj� SIGNATURE %/rI D n PHIS AREA MAY DE USED FOR DRAWING YOUR SITE PLAN (IneluddilI of the fol roperly Tina ct and dimensions, structures, selbscke, and septic locations). ioIsg: EztsUng and proposed Account No. — evised DCHD (07/98) Q Invoice No. / DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECnON LOT _2_14 Soil/Site Evaluation — APPLICANT'S NAME ���eyz Lj�`� DATE EVALUATED 12 0 PROPOSED FACILITYM PROPERTY SIZE SUBDIVISION ROAD NAME �tTtCot�D Sr: Water Supply: ,. On -Site Well Community Public Evaluation By: Auger Boring Pit Cut_ FACTORS 1 1 2 3 4 .5 6 7 :. Landscape position Sloe % q 7,jq HORIZON I DEPTH.. p _ Texture group Cc. Consistence �rv5 5 S3 Structure Mineralogyt HORIZON H DEPTH - Texture group G (L - Consistence 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 D• c SITE CLASSIFICATION: PS 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 - Veryfirm EFI - Extremely firm { et. NS r Non sticky , SS - Slightly sticky , S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic truc ure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineraloev 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) - - ■ MEN MEN ■E■■ MEMO MEMO ■EOE ME -•••r - --u, u,parunenr Eavlwamental Health SerifOn TrrNOV_ P.O. Box 840/210 Hospital street Hookoville, HC 27028 2 5 1998 (336)751-8760 'V*IIiQORTANPss• THIS APPLICATION CANNl7? BE i .11 i�nnin c A HEALTH nwoRmTION I9 PRO{RDED. PttOCBSSED UNLESS ALL THE QUIRWAVIECO N Refer to the IN80A ami BULLETIN for inatrua ons. :• 'name to be Billed Contact person Hailing address City/state/LIP Basle pho,e 'C I Business Phone • ,Mame on pemlt/Ata if Different. thanAbwe , 2 n _ f . O :rail.ny Address >i�?✓J Ski ah/state/sip _ h s. AMUCation ror: U Site Evaluation �� U Improvement Permit/ATCLl th i. System to service: 0 House %globile Home O Business U Industry 0 other s. If Residence: I People ti Bedrooms / Bathrooms D Dishwasher. O garbage Disposal H Washing Machine 0 amement/Ploabing U easement/'no Pluabinq S. If 8ns1ness/Industry/other: Specify type erodes # People / Bints / showers f Urinals 1 Nater Coolers Ir rOOosmmCEs i Seats 8atimated pater U8a4e on (galls per day) r. Type of water simply; �/ ��• County/City &VV(0ll 0 Community r. Do you anticipate additions or expansions of the facility this System is Intended to serve! 0 Yes O No If yes, what type! ""'/MPt7RTAN7'�••CLIENTSAIUSTCUA1PLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBdIITPF.D b the sliest with THIS APPLICATION. l'nP= b)imi,:mlons: DIRECTIONS (from Mavksvllle)/to PROPERTY: Tax Office PIN: # 5 / T . —'T lq "-( 70aI p0 Properly Address: Road Name 1' St q J / e' —/lYIII /D Ze �eo Sax. Ucd City/Zip 2Q Yn L7 � tAt!if If In a Subdiviision provide information, as follows: �� Name.(— Section: Block: Lot: Z I Date Property Flagged: _ _ %j • ,� j� Phis is to certify that the hIformalion provided is correct to the best of my knowledge. I understand that any permits) rsued hereafter are subject to suspension or revocation, If the site plans or intended use change, or if the Information �-- ubmiffed In this application is Ialaified or changed. 1, abd, understand that I am ropenSMIe for o11 charges Jacnrrrd from ILv applfcatfom 1, hereby, give consent to the Authorized Representative of the Da vjq County Health Departures s enter upon above described property located in Davie County and owned by r D 4 pr — f — �Yj: •� ar� S ) conduct all testing procedures as necessary to determine the alts sulfa It IUlm*, TATE SIGNATURE ':IIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (fueled 1 of the folio lug: Elating and proposed roperty lines and dhnimfloas, structures, setbacks, and septic locations). r} evised DCHD (07/98) Account No. di Invoice No. 9 DAVIE COUNTY HEALTH DEPARTMENT Environmental.Health Section SECTION LOT Z 1 5 Soil/Site Evaluation APPLICANT'S NAME �_ILU^^� DATE EVALUATED PROPOSED FACILITY 'v `ff^ L ' PROPERTY SIZE G• 3 71 .AL SUBDIVISION ROAD NAME �J/Ci&oo 0: a'7' Water Supply: On -Site Well Community Public `- Evaluation By: Auger Boring Pit Cut VAN • •®®�®�® ... ■rear®®®—®® • r��rL:�ri��aa®® WNW • ®�—®sem®® SITE CLASSIFICATION: 1" 5 EVALUATION BY: Y 644"_0 LONG-TERM ACCEPTANCE RATE: n , �I G2oy OTHER(S) PRESENT: REMARKS: LEGEND _. Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC 7 Concave slope --CV - Convex slope 1 T - Terrace FP - Flood plain H: Head slope - Texture S - Sand `LS - Loamysand 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)