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312-322 Swicegood Street Lots 3A & 3BAUTHOfiIZATIOAf A .18471- .DAVIE CQUNTY HEALTH DEPARTMENT 1 nvironmental Health Section. PROPERTY INFORMATION, Ssln ILL+0%ocksvme. NC27028 Subdivision Name: ng for Buildiiii of G.S. Chapte _ L,IST r,_;� Dj em Constriction MUST -BE ISSUED by the Davie County Environmental Health Section prior s FornMuthofization-Numbei should be presented to the Davie County Building Inspections'.. 11LS a, Wastewater Systems Semon .1900 Sewage.Treatment,and Disposal Systems), ��. DCt�OSN6 (Revised). � ,r .. -� -�. . Davie County Health Department EnV/romnentaff/ea/th5L*CffOn -5`7#D P5 P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 +++Il[PORTANT++* THIS APPLICATION CANNOT 8S PROCESSED UNLESS ALL THE QR INFORMATION I9 PROVIDED. Refer to the INFORMATION BULLETIN for ins tLLoeq I. Hams to he Billed Hailing address City/state/yIP a. Hams on Permit/ATC it Different than Hailing address j:-1..- e- 3- Application Por: U Site Evaluati on 4. system to servtoe: 11 House W119bile Home s. If Residence: # People D Dishwasher U Garbage Disposal contact Person a.`L± Business Phone rs—svrrse� U V Li NOY 2 5 1998 D city/state/sip -- f ❑ Improvement Permit/ATC th ❑ Business ❑ Industry ❑ Other # Bedrooms # Bathrooms 0 washing machine 8. Ir Business/Industry/other.. specify type # Co®nodes # Showers IF FOODSERVICE: / Seats 7. Type of water supply: U Basement/Plumbing # People # Urinals U Basement/No Plonbing # sinks # water coolers Estimated Hater __Usage (gallons per day) Wcounty/City H`Rag�ell ❑Community S. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑ Yes ❑ No If yes, what type? '"•/MPoRTANP**CLIENTS MUSTCOMPLEiETHE REQU/REDPROPERTYINFORMATIONREQUESTED BELOW. EltberaPLATorSITEPL•AANN-M STBESUBbITTEDb the client with THIS APPLICATION. Property Dimensions: 1—SoZj� WRITE DIRECTIONS (from Mocluville) to PROPERTY: Tax Office PIN: # 5 7 — �j — Q-54)6 0, s 716 Property Address: Road Name tr 1t I rn 704 le OFl— eiviIJW�.c.. City/ZIP e.Q 171 Q C If in a Subdivision provide informalion, as follows: Name: -1U-K 16 1— ` Section• Block: Lot: Date Property Flagged: �I/ eZ This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit($) 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 1, also, unde stand that 1 am responsMIe for aft charges incurred from this applicadom 1, hereby, give consent to the Authorized Representative of the Davjg County Health Deparimenf, to enter upon above described property located in Davie County and owned by 1 D 4 Qy- — to conduct all testing procedures as necessary to determine the site altaq`'illi DATE — 9 SIGNATURE / THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ641 of the follo�ng: Existing ad prop and Property lines and dimensions, structures, setbacks, and septic locations). Account Na Revised DCHD (07/98) �9 Involve Na r HORIZON I DE1YrTexture group Structure Consistence Mineralogy HORIZON 11 DEPTH Texture group tr■�rs�®®®� ®®t Mineralogy - .. - _ .. HORIZON III DEPTH Texture group Consistence Structure. Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION T nXTV_ CDA4 AlV UD AXT QV DATC 7 77 T_ ♦ / ..-. SITE CLASSIFICATION: EVALUATION BY OT..LONG-TERM ACCEPTANCE RATE:HER(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 plainH'- 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 l SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Mo' f VFR - Very friable FR - Friable FI - Firm VFI Very firm EFI - Extremely firm et NS - Non stick . y 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 D HD(01-90) ■ e ■■■■■ SEEM■ SEEM■ M■■■E ■■■■■ SEEM■ Permittee s Name: Directions to property:. **NOTE** This Authorization for Wastewater Sj to:issuan66 of any Building-Pertnits:;T rd!TS4t.� 1611 of G.S: Chapter 1 7 4 , e IST :t0n51 **'NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALIDFOR A PERIOD OF FIVE YEARS ED 184 IWOE C UNTY.HEALTH DEPARTMENT .-�.,/,.� "';ANiPRO EMiNT AND OPERATION PERMITS .. PROPERTY INFORMX.T10 Ae L Lr -1 F property: --Tf ;IMPROVEMENT ,ision ame; Lot: Road Name.— OTF,**.Thig improvement,Pemut DOES NOTziuthorize the construction or installation of i Sebtf6 tairik sy-st fn'cornpUptice with^Article 1; of G.S.:Chapter 130A'*, N OUCT*** 'JIM p ' LANS OR THE Wn SYSTEM CONTRAC .- .- -, 4, N R Davie County Health Department rolmrr &A11; - Envl/vnmen/a/HealtYtSetY/on P.O. Box 848/210 Hospital street Mccksville, HC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE pR�g INFORMATION IS PROVIDED• Refer to the INIWHATION BULLETIN SED UNLESS for isin THE 1. Rams to be Billed' % ` t contact, Parson Railing Address - oPhone me city/state/zip �1 a'� �, f I- BssisHesPhone 2. Ram on Dealt/ATC if Different than Above Hailing Address S�-1 3. Application For: U Site Evaluati ��on 4• system to service: D House 9.110 -bile Home s. If Residence: # People I D Dishwasher 0 Garbage Disposal rz�_vnse� v u u U Is- NOV 2 5 1998 City/state/tip _ f A— U Improvement Permit/ATC th D Business D Industry U Other # Bedrooms_ # Bathrooms D Mashing Machine 6. If Business/Industry/Other: specify type # Co®wdes # showers Ir rOODSERVICE: # Seats 7. Type of Mater supply: D Basement/Pluablog O Basement/Mo Pltabing # People # sinks # Urinals # Rater Coolers Estimated Water `visage (gallons per day) i ounty/City avde'n D ConmunJ. ty 8. Do you anticipate additions or expansions of the facility this system is Intended to serve? 11Y« 11 No H Yes, what type! ** *1MPORTANT*** CLIENTS AIUST COMPLEiE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN A1UST RESU1TPED by the client with THIS APPLIVATrns: Property Dimensions: 61 S D WRITE DIRECTIONS (from Moclnville) to PROPERTY: Tax Office PIN: 45%�Q"QQ S�� (e.9 Property Address: Road Name i ' Sf L%i1//o %D tQ O?"T r Jsr.J/ce4v:d City/Zip Q-Q7nP C .5'• If in a Subdivision provide luformation, as follows: Name: �-,17,("Y1 I A V.— Section Block: Lot: Date Property Flagged: I;z 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 Bite plana or intended use change, or if the Information submitted in this application is falsified or changed I, also, understand that I am rrsyansM1e for al/ charges Incurred froar this apPUcadon. 1, hereby, give consent to the Authorized Representative of the DavjgCounty Health Deparlmenk to enter upon above described properly located In Davie County and owned by /``jj 04 Qr— f to conduct all testing procedures as necessary to determine the site suits UM�ac� DATE_ �f —� 9j SIGNATURE ��sen THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (includrYfdl of the folio iHg: Existing and proposed Property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD (07/98) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SEcTON LOT 3 a Soil/Site Evaluation APPLIC /ill ?O j� ANT'S NAME, � DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE S• O Z G f.. SUBDIVISION ROAD NAME ' �tCEG°F�ea�✓ • Water Supply: On -Site Well Community Public (/ Evaluation By: Auger Boring Pit (� Cut SITE CLASSIFICATION: 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 VFR - Very friable . FR - Friable FI - Firm VFI'- Vey firm EFI - Extremely fine 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 Mineralou 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 r�rs�®—mss® Consistence SITE CLASSIFICATION: 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 VFR - Very friable . FR - Friable FI - Firm VFI'- Vey firm EFI - Extremely fine 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 Mineralou 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 No ME