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334-346 Swicegood Street Lots 4A & 4BSYSTEM SPECIRCAT Davie County Health DepartmentP, En r/tonmenfal Nealfll SecH017 P.O. Box 848/210 Hospital street p� Moakaville, Nc 2702e NOV 2 5 1998 (336)751-8760 •#*II�ORTANT►** ENVIRONMENiAi - THIS APPLICATION CAMM BE PROCESSED tr n&.qS ALL N INFORMATION IS PROVIDED. Refer to the INFORt91TION BOLLETIN for instructions. i 1. Name to be Billed Mailing Address city/state/zip a. Name on Pewit/ATC 1f Different than Above Mailing Address __ �.•ty_ , 3. Application For: U Site Evaluation 6. system to service: 0 House H'Rob��ile Home S. If Residence: i People 0 Dishwasher 0 Garbage Disposal I r� contact Person , nlBcros Phone 1CILF VO Business phone J __ oFor - C.Qluia - City/state/zip D Improvement Permit/ATC th 0 Business 0 Industry O Other i Bedrooms . ."?_ i Bathrooms 0 washing Machine 6. If Business/Industry/other: Specify type i commodes i showers IF FOODSERVICE: N Seats 7. Type of water supply: 0 Basement/Plmbing i People i urinals 0 Basement/No Plmbing i Sinks i Nater Coolers Estimated Water usage (gallons per day) w6unty/city anfell D Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? 11 yea ❑ No H yes, what type? ***IMPORTANT*** CLIENTS AIUST CDAfPLEP@ THE BELOW. Either a PLAT or SITE PLAN AIUST BESUBAIiTREQUIRED PROPERTY INFORMATION REQUESTED TED by the client with THIS APPLI VATrnN Property Dimensions. _ _f- D Z ql�C Tax Office PIN: 0 7_Z_T1_:r:) — 4l� — Property Address: WRITE DIRECPIONS (from Mochsville) to PROPERTY: dfA) X01.5 �D 1S Road Name �' St City/upQ-Q r„ L7 L If in a Subdivision provide Inform-#'oB, as follows: si�OA 7Ut " Name: �-.) V -M i A f" Section• Block: Lot: Date Properly Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 than I on roponsihle for all charges incarrad from this appllcadem 1, hereby, give consent to the Authorized Representative of the Davjg County Health Deparlmen to enter upon above described property located in Davie County and owned by j'} l9 q ev- — fact to conduct all testing procedures as necessary to determine the site sulfa 11 nl �r' DATE 1 f=a-� 9 SIGN RE fI�'I An THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Incinddfdl of the folio IBg: ExkrHDg and proposed Property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD (07/98) Invoice No. __a3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation M APPLICANT'S NAME ` / ! ✓ : DATE EVALUATED PROPOSED FACILITY r/TI/�f' PROPERTY SIZE �• O Z °I is �- SUBDIVISION ROAD NAME �Lv.T. 4-4064 Water Supply; Evaluation By: On -Site Well Community Auger Boring Pit Public J Cut FACTORS 1 2 3 4 =- 5 6 .7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON H DEPTH r 3 y t Texture groupG C Consistence Structure Mineralogy i 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: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscaue 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 - Sand - 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 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 ncm (01-9o) ■ iii iii NONE ■■■ ME Davie County �.... u,m,■ a Nr4 r} Health Department PIT� L Env/nvnmenfaiHealHlSe an • P.O. Box 848/210 Hospital Street MOCksville, NC 27028 (336)751-8760 NOV 2;5 ►gg� ***32t?0itTANT*** THIS APPLICATION CANNOT BC PROCCSSED INFOiiMATION IS PROVIDED, Refer to the t1NLE99 ALL THE QU3'RED.! INFORMATION BULLETIN for instrnations. I. Bum to be Billed Mailing address City/staWztp 2. Mum on Permit/ATC if Different than Above Mailing Address IA-t - e 3. Application For: U Site Evaluation a• system to service: ❑ House bile Home S. If Residence: ! People I D Dishwasher ❑ Garbage Disposal Contact Person n1 Base Phone Business Phone WI III" - te City/state/zip -- � � — - • h ❑ Improvement Permit/ATC th ❑ Business ❑ Industry ❑ Other i Bedrooms -.3— / Bathrooms _ ❑ Washing Machine 6. If Business/Industry/Other: specify type i Commodes / Showers IF FOODSERVICE: # Seats 7. Type of water supply: D Basement/Plumbing D Basement/Bo Plumbing _. / People f sinks ! urinals / water Coolers Estimated Water `U_saagge lgallons Per my) l�Connty/City t0rell ❑ Coa®unity s. Do you anticipate additions or expansions of the facility this system is intended to serve! ❑Yes ❑ No If yes, what type! ma•1MPORTANT•••CLIENTSAfUSTCDAIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED!2 the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS (from Mocbvllle) to PROPERTY: Tax Office PlN:��t 10/C/®IS Properly Address:. Road Name i ' St- / m I !P/ , �Q O' Si axr;4vcr� City/Zip ee rn e C If in a Subdivision provide information, as follows: Name: _ C) I'(11 i A i --•- Section• Block: Lot: Date Pro party Flagged: _ZZ ,2 4 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permil(s) Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the isformalion submitted in this application Is falsified or changed. 1, also, understand that! om roponsiblejdr aft charges tncrrrred frons this WUcadam I, hereby, give consent to the Authorized Representative of the D to ester upon above described Property �9 County Health Department, to conduct all testin a located in Davie County and owned by - rn g procedure as necessary to determine the site sulfa li DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SiTE PLAN (includtbldl of the folioisg: Property lines and dimetuioss, structures, setbacks, and septic locations). Existing and proposed Account No. Revised DCHD (07/98) Invoice No. l w_.,, . • DAVIE COUNTY HEALTH DEPARTMENT Water Supply: Evaluation By:: 'On -Site Well Community Auger Boring Pit Public c� Was] (617 EWA. ®®�® • a®ate-�� 3 LTA IN • SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: lT 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 oft , 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 Mineraloav 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 ocao (01.90) oe