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392-394 Swicegood Street Lots 6A & 6BDCHD 051% (ReviW) -"swam a Nrli Davie County Health Department �/!y Enviionmenfal Health Secflon P.O. Box 848/210 Hospital Street McckBville, HC 27028 13361751-8760 •as31M0RTANT►ss THIS APPLICATIOH O MHOT BE PROCESSED ZHFORMATIOH I9 PROVIDED. MUSS ALL THE R0£er t0 the IHpORMATIOH BULLETZH for ina 1. Name to ,be Billed Nailing Address City/State/LIP � Inn �n ,y ;,,,, a• Name en Pewit/ATC if Different than Nailing Address fAj 3. Application Sar: 4. System to Service: S. If Residence: ❑ Site Evaluation ❑ House U -Il bile Home # People 0 Dishwasher. D Garbage Disposal contact Person Dome Phone U ulcy/orate/zip _ SALJyi ❑ Improvement Permit/ATC X4355th ❑ Business ❑ Industry ❑ Other # Bedrooms f Bathrooms _ Z• D Washing Machine S. If Business/Industry/Other: Specify type # Comes # Showers IF FOODSERVICE: # Seats 7. Type of Water supply: D Basement/Plumbing D Basement/No Plumbing # People # Sinks i Urinals # water coolers Estimated Nater usage (gallons per day) Y County/City well ❑ Community B. Do you anticipate additions or expansions of the facility this system is Intended to serve! ❑ Yes ❑ No If yea, what type! ""'IMPORTANP** CLIENTS AIUST CDAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAANN�MUST BESUBMTEED b the Silent with THIS APPLICATION. Property Dimensions:y/ / /-S�� j /' p /� WRITEE1DDE�ONS(fToom Moccicknillle)/toPROPERTY- Tax Office PIN: #� /TJ—i'lq�I�-( �(��rii,�( Q1 S /(J O� /V ( J Property Address: Road Name St I m 1p� Za iT Sn City/Zip 9-12'M L7 C If in a Subdivisiou provide information, as follows: Name: _ �7 C 1 I A I -' Secttoq• Block: Lot: �e //% Date Property Flagged: ZZ 4 ' —99W This is to certify that the lsiormatlon 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 cbsnge, or if the information submitted In this application Is falsified'or ehauged. I, also, mirderetond that lam responsib/e for all charges lncwrred from rhlr aWycadalL 1, hereby, give consent to the Authorized Representative of the DavkCounly Health Department, to enter upon above described property located in Davie County and owned by {''}} O q py- — f rn i r. 6 ac) Spf to conduct all testing procedures as necessary to determine the site SuitswKeAn DATE SIGNATURE lrnIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inciuddill of the follorgg: Properly lines and dimenslona, structures, setbacks, and septic locations). Existing and proposed Revised DCHD (07/98) 0 Account No. 4 Invoice No. �9� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' SECTION LOT44 Soil/Site Evaluation Water Supply: On -Site Well Community_ Evaluation By: Auger Boring Pitt 1. SITE CLASSIFICATION: f S EVALUATION BY: d LONG-TERM ACCEPTANCE RATE: 0A OTHER(S) PRESENT: - l ' c oT Pal ^- -' 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 Tex r 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 AMA 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 DCHD (01-90) Structur 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 -tens acceptance rate - gal/day/ft2 Consistence r� '�i'Si�©®�®®-I HORIZON 11 DEPrH Consistence HORIZON 1. SITE CLASSIFICATION: f S EVALUATION BY: d LONG-TERM ACCEPTANCE RATE: 0A OTHER(S) PRESENT: - l ' c oT Pal ^- -' 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 Tex r 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 AMA 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 DCHD (01-90) Structur 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 -tens acceptance rate - gal/day/ft2 DAVIE�, Q, iMPRO E NOTICE*•*..THLS PERbI1T IS SUBJECT TO REVOCAUON IP STI'El f L�[ ' ' Pi.ANS nR THF. INTF.idDF.D TiSF. CHANGF..�:VnTJR WASTF,WATF.R,:.. ..oiy,mruurrintlYt PtHINII & AiC Davie County Health Department �r! EnP/ronmenfofHealth $Lcifon P.O. Box 848/210 Hospital Street Hookeville, NC 27028 (336)751-8760 •rrgrppRT �** THIS APPLICATION CANNOT IM pg=SSM UNLE39 ALL T1 INFORMATION I3 PROVIDED, Refer to the INrOBHATION BULLETIN for it 1. Rams to be Billed Mailing Address City/state/SLP a. Nam on permit/ATC if Different than Mailing Address 3. Application For: ❑ Site Eval ��uati on System6. Systto Service: ❑ House �d'Hobile Rome a. If Residence: i People D Dishwasher D Garbage Disposal Contact Person Rom plume 01y' Business RY5 1 ";4 Z U5 iTwl City/state/Lip f� ❑ Imprevement Permit/ATC th ❑ Business ❑ Industry 0 Other i Bedrooms _ a Bathrooms 2— m Washing Machine 6. If Business/Industry/other: Specify type I commodes a Showers 0 Basement/Plumbing a urinals a People 0 Basement/No Plumbing i sinks i Water Coolers IF FOODSERVICE: # Seats Estimated Nater 1J8u4e ���• (gallons Per day) 7. Type of water supply: F9 C nnty/City tisA 11 e ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 0 No If yea, what type? ***1MPORTANT***CLIENTS MUSTCOAfPLEfETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther s PLAT or SITE PLAN AIUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: �y S v j /` WRITE DIRECTIONS (from Moccljnvllle)/to�PROPERTY: Tax011icePiN: N5 /�j�— 14'—lay-�(/ I )t�Q, Property Address: Road Name )" ` St _ /e ;P/ *0 / u/lcegvc City/Zip e.Q 71 V If in a Subdivision provide information, as follows: �` Name: Section• Block•/ Lot: - G 13 Date Properly nagged: �� •7 C 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 1, also, understand that l aur rrspons161e for aR charges Incurred from this applleadom 1, hereby, give consent to the Authorized Representative of the DR* County Health Departmen to enter upon above described property located In Davie County and owned by - /} QT QI— to conduct all testing procedures u necessary to determine the aIle in 17 11 .. DATE SIGNATURE l >i'IOn THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclnddfil of the follo�sg: Existing and proposed Property lines and dimensioas, structures, setbacks, and septic locations). Revised DCHD (07/98) Account Na_ Invoice No. ^ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section.. SECTION; LOT -4 3 Soil/Site Evaluation APPLICANT'S NAME �-0Cety�—t I� J�r�% ' DATE EVALUATED �Z u PROPOSED FACILITY W�- L� PROPERTY SIZE• 7 -*o &e_ SUBDIVISION ROAD NAME �.S SUBD O 016e &60 1� Water Supply: On -Site Well Community Public i Evaluation By: Auger Boring Pit /J'. Cut SITE CLASSIFICATION: Q 7 - EVALUATION BY: �� mol y � -�4� ^T LONG-TERM ACCEPTANCE RATE: O• `t 1346 1` 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 loamL - Loam SI - Silt SICL - Silty clay loam . SII. - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE o) 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) • -,4 VA81125 a . 21 • Consistence HORIZON DEPTH ��®o—®® . • r���;•®®tee® ConsistenceHORIZON . •: ®mss®®®®® IV DEPTH • • SITE CLASSIFICATION: Q 7 - EVALUATION BY: �� mol y � -�4� ^T LONG-TERM ACCEPTANCE RATE: O• `t 1346 1` 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 loamL - Loam SI - Silt SICL - Silty clay loam . SII. - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE o) 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) iii■ NONE