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426-432 Swicegood Street Lots 9A & 9B?a Davie County Health Department �"mn.,m a sass} EnvIronmentalflea/thSection P.O. Box 848/210 Hospital Street D Mocksville, NC 27028 NOV 2 5 I (336)751-8760 ***I11P0RTANT*** THIS APPLICATIONn rANt:OT'M PROCESSED UNLESS ALL T� QSf.3.REO/IE INCOUNTY FORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. —�— I- Name to be Billed ` t Contact person (J Mailing Address 02 0 (1 ^ L Boma Phone Clty/state/LIP �I'1 Business Phone .J 1 a. Name an Penh/ATC if Different thsn Above Q I -p'- nOe llCl Halling Address rl Clty/state/zip _ f �- 3: Application For: U Site Evaluation !i',.' 11 Improvement Permit/ATC th 4. system to service: 0 House N'6tobile Rome 0 Business 0 Industry 0 Other s. .If Residence: / People i Bedrooms _ / Bathrooms D Dishwasher D Garbage Disposal D Washing Machine a Basemrat/Plumbing D Basement/No Plumbing 6. If Business/Industry/other: Specify type / People- !sinks #_Commoades P Showers # Urinals •Mater Coolers IF FOODSERVICE: % Seats Estimated gator Usage (gallons per day) 7. Tppe of water Guppies: O'CCounty/City tell' 0 Comaartlity a- Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes U No H Yes, what type? * m •IAfPORTANT**! CLIENTS AIUST COAIPLETETHE REQUIRED PROPERTY INFORMATION REQUF»S7'ED BELOW. Either a PLAT or SITE PLAN AIUST BESUBMITTED b the client with THIS APPLICATION. - Property Dimensions: /� � /WRITE DIRECTIONS (from MocckkkssAlle)/to PROPERTY: Tax Olice PiN: # ��. —`i' `-r 1' a �01.S 746 0 U ! S Property Address:. Road Name i' St` m °�/� %A Ale e a .l d eqo c City/Zip PEN If in a Subdivision provide information, as follows: Name: -)A I() r Section: Bleck:' Lot: =L� Date Property Flagged: ;Z J� This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permli(s) Issued hereafter sre.sulikci to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsiled or changed I, also, aaderstand that Ian rrsponAble for all charges Incurred frons this applkaaikm I, Hereby, give consent to the Aulhorimd Representative of the DavjgCounty Health DeparlmeBf, to enter upon above described property located in Davie County and owned by {{''}} OT py — to conduct all testing procedures as necessary to determine the site suits li J DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ 1 of the foils tog: Existing and proposed ,^ property hues and dimensions, structures, setbacks, and septic locations). .,. k Y / , A 7, Account No. Revised DCHD (07/98) ;, —Invoice Na �_ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT 9M Soil/Site Evaluation APPLICANT'S NAME- Pll DATEEVALUATED 1� PROPOSED FACILITYi(Mt, PROPERTY SIZE S • 2 %J O 0 c, - SUBDIVISION 1 ROADNAME 51,J1'C,454'tV/% Water Supply: On -Site Well Community / Public' Evaluation By: Auger Boring Pit J Cut VAN 01 114 W&"%4 •- ®9�i��-®-fie . WARM" • ®fie -ems® • ... 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 slopeT - 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 oisf . VFR - Veryfriable !'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 OR - 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(0I-90) ME ■ RESIDENTIAL SPECIFICATION: BUILDING TYPE 11V%" # BEDROOMS ' -7 # BATHS -'� .'4 # OCCUPANTS " GARBAGE DISPOSAL:;Yes o b Davie County Health Department� Env/ronmenfal Health Section D P•O. Box 848/210 Hospital street MOCkBville, HC 27028 NOV 2 5 1998 (336)751-8760 rr•I!>PORTANT*** THIS APPLICATION�bnn^nwirMTni ucn INFORMATION I9 rAN1I01' BS PROCESSED UNLESS ALL THB_REQDIRED'E 0U� NTp_y PROVIDED. Refer to the INffORt4ATION BULLETIN for instructions. 1. Name to be Billed Mailing Address City/state/LIP a. Name on V*rait/ASC if Different than Above - Halling Address _ )re%Q-1 - 3. Application For: U site Evaluation 4. system to service: ❑ House Id1Mobile Home s. IP Residence: / People 0 Dishwasher 0 Garbage Disposal Contact Person Boma Phase LL0± Business Phone a NIffm� City/atate/rip _ 0 9-1�71 ❑ Improvement Permit/ATC X& 6th 11 Business ❑ Industry ❑ Other i Bedrooms _/ Bathrooms _ ' 0 Washing Machine 6. If Business/Industry/other: Specify type t Commodes t showers 0 Basement/Plumbing 0 Basement/Ho Plumbing f People s sinks f Urinals t water Coolers IF FooDsERVICE: 11 seats Estimated Hater Usage"e.(gallons per day) 7. Type of water supply: .{dd ewunty/City 11 e 11 Community S. Do you anticipate additions or expansions of the facility this system is Intended to serve! ❑ yes 0 No If yes, what type' ***/MPORTANT***CLIENTSAtuncOAIPLETETHg BELREQUIRED PROPERTY INFORMATIONREQtJES7Ep BELOW. Either a PLAT or SITE PLAN AIUSTBESUBMiTTED by the client with THIS APPLIVATInN Property Dimensions - WRITE DIRECTIONS (from Mocluville) to PROPERTY: Tax Office PIN: p S 764- Property Addngs: Road Name_740- Ile 00 L d City/Zip ee ht Q C If in a Subdivision provide information, as follows: 'tz'701# n f B Name: _ -1-),114 I A I-- Section• Block: Let: q 3 Date Property Flagged: _�f ;Z_6 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 appReation is falsified or changed. 1,, also, understand that t am rapomiblefor all charges lncurred frena this application. I, hereby, give consent to the Authorized Representative of the DavkCounty Health Depsrlmen to enter upon above described property located in Davie County and owned by — {'�i O4 2y — f Alit ac) S to conduct all testing procedures as necessary to determine the site tuna li il) DATESIGNATURE �� l%n THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (includfifdl of the follo ing: -Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). I Revised DCHD (07/98) Account No. Invoice No. 73 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME ' nn YT_4il - -v" 1 J DATE EVALUATEDInk PROPOSED FACILITY r • a0M!! PROPERTY SIZE S. D Zo A -e, SUBDIVISION ; . ROAD NAME5ewaocoJ S% Water Supply: _ On -Site Well Community .Public / Evaluation By: Auger Boring Pit Cut IN •. Consistence Consistence Bp_ila�i��---- WWROGYNIT80- SITE CLASSIFICATION: 7T EVALUAT�TIIOr B �� rV V r ��, LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: J Wt- 11n�vMN 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 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 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-N)