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427-443 Swicegood Street Lots 16A & 16BDliectio'to 0 p DCHDOS(RcVtW) M Davie County Health Deparhnent Environmental Health SaWan ,r P,O. Box 848/210 Hospital Street Hockeville, HC 27028 NOY 2 5 1998 (3361751-8760 ***y�ORT�.*** THIS APPLICATION OUIII ES ENVIRONMENTAL HEAL THE '"JIU HATiON IS PROVIDED. Refer to the INFOBHATZ BM=TiN Por iinstructions. 1. Name to be Billed ` Cma�taaG Person Hailing Address Bame Phonecity/state/LIP C. a�e14-. JS 2. Run on peau/A1C SL Different than Above Business Phone _ �I L..... I f C_11 I. Hailing Address 3. APplication For: RI Site Eval ��uati ��on e• system to service: O House l�'Ltobile Home s. If Residence: + People 0 Dishwasher 0 garbage Disposal city/stale/Lip D Improvement Permit/ATC th D Business 0 Industry 0 Other / Bedrooms • Bathrooms _,� 0 Washing Machine s. I! Business/Industry/other: specify type a ccmtmode° i showers Il y00DSERVIcz: g Seats 0 Basement/Plumbing 0 Basement/No Plumbing i People / sinks i Urinals' 1 water Coolers Estimated Water ` 11 Usa ge !gallons per day) 7. Type of water supply:County/city tF W e 0 community e. Do you anticipate additions or expansions of the facility this System is intended to serve! 0 Yes . ❑ No If yea, what type' -- '•*1MPoRTAN7%**CLIENTS AIUSTC0,11PLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLANAnt-crnF.crram,r�.n._-..__..- ,Property Dimensions: Tax Office PIN: Properly Address: VR1TEtD1RECflONS (from M«knIlle) to PROPERTY: 7i*i'- WOl5 Rand Name i St City/Zip t?QYn 0 h If in a Subdivision provide information, as follows. 7Uj Name:-17.(� l Iy ►— Section: Block: .. Lot: I IA A Date Property Flagged: r� This is to certify that the isformatt00 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 plana or intended use change, or if the information submitted in this application Is falsified or changed. I, also, underetand'hat I am r"Pnnsible jar all charges Incurred from this application. 1, hereby, give consent to the Authorized Representative of the DI County Health Department. to enter upon above described property located in Davie County and owned bi rr l9g ey — f to conduct all testing procedures as necessary to determine the site mita li 1I J 0 DATE _ Jr-- 15_ SIGNATUttE THIS AREA MAY BE USED FOR DRAWING YOUR SFFE PLAN (Inclm Property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) pv r A -I X10 lv Existing and proposed Account No. ?±— Invoice No. 4-3 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LoT II � t9 Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATEDt f'9� PROPOSED FACILITY "` � PROPERTY SIZE S -.61 I. A_Ct SUBDIVISION ROAD NAME 6�-4'4* ` W 5f Water Supply: On -Site Well Community Public Evaluation By: Auger Boring' Pit Cut FACTORS 4 2 -21 3 4 5 6 7. Landscape position Slope % & % 7 7a HORIZON I DEPTH Texture group Consistence — Structure Mineralogy ,' :1 HORIZON II DEPTH — - Texture group Consistence SP SIP Structure Mineralogy HORIZON IH DEPTH Texture group�L Consistence S 1 Structure Mineralogy /. HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS i TRICTIVE HORIZON SAPROLITE CLASSIFICATION . PS p . LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: / ✓ d EVALUATION BY: �1n LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: �ili/,J% / 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 SII.. - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C,- Clay CONSISTENCE ist 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 withbhroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long -tern acceptance rate - gal/day/ft2 Dcaum1-so) ■■■ MEN o■a EY■ III Davie County Health Department�l' EnvinonmenfalHea/ih Section '7' P.O. Box 848/210 Hospital Street uu NOV 2 5 1998 Mooksville, HC 27028 (336)751-8760 '"'ZWORTANT•"* THIS APPLICATION CANNOT BS DAVIE COUNTY INFORNATf.L27 I9 PROVIDED, Refer to the IMMIATTIIplt ULLETIN ALL iinnstruatio- 1. risme to be Billed ` t Contact Person 0 Na114n4 Address Home Phone City/state/LIP C a�o1N' . - Business Phone a. Mase on Pewit/ATC if Different than Above_[j/Jp II & I' L o Mailing Address —�-' ll/Ih l l'(• ✓I OAC :)A -i - ! City/atate/8i 3• Application For: U Site Evaluation U Improvement Permit/ATC th 6• System to service: 11 House 14_19bile Home O Business U Indust - ry 0 Other 3- If Residence: / People A Bedrooms - 3 / Bathrooms._.2, . 0 Dishwasher 0 aathage Diaposal 0 Washing Machine D Basement/plcabing 0 Basement/Wo Plumbing 6: -elf Business/Industry/other: Specify type People # sinks # Commodes/ 8hawers * Urinals # Water Coolers IF FOODSERVICE: g Seats Estimated Nater Usage (gallons per day) 7 Type of. water supply: fr aunty/City 811 0 Co"exunitY e I Do you anlicipate additions or expansions of the facility this system Is Intended to serve? p yp 0 No It yea. what type! ""'IMPORTANT'•• CLIENTS AfUSTCOAIPLETE7Itg BELOW. Either a PLAT or SITE PLAN dIUST BESUBMiTTEDUby the client PROPERTY THIS AppLlCAT1ONION �UESTED Property Dimes siom•. _ S� al L WR,,I�TE� IREEMONS(fromMocknille)toPROPERTY: Tax Office PIN: # 57� .5- �q " A� of der~C7 % S � Gfi r C� Properly Address: Road Name �/—•AZe 7L LJ�N /lC BU cityizip ee 771 e C If 16 a Subdivision provide information, as follows: A7014 f Name: Q711l ly)- Sect. . Block: Lot: ( Date Property Flagged: 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 site plans or intended use change, or if the information submitted in this application to falsified or changed. I, a'ro, R""Wand that I am rrspoestb/ejor all charges Incurred from this uMMcation. I, hereby, give consent to the Authorized Representative of the Davjg County Health epartmea t. to enter upon above described property located in Davie County and owned by {'} t94 2v — J:- rn to conduct all testing procedures as necessary to determine the site mile li tr pct DATE �f —��SIGNATURE THIS AREA MAY BE. USED FOR DRAWING YOUR SITE PLAN (Inclad I of the follo Ing: Existing and proposed Property lines and dimensions, structures, setbacks, and septic locations). IYh IpIa� Revised DCHD CJ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOTH L. B Soil/Site Evaluation ^, o t APPLICANT'S NAME L&I, Ulv^ � DATE EVALUATED h1 i I PROPOSED FACILITY N/I, vow PROPERTY SIZE S• b l G IA SUBDIVISION, ROA _ D NAME/ Water Supply: On -Site Well Community Public Evaluation By:. Auger Boring Pit -- Cut - 1 •' Consistencerg30WMJ � ®�— M-a®o®®ops HORIZON .' SITE CLASSIFICATION - PJ EVALUATION BY: A94— J LONG-TERM ACCEPTANCE RATE C)=h) 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 - 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 - gaVday/ft2 DCHD (01-90) e■ ON No