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461-475 Swicegood Street Lots 15A & 15Bproperty. i�0 rt s S NOT'authoriie the''construction or mstalladon of a septic tank system or any wastewater system ) it TEWATER SYSTEM CO '. NSTRUCTION"must b _ ... . „e obtained from this Deparfgient pnor to the Y�WHI ur p10 mnuauwui a quuuulg pcum� apter l30A, Wastewater Systems Section 1900 Sewage Treatment and`Drspo§al Systems) L -i r.•NOTICE+*eTEIIS PERMIT IS SUBJECT TO REVOCATION IF SITE - PLANS OR THE MTENDED USE CHANGE YOUR WASTEWATER P47 AsimD SYSTEM CONTRACTORMUST SEE THIS PERMIT BEFORE INSTALLINGTHE SYSTEM. Davie County Health DepardnentN�� Enviroamenfa/NealthSecaen �� -& f ig P.O. Box 848/210 Hospital Street Hockaville, NC 27028 NOV 2 5 19% (336)751-8760 •r+�ORTAHT.s*s APPLICATION ENVIRONMENTAL HEAL INF W%TION IS PROWDED. Refe(r]Nto MrORHATI BULLETIN for instructions. 1. Name to be Billed 1/�� P � Ti� lid Hailing Address City/state/LIP 2' Name on Permit/ATC if Different than Above Hailing Address S� 3. APplication For: ❑ Site Eval ��uati ��on 4. system to service: 11 House Id-Flobile Home s. If Residence: 0 Dishwasher People 0 Garbage Disposal Contact Person Boma Phone Business Phone v-:vrff� City/state/LSP _ ��!✓/� ❑ improvement Permit/ATCth ❑ Business ❑ Industry ❑ Other f Bedrooms _ * Bathrooms 0 Hashing Machine 6. If Business/Industry/other: Specify type f Commodes i Showers IF FOODSERVICE: Seats 7. Type of water supply: 0 Basement/Plumbing / People 1 Urinals 0 Basement/No Plumbing / Sinks / Hater Coolers Estimated gates Usage (gallons Per day) &i C unty/City wl;rell ❑Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No H yes, what type! •**IMPORTANP**CLIENTSAfUSTCOAIPLETETHE REQUIRED PROPER TYINFORMATIONREQUESTED BELOW. Either ■ PLAT or SITE PLAN AIUST BESUBMITTED by the silent with THIS APPLICATION Property Dimensions: IREC ONS (from Mociuvllle) to PROPERTY: Ta: Office PIN: q 5 %��— �y — J�� �/ Q l �Ir O / S � C/"1 / CS Property Address: Road Name #1A9 `St m °� f p,� Ze Of� L I o iT City/Zip eQ It in a Subdivision provide information, as follows: � Name: _ C) -),(h I A ►— • Section Block• Lot: Date Property egged: Pl 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. I, also, undastandtharI am reipansiMlejor all charges incurredroar thisWHcatfou. 1, hereby, give consent to the Authorized Representative of the Ds* County Health Depa tmen� S to enter upon above described property located in Davie County and owned by F O 4 pv- to conduct all testing procedures as necessary to determine the site alta ,lid, DATE f=h 9 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SrM PLAN (tucluddill of the follo Ing: Existing and proposed Property lines and dimensions, slructura, setbacks, and septic locations). Account Na o �_ Revised DCHD (07/98) 3 Invoice Na �_ kw" ~• :;': DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section sECTION LOT ASF} Soil/Site Evaluation APPLICANT'S NAME & X 4 14 DATE EVALUATED �dl PROPOSED FACILITY t . PROPERTY SIZE S• O L Q•e_.. SUBDIVISION ROAD NAME Water Supply: On -Site Well Community . Evaluation By: Auger Boring - Pit Public SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: Dcantoi-so> EVALUATION BY: CJV" -X�� OTHER(S) PRESENT: 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 Sand LS Loamy sand SL Sandy loam S, - 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 - Vey firm -' EFI - Extremely firm Wet NS - Non sticky SS Slightly sticky S - Sticky VS - Ve ry 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 , . • • • • tttsi>•tttt���o®—® • • . ttrattttr�®®®®® • rr.+ar�ca—®tea® •_ tttt�stat-�®®®®' ... tttr�t■a.®®®®� Consistence LIJ •14 Mejes1 I PIN •lai��-®®®® • t��s�tt��st®®®®® •: ®etas®®®®® Consistence • tt�>�tt�.s�®®®® SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: Dcantoi-so> EVALUATION BY: CJV" -X�� OTHER(S) PRESENT: 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 Sand LS Loamy sand SL Sandy loam S, - 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 - Vey firm -' EFI - Extremely firm Wet NS - Non sticky SS Slightly sticky S - Sticky VS - Ve ry 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 , MEN Y, K,�: v�Fi MEN] LTMENT'-� ERMITS ',,'PROPEL 0 Davie County Health Departmentu �w Env1rvnmenta/Ilea/thSMW47H �17� P.O. Box 848/210 Hospital Street Hocksville, HC 27028 NOV 2 5 1998 IN (336)751-8760 s4 DWORTANT•s• THIS APPLICATION CANNOT BE ENVII INFORMATION I9 PROCESSED UNLESS ALL THE BL!QpIgpp- PRr7�lIDED• Refer to the INFORMATION BULLETIN For instructions. _Hams to be Billed ,'-;:l `- Contact Person Q Home Phone 4I;�,:I Nailing Address _ City/state/LIPE? C Business Phone a. Name on Permit,—- . If Different than Abovm n Mailing Address 3. Application For: U Site Evaluation e. system to service: 11 House b'Mobile Home s: IF Residence: i People 0 Dishwasher 0 Garbage Disposal 6. If Business/I- 7. =K—svrrse� City/state/LSP 11 Improvement Permit/ATC th ❑ Business ❑ Industry ❑ other i Bedrooms — 11 Bathrooms _2L_ 0 Washing Machine stry/other: -specify type _ It Commodes / showers IF MI)SEMCE: / Seats .Type of water supply: 0 Basement/Plumbing I People f Urinals 0 Basement/Wo Plumbing / Sinks # Nater Coolers Estimated Water Usage (gallons per day) 9 runty/City rinWeli e:. Do you anticipate additions or expansions of the facility this system is intended to serve! 1f yes, what type! ❑ Community ❑ Yes ❑ No ••'IMPoRTAN77% CLIENTS AfUSTCOiIPLEIETHE REQUIRED PROPLRTYBVFORMATIONR6QI1pSTgp BELOW, Either a PLAT or SITE PLAN AIUST RESUBMITTED b the client with THIS APPLICATION. Property Dimensions: :2ze 1RE9Cf1ONS(f�rom Mo(cl�uville)/to(PROPERTY: Tax OincePIN: NJOle OLS /0 Properly Address: Road Name i ' st` /Ml/ /D /Q TT � S r�r1)c z4v r City/Zip eQ Yn LO C If is a Subdiviissi�ion provide information, as follows: Name: _ �--17(h'1y i— Section• Block: Loh, 5 • Date Property Flagged: Issued hereafter are subject to suspension or revocation, if the site plThis Is to certify that the information provided is correct to the best of my knowledge, I understand that any permit(s) submitted In this application is falsified or changed )ans or intended use change, or If the information , also, understand that I am rMonsMte jar ap charger Incurred from this RMfleadom 1, hereby, give consent to the Authorized Representative of the Davjq County Health Departmen to ester upon above described property located in Davie County and owned by 04 er — f to conduct all testing procedures as necessary to determine the site suite li %�% rn i r ��ar� �Irlf DATE �1�=� 9 SIGNATURE /71 f"J� An u _ �A ��1�_ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (includdill of the fella isg: Existing and proposed P roperty Hues and dimensions, structures, setbacks, and septic locations). Account Na 0?1� Revised DCHD (07/98) Invoice No. Soil/Site Evaluation DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT 15Ii APPLICANT'S NAME—* PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut_ SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 0.7 j REMARKS: DCHD(01-90) EVALUATION BY: �/ f OTHER(S) PRESENT: 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 - gal/day/ft2 • • • • • • �i''��S®000 . • GgZ�JR�f[�®®�0® • r WMrAj=4r Consistence SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 0.7 j REMARKS: DCHD(01-90) EVALUATION BY: �/ f OTHER(S) PRESENT: 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 - gal/day/ft2 MEN ■ ■