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492-496 Swicegood Street Lots 12A & 12BDirections to property AC r **NOTE** This Improvement Permit AUTHORIZATION,FOR constructioD/installahon'o: qri complinnce'with Article' I1 of G.S. 17 Section Lot'. i2 er ,;;'IMPROVEMENT 'i' 1' PERMIT Tax Office PIN: c Road Name „V tI�E(_.LU)p 2 iY DOES NOT authorize the construction or installation of a septic tank system or any wastewater, system An WASTEWATER SYSTEM CONSTRUCTION must be obtaitied from this Department prior to the A system or the issuance'of a building petnut Chapter 130A, WastewateX Systems, Section 1900 Sewage Treatment and Disposal Systems) t a ***NOTICE"*",THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE 1�r D SUED NSTALLINGTIIESYSTEM RESIDENTIAL SPECIFICATION: BUILDING TYPE_ ON E1 # BEDROOMS' -2, ;�# BATHS 2— .# OCCUPANTS GARBAGE DISPOSAL: Yes r No R COMMERCIAL SPECIFICATION FACILITY TYPE ' # PEOPLE # PEOPLE/SHIFT. :#S EATS INDUSTRIAL WASTE Yes or No 'LOT SIZE TYPE WATER PLY �,,,, �� �^� SUPPLY tJ � DESIGN WASTEWATER FLOW (41)y A NEW SITE ✓ REPAIR SITE W QiAL: PUMP TANK GAL. -TRENCH WIDTH 3co ROCK DEPTH � 2 t I LINEAR FT.; SYSTEM SPECIFICATIONS: TANK SIZE 1 + OTHER - 1 1/'I�TQ.1 �IiTIOn.�� :' A\YfCO�t67 GYF'1.1.JtG '�1 •REQUIREDsrrEMODIFICATIONS/CONDITIONSi-lNkA ON 14 10l%"-, (�,P.S IMPROVEMENT PERMIT LAY - - - - IF 'LAN -I C) r ArJT **CONTACT A REPRESENTATIVE OF THE DAV IE COUNTY HEALTH DEPARTMENT FOR FINAL ;INSPECTION OF.THIS SYSTEM ".. BETWEEN 8:30 - 9:30 A.M. OR 1:00'= 1.30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)7514760.' - DCHD 05N6(Revised). - --•� --array nworur ueparonent Earlivamenfa///eslfhSwffon P.Oa Box 848/210 hospital Street { Hooknviue, NC 27028 ! li.(, NOV 2 5 1998 13361781-8760 aaayy�p xAM!wwaa THIS ENVIRQNMF.PIIALHEAL XIMPI ATION IS PRMIDED. PeIM CatfHOT IM PJ20=581M UNLESS ALL THE HE 191 o the INrOBMATION BULLETIN for instructions. Mass to be Milled Mailing Addressess Contact Psrsaa i7 (1 �1 /L _ City/state/LIP C I�f Mnsinesa o •i /�, C % Maas on Persdt/ASC if Different than Ahoee-- ' Mailing Address Application ror: U Site Evaluation system to`'eeiviee: U House Ud-Iq bile Home V^,Resideuae: / People U Dishwasher D garbage Disposal a..an, vl N City/state/rip 0 luvrovement Permit/ATC th 0 Business 0 Industry 0 Other / Bedrooms U Mashing Machine If.Business/Industry/other:. Specify two / des / showers Ir rowsmmcE: / Seats Type of water Supply: / Bathrooms _2. 0 Maseaent/Plumbing D Masesent/no Plumbing — / People / Sinks / urinals I water coolers Estimated pater usage lgallons par day) !9 cmty/City [F�itell 0 Coamuaity Do you anticipate additions or espausions of the facility this system is intended to serve! H Yes, what type! 0 Yes 0 No ""'1MAORTANT1ee CLIENTS MUST CDAfPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED or SITE PLAN MUSTBESUBM/TTED by the client with THTs tpP),IraTInN BELOW. Either a PLAT Property Dimensions: _ �/ Ii /�- /� IREMONS (from Mocteville) to PROPERTY: Tax OmcePIN : NJ57'TJ—i'l4�-r�(,o�aA� O/ S 7 �D�S Properly Address: Road Name Sf jmlj�7 /e 7T 4:90 SW1Ge4< Ctly/tip 2¢ Yn Q C S If 1-0 1.2 Saibdivision provide tnformallon, as follows: Name: C) 7. -M I r Section: Block: Lot: Date Properly Flagged: 'is is to eerily that the larormation provided is correct to the best of my knowledge I understand that any permit ) Bred hereafter are subject to suspension or revocation, if the dte plans or leleeded use ebsnge, or if the Information bmlHed to this Application is falsified or changed. /, ahv, isS&rsfassdMat/ass s aPPRcatiam 1, hereby, p rrspoissible for all chaste$ incanrd from give property to at Authorized Daviel on reaegtallve of the D County Heallb epartme"k enter upon above described property located tq Davie Caenty Suit owned b _ L S conduct all testing procedures of necessary to determine the site sulfa 11 ? Q9 Qv- — � /-% ►TE 9 st 5 SIGNATURE /7i f"li? ✓� y _ J SOU _ IIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN peclnddldl of 16e folio IMg: E=yage proposed sporty IIgRs Med dtmensioes, dructurel, setbacks, and septic locations). K • s— Toy Account No. wed DCHD (07/98)_ 3� Invoice No, C DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION ` LOTIaA' Soil/Site Evaluation APPLICANT'S NAME DATEEVA LUATED, 'l17-f1�1' PROPOSED FACILITY PROPERTY SIZE S• 5-(+-7 A�- SUBDIVISION ROAD NAME ... 'Water Supply: Evaluation By: FACTORS 1 2 3 4 5 6 7 .Landscape position . On -Site Well Community Public 22ii Auger Boring Pit Cut 0 -to . I - FACTORS 1 2 3 4 5 6 7 .Landscape position . L L Slo e % 22ii 3 c HORIZON I DEPTH 0 -to . I - Texture ou Texture L Consistence g Structure Mineralogy1 l l HORIZON H DEPTH te - 7 - Texture group Consistence F; . Structure Abk 3 Mineralogy; HORIZON III DEPTH Texture groupG+$ C Consistence 5 Structure Ic K� Mineralogy1:7 HORIZON IV DEPTH Texture grouptJd rt�Z Consistence Ij p T Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE' SITE CLASSIFICATION: PS EVALUATION BY: r '60AJr_4 1" LONG-TERM ACCEPTANCE RATE: 7 , OTHER(S) PRESENT:-iiL,flr i P t^^ 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. - Siltyloam .. , 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) ' LIAR = Long-term acceptance rate - gal/day/ft2 DCHD(01-90) AUTHORIZATION NO ,1 9 8 DAVI$OUNTY HEALTH DEPARTMENT iiiiii Environmental Health Section. PROPERTY INFORMATION PermittFe s P.O. Boz 848 Name:lllw�n�.f - �i Mocksvi]Ie, NC 27028 Subdivision Name: QQ S Phone # 336-751-8760 Z L Directionstop iLAS —Iy `� l Section: I 4' Lo/t:: CJJ 1Gi�C�C�t� - AU-WASTEWATER WASTEA ATER OR - %7�' �t SYSTEM CONSTRUCTION Tax Office PIN:# �vic � ST 2�U2b Road Name: Zip: This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie, County Environmental Health Section prior to issuance of any_BuildingPermits; This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits - (In compliance with Article -I l of G.S. Chapter 130A, Wastewater Systems; Section .1400 Sewage Treannent and Disposal Systems) ***NOTICE*.*! THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENV IRO M >IVT " ALTH SPE �� IA DA 1 SUED Davie County Health Department �17 En vironmenfa/ Health SeWan P.O. Box 848/210 Hospital Street Hookoville, HC 27028 (336)751-8760 �h�� 1 5 D NOV 2 5 1998 ***XW0RTRd7T*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AIS, THE — UIRE� TNFORHATiON IS t?ROPIDED. Refer to the INFOR1=1011 BULLETIN for instructions. 1. Base to be Billed :falling Address City/state/LIP 2. Name on permit/ATC if Different than Above_ Nailing Address _ 5+Q--1 / 3. Application For: 0 Site Evaluation 4. system to Service: ❑ House W-Itzile Home S. If Residence: * People 0 Dishwasher n garbage Disposal -W Contact person Game phone -sem• 1 DDeasiness Phone AL0r- & city/stage/zip 0 Improvement Permit/ATC th 0 Business ❑ Industry 0 Other IF Bedrooms -? 4 Bathrooms 2_ D washing Machine S. If Business/Industry/other: specify type Co®odes I Showers IF FOODSERVICE: / Seats 0 Basement/Plunbing people Urinals 0 Basement/No plarbing / water coolers Estimated Rater �usage (gallons per day) 7. Type of water supply: maty/City t�f 11 a s. Do you anticipate additions or expansions of the facility this system Is Intended to serve! - H yes, what type! 0 Community 0 Yes ❑ No ""IMPORTANT*** CLIENTS AfUSTCOAfpLETETHE REQUIRED PROPERTY IN REQUESTED BELOW. Elther a PLAT or SITE PLA-N�-A-IUST RESUBMITTED by the client with THIS APPLICATION Property Dimensions: DONS (from Modnvllle)toPROPERTY: Ja:OfRCe PIN: 957 - � -ley R�olaB S®�s Properly Address: Road Name 740�e f.+Jite40f City/71p e27np 17 In a Subdivision provide information, ss follows: i•im" Block: Lot• /.7B Date Property Flagged: _ �% eZ iY This is to certify that the Informalion 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 ax change, or if the Information submitted in fhb applicalfon la filsiRed or changed I, also, understand shat I am roponsfble for a// cha/gu Incurred frons tills appllc4&JL 1, hereby, give consent to the Authorized Representative of the Da County Health DepsrlmeB to ester upon above described property located In Davie County and owned by f104 ev- — to conduct Al testing procedures as necessary to determine the sitesuits It s 4C) DATE ' ��_�� s� SIGNATURE nl� In THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ64l of the folle(lBg: Existing and proposed Property lines and dimensions, structures, setbacks, and septic 10ations). Revised DCHD (07/98) Account Na Invoice Na _ ' DAVIE COUNTY HEALTH DEPARTMENT 'Environmental Health Section SECTION LOT1,3 Soil/Site Evaluation APPLICANT'S NAME 4,�Me— QILWY• 4,) ' DATE EVALUATED I IZ7, PROPOSED FACILITY �' :1401. r, PROPERTY SIZEs � Jrr 47 j4` SUBDIVISION ROAD NAME 5U)jeZt�o.0 sr Water Supply: Evaluation By: On -Site Well . -Auger Boring Community Pit Public Cut_ SITE CLASSIFICATION:�> EVALUATION BY: 1` LONG-TERM ACCEPTANCE RATE: D• _f OTHER(S) PRESENT: �IM / ) 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 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-term acceptance rate - gal/day/ft2 D D (01-90) l • ' • 1 • Jjjjw�j M`Z'®®®-- Consistence • r��r��io�®sem • •: si��l®-®®s- • • �M�j sem -- SITE CLASSIFICATION:�> EVALUATION BY: 1` LONG-TERM ACCEPTANCE RATE: D• _f OTHER(S) PRESENT: �IM / ) 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 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-term acceptance rate - gal/day/ft2 D D (01-90) l OEM 0■■■■ ■■t■■ ■■■■■