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497-498 Swicegood Street Lots 13A & 13B'Directions to property Tc' *.*NOTE** This Authorization for W to, issuance of ahyBiiildin Office when applying for (In cbrnplimce with JUiiclell o ENVIROTOIfVLHFALTRSPECI Davie County Health Department Env/tenmentalHealth Sertlo,7 P.O. Box 848/210 Hospital Street II'� Hockaville, NC 27028 Lj NOY 2519% (336)751-8760 •rt��T ,+*� ENVIRONMENTAL HEALTH 448 ) THIS APPLICATION GINNOT BE PROCESSED UNLESS ALL INFOBMATTON IS PAONIDED, Refer to the MMMMMTION BULLETIN for inntruetionB. 1. Nano to be Billed Mailing Address :t Clty/State/LID Pe=lt/ATC It Different than Above Address ''+t;^PPlloatlon For: ❑ Site Evaluation a System to Service: ❑ Ron Id�Fiobile Home a: i If llasidence: / People '0 Dishwasher O'oarbage Disposal 6. If Business', contact Person Nm ae Plane T4 Business Q �rr1a5� City/stale/Lip _ 0Ayy, . 11 Improvement Permit/ATC th 11 Bus iness 0 Industry 11 Other 4 Bedrooms_ s Bathrooms _ O.Washing Machine 0 Basement/Plumbing ndustry/other: Specify two i People / Co®OdeO - 4 Showers - 4 urinals Ir tonus " 0 Basement/Wo Plunbing / Sinks f water Coolers ERVICB: Ii Seats Estimated Yater usage (gallons per day) 7. type of water supply: COnntY/City [T�Nell ❑ Community 6- Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No 1f yes,'what type? '"•/MPORTANT••*CLIENTSA/USTCOMPLEiETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBMiTT, U h the client with THIS APPLICATION. Property Dimensions: WRIITT/ED�7�77�� m Mjnville) to PROPERTY: Tat Office PIN: �S Property Address: Road Namei j>` �m°J f� 7 le 'J / City/ZipC.Q ht Q If in a Subdivision provide int ti A 7Ul# orma on, as follows: /)!"7- /i /Y , Name:y 11 1 A 1—' Section:Block:. Lot: �tr Date Pro pert? Flagged: �/� -- � f0 'This is to certify that the information provided is correct to the best army knowledge. 1 understand that any permil(s) issued hereafter are subject to suspension or revocation, if the site plans or intended usechange, or if the information submitted in this application Is falsified or changed. 1, also, understand that 1 am rope Ab/e if all charges Incurred front this apPBcmlam 1, hereby, give consent to the Authorized Representative of the Davjg County Health Depart to enter upon above described property located in Davie County and owned by n _! 2r — f — to conduct all testing procedure as necessary to determine the site suits It rn r act Snir��)r�a DATE J(— 5 9 tq SIGNATURE /7l 121T An P/� I///_ _ THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (tocluddill of thefolio iDg: Existing and Proposed Property lines and dimensions, structures, setbacks, and septic locations). �3j i3�1 2� Account Na —�- Revised DCHD (07/98) 4I `Y� H Invoice Na "T / r1 . ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation Cn \\ APPDATE LICANT'SNAME �n� �nA� � EVALUATED PROPOSED FACILITY M r tEM. PROPERTY SIZE _S• % 20 ke- SUBDIVISION ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: - Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7: ' Landscape position L_ Slo e % 2 o Z HORIZON I DEPTH O - (o D Texturerou 1� .Consistence i S � Structure . Mineralogy l ; ; HORIZON lI DEPTH Texture group C. Consistence Structure k Mineralogy HORIZON III DEPTH 3Z 1 Z Texture group.. �k Consistence ( r5 Structure Mineralogy. HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS . RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 2 EVALUATION BY: 7' LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: l - F lRIVr i1 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 ; 1 VFR - Very friable FR - Friable' FI - Firm VFI Very firm EFI - Extremely firm Wet NS Non stickySS - Slightly sticky S -StickyVS Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic tructur 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) „ 0 **NOTE** This,ilu idissuar Office x .; COMMERi LOT SIZE, Davie County Health Department1 1, En vironmenfa/ Hea/dr Se coon Y r P.O. Boa: 848/210 Hospital Street Hockaville, HC 27028 (330751-8760 ORTART**+ THIS APPLICATION CANNOT BE PROCBSSZV UNLESSALL THE INSORMATION IS PROVIDED. Refer to the In=MTION BULLETIN for inn I. Name to be Billed 2. Mailing Address C1ty/state/LIP Bass on Peralt/ATC if Different than Above4612 Mailing Address 3. Application For: t. system to service: s. If itesidence: Site Evaluation ❑ House 16'Fiobile Home / People D Dishwasher D Garbage Disposal contact Person Hama Phone 2,rl o NOV 2 5 1998 racy/state/Lip Selt-1y. . ❑ Improvement Permit/ATCth ❑ Business ❑ Industry 0 Other s Bedrooms -_ 13 Washing Machine e. If Business/Industry/other: specify type f Coemodes / Showers IP FOODSERVICE: / Seats 7. Type of rater enpply: D Basement/Plorbing i Bathrooms _2l H Basement/No PlUlbing / People / Sinks 4 Urinals tl Nater Coolers Estimated Rater Usage (gallons per day) w6unty/City 80116'11 ❑ C---4 s. Do you anticipate additions or expansions of the facility this system is Intended to serve? 1f yes, what type? ommun y ❑ Yes 0 No * **IMPDRTANP*• CLIENTS AfUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the elle,# with THIS APPLICATION. Property Dimensions: /-- ��. (WIR'11;CHONS (from Mocksville) to PROPERTY: Tax Office PIN: a 1 % — (q — j n10/�� qqI � � C� U Property Address: Road Name /11 I lP, %D�Ze F/ Lqn s6V1C e40C) City/Zip Wan Q C 5• �L1� If in a Subdivision provide information, as follows: Name: �1'(11 i A k --- Section: "Sectio, Block: Lot: 13 13 Date Property Flagged: Z0 2 I 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 i, this application Is falsified or changed. 1,, also, undastand that I ars "WOnsible jor all charm incurred front this appRoadom 1, hereby, give consent to the Authorized Representative of the Dark County Health Departure, to enter upon above described property located in Davie County and owned by _ fr UT e — fr to conduct all testing procedures as necessary to determine the site suits li .. 0 `�/,�nr� �i�/'�� DATE_ SIGNATURE__ On .An/!! THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclui Property lines and dimensions, structures, setbacks, and septic locations). Existing and proposed Account No. Revised DCHD (07/98) l'` Invoice Na - 'T7 AFFLIUAN I'N NANIE "�'!�+''�11__ artl.l-t+w•�••• PROPOSED FACILITY �• HBA SUBDIVISION Water Supply:, On -Site Well Community_ i Evaluation By: Auger Boring Pit DATE EVALUATED - 1l�51`i'7 ' PROPERTY SIZE CJ°^—• 120 iA �� .. ROAD NAME ALJ /C Sf Public Cut ; FACTORS 1 2 3 4. 5 6 7• Landscape position A( Slope % Z HORIZON I DEPTH Texture u U— CL Consistence SSS SS SP Structure C!L Mineralogy1 t 1 HORIZON H DEPTH. ^ Texture groupL' G Consistence : Structure S L Mineralogy1 HORIZON IH DEPTH 3 b ^ Oqq Texture groupC_ t Consistence S Structure Mineralogy HORIZON IV DEPTH Texture group Consistence - Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATEp PS ' SITE CLASSIFICATION. EVALUATION BY:-A`Y-t2ie.4c,?CIA- 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 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 .. 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 DcnnmI-W) - NONE MEOW NE