110 Cummings Lane Lot 8A1W" +.'i - i.,, i tl�.t .�. r.. ,. }�ycy. �..,. w�� ef, >.,p.. r.-. Y}: 1�v�@";n' ~ t1. e.l .,
AUTHORIeAATION NO 1720 DAVIEOUNTY HEALTH DEPARTMENT
- Environmental Health Section PROPERTY INFORMATION
Permittees .I '— P.O!Box 848
Moc
Name �f IflMN ksville, NC 27028 Subdivision Name:
Directions t-oproperty:, (pt�►S'Ta / +dA tt r S Phone # 336-751-8760 8 A > 1
,Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PINI.S
SYSTEM CONSTRUCTION /�
-,A I �] °t A IS 0 F 54t_ut tl�rLfS Road Name: / / IC1114Ee5 eb Zip: , Z�t3xg
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County,Environmental Health Section prior
to issuance of any Building -Permits. This Fomt/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I I of .S':.Chapter 130A, Wastewater Systems; Section :1900 Sewage Treatment and Disposal Systems) ; '
NOTICE THIS
VALID OR AUTHORIZATION PERIOD OFA�E EARS. CONSTRUCTION
- /
***NOTICE***
ENVIRONMENt AE;kl:fH SPE IST DATE ISSUED r,
PV�(p �p 11 21 9Y
7:2 Q DAVIE OUNTY HEALTH DEPARTMENT
IMP.RO, EMENT AND OPERATION PERMITSPROPERTY INFORMATION
DIIiJec'tronst property �'� �*J""rT:
�—rJ tJt��.il%tF �'rf _1u.3t.tt^+.�. •�
S
**NOTE**;This Improvement Pe
AUTHORIZATION 1
constmctionfinstallatu
R.. .: .....1..,....d:d,.�h m7
dation of a septic tank system or any wastewater system An
)N must be obtained from this Department prior to the
IOMCnmaan Tmafman4 aniiTwnncal .CvctPmcl .. .,
t APPLICATION FOR SITE EVALUATION/IMPROVFMFM PERMITB C�
Davie County Health Department
EnWivamental Health Section
P.O. Box 848/210 Hospital Street SEP 23 1998
Mocksville, NC 27028
(336)751-8760 FNVIRONMENTALHEALTH
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed _�UCiE(L SID IIMAJ Contact Person. '20GER. QQfl JkiA O
Hailing Address P.0• 60"L 1.38 �,1 Some Phone BZU 0291- ^Irlg7
City/State/ZIP � CA lr N C rn `� b i q Business Phone 3 o Q� i -Tt
2. Name on Permit/ATC if Different than
Nailing Address
3. Application For: ❑ Site Evaluation
4. system to. Service: ❑ House Y� Mobile Home
5. If Residence:
0 Dishwasher
t) People q
City/state/zip
❑ Improvement Permit/ATC Both
❑ Business ❑ Industry ❑ Other
► Bedrooms 3 a Bathrooms
0 Garbage Disposal c0Nashing Hachine
6. If Business/Industry/Other: Specify type
1: Commodes
IF FOODSERVICE:
7. Type of water supply:
e. Do you anticipate addit
0 Basement/Plumbing
f People
M Showers i Urinals
0 Basement/No Plumbing
i Sinks
* Nater Coolers —
Y Seats Estimated Water Usage (gallons per day)
❑ County/City ❑ Well ❑ Community
ions or expansions of the facility this system is intended to serve? ❑ Yes P1140
x1MPURTAMP" CLIENTS AIUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLATT or SITE PLAN AIUST RESUBMITTED by the client with THIS APPLICATION
Property Dimensions: / -Z
WRIT �q7�►
ry ` /J E� IONS (from Mocksville) to PROPERTY:
Tax Office PIN: 8 5 / J (/ l �� i pJf 1/� OQ�/4I
Property Address: Road Name
City/zip L
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot: 19A
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. 1, also, understand that I am responsible for all charges incurred from
this application. 1, hereby, give consent to the Authorized Representative of the Davie Cqqnty Health epartmynt
to enter upon above described property located in Davie County and owned by 6 P�P� � t m a-,
to conduct all testing procedures as necessary to determine the site suit lily.
DATE L SIGNATURE Lta" Q
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN:
w ltd FIgap 9
'q-&r--JV
n%pplliestionNo. R4
Invoice No. A17
Revised DCHD (07/98)
r, c, - I'-Iy /1-1
S 7+?°51'00"E \
17.88'
813.83' Total S 02°43'20"W
"Buggy" Axle: Found
P 592.33 IRS
r- L-7 P
�- Centerline Proposed 60' Access Easement See Coll Table
IRS N 02°43'20"E 314.5f' IRS /
o1' Tax Lot 16 N 65°i 7'45"W a /
Parcell 64.:9'
-ea: 5.09b Acres
RS h /
F/
oa rax Lot 16
/ g 't
I ro Tax Map M-5 0 /�
n/f Roger P. Spillman
DB 190 O PG 101
P/0 Parcel 7 o
30
n.
15 v rax Lot 16
a Tax Map M-5
�A74, O ;1l / If Roger P. Spillman
C DB 190 0 PG 101
ti ?2 .00• / / P/0 Parcel 8 17
C ` / c
IRS
iq
4-9
414
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hof L?�-I'x'
Ins
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ti Vi4SFac`� A
125.00' See Oo Tame oes s Ease pnt
83°46'55"W 1 1 o
'�7 rSFe
IRS
\ N 83".
Tax Lot 16
Tax Map M-5
n/f Roger P. SpillmanTaxi of 16
DB 190 O PG 101 o Tay M-5
n/f Roger P. Spillman
Parral 7 ` 1 DB 190 ` PG 101
(Aria: Acres
Pv el 8
CA o
v Lot 16 � �.
rn
931 Acres
PJImq 14 t
119.22' ,
112" EIR
S 03056'35"W IRS e —Ti ; Line 1/2" EIR
1/2" EIR 1/2" Elf N 05'24'05"E 255.67'SOS°24'05"W
I I I 119.89'
Tie Line
I I I j I I
N I I
e
in
T a
M
5.70'
14'35 "W
K
rn
"Sallie Acres"
Sheet 2 of 2
PB 6 O PG 160
17 �kJ 15 I 14
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"Sallie Acres"
Sheet 2 of 2
PS 6 O PG 160
StA
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation "
APPLICANT _ 1 DATED
S NAME ' E C.l.v`'�y/� � ,DATE EVAI: �
PROPOSED FACILITY -SIZE
PROPERTY TVtli �ML :S�ceCS
• '
SUBDMSION ROAD NAME
N6ct-1 a �g .
I.
Water Supply:. On -Site Well Community Public
Evaluation By:. Auger Boring Pit ✓ Cut
SITE CLASSIFICATION: PS EVALUATION BY: sJ�p
LONG-TERM ACCEPTANCE RATE: D 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 i 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
ist '
VFR - Very friable FR - Friable FI - Firm VFI Very firm EFI - Extremely fpm
wet
NS - Non sticky SS -Slightly sticky ,' S - Sticky VS - Vey 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
Mineralo¢y
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
HORIZON I DEPTHrtes®®®®®
Consistence
HORIZON III DEPTH;
0=24(11.1.
•
�Ildl13�7®�-®®
SITE CLASSIFICATION: PS EVALUATION BY: sJ�p
LONG-TERM ACCEPTANCE RATE: D 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 i 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
ist '
VFR - Very friable FR - Friable FI - Firm VFI Very firm EFI - Extremely fpm
wet
NS - Non sticky SS -Slightly sticky ,' S - Sticky VS - Vey 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
Mineralo¢y
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