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115 Cooks Trail Lot 7A1A�THORI Permitteco *.*NOTE" ililsA,Iuth6iizai to issuance of i �-7j44rkrJ 0 ax OfrlcePIN :�-:��> 14),' —,WASTEWATER,,� 'T SYSTEM CONSTRUCTION Road Nam6P: INIALK ---------- � �A�m NEYNEWCAMMM AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRU( consttuctioeimstallitiorlotasys'temissuance or issuanof a building pert (kbornplia&6 with Article 11 -of, GS. Chapter 130A, , Wasteivaipr Systems, Secd 7 ............. ',PLANS i or any iN must be obtained fruni tids Department prior to the 900.,Sewrigelreatment and biippia'I Systernsj" i / APPILICANION FOR SITE EVALUATION/IMPROVEMENF PERMIT & '/ V,,..nK1kKMTA1 Davie County Health DepartmentEnvIronmentalHea/thSeo;ion 23 1998 CpP.O. Box 84B/2Y0 Hospital StreetGr'Kocksv311e, NC 27028 (336)751-8760 HEALTH ***-V4T0RTAP'.T*** THIS APPLICATION CANNOT HE PROCESSED UNLESS ALL THE REQUIRED —INFOi.L;MR'ION, IS PROVIDED. Refer to the INFORMATION BULLETIN four %instructions. 3. Name to be Milled _mo o r P � / ( � Contact Person LC OG,' f Y Mailing, Address City;State/ZIP C, 2. Name on Permit./ATC if Different than Above Wailing Address 3. Ag-olicatiom Por:' , ❑ Site Evaluation Some Phone Business Phone J�(p'pCb T�Uc}S� City/State/zip ❑ Improvement Permit/ATC 4. system. to Service':' ❑ House to Mobile Home ❑ Business.hS❑ Industry 5. If Residence: # People_ # Bedrooms c� D Dishwasher a Garbage Disposal Nashing Machine 6. If Business/Industry/other: Specify type 0 Basement/Plumbing # People Both ❑ Other # Bathrooms It 0 7asement/No Plumbing # Sinks # Ccmmodes # Showers'—� # Urinals #Water Coolers IF FOODSERVICE: li Seats Estimated Water Usage (gallons per day) 7. Type; of water supply: ❑ County/City - ❑ Well ❑ Community a. _ Do you anticipate agditions or expansions of the facility this system is intended to serve? ❑ Yes al o _f "•/M!'(1RTA/Y --* CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATIONP.EQUESTED T BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with TILS APPLICATION Proper;y/ZA O T 5,19 Dime�sioris: Tax OfficePlPJ:. ITE DIRECTIONS (from Mocksville) to PROPERTY: !lC, O��A�.E� �. �rl�� Ogg; t gI Property Address: Road Name %�/C `7Gt - —"- — City/ZipIf in a Subdivision provide information, as follows: - - Name: Section: Block: -- Loh 7/7 • / This is to certify that the information provided is correct to the best of my knowledge. I nnderstaod:bat any permit{s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the naformatien submitted in this application is falsified or changed. 1, also, understand that I am responsiblejor all charges incurred.07,om this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Depailment to enter upon above described property located in Davie County and owned by wDquL to conduct all testing procedures as necessary to determine the site suitability. DATE - y -a,3 / v SIGNATURE 00 THIS. AREA MAY BE USED FOR DRAWING YOUR SITE PLAN: -Z ficct -`ppt No. Invoice No. vg g/ Revised DCHD (07/98) F1"83' Total S 02°43'20"W S 7995110011E 17.88' "Buggy" Axle Found P 592.33' IRS�N 76 5 5'E •--- L-7 FIT lie 0171 346 91, �— Centerline Proposed 60' Access Easement See Call Table IRS IRS N 02°43'20"E 314.5EIRS / of TOX LC,t .16 N 65°i 7'45"W u Parcel L 64.:9' ,ec: 5.096 Acr.:s RS fax Lot 16 ,a W Tax Map M-5 m /} '1b z n/f Roger P. Spillman /Ij I / K2- DB 190 O PG !01 I o / / ©� P/0 Parcel 7 <o \f N y rax Lot 16 76, . OFA lax Map M-5 / n/f Roger P. Spillman \l !��( 711do C' / DB 190 e9 PG 101 o ?0 000` ` ! Ll J �� / m I� P/0 Parcel 8 S �\eiyne P po ci E • � .... � Sed` + r i, 77 i �—�.C5 % tris y \` ` , ,1'"� _ _- � -_ __ c :' ' - -•' `"'., � � 1 _ __ -10),��r P e iq�g 125.00' 1� Access F.ose.483°46'55"W - able �3�� _y��7 �5Ff IRS yt Oq -"�21 �- I 1201.1 f „ L— N 83`, 1 Tax Lot 16 1 C-) Tax Map M-5 n n/f Roger P. Spillman ? Tax i of 16 08 190 O PG 101 o Tor M-5 n/f Roger P. Spillman Parc,l 7 1 1 t DS 190 ` FG 1 (Area: Acres +i'-� r ,a ! z s 1 Pu el 8 W O 11110 10, �' O Ln 1m 1 i;" Lot t 16 p m 0! • U � u 1 c 1 Pi� ��ct ►� r 1 0 1 ,'� 1 119.22' r ,1 1. S 03°56'35"W IRS EIR Ti : Line 112' EIR 1/2" EIR 1/2" Elf", N 06'24'05"E 255.67' S 05°24'05"W 119.89' I I I I I I Tie Line "�0' ::+,x'35"W 21 I 20 I 19 6 ,Sallie Acres" Sheet 2 of 2 PB 6 O PG 160 "Sallie Acres" Sheet 2 of 2 PS 6 O PG 160 -74,1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT S041/Site Evaluation —' APPLICANT'S NAME &00t —+ 1LU1 ,AcJ DATE EVALUATED: �d�23 1j PROPOSED FACILITY �' Ow�� PROPERTY SIZE SUBDIVISION ROAD NAME �'JQrzS 2O Water Supply: _ On -Site Well Community Public Evaluation By: Auger Boring Pit Cut - FACTORS 1 2 3 4 5 6 7 - Landscape position L 4 - Slope % 20 ig 9 HORIZON I DEPTH' - Texture group G Consistence Structure Mineralogy HORIZON H DEPTH .: _ Z 2 Texture groupG G rS Consistence F: SFS S P Structure tL Mineralogy1: HORIZON III DEPTH Texture group Consistence Structure ie Mineralogy. HORIZON IV DEPTH. Texture group Consistence r SS Structure �Q Mineralogy: 1 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE' O. SrM CLASSIFICATION: ' t EVALUATION BY: �JL� Y fes+ Cit Ykw�l" LONG-TERM ACCEPTANCE RATE: O. 't OT HERS) 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,7 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 Mineralog! 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 Dcaom1-90> - ■■■ M