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119 Cummings Lane Lot 8B2*'*NOTE*,* Ths hriprovement Permit DOES 1461 ''AUTHORIZATION FOR WASTEW, _ystemlor (In cbrnphahm*ith AAle I l'of G-S. Chapter 13f ***NOTICE*** THIS PE PLANS OR THE RYTEN +'.SYSTEM.CONTRACTO ,. �-INSTALLINGTHESYS! ANGE. YOUR WASTEWATER, ;Tins PERMIT BEFORE APPLICATION FOR SITE EVALUATION/1MPROVEMENF PERMIT Davie County Health Department EnvironmentaiHealth AXV0tl P.O. Box 898/210 Hospital street Mocksville, NC 27028 (336) 751-8760 SEP 2 3 1998 D ENVIRDNMENTAL HEALTH DAVIE COUNTY ***II PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed LY(.K.� I (YI t1 Contact Person Nailing Address Po (3N '/73W Some Phone 33 Ce `t a/% T I City/State/ZIP _.0,© 1-Q_Q,m-Q 1 L (—�;gQ(y Business Phone 33Ce La -q a -s' -s-/ 2. Name on Permit/ATC if Different than Above Hailing Address City/State/Zip 3. Application For: ❑ site Evaluation ❑ Improvement Permit/ATC C S -nth a. system to service: ❑ House 1;Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People%�-_// # Bedrooms A Bathrooms a ❑ Dishwasher 0 W Garbage Disposal Hashing machine 0 Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sinks # Commodes # Showers # Urinals-- # Water Coolers IF FOODSERVICE: (f Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ well ❑ community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes leo .0'I ***1MPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBJIITTED by the client with THIS APPLICATION Property Dimensions: �/ 7 a S WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # S`rl 4 Vf Q Property Address: Road Name (n0—kc)i CIO Ed City/Zip 0, l'� �9— If in a Subdivision provide information, as follows: Name: Section: Block: Lot: 016i 2- 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, understand that I am responsible for all charges incurred from this application. 1, hereby, give consent to the Authorized Representative of the Da}' County Health Department to enter upon above described property located in Davie County and owned by /�C (9 CQX tI Yl a n to conduct all testing procedure; s as necessary to determine the site suitability. DATE i 2�j' -((i) SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN: W', l 6t. PlaSCtD 7 q-zr-5 �- Application No.Iq 1� Invoice No. .911 / Revised DCHD (07/98) z�`• S 71)°51'00"E 17.88' 813.83' Total S 02°43'20"W "Buggy" Axle Fouad P 592.33' IRS �N 16° 5 5'E �— u-7 P Te Lige 346,91, �-- Centerline Proposed 60' Access Easement See Call Table IRS IRS N 02043'20"E 314.5E' IRS / of Tax Lot '1 6 N 65°i Y45"W a � Parcel 2 64. 19' h°/ 1 -cc: 5.09b Acres R,C,K RS / fax Lot 16 � 1 Tax Map M-5 'Jb = n/f Roger P. Spillman / 7 G r DB 190 O PG 101 P/0 Parcel 7 N X 3dS yv Tax Lot 16 i 1 X%(p 0 / f Roger P. Tax Map M-5 cf', I 3 n Spillman �33°\� OB 190 Pc 101 00' P/0 Parcel 8 n I /I'{ •� -\60 Acca; �-9 lay IFcS j } r P F' V' US�°SC4' AcCe 125.OU' Sae Cvl, Table ss fo-,$,t 83°46'55"W 1 1 y�/��� +�21 ►$ Ft IRS / Iyt �< 1201.1 N 83' Tax Lot 16 1 C-) Tax Map M-5 e n/f Roger P. Spillman? Tax i of 16 DB 190 O PG 101 'o Tay M-5 n/f Roger P. Spillman Parrot 7 DB 100 ' PG 101 (area: 4cr,?s +�`-..) 1 ° yl z all Pu el 8 / 1 „J Of _. fU W O �dr n 1 O rn 1 m y 1 x Lot 16 �. 15 331 Acres 0 1 of ►I Iraa � 1 0 l 1 119.22' 1 1 S 03• 56'35"W IRS 1 1 1/ g" EIR T Line 1/2" EIR ee Elf N 0.",:x'24'05"E 255.67' S 05024'05"W 1/2" EIR 1/_lL � _ y _ I I I 119.89' Tie Line W N 20 19 18 � 17 1t I 15 I 14 cc (n ». ,0 "Sallie Acres" � N Sheet 2 of 2 "Sallie Acres" N PB 6 0 PG 160 .I I Sheet 2 of 2 'E „Nj r PB 6 O PG 160 6.70' i W AR 11W 11 1 FACTORS .1 2"• .3 4'.. 5. 6,i - 7: -... Landscape position L , Slope%' 70 DAVIE COUNTY HEALTH DEPARTMENT 22- Texture group" . Environmental Health Section swrioN . ` ` LoT . i Soil/Site Evaluation Structure k Mineralogy. HORIZON II DEPTH . _ _ Ul 3� APPLICANT'S NAME Texture group DATE EVALUATED' Consistence PROPOSED FACILITY PROPERTY SIZE ' S Structure SUBDIVISION 'ROAD NAME %NAA lA A --S HORIZON IH DEPTH Water Supply: On -Site Well Community Public 'Evaluation By: Auger Boring Pit Cut Structure Mineralogy— HORIZON IV DEPTH 11 1 FACTORS .1 2"• .3 4'.. 5. 6,i - 7: -... Landscape position L , Slope%' 70 HORIZON I DEPTH 22- Texture group" . C+I` C L Consistence : i r $ . Structure k Mineralogy. HORIZON II DEPTH . _ _ Ul 3� _2Z, Texture group Consistence r -_ -3 ' S Structure k Mineralogy HORIZON IH DEPTH 2 �Sk1 —3.0 Texture group Consistence S5' 5- Structure Mineralogy— HORIZON IV DEPTH Texture group Consistence r Structure 2 Mineralogy,; SOIL WETNESS RESTRICTIVE HORIZON SAPROLr1'E CLASSIFICATION . � LONG-TERM ACCEPTANCE RATE. n. SITE CLASSIFICATION:.ef 'EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: ����. To vt eJv Lhnr�c 1< 6PP061C. 'yS : 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 loan - L - Loam SI - Silt SICL - Silty clay loam SII. - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC Silty clay C - Clay CONSISTENCE .' Moi �Very VFI - Very firm EFI - Extremely firm - Ve friable FR - Friable FI -Firm NS - Non sticky SS - Slightly sticky S` -Sticky ' VS VerySticky 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 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 - jnches 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 DceD(o(-90) ■■■ M MORE ■■R■ s ■