Howell Rd Lot 7 APP CAMON FOR SiTE EVAWATION/IMPROVEMENT PERMR do ATC
Davie County Health Department
NOV 17 1999 i Envlm mentd Health SeWon -r, •
P.O. Bos 8410/210.1lospit:al street
. . . . _...� Mocksville, HC 27029
L[Miwi Ii.d41t -IULTH (336)751-0760
IAC0014TY
*•*nWORTUg"** TRIG UPLICIiTION Gl1Mm ffi pn=S9BD Mnag8 ALL TIM UQUUM
1HT01M%ION 18 PROVIDIID. vRotor to)the nuroaM mica BULL121N !or instructions.
1. Masa to be Gilled/X,&-y/ /J. Bre.JA �S +�Tt Contact a.s.00 �Y�.r i S 6 ro CC_ yntdk�V,"7
b"ling address 4 p/ e c k t �G I some mme -_36— 46$-4(6 11
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a. GM'aaaas on Remi
d'y= is Diss sant above
11stliaq-am" me �a�K c City/state/amp at A/C.. Z 7 m 2,
XPi e. a`ivation 0 tmprovesient Permit/ATC 0 Both
a. tystaa to svice& Bousa
erXNobile Borns 0 Business 0 industry 0 Other
s. it Residenoes I People s Bedrooms Zoe- e3 s Bat:broons a f�
O DishwWWW 0 Gasbags Disposal 0 Mashing Machina 0 auamant/plumbing 0 aaseaant/ma plumbing
e. ss nusinass/Lmdustsy/Others specify type i people s sinks
/ commodes 1 showate 1 Urinals 0 Mater coolsrs
It 100082MCM% seats sstistated Rater usage Igalons par day)'
7. Type of Mater supply: County/City 41 •11 0 Community
a. Do you anticipate addition or expansions of the 0scWty this system Is Intended to serve? 0 Yes a
11yes,what type!
***1MP0ATANT"**CLIENTS HUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELAW. Either a PLAT or SITE PLAN MIST BE SVBWTM by the cileat with T"Jq ioPi JC_k1r!nN_
Property Dimemiows .sGe- _ �"� 'FRlX"TE:;1RIXi10N6(has MoebwAle)to PROPERTY:
Tax OtAes PIN% # Me V b1cil
Property Address% Road Name walk ;f U " iQdaw C-4 K 'c
CIty21pka•m:/. �t Jos..
If in a Subdivision provide information,as follows% 61
Names
Sections Blockt Loh Data Property Flagged% 1 �--•
This is to certify that the Information provided is correct to the best of my knowledge. I understand that any permits)
issued hereafter are subject to suspenslon or revocation,it the site plans or intended no ebauge,or If the Information
submitted in this application Is fsbitied or changed. 1,abo,aderstand that I an raponsibite for all charges incurredJt ow
this appi cadom 16 hereby,give consent to the Aathorked Representative of the Davie County Health Depa cn
to enter upon above described property bated In Davie County and owned by, .,✓y ��-Z4
G- i to conduct all testing procedures as necessary to determine the site suitabWty.
DA-FE ZC, :: I �'!�9 SIGNATURE4-*
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(include all of the followings xbOng and proposed
property lines and dlmeoslon, structures, setbacks, and septic locations).
Site 11"hil Charge
Please complete the highlighted area(s)and
Date(s)s
retum. Client Notification Dates
EHS%
Account No.
Revised DCHD(07/99) Invoice No. 2�3
HOWELL ROAD
iYBERRY SR 1419
346
I
I
_ R R Spilyf
S 01'50'58" W
57.68• Tie
48 2.
I
1 7,128 sq.ft.
IR P
6 0.1636 acres
m
N N
U' t
v CLAY HUNTER b
C4 96E-241
qD
m
M�
133' .01' S 84.03.38" E
260-55'
1 805.90•
cp N
°°
1 WILLIAM HICKS g ~ f
DB 81 PG 431 P 103,386 sq.ft.
4
'g 2.3734 acnes
N 84•x. I`
0
Ppm vf`—r $ G
y r w
l
769.76.
S i
O8
3,4
106,927 sq.ft.
2.4547 acres n�
S 5935.0!7• E din
745_32-
S 8935.w E
J a 250.00,
R
O
tie � 9
1 124,504 sq.ft.
49, 2.8651 0crw409 eqft.
'i_
1.1363 acres
40
N
y
224.64-
It
l = N 8935'00` yy 451.84'
678.47• 7 Rebar
�1
LOT 1
Spike LOT 2 LOT 3 THS WL CUM 7W 11E
AS DE'—
' w \� COUNTRYSHIRE WAY "! K&*&TM L ter, KS zSW
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
SoiVSite Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000872 Tax PIN/EH#: 5822-62-1818.07
Billed To: Grady Beck Subdivision Info: Mary Beck Estates Lot#7
Reference Name: Grady Beck, Executor Location/Address: Howell Road-27028
Proposed Facility: Residence Property Size: 2.37 Acres Date Evaluated:
Water Supply: On-Site Well / Community Public 1_�
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Sloe%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group (i
Consistence Y;:-
Structure
Structure b/( AU/G
Mineralogy -e
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: #Koz GI DAf'r EVALUATION BY:
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
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)
LTAR-Long-term acceptance rate-gal/day/ft2
DCHD 05/99(Revised)