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311-323 Swicegood Street Lots 20A & 20B`; AUTHOI i�i �Permrtfec "`,`Directi r �v *NOTI (In comE VIR **.This':Ai ;to, ssua Office: i .iance witt OWN R7ATE ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FORA' PERIOD OF FIVE YEARS. SSU ALL 10=11=11-21"m - Davie County Health Department a wry 1 EnWronmenfalIlealth SecHOn 7 .6 P.O. Box 868/210 Hospital Street HcckBville, NC 27028 NOV 2 5 IM (336)751-8760 +•+nwORTA** ENVIRONMENTAL HEAL THI9 APPLICATION CANNOT HE PROCESSED UNLESS ALL THE A84pIREp tic INFORI4►TION I9 PROVIDED, Refer. to the IIIFORNATION BULLETIN for instructions. i I. Basis to be Billed Bailing Address City/state/aIP a. Name on Permit/ASC if Different than Above walling Address S�-1 _ 3. Application For: U Site Evaluati ��on e' system to service: U House 9-flobile Home a. If Residence: 6 People 0 Dishwasher D Garbage Disposal Contact Person �IL� Business s —�ffro!mo city/sta6/21P 0 Improvement Permit/ATC th 0 Business 0 Industry 0 Other Bedrooms .19,_ 6Bathroom _ 0 Washing Machine 6. If Business/Industry/other: specify type 6 Commodes / Showers IF FOODSERVICE: i! Seats 7• Type of water supply: 0 Basement/Plumbing 6 People 6 urinals D Basement/Wo Plumbing / sinks 6 Water Coolers Estimated Water usageon {galls per day) &Y ounty/City wtoeagll 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yea 0 No 1f yes, what type? _ ""•IMPORTANT"""CLIENTS AIUSTCOAWLE ETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUSTB.3UBMiTTED by the client with THIS APPrsCATrnm Property Dimensions:3r I�-fal % ±j �J EDIRECTIONS(from Moccluville)to(PROPERTY: Tax Oliice PIN: J / T 7 — i' l4 —/ v�-r �(60�O' S � O /J 0 ( Property Address: Road Name i St70) le F4 0N 5����yo,d City/Zip EQ In 60 If in a Subdivision provide information, as follows: Name: 7A TI I �)- Sectsou• Block: Lot: - o Date Property Flagged: This is 10 certify that the information provided is correct to the best of my knowledge. I understand that any permll(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 h falslBed or ebnnged. I,#&*, understand that /am ropanslblejor all charges lncarred frons this applicaflom 1, hereby, give consent to the Authorized Representative of the ank County Health Department, to enter upon above described property located in Davie County and owned by _ /)O q 2ro- to conduct all testing procedures as necessary to determine We site suits Itt - fin /, DATE � SIGNATURE ; fineinn �l� _ _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclm Property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) "to f mb Existing and proposed Account No. _ y Invoice No. _ �9� DAVIE COUNTY HEALTH DEPARTMENT A Environmental Health Section SECTION LOT2019 Soil/Site Evaluation APPLICANT'S NAME['t"Z DATE EVALUATED PROPOSED FACILITY l 1 Cz PROPERTY SIZE SUBDIVISION ROAD NAME dztitGEC�mD ��— Wates Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit ' Cut - FACTORS �1 1 2 3 4 5 fi 7 Landscape position L Slope % 14 q.. HORIZON I DEPTH • 67 Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupc Consistence Structure SQl 5C3 k Mineralogy I " t -I HORIZON III DEPTH- 2 (1 If Texture group 7r Consistence Structure- ►� Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE x 014 SITE CLASSIFICATION: - EVALUATION BY. LONG-TERM ACCEPTANCE RATE: T 0THER(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 - Loam sand SL'- Sand loam L = Loam SI - Y Y 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 RST- Non sticky SS - Slightly sticky S - Sticky VS.- Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structur SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangulu 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) LIAR - Long-term acceptance rate - gal/day/ft2 ocm(o(-90) Pen 'N a7n **NOTE",Tbis A toissua '.Office:� ty: L4�'7 , IL) Vvl bection: LOI: AUTHORIZATION FOR ASTEWATER 6;WD WC Tax Office PIN:# SYSTEM CONSTRUCnON Knmp- ALTI-ISPE.CIALISX-�J DATE ISSUED, fl, it r-4 Ect 'PERMIT ' Tax Offi66PIN4--)i R oad N, ruction or installation ofa set ***NOTICE"* THIS ---".']PLANS OR THE INTI .,ENVIRONMA'L HEALTH SPECIALIS-r-; DATE ISSUED _'" INSTALLING THE SYSTEM __'", 2 -7, W•6N #BEDROOMS 3 iBATHS GARBAGE DISI RESIDENTIAL. SPECIFICATION:, BUILDING TYPE —�4OCCUPANTS -- COMMERCIAL SPECIFICATION:#PEOP, FACILITY TYPE Lli.OkOPLFJSHIFT SEATS INDUSTRIAL WASTE: Yes or No 6--S 3 Ad6 LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)a&'NEW SITE REPAIR . SITE 6A 'ROCKDE 2-l'.i -00. 'SYSTEM I ObvdAL., PUM PTH NEAR FT. SPECIFICATIONS TANK SIZE PUMP NK L. TRENCH OT L OTHER REQUIRED SITE MoDIFICATIONSXONDITIONS; el, IMPROVEMENT PERMIT LAYOUT q T a 4 A qd p **CONTACT L Y HE 17�AREPRESENTATIVE OF THE DAViECOUNT HEALTH DEPARTMENT, FOR FINALiNSPECTION OF THIS SYSTEM, ' . 9 - !�:" BPTVff-F��30 - 9:30 A.M: OR IM -,1 0 P.M: ON THE DAYOF INSTALLATION.,TELEPHONE#,IS;(336)751-8760. b I OPERATION P SYSTEM INSTALLED BY:' r p d AUTHORIZATION NO. OPERATION PERMIT RV. DATE: - It M '"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE T C E R BEEN INSTALLED COMPLIANCE 'tAND;DISPOSAL S S, WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900!'SEW A[�G�E =A�-Sp�� SYSTEMS", BUT SHALE IN NOWAY BETAKEN ASA • GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FO ANY GIVEN PERIOD OF TIME DCHD 05196 (Revised) ••,,y.,... uv.mmmTm rrn nui a Alt; Davie County Health Department (� EavIroaMeatal Health SeW,7,7 1r_ . P.O. Box 848/230 Hospital Street MOCksville, s:C 27020 NOV 2 5 1998, (336)751-8760 ENVIRONMENTAL HEALTH HEALTH THIS Apr'! PPLICATION CANNOT Bi; pROCBSSED UNLESS ALL TBE INFORMATION I9 PROVIDIO), Refer to the INFORMATION BULLETIN for instructions. 1. Base to be Billed Bailing address City/state/LIP 2. Ham on Peon "ATC It Different than above_ Hailing address 3. Application For: LI Site Evaluation 6. system to service: [I House W111-ile Home s. If Residence: tl People I l] Dishwasher D Garbage Disposal Contact Person some Phone 8.`L± Business Phone Ili 1111E City/state/zips. ❑ Improvement Permit/ATC th ❑ Business ❑ Industry ❑ other t Bedrooms_ / Bathrooms 2_ D Hashing Machine 6. If Boniness/Industry/other: Specify type i Cc®odes 1 Shovers IF FOODSERVICE; / Seats 7. Type of water supply: U Basement/Plumbing of People U Basement/Ho Plumbing / Sims f urinals • Hater Coolers Estimated Nater ``O"�saag�ge (gallons Per day) w6unty/City IiFHell ❑ Community a. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yes 0 No H yes, what type? "••IMPDRTANT"m• CLIENTS ,1fUSTCODfpLETETHE BELOW. Either a PREQUIRED PROPERTY INFORMATION REQUESTED PLAT or SITE PLAN AlUST RESUBMITfFD b the client with THISAPPLICATION Property Dimensions: Tax OMce PIN: Property Address: Road Name City/Zip P Q 171 Lo C If in a Subdivision provide for-- -s as follows: Name: -1-M 11 I A V.— Section: Block: Let. Z O DBIECHONS (from Mechsvllle) to PROPERTY: '10S 7t�® /.S 60 Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge- I understand that aBy permlt(s) Issued hereafter are subject to suspension or revocation, if the site plans or lateeded use change, or If the information submitted in this application is falsified or changed. 1, also, andaslsodthat I one ncrponslblejor o!l charges !»corredfmm fhtsWUca&m I, hereby, give consent to the Authorized Representative of the DAvjgCounty Health Department, to ester upon above described property located in Davie County and owotd by // �) l9 q Qy — f 1. to conduct all testing procedures As necessary to determine the site suits li . J 0 ` /+J rn DATE 1/-- h 9 � SIGNATURE ZKe7dn . f - !/_ _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLANdl Incuv V -� Property lines and dimensions, structures, setb ( 1 of the folio isg: Existing and proposed acka, and eepfic lacattona). (7 �- c�p Revised DCHD (07/98) Account No. Invoice No. __ ia-15 i .; • `" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section.. SECTION LOTZO� Soil/Site Evaluation APPLICANT'S NAME J DATE EVALUATED 1z� 3P PROPOSED FACILITY ry\. 14� li: PROPERTY SIZE G • 2q z oif_ SUBDIVISION ROAD NAME 5� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring / Pit ✓ - Cut SITE CLASSIFICATION:g l EVALUATION BY: LONG-TERM ACCEPTANCE RATE: D • OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R - Ridge, S - Shoulder L - Linear slope FS - Foo_ t 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 I SIL - Silty loam CL - Clay loam SCL - Sandy clay loam jr 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 r 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) gmir =-22 : ®tel•--�-® SITE CLASSIFICATION:g l EVALUATION BY: LONG-TERM ACCEPTANCE RATE: D • OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R - Ridge, S - Shoulder L - Linear slope FS - Foo_ t 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 I SIL - Silty loam CL - Clay loam SCL - Sandy clay loam jr 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 r 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)