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335-347 Swicegood Street Lots 19A & 19Br Davie County Health Department �/ �LNOV2 LEav//vamenta/Nea/thSecffo,7 DP.o. Boa 848/210 Hospital Street Hocksville, NC 27029 8 (336)751-8760 •*+Il"ORTANT+*+ENVIRONMENTAL HEALTH THIS APPLICATION CANNOT = pROCSgS Maass ALL THE t1I INFORMATION IS PRO{RDED, Refer to the INHORNATION BULLETIN for instructions. I. name to be Billed Mailing Address City/state/ZIP a. Mame on permit/ASC if Different than walling Address a. Application Tor: U Site Evaluation 4• system to Service: ❑Nouse 9 -110 -bile Home a. If Residence: i People 0 Dishwasher ❑ garbage Disposal Contact Parson Home Phone c1ty/state/E1p ❑ ImProvement Permit/ATC th ❑ Business ❑ Industry ❑ other IF Bedrooms '_ I Bathrooms 0 washing Machine 6. If Beslnesa/Industry/other: Specify type a commodes t Showers it roODswacE: f Seats 7. Type of water supply: 0 Basement/Plumbing # People 4 Urinals 0 Basement/wo plumbing 0 Sinks / Nater Coolers Estimated Fater `Usage (gallons per day) �unty/City l�Fell ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended le nerve! ❑Yea ❑ No if yes, what type! "••IMPORTANT'•• CLIENTSAfuncompLE1ETHgREQUIREDPROPERTYINFORMATIONREQUES ED BELOW. Either a PLAT or SITE PLAN AIUSTBESMIMED by the client with THIS APPLIVATrnro Property Dimensions: rye S DaJ TaI Oliice PIN: Property Address: Road Name City/ZipQQ 7n Q C - If in a Subdiviisa Subdivision provide informtlon, as follows: 7V� Name: _ C) 11 I A C-' Section Block: Lgt.I q + ffRfI'E DIRECHONS (from Mocknille) to PROPERTY: 9N) 0 S 7t 0 (�S Date Property Flagged: -/// e2 rj —9zff� This Is to certify that the information provided is correct to the best of my knowledge. I understand that any permil(s) Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information IsaPPsubmitted is this application is cesefalsified or ehaBged I, also, understand that I am rMansib/e for aft charges Incurred from th[r appBcmlon 1, herc6y, give consent to the Authorized Representative of the DS* County Health Department, to enter upon above described property located in Davie County and owned by {{''}} p 4 ey- — f 1, S to conduct all testing procedures as necessary to determine the site wits 11 . rn ar� F DATE .—��SIGNATf?On � THIS AREA MAYBE USED FOR DRAWING� — �—� YOUR SITE PLAN (includ 1 of the folio lug: Extatlug and proposed Property lines and dimensions, structures, setbacks, and septic loations). Account No. � I Revised DCHD (07/98) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOTJ Soil/Site, Evaluation cc APPLICANT'S NAME Lr�i �l�bm �%IV ' DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE S• d S �- SUBDIVISION ROAD NAMEtV 0T� Water Supply: On -Site Well Community. Public' Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4' 5 6 7; Landscape position .. �. . Slope % HORIZON I DEPTH ., Texture group Consistence Structure Mineralo ...._ HORIZON II DEPTH Texturegroup Consistence i Structure : y Mineralogy HORIZON IIIDEPTH 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: ! EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R -Ridge , ' - S -.Shoulder L - Li near slope FS -Foot slope N: Nose slope CC - Concave slope CV - Convex slope T" -Terrace FP - Flood plain HL- Head slope Texture S - Sand LS: Loamy sand SL; - Sandyloam L -Loam ;SI -Silt , SICL"- Silty clay. loam SIL -Silty loam CL -'Clay loam SCL - Sandy clay loam . SC -Sand clay Y SIC 2 Silty clay C.- Clay Moi CONSISTENCE . Moist - VFR - Very friable . FR -; Friable ; ' -FI 7 Firm VFI - Very" firm EFI - Extremely firm - 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 GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineraloev 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 chroman or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 ■ENNEN ■ENNEN ■■■■■■ ■MEMS■ ■■NN■■ 0■C■■■ ■■■■■■■ ■■EMs■■ ■■■■■■■ esus■s■ RESIDENTIAL SPECIFICATION: BUILDING TYPE ' M rl _' N BEDROOMS _Z # BATHS - d-- # OCCUPANTS'_ GARBAGE,DISPOSAL':;Yes_dEVo Davie county Health Depatiment Env1Mnmenfa/Hea1ffi5 cHon �. P.o. Box 848/210 Hospital Street Hockaville, HC 27028 (336)751-8760 NOV 2 5 19% •siIPPCRTANT'a*• THI9 APPLICATION tNVIRON CANNOT RE PROCESSED UNLESS ALL THE QUI INFORlD►TION IS PROVIDED, Refer to the ItTFORtMTIOH Bt1LLETIR for instructions. 1. Name to be Billed Nailing Address City/state/aIp a. Name on Permlt/ATC if Different than Mailing Address '->A t 3. Application For: U Site Evaluation 4. system to service: 11 House Id-110Home 5. If Residence: / People D Dishwasher D Garbage Disposal g,V contact person Sane phare CI� Business phone City/state/Zip f� ❑ 1mProvement Permit/ATC ❑ Business ❑ Industry ❑ other # Bedrooms _"? # Bathrooms _2— D Washing machine 6. If Business/Industry/other: specify type # Commodes # showers D Basement/Plesbing # Urinals # People D Basement/No Plumbing # sinks # Nater Coolers IF FOODSP ICE: / Seats Estimated Water usage(gallons per day) 7. Type of eater a�plp: �unty/City (ll e 11 Community S. Do you anticipate additions or expansions of the facility this system is intended to serve! ❑ Yea ❑ No If yea, what type! ""'IMPoRTAN7***CLIENTS AIUSTCOA1PLElETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either* PIAT or SITE PLAN A1UST BESUBAf17TED by the client with THIS APPLICATION Properly Dimensions: 00t WRITE DIRECITONS (from Mocksville) to PROPERTY: TSx OMce PIN: # � % — —' l 0 s Property Address: Road Name�m 1P ,y Z� O�V i�J�tw'ce4Ucd City/Zip Q.einQ C YD If in a Subdivision provide inl'ormatioD, as follows: Name:►— Section: Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if the information submitted In this application h falsilied or changed. I, also, understand that ! om resportr761e jar a/! charges lncarred front this ter upon a I, hereby, give consist to the Authorized Representative of the DavjgCounty Health Departmen to ester ct all above described property located in Davie County and owned by _ (rrjj 04 pr — f — �Yj:r.� cel �Bf i to conduct all testing procedures as necessary to dekrmine the site suits 11 DATE _ f -- a h SIGNATURE Z2J ✓n . A n / !! THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (includdill of the tollo�ug: Esisting an pd roposed Property lines and dimensions, tlructure, setbacks, and septic locations). Account No. Revised DCHD (07/98) 9 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOTj_qB Soil/Site Evaluation APPLICANT'S NAME / AZrJ DATE EVALUATED Y PROPOSED FACILITY PROPERTY SIZE S• G O S - kc/ SUBDIVISION ROAD NAME`�l�c/od+ Water Supply: Evaluation By: On -Site Well, - Community Auger Boring Pit Public' Cub SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS:, DCM (01-90) EVALUATION BY:/Pl < OTHER(S) PRESENT: LEGEND Landscape Position j 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 Mineraloev 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 HORIZONConsistence Consistence • • SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS:, DCM (01-90) EVALUATION BY:/Pl < OTHER(S) PRESENT: LEGEND Landscape Position j 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 Mineraloev 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 ■ No ME so