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440-450 Swicegood Street Lots 10A & 10BAUT1401, Per m Jttee 'Name: nirp.r.tion, IWAW— i ,NVIR NM !OUNTY,HEALTH DEPAI ,CEMENT AND OPERATIONT 14 TMEN :RMITS ::TROPERTY. INFORMATION' construcfionhnstallation of a systein or the issuance of. a building pe rmit. i6liance'-Mth:Article I 1 4& Cfiabtef G130A. Wastewater Svsterns. Sectiod.1900 Sewage Treitmerit and Disposal S, ***NOTICE*** TIUS PERMIT IS SU :Water system. An 11 prior to the' )CATION IF SHE Davie County Health.Departm Department rrsnutt � Ale Environmenfa/Hea/thSe�►on g V- P.O. Box 848/230 Hospital street rr D ltockaville, NC 27028 NOV 2 5 1998 (336)751-8760 — w1RONMFNT i u TH arsylg T10H 13 THI3 APPLICATION o the BS FJ=IoH trNLESS ALL TIM RE OIREU' "OUNTY . INFOR29�TI02L IS PROVIDED. Refer to the 4 )+ai INFORi4►TION BULLETIN for instructions. 1. Dlams to be Billed ` t Contact Person Mailing Address 1 Hama flan CSty/state/aIP - C. 2.�co�1- ,/(�BJTusiness phone a. Mame on Pemit/ASC If Different than Above _� „ddol' Mailing Address 3. Application For: ❑ Site Evaluation 4. system to service: ❑ House W116 -bile Home s. If Residence: / People D Dishwasher City/state/alp S� ❑ Improvement Permit/ATC th ❑ Business ❑ Industry ❑ Other f Bedrooms_ D Garbage Disposal " 0 Washing Machine 6. If Business/Industry/other: ,specify type i commodes „ / Showers IF FOODSERVICEe i Seats 7. Type of water supply: 0 Basement/Plumbing i Bathrooms 0 Basement/Wo Plumbing I People f sinks 4 Urinals tt Water Coolers Estimated Nater Usage (gallons Per day) w6unty/City it 11 Community 's. Do you anticipate additions or expansions of the facility this system to intended to serve! 11 Yes ❑ No If yes, what type! — m"•IMPORTANT••• CLIENTS AIUST COAMLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN AIUSTBESUB_ 1ZTED by the client with THIS APP11VAT.nml Property Dimensions:—S Tax Office PIN: Property Address: Road Name City/Zip EC )7) Q C If in a Subdivision provide Information, as follows: A rlvl - Name: 17A -K 116 Section Block: `_.. Let: Date Property ed. Flagg •� NRIIF 11IRELMONS (from Mscksville) to PROPERTY: no S � ISD /S This is to certify that the information provided is correct to the best of my knowledge. I understand that any permil(s) issued hereafter ire 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 responafb/e jor a/! charges Incurred from thla s rUcadlan. L hereby, give consent to the Authorized Representative of the DsvkCounty Health Deparlmenf, i to enter upon above described property located in Davie County and owned by _ y} (94 ey to conduct all testing procedures as necessary to determine the site alta 11 DATE / f — 9 SIGNATURE p'/1 fI/?Dell . A � / !i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ4l of the property linea and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) 0 Existing and proposed Account No. L _ invoice No. 3'1 r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION L6T 0h Soil/Site Evaluation [1t 1_ ,APPLICANT'S NAME ����"" DATE EVALUATED PROPOSED FACILITY r4.46TWLf PROPERTY SIZE 5 • a zo i -c SUBDIVISION ROAD NAME S,)I6CW9 5r .. Water Supply: On -Site Well Community Public Evaluation By: 'Auger Boring Pit ✓ Cut SITE CLASSIFICATION: Ps EVALUATION BY: f LONG-TERM ACCEPTANCE RATE: �.35� 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 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(OIAO) .•; ._ .. `cy%��rt�—®sow HORIZON I DEPTH: .. Consistence HORIZON III DEPT ' ' ' �'i L•�►J�i cif®O—�® • • • • tics,=!®�®®® 1 • ti3iOff0MV COQ® SITE CLASSIFICATION: Ps EVALUATION BY: f LONG-TERM ACCEPTANCE RATE: �.35� 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 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(OIAO) .�TIi.?AiZATION NO: ' � � 1 4 DAME OUNTY HEALTH DEPARTMENTlit . X01 �a6-�j 4 Environmental Health Section PROPERTY INFORMATION Permittees P.O. Boz 848 Name: �t C.lr 12 1 J'►L l tnn��7 Mocksville, NC 27028 Subdivision Name: Phone 336-751-8760 Duectiopstoproperty (DUIS �V �UiS Section: Lot tia(� AUTHORIZATION FOR —Tut . "WASTEWATER Tax Office P1N:# .� 74 SYSTEM CONSTRUCTION .. Road Name: ICs:C ? zip. **NOTE**.This Authorization for Wastewater System Conswction MUST. BE ISSUED by the Davie County Environmental Health Section prior `to i'ss'uance of any Building -Permits. This FomJAuthorization Number should, be presented to the Davie County Building Inspections Office when applying for Building Permits. (Incompliance with Article "II of G.S.Chapter 130A; Wastewater.Systems, Section .1900 Sewage.Treatment and, Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION --_ ''2 /" IS VALID FOR A PERIOD OF FIVE YEARS. IRO ME TALj � "SPEdA 1ST DA., _ IS ED DCHD 05196 (Revised) u nwrmtivs VIRM11 & A1C Davie County Health Department �PJ Environmental SMWOH -' P.O. Box 848/210 Hospital Street stockaville, HL 028 NOV 2 5 1998 (336)751- •*aa1PORTANR•*+* ENVIRONMENTAL HiAI TH28 APPLICATION CANNA? Br g� UNLESS ALL THE gSQprgEO-- INFORRlATZON IS PROVIDED. Refer to the ItiE'ORt9►TZON SULLETIH for instructions. 1. Name to be Dilled ` Contact Parson (J Nailing Address Dame Phone csty/state/SIP!o'� R�� a�01- Dussness Pnone 7 lL L i 2. Nass on Permit/ATC If Different than Ab"s Nailing Address a. APP_'ication ror: U Site Evaluation a• Systemto Service. D House 9.19bile Home S. If Residence: I People I 0 Dishwasher - O Garbage Disposal — V Iv," — City/state/Zip _ 11� U Improvement Permit/ATC th U Business D Industry 11 other i Bedrooms / Bathrooms _2 D Washing Machine 6. If DU81ness/Industry/other: Specify tnm i Ca®odes - / Showers Ir FOODSERVICE: / Seats 7. Type of Water supply: D Dasment/Plusbinq i People f Urinals D Danmeut/No Plumbing / Sinks • Nater Coolers Estimated Water nU"�sage (gallons per day) County/City well U Community e. Do you anticipate additions or expansions of the facility this system is lalesded to serve! 0 Yes ❑ No H yes, what type! BELOW gR BELOW. TANP**CLiENTSAIUSTCOAIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BEither a PLAT or SITE PLAN AfUSTBESUB iTTED by the client with THIS APPLICaTrnml Property D(mensions:_ ��f�f$.o� Tax Office PIN: to -5`714 1;- 4 r/y141;-4 L — Property Address: Road Name City/Zip6-e ]71 Q C/,� If in a Subdivision provide information, as follows.. 7U�7 Name: a l.4111 ;/) V.— Section: Block: Lot: D WHIM DIRECTIONS (from MocksWlle) to PROPERTY: 78 o S � i0D �S Date Property Flagged: _// This is to certify that the information provided Is correct to the best of my knowledge. 1 understand that any permits) Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this applicatfos Is falsified or chauged. 1, afro, undewandthat I am rrsponsibfefor agcharges tncurredfront this aRPUcadon. 1, hereby, give consent to the Authorized Representative of the DavjgCounty Health Departmen to enter upon above described property located in Davie County and owned by (��jj O4 Qr — S De! �j to conduct all testing procedures as uecessary to determine the site suits li Men ` ar� S DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SiTE PLAN (Includdfdl of the follo ing: ExisH- and proposed Property lines and dimensions, structures, seibscks, and septic locations). Revised DCHD (o7/9s) Account No. a!L Invoice No. I Jhklk. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOTS Soil/Site Evaluation APPLICANT'S NAME 11_DATE EVALUATED .PROPOSED FACILITY fltl*^Z PROPERTY SIZE S • 0 z-,6 Pe` SUBDMSION < ROAD NAME1 GSD Water Supply: • On -Site Well ' Community Public Evaluation By: Auger Boring Pit Cut SITE CLASSIFICATION: PS - 2• EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ©3� OTHER(S) PRESENT: �iN f ./ REMARKS: DCHD(01-90) :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 plainH.- Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L 7 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 7 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 HORIZON I DEPTH Wilt- 31we . • • • ��r•,�'®®—moo■ Consistence HORIZON III DEPTH ' Irdsfaoff?& • tL��i���®®®® SITE CLASSIFICATION: PS - 2• EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ©3� OTHER(S) PRESENT: �iN f ./ REMARKS: DCHD(01-90) :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 plainH.- Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L 7 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 7 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