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485-495 Swicegood Street Lots 14A & 14B(In compliance with Article 11 6fG.S. Chapter l30A,Wastewater,Systems,Section ,1900Sewagc, ***NOTICE•** THIS AUTHORIZ, I, S VALID FOR ENVIR6� FiRTfIF §PECIA T MUEE)�,.. reatment and Disposal Systems) TION FOR WASTEWATER CONSTRUC.TION.: L PERIOD OF FIVE YEARS. "..***NOTICE***THIS PERNHT IS SUBJECT TO REVOCATIONIF.SITE:; , Davie County Health Departmentr� /,� u 9 & A jh Envlronmen[a/Hea/fhSelcHon '7r D r... P.O. Box 648/210 Hospital Street MoClesville, NC 27026 NOV 2 5 19M (336)751-8760 aaaI�ORTANTaaa TIr HI9 APPLICATION CArtNOT BE pgO�gr,Ay _ MENTAL HEALTH INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for innsstructions.Vn UAl 1. Name to be Billed t contact person' O Nailing Address "some' phone city/state/zip J -, a'�el+� _ Business Phone •( ' a. Nam on permit/ATC If Different than Above - /I I 1 �+ —+��� . 0i'_'_k- LOCI l//h it { dC ( 7��htaL11 .Nailing Address >' �' 1 r City/state/zip S� 3. Application Por: U Site'Evaluation U Improvement Permit/ATC th 4• system to Service. 0 Honse id'Mobile Home D Business 11 Industry U Other a. If Residence: People i Bedrooms # D Dishwasher Bathrooms n Garbage Disposal D Washing Machine D Basement/plumbing D 9asement/No Plumbing 6. If Business/Industry/Other: specify type # people # sinks # Commodes # showers' # Urinals # Nater Coolers IF FOODSERVICE: ,# Seats Estimated stater Usage sag (gallons per day) 7. Type of Nater suppip: WC'Ounty/City wR 11 e U Com®snity s. Do you anticipate additions or expaasions of the facility this system is intended to serve! 11 Yea ❑ No H Yea, What type! "saIMP0RTAN7%*a CLIENTS AfUST COAfPLETETHE BELOW. Either a PLAT oREQUIRED PROPERTY INFORMATION REQUESTED r S1TE PLAN REQUIRED BESUBMITTED by the Client With THIS APPLICSTrnN Property Dimensions: hy�$� / �T �CMONS (from Mocluvllle) to PROPERTY: Tai Office PIN: #tel / � — �q —I ay � I, 0lL�A�' 78 !' Property Address: Road Name 1 ' I J� / r.✓xe9oc City/Zip e¢ rntvsy� If in a Subdivision provide information, as follows: si� Name: _ �- V m I /) 1—' Section Block*r 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 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, She, asderitandthat I an reVOm Mefor a/i charges incurred front this appBcadom 1, hereby, give consent to the Authorized Representative of the Davjg County Health Department, to enter upon above described property located in Davie County and owned by frj l94 2y — f to conduct all testing procedures as necessary to determine the site suits li DATE 9 R- SIGNATURE ✓n . An / !! _ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN Property lines and dimensions, structures, setbacks, and septic IDs Revised DCHD (07/98) of the folloAlug: Esisting and proposed Account No. Invoice Na DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION' LOTS Soil/Site Evaluation APPLICANT'S NAME �CL'1la Wvp� PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By: On -Site Well Auger Boring Community Public Pit ✓ Cut SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: O ' fi. REMARKS: LEGEND Dcaom1-sot EVALUATION BY: OTHER(S) PRESENT: 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 SICL - Silty clay loam SII. - Silty loam CL - Clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE VFR - Very friable FR - Friable FI - Firm VFI - Very fii Wet SI - Silt SCL - Sandy clay loam n EFI - Extremely firm - 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 Mineraloav 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 I DEPTH, HORIZONHORIZON tt DEPTH • -®�-mss® • ��-�®moo 10 VNI •-®�®-o ... • SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: O ' fi. REMARKS: LEGEND Dcaom1-sot EVALUATION BY: OTHER(S) PRESENT: 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 SICL - Silty clay loam SII. - Silty loam CL - Clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE VFR - Very friable FR - Friable FI - Firm VFI - Very fii Wet SI - Silt SCL - Sandy clay loam n EFI - Extremely firm - 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 Mineraloav 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 MEMO iii■ ■■t■ - ". Tlirar 'Directions i6 i ,! I Davie County HealthDepartment �mU Environmenfa/Hea/l�liSecHon 5 �u P.O. Box 848/210 Hospital street I� Hockaville, HC 27028 NOY 2 5 1998 (336)751-8760 ••*IE�ORIANT►*• THI3 APPLICATION ENVIRON F TH INFORMATION I9 CAW07 BE.PRa=9=D UNLESS ALL THE COUNTY PROVIDED' Refer to the INfMNATION BULLETIN for instructions. I. Name to be 8111ed 7 t cbntaat nesse, 0 Nailing address nun name Phone sI.J• Clty/state/LIP C I Business Phone 2. Name on Aersdt/ATC 1! Different than Alfove �'• --^- ,� II ff Hailing Address City/state/a1P _ Jld�?✓J.i 3. Application For: ii site Evaluation it/ATC � �� ❑Improvement Permth s• System to service: 13House 9'Robile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: f People i Bedrooms f Bathrooms 0 Dishwasher 0 Garbage Disposal 0 Washing machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. I! Business/Industry/other: Specify type f People i elute f cO1®0de• i ahowera f Urinals ♦Nater Coolers IF FOODSERVICE: / Beata Estimated gator Usage (gallons per day) . 7. Type of water supply: fi/Countp/City ar we'll 11 community . s. Do you anticipate additions ore ifun stons of the facility this system is intended to serve! ❑ Yes ❑ No H yes, what type! aa•/HPoRTANT%a•CLIENTS A/USTCOAIPLEfETHE REQUIREDPROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST Bt: SUBMITTED by the client with THIS APPLICATION Property Dimensions: y , � DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: I, ( � ,Ej — 6 �Q / S 7L Property Address: Road Namei' St lYl l lP ��70 le 7 /– JWuayocd CitylZtp2 ¢ 771 6 L �. If in a Subdivision provide information, as follows: Name: _ DMYI 'I'A V.— Section: Block: LoL•� Date Property Flagged: _/� 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 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, ands stand that I am mraPonslblefor all chatres lmnrred froom this apPfibatom 1, hereby, give consent to the Authorized Representative of the Da County Health Departmes to enter upon above described property located in Davie County and owned by ('`}} p 4 ev- — f' to conduct all testing procedures as necessary to determine the site alta li A /'� n) DATE _l � b 9 SIGNATURE / i"ls7Dn %1// THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Includdill of the follo IDS: Existing and Proposed Property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD (07/98) Invoice No. FACTORS 1 2 3 .. 4 5 6 7 Landscape position L Slope % U10 HORIZON I DEPTH .. O U _ _ Texture group Consistence f Structure .. . Mineralogy HORIZON H DEPTH - --37- 3Texture Texturegroup Consistence ; Structure Mineralogy HORIZON III DEPTH 2'3 32 Texture group Consistence Structure Mineralogy HORIZON IV DEPTH, Texture groupWQ Consistence lt3 Structure . .. Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION . :. . LONG-TERM ACCEPTANCE RATE' oiin l-LASSIFit.A 11VN: N Ib - CVALUAI WiN IS Y: C:M, i 1,7J I-FIbi1►9'1nT LONG-TERM ACCEPTANCE RATE: 7 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 ist VFR - Very friable FR - Friable FI - Firm, VFI - Veryfirm •EFI-Extremely fhm 'iWet. 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 MineraloPy 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 DCM (01-90) l