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180 Deadmon Rd OPERATION PERMIT F*CDP ice se nv fes. Davie County Health Department Number 122670-1 210 Hospital Street K5-100-AO-015& P.O. Box 848 umber. K510OA0015-01 Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Matt Owen Property owner. Minor Steele Address: 141 Edge Way Address: 134 Far Steele Lane City: Mocksville City: Mocksville State2ip: NC 27028 State/Zip: NC 27028 Phone#: (336)582-7661 1,,Phone#: Pro a Location & Site Information CAddress/Road#: Subdivision: Phase: Lot: dmon Road ksville NC 27028 Directions Structure: Hwy 601 South, Property on right past Will Boone Rd -'�`" � SINGLE FAMILY #of Bedrooms: 3 #of People: 4 *Water Supply: PUBLIC *IP Issued by." *System Classification/Description: - TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: Saprolite System? 0Yes QNo Design Flow: -- - 3 6 0 GRAVITY-SERIAL Pump Required? _ 'Distribution QYes ONo Soil Application Rate: 03 *pre Treatment: Drain field r on Field 1 a 0 0 Sq•8• *System Type:n Lines 3 Installer: Tim Abee Total Trench Length: 3 0 0 ft. Certification#: 1011 Trench Spacing: 9 Inches O.C. Feet O.C. 'EH S: 2140-Nations.Robert Trench Width: — 3 Inches Feet Date: 1 0 / 0 8 / 2 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover, a 4 Approval Status Inches . Maximum Trench Depth: 3 6 R1Approved 0 Disapproved Inches Maximum Soil Cover. a 4 Inches CDP File Number 122670 - 1 : K - 0-A0-10i Septic Tank County Number 51 10. Manufacturer. Shoaf Lat. STB: 760 Long: _ Gallons: 1000 Installer. tim Abee Date: 0 3 / 3 0 / 2 0 1 4 Certification#: 1011 'EHS: 2140-Ratans,Robert 'Filter Brand: POLYLOK PLA 22 With Pipe Adapter ST Marker. El Yes MNo Date: 1 1 / 0 8 / 2 0 1 Q Approval,Status Reinforced Tank: ❑ Yes ® No 1 Piece Tank: ❑ Yes ® No ® Approved❑'Disapproved. Pump Tank Manufacturer Installer. _ PT: Certification#: -Gallons: 'EHS: :. : . Date: / / Date. RiserSealed ❑ Yes ❑ No RiserHeght: ❑. YeS ❑ No (Min.6 in.) - Approval Status Reinforced Tank. ❑ Yes O No ❑ Approved❑ Disapproved 1 Piece Tank; YeS _. _._..❑ N0: r ,,,,,r Supply Line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: `Schedule: "EHS: Pressure Rated_.❑._Yes__.__, ❑ No Date. Approved fittings ❑ Yes ❑ No Approval Status ❑ Approved❑ Disapproved Pump u e e Pump Type: Installer Dosing Volume: — Gal Certification#: Draw Down: Inches 'EHS: 'Chain: Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ NO :_ ApprovalStatu PVC unions ❑ Yes ❑ NoC1Approved❑ Disapproved , Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes ❑ No 122670 - 1 K5-100-AO-015& CDP File Number County ID Number: K5100AD015-01 Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ElNo Installer. Box 12 inches Above Grade ❑ Yes ❑ NO Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No -Conduit Sealed ❑ Yes ❑ No THS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Approval Status Alarm Audible ED Yes ❑ NO - ❑ Approved❑ Disapproved -- :" Alamt visible ❑ Yes ❑ No 2140-Nations,Robert __. *Operation_Permit completed by: _ Authorized State Agent: ZDate of Issue: 1 0 / 0 8 / 2 0 1 4 AOwner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal,15A NCAC 18A .1900 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE a A. sewage septic system. Rule.1961 requires that a Type TYPE 11 A septic system meet the following criteria: Minimum System Review By The Local Health Department: wA _Management Entity:. OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator. N/A Reporting Frequency By Certified Operator.NIA Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract-with a public management entity with a certified operator or a private certified operator for the life of the septic system. _ Rule .1961 requires that Type VI septic systems designed for a hometbusiness owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained bya public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibiities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. O Hand Drawing Olmport Drawing **Site Pian/drawing attached.** OPERATION PERMIT 122670 - 1+ Davie County Health Department CDP File Number: 210 Hospital StreetK5-100-AO-0/5& P.O.Box 848 County File Number: K51OOAC015.01 Mocksville NC 27028 Date: O Inch Scale: . Qslock Drawing Drawing Type:-Operation Permit - ON/ Ir Ll F` I t ! .......�.,! ..�..... ._.�.,�..�..,. _,,._.. i I X __ 1._ _1 L ............. .E� 1 1 - 0- LA , R ` 1 CONSTRUCTION For Office Use Only AUTHORIZATION "CDP File Number 122670- 1 ,� ~""• ''� Davie County Health Department County ID Number: K5-100-AO-015& 210 Hospital Street Evaluated For: NEW •� ;,. P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 9 / a 3 a 0 1 8 Applicant: Matt Owen Property Owner: Minor Steele Address: 141 Edge Way Address: 134 Far Steele Lane City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)582-7661 Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Deadmon Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 601 South, Property on right past Will Boone Rd #of Bedrooms: 3 #of People: 4 `Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign fication: Ps Inches Minimum Soil Cover: ystem? OYes ®No Inches : 3 6 0 Maximum TrenchDepth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: Inches "System Classification/Description: `Distribution Type: GRAVITY-SERIAL TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons 'Proposed System: 25%REDUCTION 1-Piece: O Yes (8)No Pump Required: O Yes (&No O May Be Required Nitrification Field Sq.ft. Pump Tank: Gallons No. Drain Lines 1-Piece: OYes ONo Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH Trench Spacing: g _ O Inches O.C. Dosing Volume: _ Gallons _ 8Feet O.C. Trench Width: Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: O NSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01011 O III 01V Page 1 of 3 CDP File Number 122670- 1 County ID Number: K5-100-Ao-015&K51 0OA001 5-01 ❑ Open Pump System Sheet Repair System Required:(&Yes O No O No, but has Available Space CDesign System Trench Spacing: Inches O.C. fication: Ps — Feet O.C. Trench Width: Inches w: 3 6 0 — Feet Soil Application Rate: 0 - 3 Aggregate Depth: inches .__. 4 *System Classification/Description: Minimum Trench Depth: 02 Inches TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: LESS) Inches Maximum Trench Depth: 3 6 Inches *Proposed System: 25%REDUCTION Nitrification Field Maximum Soil Cover: -SERIALInches Sq.ft. No. Drain Lines *Distribution Type: GRAVITY Total Trench Length: 3 0 0 ft Pump Required: OYes ®No O May Be Required Pre-Treatment: O NSF OTS-I OTS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been completed during the period of validity of the Construction Permit,the information submitted in the application for a permit or Construction Authorization is found to have been incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(A 937(8)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps.Signature Required? OYes ®No Applicant/Legal Reps. Signature- Date: *Issued By: 2244-Daywalt,Andrew Date of Issue: 0 9 .2 3 / a 0 1 3 Authorized State Agent: Malfunction Log OYes ®Hand Drawing O Import Drawing Total Time:(HH:MM) **Site Plan/Drawing attached.** 0 1 Hours 0 0 Minutes Page 2 of 3 S-8-CAS issued-new y CONSTRUCTION AUTHORIZATION 122670 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: K5;OA0015-01& Mocksville NC 27028 Date: 0 9 / a 3 / a 0 13 O Inch Drawing DrawingType: Construction Authorization Scale: , O Block YP O N/A 0' Qt Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 122670 - 1 P.O.Box 848 K5-100-AO-015& Mocksville NC 27028 County File Number: K5100A0015-01 Date: .0.9./ . 3 / . 0 13 Click below to import an image from an external location: Drawing Type:Construction Authorization Page 3 of 3 P1 P2 t _ For Office Use OnIY IMPROVEMENT PERMIT 'CDP File Number 122670- 1 Davie County Health Department 3= 210 Hospital Street County Number:ID NumbK5-100-AO.015& ��•����••��. P.O. Box 848 Evaluated For: NEW Mocksville NC 27028 Township`. Phone:336-753-6780 Fax:336-753-1680 pERr.1Ir vAuo urlrlt: 8/13/2018 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. -7 pplicant: Matt Owen Property Owner: Minor Steele Address: 141 Edge Way Address: 134 Far Steele Lane City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone (336)582-7661 Phone Property Location & Site Information Address/Road 9: Subdivision: Phase: Lot: Deadmon Road Mocksville NC 27028 Directions structure:- SINGLE FAMILY Hwy 601 South, Property on right past Will Boone Rd of Bedrooms: 3 of People: 4 'Water Supply: PUBLIC �(;Iassdication: System System Specifications PS Minimum Trench Depth: 2 4 Inches Saprolite System? QYes QNo 1.1aximum Trench Depth: 3 6 Inches Design Flow: 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 3 1-Piece: QYes QNo Pump Required: (_-)Yes QNo 01.1ay Be Required `System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) 'Proposed System: 25°o REDUCTION 1-Piece: Q Yes Q N o Repair System Required:OYes ONo ONO, but has Available Space Repair System 'Site Classification: PS Minimum Trench Depth: 2 4 Inches Soil Application Rate: 0 3 Maximum Trench Depth: 3 6 Inches 'System Classification/Description: Pump Required: QYes QNo Q May be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) 'Proposed System: 25io REDUCTION Page 1 of 3 CDP File Number '12267.0 - 1 County ID Number: K5-100-AO-015&K5100A0015.01 *Site Modifications ❑ Open Fill sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for 5 years from date of issue with a site plan(means a drawing not necessarily drawn to O scale that stows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale atone Inch equals no morethan 60 feet,that includes:the specific location of the proposed facility O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county registerof deeds,a copy of the recorded subdivisions plat that Is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article:This permit is subject to revocation if the site plan,plat,or intended use changes(NCGS 130A-335(f)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance monitoring, reporting,and repair(.1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: 'Issued By: 2244-Daywalt.Andrew Date of Issue: 0 8 / 1 3 2 0 1 3 Authorized state Agent: OValid without Expiration? OCre ate CA. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Total Time:(HH:1.11,1) 0 1 Hours 0 0 l3inutes Page 2 of 3 ActivRv Code: S4-IP'S issued:new.valid for 60 mos. IMPROVEMENT PERMIT 122670- 1 Davie county Health Department CDP File Number: 210 Hospital Street K5.100-AO-O15 8 P.O.Box 848 County File Number: K5100A0015.01 Mocksville NC 27028 Date: Oinch Drawing Drawing Type: Improvement Permit Scale: , OOnN/A r i I I ► ! I. . . I i 1 l i l � � I � I I � f � l il M 1 1 I 1 i t t i I ! ;2J I 1 i . • r e e 1 1 ! ! Page 3 of 3 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street pXCEVED Mocksville,NC 27028 %* (336)75376780/Fax(33a� 7 1683 „ L1 A p p I a io44t/ n �Site Evaluation/Improvement Permit D Authorization To Construc TC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name ma;* n,o e V1 Contact Person .-YK a;tk- .e vL, Address 14 k 04sp,� Way Home Phone 33(o --_5 Z.$— 7(o(a City/State/ZIP 11l�eth�3ut�1P, . 1�G '�'TO�g Business Phone Email Email: Rt(.UdLt r,6ct O0 KSC_Q_ V o& ✓-- Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months'with site plan,no expiration with complete plat.) Owner's Name__M `vlor Sfee(e. Phone Number Owner's Address)3`f- far 5�- ,e Ln City/State/Zip 0 c.(1`S d it t G Property Address /, City yl 0CJ::.SV1(L Lot Size .115 A C_ Tax PIN# Subdivision Name(if appkMb1'2r— Section/Lot# ' Directions To Site: (,,p I 4v ward Sa-1 i s(aur L_ o h h-,*_o _Vy_0 e l o-t- O✓� R, nowt- db 3 rA ( , If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes ✓No Does the site contain jurisdictional wetlands? _Yes ✓No Are there any easements or right-of-ways on the site? _Yes /No Is the site subject to approval by another public agency? _Yes /No Will wastewater other than domestic sewage be generated? Yes ✓Ro IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms 3 #Bathrooms a- Garden Tub/Whirlpool R'y'es ❑No Basement: ❑Yes XO Basement Plumbing: ❑Yes Cho IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People # Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: &&nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: County/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes AJNo If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any per nit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corers and locating and flagging or staki t e o se/fa ' n,proposed well location and the location of any other amenities. ��o,� ��— Site Revisit Charge Property owner's or owner's legal representative signature Date(s): 0 f sj Client Notification Date: Date EHS: Sign given ❑Yes ❑No C�t1/7 Account# Lq Revised 11/06 Invoice# - -- 9 W&n y 227 � - N / . f • M r ''L'� .AN'�• n �` ...+ •. fj ` y].f • •_ 1- • . •..�1 •k.� 1 r. t` _�`1' /M. %% ♦tet ► -al`,' ! ., • •I�j•+.� I.//•"-- • j 1-0 n j,• ' .y , P. `,,,fir`_` .� i r 'Y/ , M r • `- � 1 ''r �r't`e �, - •�� - � ;°y l� % .���_ •r )`^" y�r iii�. . '..� ^` ;• j..1��$ � • I\,�•1 —_ )'' R� 1 ,l l C :I�f , \ ,w fir, \ �\ • ' « I 'i• � d ra v, '• J ,'j{Q w Com' " `• 1" 1 .t.. 1• • T � 144%rt / Appraisal�aird Page 1 of 1 DAME COUNTY NCf 22 201312:25:37 PM TEELE MINOR STEELEIRENE R ./Appal NRt.: KS-300-A9.O13.1 UNIQ ID 20835 Owner:STEELE MINOR T Parcel:K5-100-AO-OLS-01 0838000 DJ N0:57/7127257 COUNTY TAX(100),FIRE TAX(100) CMD NO.I er 1 RXAI YRAr:2013 T.X Y—2013 1.02 AC DEADMON RD 1.020 AC SRC-IrVedlpn Nes p 19 on 05/20/2 08 05001 FAIRFIELD TVI-05 C- EX*AT- LAST AMON 20110712 CONSTRUCTION DEFAIL MARKETVALUE DEPRECIATION CORRELATION OF VALUE MAL POINT VALU! ER. SASE SUILDIND ADJUSTMENT USE MOD Area UAL RATE R[N. REDENCE TO OTAL ADJUSTMENT 97 DO %6W0 DEPR.WILDING VALUE-CARO ACTOR TYpE:Vaunt EPR.OS/XF VALUE•GAD OTAL QUAl1TV INDEX AKKEF LAND VALY[-GRD 17,51 STORIES: OTAL MARKET VALUE-GRD 1)81 OTAL APPRAISED VALUE-GRD 37,81 OTAL APPRAISED VALUE-PARCEL 17,84 OTALPRESENT USE VALUE-PARCEL OTAL VALU!DEFERRED-PARCEL OTAL TAXABLE VALUE-PARCEL 1781 PRIOR ILDING VALUE BXF VALUE ND VALUE 17181 -SENT USE VALUE EFE0.RED VALUE TAL VALUE 17 H PERMIT CODE DATE NOTE NUMBER AMOUNT WT:—ASHD: (ALES DATA FF. ECORD AT! DEED ....CATS SANS BOOK AGE M TY►! PRIG[ HEATED AREA NOTES ROM STEELE F M HEIRS SUBAREA UNIT MIG% GS SiNDPV CND OS/XF DEPA CAN "ITJ AONVALUE AREACSTY►! ora OB zF VALUE Reruce =UBAS" LS UILDING DTMENSIONS NO INFORMATION TNER Io BES ]VST11[NTS AND TOTAL ND BEST US[ LOLL FRON D SUE/ LN.Do CONT R A OA ANO UN L•ND UNT TOTAL •DIUST[D LAND LAND S! COD[ IONINO TAG[ E 512[ MOD FAR l! AC Lt TO OT TYPE ERIC! UNITS TY► AD]ST UNIT►RIC[ VALUE NOTES URAL AC 0120 1 330 1 0 1 2.4730 1 4 1 1.2000+10+20 +00 1 PW I 5,900. ].02 AC 2.% 17,193.5 1-3 - 00 OT•L MARKET LAND DATA 1.02 17151 OTAL PRESENT USE DATA htt ://ma s.co.davie.nc.us/ITSNet/A raisalCard.as x? arcel=K5100A001501 7/22/2013 ' DAVIE COUNTY HEALTH DEPARTMENT . . Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION 1 PROPERTY INFORMATION (!.�[ yl&wly f�5-t�OrAo-v15 2,06 '-IdO-fid-016-01 Water Supply: On-Site Well Community Public x I Evaluation By: Auger Boring V Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position .0 L Slope % o/ 2-1/16 op. HORIZON I DEPTH . P 6_210o Texture groupC Consistence Structure Mineralogy ` HORIZON H DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON -SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS EVALUATION BY: LONG-TERM ACCEPTANCE RATE: .-3 OTHERS)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 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) ITAR -innv-term acrPntanrP rate_oal/Aau/ftp nnrir%nc/fir m__:__.JN f ' 1 � � r b 'l Xv of .�= W. DAME COUNTY ENVIRONMENTHAL HEALTr • P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 990006143 Tax PIN/EH#: K5-100-AO-015 Billed To: Matthew Owen Subdivision Info: Reference Name: LocationlAddress: Deadmon Road-27028 Proposed Facility: Residence Property Size: D C ATC Number: 122&q0:1 CflP **NOTE**The issuance of this Operation Permit shall indicate the system described on-the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO WAY•be taken as a guarantee that the system will function satisfactorily for any given period of time. System Type.-, S.T.Manufacturer Tank Date Tank Size Pump Tank Size Bedrooms: System Installed By: Installer# Date: GPS Coordinate: Environmental Health Specialist Date: DCHD 11/06(Revised)