420 Dulin RdOPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Arthur Wayne Johnson
Address: PO Box 1218
City: Norton
State/Zip: OH 44203
Phone #: (330) 730-8258
Propeft Loca
Address/Road #: Subdivision:
420 Dulin Road
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 1
# of People:
*Water Supply: N/A
*IP Issued by:
*CA IFissued by:
Design Flow: a 4 0
Soil Application Rate: 0 3
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
ror urrice use unly g
*CDP File Number 123758 - 1 '
G6-000-00-017-01 "
County ID Number:
Evaluated For: NEW.
Township:
Property Owner: Arthur Wayne Johnson
Address: PO Box 1218
City: Norton
State/Zip: OH 44203
Phone #: (330) 730-8258
Phase: Lot:
Directions
Hwy 158, about 7 miles Dulin Road on right past
Lonesome Dove Lane, and drive is on right beside
barn at 400 Dulin Rd. The drive goes right beside
barn, you think it's not a road but it is.
Sq. ft.
3
3 7 J ft.
*System Classification/Description:
TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? O Yes (9 No
*Distribution Type: GRAVITY -SERIAL Pump Re uired?
O Yes RNo
*Pre -Treatment:
9 _ Inches O.C.
Feet O.C.
3 6 _ elnches
Q Feet
inches
Minimum Trench Depth:
3
6
Minimum Soil Cover:
1
a
Maximum Trench Depth: 3
6
Maximum Soil Cover:
1
a
Inches
Inches
Inches
Inches
Page 1 of 4
*System Type: INFILTRATOR QUICK 4 STANDARD
Installer: Sherman Dunn
Certification #: 2702
*EHS: 2325 - Mitchell, Brittany
Date: 0 3/ 1 6/ x 0 1 6
Approval Status
® Approved O Disapproved
CDP File Number 123758 - 1
Manufacturer, Shoaf
STB: 760
Gallons: 1000
Date: 1 1/ 1 4/ a 0 1 5
*Filter Brand:
ST Marker:
❑ Yes
®
No
inforced Tank:
❑ Yes
®
No
1 Piece Tank:
❑ Yes
®
No
Yes
❑
No
Manufacturer:
PT:
Gallons:
Date:
Riser Sealed ❑ Yes ❑ No
Countv ID Number: G6-000-00-017-01
S
Lat. 0
Long:
Installer: Sherman Dunn
Certification #: 2702
*EHS: 2325 - Mitchell, Brittany
Date: 0 3/ 1 6/.1 0 1 6
gggApproval Status
®Approved ❑ Disapproved
Puma Tank
Installer: Sherman Dunn
Certification #: 2702
*EHS:
Date:
Riser Height: ❑ Yes ❑ NO (Min. 6 in.)
Approval Status'
nforced Tank: El Yes ❑ No ❑ gpproved ❑ DisapproVetl
1 Piece Tank: ❑ Yes ❑ No
Pipe Size:
Pipe Length:
*Schedule: 40
Pressure Rated ❑ Yes
Approved fittings ❑ Yes
Supply Line
a inch diameter Installer: Sherman Dunn
a 3feet Certification #: 2702
*EHS: 2325 - Mitchell, Brittany
® No Date: 0 3/ 1 6/.1 0 1 6
® No Approval Status
® Approvedr0 Disapprove -74d
/ Pump Type: Installer: Sherman Dunn
Dosing Volume: - Gal Certification #: 2702
Draw Down: Inches *EHS:
*Chain:
Date:
Valves Accessible ❑
Yes
❑
No
Flow Adjustment Valve ❑
Yes
❑
No
Check -valve ❑
Yes
❑
No
Approval Status
PVC Unions ❑
Yes
❑
No
❑ Approved ❑ Disapproved
Vent Hole ❑
Yes
❑
No
Anti -siphon Hole ❑
Yes
❑
No
Page 2 of 4
. CDP File Number 123758 - 1
Itlectric taulioment
County ID Number: G6-000-00-017-01
NEMA 4X Box or Equivalent
❑
Yes
❑
No
Installer:
Sherman Dunn
Box 12 inches Above Grade
❑
Yes
❑
NO
2702
Certification #:
Box Adj. To Pump Tank
❑
Yes
❑
No
Conduit Sealed
❑
Yes
❑
No
*EHS:
Pump Manually Operable
❑
Yes
❑
No
*Activation Method:
Date:
Approval Status
Alarm Audible
El
Yes
1:1
No
❑Approved
❑ Disapproved
Alarm Visible
Yes
❑
No
2325 - Mitchell, Brittany
*Operation Permit completed
Authorized State Agent: ��71 � Date of Issue: 0 3 / 1 6 / a 0 1 6
Owner/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 tl A. sewage septic system.
Rule .1961 requires that a Type TYPE ° A septic system meet the following criteria:
Minimum System Review By The Local Health Department: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a 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 home/business 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 by a 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, responsibilities 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.
® Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 3 of 4
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC
DrawinL Drawing Type: Operation Permit
CDP File Number: 123758 -'1
G6-000-00-017-01
County File Number:
2�°28 Date: / /
� Inch
Scale: O B�ock = , ft.
O N/A
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Page 4 of 4 P1 P2 p3
�
Tax Map:
Address:
Installer: •GYMpY1 l��hY1
EHS: Qa M e11
Date: 3-110 -1y
Operation Permit Inspection Checklist
Location and Separation Distances
1. Distance from septic tankipump tank to foundation/basement feet
2. Distance from system to well if applicable feet
3. Any other setback (.1950) requirements
Supply line
1. Material supply line is constructed of diameter inches
2. Length of supply line (2' min.)
3. Amount of fall in supply line (1/8" per foot min)
4. Distance from ST/PT to the nitrification field/dist. device) 23 I feet
Septic Tank/Pump Tank
1. Visually inspect top of tanks(s), interior & exterior walls, baffle wall and bottom IJ
2. Any honeycombing or exposed rebar present? Circle : YES or
3. Visually inspect sanitary tee, lids, and air vent for proper installation and sealant
4. Tank Serial Numbers: STB_ -)& 0 PT
5. ST w/in 6" finished grade? Circle: or NO
6. Date of manufacture: ST 1111-4 PT
7. Liquid capacity of tanks ST 0QQ PT
8. Effluent filter type
9. Pipe penetration seal present? Circle:or NO
10. Riser(s) present? Circle: YES oro ser Type
11. Pump Tank riser 6" above finished grade? Circle: YES or NO P/ k
12. Riser approved? Circle: YES or NO o) R
Nitrification Field
1. Septic Tank outlet elevation
2. Trench Depth Readings (inches) 3l.' 3 U 3 k.
3. Number of Trenches 3 Distance between trenches 9 o G
4. Trench Width 3to"
5. Aggregate material type GYl a M r and size 3 4 5 6 57 (Circle)
6. Aggregate Depth (inches)
7. Nitrification lines installed on contour? Circle: S or, NO
8. Innovative system type Installer certified for installation? Circle: YES or NO
9. 2' earthen dam between ST (or d -box) and beginning of nitrification line? Circle: YES or NO
10. Stepdowns
a.
b.
C.
d.
e.
2' undisturbed earthen dam(s) Circle: YES or NO
Proper rise over stepdowns? Circle: YES or NO
Solid pipe used? Solid, Corrugated or other?
Elevation of each stepdown
Are all stepdowns lower than the ST outlet elevations?
Circle: YES or NO
Distribution Devices
1. Type N� b Is the device watertight? Is it level?
2. Distance from Dist. device to trenches feet
3. Record elevations: Inlets Outlets
6'
3(�$
ti�ti
��
� �
��' .
3�
�.
3'
� iag
° CONSTRUCTION
AUTHORIZATION
Davie County Health Department
' t 210 Hospital Street
• P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Arthur Wayne Johnson
Address: PO Box 1218
City: Norton
State/Zip: OH 44203
Phone #: (330) 730-8258
Address/Road #: Subdivision:
420 Dulin Road
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 1
# of People:
*Water Supply: N/A
For Office Use Only
*CDP File Number 123758 -1
County ID Number: G6-000-00-017-01
Evaluated For: NEW
Township:
h'EKMI I VALID UNTIL:
1 0/ 1 5/ x 0 1 8
/'Property Owner: Arthur Wayne Johnson
Address: PO Box 1218
City: Norton
State/Zip: OH 44203
Phone #: (330) 730-8258
Phase: Lot:
Directions
Hwy 158, about 7 miles Dulin Road on right past
Lonesome Dove Lane, and drive is on right beside barn
at 400 Dulin Rd. The drive goes right beside barn, you
think it's not a road but it is.
Site Classification: Ps
Minimum Trench Depth: a 4 \
Inches
Minimum Soil Cover:
Saprolite System? O Yes
9 No
Inches
Design Flow: 2
4 0
Maximum Trench Depth: 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) SeptlC Tank:
1 0 0 0
Gallons
*Proposed System: 25% REDUCTION
1 -Piece: O Yes 0 No
Pump Required: O Yes ® No O May Be Required
Nitrification Field
Sq. ft. Pump Tank: Gallons
No. Drain Lines
1 -Piece: OYes (&No
Total Trench Length: a
6 6
GPM—vs— ft. TDH
ft,
Trench Spacing:—
O Ineet O.C. g ches O.C. Dosing Volume: _ Gallons
O F
Trench Width:_
OInches
O 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 123758 - 1 County ID Number: G6-000-00-017-01
❑ Open Pump System Sheet
Repair System Required: ®Yes ONO O No, but has Available Space
Repair System
Trench Spacing: O Inches O.C.
*Site Classification: Ps — O Feet O.C.
Design Flow: a 4 0 Trench Width: _ O Fe tInches
Soil Application Rate: 0 3 Aggregate Depth: inches
.�
*System Classification/Description: Minimum Trench Depth: a 4 Inches
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover:
LESS) Inches
Maximum Trench Depth: 3 6 Inches
*Proposed System: 25°i° REDUCTION
Maximum Soil Cover:
Nitrification Field Sq. ft. Inches
No. Drain Lines *Distribution Type: GRAVITY - SERIAL
Total Trench Length: a 0 0Pump Required: OYes (&No OMay Be Required
ft.
� Pre -Treatment: O NSF OTS -1 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 (.1937(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? O Yes ®No
Applicant/Legal Reps. Signature: Date: / /
*Issued By: 2244 - Daywalt, Andrew
Authorized State Agent: oul
Date of Issue: 1 0/ a a/ a 0 1 3
Malfunction Log OYes
® Hand Drawing O Import Drawing Total Time:(HH:MM)
**Site Plan/Drawing attached.** 0 0 Hours 3 0 Minutes
Page 2 of 3
S-8 - CA'S issued - new
' CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number:
210 Hospital Street G6-000-00-017-01
P.O. Box 848 County File Number:
Mocksville NC 27028 Date: 10 / 2.2/ .2013
O Inch
Drawing Drawing Type: Construction Authorization Scale:. 0O Block ft.
_.
M
—72
Page 3 of 3
P1 P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number:
County File Number: G6-000-00-017-01
Date: .1.0./ .2.2 / 2 0 13
Click below to import an image from an external location: Drawing Type: Construction Authorization
Page 3 of 3
P1 P2
APE aTION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC
C3 r Davie County Environmental Health D P-4
lb
P.O. Box 848/210 Hospital Street ��
Mocksville, NC 27028 b
9 (336)753-6780/ Fax (336)753-1680
Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct (ATC) oth
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT*** THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION r
Name4%//U.4 �,r✓ �l DContact Person 497 t%`0 A6V f,,,,t/
Address d� (� �! / L/ !� Home Phone '3'3o Yo 9w el
City/State/ZIP a /r!D qMA 3 Business Phone ?Q 7j O Z T/i
Email Email: —
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip Al e?
PROPERTY INFORMATION *Date House/Facility Corners Flaizaed 16-16-15
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan Wlat(to scale)
(Permit is v lid for 60 months with site plan, no expiration with complete plat.)
Owner's Name T cI -1-4rVAJ Phone Number Uv 73 O kuc
Owner's Address City/State/Zipy/(� %OAJ 04110
Property Address Z O nl City
Lot Size rZ .1c4AZ Tax PIN# 000-00-0 17-01
Subdivision Name(if applicable) Section/Lot#
Directions To Site: '7 f.�Al re(Z;r.� e �- j f ,1✓ I I ��2,0
IF RESIDENCE FILL OUT THE BOX BELOW
# People —# Bedrooms / # Bathrooms Garden Tub/Whirlpool ❑Yes INNo
Basement. ❑Yes Wo Basement Plumbing: ❑Yes '5No
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: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type:1&ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? W -Yes ❑ No
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 permit(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 theDavi County Health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I ppqerst at I am responsible for the proper identification and labeling of property lines and corners and
locating and fla or s g the h e/facility location, proposed well location and the location of any other amenities.
Property ow Ws is or ow legal representative signature Site Revisit Charge
Date(s):
_(0— '(J Client Notification Date:
Date `3 ^ . � EHS:
00 . ti �' .
Sign given []Yes ❑No 5-0 6 0 . Account # ��✓ J
Revised 11!06 Invoice #
0-2
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 00
Does'the site contain jurisdictional wetlands?
_Yes _No
Are there any easements or right-of-ways on the site?
_Yes _lNo
Is the site.oj jept to approval by another public agency?
_Yes .ANo
Will wastewater other than domestic sewage be generated?
_ Yes _)(No
IF RESIDENCE FILL OUT THE BOX BELOW
# People —# Bedrooms / # Bathrooms Garden Tub/Whirlpool ❑Yes INNo
Basement. ❑Yes Wo Basement Plumbing: ❑Yes '5No
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: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type:1&ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? W -Yes ❑ No
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 permit(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 theDavi County Health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I ppqerst at I am responsible for the proper identification and labeling of property lines and corners and
locating and fla or s g the h e/facility location, proposed well location and the location of any other amenities.
Property ow Ws is or ow legal representative signature Site Revisit Charge
Date(s):
_(0— '(J Client Notification Date:
Date `3 ^ . � EHS:
00 . ti �' .
Sign given []Yes ❑No 5-0 6 0 . Account # ��✓ J
Revised 11!06 Invoice #
0-2
v V n ►_nom � _ --�
TVIOU
/ 0ot
T
�`�s�,�'�
!_ f1 h
Printed:Oct 10,:`2013
All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not,limited to the implied
warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie,
North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or
inability to use the GIS data provided by this website.
All data Is provided as is without warranty or guarantee of any kind either expressed or implied Including but not limited to the implied
c��� c f warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of
4�
Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of P ri nted:Oet 10 2013
6 the use or inability to use the GIS data provided by this website. +
Appraisal Card
nAVTE COUNTY. NC
Page 1 of 1
10/10/2e13 9:56:51 AM
OHNSON ARTHUR WAYNE Return/Appeal Notes: G6-000-00-017-01
UNIQ ID 10992
302038 NN: 26 - CHANGE OF OWNERSHIP ID NO: 5850436592
COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of I
eval Year: 2013 Tax Year:. 2014 11.71 AC DULIN RD 11.720 AC SRC- Inspection
,ppralsed by 02 on 09/06/2007 03005 SMITH GROVE TW -03 C- EX- AT- LAST ACTION 20130501
ONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE
TOTAL POINT VALUE Ef.
BASE
BUILDING USE MOD Area
UAL
RATE RCN
EYB AYB REDENCE TO
% GOOD EPR. BUILDING VALUE- GRD
ADJUSTMENTS 97 00
OTALADJUSTMENT TYPE: Vacant EPR. OB/XF VALUE -GRD
ACTOR ARKET LAND VALUE - GRD 111,24
TOTAL QUALITY INDEX STORIES: OTAL MARKET VALUE -GRD 111 24
OTAL APPRAISED VALUE - GRD 111,24
TOTAL APPRAISED VALUE -PARCEL 11124
TOTAL PRESENT USE VALUE - PARCEL
TOTAL VALUE DEFERRED - PARCEL
TOTAL TAXABLE VALUE - PARCEL 111,24(
PRIOR
UILDING VALUE
BXF VALUE
.AND VALUE 111,24
RESENT USE VALUE
EFERRED VALUE
OTAL VALUE 111,240
PERMIT
CODE I DATE NOTE I NUMBER AMOUNT
ROUT: WTRSHD:
SALES DATA
FF.
RECORD ATE DEED INDICATE SALES
BOOK AGE M R TYPE / PRICE
0208L1820
12 199 WD Q V 640009197
3 01WD 1 V 5700091168
12 01 FC P V 9400009140
9 197 WD U V
HEATED AREA
NOTES
SUBAREA I I UNIT ORIG % SIZE ANN DEP % OB/XF DEPR.
GS RPL OD UA DESCRIPTIO LT NIT PRICE COND LDGML FACT Y EY RATE V COND VALU
E AREA CS OTAL OB/XF VALUE
CE
FlG
DIMENSIONS
EIREPLACE
FORMATION
THERADJUSTMENTS
LAND TOTALT
USE
LOCAL FRON
DEPTH/
LND
COND
ND NOTES
OAUNIT
LAND UNT
TOTAL
ADJUSTED LAND LAND
CODE
ZONING TAGE
EPT
SIZE
MOD
FACT
RF AC LC TO OT
TYPEPRICE
UNITS TYP
AD3ST
UNITPRICE VALUE NOTES
0120
310
0
1.1060
4
1.0100
+01 +20 +00-20 +00
PW
8 500.0 11.71 AC
1.11
9 494.5 11123ARKET
LAND DATA 11.71 11124RESENT
USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=G60000001701 10/10/2013
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Account #:
Billed To: �,� ll,iu� �, 9• 0`-�
Reference Name:
Proposed Facility: Property Size:
Water Supply:
Evaluation By:
PROPERTY INFORMATION
Tax PIN/EH #:' (1�46-0QO 00-x17"61
Subdivision Info:
Location/Address: Pgj;/v)e
Date Evaluated: jt/Z1ZWt3
On -Site Well Community
Auger Boring Pit
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
L
Slope %
HORIZON I DEPTH
0.1/b
Texture group
4LL
Consistence
Ogg
Structure
Gur
Mineralogy
; l i
HORIZON II DEPTH
12 -461tc>-LIK
Texture group
Consistence
Structure
Kk
,Mineralogy
I;
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
1�
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: S
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY: _ �` U0100(
OTHER(S) PRESENT:
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
1' xtur
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 ,
MQiSlr'.
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
LYfltg&
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-ierm accentance rate - val/davM2 ru-urn mint
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