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247 Apache Rd Well Construction Permit For Office Use Only Davie County Health Department *CDP File Number 138999 210 Hospital Street � PIN_.Number: H7-000-00-094 P.O. Box 848 Mocksville NC 27028 Tax Lot#: Tax Block#: Phone:336-753-6780 Fax: 336-753-1680 Evaluated For: WELL PERMIT VALID UNTIL: 2/11/2020 Property Owner: Rodney Harpe II Applicant: Rodney Harpe II Address: 163 Fairway Drive Address: 163 Fairway Drive City: bermuda Run City: bermuda Run State/Zip: NC 27006 State/Zip: NC 27006 Phone#: (336)409-5523 Phone#: (336)409-5523 Property Location & Site Information Address/Road#: ��� Subdivision: Phase: Lot: APACHE ROAD -- *Proposed use of Well: ADVANCE NC 27006 Directions If Other: Site Address:APACHE ROAD Directions: Hwy 64 East,turn left on Fork Bixby Rd. Left into Indian Hills. Right on ComacheRd around curve to Apache on the left Well Contractor Information Drilling Contractor Driller Registration Permit Conditions *Permit Conditions Characters Rema`ning 4000 Well location,construction and protection must meet all state and local regulations and must be inspected and approved by an authorized representative of the Local Health Department.The permit may be revoked at any time for failure to comply with existing regulations.The siting of approved well construction area(s)by the Health Department is to provide protection from the known possible sources of contamination.The approved well area(s)may not be changed without written permission from an authorized representative of the Local Health Department.No volume of quality of water is guaranteed by the Health Department. *Issued BY: 2140-Nations, Robert *Date of Issue,0 , a, / , 1 , 1 , / , a, 0 , 1 , 5 , Authorized State Agent: (&Hand Drawing O ImportDrawing Owner/Applicant'Sgnature e **Site Plan/Drawing attached.** Page 1 of 2 WELL CONSTRUCTION PERMIT 138999 Davie County Health Department CDP File Number: `� p 210 Hospital Street H7-000-00-094 P.O. Box 848 County File Number: Mocksville NC 27028 Date: 0 a / Il / .2015 Q Inch Drawing Type: Well Permit Scale: . O Block J Q N/A zlo t 40 lk T7 I L } b y w � P . v Page 2 of 2 P1 P3 Davie COUNTY 210 Hospital Street P.O. Box 848 Mocksville NC 27028 TEL: 336-753-6780 FAx: 336-753-1680 Request ID: 59379 REQUEST FOR SERVICE/COMPLAINT INVESTIGATION REPORT REQUEST DATE: 08/21/2015 TAKEN BY: SECTION: N/A TYPE: PROPERTY NUMBER: 138999 ASSIGNED TO: Nations, Robert ESTABLISHMENT NUMBER: PERSON OR PREMISES TO SEE: OWNER: Rodney Harpe II Rodney Harpe II 163 Fairway Drive APACHE ROAD bermuda Run , 27006 ADVANCE NC, 27006 (336) 409-5523 REQUESTED BY: HOME: WORK: Cell: CONDITION REPORTED:Water tested COMMENTS: RECORD OF INVESTIGATION DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: DATE: HR/MT: COMMENTS EHS: EHS #: ACT CODE: Next Inspection Date: Status of Complaint: OPEN Resolved Date: Complaintant Contacted: NO OPERATION PERMIT or ice use UnIV Davie County Health Department *CDP File Number 138999-1 r- 210 Hospital Street H7-000-00-094 P.O. Box 848 County ID Number_ Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township:` Applicant: Rodney S. Harpe II Property Owner: Rodney S. Harpe II Address: 163 Fairway Drive Address: 163 Fairway Drive City: Bermuda Run City: Bermuda Run State2ip: NC 27006 State/Zip: NC 27006 Phone#: (336)409-5523 Phone#: (336)409-5523 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: APACHE ROAD ADVANCE NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 East, turn left on Fork Bixby Rd. Left into Indian Hills. Right on ComacheRd around curve to #of Bedrooms; 4 Apache on the left #of People: "Water Supply: NEW WELL "IP Issued by. 21ao-Nations,Robert *System Classification/Description: TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? @Yes ONo Design Flow: 4 8 0 * GRAVITY-SERIAL Pump Required? Distribution Type: OYes @No Soil Application Rate: 0 - a *Pre Treatment: Drain field rNtrification Field 1 8 1 0 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARDDrain Lines 4 Installer: Tim Beeson l Trench Length: 6 0 0 ft. Certification#: Trench Spacing: _ 9 Inches O.C. g(g)Feet O.C. *EHS: 2140-Nations,Robert Trench Width: _ 3 (Inches .Feet Date: 0 7 / 0 7 / 2 0 1 5 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches r - Minimum Soil Cover. a 4 Inches Approval Status Maximum Trench Depth: 3 6 Inches ® Approved Dlsapprouetl Maximum Soil Cover: 2 4 Inches 1 CDP File Number 138999 - 1 County ID Number: 1-17-000-00-094 Septic Tank Manufacturer. Soaf Let. STB: 760 Long: Gallons: 1000 Installer: Tim Beeson Date: 0 5 / 0 4 / 2 0 1 5 Certification#: *EHS: 2140-Nations,Robert *Filter Brand: POLYLOK Dual PL-122 With Pipe Adapter Date: 0 7 / 0 3 / 2 0 1 5 ST Marker: El Yes 0 NO � - - - - - - - - - Reinforced Tank: E] Yes ® NO Approval Sfatus 1 Piece Tank: ❑ Yes � No ® Approved ❑.Disapproved Pump Tank Manufacturer. Installer: PT: Certification#: Gallons: *EHS: Date: / / Date: Riser Sealed ❑ Yes ❑ No Riser Height: (:1 Yes ❑ No (Min.6 in.) ApprovalStatust _ Reinforced Tank: ❑ Yes ❑ No 0 Approved❑ Dlsapproved 1 Piece Tank: ❑ Yes ❑ No 7 Supply Line CPipe Size: inch diameter Installer: Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ NO Date: Approved fittings ❑ Yes E] NO Approval Status -11 r ��e ❑ Approved❑SD Jsapproyied,r 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 ApprovahSti�tus ` PVC unions El Yes ElNo ❑ Approved❑x Dlsapprovpd Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ 'Yes ❑ No CDP File Number 138999 - 1 County ID Number: "7-000-00-0s4 Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer: Box 12 inches Above Grade ❑ Yes ❑ No 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 ❑ Yes ❑ NO Alarm visible El Yes F1 No ❑ Mppr4ved O Disapproved'- �ti. x ==. 2140-Nations,Robert *Operation Perm//it completed by: Ot Authorized Sfate Agent Date of Issue: a 5 Owner/Applicant Sigftature: 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 it A. sewage septic system. Rule.1961 requires that a Type TYPE II A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator:NIA Rule .1961 requires that a Type 1V 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 forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora 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 ownerand certified operator are the same. The contract shall require specific requirements formaintenance and Operation,responsibilities of the'ownerand 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 OlmportDrawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department CDP File Number: 138999- 1 210 Hospital Street H7-000.00-094 P.O.Box gas County File Number: Mocksville NC 27028 Date: OInch D>ra'vyinE Drawing Type: Operation Permit Scale: , OBlock ONIA .. -,,.,... f � .,....._s i E 1 r ..:.. . __ � _ _... n .. .: . ._ . .... o. a _ �.. .. �. _.. ,o{_ ..� .._...... __ _ ...... r C, r) A,00� ---------- ------ c �� Icy l3�c ell; I Iop - A I Leo I �.�► c. (-_.__ -j } � �pp -- 1 tc4q 3 6 ^ 1 _ , 1 f � I i I .... . W u...._ . ._... :l _ _.... 1__ y.. . f .......... _L_Lj -CON. For office use only AUTNORIZA110N *CDP Fife.Number 138999.1 Davie County Health Department County ID Number.1-117-000-00-094 210 Hospital Street Evaluated For: NEW P.O. Box 848Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 a / 1 1 / a 0 a 0 Applicant: Rodney S. Harpe II r roperty Owner: Rodney S. Harpe II Address: 163 Fairway Drive ddress: 163 Fairway Drive Cky: Bermuda Run City: Bermuda Run State2ip: NC 27006 State0p: NC 27006 Phone#: (336)409-5523 Phone#: (336)409-5523 Property Location & Site Information F ad #: Subdivision: Phase: Lot: ROAD E NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 East, turn left on Fork Bixby Rd. Left into Indian Hills. Right on ComacheRd around curve to Apache on #of Bedrooms: 4 the left #of People: 'Water Supply: NEW WELL System Specifications Minimum Trench Depth: 3 6 Site CIaSSIf#catiOn: Provisionally Suitable �Inches Minimum Soil Cover. Saprolite System? @Yes ONo a 4 Inches Design Flow: 4 $ 0 Maximum Trench Depth: 3 ti Inches Soil Application Rate: 0 a Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 251%REDUCTION 1-Piece: Oyes ®No Pump Required: OYes @No 0May Be Required Nitrification Field a 4 0 0 Sq,ft. Pump Tank: Gallons No.Drain tines 5 1-Piece: OYes ONo Total Trench Length: 6 0 0 ftGPM—vs— ft. TDH Trench Spacing: _ Inches O.C. 9 . @FeetO.C. Dosing Volume: _ Gallons Trench Width: Inches 3 • ` 'Feet Grease Trap: Gallons Aggregate Depth: • inches Pre Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: 01 Oil 0111 OIV Dana I of Z CDP Fite Number 138999 r.1 County ID Number H7-000.00-Osa• ❑ Open Pump System Sheet Repair System Required:@Yes ONo ONo, but has Available Space rDesign System Trench Spacing: E*130 7et O, . ification: Provisionally Suitable 9 .C. Trench Width: Q w: 4 8 0 — "3, @)Feet Soil Application Rate: 0 - a Aggregate Depth: inches .� Minimum Trench Depth: 3 6 *System Classification/Description: Inches TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. a 4 Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover. a 4 Nitrification Field a 4 0 Inches Sq.ft. No. Drain Lines 5 *Distribution Type: GRAVITY-PARALLEL(eq.d-box) Total Trench Length: 6 0 0 ft• Pump Required: Oyes ONo OMay Be Required Pre Treatment: ONSF OTS-1 OTS-11 *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 bythe Health Department in noway 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 bevalld fora person equal to the period of validity,of the Improvement Permit,not to exceed five years,and may be issued atthe 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 fora permit or Construction Authorization is found to have been Incorr+ec%falsified or changed,or the site Is altered,the permit orConstructlon Authorization shall become Invalid,and may be suspended or revoked(.1937(8))•The person owning or controlling the system shall be responsible forassuring compliance with the laws,rides,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: 2140-Nations,Robert Date of Issue: . 0 a 1 1 a 0 1 5 Authorized State Agent Malfunction Log OYeS @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 • CONSTRUCTION AUTHORIZATION ' Davie County Health Department CDP File Number: 210 Hospital Street County File Number: P.O. Box 848 H7-000-oaosa Mocksville NC 27028 Date: 0 a / 1 1 / 2 0 1 5 Q Inch Drawing Drawing Type:.Construction Authorization Scale: . OBlock I (60 __ . ..... ._ ...... I, 461 1 d ori a p °cr . .V611 Construction Permit For Office Use Only Davie County Health Department *CDP File Number 138999 3 •�'� 210 Hospital Street PIN Number.H7-000-00-094 3 I P.O.Box 848 . Tax Lot#: Tax Block#: Mocksville NC 27028 Phone:336-753-6780 Fax: 336-753-1680 Evaluated For:WELL PERMIT VALID UNTIL: 2/11/2020 Property owner. Rodney Harpe 11 FApplicant: Rodney Harpe 11 Address: 163 Fairway Drive Address: 163 Fairway Drive CRY: bermuda.Run City: bermuda Run State/Zip: NC 27006 State/Zip: NC 27006 Phone#: (336)409-5523 Phone#: (336)409-5523 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: APACHE ROAD *Proposed use of Well: ADVANCE NC 27006 Directions If Other: Site Address:APACHE ROAD Directions: Hwy 64 East,turn left on Fork Bixby Rd.Left into Indian Hills. Right on CorracheRd around curve to Apache on the left Well Contractor information Drilling Contractor Driller Registration Permit Conditions *Permit Conditions Well location,construction and protection must meet all state and local regulations and must be Inspected and approved by an authorized representative of the Local Health Department.The permit may be revoked at any time for to complywith'existing regulations.The siting of approved well construction area(s)by the Health Department is to provide protection from the known possible sources of contamination.The approved well area(s)may not be changed without written permission from an authorized representative of the Local Health Department.No volume of quality of water is guaranteed by the Health Department, *Issued By: 2140-Nations, Robert *Date of Issue; 0 , a , / , 1 , 1 , / . .a , 0 , 1 . 5 , Authorized State Agent: OHand Drawing Oimport Drawing Owner/ApplicaMSgnature **Site Plan/Drawing attached.** WELL CONSTRUCTION PERMIT Davie County Health Department CDP File,Number: $ � 210 Hospital Street H7-OW00.094 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 2 / 1 1 / 2 0 1 5 Q inch Drawing Type: Well Permit Scale: , Qelock _ QN/A =:�'ft. ------------- I I L APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERN#A&ATC Davie County Environmental Health Date: P.O.Box 848/210 Hospital Street Received r Mocksville,NC 27028 (336)753-6780/Fax(3 53-1680 Application For: ❑ Site Evaluation/Improvement Permit Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name t c �; c,f P � Contact Person S a wt e Address 6 k,`r,4J oft JO r Home Phone 3 51-Cl(>el-S S2 City/State/ l eerol✓o(at ytt A/C a 7O0 Business Phone 06 e;_ Email > *J-Pe 7 e G-o%-% L- ch w� Name on Permit/ATC if Different than Above Mailing Address $cwt e City/State/Zip s aw• 2 PROPERTY INFORMATION *Date House/Facility Corners Fla ed NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to'scale) (Permitis Alid dor 60 months with site plan,no expiration with complete plat.) Owner's Name ,(nc A �.� e 7Y Phone Neumber 3 36-�1o9-SS 2 3 Owner's Address &Lke- City/State/Zip_ � ly ince- b C 270 d 6 Property Address City Lot Size r6• 6 '9 4 Gffe S Tax PIN# _(, t Subdivision Name(if applicable Section/Lot# Directions To Site:L- -9, 1p y�ni fGlek- R . - leg /N fit! iQill /�S Specify Problem Occurring: IF RESIDENCE FILL OUT THE BOX BELOW_,, #People #Bedrooms . #Bathrooms Garden Tu)/Whirlpool es ❑No Basement: ❑Yes Rflo Basement Plumbing: ❑Yes FrNo IF NON-RESIDENCE FILL OUT TIJE B X BELOW Type of FacilityBusiness ?s Total Square Footage of BuildingeOd M 0 M #People_ #Sinks #Commodes _ #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: M"Conventional ❑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 ❑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 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 corners and locatingand a ing or staki the house/facility location,proposed well location and the location of any other amenities. Property owner' or owner's leg 1 representative signature Site Revisit Charge J Date(s): -Client Notification Date: 'Date EHS: Sign given ❑Yes ❑No Account# I Revised 11/06 Invoice# revii,1 vi y N��cc• � vm 6ev- co, 6d1 ale) f I W4M . � � t,O� I �f Y1 V� �� l �• ti ;ytILA clI: i At ------------ �f i county en%-Mealth a'= 151 8786 p. 1 11i1i� APPLI '.'.•ION FOR SITE El'ALUAI1ON/11t1'1(01'F N4..%1 VEKhtl f sr ATC or-�i IIS Davie County Health Department `� Y ply Environmental Haalth Section P.O. Box 848/210 Hospital Street Mocksvi.11e, NC 21028 �. 50 (336)751-8760 j 1'k*Tb1P0RTANT*** THIS AP:?LICATION CANNOT BE PROCESSED UNLESS AL:a THE REQUIRED i INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �•�:' :rade to be Billed w�X 0.f t'_ Cortaot Person O s, a�toe _ -/ ailing Address Uls,IYj(�Ir��l Qat�� T�ql acne Ph ae _ 336--u714 -2767__ City/State/ZIP �•.1S�drla�e�t N,Cv�� 10� L'sinessFhcne 3-V4' ��Noma on Permit/ATC if Differt-nt than Above______ _ VT3ailing Address _ — City/State/Zip �/s. Application For: Ll Site Evaluation 11Improver,snc Perx►it/ATC ElBoth (f System to service: i3-House ❑ Mobile Home O Bus ziess ❑ Industry ❑ Other 5. Type systen requested: Conventional ❑ conventional modified ❑ innovative . &1-6�. If Residence: # People # Bedroom3 I� # Bathrooms 3 dishwasher lfoarbage Dis;:osal a Washing Machine 2Bnsexer t/F l=tbing ❑Basement/No Plumbing 7. If r;:siness/Industry /Othe:s: verify type_! __ 4 People # Sinks - # Cormodes # Showers _ # Urinals # Water Cooler-- IF oolersIF FOODSERVICE: ## Seatn Eetimated Water Us,%ge (gallons per day) �8. Typw of water supply: ❑ Co%:nty/City 'Aeli ❑ Community /3 Do you anticipate additions or expansions of the facility this systern is ic:tended to serve'. ❑ Yes ® No ;If)cs,what type? ***LVPW RTXiV7q**CLIE`,1'S,1 - LETE THE .REQUIRED PROPERTY INFORMATION REQULs'rED J BFLO fV. Either a PLAT or SITE PLAN i�T BE SUBMITTED by the client with THIS APPLICATION. !1'raherq Dimensions: a ITE DI[2ECTtONS(from �lodsville)to PRUPL 2T1': Tax Office PIN: # 1—�.� 7_' ?y— _ L�o�S TiJoc/�f L��a�9fpr4 l'ye�erty Address: Road Name City/Zip ---—_ 1'e �� o 11 -csnd,K�t a l �;yk L If in a Subdivision provide information,as follows: loneI Lkee �� T—P oe-f ✓ Name: _ � /�A l a Section: Block: _ Lot: t�W;11L co: mrs flagged: Ste// / w � / This is to certify that the information provided is correct to the best -nr,wied Je. tat Any pe- issued hereafter are subject to suspi nsion or revocation,if the site plans or intended use change,or if the information submitted in this application is falsVied or changed. I,also, understated that 1 ant respoirsible for all charges incurred frot» this application. 1,hereby,give consent to the Authorized Representative of tine Davie County Ilealth Department to enter upon above described prop:rty located in Davie County and owned b% to conduct all testing procedures as necessary to deter:niaL the site suitabili±y. /DATE L--""SIG NA I'UIQ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks. and septic locationc). Site Revisit Charge Dat (s): Client Notification Date: Sign g en i� �'�. Account No. � _ ) Invoice No. �/ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003221 Tax PIN/EH#: 5769-51-4250 Billed To: Rodney Harpe II Subdivision Info: Reference Name: Location/Address: Apache Road-2702 Proposed Facility: Residence ' Property Size: 17 acres Date Evaluated: Water Supply: On-Site Well Community Public i Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% o HORIZON I DEPTH -)Z � --& 0— ILI Texture — Texture groupt. S 3l_ ' Consistence C�S f-r S Structure Mineralogy HORIZON II DEPTH 2. 2,2- Texture 2 — —3� Texture group Consistence V Structure 1L /✓� {tJl Mineralogy HORIZON III DEPTH Texture group CL " Consistence cp Structure S f3 C Mineralogy tel✓ C,. HORIZON IV DEPTH Texture groupSCc Consistence Structure Mineralogy SOIL WETNESS ID^ 3to RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION �J S LONG-TERM ACCEPTANCE RATE .Z f),L SITE CLASSIFICATION: '4� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: C) 2 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 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 . 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H, .1 r{.= l4 Y:4�0�'' y ,i ` "k7 ;��fr\�� "r . ..� �,�'� Irf t Y.. 1 }� a� *` -t . -}t a r t .°Ii#; >zf4 '1t' •"'a1C�� •►�� It I 411 IN o 40 `f (4.69A) C ► 39 7 tAk! 55w N jass,. s 4 t � • /� � .4 i ►IRS r �` � # - �� �, 1 � .�}�`,'i r`r"r � ; �.'-� Y '-�[ I gf?QO TR l i tY i k ' 331• ___- � yy (( . .. . t 1 .72 a { �' �� �0 F A6 1 Oil 8 R r # A t P 1 }.,< 0.w, -. �. . 1 t �e „{ A �Y HZ.p N� ! ' # gyp �• + . 4i. 1 i � � - q .: .� -; VVVFFF 4' 147 , ,. L.I. APOO _ z - Q Q DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 May 14, 2004 Rodney S. Harpe 11 2695 Merry Oaks Trail Winston-Salem,NC 27103 Re: Site Evaluation- 17 Acre Tract/Apache Road Tax PIN#: 5769-51-4250 Dear Mr. Harpe: As requested, a representative from this office visited the above site May 13,2004 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an oversized, modified on-site sewage disposal system. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerel Jeff G. eauc amp, R.S. Environmental Health Section Enc(s)