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631 Juney Beauchamp Rd ' OPERATION PERMIT or tficeuse =91 Davie County Health Department "CDP File Number 192903"-1 210 Hospital Street 5861626396 P.O.Box 848 County tD Number. ` Mocksville NC 27028 Evaluated Fora NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Matthew Logan Property Owner. Scott Beauchamp Address: 1060 Wagner Road Address: 153 Longwood Drive City: Mocksville City: Advance State2ip: NC 27028 State/Zip: NC 27006 Phone#: (336)492-5094 Phone#: Propeqy Location & Site Information rJAdvance dress/Road#: Gi3 Subdivision: Phase: Lot: uney Beauchamp Rd NC 27006 Directions Structure: SINGLE FAMILY Hwy 158 right on Baltimore Rd. right on Juney Beauchamp Rd. property on the Right across from #of Bedrooms: 4 #602 #of People: *Water Supply: PUBLIC *IP Issued by. 2140-Matrons,Robert 'System Classification/Description: TYPE III B.SYSTEM MINGLE EFFLUENT PUMP *CA issued by: 2140-Nations,Robed Saprolite System? 0Yes (E)No Design Flow: 4 8 0 *Distribution Type: PUMP TO GRAVITY Pump Required? QYes QNo Soil Application Rate: 0 - a a 5 'Pre Treatment: Drain field �Nkrification Fiela 1 3 3 Sq•ft• *System Type: INFILTRATOR QUICK 4 STANDARD No.Drain Lines 5 Installer: Sherman Dunn Total Trench Length: 5 3 6 It. Certification#: 2702 Trench Spacing: _ g Feet O.C.Inches O.C. *EHS: 2140-NaGons,Robert & Trench Width: _ 3 Inches Feet Date: 0 3 / 1 0 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Approval Status Inches Maximum Trench Depth: 3 6 Inches ®'Approved O Disapproved Maximum Soil Cover. a 4 Inches CDP File Number 192903 - 1 Septic Tank County ID Number: 5861626396 Manufacturer. Shoaf Let. STB: 760 Long: Gallons: 1060 Installer. Sherman Dunn Date: 1 a / 1 1 / a 0 1 6 Certification#: 2702 THS: 2140.Nations,Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker. El Yes ® No Date: 0 3 1 1 0 / a 011 6 Approval Status Reinforced Tank: ❑ Yes 0N o 3 1 Piece Tank: ❑ Yes D No ®�Approvetl CI Disapprove Pump Tank Manufacturer. Shoaf Installer. Sherman Dunn PT: 42 Certification#: 2702 Gallons 1250 THS: 2140-Nations,Robert Date: 1 x / 1 1 / a 0 1 6 Date: 0 3 / 1 0 / 2 0 1 6 RiserSealed p Yes ❑ No RiserHeght: 0 Yes ❑ No (Min.6 in.) =A "rov�il Status Reinforced Tank: ❑ Yes D No PP ® Approved❑ Disapproved� 1 Piece Tank: p. Yes - ❑ No -��- Supply Line FPoe ize: a inch diameter Installer. Sherman Dunn gth: a 0 7 feetCertification#: 2702 Schedule: 40 THS: Pressure Rated R1 Yes ❑ No Date: 0 3 / 1 0 / 2 0 1 6 Approved fittings ® Yes ❑ No - Approval Status fJ Approved❑ Disapproved Pump Requilrement (' Pump Type: Zoeler Installer. Sherman Dunn Dosing Volume: - Gal Certification#: 2702 Draw Down: Inches THS: 2140-Nations,Robert *Chain: STAINLESS Date: 0 3 / 1 0 I a 0 1 6 Valves Accessible p Yes ❑ No Flow Adjustment Valve p Yes ❑ N o Check-valve ® Yes ❑ No Approval Status PVC unions 1 Yes ❑ No = p ApOrovetl(� Disapproved Vent Hole ® Yes ❑ No Anti-siphon Hole ® Yes ❑ No CDP File Number 192903 - 1 County ID Number: 5861626396 Electric Equipment NEMAT4XBox or Equivalent 2 Yes ❑ NO Installer. Sherman Dunn Box 12 Above Grade O Yes ❑ No 2702 Certification#: Boo Pump Tank 0 Yes ❑ No Conduit Sealed p Yes ❑ No *EH S: 2140•Nations,Robert Pump Manually Operable p Yes ❑ NO 0 3 / 1 0 / 2 0 1 6 *Activation Method:PIGGYBACKwa Date: ;Approval Stafus Alarm Audible ® Yes ❑ No ® Approved❑ Disapproved Alarm Visible ® Yes ❑ NO n 2140-Nations,Robert *Operation Permit completed by: Authorized State Agent: Date of Issue: 0 3 / 1 0 / 2 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 111 13. sewage Septic system. Rule.1961 requires that a Type TYPE IIIB. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: 5YRS. Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: NIA 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 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 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. OHand Drawing 0Import Drawing **Site Plan/Drawing attached.** ' OPERATION PERMIT 192903- 1 Davie County Health Department CDP File Number: 218 Hospital Street 5861626396 P.O.sox Bas County File Number: Mocksville NC 27028 Date: 4 �I Q Inch Drawing Drawing Type: Operation Permit Scale: , OOlev A k A. _ � I 71 - 9. co vc .............. f i I 1 ' .�p CONSTRUCTION For office use Only AUTHORIZATION *CDP File.Num' ber 192903-1 ° Davie County Health Department County ID Number.5861626396 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 4 / 1 6 1 a 0 a 0 Applicant: Matthew Logan Property Owner: Scott Beauchamp Address: 1060 Wagner Road Address: 153 Longwood Drive City: Mocksville City: Advance State2ip: NC 27028 State/Zip: NC 27006 Phone#: (336)492-5094 Phone#: Property Location & Site Information r ad M Subdivision: Phase: Lot: auchamp Rd NC 27006 Directions Structure: SINGLE FAMILY Hwy 158 right on Baltimore Rd. right on Juney Beauchamp Rd. property on the Right across from#602 #of Bedrooms: 4 #of People: *Water Supply: PUBLIC System Specifications CFlowMinimum Trench Depth: a 4 : Provisionally Suitable Inches Minimum Soil Cover. OYes ®No 1 a Inches 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a a 5 Maximum Soil Cover: .2 4 Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons "Proposed System:25%REDUCTION 1-Piece: Oyes ®No Pump Required: OYes ONO 0May Be Required Nitrification Field 2 1 3 3 Sq. g, Pump Tank: 1 0 0 0 Gallons No.Drain Lines 5 1-Piece:,OYes @No Total Trench Length: 5 3 3 ft GPM—vs— ft. TDH Trench Spacing: Inches O.C. 9 . @Feet O.C. Dosing Volume: _ Gallons Trench Width: �Inches 3 `='Feet Grease Trap: Gallons Aggregate Depth: - _ inches Pre Treatment: O NSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01011 0111 OIV Dana I of Z CDP File Number 192903 - 1 County ID Number. 5861626396 ❑ Open Pump System Sheet Repair System Required:OYes ONo ONo, but has Available Space eaair System Trench Spacing: Q Inches 0. . "Site Classification: Provisionally Suitable 9 e Feet O.G. Trench Width: Inches Design Flow: 4 8 0 — 3 - @ Feet Aggregate Depth: inches Soil Application Rate: 0 a a 5 Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE IIA.CONV,SYSTEM(SINGLE-FAMILY OR 480,GPD.OR LESS) Minimum Soil Covera 1 a inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Craver: a 4 Nitrification Field a 1 3 3 Sq.ft. inches No. Drain Lines 5 "Distribution Type: PUMP TO GRAVITY Total Trench length;: 5 '3 3 � Pump Required: OYes QNo OMay tae Required. Pre-Treatment: ONSF OTS-I OTS-ll .Site Modifications ,No grading or construction activity is allowed in areas designated for system and repairwithout approval of Health Department. "Permit Conditions The issuance of this permit bythe Health Department in nowayguarantees 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 for a person equal to the period of validity of the improvement Permit;not to exceed five years,and maybe issued at the sane the improvement Permit Issued(NCG5130A-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 Gonstmctlon Authorization is found to have been Incorrect,falsified or changed,or the site Is altered,the permit orConstructlon Authorization shall become invaild,and maybe suspended or revoked(.1937(g)).The person owning or controlling the system shall be msponsibie forassuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps.Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: . 0 4 / 1 6 / 2 0 1 5 Authorized State Agent: Malfunction Log Oyes s` , @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 ` CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File'Number: 192903- 1 . 210 Hospital Street 5861626396 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 04 / 1 6 / 2 0 1 5 Q Inch Drawing Drawing Type: Construction Authorization Scale: , pN lock I � •oma b APPLICATION FOR SITE EVALUATION/IlVIPROVEMENT PERMIT &ATC RECEIVED Davie County Environmental Health P.O.Box 848/210 Hospital Street D Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: ❑ Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) C9'13oth Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name Mp\ZTC1.ow 1 or,g,j Contact Person Address )0 6 O c Home Phone('33 6) Ll-)Z-5-09v) City/State/ZIP X10 sv1 1J �., Z7 Business Phone(33(. Email Name on Pe t/ATC if 25ifferent than Above Mailing Address ICity/State/Zip PROPERTY INFORMATION *Date HouseTacility Corners Fla ed 1,97 '- 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 S coTj ay Phone Number Owner's Address La N mnp. City/State/Zip Aa u o,,,,c,c 1,,C o o PropertyAddress L , "u6n,"wo City 66 Ni a c tr N C'Ll 00 Lot Size 5.S-3- Ac, Tax Subdivision Name(if applicable) Section/Lot# Directions To Site: wp—,N)l ac,6 oss hL s+m - (r'ror^ C�OZ 3�NQ.y ,vd"%r P- Specify Problem Occurring: IF RESIDENCE FILL OUT THE BOX BELOW #People 9 #Bedrooms 4 #Bathrooms 3 Garden Tub/Whirlpool Cies ❑No Basement: ❑Y�o Basement Plumbing: ❑Yes ❑No 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: etounty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this stem i intended to serve? ❑Yes Cdo If yes,what type? � a 0O a 1y-i-►4 QIP _ LiAj i Al S) 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 comers and locating and flagging ' or �ac' ' :2tin,proposed well location and the location of any other amenities. Property owner's o s legal representative signature Site Revisit Charge Date(s): 1 -Z 7>> Client Notification Date: Date EHS' Sign given ❑Yes ❑No Account# 1 Z !03 Revised 11106 Invoice# 1 1 I THACT 1 OP IM MAT ENTITLED PIAT NAP:SUE REAUCHAMP 9"58010:'7000 I 1'M 40,31024047 I ____ _ TRACT 11 OP TIE PLAT ENTITLED-PILAT NAP.SUE RZAUCUAHP FLLAS- t PIN 60511130007 _-------`-- H 1 SUE BrAUCHAMP EUIR 1'N[ V A 1, i....- ��...•.�.__�_._�- -.�....J lu I mMn+ol• ■■>afM■Y rl)/Ja TOTAL A a p�L A i e 0 4 d Iy/ .P B u Ry Rq,E N T OEEU ODOR 150 PACE JE7 1� - C°W1fE---ji0.M 0•0 laai Yua• n•i kmuo1 rFJsbl■tw*TOTAL 1 )m. `r�a)xs't mtnl• tR MN 66816475&6 ME.m nA `U s if-it wo N A sm i ,r-JN a l. ....... / ^• \ ACTUAL~1m OP c__ •� 1. . y \ (.l1 / S+G •« / '�--� J I• �l of IUAIrn �/ F PIN 46GI6MI21 L•- "& •-• � �� R •J ` ,_/. \ . r '• r 5.52740CAC:RES m I "y°1 AAy 1.233118!ACRCS A: I.333:3111ACREti _ 1.307LI!,ACRES .R 1 4321b=ACRES r MY cwtoxMTE COU14MATICH UY CWNUIMAit UIN�VI'I�t1U11 IR 1T101tIWMYE NM•tRAnOr •� Or amdsRA1S COMI"ATMIN j Y ;g ryN7Arim Kx:w-Or-vAn U11mmEs O N R-0r-un Ifwuwwa IaaaT-OV-WAY) 1i IwC1A10YMF W1R-oI-tAYI - UMiLOWO 4rzgIROYW{AnON 4s . -OF-■ATIME o. . It h Oa,Q t 11:1723=ACRE9 1.2307WACRES 1.29049!ACiCEY 1.135584ACRES 7 R■• c M COOIro1NATR m VTAnOII IR LTIrMIMwAT%=ME—AT■M MY OUONWAm WNTRATI011 RT m°IaMAATc LTAIPVTATMN 5.18..95=ACRES O 1 Mr m°■nMAn°RMnrrAnOW ,�tlm VINN MGR-O►-■An IRNNLwa7M1 wGR-Ot-■AT1 ICAt'Wu1NO MLYR-O/-.An OMLT1410 MIOIR-OI-.An S GNNOMOINO IIFM-0M1RAYJ 1 � err LS ■� y _mss-W.ri• `.Of yy +�� 4•'-:`�2`Ci.=6i'° r,'� +1 7r,A- '1 • i _ 'Ail iGgq t'A lvr.;. �. *orv.'^ Tr°t"ME- il%t,• r - rra DAVID COUNTY REGISTER OF DEEDS - _ �1 y_rr. PIAT REGISTRATION - - '`�`' �T� N f)~` la N)rlr ry of ---r ra�l_�} :asr-------- pr tip. a■1 1---- ----_ FILED FOR REC1STRATIUN AT_„-----q'C1AlCR N. "�'-� _��-- ~^» 1''�-�'-•-�,- M -� �-2014 A140 X=RDtO INr yr, ml _ yam__ K • PLAT&OOH—_ FACE OWNER CONSENT CERTIFICATION LEGEND IrGCEND -----_ . FUND M.A .00 PAID u Nair wMnr-RAVIC C9UKIT WEENirsR or DMS 41 ~�'- --_t_� •_-f_-� n1• MsaTiMa fmN tw 1 IItHEUY CEHTIFV THAT 1 AN TIE OWNER UP TIE IVIT O D SHOWN MIO 9 I' M uT YY IIMSDEV.I1DED IPT THIS PIAN F UICATESURDIVI IN VIt TOY I OF IMn1L THAT 1 Bii ir�FiM7.y�e wcTE 11Pt •YLlv17-AiAtiTAMf IIERIN6Y NIDI'1'TIIIS PIAN OF 9URI71'�LSWM WRII YY DNF$CONS&+T �f� °ru■1 . REVIEW OFFICSIC'S CERTIFICATE TOTAL ARCA L -�_.IiCV1EW OPFTC^-R OF DATE COUNTY. DATES SCOTT mulim IWAUC IANP 10.91397=ACRES IT LOORnfIMTt COMPUTATION UERTD'Y THAT THE PUT OR HAP TO WHICH THIS CERTIFICVITTON - (INCLUIIINU Nuarr-OP-RAY) IS AFFIXED mums AW STATUTORY RtOU11U:HCNTN Putt 81 ommiNc. A • REVICR UPI= DATE SURVEYOR CERTIFICATION.OF CLOSPRESURVEY AND RECORD PUT PREPARED POR L n10HFN A.HIL'CIO,cPHYF'Y TtuT TIAs PIAT WAS DRAWN NY Mt FROM AN "�` SCOTT KIMBER BEAUCHAMP • 4 11 IAL TRIRVEY MADE IINUER MY OUPERVLSIGN I DEED DESU•tIPTION RECORDER DIVIDING PIN 6881844336 ' SURVEYOR CERTIFICATION FOR SUODIVISION IN OECD NOVA----:PADS.----.ET•C.)(OTHER).THAT THE 0011,111ARIES NOT 1�i PARMINOTON TO ,4HIP•nAYIE LOUX NO CARO�J '5URY6A717 ARE CLEARLY INUICATL•D A8 DRAWN PROM INFORMATION►011NU W IM7W EtFTEtG1ElF•LRD 2314 OIIAWFIIG NIIµFFER 1 4, ' DATE I.WUNTY-NORTit CAROUKA 1yAT ROOT:„_ )Act - :_-riIAT TIES RATIO 0/PRECIJION M CAILTIIAT�"4yyy„ " n0 0 00 100 l60' L THOMAS A.WCCIO.PROPRESIONAL LAND SUIIVEYOM LT=FY T11nf4 120.0001•;TlTA7'T1IS Pub NA:F"'AT a IN AttY7NDANIE WITH"r 47-30 Yl 13 13 A PIAT OF A SURVEY•TIMT CWATIS A 1WNOIVISION OF IATNIAUSNI160. RTTHESY NY OWUINAL UIONATUR6 IIOgiSTUAnON AND NEN.Tills rM M'V° -r ' WITHIN Tilt A1ffA OP A COUNTY'OR NUNICIPMM TINT LWT AN ;MD DAY Or EEPTEMUCt.9.014. � r UWIIIC 6CAL6--FEET ONE INCH .60 PEST ORIENNANCE THAT REQUI.ATU PARCULT OF)AND. TFIOHAS ARTLY PRMCIO AND/�i350CiAT'ES 440 W'=Ell-K1111 BOUIEVARU . TI40IW A WCIIo ir?S15 �TUTA S A.ME=,P4.S. L-4H10 LOCATION MAT' WINSTON-SAIaN•NORTFI CAa01JNA.1 Mal TO MOM :1:fa-774-0411 baa i }-�ou S-e -72 6 4 r n I � 4 9W APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT& Davie County Health Department14 2C9 Environments/Health Section P.O. Box 848/210 Hospital Street ENVIRONMENTAL HEALTH Mocksville, NC 27028 DAVIECOLIn (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 4`C077—,Q�- ��Q�LC1�i9 Contact Person AJC/ /��ef/tC�CQ/�� Mailing Addressy L/Orl 7'7-i X1' f . Home Phone 330 900 �O/'f City/State/ZIP J134JCZ /V e, , 7Jd�o Business PhoneIr 2. Name on Permit/ATC if Different than Above £ 109- 4914pUc Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC [IYBOth 4. System to Service: V/House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms /41 # Bathrooms .3 V--Dishwasher a Garbage Disposal Iy Washing Machine ❑ Basement/Plumbing f/Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes B No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. � WRITE DIRECTIONS(from Mocicsville)to PROPERTY: Property Dimensions: 3.BX l3/3 r3*23X IV3 rRK cec Tax Office PIN: #_ SY61 .2 -X335 7.S.Z /of'*sr &X/- AX;)'Xr Aoao.egv Property Address: Road Name _ �iyit�fA'LCII�/�IQo G , � /��C�S Af Z641- �N City/zip I QD c� cJG� �����7��0 Z12f 4,2g-- ��G�L[S b.cliC 7 If in a Subdivision provide information,as follows: Name: Section: Block: 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,also,understand that 1 an:responsible for all charges incurred frons this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine thesite suita DATE / SIGNATU %!� 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 locations). Site Revisit Charge Datc(s): Client Notification Date: EHS• Account No. �� s Revised DCHD(07/99) Invoice No. t 13131 ,5l, Lo 6ft � � ^c (15.18A) 6067 I -- 142 118.59 �5B 755 73 I (10.34A) 4335 1 ROAU r - iz 78 9 (4.69A) 6843 400 133 300 � w DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002105 Tax PIN/EH#: 5861-62-4335 Billed To:. Scott Beauchamp Subdivision Info: Reference Name: Location/Address: Juney Beauchamp Road-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: "'Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 ' g Landscape position t— � Slope% qLP2o 0 HORIZON I DEPTH - O- - 0 , 7-- r - a-j Texture group OL GLS Ct �.- 4: L- Consistence / / - ,5V f-r555411 Structure L Mineralogy HORIZON II DEPTH I n1_ 1 - O CO- 1 - .D - / /z Texture group- G C Consistence S IV k lf6y QVmay, Structure iL ►L /y� Mineralogy It 1.11 •'/ HORIZON III DEPTH i q,- \©- t(=90 �26 Texture rou _ GfGt- CConsistence Structure LMineralo �HORIZON IV DEPTH Texture group r Consistence S �/ Structure N� �►^ .Mineralogy2- - SOIL WETNESS rD Z RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION V5 �i LONG-TERM ACCEPTANCE RATE I 2 3-0.3> VQ SITE CLASSIFICATION: 1y EVALUATION BY: � 044V- LONG-TERM ACCEPTANCE RATE: ©� Z'1s� 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 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) 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