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285 Leatherwood Trail -. � ,, .;� od • � DAVIE COUNTY ENVIRONNI�NTAL HEALTH r�O • - " �' �� _ � P.O.Box 848/210 Hospital Street ,nQ�l . '� • Mocksville,NC 27028 �' - — "' (336)751-8760 F�#(336)751-8786 , U�[ �D'J OPERATION PERMIT Account #: 990004193 Tax PIN/EH#: 5769-46-6372.02 Billed To: Debora Smith Subdivision Info: Reference Name: Transfere Permit(From) David Moore Location/Address: Leatherwood Trail-27028 Proposed Facility: Residence Property Size: 6.67 acres ATC Number: 3280 **NOTE**The issuance of this Operation Permit shall indicate the system described on We ATC has been installed in compliance wiW Article 11 of G.S. Chapter 130A,Section.1900"Sewa�e 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 cYrra`�► Tank Date T Size �� Pump Tank Size S em Installed 8 � �� �� E.H. S 'st: 2 � Y� Y• ?1� �2� ������ � �� � �� � � � � � � �ti ; ` ` ���� 5� r � . �- .���`�' ;� f� � �� � �� � r �""�-v � �S���J,� � � � � � �q � < �,� r�� � � � � � �� 2� c�'� � , � DCHD 11/06(Revised) /� `'�� �� , . , DAVIE COUNTY ENVIRONMENTAL HEALTH � � " � ' P.O.Box 848/210 Hospital Street � '•'. � �j' . Mocksville,NC 27028 ' � r (336)751-8760 Fax#(336)'151-8786 ' ��!J�,6? (/`�" AUTHORiZATION FOR WASTEWATER SYSTEM CONSTYtUCTION � Account #: 990004193 Tax PIN/EH#: 5769-46-6372.02 • Billed To: Debora Smith Subdivision Info: Reference Name: Transfere Permit(From) David Moore Location/Address: Leatherwood Trail-27028 Proposed Facility: Residence Property Size: 6.67 acres ATC Number: 3280 � **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specification:Building Type Ot�E #peaple #Bedrooms 3 #Baths Z Baseme�t w/Plumbing:_Basement/No Plumbing� Commercial Specificatian:Facility Type #People #People/Shift #Seats Lot Size�7,(p�_Type Water SupP1Y�/ ,ra1=Design Wastewater Flow(GPD�Site:New� ...�_�-�� System Specifications:Tank Size��GAL.Pump Tank„_G.AL.Trench Width 3b��Trench Depth ZZ��"'-��� +��E Rock Depth 12� Linear Ft. (oGY�' ' 1 As stated ir� :9,5A NCAC 18A.196�(5) Other. `�f"�1ST�F�I�L� �S_��`S dcc�pted Syst�ms may afso b� useG Required Site Modifications/Conditions:��9,L1_t�� �c�Q. ���O ��dt�_��'p�� �S� � Contact thc Davie County Environmental Health Section for fin�l inspection of tlris system between t.i^� 8:30—9:30a.m.on the da of installation. Tele hone# 33 751-8760. ��, ��° ���,'C��- �71� �lfi�►C,T - /,,, � °� , , �r �f►S � /� �t `ta ��S ��� � � lnln�Jn1G� (,J�+� � � � ' �'��'� c�.R ...� �' ,-� � �, �, � �. � � o � ��� �F�� ����� �a - � N � � r�' �� ��� � � .7,�. � Environmental Health Specialist i p� U..� Date: / l��°% DCHD 11/06(Revised) 28%12 ?008 10:50 FAX 1 3�6 938 2149 YF JEANSFYEAR �1ooa . . Dec 27 �6 G3:S9p tlav�ie ceunLy �nGhg�ith' ��� 751 6?�& R•� , • • . � . � � . � , }_- �� ����� [C�TtON FQ�i�:ITE EVALUATION/IMPI;:OV}:MENT PERMIT yQc AT� _ � Devie�ounry EpVirODmeDtxl Ile�lth �� P.ti.bo�i 848R]Q Hospitat Sireet pE� 2 8 200��. �� �IV��� (336}9�-87�6o/Fnx(3��si.s�s� . �2 I2����P wtion For Sita EXaluatiohllm�rC�vement PcnbR G Auchor��c;oa'LaCons�uct�nTCt n duh /I�///�„►/ .. ,.. . i .._ + ENVIRONMENTA�H� ot Appjtw' �Ntw Syttem 7Fxpalr ro�xiiliog Jy��ero OExpans�onlModiC�cetiun of E:tistin,q 5ystcin or Fecllrry � 1 xC �` pAViE COUNn . L ""�MPL?�TANl'!!-"THIS APPI,.(CA71��N CdNNOfBE7'�OC655EDUNI�E$S AI.L OF TE(E1C6QUlRED �/ �IIVFORMA'1'ION lS PROYmED. ltc�'�ta ttk Ir7FORMAT(ON DVLLE7TN for;mp�uc�iunt. �(f f��I� �y r�v APPLICAb1'f INF(1ItMt1T10N � Name w be II�tle� Ve�io�0� f� i �Mi`'f�.� , Contset Ptnon 33!'�'L►S'�-8(v(p6 �V°" '� ( � Billiog Addre+s- �m:�FR t 1 o G w P h o n c �3 6� 6 C� � Ciry/Statc2lP� �/�..- 9usincsaP6anc��G- 31r-�}/!J __ �,, 1; _ J ' � ��m� NatttC on�ct�tiiNATC:i1'drffe�en/than Abo�e �aY•t�___,�Y1Qere. --• � � al�tuiling Addremy ����Ki,}�lill� f 5.��Ciry;StakJZip� � G� Q. _ PROPERTY l,IY�ORMATION _.- 'Datc House/Fx�.ility�ot�urB Flig.ed �-- ����y bJ07'�: A survty plat M�1tt plari�sE�G:onipony Mi��ppliWdoa Induded�C1$�te Plus OPI�t{ta�calo) � ,/������1� (Neq7i�l.',y r�ili�foc 6Q n�uhs wi�:xik ph1n,eo ekpinlion witN tomplft:p1�[) ..- . _ �/ Owner'nlYamc- _„`PhontNumFet�3G'45`S�fj� Owner's Address - CiryiSi�tr/Zip,_�� � Propertyr Addrsss - - ^rt��� -. �;c�. ` �f �'�/� i,at Sisc . Tax YW� - 7'v�-� ' 1 �'i�l.f ��� Subdivision Nzmcjifeppitc�ble)�_ Scccia��Lota Uirecpona To Site:: ___ `� r �_ � '�� (!!hc intwn b any et'dw followi�9cNtfa 3-(e'�es",.snppwnne Qoeutaenhtion mast be�na�hed. A��t6ere��paisaaC w�sxwau�a�rnmi on dM rite? OYts 1�� • � UDCS ILCl1[!COM11C)IYIS{IICIIOIN{wCditµlY� pYti fl'(�io A�re tberc any C�temean ot tiCi�ao�•ways on thc Yile? C1Vet . � !�ibe 4i►t subject to opptov�l by;m:�thet publie t$enc,I?. Q}fcy n w�U wurew�ur ythor dun dom�ftu:�awngc be;e,xnied? GYts pf I:� I�RESIDENCF FILL oUr TH�e['�XBELow - , SPeople ' NBtOroonis" � J! attuooms,�,_, C+ardenTubNuhirlpoo!qYes dfJc Aaoc�ts�ni: , ef o Hiumou 7'lumpia . td'?es No _�_ � , —Tf-NON-RF,SiDEN('E FQ.L OUT T.(�.�90X}3ELOW �_ _�� yp�of FacilityfBuuincss,� __, To�al Cguore Psi�ta�u of'Huiid�nx _,.,#People„�� N Sinks #Comn,odes�, �t Showers_,_,�„ 1�Urinets Tuiawted�Wa�or 11�ag¢(gallons pet duy) (Atttich doeumen��eon of similar taeility w�ter consumption) FQODSERVJC�ON1.Y:.�Sest� ,�, - � � � � �,? V � Typesy��emraqunced: E�Cunvencion�l t)��xe�fed Ot�horntfvc OXItFinative JO�hec ---_ WOtpt S6pplp'�piic:U�omirytCiry Woter .ew iYell VExl�tiaeµ�cll O Con�muniry Well _- _ ---_-----� ` — - ' Do you anrictQatt uldilions or expe„sioni irf��faciliry rhis rycxm is inleoded u+sCrve7 Q Yes U No �llycs,wh,itfype?„_ - - � _ ..�....�---•� Thit i�eo cetcify tlut�he intormetioa pmviilci on this oPp�ic4tio!?I�kue�ad eoftcr�to�bpt of my Imuwkdge. 1 wde�s�anA Ihot any perm)qs)or ATC(�)u�ued herrafler are's.���CCt 10�ufPC1L{OIl 4r RvpClT1011 i�1]C NfC if�1tEKO:the iu�eud.d uce ehu+�es�nr if �.4e iafQimatioQ wbmi�tnl in thie�p�+l icatlon i.f�lsified or cl�ar�yed. I I�er�Drannr.tib�hi ot entry to i1x�uthoniid 1Fcp��senro►ive OrHu D�vie C.�,unlY Halt1�DcpaiIInons��Q��Q4ct aecel9iry inspttilC4i 16 deremtiue eompli�nc�.vi�rpplw�ble IaMs and.nlcj, t uodencand thec I am recpons�b(e fo�the yrop�idootiGee[ion�nd IabGing of prope:ty 1i,ks:�nd Corncr en�t loeati�a�qd naYgi rig or.�kin�ihe 6u�uct+3ciliy loealiuu,prupuycd wcll lntotioa and t11e lOcadoa of3rry•other utk�tt(ec. � ty/ 0'Y`"� �.+ �h'+��.— SItG Rtrittf CMtt! 'ai'roperty owner'�or ownerb lea■1 rcprtit�i tiTi�ro iignnwre -- -• Dst�(+): � ��'��i�Q Client NoGCKatiou O�m: D�I'C EH$' � Sign givw f�Y4 ONO Attount M � t� • R�vGed 1 llU6 tnvaic�:K _ �, �,'1f:,� ' �PtF � rny, �• �h `r , , \ CEMER pF ' , i ' �;w� , �'I v v� -�'- ��� EXISTING '' , '��` /� a'- CENTER pF pR P DRIVE ANb � . 0 OSED 50' EaSEMENT '' ` `'� a' � k.s�, i� `� o. � ��; '��rf w . 1/�. � . rrx�`: � � � ' �n i;s�, �{ 4� . . f/f' . .. ��� , . � - ;�:5���' .� ; . N � . . + - - � F+����. . ' .. . lr� ; • JAMES E. NANCE � � �} • � ' � � � ��. D.B. 137 Pg`� 249 � � . . � ` 's; � Z � B. 137 P ��245 2nd trvct � „' :.;, ',��! �� . ��$• g ��� ( ) - ,��:� .. .B. 137 Pg.� 250 � '` � , . , , , � ' •. . f��'.�� . � � � ' ; r bolt found at 1lEST __--- _ �IIEST = ------� . �f�ky . : ��.��t�4,� ` � . lence comer . _ --200.85 336.60 272.00. o��(i• � . � �„Fyi�aa�� ; �s + \ �-- ;f� N 8�'36'pg• � r�� iron found on f\ '�'" � `Ir/.. i �•�rlyr� � �''T�A, , 'j��t,l � • � lence line '! iron � . }�.�;•. : � � ' ' k aaN2�y .' . ^ ��., , r �OUfll� / � �7��� - i.+ � �r,� � �D r� 'rw �.i �' . � .. Ma��f�d'��f� ���� "' o y� �f � ! I �t�}l+� ,1., � ..7 x�0 �-��; Y p� � . '� i ' t"� : 1 1�i1 �x� � � o ' } . ; . .t�v'�'�1�;t1 � 0 t7 '� . ; ��°t. , �'t,� #.� / o t- i'' � 1'�� i (,y;y����,��F'� �; • Z �� � v � ,' f� ' - --�'�:: ; ,;`� 5�,rff`'3.��, , ;�f �0`' ;� �Z � • � �a : . ��ST� ��A�� .. . S 89 25 59 E' ' ' ' ''aA 1 a�'�, iron ploced � � � '. � � • � �� v v� �1 � • �6�2a s�:�.�. , ; ., �, . , c� : �, �, � � ti z a . �a.� . 3 ,��}�-- , . o :�r. . � - � � r ,•.;,' F � ' � ch�._._ � �v � . +'. ;t,���`�i:� / �• t N 1� -+.- � p • � � . t•'.+,��r J��y '� ' � .-r i ..,� �i/(Q �.t , „J;ts�r�ti!1 ' � /� o h ' . r�'y i , � i ��'� .��-.`�. lal �/ � 1 � �'.., � � � � � � �� �, ,.. / Z j O �? �� ►�,� � ' � ' . ; t �r"�s�� ' � f, ` �, � ,^� i , � o ,� .. . . � ,; ,+j' -r� ;,� ,';',_;-'- / °0 y o � �' � � s � Y� , ' ' ocM i � 1 � �?;ii`�t 7�¢ � , !i� � 4 I ,i .i{ 'ti'' ' � ,."h' � '� 1.5` bent � • „ , ' t0 , �,� i.. 1a a ;, �5 ;:: bor (ound � � �i �l�on /0u�d i tn _ :��•�•, 'y� �+ ' naw iron'on,. '� � ot 12x 12 stone � 8.00 j/ �, �/. / ! 2 ACRES���1�Ca"��� ,f Propertyll(ns. ��ry�j, ,tn 1 �336.89 ` �"''� �� }���i�,ir , r "..,����i��, ��s''p ��409.16 T , , Y, S cg2•36 23TOTq� UDES DUKE POWER R/W)�? •�, �� � �,� �,�' �r,..�. 0.• qTAI cor )ock � , �;°��' �`�� , �.�. �i'�+e.� 39 4.]6 �;' . � 28, . . �x� �,i '��;f'� �}1 �� ,(,��,.r4�`��� `,r;,r. N,84•q9�1e. `5-97•_33'49'_ E. .�153 00'_ : 89 ti � �w � J � Q�.; +��'�? . , . N I 98.35 . , �. , . � - iron /ound at � ,, k,��. , ,t. � ,,i ,� S 38 26 23 V .i, N 87 30 00 },� ..,�,,. N 04• , lence cor� .�'���i � � �,.. pQ � . ' � �?� '62.19' � ao •,� 3593. � er . �. : r� ,s��t ���.. . � 73, . t Ap s ;^ Q '� iron found�.• ao • I '' � '` • ,�,� ,,;�j�� 3,y ::`y ; S:;E30'S6'02' 1! .�..• . so� 5 , ,i �l �t � �� ��: . � ,wi13.32 . �.,.••' �e •' ' � ;"�s .�,.,��►�; .:f� ^ ,';\$;29•S9'g 4'. �W �,2� �..••• ' • �� . � � �! ' � �27,43 � C`�. ''� r�'�'` ��'': ' ,�•�.S 47•51'10'�V:.�+:� •''���•' m 'Yl `�. '�ay ��pF �+�Y�� /� :i':. :' 89�•79��,���s�;.... .... �.�'�•���,•' . . � � �'P `'r4��`K:���; yt�Q-�;� a�����A4•11'37' �1l►►�aty� �Z �22 ne '�'. " `2J' . .... ��. •��. i: •. � �.�.•7 1. ��, .w�. ..�3155.01 ��,,t•. o ,L;'. .... . � � .''�,,. �'' �'�c^,�".f"a��44''�' El�.r�`: S�,09•58'03'•E.• ,��2t'�;�;�, .�e� . ; � �. / •�.�� �a,.:�. �;? <3 `J4`t� .:, �q��}xiN,��; � 0 . � J • ('x� �. N t ,�t. ��.�._ �r..t�� F t� r N� Q / ,� Y�t...l' �� •i 1r 1 :�3��.,.•''��,�•• ''':. . �"�o :F��''� �`; ��'��;�'ya�: � ;;������.�,,;_ . ' 60� �►���'�" � ' ;AREA = 25.830 AC ,.. �° •., .� �'�,�-k����"�t �`�;�� a�9:: �fF�'���#�`'���;;:F� � os�o t� � � � �'. ''. :�,�'.i�'���y�" i�!,�;�`;:��ii �i �ts�,���O�t�Q��p. . .� : . .. �' placed �•. �6. ;t�t�yr��,l��1 •+t�'• 1 #� t C y� r., .. �,� , :orner) � '�'1�:, ..i.: �.� ��• � E�"��t.•��+ ! i;:: . i 1 ' • r:�.Ci x r �/1 11►�^ . - - , ,. . � 4691 ,�...,_,_.,�,,� 496 e�w.._.__.�.. . ,., .. � _ . .: . � �, . _ . . _ ___ . . t ` 174 / �" ' • /� ��� � ��� .�,.�,� �� �E � � � �, / / 1 �o � � � ;�., � � .A � �. / .�'��.»�� ,, .� � � � _ __ .___..�. �473._._._._ ---------- I / -�-`---•�--- ----__,_,3.�7 ___�_._.__ � MsC ��� � /� � '� � � � � �� , ` MrB2 � � � � � . � � � �:� �� I , � �� -�� ..� � � �� , � � � - ����� ��F�� 3� ���� � "A ; i°- 'TP',y, y"''$ 4 p`�... •Nn� � � . / P�, � � . �}. 1 � I i..� .d.i.�.t � . .. . . . 1 �.��. + , ' EnB i � � �� �� � i ��b � 6.677A � � { � � (5.13A) �.----_____ o � � ���� � 282� � � 6826 �� � �� _�� 'o �.������k'' � � � �� / � I � ' � . �; � .. .. . / � : _._ ; . � F� � ,,., �� � �� / �, / � I I �� `� � �� � � � � � -�� � � �� . , g , , 2 � ' � � 8 Rre_337 _ ��� / � �', 409 ^ � � _. ., . � �� 1.007A �� y .n� .A..� . � � 51 . ._ �� 718 fr' �Q i � 5424 `1• / ' o' � ' '' `��.` y rto 792, ��, 6��� ` ry Vl, / � i ./y / . . . . . � ��� �1/ . / a , Y I "F` .i d , .- . . ; , � � � .> . . b�.. ,a .. w �e . .� il �' � e a� � �. . i . . . ^.. � � � ' .' .,m �.a . .. i . .�� '� ,. ; ..' . �i , .... . . i�.. - - ' � I . , rl ' . . . � � � < r . , �_ � y. .a _ , . . _ .� . ' - F z'. . . . . .. . �..---^`✓�w"' � � t".. /^" �nti�-� y � :/�f Pr"` . a$ �""Y;:'�" ^C't�S . . f�x.. J�i✓r `% 7 � i � � e ..,,'.; , ; ; .. . >, t . �' , ' '- . • DAVIE COUNTY HEALT`H DEPARTMENT � ' ;': ' � Environmental Health Section • ' Soil/Site Evaluation � APPLICANT INFORMATION ' PROPERTY INFORMATION Account #: 990004193 Tax PIN/EH#: 5769-46-6372.02 Billed To: Debora Smith Subdivision Info: Reference Name: Transfere Permit(From) David Moore Location/Address: Leatherwood Trail-27028 Proposed Facility: Residence Property Size: 6.67 acres Date Evaluated: / �7 ��ZsJ�� Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring f Pit Cut FACTORS . 1 2 : 3 4 . 5 •, 6 7 . Landsca e sition L °L L Slo % !.E 3 HORIZON I DEPTH D - � c> - � O - Texture rou eL ;� � �L Consistence - (�. � Structure � � _ ` Mineralo 5is �"X � �,,, HORIZON II DEPTH ' Z� _ . � �(,p .. , Texture rou C.�� 5;C_ G G- , : Consistence . _. � f=i�/� $ ;S ; - Structure yh �y� Mineralo � � L HORIZON III DEPTH - � 3tv (o - Texture rou �. c� � 5(_ Consistence '� ;dS V � '� ,,Q Structure 3 Mineralo '- L rinf ; HORIZON IV DEPTH 3 3 Z- Texture rou � Consistence - Structure Mineralo �� SOIL WETNESS . - ' t- -- RESTRICTIVE HORIZON �l� -- I lo Zt� y-� SAPROLITE �— S CLASSIFICATION � U S LONG-TERM ACCEPTANCE RATE �.2 c9.� SITE CLASSIFICATION: �s EVALUATION BY: , �� `Gz�A4..I� LONG-TERM ACCEPTANCE RATE: C9.� : OTHER(S)PRESENT: ' REMARKS: � . . . . LEGEND � i, n s �e 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 Textiug . ' 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 �Q1s� __�.__ __,__ � . __i_..__._. _._ ___.,_.._--- - • ,� . - VFR-Very friable FR-Friable FI-Firm VFT-Very firm; EFI-Extremely�rm , 3� . . . � � ' NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky . " NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Stturtilr.e ' - , . SC-Single grain M-Massive CR-Crumb GR-Granulaz ;. � ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic '"'" ,Minera�oQv _ 1:1,2:1,Mixed LY.ote� � � Horizon depth-In inches Depth of fil1-In inches Restrictive horizon-Thickness and inc6es from land surface Saprolite-S(suitable),U(unsuitable) Soil wemess-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less _ . 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, �' . DAVIE COUNTY HEALTH DEPARTMENT . ' - = � -� - � • Environmental Health Section /� . � :�� ' , .`�e, , , P.O.Boa 848/210 Hospital Street /� � / �' 3/�—� �' - " . Mocksville,NC 27028 :. (336)7S1-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990001401 �'fax PIN/EH#: 5769-46-6372.02 . Billed To: David Moore Subdivision lnfo: - Reference Name: Location/Address: Harrow Lane-27028 /�TH�wo�d� b2 Proposed Facility: Residence Property Size: 3.266 acres **NOTE�*�Thri b�mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Waste�vater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS ' PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACT�R MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type ��V� #People� #Bedrooms � #Baths � Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: � BasementJNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size �•�? ����T'ype Water Supply �E'-�— Design Wastewater Flow(GPD) ZN� ,,:'Site: New�Repair❑ System Specificarions: Tank Size�� GAL. Pump Tank GAL. Trench Width�r� Rock Depth 1Z�/ Linear Ft. "7�t �� ��: 1- ���-����-��a �, !`��TAu, �.��� q'�. c. �t�. ; � � Required Site Modifications/Conditions: � tl., OI�K � 7 �'� U�,�f} INIPROVEI�9ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW �! FINIS1iED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Depariment for final inspection ofthis �' system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m,to 1:30 p.m.on the day of installation. Teleplione`#.is(336)751-87G0.**** � ; � � I t`�� �"^� ��`'t�.— ' �* ,��T A(X12ox �� �S�T �J���o� P��.�,-P � �S�n�,�t- Pw��}+�� � 2� �-�sc , „ �� 6Sw��t-- _ .��� �1�� '�I ��s�.� �, � ` '-� ��' ���,2 ' -� � � � � � � � � �� �J To�� ���-� � Environmental Health Sp ali s ture: ��N�►�� VQ��� �2 � ��' \ DCHD OS/99(Revised) ��� _ . e�-,P��Q . � �. , . . I . ' . � ' � DAVIE COUNTY HEALTH DEPARTMENT �'• � �� ' � ' . • Environmental Health Section � P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990001401 Tax PIN/EH#: 5769-46-6372.02 Billed To: David Moore Subdivision Info: Reference Name: Location/Address: Harrow Lane-27028 ATC Number: 3280 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WAS ER'- ON T IS VA D A PERIOD OF FI YEARS. Environmental Health Specialist's Signature. • te: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation Permit 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. Septic System Instalied By: Environmental Health SpecialisYs Signature: Date: DCI-ID OS/99(Revised) ��-- l/' / �:.�r�--� ' " i 7( . , Gp�� �,I� /1PE'L�CJ1TlON F�UR SIIE EVALUAIlUN/{h1f'ROVEAiC1YT P�fiM�&A7C 2 n� � i , ,�� t(�� . Davio County Health Department � � l� lJ i :, l� . ��1. 1 '. Envi►ronmenta/Ne�arlth Se.^.don D �__.--- ; � �J� P.O. Box 848/�10 Hoapital 8treet �� � � ' � . Mockeville, NC 27028' . (336)751-8760 *+►*I�ORTANT*** THI3 APPLICATION CANNOT B,L'PROC�33ED UNI,E88 ALL T �. INH'ORI�TION IS PROM1►ZDED. Refer to the INH'ORMATZON BULLETIN for inatruatione. 1. � N� to b� Dill�d ���1 i�J ("/(.����� Contaot P�r�on c�f�b�._. ��� ,►�... ,i?D �����l ��. ��. _ J��--�i.»: �s��e�.�.�zZp A��IIF-�,�.�� �s.� ;��aa� �.s�... p�o�. 2. Nam� on D�rmit/]►TC i! Di!l�r�nt than ]►bov� Hailiaq l�ddr��• City/8tab/Eip 3. Appiication For. Site Evaluation � Impronement Pormit/ATC ❑ Bo�h 4. sY.t.m to s.n►io.: �� Iiouae � Mobile Home 0 Buaineaa D Induatlry ❑ Other �" � �. y . `� It Bedrooma �Z f Bathrooma �'S s. I! Residencao i People O�Di�hwul�r . �1'�Oarbaq� Di�po�al C3�/�i�hinq ?laohin� �ar�nt/plwebinq ❑ 8uam�nt/No Plumbinq . 6. tt Hu�in���/Indu�tzy/Oth�rs Sp�oily typ� � p�opl� $ 8lnlco � Commoci�� � 8how�r■ � Osinal• � Kabr Cool�rs IF FOODSERVZCE: # 3eata ' $atimated �Pater Usaq� toaiioa. p.r'a.y) �. 1'ype ot �ater supply: � County/City ��11 ❑ Community e. �o you anticlpate addltioms or ezpanaiona of thc tacillty this aystem la intended to aerve? ❑Yea �o If ycs,w6at type? �"''IMPORTAN7�''�"�' CLIENTS MUST COMPLETETIiE REQUIRED PROPERTY INFORMATION itEQUESTED BEWW. Either a PI.AT or S1TE P1.AN MUST BESUBMITTED by the cUent �vith THLS MPWCATION. Property Dimenslons: �3'=�,S-��t" �� �� � WRITE DIREGTIONS(from Mocksville)to PROPERTY: Tai Ofiice P1N: # .� 7„� '�J" �lD �(��7��' � � 7` � �e�� �/U CD`/�J� ��'F� � Property Address: Road Name /0'1��'Y� �C.-l� /� i� h /l� �'Y��l.� v�/v City/Zip �N/�. :� ',•�2 7���S� ` ;: If in a Subd[vision prov[de information,as follows: Name: . . Section: ' Block: Loh Date Property Flaggcd: �"/C�'-LQZ/ This is to certify that the in�ormatton provided Is correct to the beat o[my knawledge. I anderatand that any permit(s) issued hereaRer are subJect to aaspension or revocaHon,(f th�'eite plana or Intendcd ost c6ange,or if the Informallon � aubmitted in thta appltcation Is falsitied or changed I,also,understand that 1 am responslb/e jor al/charges tncurred from tfits appllcatlon. I,hereby,g(ve con�eat to the Authorized Repreaentative of the Davie County Hcalth Departmcat to enter uiwn above deacribed property locatcd in Dav{e County and owned by��-U� �i Xl/?/ , to conduct sll t�sting procedures aa necossary to determine thc elte euitability. DATE �� �"-�� SIGNATURE �V U Y GL- l�. � d ��-Y-.�.i'� TH1S AREA MAY IiE USED FOR.DRAWING YOUR STI'E PLAN(Include all of the foltowing: Ezinting�nd propoeed property liuea and dimenaIons, stractarea, setbacks, and aeptic 1ocaHons). • Site Rev�slt Charge : Date(s): ' ; + Cllent Notlflcation Date: �.; EHS: \ .., � � \ ���. : Account Na ( � '� ``� , - \ lnvoice Na � ' � , 31'7 � . � , - ; , ; DCHL � . , , • ', . '� ' - � • . DAVIE COIJNT'Y HEALTH DEPART'MENT' '.; . , � � . . _ Environmental Health Section � . � Soi]/Site Evalua#ion APPLICANT INFORMATION PROPERTY INFORMATION � Account #: 990001401 Tax PIN/EH#: 5769-46-6372 Billed To: David Moore Subdivision Info: � Reference Name: Location/Address: Leatherwood Drive-2 028 Proposed Facility: Residence Property Size: 6.677 acres Date Evaluated: -/ �/ �L---- ,: Water Supply: On-Site Well Community Public ' Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3' . 4 5 6 7 Landsca e osition • Slo % � HORIZON I DEPTH E- - �=' � Texture rou S'C(� (.�- Consistence r —,` Structure Mineralo ° 1 X HORIZON II DEPTH - - I - Texture rou -r C. - Consistence — ` � Structure ` � � Mineralo ; • HORIZON III DEPTH (i- � 2- r`'' Texture rou C� Gf• Consistence � „/' Structure /c ` . Mineralo - �( � � HORIZON IV DEPTH - � Texture rou Consistence ; V Structure - 3fL Mineralo 2.' SOIL WETNESS � ' RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION l. - S LONG-TERM ACCEPTANCE RATE v• . � a.Z • 1� SITE CLASSIFICATION: 'EVALUATION BY: e\�� �`^�'' I LONG-TERM ACCEPTANCE RATE: �' 2 OTHER(S)PRESENT: REMARKS: . � LEGEN� � � 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 day 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 Mineraloev 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-gaUday/ft2 '�� DC�ID OS/99(Revised) /. ■����������1�■■��■�■�������■���■■��■����■�■■�������■Ii�■■■!■����r■�■ ■■�����■���I�������������■�■����■��■��■�■��■��■��■���I�������������■ ■�■�������R���■■���■�■■��■��■���■����■��■�■■����■�■I10����\�������■ ■�■�������■1���■����������������■ ■■■■■�������������I�■■�■��������■ ■���������■i���■■�■�■��■�����■■���o�■■�■��■�■■�■■�■v�i■�■�e■�a��■��■ ■�■����������■■�■�■����e■�■■■■�������■�■���■■��■■■���i��■■■�����■��■ 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D d , � ,. f O �d-/%7" c:�C'� �fl� ,° ` ° APPLACATIUN�UR SITE EVALUATION/IMPROVEMENT 1'E1iMR&ATC . t� 2 �!7 - ' 0��� - Davie County Health Department L5 � t5 � �=/ �s . A�`�iq�`�;4 { • Envrronmenta/He�a/th Seradon : D , � ` . P.O. Box 848/210 Hospital Streat � � � 2000 ' . � Mockaville, NC 27028 • " ` � (336)751-8760 ***Zl�'ORTANT*** THIS lIPBLICATION CANNOT EL� PROC�89�D UNI,�88 ALL T 7.�tH'ORMAT=ON IS PROVIDED. RePer to ths =NH'ORMATiON HULL�TIN for inatruationa. 1. t7as� to b� Dill�d � Cosataot P�r�on ;��f� ��� �... �D�,����1 � 8�. �. q�a��r�s cshr�st.t.�s=r �a�l/�'l�?i�E. IJ�.�. �'7Dd� au.sn... rt�. 2. ltae� on p�rait/7►TC it Di!l�r�nt than 11bov� • MailiaQ Ildds�o City/8tat�/Eip 3. l►ppiication For: 9'Site Evaluation l] 2mprovemaat Parmit/ATC � Hoth a. sY.t.n to s.r�o.: fYHoua• O Mobile Home O Huainesa � Indua4�sy 0 Other ' ��' � C 2 s. It R,esideaaa: � People �/ � Bedrooma �Z � Sathrooma �� -O"Di�hxuh�r �iarbay� Di�posal aihinQ Maohia� �Ha��nt/Pluabiaq O Sasu�n!/2Jo pluabiaQ 6. 2! 3u�in���/Indu�try/Ot2�r: sp�aify typ� f D�opl� � eiak� � Commod�• i ehow�z� E Usinal� � Nat�r Cool�r� IS a'OODSERVZCE: # 3eats �atimated Natar Osaq� �Qaiion■ p.: a.Y) �. . Type o! Mates aupply: ❑ Couaty/City @�11 ❑ Comtttutiity e. �o you anticipate aciditloma or e�anatona of the tactltly this ayatem ia intended to eerve? �Yes 0�0 ' If yes,w6at type? � **�IMPORTANT''"*CLIENT3 MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PI.AT or S1TE PLAN MI/ST BE SUBMITTED by the el�ent w�tth TH13 APPL!(:ATION. Property Dimenaions: �l 7� WRiTE DIRECTIONS(from Mockivttle)to PROPERT'Y: Ta:Oliice PIN: # .�' 7�g`- �(� 'r�� 7� � `1' � �e�� �/U �`/�N ��F� Property Addre�: Road Name N'�rY� �J� /�' i� h ✓ �/l/ /p`i�f'}'B� o'�/� r � cicyiz�p..l�fze���1-,��N�,�7�� If in a Subdlviaion provtde intormation,as follows: Name: . Scctiou: ' Block: Lot: Date Property Flagged: 7'��`—� Th[s ls to certi[y that the intormatton provided i�correct to the beat of my krimvledge. I anderstand thst uny permit(a) fssaed hereafter are aubject tu swpena[on or revceaHon,it th�'eite plans or Intended mse chsngq or i!the iniormaHon • aubmiHed In thia appllcallou i�falsitied or changed. I,also,Wnders�and lhat I ant resportsl6/t jor a!1 charges lncumd jrom tbls appllcatton. I,hereby,give consent to t6e Authorized Representutive of the D�vte Coanty Health Department to enter upon above deacrtbcd property Iceated in Davte Connty aad mvned by �l�-l�� �i�C?� to condnct sll teaHng procedarea�s neccsaary to determine the elte ealtubWty. I DATE %'i ��� " SIGNATtTRE �V T}YGL- �. ��--e� ' _ ..' THiS AREA MAY BE USED FUR DRAWII�IG YO[JR S1TE PLAN(Include ail of the follmving: L�ating and propased property liues and dimensiona, stractarea, eetbacks, and pepdc IocAHons). � Site Revlsit C6arge Date(�): ' • . � ~ CUent NoHficuNon Date: . EHS: , Account Na ` �� / Revised DCHD(07/99) Iavolce Na 'S� �l�Ql , , . � , , , V ► . , , T�avie Gounty,7�ea1 rh Z7e�artment Errvlronmental,�fealth Sectlon PO Box 848/210 Hospital Street Mocksville.NC 27028 Phone: (336)751-8760 � September 18, 2000 Mr. David Moore PO Box 2221 Advance,NC 27006 � Re: Site Evaluation- 6.677 Acre Tract/Harrow Lane Tax PIN#: 5769-46-6372 Dear Mr. Moore: As requested, a representative from this office visited the above site on July 5, 2000. 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 on-site sewage disposal system. Please find attached a letter to Bryan Barringer dated July 6, 2000 in reference to a site evaluation of a 3.411 acre tract on Harrow Lane. As the tract described above includes this 3.411 acres and the proposed house location is the same, no additional site evaluation is necessary. Please note that a pump station may be required. Actual design and dimensions of the septic drain field will be determined at the time an improvement pernut is issued. . , Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office.l The location of the facility the system is to serve must be staked off. ' I . If you have any que Itions, feel free to contact this office at (336)751-8760. � I I Sincerely, , � � / � JeffG. eauchamp, R.S. � � Environmental Health Section enc(s) i • � i I ��� , . �I '! • � � � . . � . .. ' • ? . , • I . ' � I � � Z�avte �Gounty,7fealrh Z7epartmenr Ejivfrorrmental,�fealth Secrfort ' i PO Box 84s/210 Hoepital Streer Macksville,NC 270Z8 Phon� (336)751-8760 � � July 6,2000 I Mr. Bryan Barringer , 820 Duckview Court ! Winston-Salem,NC 27106 � i , I Re: Site Evaluation- i3.411 Acre Tract/Harrow Lane � Tax PIN#: 5769-56-8655 , , i Dear Mr. Barringer: I i As requested,a represeatative from this office visited the aforementioned site on July 5,2000. Based on the information pmvided on the Applicatian for Site Evoluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system However, it should be note�i that better soils were found on the back side of the tract, which may require setting a pump station '� ; ; Before a representative if this office will revisit the site to issue an Improvement Pemiit/Authori7adon to Construct the appmpriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. i �, ; Ifyou have any questions� feel free to contact this office at(336)751-8760. � � � Sincerely � � �� I I � JeffG. Beauchaznp, RS. � � Environmental Health Section enc(s) i ; � I I I � I w.-�ao.e. ��f�u� Y'"P"'�J �'���auu u�wcu�wn�� �a�ucsu�c�� aosvoa.n�� auu ac�a�a.�va.aawu��. _.. . _ .. ._ � t5 , � , _ ,_ . . p � . , [� ��_ �.__.� �� - �_ • . . - � p �---�- ' . .J • - . � I#Fr'F]JCJA�601� fOR Sl�F EVALlJAT10N/IMPRQ1i�lWENf PERMR&AT `, • � ' , • � � �avie�ounty Heaith Departme�** � �� � 6 200o E_ � • � p,6 j Environmenta/Hea/lfi Se�ction �__., _ �..tl � `� ��/ li P.O. Boa 846/210 Hospi'�,:.al StreeL ��Vl�p;;;;ii:;f;�`�f�;.r',CIi•i - Mocksville, NC 27028 _ DAVIE COII�lIY (336)751-8760-: � 2 �/ J'%yl��iti{J�t. y�cJ�J c���o Q" ***I,.�ORT'AN1'*** HIS APPLICATION CANNOT 8E PROCESSED UNLE ALL THE REQUIRED ` INF�R1�iTI01�3 IS P VIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nr:me to ba Billed � �./ contact Porson !J � � Mailiny 1Wd=eas t Home Phona G Cib�/State/2IP ��/�S771N Jo� ��-�����/�Busineaa Phone ��� Q /�V " - . 2. Nama on Permit/]�TC i! Different than Abo�ro • ' Mailit�q )►ddress City/Stato/Zip ' 3. �,ppiication For: ite Enaluation ❑ Improvement Permit/ATC ❑ 3oth '4. Syst.om to Sarvice: f r Y H o u se ❑ Mobile Home ❑ Business O Industry O Other - - 5. IF Resi ce: � P e # Bedro03ns � � 88thsOOms _� Dlahraaher Garbaqa Diapoaal Wa[i' ahinq Machine ❑ Haaoment/8lumbinq ❑ Saaement/No Plumbinq 6. If Busiaesa/Induetzy/Other: Spacify type # Peopla � Sinke . � Commodes � Showera � Urinala � Water Coolera IF FOODSERVICE: # Se8t8 Es�imBted Wate=' Usaqe (Qallons per day) d �. Type of water supply: ❑ Couaty/City ❑ Well ❑ Community e. Do you anticipate additions or ezpansions of the facility this system is intended to serveT ❑Yes 0 No � Tf yes,what type? � ***IMPU��'{TANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY I1�FFORMATION REQUESTED BELOW. Either a P➢�AT or SITE PLAN MlIST BE SUBMITTED by the client wit6 THIS APPLICATION. ' Prouerty�9 e wo : 7 ! / �G< �:,�.:c i3I cE�'"'iI6���irom ivioc;csv�l�e)to�rifUPEifiTY: 't TazOffice . � � � — � ��� ���/►a7'zd /''l/" cf-rcc� /�G/7imvr{� , Property Address: Road Name,�fT¢���� ��� �� C[� �O fa� � �o,a�� �troc,/� City/Zip ��v�G� •Z�v06 .f'"rr7,�5 �/� di� Mc%Ow L.-+Cr, If ia a Subdivision provide informallon,as follows: C/�w��1' C�Urd� i�, rJ<<t'� t-o �c� -�/` Name: Q Gc.� U Ct.�-- ��u.A � � r. �e� S S 6 ° a �o� �°Q°" ,r SecNon: Block: Lot: ate Property F7agged: �-�/7—�'t'� ba�� This is to certify that the information provided is correct to tLe 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 su6mitted in this application is faLsified or changed. I,a/so,understand lhat I am responslble for all charges incurred from . this appllcation. I,hereby,give consent to the Authorized Representative of the Da�'e County I�Ith Depar�ment to enter upon above described property located in Davie County and owned by 4.)�,> >e.. \���� ,�J to conduct all testing procedures as necessary to determine the site suita ' � DATE �h C� 1� (J[� SIGNATURE � c �� � THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(I ade a of the following: Eristing and proposed property lines and dimensions, structures, setbacks, and septic locatcons). ' Site Revisit Charge l , 3" Date(s): � ' Client Notification Date: EHS• . Account Na ��� Revised DCHD(07/99) Invoice No. ��r i �. 4'� _ ?�£� :� K,.i, V�� �< t �`y�'��_�; � �A ,� � . F ,i�:;����;�� � � W ':,ti� 7 �' :��r�r; � ¢ - i � i: k r�'� � �� . ~ V , Q� . •� '.1.• . 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DAVIE COLTNT'Y HEALTH DEPARTMENT . . . - � . • � . • Environmental Health Section , ° " •� r � Soil/Site Evaluation � � . � APPLICANT�NFORMATION PROPERTY INFORMATION Accqunt #: 990001228 Tax PIN/EH�: 5769-56-8655 Billed To: Bryan Barringer Subdivision Info: Reference Name: Bryan B�rringer , Location/Address: Harrow Lane-27006 Proposed Facility: Residence Property Size: 3.411 Acres Date Ev�tuat�d; f� � Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 ; 2 3 - 4 5 6 7 Landsca e osition � Slo % HORIZON I DEPTH � Texture rou • L t- � � L C Consistence Structure � Mineralo HORIZON II DEPTH — �— — I — Texture rou Consistence r-� Structure Mineralo � HORIZON III DEPTH � —� ` ' Texture rou -� � Consistence ; S - SWcture ° Mineralo M� ' • HORIZON IV DEPTH ' �3 � Texture rou ' Consistence Structure Mineralo SOII.WETNESS . y RESTRICTIVE HORIZON " • � SAPROLITE CLASSIFICATION ? LONG-TERM ACCEPTANCE RATE .F SITE CLASSIFICATION: �j EVALUATION BY: �-'N a`^� LONG-TERM ACCEPTANCE RATE: �'2 y"` 'v OTHER(S)PRESENT: . REMARKS: �VIC_ 1� f� �M�� ►��'�Lj i'1�L`.l� . . . LEGEND �. Landscape Position ' ; R-Ridge . S-Shoulder L-Lineaz slope FS-Foot slope N-Nose slope � �� CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope �� �� i�'' j 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 ii, NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic "' �,,� .�� tructure - SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky a��' �: SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloav 1:1,2:1,Mixed' "' Notes . Horizon depth-In inches Depth of fi11-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-gaUday/ft2 DCHD OS/99(Revised) ' , � ■�t�������■■■■���■�■��■�■���■■s�����■■��■ ■�■�■����■���■���■■�■�����������■■��■�■��■ ■�■���■■��■■■■■��■�■���■■■�■■■■�■����■��■���■�■■t������■���■�■�■■■■a■�o���■�����■■■■ ■�■■�■■■��■���■�■���■■���■■■�■■■��■�■s��■������■�■��■�■�■�■����■■���■����■�■■■������■ ■��������■������■��������■�■��e��■■�■■��■��■■■■■■■■����■s�o■�����������o■■��������■■■ ■■■■■■��������■■■�■■■■���■■■■�■�������■■■■����■■■■�■■■■■s�■�■■■�■���■������■■■■■■■■■s ■��■�■���■■■������■�■■■■■���■�■���■■■■�■���■■�■�■■�■�■■■��■���■■■��■�■�■����■�������■ ■���■������■■��i���■�■�■■�■�■���■■���■��s���■■■■■■■����■�■■■���■■��■■��■�■■�■�■■■��■■ ■■�■■�������■■v■��■■����■�■��■������o■��■■�■�■��■■������■���■■������■��������■������■ 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■■������■■�■�■■■��■■���■�■�■e���■�■���■��■ ■■■�■���■�■�■����■��■�■�■���■■���■�■■�v�■�■■��■���■�■��■����■�■��■�■■�e����■������■ � ' � . � y � •e:. ..�'+ � •. ',�,� ` .. . . _4 '. • , . . . r . - . • � � a, _ • " � ,. • r a ' ' _ . ' '� Z7uvte Gounty,�fealth T�e�arr`ment � �� . Errvfronmental,�feal th Sectfan � ` no s�X s48/2io x�;�s�t Mocksville,NC 27028` Phone (336)751-8760 July 6,2000 �. . . Mr. Bryan Barringer � 820 Duckview Court Winston-Salem,NC 27106 , Re: Site Evaluation- i 3.411 Acre Tract/Harrow Lane Tax PIN#: 5769-56-8655 Dear Mr.Barringer: As requested,a representative from thfs office visited the aforementioned site on July 5, 2000. Based on the information provicieci on the Application for Site Evaluution . and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. However, it should be noted that better soils were found on the back side of the tract,wIrich may require setting a pump station � Before a representative of this office will revisit the site to issue an Improvement Permii/Authori7ation to Construct the appropriate application must be completed in full 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(336)751-8760. Sincerely --� - � Jeff G. Beauchamp, R S. Environmental Health Section enc(s) � � � / ' . / � � . � � � � : �. ,: