Loading...
203 Primrose Rd Lot 9 •-, ' ` �; DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002285 Tax PIN/EH#: 5789-97-0344.9 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#9 Reference Name: Location/Address: Peoples Creek Rd.-27006 Pro osed Facility: Residence Prone Size: see new ma ATC Number: 4389 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This 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 1 I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION.FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ze Date: � 6 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall i O AY be taken as a guarantee that the system will function satisfactorily for any given period of time / r Septic System Installed B : f le eP Ys Y Environmental Health Specialist's Signature:--z �/ Date:L'� .2 �- DCHD 05/99(Revised) LI. S Cp ' DAVIE COUNTY HEALTH DEPARTMENT • '. Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002285 Tax PIN/EH#: 5789-97-0344.9 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#9 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see new map qTC Nit rnber: 4389 **NOTE** 1 his Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION 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,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACT R MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths_ Dishwasher-,Z100, Garbage Disposal:;T— Washing Machine Basement w/Plumbing:2y Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _ Design Wastewater Flow(GPD) Site: New❑ Repair❑ System Specifications: Tank SizeGAL. Pump Tank GAL. Trench Width Rock Depth4W&Linear Ftq ,�l� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISERS)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 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. Telephone#is(336)751-8760.**** lot Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) Mt`t:fd <a V-2 VI ; -r,7t' �.. ._4_r.,.-.r.tn_.a..a..r--5-v-n oa0 7.N70� G i --- •-- -• -- 3� �os� • `~'• APPLICA770N FOR SITE EVALUATION/LHPROVENM PEINIT A ATC L-0 'Davig Coun(y Health Department 'Env/tvnmental Nealtfi Section P.O. sox 865/zl0 Hospital Street M90ks.:114. I4C 27020 ` (336)751-8760 e••ZMPORTANrT•- THIS APPLICATION CAtImTD1•BY kRDCSS= DHLESS ALL TRS RZ=RBD . XNr0R3ulTICR IS YxOVI11Y0.. Refer to the XNFOR20=ON BDId.3TIR for instructions. - ✓3. lr.a. to be Diller / .Y fyiVIJCY��/J��fJS 7'-�. (�,e,oe.ec sec.— Dzae dA) ailt.t3t.y Aaeress x.25 WlAe6=J4 ✓Ge-U Gil -w—rtm..e 7579 ✓city/ante/Sa.- MA ✓nom a/(_ 2709 ✓anatbea Pcoaa _ rlQcrl-7.1.7q f.-2. tzar ee Pocsit/ATC aro .roup tAm Above N.111.g eddraes clty/Scae.laiP •—l. Appllcstlon for: JO sits INAluation ❑Isprwemegt Sermit/ATC 0 Both ,-t. eyste to 1.s.l.o.x12ouse ❑ Mobile name ❑ Business Cl Eaduatry r3 other --4. Trp"•Y.t—ropuestod. a cowontaoeal B coo..atioaal sodifted Q imw.tiv. --s. IIf Xeesideace. /r Poople P Badrooma ,3- 1 Bathrootns -�' ad0l.lw.Me 06:.uy.movo*.l aAiae tia4ma. ❑luer.t/v1..obiaq ❑au.e..t/1ss plr blwq 1. 11 8ua1e4e./tedustry/ath.r: verify type t People 1 Stoke a cooredae 1 r:to.ere 1 OrinAle a grater Coolers Ir r00VSSXVZC3t N seat* ttat1--S-4 Mat@r IIaag. (scum,Per day) --a. Typo or+star supply, Ql o =y/City 0 Well I a Combluaity s. no yo..anticipate.dditiode or expansions orthe facility this System is intruded to serve?Cl Yes 01110 Ityts.tvhatt _ ___• IMIoRTAA7"`Curwri NUSTCO PLETE THE REQUIRED PROPERTY WFOWNATION REQUESTED u EithtraPLATorsrrBPL TBEStIRAf TTEDb lbeettent with THIS APPLICATION. tfY►operty Dimensions:_Z�. 5$M 6(-�RiTE DtREcrioNS(frotm M*cksvttk)tG rROPERTY. i r/yax Omee PIN: a ?M /58 ro ffvt s m Pfr�PeF�Cr�-� - -P►operlyAddresr. JZgadName Cityrzip 4Q VAy CE JJC t2702K (flnaSubdiyicloa rovldelaforttnHsn,;7as'follosrs: Name: /�/LCLi lum)4 r 114sS_�4 Section: Work: Lot•.!I� c-trate home comers(hgtcd: 122GCr92 This is to certify that the larorinarlon provided is correct to the best ormy knowledge.I underst2nd that lay peratit(s) Issued hereafter are subject to suspension or revocation,U the site pians or intended use change,or it the inrornution submitted In this application is fatsifitd or chancel.4 s/so,tmdtrs±and/hat Jnnt r e:ponsil ttjorail eLarrc Incurred from fAfs application. I,Ixreby,give consent to the Authorized Representative or the Davie County I(e21th Dcpartmtnt to enter upon above described propertr located in Davit County and onmed by to conduct all testing procedures as accessary to determine the site sult. /�i t✓DATE a-STGNATI)RE THIS AREA MAY BE DEED FOR DRAWING YOUR Sn E PLAN(Include all of the relloning: ExistitV and proposed property Goes and dluscusions,sttuclu:T2.setba"and septic locations). Site Revisit Ck2rfe D2lc(s): Client Notification Data: EHS: Sigu givenAccount No. ��'J S It"ised DCHD(05103 Invoice No. y •, ° +�, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION 5 Tax PIN/EH#: 5789-97-0344.1'2 U , Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#12 Reference Name: Location/Address: Peoples Creek Rd.-2700 _ Proposed Facility: Residence Property Size: see map Date Evaluated: c3 L) p5 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit V-11 Cut FACTORS L 2 3 4 5 6 7 Landscape position 0- Slope% 2 HORIZON I DEPTH ©– Texture group ��— Consistence Structure MineralogyS-- HORIZON 11 DEPTH - Texture group C_ Consistence P. Structure Qj Mineralogy5 HORIZON III DEPTH -� Texture group GE 511P Sli� Sac. Consistence S SSe Structure Mineralogy HORIZON IV DEPTH �7 Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0.3S SITE CLASSIFICATION: i EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �•3� 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 VF1-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 r r *SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prisrpatic 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) �, LTAR-Long-term acceptance rate-gal/day/ft2 I�"Lt 6J�5JJ�,ILV'�r -----Mats, ill ltA t't�7Vt) ___ ` JJO .7+74 !G !•7 r'�+ A A APPLICA PION FOR SITE EVAI2)ATION/LNPROVEMW PEIGNIT l4 ATC '94yie Coynty Heelth Depa rtrlunt En vfrssttmental Health Section P.O. Box a45/210 Hospital Straat (•lggispyill4. NC 27428 (336)751-8760 •••ZZEP=7A6r7••• T=S APYLICATION CAfihVr BE PROCSSSPD W=S AI.I, MIX RSp(RRBD ' INTOxX&T=lr ZS 7107=311]. Refer to theaXN70XWMON B)7LLETIN for inetzucti{o�na.�,,�+�� ✓I. xus to of silica 1 6&(I::&E� d 641S _L ,c v—t.ct s.cwn IDI CG�TN,C.�.-8 dA) e�t.ill,.y Afar... ,,t �LU/NG,14AIy" �/l (,—W.Pit— /U� -f7579 . ✓city/3tat*/La [/[A�t[^SV,cL - A �?OJ$ �•,in..asrooa• -[Q�—!.1,7q Y 2. rtasr N►*cu Lc/ATC 1r o .rent than &bow* Mell Ley Add aes city/it•Ce/LIp Applleation Fors XSito ]WAluation 0 Improvement Permit/ATC - O Both ,rt. or.%—to sL.Loo,xBnuse M stabile ]I=* ❑ Business (3 Industry. ❑ Other --4. type or.t—repueatad. O Con•rentl*oal d eonr.auesal+.odifted 0 lmovative r–s. IIf Xeesidence,_/r Poople r Bodrocum i Bathrooms 1 sdDis►waMr l%rbye 8lapeoal as isy Mackie* E3s"—t/P2u btsg ❑sa.erat/se plv bi-I t. It susloes./Industry/ethar: vrlfy typo - 1 Pwple l SLnks I Cmsodas a fieuara s Drl•als s Natar C"Urs IP TOODS14tYICB; / socttst s_t.timgc.d ►tae.; pang. (yeunea Par d.y) ✓a. Type of"tar supply, a-caua:y/city ❑ well Cl ccenta ity a. Do you aaueLpat.addtuoda or expansions of the raality this system is intttdcd to serve?C3 Ycs ETFIo lMIOItTANY—CLtCKr`.i MUSTC0 ft"fi THE REQUIRED PROPERTY INFORMATION REQUESTED B EithcraPLAT orSITE EL TRESUdM)77EDb theelleat with THIS APPLICATION. tOyroperty Dimensions: Atin.O "97RITE DIRECTIONS(fro,MockMtle)to PROPERTY: a—r ar Otfiec PIN: 11 t9 M &JI S 7Z) P2 P6 USS < ---PropertyA44rgr. Read Nim l' Pis.tG2F�+e/& Cilymp�QU/.y C.E /t/C L270.2K f Ip a Subdlyitiaa rov(de Iarorutatim,as follows: Manse. 1M$1ZQ'Y AJ004 17 13/AS0E p4 es, Section: Block: Lot:_�1 &.Efate home corners f Ragged: 15,4c ,69 fac 42-e 'Akr- This is to certify that the iaforusation provided is correct to the best army knowledge. I understand that any pernsit(S) issued hereafter are subject to suspension or revoeatlou,If the site plates or intended use change,or if the information submitted In this application is falsified orchangnL I,rtisp.tmdrtsrQnd cher[nrq rerponst lejora1fclary&Jnurrred Jrom this application. E,hereby,give ceasent to the Authorized Representative of the Davie County FEcalth Department to enter upon above described propert_•located in Davie County and owned by to c2nduct all testing procedures as seressary to determine the site sur i (DATE .2-eR.3•0 S a-9ZGNATURE 4t -- THIS AREA MAYBE USED FOR DRAWING YOUR SrM PLAN(Inciode all of the Winning: Existing and proposed property lines and dimensions,Structures.setb2cks,and septic lamtion3.) Site Revisit Cur=e Date(s): Client Notification Date: EH&- Sign given 6 Account No. Revised DCHD(051°3 invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION ccoun 285 Tax PIN/EH#: 5789-97-0344.69 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#09 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence - Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public _ Evaluation By: Auger Boring Pit Cut FACTORS 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group ��- Consistence S Structure S; Mineralogy HORIZON I1 DEPTH r 75 4 Texture group C 1 " Consistence - Structure Mineralogy '1C HORIZON III DEPTH Texture group Consistence S SS P Structure L Mineralogy HORIZON IV DEPTH —(07 -5—T Texture group 1540 L S �- Consistence �S Kr aS Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0. SITE CLASSIFICATION: VS 1 PS Ca"6?-"' �� " VALUATION BY: LONG-TERM ACCEPTANCE RATE: 3 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 EF1-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-Prisrpatic Mineral-= 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-gal/day/112 I�"Lt 6J�5JJ�,ILV'�r -----Mats, ill ltA t't�7Vt) ___ ` JJO .7+74 !G !•7 r'�+ A A APPLICA PION FOR SITE EVAI2)ATION/LNPROVEMW PEIGNIT l4 ATC '94yie Coynty Heelth Depa rtrlunt En vfrssttmental Health Section P.O. Box a45/210 Hospital Straat (•lggispyill4. NC 27428 (336)751-8760 •••ZZEP=7A6r7••• T=S APYLICATION CAfihVr BE PROCSSSPD W=S AI.I, MIX RSp(RRBD ' INTOxX&T=lr ZS 7107=311]. Refer to theaXN70XWMON B)7LLETIN for inetzucti{o�na.�,,�+�� ✓I. xus to of silica 1 6&(I::&E� d 641S _L ,c v—t.ct s.cwn IDI CG�TN,C.�.-8 dA) e�t.ill,.y Afar... ,,t �LU/NG,14AIy" �/l (,—W.Pit— /U� -f7579 . ✓city/3tat*/La [/[A�t[^SV,cL - A �?OJ$ �•,in..asrooa• -[Q�—!.1,7q Y 2. rtasr N►*cu Lc/ATC 1r o .rent than &bow* Mell Ley Add aes city/it•Ce/LIp Applleation Fors XSito ]WAluation 0 Improvement Permit/ATC - O Both ,rt. or.%—to sL.Loo,xBnuse M stabile ]I=* ❑ Business (3 Industry. ❑ Other --4. type or.t—repueatad. O Con•rentl*oal d eonr.auesal+.odifted 0 lmovative r–s. IIf Xeesidence,_/r Poople r Bodrocum i Bathrooms 1 sdDis►waMr l%rbye 8lapeoal as isy Mackie* E3s"—t/P2u btsg ❑sa.erat/se plv bi-I t. It susloes./Industry/ethar: vrlfy typo - 1 Pwple l SLnks I Cmsodas a fieuara s Drl•als s Natar C"Urs IP TOODS14tYICB; / socttst s_t.timgc.d ►tae.; pang. (yeunea Par d.y) ✓a. Type of"tar supply, a-caua:y/city ❑ well Cl ccenta ity a. Do you aaueLpat.addtuoda or expansions of the raality this system is intttdcd to serve?C3 Ycs ETFIo lMIOItTANY—CLtCKr`.i MUSTC0 ft"fi THE REQUIRED PROPERTY INFORMATION REQUESTED B EithcraPLAT orSITE EL TRESUdM)77EDb theelleat with THIS APPLICATION. tOyroperty Dimensions: Atin.O "97RITE DIRECTIONS(fro,MockMtle)to PROPERTY: a—r ar Otfiec PIN: 11 t9 M &JI S 7Z) P2 P6 USS < ---PropertyA44rgr. Read Nim l' Pis.tG2F�+e/& Cilymp�QU/.y C.E /t/C L270.2K f Ip a Subdlyitiaa rov(de Iarorutatim,as follows: Manse. 1M$1ZQ'Y AJ004 17 13/AS0E p4 es, Section: Block: Lot:_�1 &.Efate home corners f Ragged: 15,4c ,69 fac 42-e 'Akr- This is to certify that the iaforusation provided is correct to the best army knowledge. I understand that any pernsit(S) issued hereafter are subject to suspension or revoeatlou,If the site plates or intended use change,or if the information submitted In this application is falsified orchangnL I,rtisp.tmdrtsrQnd cher[nrq rerponst lejora1fclary&Jnurrred Jrom this application. E,hereby,give ceasent to the Authorized Representative of the Davie County FEcalth Department to enter upon above described propert_•located in Davie County and owned by to c2nduct all testing procedures as seressary to determine the site sur i (DATE .2-eR.3•0 S a-9ZGNATURE 4t -- THIS AREA MAYBE USED FOR DRAWING YOUR SrM PLAN(Inciode all of the Winning: Existing and proposed property lines and dimensions,Structures.setb2cks,and septic lamtion3.) Site Revisit Cur=e Date(s): Client Notification Date: EH&- Sign given 6 Account No. Revised DCHD(051°3 invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION ccoun 285 Tax PIN/EH#: 5789-97-0344.69 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#09 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence - Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public _ Evaluation By: Auger Boring Pit Cut FACTORS 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group ��- Consistence S Structure S; Mineralogy HORIZON I1 DEPTH r 75 4 Texture group C 1 " Consistence - Structure Mineralogy '1C HORIZON III DEPTH Texture group Consistence S SS P Structure L Mineralogy HORIZON IV DEPTH —(07 -5—T Texture group 1540 L S �- Consistence �S Kr aS Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0. SITE CLASSIFICATION: VS 1 PS Ca"6?-"' �� " VALUATION BY: LONG-TERM ACCEPTANCE RATE: 3 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 EF1-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-Prisrpatic Mineral-= 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-gal/day/112 I"Lt 6J�5JJ�,ILV'�r-----M"1 r, ill IU40(,7Vt1 ___ ` JJO .7,717 I t•7 A A APPCICA 1'IO.N FOR SITE EVAl1)ATION/LNPROVEMW PEiGNIT l4 ATC '94yie Coynty Health Depa rtrr)gnt En vlrwrmental Health Section P.O. Box a45/210 Hospital Stroat lIgg4pvill4. PC 27428 (336)751-8760 a�eZZEP=TABT-es 1'=.S APYLICATION CAAN= BE FROCSSUD W=S Ali, MiX V=I=RBD I , INTOMXT= ZS 710Pt112D. Refer to the XN70XWMON Bi XJMIN for inetzucti{o�n%a. ✓t. X.se to o. slllee 1 t f7/V�G!�t� ��S T_ c v -t. t s.rson IDICe STN -8 d ,,,t 1-E�l+?y�'`-il Al" /��1 g�-7579 ✓6t7/3tato/zxr [/[A�t[^S V ,cL - A [! .?O J$ �•,in..a Yt,Ca• -[Q� —%.L 7 Y 2. else oe ►.tsLe/ATC 1r o .rent than &bove M.ilieg sddrus City/state/zip �1. applleation Fors XSito ]WAluation 0 Zmprovenent Permit/ATC - 0 Both ,rt. or.%- to NON -Loo, xBouse 0 stabile N=* ❑ Business (3 Industry. ❑ Other ...ri. lYp• er■[a reou.at.a. O Coa•reatlooal 0 eoar.etlosal +.oditted 0 lmwetive IIf Xeesidence, _/ r Poople r Bodrocre D Bathrooms 1 DdDis►wsMr CK rbye Blspersl as isy NaeAL. E3V"-t/P2..b1sg ❑ t -e -t/)le plv btwq 1. It Duslnes./Industry /other: verify type _ 1 people l Storks D Cm'odes a sir ra t Drlaal• s Nater C"Urs IF TOODSMtV=,. 0 ffoats s_r.timgc.d ►sae.; psag. (oellne!, per 4-Y) --I.s. Type of sratar supply, Uat' Caua:yJCity ❑ Well a cammWoity s. Do fou • Lletpat. eddsuods or expansions of the facility this system is intended to serve? C3 Ycs CTFIo If; LOYroperty Dimensions: S g� Atin.O "97RITE DIRECTIONS (from MockMt1e) to FROMM: a -Tax 01rce M. A 78 7 ° t9 M &JI S - 7U P2 G6 USS < ---PropertyA44rq : Read Nim l' Pis. tG2F�+e/� Cltymp� VAy CE /t/ 15 L270 -1K f Ip a Sub41:,,Waa rovlde Iarormatim, as follows: Name. 1M$__(J0114 c RI:iS6 p4 f, Section: Block: lot: _� 1 &.Efate homecoracmt)aggcd: i?�:GCfi�`J fG� p`^"esxA6, r- This is to certify that the information provided is correct to the best army knowledge. I understand that any pernlit(s) issued hereafter are subject to suspension or revoc2ttoo, It the site plans or intended use change, or if the information submitter) In this application is falsified orchangnl I, olio. m.denrond that[an# terponsr7rlejoralteliorrc incarred from (his application. E, hereby, give ccusent to the Authorized Representative of the Davie County iEcalth Dcpardnent to enter upon above described propert_• located is Davie County and owned by to c2nduct all testing procedures as necessary to determine the site tui i (--DATE .2 - a. 3• 05 a-9ZGNATURE z. THIS AREA MAYBE USED FOIL DRAWING YOUR SrM PLAN (Include all of the following: Existin: and proposed property Gnes and dimensions, struetums. setb2cks, and septic iomtion3.) Site Revisit Charge Datt(I): Client Notification Date: EHS: Sign given d 6 Account No. Revised DCHD (05!°3 invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION ccoun 285 Tax PIN/EH #: 5789-97-0344.69 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot # 09 Reference Name: Location/Address: Peoples Creek Rd. -27006 Proposed Facility: Residence - Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Public_ Evaluation By: Auger Boring Pit Cut FACTORS 1,1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group��- Consistence gcjsvS Structure S� Mineralogy HORIZON I1 DEPTH r 4 Texture group C 1 " Consistence - Structure Mineralogy '1C HORIZON III DEPTH Texture group Consistence S SS P Structure L Mineralogy HORIZON IV DEPTH —(07 -5—T Texture grou L L Consistence 4 IRKr aS Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE fl SITE CLASSIFICATION: 01 1 PS Ca,,.,�►.J�°i) " VALUATION BY: LONG-TERM ACCEPTANCE RATE: D . 3 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 is VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFl - 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 - Prisrpatic Mineral-= 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 - gal/day/112