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213 Shady Knoll Ln , � � � . � � . . Davie County Health Department . v�s 6j� . Environmental Health Section " �.;,_ -. . -� . � � P:o. BoX s�s . }�� �� � ,�, � 210 Hospital Street ���, � . O� �'S. . Courier# : 09-40-06 � - - 1Vlocksville, NC 27028 - --� Phone:(336)-753-6780 Fax:(336)-751-8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection . Name: � � � Phone Number c�.:� o '����,�7 7 (�e) Mailing Address: C��� �110 (Work) • ����(1%l� /l/� 274� Email � , ,,� Detailed Directions To Site: � �. �� � G� � �� • ..2� .� ���:� . Property Address: � Please Fill In The Following Information.About The EXISTING Facility: Name System Installed Under: (, Type Of Facility: ��� Date System Installed(Month/Date/Year): ��1� Number Of Bedrooms: � .Number Of People: �/ Is The Facility Currently Vacant? Yes 1� If Yes,For How Long? ' Any.Known Problems? Yes � If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility:� - . Number Of Bedrooms:�Number of People � Requested By: Date Requested: o�y� aol� ;, ($ignature) � For Environmental Health Office Use Only A proved Disapproved , � Co ments: � Environmental Health Specialist Date: 3 Z �.��.—�- *The signing of this form by the Environmental Health Staff is in�o way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function properly for any given period of tirrie. PaYment: Cash Check Money Order # Amount:$ Date: Paid By; Received By: Account#: Invoice#: I ' � I ! i I I I ! 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'(336)753-6780/Fax(336)753-1680 l �• �j,�(��� h� �l WELL PERMIT . � � V� P �, �,�; �� �.�. � �� Accou�t #: 990005297 � �� �'ax P1�€iEH#: 5718-00-2720 � BiilEd Tc�: Andrew Daywalt �� Suk�divisiar� Info: Refer�r�ce Nanie: LocaiianiAddress: Shady Knoll Lane-27028 �. Pro�c�s�c9 Facifity: Residential-Well �fo�er#y�ix.�: 10.25 Acres " a�TC Numb�r. 0048 Actions of the employees of the Davie County EH Section shall in no way be taken as a guarantee that this well will produce water of any particular quantity or quality or for any amount of time. This permit is valid for a period.of 5 years from the date of issuance. This permit may be revoked if it is determined that there has been a material change in any facticircumstances upon wliich this permit was issued. Permit Type: New[� Repair ❑ Abandonment ❑ _ 0 osed Well Location Diagram ' Certificate of Completion Diagram . � � „ � 1,.,`'L . � _ ��_ , � � t� ��� � � _ _ _ . r���'��` �`,.`�" , � ��' - - - � . � � � � '� � , �,�> � � �� � � � . � �'�� � `� 4' � V� 1.� 6�� KNID�A ��,p - Comments: Driller: �y}j,w�. Certification#: ��3 � �`� Grout Inspected: Jd Well Head Irispected: /O GPS Coordinates: 3 �.SQ'1.N �����1.2�fw S• Date: l (l D EHS: Date: W.P.7-08 . � � ` �P , ATION FOR PRIVATE V�LL PERMIT ; (� � � � � � avie County Environmental Health . P.O.Box 848/210 Hospital Street V 1 � 2p10, Mocksville,NC 27028 �PN (336)753=6780/Fax(336)753-1680 �!� v�R�N�'��t�'puta� ***IMPORTANT*** TH APPLICF"�TT�S NOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. w APPLICANT INFORMATION Name to be Billed � Contact Persox �-e_ Billing Address � Home Phone ��('„-�/0-?39 7 City/State/ZIP Business Phone � �'��o Name on Permit if Different than Above � Mailing Address City/State/Zip PROPERTY INFORMATION .*Date House/Facility Corners Flagged NOTE: A survey pla r si e plan must accompany this application. Included: � Site Plan ❑Plat(to scale) Owner's Name Phone Number - • Owner's Address ►M t� City/State/Zip r'Gt�'�'u�/ QNC a7 c�2d Property Address (,�.. City {�lGC.Ki-vl,l{� Lot Size jd.� Tax PIN# �71�3 DOa�,�C� Subdivision Name(if applicable) Section/Lot# - Directions To Site: "�'Q�� ��� �1� Q �j�� � �ck, (� va�. � DEVELOPMENT INFORMATION Permit Type: New Well_� Well Repair Well Abandonment Other(specify) Facility Type: Residential / Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO / Do You Intend To Install A New Septic System On This Site? YES .i NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed property lines with dimensions,the specific location of the facility and any existing or fuhue appurtenances,the location of any existing septic system,sewer lines,water lines,any existing water supplies and any surface waters. The applicant is responsible for identifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application,the applicant signifies that they understand the terms and conditions and that they give permission for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a we1L l �� �o Signed D te Site Revisit Charge ' Date(s): Client Notification Date: EHS: 7/30/09 Account# � Invoice# GoMAPS -Davie Counfy NC Public Access Page 1 of 1 . . , • Davie County, NC - GIS/Mapping System o�;Ve�F '`{ f � ✓�='� ._ � Click Here To Start Over - r„ . -� `� � �;, Quick Search:(County ID or Owner N� �,�� � Active La er. , '.; Y ❑Use �tap Tips � f�� �, � � ❑ ,PARCELS (Map Tips Available} � ; ri� ° �- -- - _ - ---- __ __.___ Addre -------- -i- - ------�-��-�,� ---- --- - ----------_ �- - � ., � - si+aor_tcr�o�� u�a _ --� � _ - _ _.. _. , QERRY Lrd r ���' r/ � �� � Ir,r �.�r �- � �1G9ft frf I ., http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=412... 1/11/2010 �'��, D . �� � •r. : � lIESIDE,N,T,�L W�Y,�.CONSTRUGTION RECORD � • � ��� I�orth Cuvlins Departrneat of F�nvironmmt and Netr,:el kesourocs-Diris'ron of Waur Queliry ���.�p n ,..�^ '�VEY.Y.CdNTRACTQR C�RTIFICATION# 23,Y1 1.YYeLL CONTRACTOR: 9. YVATER 20NE9(depth): ChriS�,, BUIIInS Top 110 eottom 112 Top eorcom Well GontrocEor(Individua�Name Top Bottom Top 8otlom Ravmond BroYyn_Weli Co. rov Bo1LDin Top eo�, Ws11 ConYador Company Name Thlcknaal P.O. Box 337' : r. c�siNc: oepen o�amece� we�9ne Mse�rtai StreetAtleres6 : Top Eonom 88 Ft.81 sdr 21 avc Daqburv , NG 27016 = rop eomo►R,._.Fc Cily o�Town 5�te Zjp Code c 336 ' 593-8239 : T°p 8°m°m Ft Area code Phone ntunber ' 8. GROUT: Dopfh Ma6erial Mefhod 2.WELI.iNFORWI7�ON: Top� Bottom 23 Fc C.�.;....�.�� pour WELL CONSTRUCTION PERMIT#t 1309 = Top Bonom Fl,_ OYH�R A550CIATED PERMIT�CdaPP�cebe) : Top Botmm Ft._ 811'�WELIIDi�NappAabh) : 9, SCREEN: Depth Dlameter SIot8�o Nlotorial 3.WELL USE(CAetKApplimble eo:): Re6ideoUal Waber 3upply❑ : Top BoEDom Ft. h1. In. DATE DRILLED 03-24-1 Q rc� Boaom �s. �,. �n. . 71ME CqMPLETED,(�;3_�.__ AAA p PM� Ton_ Botbm Ft. In. in. a.1NEu.LOC�noN: � ��•Su�oKiRAVEL YACK: cmr: courrnr_Davie °iptl' s`� �`� Top bollom Fi 213Shadv Kt�oll Lane Tov ��M FR cser�e n�,�.nn,�,��,c«�,�,,s�aw�Wor+,�a rb..�"�p caa.> ToP eoaom^._.�._ TOPOGRAPHIC/LAND SFTTING (Chetlt appropriels bmQ O�oPe oValiey DFlat pRidge oOU+er, 11.ORILLINGL�G LATITUDE 38 • • Top Bottom Formation beseri00on , 'DMS OR 3X_�0000p000t DD = / lON(3RUDE TS '_' "OMS pR 7xx�q000�00C pp : 0 /10 day �atitudeAonpitude sour�o: C�PS pfepographtc map / (loeation of well muat 6�ahown on a 11SGS lopo map aedatlached to ' �0 /80 rock Lhls Ibm�ilnot using GPSJ � � �.1NFLLowW�tt = 80 /425 qranite Andrew Davwalt � Owner Name � / straee naaress � NC / CHy or 7own Slafe Zp C.ode / c336 ' / �►rea oode P++one number ' 12. R�MARKS: 6.WELL DETAILS: a. TOTAL DEPTH:425 � b. DOES WELL REPUICE EXISTiNa YYELL? YES❑ NO pI : ���R&9V(,ERTlFY THAT 7HIS WELL WAS CONSTRUCT�D tN e. WATER LEVEL Be(ow Top of Csainp: SrJ FT, : ACCORDANCE WITH 15A NCAG 2C,WEU.CONSTRUGTION (Use'+'HADova Top of Casmp) � ����•�D TFNT/►COPY OF THIS RECORD HAS BEEN : PROVIUED TO THE WELL O�NNER. d. TOP OF CASING 16 � FT.AbOve L8n4$OrfdCe' 'Top o�casinB tamtinated aU�below fend aurtaae mey iequire 09-2410 d v9�2ttC9 in BpGprQ0r1C6 vAQf 16A NCAC 2C.011fl. : SIGNATURE OF CERTiF1ED WELL CONTRAGTOR DATE e. ne�e cew�):��ETHOD OF TEST SIOIIt . (��S J.BUIGt1S 1. Dt81NF�CT1oN:ryp.HTH Amount„�,OT : PRIN7E0 NAME OF PERSON CONSTRUCTiNG 7HE wEL� Subttllt wlthin 30 days Ot completlon to:Dlvlslon oT Wabsr Qualtql- iMbnnatlon Praosasing� Fo,,,,Gw.�s 181T Maq Servtc.Cantsr�Raleigh,NC 27689161�Phone:(919)Q07�00 Rev.2ros . , . , . ,- ' • DAVIE COUNTY ENVIRONMENTAL HEALTH � P.O.Box 848/210 Hospital Street Ivlocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT . . Account #: 990005297 Tax PIN/EH#: 5718-01-5061 Billed To: Andrew Daywalt Subdivision Info: Reference Name: Location/Address: Shady Knoll Lane-27028 Proposed Facility: Residence � Property Size: 10.250 Ac ATC Number: 4975 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type: S.T.Manufacturer,��6„�,�7 Tank Date �.Z Tank Size�Q�� Pump Tank Siz� System Installed By: �E.H.Spe ist• ate:��/1�/`O ���1 � � ' `� � � 100�P.CtG�. "�,� `J �� l� _ � � DCHD 11/06(Revised) . -w+ ^f� • • ' . . ' � • ' DAVIE COUNTY ENVIRONMENTAL HEALTH " P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005297 Tax PIN/EH#: 5718-01-5061 Billed To: Andrew Daywalt Subdivision Info: Reference Name: Location/Address: Shady Knoll Lane-27028 Proposed Facility: Residence Property Size: 10.250 Ac ATC Number: 4975 . Site Type: C�New ORepair �Expansion **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 OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms � #Bathrooms�'�#people ""'1 Basement9Basement plumbing❑ Non-Residential Specifications: FacilityType �tx'�t►.ic �`'`��'��'eople_�O#Seats Square Footage(or Dimensions of Facility) )< <-{ () Lot Size �d ' a� aCC� Type of Water Supply: ❑County/City ell OCommunity Well System Specilications: Design Wastewater Flow(GPD)��� Tank Size�GAL.Pump Tank�GAL. �� �` K 6 Trench Width�y[_ Max.Trench Depth�� Rock Depth �a Linear Ft. b Q Site Modifications/Conditions/Other: �� eta2ed in 1vJ1 {V�/1C 18d.19fi9�S� c .�teci S;�tems may-81�a� Contact the Davie County Environmental Health Section for final inspection of this system between , 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. _ .v � 1T lo�r��n , �3 .' �I �l) 1 aa �3' �� �y • 4� o / � � � $, � - O � r" ; ���d.�� �-- � q �1 rW��` � � ���`° �� Gp � �� t0o'anr�n ,_ � � � � � ' � O . � � � � � � � � �S� �Env' orunental Health Specialist Date: � rv ^V ! DC 11/06(Revised) ' ._. - -• . . ,• • ' Davie County Environmental Health . P.O.Box 848/210 Hospital Street Mocksville,NC 27028 '_;'�� (336)751-8760/Fax(336)751-8786 � IMPROVEMENT PERMIT • � Account #: 990005297 Tax PIN/EH#: 5718-01�-5061 Billed To: Andrew Daywalt Subdivision Info: Address: 1702 Davie Academy Road Location/Address: Shady Knoll Lane-27028 City: Mocksivlle Property Size: 10.250 Ac ;;. Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this`office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject'to revocation if site ans,plat or the intended use change. , Permit Type: ew ❑Repair ❑Expansion Pernut Valid for: 5 Years ❑No Expiration . Residential Specifications: #Bedrooms 3 #Bathrooms d�#People � Basement❑ Basement plumbing0 Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Desiga Flow(GPD): J l�¢� Type of Water Supply: ❑County/City C�'Well ❑Community Well � �tated in 15A NCA�C 18,i.1963(5� Site Modificarions/Permit Condirions:�r�.���� c,�t�qms m�01��psp--�g: S stem T e LTAR Inirial G , .� , � Re air � 7 Site Plan ?� � �4 a. -Q 0.c � / i� E$ £-i�� O v �` . _ rg I h"� � r � � a � � � � w-cll � C� �` �4 Q �+ \ ��tQJ � _ � ��` Q� � `�-�-- t 0 O w�t v�. � ��Q C.-] ' . Q � c S � � � `�- -� A � � � � � � '� � 4 -v Environmental ealth Specialist oi�� Date ��rv �d� i.p.I 1-06 , • � . �� ��.3�.+ . ' '� � � � 4�. � �--, �pn " �"' s� • � M �' � APPLR ON FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC �Y�^�i� Qr � �'a Dav�e Couoty Environmental Heatth � � 2�Q9 P O.Boz 848210 Hospita[Street � �uN � �` � . � M«��,rrc z�oza � ; �� � � �._., , .. : i;- N��l1 . . ... . . ';f336�751-8760/Faz(336}751-8786 . .,,. :', G�.�S Al. ���v+rO��A�pl�c �;o�{For• ' provement Permit Authorizauon To Construct(ATC) Both p'I' p icati : New System Repair to Existing System Expansion/Modification of Exisdng y m or Facility •"lMPORTANT"'THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF TE�REQUIItED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for insVuctions. APPLICANT INFORMATION Name to be Billed Contact Person��yytQ � Billing Address O ��. Home Phone 3�'L�-�34 7 City/State2IP � Business Phone _4a,�,t._ Name on Permit/ATC if D�erent than Above Mailin Address City/State2i � � PROPERTY INFORMATION *Date House/Facili Comers Fla ed G-ij.0 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�/PVL 4raa,Mci��iQlli�i2� LL�a�L/<r Phone Number Owner's Address City/State/Zip D�2�XJt'' ,L' i(/_ Property Address City H.IcGKtu//ll. �t,�L LotSize b.2Sa�_ TaxPIN# �7/$-Q/-5�(p/ Subdivision Name(if a plicable Section/Lot# .3 D'uect' ns To Site: � . 1� If e answer to any of the follo mg questions is`�es",supporting documen ' must be attached Aro there any existing wastewater systems on the site? Yes o Dces the site contain jurisdictional wedands? Yes o Me there any easements or right-of-ways on the site? Yes Is the site subject!o approval by another public agency? Yes Will wastewater other than domestic sewage be generated? Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms _� athrooms�.S Garden Tub/Whirlpool es No Basement: Yes No Basement Plumbing: es No ' � � IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Building #People 1 #Sinks #Commodes #Showers #Urinals " Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats � Type system requested: Conventional 4 Accepted Innovative Altemative Other Water Supply Type: Counry/City Water New We(I" � Existing Well Community Well Do you anticipate additions or expansions of the faciliry this system is'intended to serve? Yes No If yes,what type? ` This is to ceRify that the infocxnation 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 aze subject to suspension or revocation if the site is altered,the intended use changes,or if the infomiation submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie Counry Health Deparhnent 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 staking the house/facility location,proposed well location and the location of any other amenities. �� / Site Revisit Chazge operty owner's or owneP gal representative signature Date(s): Client Notification Date: D� EHS: Sign given Yes No ' Account# r�� Revised 1 I/06 Invoice# � �i� � . f�� � J z P�3� . . �� � ,� � o r� P .� P/ .��� � . � 33�-�r�� ?�t�y 2oZyou23 .,�_ h� v''3 659.92 �� �RON N 87•20'31• V E--- NEW t' . IRON i ! � . c'"u. 3 n �N� TRACT 3 �, �� �o�A , AREA= 1Q.250 AC. ����, � �oa . �� � s '�,�� z ,ri�' INCLUDES S.R. 1153 R/W ~+- ������� y� J----J�� �A �E—�-3 � �� t�,t,t i � ! � �P�``� � c Ei � ''—' •�-- 474.64 PUCEp N �'�0 , 338.27 HEw N 89'43'30' E _._ -�RON v! 89 04 39 Y N 88'25'49' V o IRON 20' PAVED! - ____ _ --- --� c7 ___._------ , Ct-j,.'�S7'( 4!;J�^,1_L ��, a � R/R SIKE � 5.�. i I�Z Ct�� IN RD. � PHILLIP E. FUJ.LER dr. ��,v TEO,YA . D.B. f96, PG. 2'YB 4 S �lRNTgR � � D.B. f ss, pc 8s �� n_ter Subdivir�on - Davis .,�n.F._ NertA CnrnRne �► ore�of ths f IowfnQ�oYi fedkote0 by On X27 �� o plct af a surwy tt►aR cnrata a aubdivF�ion of Q Q n oroo M o eaxrty or municipoHty thot hos on 1, Grody L Tutterow, certify that this plot woa drow rt rsQubtes porce�s at bnd; under my superv�sian from on actuai aurvey mode '� � a a a+�Y � k �b � �+ a under rtry supetvision (deed deacri tion recorded in ro++rrty or municipolity ttat ir unrsgulated aa to cn Book • Poge . etc.) �ither)�hot the ' `�°Q"�°� p°"� °i b^�� boundariea not surveyed ate cleerty indiceted as dn i" °t ° �"1°r °f °" °7�� �O''C°� °f from intormation faurtd in PI.: Book �. Page ._,_ is ot o w,rw�r ot unother cctpory. wch w the that the retio of prociaion is ealculoted aa t�ZQ, � �;n; � o ��_�,� ��,. � that this piat was prepored in eccordanca with G.S. to the�in�tio+► of o subd'msion; 47-30 as omended. MlFtness my ariginal signoturo, natton ova'bbls to th�s surveror u wch registrotion number and aeol this day of �+e to mok� o detersninotton to tM best oi mp Gty ca to p►ovisiom coatoinsd in o, throuqh d. above. A.D.. 2008 Survryor (Secl cr Stcmp) Registration Number or Registrartion Nurt►ber � � . 1 .97 � � . i � I � , S 0027h7�� �y . � . � ll0.N � - ~ ` ��1�l..1W%��i� �' � � ' N•� r TRACT > � �� . ��� AREA= 12.740 AC. m•1 . _ - MCLlNES AR.1133 R/'N c I , a we. �aw L22t7 p TUTK�tei �.. �s+rtG � �a.. wa �D.`' y ytilp . . j O� r'� � ► r r�° b � � � yp�j ' ��� q�o r� r TRACT 2 .u'S, .r. CE`i.. N �� o4oN a�c m ��� AREA= f 0.548 AC. N�o� '' �,�� ~ . bo = ��SR. 1133 R/W � �� � ~ �O �� . y� 'T�f. � � oqj . �ta . ..rj �' E�`,C . .. o► �fC, !• . t�� u� ° �d '� � as.st . ��fl _ '�� a�w M a+3�•v � � 777.]7 � (_ . �y � N B)'20'�l'V .. ��l_�Sf9.77 � �� D r � A �^ +„� PRE�i1�� tr�� TRACT 3 =� �� ��� AREAa f0.250 AC. �t��� TRlCT f » L��I�AR� : � Mauoes s.rt.nss a/w s� AREA= f0.268 AC. . k�RE �s.R. ,��R� ""'"` M Ilp. ,^ � W DOUCLS l. IILL �/ � �. D.B. IW.PG /02 1�� M tT1E) 1•� � a7..H �tt N/!'0�'77'V N M'[S17 V � 624N � ----_ __�. w erer�r v BERRY LlWE �-—p—'�M-(p � ��RK11OS3.RD. _" . . y •N RC V M � N�0� �1�'V pg7LLlp l,lflLL[R h. s�rnaa�.roornz T90L�S GRNTSR �OY/S L CARN7'sR JtRRT C.Sd/Y0/r � D.B. /DQ.PC.tlt q� D.B. I R J.P R !d D.B. J/Q.PG !D � D.B. W.PG f0l 1 O.e. /7!,p G, !d D.B.d 9,P Q 1/6 � M1 . \ . D.D. I!!.PG St6 . � , , �- � � DAVIE COUNTY HEALTH DEPARTMENT � . �, r , , • � Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION �'ROPERTY INFORMATION Account #: 990005297 Tax PIN/EH#: 5718-01-5061 � Billed To: Andrew Daywalt Subdivision Info: Reference Name: Location/Address: Shady Knoll Lane-27028 Proposed Facility: Residence Property Size: 10.250 Ac Date Evaluated: -� "d � Water Supply: On-Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH �-3 � O�' --4' Texture grou � L G Consistence f j.r S tructure k Mineralo s^ HORIZON II DEPTH — � Texture rou (,,, C(,,.. �L • Consistence ' " Structure � Mineralo r' HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo - SOIL WETNESS � � RESTRICTIVE HORIZON � / SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . • SITE CLASSIFICATION: EVALUATION BY: � ��CI�'" LONG-TERM ACCEPTANCE RATE: v 6 OTHER(S)PRESENT: � � ' ' REMARKS: LEGEND T, n�d��ane Position , R-Ridge S-Shoulder L-Linear slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope . T-Terrace FP-Fiood plain H-Head slope • � Ts�xtuTg � 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 . CONSIST ,N +, Mpic VFR-Very friable FR-Friable FI -Firm VFI-Very firm EFI-Extremely firm � � NS -Non sticky SS -Slightly sticky S-.Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic , P=�Plastic, VP-Very plastic StrLctLre � SC-Single grain \ M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv ' 1:1,2:1,Mixed 1�Iotes 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) TTAR -Tnna-iPrm arrrntanrr rata_ val/Aa��/fY7 nnrlr nc�nc ir�_____�� ■�����■■��■��������■�������■���■■■s��■�������■�����■����������■��■ ■�������������e������������������������t������������������������■ ■���s■�■�■��������■�■����■�����■ ■��■��o�■��■���■�■��o�■������■�■ ■������■�������������������■���������■������■■��������������■����■ ■�����■■�■�������■■v�����������■�■a��■�������■�������■�����������■ ■����������������e���������������o�����������������s��������t����■ ■s���■�����s■�■���■■�����■■�■�■����■■■���e�������.�■���■o��������■ ■■�����■���������■�■��������■�■��■���■��t��������■���������������■ ■����■■■����o����■�■■���������■�����■�������■■■��■���■��t���■■���■ ■�����������������������������������o������������������e��������■ ■����■������������■�■���������■■ 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