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120 Wyatt Dr OPERATION PERMIT F*CDP ice use v Davie County Health Department Number 193250-1210 Hospital Street18-030-AO-os8P.O. Box 848 umber. Mocksville NC 27028 Evaluated For NEW Phone:336-753-6780 Fax:336-753-1680Township: FAdd ant: Rs Parker/Joy Springer Property Owner. Rs Parker/Joy Springer ss: 502 Hickory Ridge Dr Address: 502 Hickory Ridge Dr City: Greensboro City: Greensboro StatefLip: NC 27409 State/Zip: NC 27409 Phone#: (336)978-7120 phone#: (336)978-7120 Property Location & Site Information -Address/Road#: Subdivision: Essex Farms Phase: Lot: 58 120 Wyatt Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy,64 East left Comatzer Rd. Left Essex Farm #of Bedrooms: 4 #of People: "Water Supply: PUBLIC *IP Issued by. 2140-Matrons,Robert *System Classification/Description: *CA issued by: 2140.Nations,Robert Saprolite System? ( Yes QNo Design Flow: 4 8 0 * PUMP TO GRAVITY Pump Required? Distribution Type: / Yes ONo Soil Application Rate: 0 - .1 5 *Pre Treatment: Drain field (Nitnification Field 1 9 2 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDAI20 o. Drain Lines 6 Installer: Frank Transou Total Trench Length: 4 8 0 ft- Certification#: 2771 Trench Spacing: 9 Inches O.C. ()Inches O.C. *EH S: 2140-Nation.Robert Trench Width: _ 3 Inches Feet Date: 1 1 / 1 7 / 2 0 1 5 Aggregate Depth: inches Minimum Trench Depth: 3 6 _ Inches Minimum Soil Cover. a 4 Approval Status Inches Maximum Trench Depth: 3 6 ® ;Approved 0 Disapproved Inches Maximum Soil Cover: 2 4 Inches CDP File Number 193250 - 1 Septic Tank County ID Number: fM30-AO-058 Manufacturer. Shoaf Let. STB: 760 Long: Gallons: 1000 Installer Frank Transou Certification#: 2771 Date: 0 7 / a 7 / a 0 1 5 *EHS: 2140-Nations.Robert *Fitter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker El Yes ® No Date: 1 1 / 1 7 / 2 0 1 5 Reinforced Tank: ❑ Yes R No . App>1talStatus 1 Piece Tank: ❑ Yes O No -Approved❑ Disapproved Pump Tank Manufacturer. Shoaf Installer Frank Transou PT: 42 Certification#: 2771 -Gallons:` 1250 *EHS: 2140-Nations,Robert _ Date: -0 8 / 0 4 / x 0 1 5 Date: 1 1 / 1 7 / a 0 1 5 RiserSealed Q Yes ❑ No RiserHeght: O Yes 13 No (Min.6 in.) Approval Status Reinforced Tank: ❑ Yes ® NO l Approvetl❑ Disapproves! 1 Piece Tank: ® Yes ❑ No Supply Line Pipe Size: a inch diameter Installer; Frank Transou Pipe Length: 1 6 5 feet Certification#. 2771 *EHS. *Schedule: 402140-Nations,Robert Pressure Rated 0 Yes ❑. No Date: 1 1 / 1 7 / a 0 1 5 Approved fittings [j) Yes E3No Approval Status Ain .A ❑ Approvetl❑ Disapproved PLimp e Pump Type: Zoeter Installer. Frank Transou Dosing Volume: - Gat Certification 9: 2771 Draw Down: Inches *EHS: *Chain: STAINLESS Date: 1 1 / 1 7 / a 0 1 5 Valves Accessible [] Yes ❑ No Flow Adjustment Valve ® Yes ❑ No Check-valve ® Yes ❑ N oA -oval Status pp PVC unions L7 Yes ❑ No CI 'A d- C1 Disapproved Vent Hole p Yes ❑ No Anti-siphon Hole R1 Yes 0 No CDP File Number 193250 - 1 County ID Number: f"30-Ao-058 Electric Equipment CNEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer. Box 12 inches Above Grade ❑ Yes ❑ NO Certification#: Box Adj.To Pump Tank ❑ yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No =Activation Method: Date: Approval Status Alarm Audible _E1 Yes ElNo ;p :Approved❑ Disapproved Alarm Visible Yes ❑ No 2140-Nations,Robert 'Operation Permit completed by: Authorized State Agent:. /I --- —'� Date of Issue: 1 1 / 1 7 / a 0 1 5 Owner/Applicant Signature: This system has.been installed incompliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for - Sewage Treatment and Disposal,15A NCAC 18A .1900 of. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a sewage septic system. Rule.1961 requires that a Type septic system meet the following criteria: Minimum System Review ByThe Local Health Department: Management Entity: Minimum System Inspection/Maintenance Frequency By Certified Operator. Reporting Frequency By Certified Operator. 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 entitywtth a certified operatoror a private certified operator forthe life of the septic system. Rule.1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as tong as the system is in use,and other requirements for the continued proper performance of the system. It shalt also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. ®Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** t OPERATION PERMIT 193250 - 1 Davie County Health Department CDP File Number: 210 Hospital Street f8-030-AO-058 P.O.Box Bas County File Number: Mocksville NC 27028 Date: L..-A-.-JI Olnch Scale: . OBbCk Drawing Drawing Type: Operation Permit ONSA ay 11 I I I IG l '-` i I -3 I ' 1 � � r l I I ! CONSTRUCTION For office Use Only AUTHORIZATION *CDP File Number 193250-1 Davie County Health Departmes�,�� County ID Number:f8-030-Ao-058 21.0 Hospital Street �y'" �� Evaluated For. NEW P.O. Box 848 . Township: Mocksville C 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 4 / 2 1 / a 0 a 0 Applicant: Rs Parker/Joy Springer Property Owner: Rs Parker/Joy Springer Address: 502 Hickory Ridge Dr Address: 502 Hickory Ridge Dr City: Greensboro City: Greensboro State/Zip: NC 27409 State/Zip: NC 27409 Phone#: (336)978-7120 Phone#: (336)978-7120 Property Location & Site Information Address/Road M Subdivision: Essex Farms Phase: Lot: 58 120 Wyatt Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 East left Comatzer Rd. Left Essex Farm #of Bedrooms: 4 #of People: "Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign ssification: Provisionally Suitable Inches System? Minimum Soil Cover. y OYes QNo 1 a Inches low: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - a 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 6 0 0 Gallons *Proposed System 25%REDUCTION 1-Piece: 0Yes ®No Pump Required: ®Yes ONo OMay Be Required' Nitrification Field 1 9 2 0 Sq.ft. Pump Tank: 1 0 0 0 Gallons No.Drain Lines 5 1-Piece:OYes ®No Total Trench Length: 4 8 0 ft GPM vs— ft. TDH Trench Spacing: @Feet Inches O.C.9 O.C. Dosing Volume: Gallons _ Trench Width: Inches 3 . 2Feet Grease Trap: Gallons Aggregate Depth: p inches Pre-Treatment: ONSF OTS-1 OTS-11 SepticTank Installer Grade Level Required:''01 OII O 111 L Dana i nt Z f8-030-AO-058 CDP File Number 193250,- 1 County ID Number.• ❑ Open Pump System Sheet ,Repair System Required:OYeS ONo ONo,.but has Available Space epair System Trench Spacing: Inches 0. . *Site Classification: Provisionally Suitable 9Feet O.C. Trench Width: Q Inches Design Flow: 4 13 0 �� — , 3 * Feet Soil Application Rate: 0 - 2 5 Aggregate Depth: ` inches Minimum Trench Depth: 2 4 =System Classification/Description: Inches TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480,GPD OR LESS) Minimum Soil Cover. 1 2 inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 1 9 a Sq. Inches ft. No. Drain Lines 5 "Distribution Type: PUMP TO GRAVITY TotalTrench length: � 8 � �. Pump Required: (QYes �No OMay Be Required Pre Treatment: ONSF OTS-I OTS-II .Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. "Permit Conditions The Issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ell This Authorization forwastewarter system constwdon shall bevalld for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued atthe sametime the improvement Permit Issued(NCOS 130A-338(b)).if the Installation has not been completed during the period of validity of the Construction Permit,the information submitted in the application for a permit or Construction Authorization is found to have been incorrect,falsified or changed,or the site Is altered,the permit or construction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible forassuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance;monitoring,reporting and repair (1836(b)). Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps.Signature: Date:, W 'Issued By: 2140-Nations,Robert Date of Issue: . 0 4 / a 1 / a 0 1 5 Authorized StatJ - --�---- Malfunction Log OYeS @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION • Davie County Health Department CDP File Number: 210 Hospital Street f8-030-AO-058 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 4 / a 1 / a 0 1 5 Q Inch Drawing Drawing Type: Construction Authorization Scale: , ON lock `a- T L _ R �� f �� Gac � � � � ~� � 5- Z`,�' �, �� ( c.r` �'>. r �12 y Q� -� �� 7- �� a l�� _ � �� ForOce Use ni IMPROVEMENT PERMIT *CDPFileNumberf 1932 0o1v r � Davie County Health Department 210 Hospital Street County ID Number.f8-030-A0-058 P.O. Box 848 Evaluated For NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 4/21/2020 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Rs Parker/Joy Springer Property Owner: Rs Parker/Joy Springer Address: 502 Hickory Ridge Dr Address: 502 Hickory Ridge Dr City= Greensboro City: Greensboro StatefZip: NC 27409 State/Zip: NC 27409 Phone#: (336)978-7120Phone#: (336)978-7120 Property Location & Site Information r ddress/Road#: Subdivision: Essex Farms Phase: Lot: 58 120 Wyatt Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 East left Cornatzer Rd. Left Essex Farm #of Bedrooms: 4 #of People: *Water Supply: PUBLIC S stem Specifications nitiai Sstem ,Site Classt x:a ion: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? QYes @No Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 . a 5 1-Piece: QYes QNo Pump Required: QYes QNo QMay,Be Required *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: 1 0 0 0 Gallons LESS)` *Proposed System: 25%REDUCTION 1-Piece: Q Yes ®N o Repair System Required:OYes ONo ONO, but has Available Space rsofti�le� epair System Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches pplication Rate: - a 5 Maximum Trench Depth: 3 6 Inches "System Classification/Description: Pump Required: *Yes Q,No Q May be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) "Proposed System: 25%REDUCTION Pagel of 3 1 9325 f8-030-AO-058 CDP File Number County ID Number:' *Site Modifications ❑ open Fill sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be%alid for b years from dateof Issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions,the location of thefaciilty and appurtenances,the site forthe proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be vatld without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale of one inch equals no morethan 60 feet,that Includes:the specific location of the proposed facility O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,forsubdivislon lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisly the conations,the rules,or this article.This permit Is subject to revocation If the site plan,plat,or Intended use changes(NCGS 130A-335(1)).The person owning orcontrolling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,'installation,operation,maintenance,monitoring, reporting.and repair(.1838(b)). Applicant/Legal Reps.Signature Required? Oyes; ONO Applicant/Legal Reps.Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 4 2 1 2 0 1 5 Authorized State Agent; � —�` ---�"E' OValid withot Expiration? "reate CA? @Hand Drawing Olmport Drawing4; **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 193250 - 1 Davie County Health Department CDP File Number: 210 Hospital Street f8-030-AO-058 P.O.Box 848 County File Number: Mocksville NC 27028 Date: / f Q Inch Drawing Drawing Type: Improvement Permit Scale: . Qslock 1 oN/a . lit Q - �Or ilk a,P APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 - (336)753-6780/Fax(336)753-1680 Application For:,Site Evaluation/[mprovement Permit >Authorization To Construct(ATC) ❑Both Type of Application: XNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***LLIPORTAIVT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Q S NomContact Person J 0 Sp r i Y Billing Address D r Home Phone 33 • 7 CLQ o City/State/ZIP WC Business Phone 'Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facili Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: Site Plan ❑Plat(to scale) (Permit is lid fo 60 months with site plan,no expiration with complete plat.) Owner's Name 5 fries Phone Number an, C/ Owner's Address L City/St to/Zip OI'D L*r— Property Address 1U City 0.Y► Lot Size Tax PIN# C) 3 0 Subdivision Name(i a plicable) Sectio"ot# Directions To Site: 1 5 > t t1CLt } r If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes o Does the site contain jurisdictional wetlands? ❑Yes Are there any easements or right-of-ways on the site? ❑Yes Is the site subject to approval by another public agency? ❑Yes Will wastewater other than domestic sewage be generated? ❑Yes I. IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Batbrooms Garden Tub/Whirlpool es ❑No Basement: Yes o Basement Plum ing. ❑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: t�onventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type:xcounty/City Water ❑New Well ❑Existing Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes 1�No If yes,what type? // This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and 1 ingan agging ornkithe house/facility location,proposed well location and the location of any other amcnitics. 10—nP et own 's or owner)legAI representative signature Site Revisit Charge Client Notification Date: Date EHS: 3 a.3—U Sign given ❑Yes❑No Account# Revised 11/06 Invoice# R—A SETBACKS: FRONT: 45' SIDE: 15' SIDE: 25'(STREET) REAR: 30' . 1 S 82.28'00" E _ SETBACK F I I 57 I 59 t 58 I I I I I C4 I to w o I I I PROPOSED RESIDENCE ig - I 1' 50.00' 30 SETBACK 10' UTILITY EASEMENT 109.61' PRELIMINARY N 82.28''000" W PLOT PLAN FOR. WYATT DRIVE RSP BUILDERS LOT OF 50' R/W (PUBLIC) P.B. 9 PG. 388 ESSEX FARMS, PHASE 1-B GRAPHIC SCALE 40 0 20 4° I Fuming 6101mum*19, Inc. 8518 Triad Drive Colfax,NC 27235 ( IN FEET ) Phone:336.852.9797.Fax: 336.852.9766 1 inch = 40 ft. NCBELS C-0950 DATE 03-05-2015 REF: PROJ\1831-01\dwg\ESSEXFARM.dwg r P�G 2 APPLA ION OR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Application For: Q'Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) ❑Both Type of Application: ONew 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 *73� Z//- Name to be Billed ASC /)c'VBGoprr rAT�'�at, ,ezc-- ' Contact Person 7-'iegy 847L ax e4+d do 9; �T Billing Address A.*•dax 3f0 __ Home Phone ; c City/State/ZIP_&Aocrsuicc�r rrG 2702 8 Business Phone 7S'/-"7300 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip. _ PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included:0 Site Plan lat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name .Or'VBcoPr/Fi�+i cif irtG Phone Number 75/-73� Owner's Address 40 d0K h6a City/State/Zip^ 7cZ9 Property Address City Lot Size 01 Tax PIN# -ZZ.& Subdivision Name(if ap licable) 49 = Sectio ot# J�1S Directions To Sjj�: S 2 I Z&111 041 h S �1 Ci oin f the answer to any of the following uestions is"yes",supporting documentatiogg must be att ched. Are there any existing wastewater systems on the site? Dyes ON Does the site contain jurisdictional wetlands? Dyes❑No Are there any easements or right-of-ways on the site? UKes❑No Is the site subject to approval by another public agency? Dyes cr� Will wastewater other than domestic sewage be generated? Oyes C�YNo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms X16 #Bathrooms Garden Tub/Whirlpool Dyes ❑No Basement: Dyes ❑No Basement Plumbing: Dyes ❑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: IlConventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type:C3'County/City Water ❑New Well ❑Existing Well 0 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 Yes ❑No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating an ging or staking the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Prope rt--or legal represents re Date(s): Client Notification Date: Date EHS: Sign given Dyes ONO Account# Revised 11/06 Invoice# DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004425 Tax PIN/EH#: 587D=64=226STJ%I Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot#55 Reference Name: Brad Coe Location/Address: Cornatzer Rd-27006 Proposed Facility: Residence Property Size: 0.689 Acre Date Evaluated: `�� 1 -7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ,` Cut FACTORS ( l $3 4 5 6 7 Landsca a position L L Slope% Z HORIZON I DEPTH — 14 Texture group C C Consistence P �r Pr Structure $E Mineralogy HORIZON II DEPTH Texture roup ' Consistence ��✓ � Structure t Mineralogy HORIZON III DEPTH 0 Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture roup Consistence 1 Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE r CLASSIFICATION u, LONG-TERM ACCEPTANCE RATE n � 1 SITE CLASSIFICATION: k`'ab(-P EVALUATION BY: K. JpV a—'t1 5 LONG-TERM ACCEPTANCE RATE: • a 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 �.t 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-gaI/day/ft2 DCHD 05/05 (Revised) / 1 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Account #: 990004425 IMPROVEMENT PERMkTpIN/EH #: 5870-64-2265.5 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot#5$ Address: PO Box 340 Location/Address: Cornatzer Rd-27006 City: Mocksville Property Size: 0.689 acre Reference Name: Brad Coe 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 plans,plat or the intended use change. Permit Type: kTew ❑Repair. ❑Expansion Permit Valid for: 5KYears ❑No Expiration Residential Specifications: #Bedrooms -f #Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): q 190 Type of Water Supply: ❑County/City R<Vell ❑Community Well As stated in 15A NCAC 18A.1969(5� Site Modifications/Permit Conditions.: GCCepted Systems may also he usr System Type LTAR Initial Q c e- co Repair OL c c,4 -1 O. site Plan x-73.1 Zc. 0. � Z-7 3. WL e Environmental Health Specialist Dat