322 Baltimore Trails Lane Lot 4DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Account #:
990003964
Billed To:
Jennifer Crain
Reference Name:
Nancy Stonehouse
Proposed Facility:
Residence Property Size:
Water Supply:
Evaluation By:
On -Site Well
Auger Boring
Community
Pit
PROPERTY INFORMATION
Tax PIN/EH #: 5860-74-3492.04
Subdivision Info: Baltimore Trails Lot # 4
Location/Address: Baltimore Road -27006
14.76 acres Date Evaluated:
Public
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON 11 DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
KINNEXITI.Q10
LEGEND
EVALUATION BY:
OTHER(S) PRESENT:
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
Moist
VFR - Very friable FR - Friable FI - Firm VR - Very firm EFI - Extremely firm
3y- 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
Mineralogy
1:1, 2:1, Mixed
N9�gS
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 DCHD 05105 (Revised)
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
May 19, 2006
Jennifer Crain
1744 Curraghmore Road
Clemmons, NC 27012
Re: Baltimore Trails Subdivision / Lot #
14.76 Acre Tract/ Baltimore Road
Tax PIN# 5860743492
Dear Client(s):
As requested, a representative from this office visited the above site November 11, 2005
and May 17, 2006 to perform site evaluations. 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.
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 or the intended use change.
Improvement Permit
System To Serve: `, I�Z-- Rbco , L&�CF— Wastewater Design Flow: 6'Plb
System Type: conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
System Location: (75�13 F1 ELT-) Ab KP�u Valid: Years ❑No Expiration
Site Modifications/Permit Conditions:
ps-Lp.letter 2/06
ICRES
64/28
14:38 REMAX -► 7518766
Rpr el
s 01:48p davfa county envhea1th 3
APPLICATION FOR SITE EVALUATION/IM!'ROVE
Davie County Health Dupartini
Environmental Health Sediol
P.O. Bolt 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax(336)751-8786
/
Application For.(dSiteEvaluationtln,pmvementPmnit n Authodi otion To Co
NO. 231 P03
6 751 8786 p-2
PERMIT & ATC
TC) l) Both
I"•1MP01tTAN7`•' THIS APPLIC ATION CANNOT BE PROCESSED UNLESS F TI IE REQUIRED I
INFORMATION IS PROVIDED. F:cfcz to the INFORMATION BULLF 11N for in tioru_
Name to be Billed • Vlr C,mtaet P on Y1a
Billing Address •lame Phofte
city/State/up— �A.isiness P e e
Name on Pennit/ATC if Different than
Mailine Address
NOTE: A survey plat or site
(Permit is vplid r y�
Street Address__ _—t i
Subdivision Name
Ditections To Site: , Q
most accompany ibis application.
Id's with site elm no exniratiun with
Tax
gate nouscrracrtay s.vmcrs rwk r%wv
Ifd= atmwcr to nay oftbe following questions is yes", supporting docum:ntatiot be attached.
Are there any existing waitrwater systems on the site? t1 Yes I 0
Does the site contain juriidictiotul wetlands? U Ycs t3No'
Are there any easements nr right-of-ways on the site? 115,11ts O�NfS
Is the site subject to appruvA by another public agency? G Yes go
'Will wastewater other than ioinestic sewatte be ttenerated? OYes 1114611
IF RF,SID CE FILL OUT ME BOX B LOW
#People # Re irooma # Bathrooms
BasementesItasetnetttPltlmbing: is ONu
IF NON -RESIDENCE FIU. OUT THE BOX BELOW _
Type of Facility/Business _ Total Square Footage of I uilding_ _. # People
# Sinks # Com—md-:s # Showers _ # Urinal.,
Estimated Water Usage (gallons per day) ,(Attach dacumentat on of sintilar facility water consumption)
FOODSERVICE ONLY:
#Stas
Type system regttested: tidC�onvetttional CIAocepted 131nnovative OAlternative Other___
Water Supply Type: O County/City Water P<. Well G" Existing W1 11 1 Community Weil
en Tub/Whirlpool Oes ri
Do you anticipate additions or expansions of the facility this systemis ittnnded to se e? O Yes V-40
If yes• what type? _
This is to certify that the informacirm provided on this application is true and come
any pemait(s) or ATC(s) issued her-*fter are subject to suspension or tet ovation it
the information subatitted in this 4pplication is falsified or changed. 1 ur dersmnd
from this application. 1 hereby grant right of entry to the Authorized Rerresentah
conduct necessary inspections�d,:temtine co lime rh spPlie 1e laws and r
Davie County and owned by
' �J .J Aa�M-;
usm
.
Date
Sign given OYes ONo
Rcviscd V06
i the best of my knowledge. I understand that
site is a [tend, the intended use ehan n . or if
I am retpaivible jot• all charges incurred
f the Davie County Health Deparnnent to
on the above described property located in
Site Revisit Charge
Client Notification Date.
EHS:
Account d
Invoice k
J
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760 /Fax: (336)751-8786
May 19, 2006
Jennifer Crain
1744 Curraghmore Road
Clemmons, NC 27028
Re: Site Evaluation -
Baltimore Trails/Tract # 4
Tax PIN#: 5860743492
Dear Client(s):
As requested, a representative from this office revisited the above site May 17,
2006 to consider the tract for a four-bedroom residence. Based on the information
provided on the Application for Site Evaluation/Improvement Permit and after the
evaluation was completed, the site was found to be provisionally suitable for the
installation of an on-site sewage disposal system.
House location, size and other design criteria may necessitate the use of a pump
station and/or an alternative or innovative system. System design will be determined at
the time an Authorization to Construct is applied for and issued.
Before a representative of this office will revisit the site to issue an Authorization
to Construct, the appropriate application must be completed and submitted to this office.
The location of the facility the system is to serve must be staked off.
Enc(s)
If you have any questions, feel free to contact this office at 751-8760.
Sincerely,
Jeff G. Beauchamp;R_S"' "
Environmental Health Section
lA