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3537 US Hwy 601 South Lot 40av ?016 9h�/�, �ooeaa WARNING: THIS IS NOT A SURVEY All data Is provided as is Wmoutvnmmy, or guarantee of any Mnd eMher expressed or Implied including but not limited to the Davie County's GlS website shall hold harmless the Implied wmparticular of merchantability or ness W a pacular use. All users of Delvwe County a Davie, North Carolina, llsagents, eommitanK contractors or employees from any and all Claims or causes & action due to or arising out of the use or Inability to use the GIS data provided by this website __ParcelInformatton___ _„_ __ Parcel Number: N60000004111 Township: Jerusalem NCPIN Number. 5755109981 Municipality: 'AccountNumber. 8305883 Census Tract: 37059.807 Listed Owner 1: PRUITT DANIEL LEO Voting Precinct: JERUSALEM Mailing Address 1: 3537 S US HWY 601 Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District: No Legal Description: LOT 4 CARMEN VALLEY Fire Response District: JERUSALEM Assessed Acreage: 1.03 Elementary School Zone: COOLEEMEE Deed Date: 12/2015 Middle School Zone: SOUTH DAVIE Deed Book / Page: 010080449 Soil Types: PcB2,PcC2 Plat Book: 0006 Flood Zone: Plat Page: 098 Watershed Overlay: DAME COUNTY Building Value: 94450.00 Outbuilding 8r Extra Freatures Value: 0.00 Land Value: 21000.00 Total Market Value: 115450.00 Total Assessed Value: 115450.00 9h�/�, �ooeaa Davie County,] I . 1�� NC All data Is provided as is Wmoutvnmmy, or guarantee of any Mnd eMher expressed or Implied including but not limited to the Davie County's GlS website shall hold harmless the Implied wmparticular of merchantability or ness W a pacular use. All users of Delvwe County a Davie, North Carolina, llsagents, eommitanK contractors or employees from any and all Claims or causes & action due to or arising out of the use or Inability to use the GIS data provided by this website OPERATION PERMIT or ice se Univ '. Davie County Health Department 'CDP File Number, .1,94660-1 I * 210 Hospital, Street 5755tosssl P.O. Box 848 `county lD NUmber; Mocksville, NC, :27028 Evaluated,Fo_ r NEW (' Phone: 336-753-6780 Fax: 336-753-1680 ll,, Township: Applicant:. Daniel Pruitt/Conni eKowalske Address: 136 Miss Ruby Lane CRY: Mocksville State/Zip: NC 27028 Phone #: (336) 940-7157 Address/Road M 3537 US Hwy 601 South Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC Propertyowl Daniel Pruitt/Conni eKowalske Address: 136 Miss Ruby Lane CRY: Mocksville State/Zip: NC 27028 Phone #: (336) 940-7157 Subdivision: Carmen Valley Phase: Lot: 4 *IP Issued by. *CA issued by: 2140-Narwns,Robert Design Flow: 3 6 0 Soil Application Rate: 0 a 7 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Directions Hwy 601 South past Boxwood Church Rd on Left 1 3 0 9 Sq. ft. *System Classification/Description: SeproliteSystem? OYes ®No `Distribution Type: GRAVITY- PARALLEL (eq. d -box) Pump Required? QYes @No *Pre Treatment: 3 3 4 4 ft• 9 QInches O.C. ©Feet O.C. 3 Inches 2Feet inches *System Type: INFILTRATOR QUICK STANDARD Installer. Steven Bryant Certification #: 1433 *EH S: 2140 - Nations, Robert Date: 1 0/ 1 3/ 2 0 1 5 Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 2,4 Inches Maximum Trench Depth`.` 3 6 ;Q A r pp• Inches Maximum Soil Cover: 2 4 Inches proVed CDP File Number 194660-1 County ID Number: 5755109981 Dosing Volume: Septic Tank Draw Down: Manufacturer. Shoat *EHS: Let. STB: 760 Date: Valves Accessible Long: 0 No 1000 w Adjustment Valve [I Yes Installer Steven Bryant Gallons: Check -valve El Yes 11 No Date: 0 7 3. 3 / 2 0 1 5 Certification it: 1433 111 Approved ❑ DisiO ...... Vent Hold [I Yes — *EH S: 2140 - Nations. Robert *Filter Brand: POLYLOK Dual PL -122 With Pipe Adapter No Date: 1 0/ 1 3 2 0 1 5 ST Marker. El Yes IN No Reinforced Tank* El Yes 1E No "A- I'St t pprove- .8 us ®Approved ❑, Disapproved 1 Piece Tank: 0 Yes 91 No Pump Tank Manufacturer. Installer. PT: Certification 9: Gallons: *EH S: Date: Date: RiserSealed E] Yes El No RiserHeight: n Yes El No (Min. 6 in.) Approval Status". Feinforced Tank: [I Yes 0 No El Appirov6d 0, DISEIDDroved 1 Piece Tank: El Yes 0 No Supply Line Pipe Size: Inch diameter Installer: Pipe Length: feet Certification #: *EH S: *Schedule: Pressure Rated [I Yes 0 No Date: Approved fittings [I Yes 0 No ---------- Approval Status "D ApprovetlD Disapproved Pump, Type: Installer. Dosing Volume: Gal Certification #: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible El Yes 0 No w Adjustment Valve [I Yes 11 No Check -valve El Yes 11 No Apprtiirai Status ,,,< PVC Unions [I Yes 0 No 111 Approved ❑ DisiO ...... Vent Hold [I Yes 0 No 7� Anti -siphon Hole El Yes r-1 No COP File Number 19.4660-1 NEMA 4X Box or Equivalent ❑ Yes ❑ No Box 12 inches Above Grade ❑ Yes ❑ No Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No Pump Manually Operable ❑ Yes ❑ No *Activation Method: Alarrn'Audible ❑ Yes ❑ No Alarm Visible ❑ Yes ❑ No 2140 - Nations, Robert *Operation Permit completed by: Authorized Owner/Applicant Signature:. County ID Number: 5755109981 Installer: Certification #: *EH S: Date: � � Appro}ral8tatus: ❑ Approved{❑ Dtsappro5ed Date of Issue: 1 0/ 1 3/ 2 0 1 5 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A c1900et. Seq.,. and all conditions of the; Improvement, Permit and Construction Authorization, This property 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 1V and V septic systems designed fore home/busi gess owner must maintain a valid contract With: a public management;entity wkh a certified operatoror a piwate 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. *Hand Drawing Olmport Drawing s. **Site Plan/Drawing attached.** "''' iKy prior to the t'entiiy; unless the interrance.and for as long es the be a condilion of OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawintr Drawing Type: Operation Permit CDP File Number: 194660 -1 County File Number: 5755109991 Date: W W O Inch Scale:. . .OBlock O N!A OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: County File Number: 5755109981 Date: ,_ / W /i. . Click below to Import an Image from an extemai location: Drawing Type:Operation Permit Drain Field: System Final Inspection Log: Septic Tank: Pump Tank: Supply Line: Pump Requirements: Electrical Equipment: CONSTRUCTION EMAILED AUTHORIZATION a Davie County Health Departmepiice: 210 Hospital Street 1r P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Daniel Pruitt/Conni eKowalske Address: 136 Miss Ruby Lane City: Mocksville State2ip: NC Phone #: (336) 940-7157 Pro Address/Road #: 3537 US Hwy 601 South Mocksville NC 27028 Structure: # of Bedrooms: # of People: 'Water Supply: SINGLE FAMILY 3 PUBLIC 27028 ^!�ForOffioe Use Only '' 'CDP File:Number '194660-1 Evaluated For:: ::,!NEW N575510968"1 County m .Township: / 0 7/ 0 9/ 2 0 2 0 Property Owner: Daniel Pruitt/Conni eKowalske Address: 136 Miss Ruby Lane City: Mocksville State2ip: NC 27028 Phone #: (336) 940-7157 Subdivision: Carmen Valley Phase: Lot: 4 Directions Hwy 601 South past Boxwood Church Rd on Left Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inches SaproliteSystem? OYes ®No Minimum Soil Cover 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a 7 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: 'Distribution Type: GRAVITY - PARALLEL (eq.d-box) TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank• `Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: 1 3 0 9 Sq. ft. 3 1 0 0 0 Gallons 1 -Piece: OYes ®No Pump Required: OYes ®No OMay Be Required Pump Tank: Gallons 1 -Piece., OYes ONo 3 a 7 ft, GPM—vs— ft. TDH 9. gInches O.C. FeetO.C. Dosing Volume: _ Gallons 3 _ 2Inches s Feet Grease Trap: Gallons inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade. Level Required:. 01 Oil 0111 OIV CDP File Number 194660 - 1 County ID Number575755109W ❑ Open Pump System Sheet ONO - ONO, but has Available Space racvan. aaraac,n Trench Spacing: OInches 0.1 *Site. Classification: Provisionally Suitable — 9 a FeetO.C. Trench Width: O inches Design Flow: 3 6 0 - 3 + Feet No. Drain Lines Total Trench Length: 3 Depth: 3 Soil Application Rate:Aggregate 0 2 3 5 7 ft. inches `J Minimum Trench Depth: 2 4 *System Classification/Description: Inches TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR480.GPDORLESS) Minimum Soil Cover; 1 3 Inches Maximum Trench Depth: 3 6 *Proposed System: 25% REDUCTION Inches Maximum Soil Cover: 2 4 Nitrification Field 1 3 0 9 Inches Sq. ft. No. Drain Lines Total Trench Length: 3 3 2 7 ft. *DistributionType: ,GRAVITY -PARALLEL (eq.d-box) Pump Required: OYes ®No OMay Be Required Pre Treatment: ONSF OTS -1 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 ofother permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall bevalld for a person equal to the period of validity ofthe Improvement Penult, not to exceed five years, and maybe issued at the same time the Improvement Permit Issued (NCGS 1311A -2136(b)} if the Installation has not been completed during the period of validity of the construction Permit, the Information submitted In the application fora permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the sitars altered, the permit or Construction Authorization shall become Invalid, and maybe suspended or revoked (.1937(8)). 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 - (1939(b)). Applicent/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps. Signature? Date: _ / / *Issued By: 2140 -Nations, Robe Date of Issue:. 0 7/ 0 9/ 2 0 1 5 Authorized State Agent Malfunction Log Oyes <i OO Hand Drawing OlmportDrawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department " 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type:, Construction Authorization CDP File Number: 194660 -1 County File Number: 5755109981 Date: 0 7/ 0 9/ 2 0 1'5 W W ` Qlnch Scale: plelock QN/A CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 194660-1 P.O. Box 848 ! ={ 3-3 5755109981 I`Oo M°,�vil NC 27028 County File Number: 0 1 / Date: 0 7/ 0 9/ 2 0 1 5 Click below to Imbort an Image from an extemal location: Drawing Type: Construction Authorization APPLICATION FOR SITE EVAMATION/INIPROVEMENT PERMIT & ATC 3�1 . l IM - Davie Co" Environmental Health 'P.O:Boramlo Hospital Street . / Mocksv le, NC 27028. (336)7534M/Fax (336) 753-1680 Applicsticarm'Jsit. EvahmCoollmpmv®mtFcmit ❑ AuOwrizabon To CWsUuc(ATL) 13 Both - TypeofAppli..Mon:,P&eWSystM pgrya.WERsbgSystem nEgwlsiodMaddafimofBidctmg SysmmwFwflity /u'rLll l LNtUKMAIIUN ,, Name to be Billed �PeU mL �(Q,�,\� 'Contact Person cnWk5'lf'z`,' Ct0VSk li li ig Address 131„ JV\t>g V 1g C RW M 'Homophone City/Stdw71P. V�t1;k5ntllL(5-j'��BusmcssPhone 1� PROPERTY INFORMATION - *Date House/FacflitvComm Flasmed NOTE Asurvey platersite pissmustacampeny thisappliatim Induded;OSitePlar DF184ttsale) (Permit is valid 6o�60 uronths with 'Iepluno.rp an with completeplat) /. Owmet's Name .\ r�iOQ.Y�O�I�CCT�\��• 'PhoneNumber`C.2_$-1��1•%i(�rS Owtax's Address;lD ( - City/SlateJLip ' h ��_ Prol�3'Ad,(hm 3ti2"7 . S l S —City iT C - �ME ) Lot Size- iit�(1 RC1Q—R_Tax PIN#��t'j- SubdivinonName(ifapplicable) CA12fiEN -i1 ,Y Stxtiorrll.otlF "L Mecuons To Sher i n191'L t�T RST -Yank �nni^ IQ(s �]j I)W (_t 11 \A1)1x)yv Ohl C Lfq-A1 tit a me answer to coy ofthe following questions is -yes ; supporting documentation mast be atmched. .Am them any existing waahwata systems; on the site? OYesoo - .Doesthesiteeontemjurisdictimgvmtbmds7 pyeq"0 Are the, any asameatsor tighEofwaysonthe site? DYes,2K0 )sthe site suhjed to approval by another public ageny7 OYajlo .....Will wasewateroPox then domestic E= be enemeV ErywjAo IF NON RESIDENCE FILL OUT THE 1303(BELOW Type ofFacOhymm aass -Total Square Footage ofBmldioa - #people #Sivics Commodes #Showers #Urinals [FOODSERVICE xhdoarmentatimofsi®pONLY:: # Scats - - TYpcsystemmpcsted. 'on.l OAccepted Dlanovative 13Altcrrmtive '130d nr - Water Supply TypexCmmty/LSIyWater t7 NewWall'.(3FaoslrogWe0 DCommunityWell Doyon anticipate additions or mqp Ions pfthefaadity thissystamis pntended t>sawda Ya , IRW. Ifyes,whet type? This 0 to arfify that the Morne0on provided on this application Mite and comet to the bestofa y knowledge. I aMeislaM that airyry pamit(s)or ATC(s) issued hemafterma subject to suspension or revocation, if" site is slteral, the i mxded use chaoga, or iftbe roti'oMeton submitted in this application is felsiW or changed. I haebygant rightofmtfyb the Authorized Representative OftheDarie County Health Deparmterttto cosh ctn cessav with nmumhlw' CUM COmtNdi£xNion Dan; EHS: Sigagivm OYM13No Arxowd# j9i(o 60 Revised 11AM - - - favoia# V i3; 4- 6-0.0z, C� �.2lt•Y11-� 1 �pD 9 112 r: , d .r'p ypo e� 1070 .. ab Qtr IQ 21074 ,.r z�10.4 a N C O 1111 data is provided as Is without wamMy or guarantee of any pdntl either expressed or implied Including but not limited to the Implied INV, _' • authorities of memhantabllity, or fitness fora particular use. All users of Davie County's GIS webslte shall hold harness the County or J ' Davie, NoNtCarolina, Its agents, consultants, contractors oremployees from any and all claims orcausesofaction due toorarising out S ofthe use or Inability to use the GIS data provided by this webshe. printed:Jun 04, 2015 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT • Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 _ 1. Application/Permit Requested By Mailing Address Home Phone lo--�?f-76W Business Phone 5Ifil"e 2. Name on Permit if Different than Above 3. Application for: eneral Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision edn Alley Section of # No. of People No. of Bedrooms No. of Bathrooms a Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No, of Urinals No. of Lavatories No. of Water Coolers _ No. of Showers Water Usage Figures . 7. Type of water supply: CS"'Public ❑ Private 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Basement/Plu bing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes EKNo ❑ Community NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: This is to certify that the information provided is correct to the best of my know) dge, and I Incurred from this application. /o-d/-Z'Z DATE IGI I am responsible for all charges CONSENT EQ -R- SITE EVALUATION TO BED NE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: Y1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. -, SIGNATURE DCHD (1183) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME w c\ DATE EVALUATED i O - 2O ' 9 4 ADDRESS S P c\d�R PROPERTY. SIZE. +) SSS Ossa PROPOSED FACIILTY `�� �� LOCATION OF SITEi��>ny - by Water. Supply: On -Site Well Community - Public Evaluation By:ttt Auger Boring - Pit, 1� - ,Cut FACTORS 1 2 3 4 Landscape position Sloe X HORIZON I DEPTH It 1 Texture group1— Consistence Structure C Mineralogy %', )"I HORIZON II DEPTH 3 Texture groupc 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 S. S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: , J�.1 EVALUATED BY: R,�� LONG-TERM ACCEPTANCE RATE:. 1 OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position -. R -Ridge S- Shoulder L -Linear slope FS-Footslope 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 -Finn 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 Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depthof fill - In inches Restrictive horizon - Thickness and inches from land surface - Saprolite - S(suilable), 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(01-901 7 .. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT .. Davie County Health Department pjAq Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Perm Mailing Address 2. Name on Permit if Different than Above 3. Application for: General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: 2/Ho use ..1 ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry N r�l�bp ❑ Other. F 11'L� �p ❑ Unknown 5. If house, mobile home: Subdivision its Y 1 LL �� � 1Section Lot # ❑ Basement/Plumbing No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served"". No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: Public No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private 8. Property Dimensions dna ax_ir4cv if,- Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal Ill ❑ Community NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: y_ 60 / SO(J 7Ly'/to �dKwPGd l I�JdC' pryd", J y L5 P1 ee—, This is to certify that the Information provided is correct to incurred from this application. 9/Z 5 /rg DATE of my kngyvledgey9nd I understand I am responsible for all charges SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. Er 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the vie County Health Department to enter upon above described property located in Davie County and owned by -7 cJ�- to conduct all testing procedures as necessary to determine saidetermine sitty for a ground absorption sewage treatmentfor a ground absorption sewage treatment and disposal system. Z��/���� DATE SIGNATURE a-, DCHD (193) DAVIE COUNTY HEALTH DEPARTMENT �► Environmental Health Section Soil/Site Evaluation. NAME u` DATE EVALUATED ADDRESS A�\ PROPERTY SIZE I PROPOSED FACIILTY , ° LOCATION OF SITE � 4 S �'fZ.rnF.if R�I.Ei Water Supply: On -Site Well Community Public Evaluation ByC�7,L Auger Boring — Pit Cut FACTORS 1 2 3 4 Landscape position 5' S -S' .5 5s Slope X _. O-ce" -' O -go _Y5" 8 -Wo $'150 HORIZON I DEPTH a Texture groupL L L 5 3,37 5 Consistence Z Structure Mineralogy i HORIZON II DEPTH 2 ° D.tt 2' G" 6" t: Texture group ? e Consistence Structure ` AO k MineralogyI I 1 1 S HORIZON III DEPTH Texture rou Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 S -s RESTRICTIVE HORIZON — r SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE �A 1 r SITE CLASSIFICATION: \� '� EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 1A OTHER(S) PRESENT: REMARKS: 'Z� \ \ L GEND Landscape Position JR -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 -Finn VFI-Very firm EFI-Extremely firm Wet. , .. '... NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP -Non plastic SP -Slightly plasticP-Plastic VP -Very plastic .Structure 3C -Single grain M -Massive CR -Crumb GR -Granular. ABK-Angular blocky _ SBK-Subangular blocky PL -Platy PR -Prismatic - 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 DCHD(01-901 May 05 05 10:43a davie county envhealth 336 751 8786 p.3 �. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section p: Soil/Site Evaluation _ NAME DATE DATE EVALUATED �' 2�) ' 9 4 ADDRESS V" A PROPERTY SIZE PROPOSED FACULTY �� SR. LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation By:-k•.l, Auger Boring_ Pits 1� Cut FACTORS 1 2 3 4 Landscape position SIC-Silty clay C -Clay Slope x Moist HORIZON I DEPTH : lr " Texture groupt— NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky Consistence F" Structure Structure SC -Single grain M -Massive CR -Crumb CR -Granular ABK-Angular blocky Mineralogy HORIZON II DEPTH 3L Texture group V. Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS _15S RESTRICTIVE HORIZON �- SAPROLITE - CLASSIFICATION .S• 3 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: _(,;D C,> EVALUATED BY: \� LONG-TERM ACCEPTANCE, RATE: _ REMARKS: _%a�.. "Z� ' - DCHD (01-901 OTHER(S) PRESENT: LEGEND Landscape Position; R -Ridge S-Shou,der 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 :lay loaut• 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 -Finn 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 CR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralogy 1:1. 2:1. Mixed Notes Horizon depth - In inc:,es 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 chrome 2 or less - Classification - S(suititble), PS(provisionally suitable). U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 Davie County, North Carolina Spatial Data Explorer algal Dia f qm rer P:crNt ::arLvir:-;: Click on the Map to: O Zoomin * ZoomOut * Recenter Map • Identify: Parcels Ez':'.f Zoom Factor: WM 0 Radius Search (feet) F77 "taw=: Vsm <h (3206 `.iVV )981 i1Lt99$'I (3.15A 207 NE 2.29A 24061 Parcel Data Find Adjoining Parcels • County /D., N60000004111 • Account Number81226500 • PIN: 5755109981 • Legal l:LOT 4 CARMEN VALLEY • Owner Name: WYRICK KEVIN BRAD • Owner/Address 1: VVYRICK KEVIN BRAD • Owner/Address 2: • Owner/Address 3: PO BOX 394 • City,State Zip: COOLEEMEE ,NC 27014 -0000 • Lend Value: $13,500.00 • - Building Value: $0.00 • Out Building/Extra Features Value: $0.00 • Assessed Value: $13,500.00 . • Property Record Card • Land Until Type: N60000004111 :l LT • Deed BooklPage: 0046510878 • Deed Date: 2003/02/18 • Sales Price: $13,000.00 • Property Address: 003537 003537 • County Zoning: R-20 • Census Code: • City Code: • Fire District: JERUSALEM • Flood Zone:ZONEX • Flood Community: 370308 • Flood Panel.• 0125 C • Flood Map Date: 12-17.1993 • Soil.• PcC2 • Township: JERUSALEM Page 1 of 2 Map Lt Draw select Census Tra City Bound County Zor Multi Syl E911 Fire 0 ■ Flood Pane Flood Zone Parcels School Disi Multi Syl .................. E Solis E Town Zonir E Townships Multi Syl E Voting Prec ■ Driveways Rail Lines ■ Street Cent US/NC Will N Aerial Phot Creeks and E911 Addre Fire Depart Schools -Drat I nis map is preps inventory of real I within this Jurisdic compiled from rei plats, and other p and data. Users c hereby notified th aforementioned p Information sourc consulted for vert Information conta http://sdx.roktech.net/seryl eticom. esri. esrimap.Esi imap?Name=Davie&Cmd=Clk&Left=1:.. 5/10/2005