208 Sawgrass Drive Lot 719DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753,-6780 / Fax # (336)753-1680
OPERATION PERMIT
Account #:
990005710
Tax PIN/EH #:
E00000719
Billed 70:
D.R. Holton Inc
Subdi,Vision Info:..
Saddlebrook at Oak Valley Lot:.#"719 -
Reference Name:
:rrrLocationiAddress:
208 Sawgrass Drive -270011
Proposed Facility:
Residence
°• *' t't!'Property;Size:
.77 Acres
ATC Number: 5912
**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 YPP6 Tank Date Jt3 Tank. Size JC00
PumpTank,Size ✓ Bedrooms: 3
System Installed By: K Installer# Date: �6JZ
GPS Coordinate:
DCHD 11/06 (Revised)
P..... `, ,
DAME COUNTY ENVIRONMENTAL HEALTH � IZ
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax #(336)753-1680
"AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005710 Tax'PIN/EH #: E000007.19
�. Billed To: D.R. Horton, Inc Subdivision 'Info',; Saddlebrook at Oak Valley': Lot # 719
Reference Name: -Location/Address: 208 Sawgrass Drive -27006
Proposed Facility: Residence Property Size: .77 Acres
Site Type: WNew ❑Repair ❑Expansion
ATC Number: 5912 :.
**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 chanee.
Residential Specifications: #.Bedrooms#Bathrooms 2#People__�(_BasementOBasement plumbing❑
Non -Residential Specifications: Facility Type # People_ # Seats
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: Wounty/City O Well ❑Community Well
System Specifications:Design Wastewater Flow (GPD) Q Tank Size 1060 GAL. Pump Tank L GAL. ` (��
Trench Width Z� Max. Trench Depth3� Rock Depth�j � Linear Ft. 3A Z y
Site Modifications/Conditions/Other:
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. onhhe day of installation. Telephone # (336)751-8760.
A
I
Environmental Health Sp€cialist (A,,L46 /Q•t tj `A
DCHD 11106 (Revised)
nppuo"tutt rbL.t u Otte nvaluatluivurlpruvciiteltt rermlL - u lkumonzation 10 t.onsQnCt(Alt;) U Isom
Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQU ^
INFORMATION IS PROVIDED Refer to the INFORMATION BULLETIN for instructions.__ �r
APPLICANT INFORMATION o., qpR n n
Name to be Billed j RZ iT Contact Person Y V( SS
Billing Addressr}i>b0 Je:A l LDv PA (SNF Cllb Home Phone
City/State/ZIP O� Business Phone - °t
Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
*Date
NOTE: A survey plat or site plan must accompany this application. Included: K&te Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name Phone Number
Owner's Address City/State/Zip
U
Property Address City < /y�
Lot Size . ' , Tax PIN# � 06000 71q
SubdidisionN e(ifapplicable)Ci(CbVOt _Sectio n/Lot#^:I
Directions To Site; 2XJM, &k ) s'17vy
answer to any of the following questions is "yes' , supporting doc
entation must be attached. s4tbdav :oe. ✓'t' on
Are there any existing wastewater systems on the site?
❑Yes 9Wo D ✓, .
Does the site contain jurisdictional wetlands?
❑ es GKO
Are there any easements or right-of-ways on the site? -
iaYes ❑Nota Ktrht
Is the site subject to approval by another public agency?
❑Yes QNo
Will wastewater other than domestic sewage be generated?
❑Yes 9No�
IF RESIDENCE FILL OUT THE BOX BELOW .
# People 14-, A? # Bedrooms # Bathrogms Garden Tub/Whirlpool es ❑No
Basement: ❑Yes VN6 Basement Plumbing: ❑Yes QN'o
IF
FILL
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:
❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type: IZCounty/City Water ❑ New Well ❑Existing Well D Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes t1 w
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
loeat�'nP and fjq ging or staking {he house facility location, proposed well location and the location of any other amenities.
A S[ ��� ..A .A t _ - Site Revisit Charge
Property owner's or owner's legal rep es ntauve signature
Date(s):
Taere:RO _ JP/)7ZI
ly rl
SKTIglMp ATTOA[m I.
MTwammmm T ye, I - I 11111=14
MTIODRO mm"
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OWNER & CONTRACTOR'S -
NAME & ADDRESS
D. R. HORTON. INC.
2000 AERIAL CENTER PARKWAY - -
SURE 110 - - -'
MDRRISNLLE•
NORM CAROLINA 27550 -
M YARD RF
ZONING- IM,_ COVENANTS
NOTES:
THIS MAP IS NOT FOR RECORDATION NOR TRANSFER OF PROPERTY. -
FRONT A' -
THIS PLAN IS SUBJECT TO APPROVAL BY BUILDING INSPECTION
SIDE STREET gr ROM
, DEPARTMENT & BUILDER PRIOR TO STAKING OR CONSTRUCTION.
SIDE -
NO CONDITIONS, COVENANTS OR RESTRICTIONS PROVIDED., -
S -
TOTAL SIDE
-
REM TO'
UO�l3tTiDU1kAl7�
� .
D►011ti®
�'�'
ly rl
SKTIglMp ATTOA[m I.
MTwammmm T ye, I - I 11111=14
MTIODRO mm"
0w \ \
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OWNER & CONTRACTOR'S -
NAME & ADDRESS
D. R. HORTON. INC.
2000 AERIAL CENTER PARKWAY - -
SURE 110 - - -'
MDRRISNLLE•
NORM CAROLINA 27550 -
r
APPLICATION FOR :SITE EVALUATION/IMP ROVEMENT PERMIT & ATC
]Davie County Health Department
Environmental Health Section
P.O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)7!;1-8786
Application For. 0 Site EvaluationMtp,mvement Permit 0 Authoriral. on To Constmct(Al C) n Both
••1MP0RT.IN2-'" THIS APPLICA'170N CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Rear totho INFORMA71ON BULLEEN for instructions.
APPLICANT INFORMATION_ ---J . /j ?�
Nametobe Billed 0,61 A�(t I olio �Coctac[Person�
Billing Address ¢a Mm Phone
City/State/7.ZP - - G 't 10 Business Phone, Dd
Name on PmniiUATC if Dii fereni than Above _
or site plan must accompany this applicatmm- �O i
d for 60 months with site plan, na expiration with complete plat.)
Subdivision Name_
Directions To Site:
Date House/Faetlity comers rlaggeo Fir trtV,
if the answer to any of the following questions is "Yes", supporting documematio must be attached.
systems on the site? OYcs
Am there any existing w,,tewala
Dow the site eontainjurisdiclional wetlands?
OYss o
Are them any ease nets or richt-of-ways on the site?
OY(s ONo
Is the site subject to approval Sy another public agency?
OYts ONO
Will wastewater other than domestic sewage be generated?
OY:s Okla
_
(�
t
OYes ONo
IF NON -RESIDENCE FILL OL'T THE BOXBELOW
Type of FacilityMusiness Total Square Fooiage of Building-__ #People
# Sinks # Commodes # Showers _._ # Urinals
Estimated Water Usage (gallons per day) - (Attsch doamtentation of similar facility water consumption)
FOODSERVICE ONLYt #SealL
E C U 6
APR ' 6 2006 D
L--
Type systemrequestul: Ia'&ventional OAccepted olmovative omwrnative nother —
Water Supply Type: C/County/City Rater O New Well OFA:fisting Well D Community Well
Do you anticipate additions or expans,ons of the facility this system is interned to serve? O Yes 040
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. 1 understand that
any permits) orATC(s) issued hemal'u are subject to suspension or revocation if the site is altered, the intended use changes, or if
the information submitted is thio application is falsified or changed. lua& stand that lam responsible for all charges incurred
from this application. 1 hereby grant right of entry to the AuthorizedRepnaeatative of the Davie County Health Department to
conduct necessary tions rotime core fiance with applicable laws and rules on the above described property located is
DavieComand ovmed by a1. DLI.
(4H�{r Crrv+'�/R �r-dwwd� �a�'�G'�;"I ASjG�lN�f! LI4 • P�S�'�i _
An Site Revisit Charge
Pro owner's or o e 's represents ve ignaare Date(s):_ '
-L Client Notification Date:
LHS:_
Dae h n �n
Sign given OYes []No Account # t� 0 31 `tr
Revised 2106 - Invoice # C/ /^s O
12 I
33,278 Sq. FJ
11
30,894 Sq. Ft.
I `
1�
cle_(urse
oDr1ve
[GALL
ralno9
St. Andrews Golf Vill
SeaHon 90, Phase It. Seotlon 2
'C� C Plot Book 8, Page 21
IQ
53,133 Sq. Ft. 33,426 Sq. Ft.
bo � soe
O
35,081 Sq. Ft.
I E:1
\ \
Be\ 148
Nh \ —
a
14 o I _1 243•
� 1 '33,897 Sq. Ft. 15 �
F.,
ferak')�,oA A
30,(88 Sq. Ft.
278
16
I
33,(69 Sq. Ft.
®
34.956 Sq. Ft.
x
35,486 Sq. Ft.
Ej
F too.]
145'
142'
Ot
Zn
F' 30,080 Sq. Ft. v
! r:!
227
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003765 Tax PIN/EH #: 5871-25-2458.14
Billed To: oak Valley Associates Limited Partne Subdivision Info: Sawgress Lot # 14
Reference Name: Bo Davis Location/Address: Beauchamp Rd -27086 �
Proposed Facility: Residence Property Size: see map Date Evaluated: / 04-
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring ✓ Pit Cut
FACTORS: 1 2 3 4 -51
7.
' Landscape position
Sloe % ..
HORIZON I DEPTH
Texture
Consistence . .-
Structure
•:,-Mineralogy
HORIZON II DEPTH
Texture group iLs .
Consistence
Structure i
Mineralogy ., .. _.
HORIZON IH 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: 4-)>,
EVALUATION BY:
��
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT.
REMARKS:
. ;LEGEND
d P^ .. .....
d. �
ane
._. Position
R -
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- Loaand SL - Sandy. loam . ` . L =Loam SI -Silt
SICL - Silty clay loam SII. - Silty loam CL'- Clay loam SCL - Sandy clay loam
SC - Sandy clay S_IC Silty clay C - Clay
CONSISTENCF.
mois
VFR - Veryfriable FR Friable FI - Firm firm EFI - Extremely firm,
Very
VFI - Ve
NS -Non sticky SS - Slightly s tick S -Sac Vg
Y Sticky Very Sticky :.
,
NP - Non plastic SP 7. 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
MinerAogy
1:1, 2:1, Mixed
Horizon depth - In inches.. , ..
Depth of fill - In inches
d
Restrictive horizon - Thickness and inches from land, surface,
,Saprolite - S(suitable)',.U(unsuitable)
Soil wetness - Inches from land suiface to free water or inches from land surface to soil colors with chroma 2 of less
Classification - S(suitable), PS(provisionally suitable), U(misuitible)
..;
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD 05105 (Revised)
J
^J/BS/P/_$_C J_U O•UJ: 40P + • — JJU'I:JT -J lUJ p.. �,
APVU GyflON FOR SITC EYALW7)0.V/l1(I'It0Y611FM Ptnd(l7 S ATC
Davit County 8021111 E 1partmfit
- E7P71vR,7mJWHW/1.i SeCBon
P.O. Box 840/210 RO.p}til S`-raeh
Mocksvillo, }1C 27020
(336) 751-870
•. <'•ZUMRTANT•v. IDIS APPLICATION CANNOT DE PROC.35SBD 17212,= ALL MM REQUIRED.
INFDRNATION IS PROVIDDO. RCiCr to thin LIFUsLA&MAN 13nLLL4)Sf for SnstMetiMV.
1, ML.U.allied Or, V a((<h GSS o:�a�s1Ct.��PG<1!w"e; r,<tM. w Pv.•a � IS''c'.iJ Gyii _
- t(al11n0 Addeeaa 3+0 I'JeA( D! .'1 •t (lora Phnne -
Cley/rtato/LIP. �(nlh�^`J GItw. ,N4' d%IIJ(,f am�la.a.s:Lima s)TG 71i 3/ 1
I. Mme ao Pas.lt/aTC 1L OlI[eaaat tA.n abP.. 1di{ )4 CK (.l lL ytt� peY1 -
Nr111n7 M,1c .e ,5/.h. { 0351•/::Gla/LSP 'fir n ^ .
J. APFlie,atia. For: Aitd Evalllati. Q Im,-.revclwat D.rluit/ATC ❑ Doth
1. [At... 0 Mobil* Homo 13 mu"
(nem O IDdw tcp ❑ OCIIaF C54S"1Vid lUl- (2ld/�
S. TIT. .r.td. ❑ <vnvootlona:mdltled ❑ lnnwatlro 17accepttd
i. I�LjlGldaneoa 1 Doop1^ )) I DCdr�Jof/:ea 0 DathiooNu 7 �(�ZhG�'I+1J�
}datamraabx 'h/Cubaae D3a0 nal 7duaahlnS'/^ee4loa IO:vaemne/Plunrlr,a Oaa.uusehro vlwrs,s.n `, .
.
T. I[ Outtnea./Zaduotry /Older: rerlfy typ< 0 People _ 1 sland
1 Cmde. P ch.r.Jr a 1hc3.n3. - I Naeee
IP POODSERVICR: 0 Seat, Datlivaced wear ve.ga toallev per seri
1. ,aypa of vats.."I" County/CSty ❑ No.11 ❑ CoamuniLy
a. 00 yb. a.eldlvs.-'adnitlmv oc et)>vuiola oflno fatality lbissysMu it inlendail to 2orve?0Yet,
(fres, xhot type' -
I1fPOR71NP'•CUENtt MUST COAfPLET6TIIE RL•(1UIR£fl PROPBILTY INI+OIehIAT]ON IaL'QUESfntl�
It1i1.OlV.F,illmra PldTor51TR{PUtiAfU,rTDGSURAfOTfOryr lheHienr vhp77IISAi`PIJCATION.
Property Diumudo1w.. _C fQZ lo1D1_. _ \vitlTB)IRECFIOYS (rrvwhleeluTiOe)IO Plt01'F71T1': -
Tat0fOce1.Ia,S `11
- Properly Addrm: Road flame_ • q0'Ad' &--w. j.L%l I, f✓Ll A?y
Cily/Lip__
Ifina Snhdirlsivu prorida)olonnaliasy as follows:
Name: - ..
Secliou: Block: Lao• a'w Date ho se corners flagged:
Thu It to Certify Ilut Oto iulurnlaUon provided Is camel to the but of toy Ju awhadge. I understand 11=1 any perndl(s) -
" Issued hera0e3' are subject to suspension or revocation, it Uies(fc plans art. (raided use change, or if Via loforvunun
subtld(led in 11111 a)Ipliealiun a falsified of 'Imuced /, a[ro, underrlandr/ver: nnr rn)ramibfe fvrnll a mlyGrnsrrrd from
Odrnpplicnfien l,kereb35 give wusenl la tl¢Aulhdrired Repmurtatiroof�!wDmie Camrty 7kallk Deparlutenc (l/ f��
Io enlcr upon shore dael(Ucdproperly lonfrd In Davie Cvunlyand mrn ' IC
-to eonducl all(nslblg proced uses as`ucu"aary la delernlhm lhes(Ie suisptril/ii�� r
_DA7T - q,ZL0') " S)GNA7'UItE i , �in7/„G fb Ci"Zt.�
71715 ARE,\ Amy BE USED FORDIb1RING YOUR S= MAN (ludade aD of (lie fo0mving.F'sisGni sod proposed
property lines and dimensions, structures, setback; and septic locations). -
.. Silt Revisit Clark
❑kulNo11DG4an Dale.
Sign given ..., 'Account No. �tP �"✓ .
Itevked DC111) (05103 111vuimNo.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #: 990003765
Billed To: Oak Valley Associates, Limited Partne
Reference Name:
Proposed Facility: Residence
Water Supply: On -Site Well
Property Size:
. PROPERTY INFORMATION
Tax PIN/EH #: 5871-25-245826
Subdivision Info: Oak Valley Lot # 26
Location/Address: Oak Valley Boulevard -272P8
see map Date Evaluated: /D 2 Ds
to/ar /07 -
Community
Evaluation By: Auger Boring k -'i 2 Pit
Public
SITE CLASSIFICATION:vs
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY- S
OTHER(S) PRESENT:
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
CONSTSTF.NCF.
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3i'et
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
Mineralog)
1:1, 2:1, Mixed
Saks
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 ehmma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
T TAR - r.nna_fnrm orrnmm.... t. - n 11A. 14O
HORIZON I DEPTH.
Consistence
• ' =
Lily
-®--�
i'0.
MA r4ows Is 01:4 W
ME=
0=090
Consistence
SITE CLASSIFICATION:vs
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY- S
OTHER(S) PRESENT:
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
CONSTSTF.NCF.
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3i'et
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
Mineralog)
1:1, 2:1, Mixed
Saks
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 ehmma 2 or less
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
T TAR - r.nna_fnrm orrnmm.... t. - n 11A. 14O
D
P.O. Box 848/210 Ho
Mocksville.NC
May 1, 2006
Oak Valley Associates, Ltd. Partnership
Attn: Bo Davis
3401 Healy Drive
Winston-Salem, NC 27103
Re: SAWGRASS Proposed Subdivision / Lot #
Caudle Tract / Beauchamp Road
Tax PIN# 5871252458
Dear Client(s):
epartment
As requested, a representative from this office visited the above site April 11, 12, 18,
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: 3 �Q 1 Wastewater Design Flow: S/L -
System Type: ❑Conventional O'Accepted ❑Innovative ❑Alternative ❑Other
System Location: _\A1 SIVE Valid: 25'Years ONo Expiration
Site Modifications/Permit Conditions:
d l 0
Enviro a i Sp ahst 0 Pate
ps-i.p.letter 2/06
/3ep!ej—Ub U.d:4ap
nrP[:p)rION GOR SWC EVALVAMON/uIMMI1311WI PEnhnr S ATC - -
Davie County'NcalU) C ypartment
EnPilOnaJeji S/Hwll.7SeCfiOn -
P.O. Sox 948/210 NoPytial SLe.et - -
Mac)ta Mo, NC 27020 -
(3361751-1171:0
-- TRIS APPLICATIOlf CWM DE PAX.ISS1iD MMr—S ALL TEC REQU=T.4
-
tIDPOAM7
OA[[ATION IS Rebar Co the INFOAIDIT.:ON LL
BUET)N for faatruet iatm.
-
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Tax Offiec I'1N: -
ProperlyAddrm: Road
Ifin a Subdiv[s(.. provide infornratiou, as faEo11r1
Name:
Section: BfocL- Lot:
WRITE NeECTIMS (rs.,.,alad.vlOt)1. PILO POITY-V
Dale Jim 'sa ..rues na(;Ced:
This is to certify that the iufurmlUon prodded Is correct to the bmf .f i -y 1. otrledte I understand that auy perudi(s)
issued hereafter are subject to sustiension or revocation, it Ow site pleas or 1. taidod ure rhaatq or If Ilse iuforantimm -
subndaed in filo appliealiun is rlkifcd or clsanCed /, also, andenlnadrhnr.' mr raponsibfe%.r all dim hesl.cum•dfrum
Wsapplicalion. I,hereby, Cut cousenl fo tlm Authdrired RiyramtativemL 4eDaie Counfygdra111jy,,Deparbswn `I
toe.(. igrpn abovedaeribcd praperiylorafedhr Davie Couniymld ours Omllta�{"/�Pljl.t( gaii(L.
lo<onduu au lesliuC procnlura as ranssaq•lD d.lernrina ❑¢site suiUhiR//ty��J-
D,1'1'E q'Z�'i SIGNATURE
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TDISAIMILMAY))E USED FORDIUMM YOUR SM]MAN (IDdade au of the foudning.Exsting and proposed
ploperfy ones and dlDienston; sfrurlurv, sctlmdt; andreptielocaUous).
Sife Hnisit Chane
CF.DLNaDDCltiall Dafc:
EDS: //
S)C. Cirme AernanlNo._ 7(p
tier&ed DCIID(05/03 _ Iisrnim N,
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003765 Tax PIN/EH #: 5871-25-2458:26
Billed To: Oak Valley Associates Limited Partne Subdivision Info: Oak Valley Lot # 26
Reference Name: Location/Address: Oak Valley Boulevard! -272P8
Proposed Facility: Residence Property Size: see map Date Evaluated: /0/2_7/b5_
Water Supply ` On -Site Well Community / Public
Evaluation By. Auger Boring j/`/ 2 Pit '� / Cut
'FACTORS 1 2, 3 4 x 5; 6
Landscape position
Slo e % .'..
HORIZON I DEPTH D
Texture group C
Consistence
Structure
Mineralogy..
HORIZON H DEPTH
Texture group_
Consistence
Structure
Mineralogy
HORIZON III DEPTH ;
Texture group .k Ct,
Consistence _ _
Structure
..Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
I -SOIL WETNESS ;
RESTRICTIVE HORIZON._
SAPROLITE _ _ ..
CLASSIFICATION -. _:..
LONG-TERM ACCEPTANCE RATE' ` 7!:> .
SITE CLASSIFICATION Q S - - - EVALUATION BY:
LONG-TERM ACC
EPTANCE RATE ,�' Z7� t': � OTHER(S) PRESENT
,REMARKS:' �MY ..'D
,.
LEGEND
Landscape Position
R - Ridge S - Shoulder . '. .L - Linear slope. ... FS - Foot slope N - Nose slope
i CC Concave slope . 'CV - Convex slope ; T - Terrace FP - Flood plain' : H - Head sloped
Texture
y
S'- Sand LS - Loamy sand, '. SL - Sand lSilt:tl
i
' SICL - Silty clay loam - SIL - Silty loam 'CL-- Clay loam ' SCL - Sandy clay to
Sandy loam ,
a<n
" Sc -Sandy clay SIC - Silty clay _ . C - Clay am SI
CONSISTENCE,
VFR -'Very friable ' ` FR Friable ' FI Firm VFI Very firm EFI -Extremely firm!,
33et ,
r NS - Non sticky SS -Slightly sticky S - Sticky VS Very Sticky
NP - Non plasfic SP - Slightly plastic P,- Plastic VP -Very plastic
.','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
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 chmma 2 or less
Classification S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised)