201 Meadow Ridge Drive Lot 6DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990000981 Tax PIN/EH #: 5749-540471
Billed To: San Filippo Companies Subdivision Info: Meadovaidge Lot # 5
Reference Name: Location/Address: Sain Road -27028
Proposed Facility: Residence
ATC Number: 2780
Property Size: see map
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1 00 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATE S CTIGN IS V ID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: -0/0 1
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Sjstems,'j but s all in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given peri of ti
Gl Nt "Vo -r- �lL "�,.� T-
2) .9
�o
5"r
Septic System Installed By: W
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
' P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 990000981 Tax PIN/EH #: 5749-540471
Billed To: San Filippo Companies Subdivision Info: Meadowridge Lot # 5
Reference Name: Location/Address: Sain Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 2780
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type �1OG� #People #Bedrooms 1-/ #Baths 3
Dishwasher: IBJ Garbage Disposal: Iff"' Washing Machine: ff" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: El
c�ation: Facility Type #People #People/Shift #Seats Industrial Waste:
4
Lot Size -7bW� Type Water Supply vii Design Wastewater Flow (GPD) Site: New 121"" Repair ❑
System Specifications: Tank Size1CG0 GAL. Pump Tank GAL. Trench Width Rock Depth tT- Linear Ft.
Other: :�- 71JTLt1)Tt d '�' 3L S I I'-NS'1,ALL t_I t O • C. w, „3 .
Required Site Modifications/Conditions: IC4. 1 ou_ 04 Gp,J rojQ-1 VCAEP s, OCP 14QQ�
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a rr t've of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. t 130 . on the day of installation. Telephone # is (336)751-8760.****
Q 1,
(--loin 2
7p• Cl:
C-�2a6r.
FP�w'r
Acpaox.
AMY— (os�
50' f
Environmental Hea .pec alist's Signature:
te: `711DIO
MEALLQ u obo-
DCHD 05/99 (Revised)
APPUCATION FOR SITE EVALUATION/IMPROVEMENT. PERMIT a ATC
----� ' Davie County Health Department
Environmental Health Section
R. n�
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
` 4 M (336) 751-8760
*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
-r-, [ c /t' a A l
1. Name to be Billed
Pr+ Contact Person
!failing Address '1 -V +( l_GG�`l
sd cu.
City/state/zIP .)qj -A2 e— ZT 096
2. Name on Psrmit/ATC if Different than Above
!sailing Address
3. Application For:
e Evaluation
B'
Home Phone
Business Phone "1�--/ Q/")
+ Y
cit
y/state/Zip
U Improvement Permit/ATC
❑ Both
4. System to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
s. If Residence: # People # Bedrooms —�/— # Bathrooms _
a Dishwasher Garbage Disposal /Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type
# Commodes
# Showers
# Urinals
# People # Sinks
# Water Coolers
IF FOODSERVICE: # SeatsEstimated Water Usage (gallons per day)
7. Type of water supply: 9/county/City ❑ Well ❑ Community
a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: J. &c {�
Tax Office PIN: #,6' -90q -06Y71
Property Address: Road Name f
City/Zip Y as ckS V�-
If In a SubdivisionprovideInformation, as follows:
Name:
Section: Block: Lot: _
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Date Property Flagged:
This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plans or intended use change, or if the information
submitted in this application Is falsified or changed I, also, understand that I am responsible for all charges incurred from
this application. 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 the site suitability.
DATE SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
I Client Notification Date:
EHS:
Revised DCHD (07/99)
Account No.
Invoice No. �! /
APPUCAIION FOR SITE EVAWA7ION/IMPROVEMENT PERMIT A ATC
' Davie County Health Deparbnent
Enviwamenta/ Ketrldi SeWon
P.O. Box 848/210 Hospital Street
• Mockaville, NC 27028
(336)751-8760
***ZMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Mame to be Billed KEN ►4ET N L - t- o -;Te Contact Parson Kt fJw1E TH L • FOST �t2
Hailing Address l ,86L (� V n A PLC Tries LnNC some mmme 704 -54,(c--7-7 E� 8
City/state/LIP 1`IOCKS.t���� N •�- • .770•2e Business Phone 33Ca-iZ3-8850
Z. Mame on Pemit/ASC if Different than Above
Halling Address
City/state/Lip
3. Application For: It( Site Evaluation 0 Improvement Permit/ATC 0 Both
a. system to service: 9111H -Ouse O Mobile Home O Business 0 Industry 0 Other
e. If Residence: i People � 9 Bedrooms • Bathrooms
O�Dishwasher 0 am age DisposalB'�lashinQ machine 0 Basement/Plumbing 0 Basement/Mo plumbing
G. If Business/Industry/other: specify type
# People # sinks
i Commodes # Showers # Urinals # Nater Coolers
IF TOODSERVICE: # Seats Estimated Nater Usage (gallons per day)
7. Type of water supply: U County/City 0 Well 0 Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes 0 No
If yes, what type!
***IMPORTANT*** CLIENTS 11IUST COIIIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBIIIITTED by the client with THIS APPLICATION.
Property Dimensions: 337A io I X 393 )( 247
Tax Office PIN: # 5!49 — 43— S-7 9 8
Property Address: Road Name 15 A 1-3 Po P. o
City/ZIPTAGC-.KS,j 01c 9-7 0Zb
If in a Subdivision provide information, as follows:
Name: McAoowRi-DGE CPrcpo D�
WRITE DIRECTIONS (from Moclsville) to PROPERTY:
L AST O N V S h 1 w.w C; f3
To o Roo, v3 ( s a 1(o 43) Tu R^1
9,1G1kT oP SAva _ A:PPQ.ox O.e. w1tLO
-rb S iTc n a lk\L%4T
Section: Block: Lot:.— Date Property Flagged: & • a• 8 - /99
This Is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I ani responsible for al/ charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health DepartmeAn
to enter upon above described property located in Davie County and owned by 1iENAJ'57W - L- Fos-rE R.
to conduct all testing procedures as necessary to determine the site suitability.
DATE G • Z8 — 199'1 SIGNAT1JM?�----' a4 ' Z�rn--
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07198)
Account Na
Invoice Na
YC2-6
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900654 Tax PIN/EH #: 5749-43-5798.05
Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 5
Reference Name: Kenneth Foster Location/Address: Sain Road -27028
Proposed Facility: Residence Property Size: 1.49 Acre Date Evaluated: g 314' 9
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit ✓
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
G¢_
Mineralogy
HORIZON II DEPTH
-1
Texture group
Consistence
P
Structure
Mineralogy
HORIZON III DEPTH
— 3
Texture groupG.F
Consistence
$
Structure
Mineralogy('
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
O
SITE CLASSIFICATION: PS
LONG-TERM ACCEPTANCE RATE: a l
REMARKS
EVALUATION BY: lC444
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
CONSISTENCE
moist
VFR - Very friable FR - Friable FI - Firm 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
Mineraloay
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 (Revised 05/99)
1.905 Acres (drd) �►
m
► --409 BL
E ---.
X17 s 15.0'
I ` 275.60•_ -� -- 40' B/i. .
n
1.742 ,Acres (dmd)
cr Mv/
L* N jj
-Nly
A
SAN
rr-
.
i= 19
( 1.161 Acres (did)
NS 11 S•0pr E
._ � 201.pg•
EA
�t
x
1.359 Acres (dmd) �
62-40-
314.13* N
S4DOW
RIDGE DRIVF�r
Right Of X'a,
5
1.76J Acres (dmd)
J
27.72' \ \
r � �
4 \
2913 Acres
1.2,
40.0' 8/L
\, RIOGEHAVEN PLACE
\ 2T P►M mss
S OK03'Og' w 212.91 <
� 40\ R
— — 2>r t1riliY EJENT_ .
27.72' \ \
r � �
4 \
2913 Acres
1.2,
40.0' 8/L
\, RIOGEHAVEN PLACE
\ 2T P►M mss
S OK03'Og' w 212.91 <
� 40\ R
— — 2>r t1riliY EJENT_ .
DAVIE COUNTY HEALTH DEPARTMENT �3. w
• Environmental Health Section
P. O. Bog 848/210 Hospital Street
Mocksville, NC 27028 P11—A
/
(336)751-8760 ( 4. d/
IMPROVEMENT/OPERATION PERMIT
Account #: 990000981 Tax PIN/EH #: 5749-43-5798.06
Billed To: San Filippo Companies Subdivision Info: Mr—Abooej06 , t -os Co
Reference Name: Location/Address: Sain Road -27028
Proposed Facility: Residence
Property Size: see map
ATC Number: 2665
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type L)SC #People #Bedrooms" #Baths 3
Dishwasher: Ml-**,- Garbage Disposal: ❑ Washing Machine: 0- Basement w/Plumbing: Er"' Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats _
Lot Size .-I 4- Type Water Supply(2VL'QT1?Design Wastewater Flow (GPD) 410
Industrial Waste: ❑
Site: New El"' Repair ❑
System Specifications: Tank Size 10C�AL. Pump Tank GAL. Trench Width7WI Rock Depth 12' Linear Ft. -!5W
Other: t4 -t-)v5rb so—, -D-Na
Required Site Modifications/Conditions: LvsT Lu f->-3 C-&--�-Tw Q
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6 "BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
I �
"
q8,
cam,
I ,lot
Health Specialist's Signature:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990000981 Tax PIN/EH #: 5749-43-5798.06
Billed To: San Filippo Companies Subdivision Info:
Reference Name: Location/Address: Sain Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 2665
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment a Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATER CONSTRUCTiONJS VALID FAR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: (� �.�—� Date: u
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
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 per�d of qTe.
o.
ol
tN 4�
Septic System Installed By:
Environmental Health Specialist's Signature: lxD
DCHD 05/99 (Revised)
R
r
APPLICATION FOR SITE EVALUATION/iAIPROV111ENT PER421T & ATC
Davie County Health Department
Environmental Health SeC On
P.O. Box 848/210 Hospital Street JAN 2 n -,l
Mocksville, NC 27028
(336) 751-8760
***IMPORTANT***
THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS
PROVIDED.. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed
Contact Person A n L k o n
Mailing Address
Some Phone
City/State/ZIP
Business Phone
2. Name on Permit/ATC
if Different than Above
Mailing Address
City/State/Zip
3. Application For:
0 Site Evaluation IR/Improvement Permit/ATC ❑ Both
4. System to Service:
IIX HOuseP--c❑ Mobile Home 0 Business ❑ Industry ❑ Other
If Residence:
# People Bedrooms # Bathrooms
5.
# _
❑ Dishwasher ❑
Garbage Disposal ❑ Washing Machine V Basement/Plumbing Basement/No Plumbing
6. If Business/Industry/Other: Specify type
# Commodes
# Showers
# Urinals
# People # Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: LZ-County/City ❑ Well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: -- ^-�
Tax Office PIN: #
Property Address: Road Name �'-Iscz-i N X o Q o!
City/Zip iGeS U I l/ -t.
If in a Subdivision provide information, as follows:
Name:
Section: Blocks Lot: w
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
64rJ- uv '
Vie' .-S� ( S /Z /(-4/1)
Date Property Flagged: V l
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. 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 the site suitability.
I Q
DATE 1 d SIGNATURE
THIS AREA MAY BE USED FOR D YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, stru777
s, tb ks, and septic locations).
Site Revisit Charge
TG c,a/
20
SG
Z� 'S
Revised DCHD (07/99) 5
r
Datc(s):
Client Notification Date:
EHS•
Account No.
Invoice No.
APPUCAIION FOR SITE EVAIIAMON/IMPROVEMUff PERMIT do ATC c\�7
R Davie County Health Deparbnent
EnvlMamenW Ifefift Sbcdon D
B.O. Bos 848/210 Hospital Street JUL 1 1999
Moekaville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANKOr BLS PROCESSZD UWXSS ALL TES -REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. name to be Billed KE M ra E T N L Contact person _KE N #A E T H L • Foc—i-e' 2
)tailing Address l �A8GL (c 1Y� A PI -E Ti2Er,7 LA -lam Hoes phone 704 - 54<o--7 -7 E� E
City/State/LIp -270Ze Business phone 3'SCo--IZ3-8850
2. name on Pamlt/A= It Different than Above
Mailing Address
City/State/Lip
!. Ilpplicatioa For: K Site Evaluation 0 Improvement Kermit/ATC 11 Both
+. System to service: td House O Mobile Home U Business O industry 0 Other
L ,S. It ce: T People / Bedroos / Bathroma .—
:�14�8�h'asher
0 garbage Disposal ;W�MhingMachine 0 Baseaent PimbitW 0 Basement/No Plusbing
6. If Business/Industry/other: Specify type # People f Sinks
i Ccamodes # Showers f urinals ti Mater Coolers
IF FOODSERVICE: it Seats / Estimated Nater Usage (gallons per day)
i�
7. Type of water supply: "County/City U Well 0 Community
s. Do you anticipate additions or expansions of the facility this system U intended to serve! 0 Yes 0 No
U yes, what type!
***IMPORTANT*** CLIENTS IIIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PIAT or SITE PIAN MUST BESUMHI TED by the client with THIS APPLICATION.
Property Dimensions: 8700 X 2 G3 X 22,6 K Z 4--7
Tax Office PIN: # 5-74l7 - 43- S`I 9 8
Property Address: Road Name 5 A t � Q A c--,
City/up niac.KSo d 15 9-107.8
If in a Subdivision provide information, as follows:
Name: McAooujk(DG6-
Section: Block: Lot:
WRITE DIRECTIONS (from MockrAlle) to PROPERTY:
L A.S T O N V S 1 d w.r► 1 S fS
To .,!Njo Rua -D (sR 1(o43) TuktJ
R%GN7 oil SA,a - APPRox 0.eo MILG-
-To S lTe nt.-1 R\C-,%4T
Date Property Flagged: Co - c� 8 - 9157
This is to certify that the information provided is correct to the best or my knowledge. I understand that any permit($)
Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application Is falsified or changed I, also, understand that I am responsible for all charges Incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health DepartmeAl
to enter upon above described property located in Davie County and owned by Is,fwtia774 L. -F 2%T E R
to conduct all testing procedures as necessary to determine the site suitability.
DATE G - Z 8 —1991
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/98)
Account No.
Invoice No. °��
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
+ z Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900654 Tax PIN/EH #: 5749-43-5798.06
Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 6
Reference Name: Kenneth Foster Location/Address: Sain Road -27028
Proposed Facility: Residence Property Size: 1.27 Acre Date Evaluated:
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
p -
Texture group
CIL-
LConsistence
Consistence
�S
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy'
HORIZON III DEPTH
1(v
Texture groupY
Consistence
P S
Structure
SIL
Mineralogy
`
HORIZON IV DEPTH
- y
Texture group
Consistence
S S
Structure
L
Mineralogyl:
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: PS
LONG-TERM ACCEPTANCE RATE: �•
REMARKS:
LEGEND
Landscape Positio
EVALUATION BY: _ C ��C.LJ/a•xp
OTHER(S) PRESENT:
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
Wet
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very p!astic
tru ture
SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineratot=_y
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 (Revised 05/99)
6 w 5
f t
1_ •74 co
8�.
� 93
�
21 88
------- 2147
6t3
ocr e3
C4
o,
ore.
557
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BK 4 PAGE 480
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