461 Gladstone Rd Davie County,NC Tax Parcel Report Tuesday, December 20, 2016
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_ WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number: L50000001603 Township: Jerusalem
NCPIN Number: 5736830677 Municipality:
Account Number:- 8304440 Census Tract: 37059-807
- Listed Owner 1: BYERLY JANEEN JAMES Voting Precinct: COOLEEMEE
Mailing Address 1: 1038 CANARY COURT Planning Jurisdiction: Davie County
City: ALCOLU Zoning Class: DAVIE COUNTY R-A,H-B
- State: Sc . Zoning Overlay: DAVIE COUNTY CZOD
Zip Code: - 29001 Voluntary Ag.District: No
Legal Description: 10.725 AC GLADSTONE RD Fire Response District: JERUSALEM
Assessed Acreage: 10.73 Elementary School Zone: COOLEEMEE
Deed Date: 11/2014 Middle School Zone: SOUTH DAVIE
Deed Book/Page: 009731059 Soil Types: PcC2,CeB2,WATER
Plat Book: 11 Flood Zone:
Plat Page: 379 Watershed Overlay: DAVIE COUNTY
Building Value: Outbuilding&Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
9�I� All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the
Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the
County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
�OU114 NC - or arising out of the use or inability to use the GIS data provided by this website.
OPERATION PERMIT EEvaluated
ice se nv
Davie County Health Department Number 20,2246-1
210 Hospital Street 5736830677
i
P.O.Box 848 umber.
Mocksville NC 27028 or: NEW
Phone: 336-753-6780 Fax:336-753-1680
Applicant: Ron Byerly r
operty owner: Ron and Janeen Byerly
Address: 476 Gladstone Road ddress: 476 Gladstone Road
Cay: Mocksville City: Mocksville -
State2ip: NC 27028 State/Zip: NC 27.028
Phone#: (336)936-9159' Phone#: (336)936-9159
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
Gladstone Rd
Mocksville NC 27028 Dlrectlons
_Structure Hwy 601 south, left on Gladstone Rd. Corner of#
SINGLE FAMILY 447. on right
#of Bedrooms: 3
#of People:
*Water Supply: PUBLIC
*IP Issued by. 2tao-Nations,Robert *System Classification/Description:
_ _- _
TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
*CA issued by: 2140-Nations,Robert
SeproliteSystem? OYes ONo
Design Flow: 3 6 0Oistnbutian Type: GRAVITY-SERIAL Pump Required?
OYes QNo
Soil Application Rate: 0 - 3 *Pre Treatment:
Drain field
rNo.
cation Field 1 _ a 0 0 Sq. ft. *System Type: INFILTRATOR QUICK 4 STANDARD _
falnLines 3 Randy Miller
Installer:
Total Trench Length: 3 0 0 ft. Certification#: 1128
Trench Spacing: 9 Inches O.C.
Peet O.C. *EH S: 2140-Nations,Robert
Trench Width: Inches
3 FeetDate: 1 0 / 1 3 / 2 0 1 6
Aggregate Depth: inches
Minimum Trench Depth: 3 6 Inches
Minimum Soil Cover. .1 4 Inches Approval Status
Maximum Trench Depth: 3 6 Inches ® Approved�l Dtsapprovetl
Maximum Soil Cover: a q, Inches
CDP File Number 202246 - 1 Septic Tank County ID Number: 5736830677
,
Manufacturer. Sheaf Lat.
STB: 760 Long:
Randy Miller
Gallons:
1000 Installer
Certification 4: 1128
Date: 0 6 1 2 0 / .2 0 1 6 -
THS: 2140-Nations,Robert -
`Filter Brand: POLYLOK PL-122 With Pipe Adapter
ST Marker:-❑ Yes 0 No
Date: 1 0 / 1 3 / x 0 1 6
Approval Status
Reinforced Tank: ❑ Yes - ® NO
1 Piece Tank: ❑ Yes 0 No
® Approved El Disapproved
Pump Tank
Manufacturer. installer:
PT: Certification#.
Gallons: 'EHS:
Date: / / Date:
Riser Sealed ❑ Yes ❑ NO
RiserHeight: ❑ Yes ❑ No (Min.6 in.)
51" Approval Status
Rei forced Tank: ❑ -Yes ❑ No
❑ Approved❑'Disapproved"
1 Piece Tank:,, _Yes_ ._❑ No.-
- - a
Supply Line
Pipe Size: inch diameter Installer:
Pipe Length. feet Certification#:
'ENS:
*Schedule:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings ❑ Yes ❑ NO ApprovalStatus
'Approved❑ Disapproved;
Pu e u re ent
Pump Type: installer:
Dosing Volume: - Gal Certification#:
Draw Down: Inches 'ENS:
"Chain:
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ NO
.. ......................... . ........ . . ...
Check-valve ❑ Yes ❑ NO Approval Status.
PVC Unions ❑ Yes ❑ No ❑.Approved C1 Disapp,roved
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole ❑ Yes ❑ NO
ti
CDP File Number 242246 - 1 County ID Number: 57330677
Electric Equipment
NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ No
Certification#:
Box Box
Pump Tank ❑ Yes ❑ No
Conduit Sealed ❑ Yes ❑ No *EHS:
Pump Manually Operable ❑ Yes ❑ No /
'Activation Method: Date:
Approval Status
Alarm Audible ❑ Yes ❑ No ❑ Approve dD Disapproved
Alarm Visible ❑ Yes ❑ No
2140•Nations.Robert
_. *Operation Permit completed by: -,
Authorized State Agent: fx Date of Issue: / 1 3 / a 0 1 6 `
Owner/Applicant Signature:
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 .1900 et. Seq.,and all conditions of the Improvement Permit and
Construction Authorization.This property is served by a TYPE a A. sewage septic system.
Rule .1961 requires that a Type .TYPE-11k septic system meet the following criteria:
Maximum.System Review ByThe Local Health Department: WA
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency ByCertified Operator.
NIA
Reporting Frequency By Certified Operator: NIA
Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain avalid contract
with a public management entitywith a certified operatoror a private certified operator for the life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora homelbusiness 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 owner and 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 shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
GHand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT 202246 - 1
Davie County Health Department CDP File Number:
210 Hospital Street 5736830677
P.O.Box 848
County File Number:
Mocksville NC 27028 Date:
Q Inch
Scale: . OBlock ft
Drawing Drawing Type: Operation Permit ON/A
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CONSTRUCTION For Office use only
AUTHORIZATION *CDP File Number 202246=1
Davie County Health Department County ID Number:5736830677
210 Hospital Street Evaluated For NEW,
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone:336-753-6780 Fax:336-753-1680 0 5 0 a / a 0 a 1
Applicant: Ron Byedy Property Owner: Ron and Janeen Byedy
Address: 476 Gladstone Road Address: 476 Gladstone Road
CRy: Mocksville City: Mocksville
State0p: NC 27028 State2ip: NC 27028
Phone#: (336)936-9159 Phone#: (336)936-9159
Property Location & Site Information
FAddress/Road #: Subdivision: Phase: Lot:
d
NC 27028 Directions
Hwy 601 south, left on Gladstone Rd. Comer of#447. on
Structure: SINGLE FAMILY right
#of Bedrooms: 3
#of People:
'Water Supply: PUBLIC
System Specifications
Minimum Trench Depth: a 4
Site Classification: Provisionally Suitable Inches
Sa rolite System? Minimum Soil Cover. 1 a
p y QYes QNo Inches
Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 3 Maximum Soil Cover, a 4 Inches
'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
_ 1 a 5 0 _ Gallons
'Proposed System: 25%REDUCTION 1-Piece: QYes QNo
Pump Required: QYes QNo QMay Be Required
Nitrification Field 1 a 0 0
Sq. ft. PumpTank: Gallons
No. Drain Lines 3 1-Piece: QYes QNo
Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH
Trench Spacing: — 9 . Feet O.C.O.C.nches Dosing Volume: Gallons
Trench Width: 3 Inches
gFeet Grease Trap: Gallons
Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-II
Septic Tank Installer Grade Level Required: OI Oil 0111 OIV
Donn 1 of Z
CDP File Number 202246 - 1 County ID Number. 5736830677 '
❑ Open Pump S�Stenj$jteet
Repair System Required:@Yes ONO ONo, but has Available Space
rDesign
System
Trench Spacing: 9 O Inches O.
ification: Provisionally Suitable Feet O.C.
Trench Width: Inches
w: 3 6 0 — . 3 . @ Feet
Soil Application Rate: 0 3 Aggregate Depth: inches
Minimum Trench Depth: 2 4
*System Classification/Description: Inches
TYPE It A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS, Minimum Soil Cover. 1 a Inches
Maximum Trench Depth: 3 6 Inches
*Proposed System: 25%REDUCTION -
Nitrification Field 1 2 0 0 Sq,ft. Maximum Soil Cover. a 4 Inches
No. Drain Lines 3 *Distribution Type: GRAVITY-SERIAL
Total Trench Length: - 3 0 0 ft. 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 of other 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 of the Improvement Permit,not
to exceed five year:,and may be Issued at the same time the improvement Permit Issued(NCGS 130A-336(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 for assuring compliance
with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature, Date:
*Issued By: 2140-Nations,Robert Date of Issue: . 0 5 / 0 .1 / a 0 1 6
Authorized State Age :
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 5736830677
P.O.sox 848 County File Number:
Mocksville NC 27028 Date: 0 5 / 0' a / a 0 16
4,
O inch
Drawing O
Drawing Type: Construction Authorization Scale: . ON/A k `
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CONSTRUCTION AUTHORIZATION ,
Davie County Health Department
210 Hospital Street CDP File Number:
P.O.Box 848 5736830677
✓ Mocksville NC 27028 .s gnty File Number:
�-za_
Date: .0 .5 / 0 2 / 2016
10 — -0 � /
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Click below to Irnport�n imiage from an extemal location: Drawing Type:ConStrlton Atkh2di ion
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7.5
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IMPROVEMENT PERMIT For officet,seonly
CDP File Number 202246-1
Davie County Health Department
210 Hospital Street County ID Number 5736830677
P.O. Box 848 Evaluated For. NEW
Mocksville NC 27028 Township:
Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 5/2/2021
"NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit.
Applicant: Ron Byerly Property owner Ron and Janeen Byerly
Address: 476 Gladstone Road Address: 476 Gladstone Road
City: Mocksville City: Mocksville
State2ip: NC 27028 State2ip: NC 27028
Phone#: (336)936-9159 Phone#: (336)936-9159
Property Location & Site Information
Address/Road #: Subdivision: Phase: Lot:
Gladstone Rd
Mocksville NC 27028 Directions
Structure: y . SINGLE FAMILY Hwy 601 south, left on Gladstone Rd. Corner of#
#of Bedrooms: 3 447. on right
#of People:
*Water Supply: PUBLIC
System Specifications
nidal S stem
.Site Classification: Provisionally Suitable
Minimum Trench Depth: .2 4 Inches
Saprolite System? OYes QNo Maximum Trench Depth: 3 6 Inches
Design Flow: 3 6 0 Septic Tank:
1 a 5 0 Gallons
Soil Application Rate: 0 . 3 1-Piece: OYes QNo
*System Classification/Description: Pump Required: OYes ON o, OMay Be Required
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons
LESS)
*Proposed System: 25%REDUCTION 1-Piece: OYes ONo
Repair System Required:@Yes ONO ONO, but has Available Space
Repair System
*Site Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inches
Soil Application Rate: 0 3 Maximum Trench Depth: 3 6 inches
u
*System Classification/Description: Pump Required: OYes QNo O Maybe Required
TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR
LESS)
*Proposed System: 25%REDUCTION
Pagel of 3
CDP File Number 202246 - 1 County ID Number: 5736830677
*Site Modifications ❑ Open Viil 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 by the 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 valid for 6 years from date of 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 the facility and appurtenances,the
site for the proposed Wastewater system,and the location of water supplies and surface waters).
Plat The tnprovement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land
O surveyor,drawn to a scale of one inch equals no morethan 60 feet that Includes:the specific location of the proposed facility
and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat
also means,for subdivision 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 satisfy the conditions,the rides,or this article.This permit is subject to revocation if the site plan,plat,or intended
use changes(NCGS 130A335(p).The person owning or controlling 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(.1938(b)}
Applicant/Legal Reps.Signature Required? OYes ONO
Applicant/Legal Reps. Signature,• Date: /
*Issued By: 2140-Nations,Robert Date of Issue: 0 5 / 0 a / a 0 1 6
Authorized State Agent: OValid without Expiration?
0Create CA?
01-land Drawing Olrnport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
IMPROVEMENT PERMIT
Davie County Health Department CDP File Number: 202246 - 1
, •' 210 Hospital Street 5736830677
P.O.sox 84$ County File Number:
Mocksville NC 27028 Date:
0Inch
,Drawing Drawing Type: Improvement Permit Scale: pBlock J
QN/A ft.
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IMPROVEMENT PERMIT
Davie County Health Department
210 Hospital Street CDP File Number: 202246 -1
P.O.Box 848 5736830677
Mocksvilte NC 27028 County File Number:
Date: 0 5 / 0 .1 / 2 0 1 6
Click below to Import an Image from an external location:Drawing Type: Improvement Permit
DATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
Davie County Environmental Health
3 �/ I P.O.Box 848/210 Hospital Street
D&bl b Mocksville,NC 27028
(336)753-6780/Fax(336)753-1680
Application For: 11 Site Evaluation/Improvement Permit C Authorization To Construct(ATC) LBoth
Type of Application: blew System DRepair to Existing System :]Expansion/Modification of Existing System or Facility
***IMPORTANT'**THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION s
Name _XNRvmContact Person Rw g/L ¢'l/BQ.d
Address S/7Co G A,1& led, Home Phone S6 '1 /
City/State/ZIP i'/ AIC Ott Business Phone
Email 26y6L9 ✓ M TGt>C'• 0004 Email: �/�+►v�
Name on Permit/ATC ififferent than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Corners Flagged -7L�
NOTE: A survey plat or site plan must accompany this application. Included:U Site Plan UPlat(to scale)
(Permit is valid for 60 months with site plan, o expira ion with complete plat.)
Owner's NamV ` Phone Number
Owner's Addres 7 it/e City/State/Zip /12OG�f/i%/P SGC Z7o�
Property Address .d� q/ City A�OYAekjw,'Ihe
Lot Size /D.7 4,c- Tax PIN#_
Subdivision Name(if applicable) Sectio t# /
Directions To Site: I— -� tf 7 wxked
- If the ansfver to any of the following questions is"Yes",supporting documentation must be attached:
Are there any existing wastewater systems on the site? _Yes -No
Does the site contain jurisdictional wetlands? _Yes VNo
Are there any easements or right-of-ways on the site? Yes Ilo
Is the site subject to approval by another public agency? _Yes —10
Will wastewater other than domestic sewage be generated? Yes o -
IF RESIDENCE FILL OUT THE BOX BELOW
#People #Bedrooms :— #Bathrooms L— Garden Tub/Whirlpool es INo
Basement: !Yes o Basement Plumbing: :]Yes Xo
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: conventional DAccepted ❑Innovative DAltemative ❑Other
Water Supply Type:fftounty/City Water D New Well ❑Existing Well :1 Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve?C Yes 0
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 corners and locating and flagging
or stakin a house/fa ''ty local' n,proposed well location and the location of any other amenities.
operty owmer's or own 's l I epresentative signature Site Revisit Charge
Pr
Date(s):
?—V,//& Client Notification Date:
Date EHS:
Sign given I Yes DNo Account#
Revised 11/06 Invoice#
1 iCz\` 433
3233 1. •1�83 y \% 7290
€ tir 7 �13 r 125
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2006 25
ti 4'
5932 /,
`///479,
85
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... .497.3`f .'`�Z i /��•.� a, 173Q
0677
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5429
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3229 �1 93 " 0381 <9Z
AN data Is provided as Is without wamany or guarantee of any kind either expressed or Implied including but not limited to the knplied
n
�Y warratles of marchaMaolkry ar-a-for a pertiwler use.AI aeon of Oavb County's GIS website shall hoW hamYess the County or Davie.
North Carolina,Its agents,consultsnts,contractors ce employees from any and as claims or Causes of action due to or anskg out
of the use or
5 Inability We,.the GIS data prvvWadbythis websRe. Printed:Mar 28,2016
' - DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 -- 5 6 7
Landscape position �.
Slope % �-
HORIZON I DEPTH N
Texture group C L C
Consistence
Structure k /C
Mineralogy ,
HORIZON"II 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 O-
SITE CLASSIFICATION: J EVALUATION BY:
LONG-TERMACCEPTANCE-RATE: OTHER(S)PRESENT: v l L
REMARKS: S to,��,fT —n f CGc,f
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
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 e
1YQIrS
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- eal/dav/ft2 rnr Lm nc/nc
NCDFNR
r Division of Environmental Health
On-Site Wastewater Section *Date: e 4 / a e / a a i 6
Soil/Site Evaluation *File#: ;z o 2 2 4 6
For On-Site Wastewater System PIN #: 5736830677
*Owner Ron and Janeen Byedy ' Proposed Facility SINGLE FAMILY
Proposed Design Flow(.1949) 3 6 e Location of Site Gladstone Rd
Property Size 10.7 WaterSupply PUBLIC Evaluation Method Auger
14Depth.940 Horizon SOIL MORPHOLOGY
Profile#
Lari scape .1941 Other Profile
Slope% (IN) Texture Structure Colnsistence Color Color Factors
1 1 L G48 C 3-Stng sbk 11 s p 2.5 YR .1942 Wet.
zra
0 %
.1943 Depth PS
GPS Saprolite:(in) .1944,Rest.
Horton
EHS
.1947 Class PS
Nations,Robe Profile
—7— LTAR 0 3
0-48 C 3-Stng sbk fi s p 2.5 YR .1942 Wet.
zra
% .1943 Depth PS
GPS Saproldcan) 1944 Rest.
Horizon
.1947 Class PS
ENS
Cop ogle Nations,Robe P °file 0 3
t LpAR,_ '
3 048 C Ming sbk fi Is P 2.5 YR ,1942 Wet.
ars
°l01943 Depth PS
GPS Saprolitcan) .1944 Rest.
Horizon
EHS 1947 Class Ps
Cop rotile Nations,Robe LTAR Profile 0 3
,_.
.1942 W el,
% ' .1943 Depth
GPS Saprolite:pn) ,1944 Rest.
Horizon
raENS 1947 Class
Copy- rotrot I Profile
LTAR
.1942 Wet.
% .1943 Depth
GPS Saprolite:00 .1944 Rest.
Horizon
EHS 1947 Class
Cop otile Profile
LTAR„_,,,
Available Space(.1945) PS OtherFactors(.1946) Site Classification (.1948)Ps
Initial LTAR: o 3 Repair LTAR: e . 3 Others Present:
Comments:
Evaluated By. Nations,Robert
NCDENR
Division of Environmental Health
On-Site Wastewater Section Date: ® s ! o s i e �'
Soil/Site Evaluation Fie Ir: 2 0 2 2 4 6
For An-Site Wastewater System PIN 4: 5 7 3 6 8 3 0 6 7 7
1940 Horizon SOIL MORPHOLOGY
Lan scape .1941 OtherProfile
Profile# Depth
Sbpe°lo (IH} Mineralogy Matrix Mottle Factors
Texture Structure Consistence Color Color
.1942 Wet.
% .1943 Depth
GPS Saprolde:(in) .1944 Rest.
Horizon
EHS .1947 Class
CopyTrofil Profile
LTAR" • .
.1942 Wet.
.1943 Depth
GPS Saprolacon) .1944 Rest.
Horizon
EHS .1947 Class
Copy—e.rofil Profile
L.J LTAR
.1942 Wet.
% .1943 Depth
Saprolde:60 .1944 Rest.
GPS Hortz on
EHS .1947 Class
Copy rOw Profile
LTAR,_, • ._. ...�
.1942 wet.
% .1943 Depth
GPS Saprolde:00 .1944 Rest.
Horizon
EHS .1947 Class
Gopygrafrl Profits
(J LTAR
.1942 Wet.
% .1943 Depth
GPS Saprolite:(n) .1944
orARenst.
apH
EHS .1947 Class
Copy0roril Profile
LIAR
Comments:
Attach Image
The "Open Drawing Form"button,opens the the drawing form. `
The"Import"button, attaches the drawing,or other image Into the space below. '~
Open Drawing Form
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Profile: 2 X - Y Z
Profile: 3 X Y Z
Profile: X Y Z
Profile: X Y Z
Profile: } X Y Z
Profile: X Y Z
Profile: X Y Z
Profile: X Y Z
Profile: X Y Z