985 Hwy 64W Davie County,NC - Tax Parcel Report a35 Tuesday, September 27, 201(
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WARNING: THIS IS NOT A SURVEY
ParcelInformation
Parcel Number: 1400000056 Township: Mocksville
NCPIN Number: 5738064646 Municipality:
Account Number: 27667000 Census Tract: 37059-806
.Listed Owner 1: FREIBERGER JAMES ' ': Voting Precinct: SOUTH MOCKSVILLE
Mailing Address 1: 985 US HIGHWAY 64 WEST Planning Jurisdiction: MOCKSVILLE
City: - MOCKSVILLE Zoning Class: MOCKSVILLE OSR
State: NC Zoning Overlay:
Zip Code: 27028-0000 Voluntary Ag.District: No
Legal Description: 3.60 AC HWY 64 Fire Response District: MOCKSVILLE
Assessed Acreage:, 3.74 Elementary School Zone: MOCKSVILLE
Deed Date: 10/1996 - Middle School Zone: SOUTH DAVIE
Deed Book/Page: 001900454 Soil Types: GnB2,MsC
Plat Book: Flood Zone:
Plat Page: Watershed Overlay: MOCKSVILLE
Building Value: 137630.00 Outbuilding&Extra 18670.00
Freatures Value:
Land Value: 39890.00 Total Market Value: 196190.00
Total Assessed Value: 196190.00
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
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County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to
ooUN� NC or arising out of the use or Inability to use the GIS data provided by this website.
. . �� -� �y
Permittee's D IE COUNTY HEALTH DEPARTMENT
Name +��� '' � "� '` Environmental Health Section PROPERTY INFORMATION
P.O.Box 848'
• Directions to property: t v5K La`I Mo`cksville,NC 27028 Subdivision Name:
Phone#:336-751-8760
-'N'L ;A 'n � _ (:L-L n^11,� Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: . 2357 A Road Name S }}iXMO D: �-76Z�)
**NOTE**'This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections.
Office when applying for Building Permits.
(In compliance Vijh Article,I I of G.S.Chapter 130A,Wastewater Systems,,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ON N T`4RlB H SPECT IS-. DATE ISSUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE 'kms' =�sEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE J- 'NC E WATER SUPPLY L DESIGN WASTEWATER FLOW(GPD) I_C)C' NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3L ROCK DEPTH IZ. LINEAR FT.
\ OTHER SfiQ LTi l o+� Y�
i
REQUIRED SITE MODIFICATIONS/CONDITIONS: ��l, li!L-"-01%) 60JTOX
IMPROVEMENT PERMIT LAYOUT lea-
T baa
**CONTACT A REPRESENTATI E OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 M.OR 1:00 1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: rN V V
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AUTHORIZATION NO. OPERATION PERMIT B DATE:
�.
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T SYSTEM DESCRIBE ABOVE 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.
DCHD MM(Revised)
A TION FOR SITE EVALUATION/IMPROVEMENT PERh11T&ATC
: Davie County Health Department dam✓
!,JAY Z7 Environmental Health Section — �✓
P.O. Box 848/210 Hospital Street
� Mocksville, NC 27028 , —
UMRDMI��ECAl11`MY (336)751-8760 0-1k
***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 / y /•
r
Mailing Address ,��vi/, �'�i/t'✓! LSV, Home Phone
City/State/z IP rw�� C �?7oa s� s3 s Phone 09-/2-rl
. ame on Pe than Above '
Mailing Address �D��J/� /,7 6vCs� City/State/ZiprtT�,:��L /y C, c�'d2O
3. Application For: R'Site Evaluation ❑ Improvement Permit/ATC � ❑ Both
4. System to Service: ❑ House ❑ Mobile Home 13 Business ❑ Industry El/Other
5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People # Bedrooms # Bathrooms
❑Dishwasher ❑Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
,IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: ❑ County/City 6d Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes B No
If yes,what type?
***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Properly Dimensions: 3_7 7 Y WRITE DIRECTIONS(from Mocksville)to PROPERTY:
Tax Offlc PIN: # 39t)6 Li6 Cly
Property Address: Road Name
/ 1
City/zip��1 "4., ,iilr.t ��t� 0 1 i•...z,� — l
If in a Subdivision provide information,as follows: L-P—A
Name:
Section: Block: Lot: Date home corners flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued bereafter 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 l a/n responsible far all charges i//curred f/•on)
this application. I,hereby,give consent to the Autliorized Representative of the Davie County Ilcaltli 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 suitabilit
DATE - -U Y SIGNATURE
THIS AREA MAY BE USED FOR DRANVING YOUR SITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
i
Sign given Account No. 0 2260 /
g
Revised DCHD(05/03 Invoice No. I
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In
lax Lot 6Q
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n/f James.Wesley Wooten
:Qnd wife ,
ilessk S Wooteft �, 1 �
DB 146';P,PG 463 7.
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Pad In
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- �. .U Lbolvy ioundal_1an / .. �t ., .•
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s DAVIE COUNTY HEALTH DEPARTMENT
ENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900158 Tax PIN/EH#: 5738-06-4646
Billed To: Richard Hendricks Subdivision Info:
Reference Name: Location/Address: Highway 64 West-2j028
Proposed Facility: Bathroom Property Size: 3.744 acres Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L
Slo %
HORIZON I DEPTH
Texture group "C-L- .
Consistence
Structure
Mineralogy
-HORIZON II DEPTH
Texture group C_
Consistence
Structure
Mineralogy
HORIZON III DEPTH 1
Texture groupSG1
Consistence
Structure l�
MineralogyS
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION PS
LONG-TERM ACCEPTANCE RATE I qM
SITE CLASSIFICATION: EVALUATION BY: �^`k '
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:
REMARKS:
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
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 05/99(Revised)
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!
! Per nittee's 1 G ( 11 COUNTY HEALTH DEPARTMENT
Name:"�!j��`+� �' f 'I"14 �° "•''-'' Environmental Health Section PROPERTY INFORMATION
P.U. Box 848
Directions to property: Mocksville,NC 27028 Subdivision Name:
E' Phone#:336-751-8760
Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: 2357 A Road Name:
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance wi Article,II of G.S.Chapter 130A.Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
�NVIIION N 1104EA H SPECIA'LIS'E_' DATE ISSUED
r�i
RESIDENTIAL SPECIFICATION:BUILDING TYPE.(,A—k`#BEDROOMS N A#BATHS I #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE 1 nu�R Y<PE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) )(Do NEW SITE REPAIR SITE ✓f
rr..-�� ,I
SYSTEM SPECIFICATIONS: TANK SIZE 1w GAL. PUMP TANK GAL. TRENCH WIDTH' ROCK DEPTH � - LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS: �� �( l. �� G hots+ � 6n4 4&c
IMPROVEMENT PERMIT LAYOUT r 0 V VSt:
wq
LG
AQ
i
l
i
!
!
**CONTACT A REPRESENTATI E OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 .M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY: I r J 1 N
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: a
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 02102(Revised)
{
f; '
A TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC
Davie County Health Department
AY 7 2004 En vironmenta/Health Section ` —
• P.O. Box 848/210 Hospital Street
Cr
Mocksville, NC 27028
EiVVIRBEAL
pAf�ECOUEN'AtM`( (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 Billedi( 1 �'•C� Contact Person
/
Mailing Address v�.�>bl/�9i/t'q LN, Home Phone p
city/state/ZIP i1�i� �� AIC 22d-R Business Phone
2. Name on Permit/ATC if Different than Above_ JK_ me e;/J �
JA s Fr i'���.-,-
Mailing Address �D�S� X/ Ivo City/State/Zip r;FT�,r'/�L
3. Application For: O'S'it`eEvaluation ❑ Improvement Permit/ATC ❑ Both
4. system to service: ❑ House ❑ Mobile home ❑ Business ❑ Industry IJ Other
5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People # Bedrooms # Bathrooms
❑Dishwasher []Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type It People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated
Water Usage (gallons per day)
a. Type of water supply: ❑ County/City 2 Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve?❑ Yes lid NO
If yes,what type?
***IA1POItTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUES'I'Ell
BELOW. Either a PLAT or SITE PLAN MUST BESUBAfITTED by the client with TI ITS APPLICATION. .
7
Properly Dimensions: '37 yy i9r%e1 WRITE DIRECTIONS(froni Moclisville)to PROPERTY:
i':lx orfie .PIN: //
S73Fo6 V6y-W
Property Address: Road Name,
City/Zi /X6,
nn {{
If in a Subdivision provide information,as follows:
Name:
Section: Block: Lot: Date home corners flagged:
'Phis is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued.11creafter arc 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 lam responsiblefor all charges incurred front
this application. I,hereby,give consent to the Authorized Representative of the Davie County Iiealtli Department
to enter upon above described property located in Davie County and owned by
to conduct :111 testing procedures as necessary to determine the site suitability Q
DATE _ G� SIGNATURE
h
TRIS AREA MAY BE USED FOR DRANVING YOUR SITE PLAN(Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Datc(s):
CIient Notification Date:
EHS:
Sign given Account No. ( 6 2
Revised DCIID (05/03 Invoice No. ��
Permittees- I to, ,`� DAVIE COUNTY HEALTH DEPARTMENT a
Name: =-'� ;Y� =-' - Environmental Health Section PROPERTY INFORMATION V`
C
P.O. Box 848 !1
Directions to property: Mocksville,NC 27028 Subdivision Name.
Q& Phone#:336-751-8760
- ��� LVA Section: Lot,
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
AUTHORIZATION j/-
NO: 0 2 A Road Name: L) -� �vp�"
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Artic1611 oLC S.Chapter 130A,Wastewater Systems,Section.]900 Sewage Treatment and Disposal Systems)
�Y I� \ r ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
all / _,� . IS VALID FOR A PERIOD OF FIVE YEARS.
`„_.EON 13 T L SALT SP 'ALIST DA E 1 SUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE jjU_L61E#BEDROOMS #BATHS 2 #OCCUPANTS GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
� 1,.#PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
W
LOT SIZE�'� TY E WATER SUPPLY CL DESIGN WASTEWATER FLOW(GPD) 5U0 NEW SITE REPAIR SITE ✓
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTHLINEAR FT..-�L�i
OTHERr \�_�� tr".1� �S� F-t:-1���.�7 C7..� 4S `�TL.:�
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
CA
GUS% ix�1 u�I►J�1 i 4t�c� (!� _ . fr u sT
F1 LLt-�LL�
wF-LL U
Tr� +
22"
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT rte+-1►�It) I L"�Z
SY�SiEOM INSTALLED BY:
PO&L,
fF
AUTHORIZATION N0.2/"Z14 OPERATION PE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY TEM DE BED ABOVE HAS N IN TALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT ND DISPO AL SYSTEMS",BU SH IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GI N PERIO OF TIME.
DOW 0=2(Revised) a faao 06/ ,
y ti-�„s +.fes n !^'- i.rt,. +'�'•tif... 't-»r�.,: ,T.a -r.s. r ..s:u��.-Y._.:.:.:a. :•4�:�. .i_.1 r-.f.'� ,. .. 4-u. 1, .t r..,..,-- �
--P�r
DAVIE COUNTY HEALTH DEPARTMENT
..
hlartre, r" .1� Environmental Health Section PROPERTY INFORMATION 6
P.O. Box 848
"mons to property Mocksville,NC 27028 Subdivision Name:
�. Phone#:336-751-8760
Section: Lot:
T AUTHORIZATION FOR
r WASTEWATER Tax Office PIN:# -
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 002802 ,%A Road Name: F �`�
**NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any'Building Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Artic)e 1 I of-CLS,.,Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
, -7 (, IS VALID FOR A PERIOD OF FIVE YEARS.
w ENVII� NI"4NT L E-ALT SPECIALIST DA E 1 SUED
RESIDENTIAL SPECIFICATION:BUILDING TYPE } � #BEDROOMS �� #BATHS `�” #OCCUPANTS / GARBAGE DISPOSAL:Yes or No
COMMERCIAL/SPECIFICATION: FACILITY TYPE
, #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE TYPE WATER SUPPLY W -
"� ELL DESIGN'WASTEWATER FLOW(GPD) '��G NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH_��kINEAR FT.
OTHER
1
REQUIRED SITE MODIFICATIONS/CONDITIONS: iL�r UZ ' I`'�Ykie 1L)W ATt+f` t CII i
IMPROVEMENT PERMIT LAYOUT
{
tyt�JN
' G I
F
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
zoo F I P0o60 Io' ,
(q -Z3) I ,
PCO L
r _j 'j N
Gh2A(aE
20, '----
T
AUTHORIZATION NO. 02&Z
2V OPERATION PE
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS EM DES ED ABOVE ASB N IN ALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S.CHAPTER 130A SECTION.1900"SEWAGE TREATMENT D DISPO L SYSTEMS",B SHAL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIV PERIO OF TIME.
DCHD 0=2(Revised)
Gj a gip_
- /75_1 .- - ��
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
r rIER
NAME �P/HI �Ic� /�L 17O
ADDRESS + 6� SUBiDIVISION NAME
LOT#
DIRECTIONS TO SIT /2� SL
f'�P'/ v�
DATE SYSTEM INSTALLED !-0 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY � NUMBER BEDRQ MS—2 NUMBER PEOPLE SERVED
TYPE WATE SUPP Y SP CIFY PROBLEM OCCURRING P V3J6,Z
V
1
DATE REQUESTED 4011 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193
GoMAPS -Davie County NC.Public Access Page 1 of 1
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http://maps.co.davie.nc.us/GoMaps/map/print.cfin?CFID=4141&CFTOKEN=64238063 8/6/2007
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
/ 697
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
Texture groupL
Consistence F;`
Structure
Mineralogy
HORIZON II DEPTH
Texture groupG
Consistence
Structure
MineralogyY�
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 D.
SITE CLASSIFICATION: EVALUATION BY-._9:=-)P
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:
REMARKS:'
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
'V11
.
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
Mineraloev -
1:1,2:1,Mixed
LYQte�
Horizon depth-In inches
Depth of fill-'In inches
Restrictive horizon-Thickness and inches from land surface
Saprolite-S(suitable),U(unsuitable)
Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification-S(suitable),PS(provisionally suitable),U(unsuitable) -
LTAR-Long-term acceptance rate-gal/day/ft2 DCHD 05105(Revised)