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116 Creekview Dr Lot 34 OPERATION PERMIT or fice use Only Davie County Health Department *CDP File Number 175719-1 210 Hospital Street P.O.Box 848 County ID Number. Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Turner Built Homes Property0wner: Todd Carter Address: 8582 Sheppard's Run Dr Address: 114 Country Circle Cky: Kernersville Cly: Advance State/Zip: NC 27284 State2ip: NC 27006 Phone#: (336)817-5202 Phone#: (336)978-9968 Property Location & Site Information Address/Road #: Subdivision: Magnolia Acres Phase: Lot: 34 116 Creekview Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy.158, right on Hwy 801, Left on Peoples Creek Rd, right on Southern Magnolia , Right on Tulip #of Bedrooms: 3 Magnolia, left on Twisted Hill, Left on Creekview #of People: *vvater Supply: PUBLIC *IP Issued by. 2140-Nations,Robert *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPO OR LESS) *CA issued by: 2140-Nations,Robed Saprolite System? QYes QNa Design Flow: 3 6 0 Pump Required? *Distribution Type: PUMP TO GRAVITY G Yes QNo Soil Application Rate: 0 2 *Pre Treatment: Drain field Nitrification Field 1 8 0 0 Sq-ft• *System Type: INFILTRATOROUICK4STAND ARD No. Grain Lines 6 Installer: Tony Ball Total Trench Length: 4 6 0 ft. Certification#: 4700 Trench Spacing: — 9 Inches O.C. i+)Feet O.C. *EH S: 2140-Nation,Robert Trench Width: 3 Inches gFeet Date: 0 4 / 1 0 / 2 1 0 5 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 ApprovalStatus. Inches Maximum Trench Depth: 3 6 Inches ® `Approved 0 Disapproved Maximum Soil Cover: 2 4 Inches CDP File Number 175719 - 1 County ID Number: Septic Tank Manufacturer. Shoaf Lat. - STB: 760 Long: Gallons: 1000 Installer. Tony Ball Certification#: 4700 Date: l a / a l / a 0 1 4 *EH S: 2140-Nations,Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter Date: 0 _4 / 0 9 / 0 0 1 5 ST Marker. El Yes 0 No Reinforced Tank: ❑ Yes CI No AppravalStatus Piece Tank: [I Yes No ❑ Approvetl❑ Disapproved �, Pump Tank Manufacturer. Shoat Installer. Tony Ball PT: 42 Certification#: 4700 Gallons: 1250 *EH S: 2140-Nations,Robert Date: 1 a / a 1 / a 0 1 4 Date: 0 4 / 0 9 / 2 0 1 5 RiserSealed Q Yes ❑ NO RiserHeght: ® Yes ❑ No (Min.6 in.) Appravaistatus em rced Tank: ❑ Yes NO ® Approved❑ Disapprovei 1 Piece Tank: ® Yes ❑ No Supply Line FPipe ipe Size: a inch diameter Installer. Tony Ball Length: 1 8 0 feet Certification#: 4700 *EH S: Schedule: 40 2140-Nations,Robert Pressure Rated [E Yes ❑ No Date: 0 4 / 0 9 / 2 0 1 5 Approved fittings ® Yes El No Approval status ovz ®SApproved❑ Disapproved Pump e Pump Type: Zoeler Installer. Tony Ball Dosing Volume: — Gal Certification#: 4700 Draw Down: Inches *EH S: 2140-Nations,Robert *Chain: STAINLESS Date: 0 4 / 1 0 / 2 0 1 5 Valves Accessible p Yes ❑ No Flow Adjustment Valve ® Yes ❑ NO Check-valve Yes 0 NO Approval Status= PVC unions Q Yes ❑ No tlva Vent Hole p Yes ❑ No Anti-siphon Hole p Yes 0 No CDP File Number 175719 - 1 County ID Number: Electric Equipment N �4X or Equivalent [E Yes ❑ No Installer. Tony Ball Box 12 inches Above Grade Q Yes ❑ No Certification#: 4700 Box Adj.To Pump Tank p Yes ❑ No Conduit Seated n Yes ❑ NO *EHS: 2140-Nations,Robert Pump Manually Operable no Yes ❑ NO 0 4 / 1 0 / .1 0 1 5 *Activation Method:PIGGYBACK Date: Approval Status " Alarm Audible ® Yes ❑ NO Approved 01-01 isapproved Alarm Visible ® Yes ❑ No 2140-Nations.Robert *Operation Permit completed by: Authorized State Agen , Date of Issue: 0 4 / 1 0 / 2 0 1 5 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 II A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER -Minimum System InspectionlMaintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator.NIA Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora hometbusiness owner must maintain a valid contract with a public management entitywith 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 for maintenance and operation, responsibilities of the owner and systems operator.provisions that the contract shall be in effect for as long 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. '9Hand Drawing 41mport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 175719- 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box Bas County File Number: Mocksville NC 27028 Date: Olnch Drawing Drawing Type: Operation Permit Scale: , OON/A = ft. i i ! I ( I 4 ------- 171 1.57 I -`C`` Cat r 3 J I I I I II � I ` CONSTRUCTION For Office use only AUTHORIZATION *CDP File Number '175719-1 Davie County Health Department 1 I Q County ID Number. 210 Hospital Street `� L 0 o Evaluated For. NEW P.O.Box 848 l �'(' Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 l a / 1 5 .2 0 1 9 Applicant: Turner Built Homes Property Owner: Todd Carter Address: 8582 Sheppard's Run Dr Address: 114 Country Circle City: Kemersville City: Advance State2ip: NC 27284 State0p: NC 27006 Phone#: (336)817-5202 one#: (336)978-9968 Ph Property Location & Site Information Address/Road #: Subdivision: Magnolia Acres Phase: Lot: 34 116 Creekview Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158, right on Hwy 801, Left on Peoples Creek Rd, right on Southern Magnolia , Right on Tulip Magnolia, left #of Bedrooms: 3 on Twisted Hill, Left on Creekview #of People: "Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesigan ssification: Provisionally Suitable Inches Minimum Soil Cover. System? QYes QNo 1 a In low: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - a Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: PUMP TO GRAVITY TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 0 0 0 _ Gallons *Proposed System: 250/6 REDUCTION 1-Piece: QYes 4g)No Pump Required: ®Yes QNo QMay Be Required Nitrification Field 1 8 . 0 0 Sq.ft. Pump Tank: 1 0 0 0 Gallons No.Drain lines 4 1-Piece: QYes QNo Total Trench Length: 4 5 0 ft, GPM vs— ft. TDH Trench Spacing: Inches O.C. 9 @Feet O.C. Dosing Volume: _ Gallons Trench Width: Inches 3 . 2Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF QTS-I OTS-II Septic Tank InstallerGrade Level Required: Q) OIl OIII OIV Dann 4 of Q CDP Fite Number 1757191- 1 County ID Number. ❑ Open Pump System Sheet Repair System Required:@Yes. ONo ONo, but has Available Space rDesign System Trench Spacing: t�Inches O. . ification: Provisionally Suitable, — 9 a Feet O.C. Trench Width: Inches w: 3 6 0 3 Feet Soil Application Rate: 0 Aggregate Depth; inches Minimum Trench Depth: a 4 "System Classification/Description: Inches TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches *Proposed System: 25%REDUCTION N itrification Field 1 8 0 0 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 4 *Distribution Type: PUMP TO GRAVITY TotalTrench Length: 4 5 0 Pump Required: Oyes ONo 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 by the Health Department in noway guarantees 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 be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may beissued atthe 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 Perini!,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 permR or Construction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).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 (1938(b)). Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps. Signature* Date:, Issued By: 2140-Nations,Robert Date of Issue: . 1 a / 1 5 / a 0 1 4 Authorized State Agent: � Malfunction Log OYeS ;'rf�z @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie county Health Department CDP File Number: 175719- 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 1 .2 / 15 / a 0 1 4 Q Inch Drawing Drawing Type: Construction Authorization Scale: . OBlock QN/A �G' o 07. V l` C Ls V � 4P, X- cl L. WINh n .c� IMPROVEMENT PERMIT For office UseOniy *CDP File Number 175719-1 �� - Davie County Health Department County ID Number 210 Hospital Street P.O.Box 848 Evaluated For. NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 12/15/2019 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: Turner Built Homes rr perty Owner: Todd Carter Address: 8582 Sheppard's Run Dr ddress: 114 Country Circle Cty. Kemersville tY: Advance State/Zip: NC 27284 State/Zip: NC 27006 Phone#: (336) 817-5202 Phone#: (336)978-9968 .Property Location & Site Information Address/Road#: Subdivision: Magnolia Acres Phase: Lot: 34, 116 Creekview Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158, right on Hwy 801, Left on Peoples Creek #of Bedrooms: 3 Rd, right on Southern Magnolia , Right on Tulip #of People: Magnolia, left on Twisted Hill, Lefton Creekview *Water Supply: PUBLIC System Specifications nitial S�,ste�m ,bite Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolde System? OYes @No Maximum Trench Depth: 3 6 Inches Design Flow: 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 _ a 1-Piece: OYes @No Pump Required: @Yes ONo OMay,Be Required "System Classification/Description: TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Pump Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: OYes @No Repair System Required:@Yes ONo ONo, but has Available Space Co Repair System ite Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches il Application Rate:- a Maximum Trench Depth: 3 6 Inches7 *System Classifratan/Description: Pump Required: @Yes ONo O May be Required TYPE III B.SYSTEM VV/SINGLE EFFLUENT PUMP *Proposed System: 25%REDUCTION Page 1 of 3 CDP File Number 175719- 1 County ID Number: *Site Modifications ❑ Open Fill 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. , provement Permit shall be valid for 5 years from date of issue with a site plan(means a drawing not necessarily drawn to Site Plan Tho Im O scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the a site forthe proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be vaild without expiration with plat(means a property surveyed prepared by a registered land 0 surveyor,drawn to a scale of oneinch equals no morethan 60 feet,'that Includes:the specific location of the proposed facility andappurtenances,the site for the proposed Wastewater system.land the location ofwater supplies and surface waters. Plat also means,for subdivision tots 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 pian that is drawn to scale). The Department and Local Health Department may Impose conditions on the issuance and may revoke the permits for tallure of the system to satisfy the conditions,the rules,or this article.This permit is subject to revocation If the site plan,plat;or intended use changes(NCGS 13OA-335(fj).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'(.1938(b)j. Applicant/Legal Reps,Signature Required? Oyes ONO Applicant/Legal Reps.Signature: Date: "Issued By: 2140-Nations,Robert Date of Issue: 1 a / 1 5 / 2 0 1 4 Authorized State Agent: OValid without Expiration? 9 0Create CA? OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 • IMPROVEMENT PERMIT 175719 - 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: , pelock ON/A ./ IG 1— 1 ,? w w� � t� r ♦ 1 Dmr�A Mr.BOOK 7. MRS pACM INTEN'PI Y LENT.BLANK i AAr j D.7i70 �4r] -57 a ..D OFED BOOK— J�_PAc the Otselro that anetar L Iced dubs•iotarpmed d teed cod art phikea ped�ppmtmmen swab Y b ds Oao�m Y fns dyls.Aed 6s O,rYr ammub�riti pmts Y fse w.pte.W tf� t_lo eanc7 the pons Y res�iyleWk Y�u•Eet�E10.bee ad akv ardl aaeeMreeti uA Wt .Onota rill rne>nr sod dete�d the tak gsisri the Mnf d le.ions d all pe". thassoesv mbjeet Y:know easpii,.K . �♦st•.ra.VA-,!r, IN WITNESSWIi ®d}tbr;tkmanEor has act his band and seal,or if corporate,has cawed this iosh'ument to be signed in its corporatename�j tts i d y�yt�o d otTi«ra and its seal to be hereunto affixed by authority of its Bawd of Directors,the day and year first i' a r ewt7 > rtnrsseeat,wr:, ;rt.aru,ra rvMr (seal) (seal) (seal (seal) (seal) (seal) (seal (sear (seal) (seal) Branch BAnking and Tntc} Crop ani By: �i2..0 •Y i t e- pm.ided _,SemNery '.�' '1`i: .'.��� , scal STA,7E•gl OpTP CAROLINA—Forsyth County P;,";'S•;:••••••.,, +r I, ,leyiaa� Su:y+U����.c ,a Nota Public of Fon NC do bene tip• %;"s certify that_ CArL £, fro.✓.✓ Notary personally carne before we this day and acknowledged that_jle is secretary of Branch 8ank3ncr and Trust Cottman}� a North Carolina corporation,and that by authority duly given as the act of the corporation,the a^ u_�(�� foregoing instrument was signed in its name by its1i President,scaled with its corporate J• , seal and attested by_ CA,L f, Brut u)nJ• as its�ss�Secreta ry. u;Itn ,o"' Witness my hand and notarial seal this the � day of 19 aeeust My commission expires (� SY ,19��. ✓w, N Public STATE OF NORTH AROUNA—Forsyth County 1, a Notary Public of Forsyth County,NC,do hereby, certify that o personally appeared before me this day and acbxmIcdgW the execution of the foregoing deed of conveyance.Witness my hand and notarial seal this the day of ,19_. stubs AW My commission expires ,19_ Notary Public STATE OF NORTH CAROLINA—Forsyth County I,___ .a Notary Public of Forsyth County,NC,do hereby certify that personally appeared before me this day and acknowledged the execution of the foregoing deed of conveyance.Witness my had and notarial teal this the day of seell3r"p My commission expires—,19—._ Notary Public STATE OF NORTH CAROLINA—Forsyth County I, .a Notary Public of Forsyth County,NC,do hereby certify that personally appeared before roe this day and aclouowledged the execution of the foregoing tied of conveyance.Witness my had and notarial seal td s the day of 19_. BEAL rAW My commission expires ,19—.. Notary Public STATE OF NORTH CAROLINA—Forsyth County . a Notary Public of Forsyth County,NC,do hereby certify that Personally appeared before me this day and acknowledged the execution of the foregoing deed of conveyance.Witness my bad and notarial seal this the day of 19—. . asALWan. My commission expires ,19�._ Nota Public The foregoing Certificate(lg of Bevorah Suzan Baker, Notary Public of Forsyth County. NC. IsWcortified to be correct pothe 28 d .of August ,19 96 , enryy G SHo advie ixFxSpm,Register of Deeds for 1tSorsyth County by: A.d,,,e, C�, •�./��p,:r„.� Daprtyt/Assistant h•eaa.w rs►r.rerrs�rmsss ` 0C sho�� � �o o �,/ao��P �� 5T-� fi 74�G c d Baa a \ 10 (4e 1y OC 100 3 r pA t PPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC " Davie County Environmental Health DatD: t . P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)_753-1680, , Application For: ❑SiLte FF,,valuation/lmprovement Permit L�Authorization To Construct(ATC) ❑Both Type of Application: 'IIINNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility IIMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION /) t yV.e f--z Q -J-r-ad.rr.e(5o4 Name to be Billed 'V6,j.-W \tooN-e5 Cc-Contact Person Billing Address 850Z eA,n mac-. Home Phone 334 ^t3IZ-SZOZ City/State/ZIP NC 2-1284 Business Phone 33(p^�z3—po�FS Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Fla ed NOTE: A survey plat or site plan must accompany this application. Included:O Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name 7-odd G>,C, 'Z' Phone Number 33(0—c?-?g 3�-4� "q � Owner's Address (14 Cogc-rFr✓ Lw r AbdazHee City/State/Zip Oe— Z-T00(v Property Address l l AAVC,0cr— City Lot Size .3•(�Oq Ac,c,t5 Tax PIN# 64-DiSubdivision Name(ifapplicable) /Kai no V-. ,4cres Section/Lot# Lc A 3`{ P64- Directions rections To Site: SeJL n,,% t-Xwy gat L I;(- vi Pdopllt Cr-t.1c Rd! Af. oh So,a-l.c�n Nola (- T! chr C . �wi i If the answer to any of the followinj questions is"yes",supporting do umentation must be attached. Are there any existing wastewater systems on the site? Dyes Wo Does the site contain jurisdictional wetlands? ❑Yes QAo Are there any easements or right-of-ways on the site? Dyes I➢'IQo Is the site subject to approval by another public agency? Dyes Vigo Will wastewater other than domestic sewage be generated? Dyes 046 IF RESIDENCE FILL OUT THE BOX BELOW #People S #Bedrooms 3 #Bathrooms a.S Garden Tub/Whirlpool Yfes ❑No Basement:Dyes 1090 Basement Plumbing: ❑Yes Wo 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: 1kConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:*-,C'ounty/City Water ❑New Well ❑Existing Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes V050 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 ging or staking the house/facility location,proposed well location and the location of any other amenities. �Y Site Revisit Charge Prope is or er's legal representative signature Date(s): .17-11 J Client Notification Date: Date EHS: Sign given Dyes❑No Account# '_ 1 Revised 11/06 Invoice# I UNE I DIREC'nONII STANCE L1 N7109 04 E 51.63 L2 N7W5 05 E 53.45' --" to N L3 N56.2Q 38 E 41.73 �..-' [� L4 N 37(r45 56:41 -wo C5 N3836 41 E• 67.39 / O L6 N7 25 E 46.43 I N a C7 35-46-p, 694 ^r. N/F ROBERT L pDTTS Q' a n' W E LB L9 N 54 38 E 4 Og ---. -� // D.B. 1 M PG. 149 U �► O L10 N654401 E 48. -1s111 ""1,,%4 Q Isis S Ltt NO3'4800 E 19.69 106.5 LL. Q Z (/)wP.B.14 PC 75 L12 N77'52 J5 E 13 7 L12 - `�'�-.•..,,,,_ O = }}«. Lid?Q Q 10 ut ¢ Z Z 0 Y LID 4 4 HWU m 1 '� -__ • U CA �sZ N/F DOUGLAS R. MARKLAND � ��' ..-r w N s O CoW W D.B. 88, PG 325 Lg �aY to /y W V /� ,` O 0 r w �.-FSR�"^ a Q w a Z�e p0 17 nom. IL C'CO Q q co .d" V- to 3.4019 AC. L5 PED 9.6 Q DWELU w _ 2ao• t° L4 ��� f 151,1' Q 11 !� 11 .4" i •qa � 0 i i 15' U LrTY �OO GE EASEMENT --------------- }" < Z e- ry 05— J 314 —— „ 0.0 REEK.\AEW � DRIVF Z59L PUBUC-2/w o d -� ----------------- r to ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION ✓ LOT�:!Z_'� Soil/Site Evaluation APPLICANT'S NAME e_ DATE EVALUATED PROPOSED FACILITY /`>•" PROPERTY SIZE StAc�/J1�17/� SUBDIVISION ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 5 6 7 Landscape position ,(, G..- G� Sloe% _77— HORIZON I DEPTH Texture group5G Consistence Structure Mineralogy HORIZON H DEPTH % 111 Texture group 4� Consistence '(` Structure / Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH N Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON ' SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: rLSjlfV k EVALUATION BY: LONG-TERM ACCEPTANCE R-ATTE: �ta�� OTHER(S)PRESENT: REMARKS: v �` < yy z LEGEND loo"kf 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 oist 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 DCHU(01-90)