121 Manu Forti WayOPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O Box 848
Mocksville NC 27028;
Phone: 336-753-6760 Fax: 336.753-1680
Applicant; James and Nancy McKay
Address: 180 Jesse King rd
City Advance
State2ip: NC 27006
Phone #: (336) 940-2345
P
Address/Road #: Subdivision:
121 Manu Fort! Way
Advance NC 27006
Structure:. SINGLE FAMILY.
# of Bedrooms: 3'
# of People:
IVVater Supply: PUBLIC
'IP Issued by. 2140 - Nat%ns, Robert
'CA issued by: 2140- Nations, Robert
Design Flow: 3 6 0
Soil Application Rate: 0 a 7 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
Property owner. Julianne Hanes
Address: 242 Jesse King Rd
City: Advance
Statefzip: NC 27006
Phone #:
Phase: Lot:
Directions
1-40 Exit Hwy 801 go left, right on yadkin Valley Rd.
Jesse King on right property "on right
*System Classification/Description:
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD'OR LESS)
SaproliteSystem? QYes (1)No
*Distribution Type: GRAvITY- PARALLEL (eq. d -box) Pump Required?
QYes QNo
*Pre Treatment:
1 3 0 9 Sq. It.
4
3 3 6 ft.
9 Qlnches O.C.
Feet O.C.
3Inches
*Feet
Inches
*System Type: INFILTRATOR QUICK 4 STANDARD
Installer. Sherman Dunn
Certification #:
*EH S: 2140 - Nations, Robert
Date: 0 7 1 2 3 % 2 0 1 5
W Y A
Minimum Trench Depth: 3 6
Inches
ell—
Minimum Soil Cover.
2A Inches
Mak mum Trench Depth' Inches
Maximum Soil Cover. 2 4
Inches
CDP Fite Number 'I39271 ' 1 Countv ID Number: B�-o0t)-o0o-4906
Manufacturer. Shoaf
STB: 760
Gallons: 1000
Date:
0
4 /
0 8/
2 0 1 5
*Filter Brand:
POLYLOK PL -122 With Pipe Adapter
ST Marker.
❑
Yes
R
No
nforced Tank:
❑
Yes
O
No
1 Piece Tank:
❑
Yes
®
No
/
Date:
RiserSealed ❑ Yes
❑
Let.
Long:
Installer. Sherman Dunn
Certification #:
*EH S: 2140 - Nations, Robert
Date: 0 7/ 2 3 / a 0 1 5
Pump Tank
Manufacturer
Installer
PT:
Certification #:
Gallons:
*EHS:
Date: /
/
Date:
RiserSealed ❑ Yes
❑
No
RiserHeight: ❑ Yes
❑
NO
(Min.6
in.)
ApptavalStatus
Reinforced Tank: ❑Yes
❑
NO
�y
— �'
❑ Approved❑ Dtsapproveci_
1 Piece Tank: ❑Yes
❑
No
Supply Line
Pipe Size: inch
diameter
Installer
Pipe Length:
feet
Certification #:
*EH S:
*Schedule:
Pressure Rated ❑ Yes
❑
No
Date:
Approved fittings ❑ Yes
❑
No
Approval Status
❑Approved ❑ Disaprovedh
Pump
Requirement
Pump Type:
Instaler.
Dosing Volume:
-
Gal Certification #:
Draw Down:
Inches
*EHS:
*Chain:
Date:
Valves Accessible ❑ Yes
❑
No
Flow Adjustment Valve ❑ Yes
❑
No
Check -valve D Yes
❑
No
Approval Status
PVC unions ❑ Yes
.. .
❑
No.
�' ❑Ap iroyed ❑ Disapproved
Vent Hole E] Yet
E3NO
4.
r r,k ." . ; s v
Anti -siphon Hole ❑ Yes
❑
No
CDP t=ile Number 139271 -1
NEMA U Box or Equivalent ❑ Yes
Box 12 inches Above Grade ❑ Yes
Box Adj. To Pump Tank ❑ Yes
Conduit Sealed ❑ Yes
Pump Manually Operable ❑ Yes
*Activation Method:
Electric
❑ No
13 No
❑ No
❑ No
❑ No
Alarm Audible ❑ Yes = ❑ N o
Alarm visible ❑ Yes ❑ Na
2140 - Nations. Robert
"Operation Permit completed byL
Authorized State
County ID Number: B7.0004=4906
Apment
Installer.
Certification #:
*EH S:
Date: /
5.cr r
Approval Status-, - ,
O
Approved ❑ Disapprsoved
Date of issue: 0 7/ 2 3 / a 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 Authora6liori. This property is served by.a TYPE II A. Sewage se is 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 Inspection/Maintenance Frequency By Certified Operator:
NIA
Reporting Frequency By Certified Operator. NIA
Rule .1,961requires that a, Type IV and V septic systems designfora ed
certhom operators owner must
a life of the maintain a valid contract
with a public management entitywith a certified operatorora ptic system.
Rule .1961 requires that Type VI septic systems designed for a home/business 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 envy prior to the
issuahce of an ;Operation Permit fora `system, required to be maintained lova public. or private management envy, unless the
system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and
p systems be in effect for as long as the
o Bratton, cesponstblities ofthe, owner and tams operator, provrstons that the contract shaft
system is in use, and otherrequirements forthe,contir ed proper perfomtiance of the system."tt shall also be a condition of
the Operation Permit that'subsequent owners of the s tams execute strch.a contract.
@Hand Drawing almport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksvilie NC 27028
Drawing Drawing Type: Operation Permit
CDP File Number: 139271 •1 .
County File Number: 67-000-0004906
Date: /
0Inch
Sc81e:(,Block = ft.
ON/A
CONSTRUCTION
AUTHORIZATION
�« Davie County Health Department
210 Hospital Street
Otarwv�-
P.O. Box 848
/ For Office Use Onlv
=CDP File Number 139271-1
County ID Number. B7-000-0004906
Evaluated For: NEW
`Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone: 336-753-6780 Fax: 336-753-1680 0 7/ a 0/ a 0 a 0
Applicant: James and Nancy McKayrAmddres;
perty Owner: Julianne Hanes
Address: 180 Jesse King rd s: 242 Jesse King Rd
CRY: Advance
State/Zip: NC 27006
Phone #: (336) 940-2345
AddresslRoad #: Subdivision:
Jesse King Rd
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
"Water Supply: PUBLIC
s
0
GAY: Advance
State2 ip: NC 27006
Phone #:
Phase: Lot:
Directions
1-40 Exit Hwy 801 go left, right on yadkin Valley Rd.
Jesse King on right property on right
p 1 0 0 0 Gallons
*Proposed System: 25% REDUCTION 7 -Piece: OYes *No
Pump Required: (Yes *No QMay Be Required
Nitrification Field 1 3 0 g Sq. ft. Pump Tank: Gallons
No. Drain Lines 3 1 -Piece: OYes ONo
Total Trench Length: 3 a 7 ft GPM—vs— it. TDH
Trench Spacing: — 9 Inches O.C. Dosing Volume: Gallons
2Feet O.C. g —
Trench VYdth:2Feet lnches
Aggregate Depth:
3 Grease Trap: Gallons
inches Pre Treatment: ONSF OTS -1 CATS -11
1 Septic Tank Installer Grade.Level Required: 01 011 0111 0IV
Minimum Trench Depth:
a
4
Inches
$ite Classification: Provisionally Suitable
Saprolite System? OYes *No
Minimum Soil Cover.
1
a
Inches
Design Flow: 3 6 0
Maximum Trench Depth:
3
6
Inches
Soil Application Rate:Maximum
0 a � 5
Solt Cover.
.1
4
inches
*System Classification/Description:
"Distribution Type:
GRAVITY- PARALLEL (eq. d -box)
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Se tic Tank -
p 1 0 0 0 Gallons
*Proposed System: 25% REDUCTION 7 -Piece: OYes *No
Pump Required: (Yes *No QMay Be Required
Nitrification Field 1 3 0 g Sq. ft. Pump Tank: Gallons
No. Drain Lines 3 1 -Piece: OYes ONo
Total Trench Length: 3 a 7 ft GPM—vs— it. TDH
Trench Spacing: — 9 Inches O.C. Dosing Volume: Gallons
2Feet O.C. g —
Trench VYdth:2Feet lnches
Aggregate Depth:
3 Grease Trap: Gallons
inches Pre Treatment: ONSF OTS -1 CATS -11
1 Septic Tank Installer Grade.Level Required: 01 011 0111 0IV
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
DrawinS Drawing Type: Construction Authorization
CDP File Number: 139271-1
County File Number. 87.000-0004906
Date: 07 / a0 / 2015
Q Inch
Scale: QBlock
QN/A
y i
i
l t�I
I
_
dt
.3
jf
'
CDP File Number 139271 -1 County ID Number: B7.000-000-4906
❑ Open Pump System Sheet
Ir -System Kequlrea:VICS UIVU l.,lIVU,[JutrrdbMVdildUlC Opdcrr
._..,..... _,..-.....
Trench Spacing:V
Inches O.
*Site Classification:
Provisionally Suitable
-,
.- , ,, 9 , Qr Feet O.C.
Design Flow:
Trench width:
Inches
Feet
3 6 0
_ ` s
Depth:
SoilAggregate
Application Rate:
0 a 7 5
inches
.�
Minimum Trench Depth:
a 4
*System Classification/Description:
Inches
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover
I a
Inches
Maximum Trench Depth:
3 g
*Proposed System:
25% REDUCTION
Inches
Maximum Soil Cover;
� 4
Nitrification Field
1 3 0 Sq. ft.
Inches
No. Drain Lines
"Distribution Type:
GRAVITY - PARALLEL (eq.d-box)
3
Total Trench Length:
3 a 7
pump Required: QYes
allo
oMayBe Required
ft
4
Pre Treatment: O NSF
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 bevalid for a person equal to the period of validity of the Improvement Fern it, not
to exceed five years, and maybe Issued atthe sametimethe Improvement Permit issued (NCGS 130A-33G(b)). If the Installation has not been
completed during the period of validity of the Construction Permit, the information submitted in the application fora permit or Construction
Authorization is found to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall became
Invalid, and may besuspended 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
(1988(b)).
Applicent/Legal Reps. Signature Required? Oyes ONO
ApplicanVLegai Reps. Signature: Date: .
*Issued By: 2140 -Nations, Robert Date of Issue: _ 0 7 / , 2 , 0 1 a 0 1 5
Authorized State Agent: Malfunction Log Oyes
@Hand Drawing Oimport Drawing
**Site Plan/Drawing attached.**
Paae 2 of
m
AI 1I,
3.0
�r p APPLICATION FOR SITE EVALUATIONAWROVEMENT PERMIT & ATC
Davie County Environmental Health
}lV�' P.O. Boz 8=10 Hospital Street
MOclsavi114 NC 27028
(331)753-67s0/ a 753-1680
�tApplication For. 11 Site Evaluation/Improvement P t 11�AAhorization To Cow i�10Soth
1�';o,.,��.rApphcm. Sir w System ORepair to Isxis System . O1 ionl I.Meation of Esping System or Facility
\` ` • * MPORTANP" THIS APPLICATION C WOTBE PROCESSED UNLESS ALL OF THE REQUIRED
aN INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructiocn.
Nae to be Billed tFr'L Contact Person _ J L� N AV -1
Billing Address / t PU4ArU r o (ZT-F-t How Phone 33 �I O -
City/Statew iV PrrJCF N C rg'7oo G Business Phone
Name on Pe=t/ATC ifDi�erew than Above
Mailing Address City/State/Lip
NOTE: A survey plat or site plan must accompany this application. Included 0 Site Plan OPlat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
OvvnWsName rA� Phone Number
ownces, Addnas—IS• t MtrtV u Fb2T-X7ton+j city/State/Zipth6hl►4r�cE nt c m7 c.
Pnopetty Address ity
Lot Size , J , t &Lam Tax PIN#
Subdivision Narne(if applicable) Section/Lod
Directions To Site. TO -M �.AOL'trl!t't.t-E�+1 'TO—ESSE K,4
If the answer to any of the following questions is `j es^. supporting documentatlor� turas be attached '
Are them any existing wastewater systems on the site? OYa pFlg
Does the site contain jurisdictional wetlands? 0 92 BRo
Are there any easements or right-of-ways on the site? Oyes LBS,
Is the site subject to approval by another public agency? 0Yes Bl low
Wal! wastewater other than domestic sewage be generaup ❑Yes BiQo
IF RESIDENCE FILL OUT THE BOX BELOW
# People 14 # Bedrooms # Bathrooms Garden Tub/Whirlpool OYes Mfo
Basement: Oyes fimo Basement Plumbing: OYes @go-
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of FacilityMusiness 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
Tbis is to certify that the information provided on this application is true and correct to the bat 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 tied in this application is falsified or changed. I hereby grant right of entry to the Authorized
Represen�ioe vieco ealth Department to conduct necessary inspections to determine compliance with applicable
laws nstsat am responsible for the proper identification and labeling of property lines and corners and
locating or the house/faeility location, Proposed well location and the location of any other amenities.
Site Revisit Charge
Property 's o egal representative signature
Ducar.
111 Client Notification Date:
Date ESS:
Sign given Oyes ONO Account #
Revised 11/06 " Invoice #
Applicant: James and Nancy McKay
Address: 180 Jesse King rd
City: Advance
State/Lip: NC 27006
Phone #: (336) 940-2345
"Address/Road #:
Jesse King Rd
Advance
Structure:
# of Bedrooms:
# of People:
*Water Supply:
Subdivision:
NC 27006
SINGLE FAMILY
3
PUBLIC
Provisionally Suitable
SaproliteSystem? QYes @No
Design Flow: 3 6 0
Soil Application Rate: 0 a 7 5
.I -
Property owner: Julianne Hanes
Address: 242 jesse King Rd
City: Advance
State/Zip: NC
Phone #:
----
27006
Phase: Lot:
Directions
1-40 Exit Hwy 801 go left, right on yadkin Valley Rd.
Jesse King on right property on right
tem Specifications
*System Classification/Description:
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR
LESS)
*Proposed System: 25% REDUCTION
Minimum Trench Depth: a 4 Inches
Maximum Trench Depth: 3 6 Inches
Septic Tank:
1 0 0 0 Gallons
1 -Piece: QYes O No
Pump Required: QYes QNo OMay Be Required
Pump Tank: Gallons
1 -Piece: QYes ONo
Repair System Required:@Yes ONo ONo, but has Available Space •
Repair System
*Site Classification: Provisionally Suitable
Soil Application Rate: 0 a a 5
*System Classification/Description:
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR
LESS)
1 *Proposed System: 25% REDUCTION
Minimum Trench Depth: a 4 Inches
Maximum Trench Depth: 3 6 Inches
Pump Required: QYes QNo O Maybe Required
Donn 1 M1
1392T1 - 1 67-000-o0049os
.CDP File Number 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.
7;
*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. A:
7!
Site Plan The Improvement Permit shall be valid for 6 years from date of issue with a site pian (means a drawing not necessarily drawn to
scale that shows the existing and proposed property lines with dimensions, the location of thefacility and appurtenances, the
site forthe proposed Wastewater system, and the location of water supplies and surface waters).
Plat The Improvement Permit shall be wild without expiration with plat (means a property surveyed prepared by a registered land
O surveyor, drawn to a scale of one Inch equals no more than 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 platthat 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 rules, or this article This permit Is subject to revocation If the site plan, plat, or Intended
use changes (NCGS 130A -335(f)). 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)j
Applicant/Legal Reps. Signature Required? Oyes ONo
.Applicant/Legal Reps. Signature', Date:
"Issued By: 2140 -Nations, Robert Date of Issue: 0 7/ 1 5/.2 0 1 4
Authorized State Agent: OValid without Expiration?
0Create CA?
Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Pana 9 of
• IMPROVEMENT PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 139271 - 1
County File Number: 137-000-000-4906
Date: ././
i
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
• "'' 1 Davie County Environmental Health
P.O. Box 848/210 Hospital Street ,
�03) Mocksville, NC 27028 n (/
(336)753-6780/ Fax (336) 753-1680
�Aype ' I Sife Evaluation/Improvement Permit ❑ Authorization To Construe ATC) ❑ Both
• of Application ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to'be Billed JAMES i- N A rU CI 1-j e - ley Contact Person N H N Cy h e l�Ab
Billing Address 1160 7e55E %ZING- 217- Home Phone 33(-- "'140- 23L15
City/State/ZIP •AD\1fJ0Ct= , AJ . C, q--1645aBusiness Phone '3 3 LD- S-1-1 - 13'13
Name on Permit/ATC if Different than Above $.A JKE
Mailins Address City/State/ZiD
PROPERTY INFORMATION
*Date House/Facility Corners Flag d
NOTE: A surveyplat or site plan must accompany this application.
Included: & Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with
complete plat.)
Owner's Name :7UL%F0JME
t4AQES
Phone Number cM
V S77 S!�
Owner's Address :ZLA'1
SSE KIUCs- ('O.
City/State/Zip A'DVA&JCE
. O ,C, 1-7COG
Property Address
Lot Size . /
City --:9 -Q Q- OQQ- 06f&
Tax PIN#
Subdivision Name(if applicable)
Secti ot#
9�itions To Site: 40 -
! W
Or
rAi Va,
eT
If the answer to aAyof the folio ing questio is "yel, suppo ng documentation must be attached.
Are there any existing wastewater systems on the site? L1 Yes o
Does the site contain jurisdictional wetlands? ❑Yes Ao
Are there any easements or right-of-ways on the site? ❑Yes o
Is the site subject to approval by another public agency? ❑Yeso
Will wastewater other than domestic sewage be generated? ❑Yes Q10
[F RESIDENCE FILL OUT THE BOX BELOW 11
f/ People# Bedrooms` # Bat}oms –I—Garden Tub/Whirlpool ❑Yes 04o
Basement: ❑Yes o Basement Plumbing: ❑Yes &&o
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 ❑Accepted ❑Innovative ❑Altemative ❑Other
Water Supply Type: [/County/City Water
❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes W<O
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 comers and
locatfpg and flagging or stall ing the�house/%facility location, proposed well location and the location of any other amenities.
/ Site Revisit Charge
Pr erty owner's or owner's leg ntative signature -
Date(s): ..
6 Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No
Revised 11/06
Account # �% I
Invoice #
P2i�t
GRfl�Ei 3C)' x
�oUS� I
W V\-jE2
ri I
i
U7
h
l�
o
j �5St �l�JCr 27 . Vflc_L4E`l �1 . l
LM
i
L43 0() r
143
5$8
M :�.180
5
M
(� o rvfA
All data Is provided as is without warranty or guarantee of any kind either expressed or implied Including but not limited to the Implied
r ^ 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 or arising out Pri nted: J u n 23, 2014
of the use or inability to use the GIS data provided by this website.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
"
Soil/ Site Evaluation
APPLICANT INFORMATIO1N PROPERTY INFORMATION
Account #: ' 3� 27! Tax PIN/EH #:
Billed To. n /aNe�/ Me �qt, Subdivision Info:
Reference Name. �y "l J Location/Address:
nesse K%nI
Proposed Facility: R�s�o(e�e� Property Size:, /' Date Evaluated: T C)
Water Supply: On -Site Well
Evaluation By: Auger Boring_
Community
Pit
Public
Cut
i
FACTORS
1
2 3
.4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
—
Texture group5C
5 C
Consistence
f
Structure
Mineralo
A—J&_
HORIZON IIDEPTH
Texture group
G
Consistence
Se Arr
t 5 1pr
Structure
S fir
Mineralogy
HORIZON III DEPTH
tf Wall
Texture group
Consistence
FC
Structure
Mineralogy!i
HORIZON IV DEPTH
i
Texture grou2
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
7
I
SITE CLASSIFICATION: , —,-,, EVALUATION BY:��
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: t'
REMARKS
LEGEND
Landscape Position
R - Ridge S -!Shoulder L - Linear slope FS -Foot slope N-- Nose slope I,
CC. - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head 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
lyd
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 - Lon¢ -term accentance rate - oal/davM2 rerun nrrnc M—A.o,��