207 March Ferry Rd Lot 33 OPERATION PERMIT or ice use unly
i� Davie County Health Department •CDP File Number 121265-2
ti 210 Hospital Street G9.090•130.033
P.O. Box 848 County ID Number:
Mocksville NC 27028 Evaluated For: REPAIR
Phone:336-753-6780 Fax:336-753-1680 To,. ship:
Applicant: William Cope Property Owner: William Cope
Address: 207 March Ferry Rd Address: 207 March Ferry Rd
City: Advance City: Advance
State2ip: NC 27006 State2ip: NC 27006
Phone::: (336)816-3813 Phone::: (336)816-3813
Property Location & Site Information
Address/Road
Subdivisions Phased -= LOt
_ ,�(ularchwoQds� �.lV� _.33
O1tiJlarch-FFerry-Rd-J,
Advance NC 27006 Directions
Structure: SINGLE FAMILY 1-40 East, Exit Hwy 801 going South. Cross Railroad
Tracks, Peoples Creek Rd on left to Development
of Bedrooms: Marchwood IV
of People:
'Water Supply: PUBLIC
'IP Iss 'System Classification/Description:
ued by. 2244-Dayerali.Andrew
"CA issued by: 2244-Daywalt.Andrew Saprolite System? QYes ONo
Design Flow: 3 6 0 'Distribution Type: GRAVITY-PARALLEL(eq.d-box) Pump Required?
QYes QNo
Soil Application Rate: 0 3 *Pre-Treatment:
Drain field
rMrification Field Sq. ft. 'System Type: INFILTRATOR QUICK 4 STANDARD
Drain Lines Installer: tranktransou
Total Trench Length: 2 0 0 ft. Certification :
Trench Spacing: _ Inches O.C.
- 8Feet O.C. EH S: 2244-Daywatt.Andrus
Trench Width: _ Qlnches
Feet Date: 0 6 / 2 4 / 2 0 1 3
Aggregate Depth: inches
Llinimum Trench Depth:
Inches
f:tinimum Soil Cover. Inches Approval Status
Maximum Trench Depth: Inches ❑ Approved❑ Disapproved
faaximum Soil Cover:
Inches
CDP File Number 121265-2 Septic Tank County ID Number: G9-090-80.033
Manufacturer. esisti"9 Lat.
STB: Long, ,
Gallons: Installer.-
Date:
nstaller:Date:
/ / Certification:::
'EHS: 2244-DaywaU,Andrew
'Filter Brand:
ST Marker: El Yes ❑ NO
Date: 0 6 / 2 4 / 2 0 1 3
Reinforced Tank: ❑ Yes ❑ No Approval Status
, P iece Tank: 1:1Yes ❑ No ❑ Approved ❑ Disapproved
Pump Tank
Manufacturer. Installer:
PT: Certification P":
Gallons: 'EHS:
Date: / / Date:
Riser Sealed ❑ Yes ❑ No
Riser Height: ❑ Yes ❑ No (Min.6 in.) Approval Status
Reinforced Tank: ❑ Yes ❑ No ❑ Approved❑ Disapproved
1 Piece Tank: ❑ Yes ❑ NO
Supply Line
Pipe Size: inch diameter Installer:
Pipe Length: feet Certification:::
'Schedule: 'EHS:
Pressure Rated ❑ Yes ❑ No Date:
Approved fittings ❑ Yes ❑ No Approval Status
❑ Approved❑ Disapproved
Pump e e
Pump Type: Installer:
Dosing Volume: — Gal Certification::: .
Draw Down: Inches 'EHS:
'Chain: Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ❑ Yes ❑ No Approval Status
PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole El Yes ❑ No .
CDP File Number 121265 -2 County ID Number: G9.090-"-033
Electric Equipment
CNI4X Box or Equivalent ❑ YeS ❑ NO Installer;
x 12 inches Above Grade El Yes ❑ NO
Certification;::
ox Adj.To Pump Tank ❑ Yes ❑ NO
Conduit Sealed Q Yes ❑ No 'ENS:
Pump Manually Operable . ❑ Yes ❑ No � 1
"Activation Method: Date:
Approval Status
Alarm Audible ❑ YeS El
❑ Approved❑ Disapproved
Alarm Visible ❑ Yes ❑ No
2244-Dayti.alt.Andrea
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 0 6 / 2 4 / 2 . 0 1 3
This system has been installed in compliance with applicable PJC 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 sewage Septic System.
Rule .1961 requires that a Type _M septic system meet the following criteria:
Minimum System Review By The Local Health Department:
Management Entity: _
Minimum System Inspection1laintenance Frequency By Certified Operator:
Reporting Frequency By Certified Operator:
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 home/business ownermust 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 priorto the
issuance of an Operation Permit for a system required to be maintained bya 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.
4Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Total Time:(HH:tAIA)
Activity Code: S-19 2Q4-OP issued NEW Type 11 Quick 4 0 1 Hours 0 0 td inuies
OPERATION PERMIT 121265 - 2
Davie County Health Department CDP File Number:
210 Hospital Street . G9.090-BO.033
P.O.Box 8413 County File Number:
Mocksville NC 27028 Date: 1
Olnch
O
Drawing Drawing Type: Operation Permit Scale: , ON/A k
id
a
L
Ilk
i
SSU
CONSTRUCTION For office use only
AUTHORIZATION *CDP File Number 121265-2
Davie County Health Department County ID Number.
G9-090-80.033
f 210 Hospital Street Evaluated For: REPAIR
P.O. Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
Phone:336-753-6780 Fax:336-753-1680 0 0,3 2 0 1 8
Applicant: William Cope Property Owner. William Cope
Address: 207 March Ferry Rd Address: 207 March Ferry Rd
CRY: Advance City: Advance
State2ip: NC 27006 State/Zip: NC 27006
Phone#: (336)816-3813 Phone 9* (336)816-3813
Property Location & Site Information
Address/Road#: Subdivision: Marchwoods Phase: IV Lot: 33
207 March Ferry Rd
Advance . NC 27006 Directions
Structure: SINGLE FAMILY 1-40 East, Exit Hwy 801 going South. Cross Railroad
Tracks, Peoples Creek Rd on left to Development
#of Bedrooms: Marchwood IV
#of People:
*Water Supply: PUBLIC
System Specifications
Minimum Trench Depth: a 4
rSaproliftaesSystem?
ification: Ps " Inches
Minimum Soil Cover.
QYes QNo Inches
Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 0 - 3 Maximum Soil Cover: Inches
* ystem Classiflcation/Description: *Distribution Type: GRAVITY-PARALLEL(eq.d-box)
TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS)
Septic Tank: _ Gallons
*Proposed System: 25%REDUCTION 1-Piece: QYes QNo
Pump Required: QYes QNo QMay Be Required
Nitrification Field
Sq. ft. Pump Tank: Gallons
No. Drain Lines 1-Piece:QYes QNo
Total Trench Length: a 0 0 ft GPM—vs— ft. TDH
Trench Spacing: _ 9 gInches
t O C.0 Dosing Volume: _ Gallons
Trench Width: Inches
8Feet Grease Trap: Gallons
Aggregate Depth: - - -
inches Pre Treatment: ONSF OTS-1 OTS-II
Septic Tank Installer Grade Level Required: 01011 OIII OIV
�^O�� Pagel of 3
CDP File Number 121265 -2 County ID Number: G9.090-130-033
❑ Open Pump System Sheet
Repair System Required:OYes ONo ONo, but has Available Space
e air System
Trench Spacing: Q Inches 0. .
"Site Classification: — o Feet O.C.
Design Flow: Trench Width: Inch_ 8Feet
es
Aggregate Depth:
Soil
Application Rate: inches
*System Classification/Description: Minimum Trench Depth: Inches
Minimum Soil Cover. Inches
Maximum Trench Depth:
'Proposed System: Inches
Maximum Soil Cover.
Nitrification Field Inches
Sq.ft.
No. Drain Lines 'Distribution Type:
Total Trench Length: ft Pump Required: OYes ONo OMay Be Required
Pre Treatment: ONSF OTS-I 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 be valid fora person equal to the period cf wlidity of the Improvement Permit,not
to exceed five years,and may be Issued atthe same time the Improvement Permit Issued(NCGS 130A-336(b)).If theinstalladon has not been
completed during the period of wlidity of the Construction Penni;the Information submitted In the application for a permit orConstruction
Authorization Is found to have been Incorrec%falsified orchanged,or the site Es altentd,the permit or Construction Authorization shall become
Invalid,and may be suspended or revoked(.1937(8)).The person owning orcontrolling 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: 2244-Daywalt,Andrew Date of Issue: 0 5 / 0 3 / 2 0 1 3
Authorized State Agent: Malfunction Log OYes
E)Handtbrawing Olmport Drawing Total Time:(HH:IAM)
**Site Planinrawing attached.**
Page 2 Of 3 1 Hours_ 0 0 ut inutes
S-10-CKS issued-repair
CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number: 121265 -2
210 Hospital Street G9-090.80.033
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 0 5 / 0 3 / 0 1 3
Olnch
DrawON
N/Aing Drawing Type: Construction Authorization Scale: . Oft.
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01
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Paae 3 of 3
Aip -4
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• +�� DAVIE COUNTY ENVIRONMENTAL HEAT THWRVICE REQUEST
4belAPPLICATION IP/ATC OSWW REPAIR
Name iffi,41 VlTelephone Number Vb— 99/E
Address ,
Mailing Address (if different from above)
Email Address: 60 h b 1"60 h Ve, , D m
Subdivision Name /11,4 RaS : Lot#
Directions — p R, 1=5" �,CI C'1ee
Date System Installed Name System Installed Under
Type Facilityp� Number Bedrooms 3 Number People Served _
Type dater Supply 00(1114(- Specific Problem Occurring S/11e��5. /ilOGll^
Date Requested �� —/?j Info Taken By
THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY
KNOWLEDGE,AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED
FROM THIS APPLICATION.
Signature of owner or Authorized Agent
Initial Fee Date REHS
Revisit Charge Date Reason
Revised 2-2011
Appraisal Card Page 1 of 1
DAVIE COUNTY NC 4/25/2013 8:46:59 AM
OPE WILLIAM D COPE PAMELA Retum/Appeal Notes: G9-090-80-033
07 MARCH FERRY RD UNIQ ID 12091
2517274 AD24-PS ID NO:5789767084
COUNTY TAX(100),FIRE TAX(100) CARD NO.1 of 1
eval Year:2013 Tax Year:2013 LOT 33 MARCH WOODS PHASE TWO 1.000 LT SRC-Inspection
kppraised by 19 on 10106/2008 07203 MARCHMONT TW-07 C- EX-AT- LAST ACTION 20110712
CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE C7
9
oundation-3 Eff. BASE Standard 0.1200 m
ontinuous Footing5.0 5 MO Area UA RATE RCN EYB AYBCREDENCE TO MARKET
ub Floor System-4 r-
I ood 8.0 01101 2,4721 131 91.70 2848 2001 001 %GOOD 88.0 EPR.BUILDING VALUE-CARD 201,07
xterior Walls-21 TYPE:Single Family Residential Single Family Residential EPR.OB/XF VALUE-CARD 2,96
ace Brick 34.0 MARKET LAND VALUE-CARD 40,00 ❑
-fing Structure-03 STORIES:3-2.0 Stories OTAL MARKET VALUE-CARD 244,03
able 8.
oofing Cover-03
halt or Composition Shingle 3.0 OTAL APPRAISED VALUE-CARD 244,03
kspOTAL APPRAISED VALUE-PARCEL 244,03
nterlor Wall Construction-5
all Sheetrock 20.00
nterior Floor Cover-12 OTAL PRESENT USE VALUE-PARCEL
ardwood 10.0c OTAL VALUE DEFERRED-PARCEL
n[erior Floor Cover-14 OTAL TAXABLE VALUE-PARCEL 244,03
'arpet 0.0 +•---28-----+ PRIOR
eating Fuel-04 +5-+ 1 WILDING VALUE 216,64
lectric 1. 1 F U S I BXF VALUE 4,44
eating Type-30 0 1
eat Pum 4. +-15--+ I AND VALUE 40,00
I F O G 1 3 RESENT USE VALUE
Ur Conditioning Type-03 1 1 1 EFERRED VALUE
ntral 4.00 4 5 I OTAL VALUE 261,080
3edrooms/Bathrooms/Half-Bathrooms I I I
31 17.00 +5+ +5-+ I _
I I +10-+ +-11-+
rooms 1 1 +7-+
S-1 FUS-3 LL-0 1 0 PERMIT
9
throoms +10-+ CODE DATE NOTE NUMBER AMOUNT
S-IFUS-2LL-0 +--19---+
alf-Bathrooms - I P T O I
5-I FUS-O LL-0 1 1 OUT:WTRSHD:
4 4 SALES DATA
mce I I )FF. INDICATE
+----25----+--19---+4+ 1ECORD DATE DEED SALES c
OTAL POINT VALUE 114.00 I B A S I
BUILDING ADJUSTMENTS 1 I OOK AGE M R TYPE PRICE c
uali 4 ABAVG 1.200 2 I 0380 31 7 001 WD Q I 24300 c
+---20---+ I 0356 270 1 001 CD- C V w
ha Desl 4 FACTOR 4 1.050 I F G D I 3 0201 585 4 199 WD U V w
ize 1 3 1 Size 0.910 I 1 1
OTAL ADJUSTMENT FACTOR 1.15C 1 1 I
OTAL QUALITY INDEX 131 2 7 1
2 I I
I +--17--+ I HEATED AREA 2,384
I SFOP +-11-+
+---20---+--17--+ NOTES
SUBAREA UNIT I ORIG% ANN DEP % OB/XF DEPR.
TYPE GS AREA % RPL CS ODE ESCRIPTIO LT NIT PRICE GOND LDG B AV EYB RATE V GOND VALUE
AS 1.07 1 9848 10 ON PAVING 3 3 1,05 4.0 1 _ L 0I 00 S 4 168
GD a26
1815 10 ON PAVING 2 4 8 4.0 1 L 001 001 S 4 128
OG 2494 OTAL OB XF VALUE 2,960
OP 2201 -
S 8170
O 119
IREPLACE Fabrriicated 1,80
UBAREA 3,15 28,48
OTALS
UILDING DIMENSIONS BAS=W4PT0=N14W19S14E19$W44S12FGD=S22E20N22W20SE20S17FOP-S4E17N4W17SE1752EllN31
PTR=N25FU5=N31W28S2W5SIOFOG-WISS14E5SIlElON25SSI5E5S3E1052E7N1E11 525 .
NO INFORMATION
IGNEST THERADJUSTMENTS TOTAL
NO BEST USE LOCAL FRON DEPTH/ LND GONDND NOTES OA LAND UNIT LAND UNT TOTAL ADJUSTED LAND LAND
SE CODE ZONING TAGE EPT SIZE MOD FACTrRF AC LC TO OT TYPE PRICE UNITS TYP ADJST UNIT PRICE VALUE NOTES
FR RES 0100 0 0 1.0000 0 1.0000 40,000.00 1.000 IT 1.00C 40,000000 4000
OTAL MARKET LAND DATA 40,00
OTAL PRESENT USE DATA
http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=G9090B0033 4/25/2013
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account M 989900025 Tax PIN/EH M 5789-76-5851.33
Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#33
Reference Name: Dick Anderson Location/Address: Peoples Creek Road 27028
Proposed Facility: Residence Property Size: 1 Acre
ATC Number. 2701
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWA R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: —/s Z
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any
given period of time.
71
Septic System Installed By: A,8a
Environmental Health Specialist's Signature: Date:
DCHD 05/99(Revised)
• DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
• P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900025 Tax PIN/EH#: 5789-76-5851.33
Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#33
Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028
Propo's'ed Facility: Residence Property Size: 1 Acre
**N Is hIs finprov701
ement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with
Article 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type Z #People #Bedrooms #Baths 2
Dishwasher Garbage Disposa - Washing Machin/e " Basement w/Plumbing: 0 Basement/No Plumbing: 0
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13
Lot Size Type Water Supply�t— Design Wastewater Flow(GPD)�� Site: Neri--l' Repair
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width ��Rock Depth `p[ Linear Ft. MO /
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 K BELOW
FINISHED GRADE. ****NOTICE: Contact a represent a of the Davie County Health Department for final inspection of this
system between 8:30 .m.to 9:3011.m.or 1:00 p.m.to 0 P. n the day of installation. Telephone#is(336)751-8760.****
10
u
Environmental Health Specialist's Signature: Al—
DCHD 05/99(Revised)
It I & 6-
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT a ATC
Davie County Health Department D
i mltonmental Health AxWon !J
P.O. Box 848/210 Hospital Street DEC 71999
Mockaville, NC 27029
(336)751-9760
***?!+!PORTANT*** THIS APPLICATION cum EB PROCBBSBD UNLESS = IM-In-MRM
2N>i't)MWIOH IS PROVIDED. Refer to the IUMMATIGH BULLETIN for instructions.
i. Itasca to be silted AK// A/aF/2b '(�Auz, Contact "neon D/GG-AAra&,e-Z�
IiailiuQ ]lddse.. AS tit//A1 c.
,A1N�A &W L N , some rhons WA- 7 57.9
City/stat./z:3? ,1IOCtcSV/t.t..L.AZ (f. ;7o t& swine.. :#hona 99&• 7.*.).7?
1. ?Iasis on reran/&= It Dilfa ent.than Above
?tailing Address Citr/stab/zip
3. Application For: Site Evaluation 0 Improvement Permit/ATC 0 Both
e. systes to services t(House 0 Mobile Home 0 Business 0 Industry 0 other
s. If Residence: f People t} Bedrooms i'Y!� 3 t Bathrooms
aishwasbar �oasba9e disposal j�washinQ DiaoBin. o suaa.nt/aluabinQ o saa.�.nt/No alusbinQ
6. it 13zine.9/tn&1stry/0thers .peony ` \type i .#.opts t sinks
i Commodes showers + w o"s I !tater Coolers
I! TOODSERVICE: # Seats Estimated !tater Osage (gailons per dry)
7. Type of nater supply: P(County/City O hell O Community
e. Do you anticipate additions or expansions of the facility this system is Intended to nerve? 0 Yes �No
If yes,what type?
***IMPORTANT***CLIENTS MET TCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLM?MUST BESUBMITIED by the client with THIS APPLICATION.
Property Dimensions: A,4rRQ A A A WRITE DI�RECTIONS(from MockMlle)to PROPERTY:
Tax Office PIN: # v�7 l -7(o -S� Jr-V) At[_70 ry $O QO A�Aa&-:g
Property Address: Road Name (94eele a — G��=T (/-1 /YI)Z�e Fz7
city/Zip MAl ecj GUy=-s—
If In a Subdivision provide Information,as follows:
mQ�o G q
Name: /LIAR-Q)4 1. O&Q-'s P�4A�eEL/ qg
Section: Blocks Lots - Date Property Flagged:
This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(:)
Issued hereafter are subject to suspension or revocation,If the site plans or intended we change,or if the Information
submitted in this application Is falsified or ebsuged. I,also,understand that I ani responsible for all charges Incurred front
this applicallom I,hereby,give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located In Davie County and owned by
to conduct aU testing procedures as necessary to determine the site sultabilltz.
zz�
DATE f A-1 " 9 9 SIGNATURE
THIS AREA MAY BE SED FOR DRAWING YOUR SrM PLAN(Include all of the following: Existing and proposed
property lines ions, structures, setbacks, and septic locations).
Site Revisit Charge
��j Date(s)s
Client Notification Date:
w
EAS:
Account No. 0.2�
Revised DCHD(07/99) Invoice No.
��
3t
19 ,_ 1W l40
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120• I zS
dr
125, 00,
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900025 Tax PIN/EH#: 5789-76-5851.33
Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#33
Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028
Proposed Facility: Residence Property Size: 1 Acre Date Evaluated:d0•.1-//1 D!�
Water Supply: On-Site Well Community Public (L
Evaluation By: Auger Boring Pit—I Cut
FACTORS 1 2 3 4 5 6 7
Landscape position ,t, 4-
Slope% $
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC G
Consistence
Structure C S IL
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 /
SITE CLASSIFICATION: EVALUATION BY:
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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