162 Nikkis WayOPERATION PERMIT
Davie County Health Department
* r� 210 Hospital Street
1,
P.O. Box 84$
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Jonathan A. Sechrest
Address: 207 Pepperstone Drive
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 940-8649
Property Loca
ool-
Address/Road #:( ��� Subdivision:
oeff;af Nikkis Way
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People: 3
*Water Supply: NEW WELL
*IP Issued by.
*CA issued by: 2140 -Nations, Robert
Design Flow: 3 6 0
Soil Application Rate: 0 1 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
"CDP File Number 123015-1
D5-000.00.017 Site 1
County ID Number,
Evaluated For. NEW
Township:
Property Owner Clara Jo Munday Shore
Address: 2017 Brittany Oaks Court
City: Yadkinville
State/Zip: NC 27055
Phone #:
Phase: Lot:
Directions
140 East, Exit Farmington Rd. turn left then left on
Hubert Rd. Right on Staya Way, then left on Nikkis,
Property crosses go right.
*System Classification/Description:
TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? eYes QNo
*Distribution Type: GRAVITY -SERIAL. Pump Required?
QYes (DNo
*Pre Treatment:
Drain field
a 4 0 0 Sq. .ft.
4
6 0 0 ft.
Inches O.C.
Feet O.C.
3Inches
Feet
inches
Minimum Trench Depth: 3
6
Minimum Soil Cover. .1
4
Maximum Trench Depth: 3
6
Maximum Soil Cover: a
4
Inches
*System Type: INFILTRATOR QUICK 4 STANDARD
Installer: gen Crotts
Certification #: 1058
*EH S: 2140 - Nations. Robert
Date: 0 4/ 0 6/ 2 0 1 6
Inches Approval Status
Inches Approved[:] Disapproved
Inches
CDP File Number 123015-1
Manufacturer. Shoaf
STB: 760
Gallons: 1000
County ID Number: °5.000-00-017Site 1
Seatic Tank
Date:
02/
❑
a 3/
a 0 1 6
*Filter Brand:
POLYLOK PL -122 With Pipe Adapter
ST Marker:
❑
Yes
E
No
einforced Tank:
❑
Yes
0
No
, 1 Piece Tank:
❑
Yes
0
No
Manufacturer,
PT:
Gallons:
Date: /
Riser Sealed ❑ Yes
Riser Height: ❑ Yes
nforced Tank: ❑ Yes
1 Piece Tank: ❑ Yes
I,—
r5
❑
No
❑
NO (Min. 6 in.)
❑
No
❑
No
r Pipe Size: inch diameter
Pipe Length: feet
*Schedule:
Pressure Rated ❑ Yes ❑ No
approved fittings ❑ Yes ❑ No
Pump Type:
Lat.
Long:
Installer: Sen Crotts
Certification #: 1058
*EH S: 2140 - Nations, Robert
Date: 0 4/ 0 6/ 2 0 1 6
Approval Status
d Approved ❑ Disapproved
Pump Tank
Installer.
Certification #:
*ENS:
Date: / /
Approval Status
❑ Approved ❑ Disapproved
Supply Line
Installer:
Certification #:
*EH S:
Date:
Approval Status
❑ Approved ❑ Disapproved
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 ❑ i Approved ❑ Disapproved
Vent Hole ❑ Yes ❑ No
\ Anti -siphon Hole ❑ Yes ❑ No
CDP File Number 123015-1
County ID Number: DS-000-oo-o»Site 1
NEMA4X Box or Equivalent
❑ Yes
❑
No
Installer:
Box 12 inches Above Grade
❑
Yes
❑
No
Certification
Box Adj. To Pump Tank
❑
Yes
❑
No
Conduit Sealed
❑
Yes
❑
No
'EHS:
Pump Manually Operable
❑
Yes
❑
NO
*Activation Method:
Date:
Alarm Audible
E)
Yes
1:1No
Approval Status .
❑ Approved ❑ Disapproved
Alarm Visible
❑
Yes
❑
No
2140 - Nations, Robert
*Operation Permit completed by:
Authorized State Agent: Date of Issue: 4 / 0 6 / a 0 1 6
Owner/Applicant Signature: i
This system has been installed in compliance wkh 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 u 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: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
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 entity with a certified operator or a private certified operator forthe life of the septic 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 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.
G)Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC
Drawing Drawing Type: Operation Permit
CDP File Number: 123015 -1
D5-000-00.017
County File Number: site 1
27028 Date:
0Inch
Scale: 081ock
nN/A
Applicant: Jonathan A. Sechrest
Address: 207 Pepperstone Drive
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 940-8649
Address/Road #: Subdivision:
Off of Nikkis Way
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People: 3
"Water Supply: NEW WELL
% For Office Use Only
*CDP File Number 123015- 1
County ID Number: D5-000-00-017 Site 1
Evaluated For: NEW
Township:
PERMIT VALID UNTIL:
10 /0 a 0 a 0
Property Owner: Clara Jo Munday Shore
Address: 2017 Brittany Oaks Court
City: Yadkinville
State/Zip: NC 27055
Phone #:
Phase: Lot:
Directions
1-40 East, Exit Farmington Rd. turn left then left on
Hubert Rd. Right on Staya Way, then left on Nikkis,
Property crosses go right.
m Soecifications
/Site
CONSTRUCTION
3
AUTHORIZATION
SiClassification: Provisionally suitable
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
a
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Jonathan A. Sechrest
Address: 207 Pepperstone Drive
City: Mocksville
State/Zip: NC 27028
Phone #: (336) 940-8649
Address/Road #: Subdivision:
Off of Nikkis Way
Mocksville NC 27028
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People: 3
"Water Supply: NEW WELL
% For Office Use Only
*CDP File Number 123015- 1
County ID Number: D5-000-00-017 Site 1
Evaluated For: NEW
Township:
PERMIT VALID UNTIL:
10 /0 a 0 a 0
Property Owner: Clara Jo Munday Shore
Address: 2017 Brittany Oaks Court
City: Yadkinville
State/Zip: NC 27055
Phone #:
Phase: Lot:
Directions
1-40 East, Exit Farmington Rd. turn left then left on
Hubert Rd. Right on Staya Way, then left on Nikkis,
Property crosses go right.
m Soecifications
/Site
Minimum Trench Depth:
3
�
6
SiClassification: Provisionally suitable
Inches
Soil Cover:
a
4
Yes O No
Saprolite System? (9) Yes
Inches
Design Flow: 3 6 0
Maximum Trench Depth:
3
6 Inches
Soil Application Rate: 0 1 5
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)
*Proposed System: 25% REDUCTION
Nitrification Field a 4 0 0
Sq. ft.
Septic Tank. 1 0 0 0
Gallons
1 -Piece: OYes ®No
Pump Required: O Yes ®No O May Be Required
Pump Tank: Gallons
No. Drain Lines 5 1 -Piece: OYes ONo
Total Trench Length: 6 0 0 ft, GPM --vs-- ft. TDH
Trench Spacing:9 ® — Olnches O.C.
Feet O.C. Dosing Volume: _ Gallons
Trench Width: 3 Inches
Feet Grease Trap: Gallons
Aggregate Depth:
inches Pre -Treatment: O NSF OTS -1 O TS -II /
Septic Tank Installer Grade Level Required: 01011 O 111 01V
Page 1 of 3
I
CDP File Number 123015 - 1 County ID Number D5400-00-017 site 1
❑ Open Pump System Sleet
r System Kequlrea:'a T Cs v ivU v NU, UUL nda rwdudU1U 0
*Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rema n9
750
*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. Remaa�ng
2000
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 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? O Yes O No
Applicant/Legal Reps. Signatu
*Issued By: 2140 - Nations, Robert
Authorized State Agent:
Date: / /
Date of Issue: 1 0/ 0 2/.2 0 1 5
nction Log Oyes
® Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
Trench Spacing:
9 O Inches O.
*Site Classification:
Provisionally suitable
— ® Feet O.C.
Design Flow:
Trench Width:
O Inches
3 �1 Feet
3 6 0
—
Depth:
Soil Application Rate:
0 1 5Aggregate
inches
Minimum Trench Depth:
3
6
*System Classification/Description:
Inches
TYPE A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR
Minimum Soil Cover:
a
4
LESS)II
Inches
Maximum Trench Depth:
3
6
*Proposed System:
25% REDUCTION
Inches
Maximum Soil Cover:
a
4
Nitrification Field
a 4 0 0
Inches
Sq. ft.
No. Drain Lines
5
*Distribution Type:
PUMP TO GRAVITY
Total Trench Length:
6 0 0Pump
Required: ®Yes
ONo
OMay Be Required
ft.
�
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. Rema n9
750
*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. Remaa�ng
2000
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 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? O Yes O No
Applicant/Legal Reps. Signatu
*Issued By: 2140 - Nations, Robert
Authorized State Agent:
Date: / /
Date of Issue: 1 0/ 0 2/.2 0 1 5
nction Log Oyes
® Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
A
I
CONSTRUCTION AUTHORIZATION
Davie County Health Department CDP File Number: 123015-1
210 Hospital Street
M_nnn_nn_m
Page 3 of 3
P1 P2
5
Jft.
CONSTRUCTION AUTHORIZATION
Davie County Health Department
t210 Hospital Street ` CDP File Number: 123015 - 1`
��•'
P.O. Box 848 if '-' � � D5-000-00-017
Mocksville NC 270(28 County File Number: Site 1
/%
U v`�
1900 d \ ,p6Z Clrci -Sate:.1.0. 0.1 . x. 0.1.5.
Click below to import an image from an external location: D(ayying Type: Construction Authorizatio
N
Page
P1 P2
For Office Use Only
"CDP File tJumber 123015-1
County ID Number: 135-000-00-017 Site 1
Evaluated For: NEW
` o,unship:
Phone: 336-753-6780 Fax: 336-753-1680 PERLriT VALID UNTIL 9113/2018
"NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit.
Applicant: Jonathan A. Sechrest
Address: 207 Pepperstone Drive
City. Mocksville
State/Zip: NC 27028
Phone »: (336) 940-8649
Address:Road :::
IMPROVEMENT PERMIT
V.
Mocksville
`% - .•:
Davie County Health Department
SINGLE FAMILY
210 Hospital Street
3
P.O. Box 848
3
'Water Supply:
NEW WELL
Mocksville NC 27028
For Office Use Only
"CDP File tJumber 123015-1
County ID Number: 135-000-00-017 Site 1
Evaluated For: NEW
` o,unship:
Phone: 336-753-6780 Fax: 336-753-1680 PERLriT VALID UNTIL 9113/2018
"NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit.
Applicant: Jonathan A. Sechrest
Address: 207 Pepperstone Drive
City. Mocksville
State/Zip: NC 27028
Phone »: (336) 940-8649
Address:Road :::
Off of Nikkis Way
Mocksville
NC 27028
Structure:
SINGLE FAMILY
of Bedrooms:
3
of People:
3
'Water Supply:
NEW WELL
/Properly Owner: Clara Jo Munday Shore
Address: 2017 Brittany Oaks Court
Cay.. Yadkinville
State/Zip: NC 27055
Phone »:
I
Subdivision: Phase Lot: -1
system s
'Site Classification'. PS
Saprolite System?
)Yes ONo
Design Flow: 3 6 0
Sod Application Rate: 0 1 5
`System Classification/Description:
TYPE III B. SYSTEM IA'iSINGLE EFFLUENT MAP
'Proposed System: 25-l" REDUCTION
Directions
1-40 East, Exit Farmington Rd. turn left then left on
Hubert Rd. Right on Staya Way, then left on Nikkis,
Property crosses go right.
Mlinimum Trench Depth 3 6 Inches
Maximum Trench Depth: 3 6 Inches
Septic Tank:
1 0 0 0 Gallons
1 -Piece:
Pump Required
Pump Tank:
1 -Piece:
Repair System Required:OYes ONo ONo, but has Available Space
Repair System
.Site Classification: PS
Soil Application Rate: 0 1 5
'System Classification!Description:
TYPE 111 B. SYSTEM WiSINGLE EFFLUENT PUMP
'Proposed System: 25% REDUCTION
OYes (,}NO
(-)Yes ONo Olrtay Be Required
1 0 0 0 Gallons
Oyes ONo
1.1inimum Trench Depth: 3 6 Inches
Maximum Trench Depth: 3 6 Inches
Pump Required: (:)Yes ONo O May be Required
Page 1 of 3
CDP Foe Numbej 123015, . 1 , ' County ID Number: 135-000.00.017 site 1
Site Modifications ❑ Open Fitt 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 tray 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 5 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 Improvement 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 rules, or this article This permit is subject to revocation If the site plan, plat, or intended
use changes (NCGS 130A335(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)).
Applicant%Legal Reps. Signature Required? OYes ONo
AppticanVLegal Reps. Signature: Date /
'Issued By: 22,1-1- Dayv.all. Andrew
Authorized State Agent:
Date of Issue 0 9/ 1 3/ 2 0 1 3
OValid without Expiration?
O Create CA?
01 -land Drawing Olmport Drawing
**Site Plan/Drawing attached.** Total Time (HH.1.1 L')
0 1 Fours 0 0 Minutes
Page 2 of 3
Activity Code: S-4 - IRS issued neva, valid for 60 mos.
IMPROVEMENT PERMIT
• .0 D vie Gunty Health Department
t 210 Hospital Street
' P.O. Box 848
hlocksville NC 27028
Drawing Drawing Type: Improvement Permit
C
CDP File Number. 123015-1
D5.000.00.017
County File Number:
Date: /
•J
Qinch
Scale: , . (Block
01`4/A = ft.
Page 3 of 3
Davie County, NC - GoMaps Advanced
t`.
D. ,
Page 1 of 1
1000 ft
http://maps2.roktech.net/davie_gomaps/index.html
9/12/2013
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
RECEIVED Davie County Environmental Health A
P.O. Box 848/210 Hospital Street
Dace; Mocksville, NC 27028 t�
(336)751-8760/ Fax (336)751-8786 °db
Application For: Xite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both
Type of Application: ❑New System ❑Repair to Existing System DExpansion/Modification of Existing System or Facility
'IMPORTANT'" THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed S. J0 Sec hRb-,fContact Person 3'V-rol v)3�-3
Billing Address e eCt-o n Q 21— Home Phone __3.3 L
City/State/ZIP _s `G t „ `� c �`7 p ,;j_�Business Phone
Name on Permit/ATC if Different than Above
Mailing Address
.Ci
PROPERTY INFORMATION *Date House/Facility Corners Flagged 2S:Q -(aor 3
NOTE: A survey plat or site plan must accompany this application. Included: a'Site Pla❑Plat(to scale)
(Permit is valid for 60mo the with si a plan, no expiration with complete plat.) � 5--0 00— 00 017 — ✓
Owner's Name Jo �� Na �� oR �. Phone N mber
Owner's Address City/State/Zip f G
Property Address oP City
Lot Size q5 N*, fir I <T -, Tax PIN#
>Subdivision Name(if applicable) Section/Lot#
Diections To Site: r
Di'
r
If the answer to any of th6 following questions is "yes", supporting documentation must be attached.
Are there any existing wastewater systems on the site?
❑Yes o
Does the site contain jurisdictional wetlands?
Are
es No
there any easements or right-of-ways on the site?
es ONo
Is the site subject to approval by another public agency?
[]Yes bio -
Will wastewater other than domestic sewage be generated?
❑Yes �lo -
IF RESIDENCE FILL OUT THE BOX BELOW .
# People�Y# Bedrooms a # Bathrooms Garden Tub/Whirlpool �❑No
Basement: ❑es 0�� Basement Plumbing: ❑Yes D#6---
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 ❑Alternative ❑Other
Water Supply Type: D County/City Water ew Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �lo --
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 m responsible for he pr per identification and labeling of property lines and corners and locating and flagging
or stakin he h se/fact ' ocati r ed well location and the location of any other amenities.
Site Revisit Charge
Pr erty owner's er's legal representative signature
Date(s):
9 C? 0/-? Client Notification Date:
Date EHS:
Sign given ❑Yes ❑No /�� Account #
Revised 11/06 '' �23V c^-� Invoice #
. 4
/
Davie County, NC Tax Parcel Report Monday, August,19, 2013
WARNING: THIS IS NOT A SURVEY
fC@F-rf'lfOITVlatId
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION ,RRQh'F., WgWNORMATION .
Account #: 990006151 Tax PIN/EH #: D5:uvvw=vrr
Billed To: Jonathan Sechrest Subdivision Info: ' ' '.
Reference Name: Location/Address: ` Off of Nikkis Wa ,-27028
Proposed Facility: Residential Property Size: 49 Ac Date Evaluated: lf3
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit - a( Cut
FACTORS
1'
2 3 4 .5 6 .' 7
Landscape position
Slope %
oc
HORIZON I DEPTH
6
Texture grow
1.
C
Consistence
PR-�
Structure
L
Mineralogy
t
HORIZON H DEPTH
1-2-v
Texture group
G C, 615A P
Consistence
Structure
PA.
M,
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
` µt
Mineralogy
I l 1 ,
HORIZON IV DEPTH'•
Texture group
Consistence ,
," S takture
-
Mineralogy
.SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
kol
LONG-TERM ACCEPTANCE RATE
,
SITE CLASSIFICATION: J
LONG-TERM ACCEPTANCE RATE:
As
EVALUATION BY: Adn01)6) w
OTHER(S) PRESENT:
' 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
CONSIST .NC .
l�uist
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
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)
T TAR - I nno-term nr'r entnnri- rnte - OatlrIaVlft7 In rT1
9
r ,z
-
"A''?� -� f i ';'1 V
d V:
z ry §
�r' ,
' 9cr , :r ��` t�,w . "� x •� R a y3 "Yg tib` �t
P
'h 'v kva �' q r'r`—*y i
-:� < UNI
3
50
QV
{
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Well Construction Permit
Myo Davie County Health Department n n n
210 Hospital Street U C/
P.O. Box 848 111
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Property Owner: Jonathan A. Sechrest
Address: 207 Pepperstone Dr
City: Mocksville
State/Zip: NC 27028
Phone #:
For Office Use Only
*CDP File Number 123015
PIN Number: D5-000-00-017 Site 1
Tax Lot #: Tax Block #
Evaluated For: WELL
VtKMI 1 VALIU UN I IL: 'I U/L/ZULU
Applicant: Jonathan A. Sechrest
Address: 207 Pepperstone Dr
City: Mocksville
State/Zip: NC 27028
Phone #:
Property Location & Site Information
ldress/Road M Subdivision:
Off of Nikkis Way
Mocksville NC 27028
Latitude
Longitude
Site Address: Off of Nikkis Way
Phase: Lot:
*Proposed use of Well:
If Other:
Directions
Directions: 1-40 East, Exit Farmington Rd. turn left then
left on Hubert Rd. Right on Staya Way, then left on
Nikkis, Property crosses go right.
r
A _ _ _ Well Contractor Information
Permit Conditions
Well location, construction and protection must meet all state and local regulations and must be inspected and approved by an authorized representative of
the Local Health Department. The permit may be revoked at any time for failure to comply with existing regulations. The siting of approved well construction
area(s) by the Health Department is to provide protection from the known possible sources of contamination. The approved well area(s) may not be
changed without written permission from an authorized representative of the Local Health Department. No volume of quality of water is guaranteed by the
Health Department.
*Issued By: 2140 - Nations, Robert *Date of Issue; 1 , 0 , / , 0 , a , / , a , 0 , 1 , 5
Authorized State A Got O Hand Drawing O ImportDrawing
Owner/Applicant Signature: **Site Plan/Drawing attached.**
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WELL CONSTRUCTION PERMIT
Davie County Health Department
'd "tet 210 Hospital Street
CDP File Number:
123015
D5-000-00-017
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