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182 Providence TrailA Account #: 990005562 Billed To: James Weston Reference Name: Proposed Facility: Residence ATC Number: 5109 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 /Fax ## (336)753-1680 OPERATION PERMIT Tax PINfEH #: 5767-96-0008 Subdivision Into: LocationiAddress: 182 Providence Trail -27028 Property Size: 45 Acres **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type:_ S.T. Manufacturer, Tank Date�J-7 Tank Size � oo Pump Tank Size System Installed By: t' E.H. Specialist:"Wte: I Z0l U GPS Coordinate: Z9 Chr'ltitte-r5 DCHD 11/06 (Revised) _ e ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street �� I�a Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Accnunt #: 990005562 Tax PIN!FH #: 5767-96-0008 Billed To: James Weston Subdivision Info: Reference Name: LocationiAddress: 182 Providence Trail -27028 Proposed Facility: Residence Property Size: 45 Acres ATC Number: 5109 Site Type: DNew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms I # People Basement❑ Basement plumbing[] Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size J " cType of Water Supply: ❑County/City e<ll ❑Community Well System Specifications: Design Wastewater Flow (GPD) � VQ Tank Size GAL. Pump Tank GAL. Trench Width 3 L Max. Trench Depth Rock DepthA(o Linear Ft. Site Modifications/Conditions/Other: As stnt� ; , , oZ 5S R�a�t�c7 =e ed Sy . _ s .n;;., a.zsN.1969 5 "7 .'v # Contact the Davie County Environmental Health Section for ina insp6!`tf4fi of this system between 8:30 — 9:30a.nl. on the day of installation. Telephone # (336)751-8760. $4u 4 f /DO 4l�iusP� 04 "P/U 6` S j Sr glect Ce X56` v, \'gyp \ �4 Environmental Health Specialist '!/ L'"v Date: DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005562 Tax PIN/EH #: 5767-96-0008 Billed To: James Weston Subdivision Info: Address: 4601 Lindsay Drive Location/Address: 182 Providence Trail -27028 City: Raleigh, Property Size: 45 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ew []Repair ❑Expansion Permit Valid for: � Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) �K Design Flow(GPD): &1-l 0 Type of Water Supply: ❑County/City Vf_e19X(S❑Coimrfiunity Well 5) Site Modifications/Permit Conditions: As stated in 15A NCAC 18A.19G9(2ceePtcd Systems may Alco bo udc Initial Site Plan Environmental Health Specialist i.p. 11-06 System Type LTAR Z 0� x� pri JA�� t ` V� ":�%1� Date\ a5--- G "JI riev`idencri Tiod � fI�veya�Zroa.ti out Drive. Me APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Env'r tealth P.O. Box 848/r-rJ19P1Mr- et Mocksville, NC 27028 (336)753-6780/"i,(3J637N 1080 trHR�MENT tit N t r riFA Jh L) Application For: '_I Site E�luation/hnprovement 4'{ `' IECOUe-A, � ltd (ATC�AVIEG otli Type of Application. ew System ORepan to is mg System ' Expansion/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. AYYLIC;AN I Name to be Billed e Contact Person James Billing AddressL0 Home Phone City/State/ZIP Business Phone Same Name on Permit/ATC if Different than Above Mailing Address City/State/Zi MUMK1 I IlNVUKAV1A I IUIN "hate House/Facility C.Orners 1-14ed NOTE: A survey plat or site plan must accompany this application. Included. Site Plan at(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name Phone Number%SSS- Owner's Address City/State/Zip Property Address City Moeltsv�l��_ Lot Size qL5 nCres Tax PIN#-MI200011101 Jr%�a�17�*-rvoo� _ r ;. , •Lv . , ; Subdivision Name(if -applicable) Sectio -111 Directions To $ite: '9 C9 Pas 4^ r..rk Ch. . '%a kie nQY� 64 0� n CeLrGrbye 06"�5 If the answer to any of the following questions is "yes", supporting documgntation must be attached. Are there any existing wastewater systems on the site? QYes ONo Does the site contain jurisdictional wetlands? Jyes t;;<o ii Are there any easements or right-of-ways on the site? A4es ❑No —� r,,4 !f! Ais atea Is the site subject to approval by another public agency? 'Yes @Nb Will wastewater other than domestic sewage be generated'? !Yes PNo IF RESIDENCE FILL OUT THE BOX BELOW # People 2 # Bedrooms — I — # Bathrooms 1 Garden Tub/Whirlpool .: Yes '&,No Basement: Yes A No Basement Plumbing: :_;Yes HN 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 ofsimilar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:Conventional Accepted Innovative Alternative iOther Water Supply Type County/City Water NeNv Well Lf`isting Well . Community Well Do you anticipate additions or expansions of the facility this system is intended to serve" i Yes Ifyes, what type? f!NO 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 ifthe information submitted,in this application is falsified or changed. I hereby grant right ofentry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. 1 understand that 1 am responsible for the proper identification and labeling of property lines and corners and locating and flagging st�ggo the tse/facility location, proposed well location and the location of any other amenities. 11 Site Revisit Charge P erty owner's or owner's legal representative signature Datc(s): ��i 1, 20� Client Notification Date: _ Date 7 FHS nonc. 41- -Arra house 33`'49$ 173'6 (556„ GT 1 f,o�l �rav AL511 � 4he if a r?�Pot L T mfo7 /Nook- �, Sign given Yes -'No Account # ��lY Revised 11/06 / �t Invoice #_'j�CO • r4 wss rnao�e and p�rini� �ratn e'oi abau7 +e. 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D �.—'t`ypc.bfll pllention: E�'„'�`'c ` � v•'lMPORTANT' INFORMATION I 7�.tA t rOviQEnL'e hd ePf��iv ut• jt•iva ►TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC lhtviefotltty.EtY"vlctriiitlienidlHe�irih ' xld$121flostiilil`,Stt4cR, ' _ fobMc�Nige;•NCr2.711?'; 3bk7.;l 07 i4it (b6)' 753400.' untiontimprovement Permit "uthorivstion To c CoasvuafA ❑ Both System ORepair to 2xisting System DE�ansion/Modiftcation oF isting Systan or Facility THIS APPLICA71ON CANNOT BE PROC&556D UNLESS ALL OF THE REQUIRED PROVIDED. Rcfcr to the INFORMATION BULLETIN for instructions. 11011/11015 I�1 Name to be Billed p /es }ort Contact Person �jnnr pj II✓tArh I' r Billing Address 0601 Lib fav Dr Home Phone - CeJ / City/Stotc/ZIP Rlie ia lba ', 7-!jg Business Phone1 01 s�rr.r Name on PermittATC if1)fi9'erent than Above VK0L'LK1Y1N VKMgfAVN *Date NOUSC/FACilityComers FimRcd NOTE: A survey plat or sire plan mast accompany this application, Included: O Site Plan iRfiat(to acalc) (Permit Is Valid far 60 months with site plan, no expiration with complete plat,) Owner's Name carnes R,W ev4z)r, Phone Number 3l9 -795-M3 Owner's AddressO City/Stam/Lip adei t. 2761?- Property Addtcss IeZ Pesti^ n City Lot Siac__E5 &Qt s Tax PIN# .T ci0000011101 Subdivision Name(if applieabiC) Section/1,00 Direetion To Site: A a;r*4 rte t! 0 A2 e ,s tf the answer io Lary of the following questions is "yes ', stpporting doccnnentatlon must be attached. Are there any existing wastewater systems an the 9itc7 ofes ONO Does the site contain jurisdictional wedands7 DYce PRO Are there any casements or right-of-ways on the site? RCS ONO ! n r�% • 1%ij 0 O R Is the site sulliect to approval try another public agcncy7 DYcs MWo' will wastewater other than domestic aLwae be gem rrded7 t1Yp ISO I# People 9 # Bedrooms I # Bathrooms I Garden Tub/Whirlpool L1Ycs Vlo Basement: GYec khNo BascmcntPlumbing: I.IYcs. R?I* IF NON -RESIDENCE FILL, OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers 0 Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Typc systcm requestoti: 05ativentional riAreepted Ulnnovativc 11Alternalive rJOthcr Water (Supply Type: 0 County/City Watcr ❑ New Well W. 61sting Well 0 Community Well Do you anticipate additions or ccpannions of the facility this system is intended to serve? f] Yes R<O 1 f yes, what typo7 This is to certify that the information provided on this application is true and Correct to the best of my knowledge. 1 understand that arty permit(s) or ATC(s) issued hereafter arc subject to suspension or revocation if the site is altered, the intended use changes, or if the infpnnation submitted in thin application is falsified or changed 1 hereby grant right of entry to the Authorized Representative of die Davie County Health Department to conduct necessary Inspections to determine compliance with applicable Ism. and rules, t understand that 1 am responsible for the proper identification and labeling of property lines and corners and 1oa9ting and flogging or stskirlgth!ouse/faci1ity jocaWn, proposed well location and the location ofany other amenities, Owner's or owner s legal reprcvcntative signature Site Revisit Charge o 16 Client Notification Date: Dare " EHS: Sign given riYes dNa Revised 11/06 .. '�; ,A4oi•l 4er4 Was w,a�e ar,ol %bt3;}Y►'i'r� 9rare�� No n•ipuM r. tMoc �o� r6. d�POr'Ox Saw►e r'O�t�fOvt Jry Account A a6e / "Oice k PAonet et' Tar') house 374-- F �e n Carl U�FStOM Ts tcsua.�ly '7llc �+,L RY7,-tt."Joc T mPo y Novk-u%' �Id e��r;aJ 44 n etwl a aT Ca t-1 • l LI -M e f O C F?oN we llp-61 09/11/2010 17121 919--787-8437 FEDEX OFFICE 1547 PAGE 03 LmR�ti�nc. � �'e�d 1.,Oeat SON cr' PT 7rave I ` Cstii� ' Po r� park G f-ve% D7 ive p"Mp *6 cj pe ZIe4 -fpr cp4ic 5,),s4ern APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER T T' :.4 Davie County Health Department �• Environmental Health Section 2 19941 P. O. Box 665 _. Mocksville, NC 27028 1. Application/Permit Requested By O I \ (,)A � Mailing Address 1$ Z E,; cXCn CE TI 2. Name on Permit if Different than Above �>Qme 3. Application for: ❑ General Evaluation 4. System to Serve: ErHouse :�ie-Business ❑ Industry 5. If house, mobile home: Subdivision Home Phone '7! r^ cl / 5 if Business Phone Sarn0 Itk'Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms 2 @Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions 15 - X�1- 3 ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Publicrivate 8. Property Dimensions 42 ACr-c S Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? RM ❑ Community This is to certify that the information provided is correct to the best of my knowl incurred from this application. A 1t9 12. I99S� DAYE , and I understand I am responsible for all charges ZjIUNA I UHL CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: "6I 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of %e Davie County Health Department to enter upon above described property located in Davie County and owned by ova 1/1t'es ]1a14 - to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1/93) - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME o w Vp DATE EVALUATED ADDRESS S A (t' A PROPERTY SIZE PROPOSED FACIILTY t"t t)%N5Z. LOCATION OF SITE Water Supply: On -Site Well ✓ Community Public Evaluation ByCtL Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .S S _r' S Slope % TIX 3° - l 9-161 1� HORIZON I DEPTH 6 " T " 4,1 Texture group C L C L C L Consistence Structure R Mineralogy HORIZON II DEPTH 2" 14 --Ik ° Texture group�. Consistence S Structure k i31� Mineralogy) ; ► . 1 1'1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON -- SAPROLITE — — CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ("2'.> LONG-TERM ACCEPTANCE RATE: ``4 REMARKS: �� - `'A DCHD(01-901 EVALUATED BY: :. � 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 :lay 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 ,3C -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 ■��■ ��■ �� ■■��■��■\��n�■��■��■�■ ■■■��■■��/�■■ ■��■�r��\��■��\��■ ■■��■��■■��/�■��■ ■�■�■��■��■��■■��■��■ ■��\��■��\��■■��■■��■ ■��■��■��■��/�� ■��E■��■��■��■��■�� ■��■��■�■■��■ .�........................................C...................... ■��■��■�■��e��■�� ■�■��■�■��■■��■��■��■ ■��■��■�■��■ ■��■�■��■��■ ■■■��■�■��■��■■��■ ■■��t��■ ■��■■�� ■��■■��■■��■��■��■��■��■��■ ■��■��■��■■��■■ ■��■��■ ■�� ■ ■ �■�� ■■■ ■■ ■��■�■��■■��o��_��i�■■ ■��■ ■��■��■��■ ��■��■■�■��■ ■��■■��o��■��■■��■■��■��■��■�■ ■■��■��■��■�■��■��■ ■��■��a��■��■ ■��■��■ ■��■�■��■��_��■■��■�� iiiii�iiiiiiiiiiiiiiiiisiiiiiiii�i=iiiiiiiiiiiiiiii�iiiiiiiiiii=� ■��■■�� ■ iiiiiiiiii��iiiiiiiiiiiiiiiiiiii�iiiiiiiii�i�i�■ii�iiii�ii�i��i=iii ■��/��N��//��n�� ■�� ■\��■��■��■��■�� ■��N■■��■��■��■��■��■ N��■�\�� ■��■��■■��■��■��■�■��\��■ ��%��\��■■��N��u�� ■��\��■��■��■�/��r��■�■��■��■ ��■��■ ■��■��■��■��■��■��■��■��_��■�� ■��■■��■��t��■�� ■�■�� ■��■��■��■��■ �� n��■�■��■��■ ■��■��■��■��■■ �\��i��Ni�i�iii�� ■��■��■��■��■�■ ■��/�� / ��■ �� ......................................... ..�.... ......�C........ ...................................... ..�...�... �....,.......... ■��i��■�■��■��■�� I�� 4'i��■ ::::�:::::::::::::C�:C::::::C:':::: ::::C�. ..C'C'�C=::::::� i1....�.. .. . . ■��■�'�� n � iiiiiiiiiii��iiii iiii'■iii'iiiii�'i�in�i��i.�iiiiiiiii■�iii'�i�i=ii�i� �u�a�C�� ■��■��■��■�►.:��r��■��_��►��n� � ■ ��■�� ■ ■��■��i��aa■r�n��■�� in ��■_ ----- .• �- -....�� ■� ■��i��t�l��:i�r��■� �� l� �� N�� ■��■��`�,�1��:;��■��fiiC�:�: �� l� ��\�� ■��v��/��!��II��I��w��II�N� � ■ ■ �� ■��■ ■��'��11■��■��I��Y ■11��'��% ��N�� ■��/��■� ��■�II��■■��11��1�� 1 �� ■ iiiiiii�Cii�i��ic�iii��iiiiyiiii��iiii��=i��r ��i�■�� ■� �� o�� ■ ■��c��ri■��:■■►��r��i��:a��i�� ■_� ��_��■ ■■��■��:�i��:.•_:i!■�I`�i��l��!!��I�H �� I�� ■�� ■�■ �� ■��1�1=_:��1��1��1�� H��■�� ■ ■��v��■��_'�:�!!�ll�/_!1��■ ■�� 1��/��■�■ ■��/��:ii/�[��H��fu� �/In��n�� ■��■��■��■��■�■��i��l�� II��N�u��■��■ ■��H��Pi�� tl��r��M�� ■��■��N�� I�n .........................C...........c,..■..��...................... iiiiiiiii�iiiiiiiiii=iieiiiiiiii�iii�i=Niiiiii�iiiiiiiiiiiiiiiiiii ��■��u��■��■��■■ ��r.��■...■.��...,��■ ■��■��■��■�.��■i�i�ii��■��,�� ■��■��■ ��■��■ ■��■��■��■�r��.��i►�►��■ ��i�r��i�i��.��..��:.yc�a�� ■��■��/��■��l��ii��l�l/��Il�f\J��1��\ ■■��■�■��■��'��■�,�I��■��■ ■��■ ■��N■��/��I�I��\��■u�� ■��■��■�■�■��■� ■�'��!!��Il'=��:�:��C��!!C��■ ■��u■��/\ i \��i��■��■��■ 6 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department i Environmental Health Section P. O. Box 665 Mocksville, NC 27028 SEP — 9 19941 1. Application/Permit Requested By 0-0.vr,es R. W e646A Mailing Address 182 Provl ence Tra;' Home Phone 710 - MD clsyi & /D-MDclsyi& , Irl, C. 27028 Business Phone Sar►Zo 2. Name on Permit if Different than Above -Same — 3. Application for: ❑ General Evaluation J.Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown 4. System to Serve: i( House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms No. of Bathrooms I V2_ Dwelling Dimensions 600 ss -4 aadrox ssuacs 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Sinks _ No. of Urinals SectionLot # El-'Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public RrPrivate ❑ Community 8. Property Dimensions 4a4�res Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes V No If yes, what type? "NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: l; .7Mtla r Prov i lienor ami 1�3 EJ For}C F-�4i34 CAA14 /7r/ xZ— �aA� Mcy -W This is to certify that the information provided is correct to the best of my knowledge, and I understand 1 am responsible for all charges incurred from this application. Scd 9, lg9f�X 4� DATff SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 9 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DCHD (1/93) DATE SIGNATURE ,iFNi DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation /� NAME //%/�S�E�� DATE EVALUATED '� ADDRESS PROPERTY SIZE _ PROPOSED FACIILTY /�S Y LOCATION OF SITE Water Supply: On -Site Well �� Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group< Consistence Structure ' Mineralogy HORIZON II DEPTH Texture group Consistence Structure a/ SX/ Mineralogyr 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 c SITE CLASSIFICATION: 6 EVALUATED BY: Z ; LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscave 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 3C -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 (01-901 ■��■■��■��■��■ �e�u�� ■��■��n��■��■ ■��■��■��■��■��■ ■■��r��■��■��■ ■��■��■��■��■��■��■ ■�■��■��■ ■��■��■��o��■�� ■��■��■��■��■��■��■��■��■�■��■ .........................................■.�.....■...■............ ....■...........■......................... ...................... .........■.......■...■■......■..■■.■■■...■■..■.■.■.■.■............ ................................�...............■.■.■■■■■■.■■■... ................................ ........■....................... .................■.........�.............■..■■■�■■■■.■■..■..■■■..■ .....■.......■............. ................... .■■..■■■.■...■■■.■ .■■■.■■.■■■.■■...■...■...■...■......■■.■.■...■ ..■.■.■. .■..■■...■ ..............■..........■...■■■.■■..■■.�■■.■�■�■■■■■■�■■.■.■�■■ ::::::::::::::::::::::::::::::::::::::.:..:�:::.:::::::::::::::: .............................■.. ■..■.■■■■■■■■■■■■■■■■■■■.■.■■■■■ ■��■��/■��■��■��i��■�■ ■��■��■��■��■��■��■��■�H�� H��■�� ■��■��■ ��\��/�� ■��■��s��_��n��■��■��_■ ■��■��■��■��■��■��■��■��u�� ■�■��■■■ �� iiiiiii�iiiiiiiiiiiiiiiiiiiiiiii�i�ii�ii�i��iiiiiiiiiiiiii=iii ■��/��N��/��M��n�� ■�■■��■��■■�/��■�� ■��N■\��■��■��■�� N�� ■ ��■��■�� ■��\�� \��u�� ■��■��■��■��■��%��■�■■��■��■ ��\��■��/�C�Gi��■�� M�� \��■�� ■��A��r�� ■��\��111��■■��■��I��■��u�� ■��\��1��1��■��■��■�■ ■��■��■■��11��1�� u�� ■��■��■�■■��■��6��Ciii�11�� ■��■ ■ ■��■��■��t�■�i��■�l�J��■ ■��■ �� ■�■ ■��e��u��ne■�� d�� ■��■ ■■��■�w��u�� ■ �i�� ■��■� ■t�■■��r�rr��■�■� �� ■ ::::::::�.::::::::::►:::::::�:::":::: ::::S:C� ::�:C..�=......� .. ...... ...................,............i1... ... .........�.�.... ■�■��■��■��/1�� ■ �� H�� ■ ��■ ■��u��■��■��■��■�� u�a��■�� ■��■■��!��n��■�_�■ ��n� �� ■��■ � ■��\�sl�%■�� N��n h �u�� ...................�................_..�:�C �. ' .�C�::�::�::::: ................................... .. ................................�3.:::' .. . .�.�.��:' ................. .............. �: s ................. .................D.�................. .. ■�� 1■ ��N�� /�� :::::::��C:C::�:Ca=:::::::::::::::::�C:::: .:"�:C:::S�:a:: ■��■��■��r��■��■�� ■ ■ �� ■ u� ��■ a�� ................��,............�...�.."=.�.�C..�C.�...C...D.=..■ ■��Y�1��■�� ■■�� /�..■�N��■� ��■ ��H■��u� ��n��n�� %v��1��N��\�� Un� ��/� ■��N��1�■��■�� ■��■��Hn �� h��\N�■�� iiiii�i�iiiiiii�iii�ii iiiiiiiiiiiiii�iiii i�iiiii�i=i iiiiiiiiiiiiii ■��■��■��i��■�� . ��i��■��■�� ■��n��t��u��■ ■��■��v��■��■��N��■ ■��■�� o��■ ��■�� ■�■��■��■��■��■��u��■ ■■��■��■■�■�_��■ ■��■_��■��■ ■■��■�� ■■ ��a�� u�� _��■��■��■��■��■��■ ■��u��s ��■ APPLICANT INFORMATION Account #: 990005562 Billed To: James Weston Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5767-96-0008 Subdivision Info: Location/Address: 182 Providence rail -27028 Property Size: 45 Acres Date Evaluated: On -Site Well / %Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH 0qP - Texture group dSeL Consistence Structure (Q Mineralogy HORIZON H DEPTH Texture group Consistence Structure 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 O . O• o� SITE CLASSIFICATION: ) EVALUATION BY:--►y�l�l L/-6GY/I Z, LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:!/L REMARKS: %e.'OA �_C) L_ %A a LA, -e " 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 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 - T nna_tPr arrant - ..oto , 1114-./C.'l — --- - August 23, 2010 Question will septic system be use for travel tailor dumping? Travel tailor dumping into private wastewater systems is not permitted, will need to use a dumping facility for this purpose. Signed. DAVIE CO. ENVIRONMENTAL HEALTH