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571 Ridge Rd , • ' DAVIE COUNTY HEALTH DEPARTMENT - � Environmental Health Section � P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003337 Tax PIN/EH#: 5707-91-6016.JB Billed To: Joseph Byler Subdivision Info: �5�� Reference Name: Location/Address: ,5�3Ridge Road-27028 Proposed Facility Residence Property Size: 10 acres ATC Number: 3868 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLJED 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: .�� Date: .�� � � CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system desaibed 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 tee that the system will function satisfactorily for any given period of time. ,�� ^ � �o G'��'�x�%`-T��rG�-1;�C� Q��b �, �� . I G� 3 .�l PT �z�,E;/�C � ����Ds� Pu,�� �T � � �d � � � : �'6ti �� `� // � Septic System Installed By: ` �l 7✓/� � ki 0'6� Environmental Health Specialist's Signature: Date:��/��/�� DCHD OS/99(Revised) - ' DAVIE COUNTY HEALTH DEPARTMENT �•- � � Environmental Heolth Section �j,. a� ` .,� , P.O.Boa 848/210 Hospital Street ' • ' Mocksville,NC 27028 /��-- (336)751-87G0 � Y-�/ �� IMPROVEMENT/OPERATION PERMIT Account #: 990003337 Tax PIN/EH#: 5707-91-6016.JB Billed To: Joseph Byler Subdivision Info: ��j'�� Reference Name: Location/Address: 57�Ridge Road-27028 Proposed Facility Residence Property Size: 10 acres ATC Number: 3868 **NOTE** This ImprovementlOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR Tf�INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMTT BEFORE INSTALLING SYSTEM. ✓ Residential Specification: Building Type #People�� #Bedrooms� #Baths �'�,5 Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ � �,/ Lot Size 1��C' Type Water Supply� Design Wastewater Flow(GPD) GbL7 Site: New 4d Repair❑ System Specifications: Tank Siz��GAL. Pump Tank��GAL. Trench Width r,� Rock Depth,�Linear Ft.��i Other: � J �>� S -' �S— ��' Required Site Modifications/Conditions: I1�IPROVEI�IENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 .m.to . . of installation. Telephone#is(336)751-87G0.**** � ��;SSti�•� , ��`C/�G�c�.s/` `����`� �v / � ,, �l��`iG�'�t�' a� !c-�% � ` �,�U,••/S �'y r�r�_ ; � � rT� jp� �� � Environmental Health Specialist's Signature: , ,�i���/ � s� Date: � 1 O DCHD OS/99(Revised) `�J� �� , . . DAVI�COUNTY HEALTH DEPARTMENT ��- �!—�'—o y . , . '... Environmental Health Section . . • P.O.Boa 848/210 Hospital Street � '� Mocksville,NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990003337 Tax PIN/EH#: 5707-91-6016.JB Billed To: Joseph Byler Subdivision Info: � Reference Name: Location/Address: 573 Ridge Road-27028 Proposed Facility Residence Property Size: 10 acres ATC Number: 3868 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction ofa 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 LS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST�SEE THIS PERMTT BEFORE INSTALLING SYSTEM. � —� Residential Specification: Building Type � #People�� #Bedrooms �S #Baths�S Dishwasher:� Garbage Disposal: 0 Washing Machine:8� Basement w/Plumbing:8/Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:❑ Lot Size Type Water Supply� t//Design Wastewater Flow(GPD)�� Site: New/� Repair❑ System Specifications: Tank Siz��1�GAL. Pump Tank GAL. rench Width���Rock Deptt����Linear Ft� Other: c�SC,c// I/� (�'Q Required Site Modifications/Conditions: I1�IPROVEM19ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6 "BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.**** �� ���� � � �tsw- �'��S ` _ � � / . � Environmental Health SpecialisYs Signature: ! Date: �— �� � DCHD OS/99(Revised) ,� . ' � .' ' , . DAVIE COUNTY HEALT'H DEPARTMENT • 'o Environmental Health Section P.O.Boa 848/Z10 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003337 Tax PIN/EH#: 5707-91-6016.JB Billed To: Joseph Byler Subdivision Info: Reference Name: Location/Address: 573 Ridge Road-27028 Proposed Facility Residence Property Size: 10 acres ATC Number: 3868 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLJED 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 WASTEWATER CONS UC ON IS VALID FOR A PERIOD OF FIVE YEARS. , � ,o Envuonmental Health Specialist s Signature: Date: ��� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system desaibed on ImprovemendOperation 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 guazantee that the system will function satisfactorily for any given period of time. [_ Septic System Installed By: Environmental Health SpecialisYs Signature: Date: DCHD OS/99(Revised) � .._ ;_ - , , . , V f� 5' �V! V•� �/' � . . . � . � � TION FOR SITE EVALUATION/IMPRQVEMENT PERMIT&ATC - Davie County Health Department �; ' En vironmenta/Hea/th Section AUG 2 a � P.o. BoX 848/210 Hospital Street ' Mocksville, NC 27028 '"'���� �� (336)751-8760 ROf�h1INTAL HfAU}I ***I PLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION_BIILLETIN for instructions. • 1. Nazne to be Billed ����� �� �'`/�� Contact Peraon ��� a.� Mailing Addresa �����Gf.�/���, Home phone 74�/ - a 7g- OS'7(�y_ City/State/ZIP �L�,��� � � Buaineas Phone 2. Name on Permit/ATC if Different than Above SC rY/� Mailing Address _�7�Q �� Cit /State/Zip „�,�c,�r��� ///� [ , ���S�.e^-�''s.:'vr' . 3. Application For: � Site Evaluation O Improvement Permit/ATC ❑ Both 4. sy.atem to serv3ca: � House ❑ Mobile Aome ❑ Business ❑ Industry ❑ Other 5. Type ayatem requestad: ❑ Conventional ❑ conventional modified ❑ innovative 5. if Residence: # People /� # Bedrooms f # Bathrooms �_ ❑Dishwasher ❑Garbage Diaposal �Washing Machine �Hasement/Plumbing ❑Basement/No Plumbing 7. If Busineas/Induatry /Other: verify type # People # Sinks # Cos�odea� # Showers �_ # Urinals # Water Coolers � IF FOODSERVICE: # Sests Estimated Watez' IIsage (gallona per day) 8. Type of water supplys �" County/City ❑ Well ❑ Coaununity 9. ao you �tic�pace additions or expansions of the facility this system is intended to serve? �Yes �No If yes,�vhat type? , ��v ***IMPORTANT'�**CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMAT[ON REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. I� �OPro�C c � � ,q��- � Property Dimensions: L/.2 � �C //d D /01 WRITE DIRECTIONS(from Mocksville)to PROPERTY: ' Tax Office PIN: # Jr 7 O 7 q f b 0 1(0 ��"``��x`'S,,�- c,�-�- �� Property Address: Road Name,-1, 7?� �r'��-P � � �-- � /"�'Y�- � ' o-- c�tyiz�P,,/���/c��,,l/�/�/, C, �-:��� o ..� ���-- If in a Subdivision provide information,as follows: °�7�`�g Name: � � �� �'e Zh C'� Section: Block: Lot: Date home corners flagged: � 'Z� ` � This is to certify that the information provided is correct to the best of my kno�vledge. I understand tl�at any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed I,also,understa�rd tliat I ain responsible for all cliarges i�rcirrred Jrone this applicatio�r. 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 the site suitability. DATE �'g d SIGNATURE 'I� � ��� �— THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Incl e all of the following: Egisting and proposed property lines and dimensions, structures, setbacks, and septic locations). , � Site Revisit Charge Date(s): Client Noti�cation Date: EHS: '� � Sign given � Account No. �--� � � � • � � � � � Revised DCHD(OS/03 �✓ (�7 7 q Invoice No. /`�" / �,� ..E � �L,r/�'`'� � �j-�-"° y' /��- �`�-"° `� ' � {_i. . . . . � � � .. . . ._ . ' .. . . � � . � . v �� � - . � . . � . . . � . � '�����-� y t� +'':t,�i ����`�*':t�''�'^."�"'-,-�x�: *^ " a. ,� -��r�-������`'ti'"+.s. ",J,S'T� . . - S�'x��it.�'�-' i� � r �;�� ��"�.;�'.-�,��'��x D�.�I�CQUN'Tlt ii�LT�i.��,�,E�'ik�T1�i�I�1�i'T�,�,z.�P,�,,.��.�.,,,�. ..�: �.�,y.a..., . .,.�.� - _�;.._.L,.,.� . �..x.....:_: - � .... _. _� ����....�„�• r4��'��"��� Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 � . . . . . . ��'r�xE``�4-.T,: z��q�,�J�-c� a `t�>Mh� ".r-.m+". -.'�-'..,..�}� a�`x"��'y 'J .� y.�.�.�,�.Q,�^-r ��. . t ..�. . . . ,s ,q„ x 1,r ^�y�r �,d�',�s-2.'� 33617_51-8760� {�^�. F 'i`'r::�py7 �s'�..2'...,{14,+�..���i ���'� . � . . q'�r'�.,`5,,� w'� 4 � c '?� s��:�L hy��, �,�v�- �� ` / * x �., v�r'�����.�u -"9^`l1`X 3 "�- '�.�,� v -e��' y,r k. rt }. ...r� r ',,..'�1:", a �r •�' �r� .s, ' � ¢ �,�k�;„'°s'Sr��."'�,'�ds •t�v✓ �.x w.�°' i *�.'. -2z +-�x�''er" a4a�-e+ar�r 3�`.ts.3 t,�,-st�;y;�,,�,+- •'�'� u'rs .�y�'' � � .. � .� ur`��. y'2''�' �`� • c"$.�,�'� s� wa�,�z�s�+i ir+�� t`�:,�,�y � `y3`�s jy �,�k Pt;'7'<i 'i'�k`�y�y �rt`�')`s'�'�"�`��`;;,�"'p�.'x�'"{+ :rs. i . . x �+�;•�xr,�t .'�� ,a"�y :3'k�* i�,.'�t..%�"' �r•. x`fs�, t , , yY ., r^����'�x�� '�"i`+'r�?'Sctj�n;.,,�f-r+{.�',F.�'`�'�``�"�`,n ,,� ,` y„+.� r � . - �� ��"�.c..;` .+Yi�:�,e�::.yV.rir:�a���5f.�.is.nsl.a:.....�3�r_.....a.,.?...,.u,r...:s,�...-3 rS i+za��`^�.a.���x.c.w....�..�.Y.._.�...4`"��+:=�> �}'..,.'�....�,��' � � u .. Apri129,2004 � . John Bishop \ 243 Bonkin Lake Road Mocksville,NC 27028 Re: Site Evaluation/Ridge Road Ta�c Office PIN: #5707-91-6016 Dear Client(s): . As requested, a representative from this office visited the aforementioned site on, Apri129,2004. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site,the site was found to be • provisionally suitable for the installation of an oversized modified on-site sewage system. Before an Improvement Permit/Authorization to Constn�ct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, � �a������� � • � . � �� v . . Robert B. Hall,Jr.,R.S. Environmental Health Specialist ' , RBH/dlf � Enclosure(s) ; . . - .� ; . . . DAVIE COiJNTY HEALTH DEPARTMENT • • '• � • � Environmental Heolth Section , " �� . Soil/Site Evaluation _APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003337 Tax PIN/EH#: 5707-91-6016 Billed To: Joseph Byler Subdivision Info: � Reference Name: Location/Address: 573 Ridge Road-27028 Proposed Facility: Residence Property Size: 10 acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition Slo % HORIZON I DEPTH Texture rou Consistence Swcture � Mineralo HORIZON II DEP'TH Texture rou Consistence Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo 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-Tenace FP-Flood plain H-Head slope Textnre 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-Subangulaz blocky PL-Platy PR-Prismatic MineraloQv 1:1,2:1,Mixed otes 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-gaUday/ft2 DCHD OS/99(Revised) '� yT _v.,; y� °� �. � , . ;� , � � � l�� �- . . s � : . . � � �'� � c� � d � �- � s � �� r�� � , � � O � 9 ""'" A!'! CATION fOJi SITL•CVALtJ�1T10N/lhli'liUVL•6IClVT 1'GIi1�11T a�l'i'C f � �R Davie County Health Department �� P��� EnYiroirmenta/Healt/i Sectioa (�, �1R0�����(t`t P.O. Dox B4a/210 Ho�pii:al StrceL ;. ':21ocY.3vil.lc, rTC 27U.2Q� (336j 751-37G0 • � ***:Ir1PORTdNT*** TIi2S 1►PPLTCATION C1INNOT 13L•' PROCESS1s"D U2dLLS5 ALL 1'lIL 1tLQUI1�Lll • y I I2JFORMATION IS PROVID�D. Refor t;o l:ho IIZFORMATION DULL�TIN L•or in.;CrucL•iori�r: 1. Nsmc to be Dilled �0�..�J ��S�p� ConLacL Pcr::on ..___�..____. 2dailing Addres� o�y�J '�7o��.i� Z�w�. �� ' ' llanc l�lionc ��1�" 50 3_3 . City/3Catc/ZZP '�t�OL�IS���V— � C- �10 a � Uu:�inc�n 1'I�oiic ~�`oa - `�o yh 2. Namo on Pcrmit/I►TC if Diffcrcnt than Abovc � Mailing nd�lrcas City/SCaL•c/'Lip _„_,_, ..,, .,_._._ . 3. Application For: SiCc Svaluation � ❑ ImprovemcnL Pei�niL/A'1'C ❑° 1soL•1, 4. sy�tem to service: House ❑ tiobile Home . ❑ nu�zne�s ❑ Indu:;try ❑ OL•l�ex• ___ __ _._ �( � S. Typc aystca requc�ted: tA`Conventional ❑ convcntional modiL•icd ,❑ ii�nuvaL•ivc � / G. If Re�idence: il Peoplc 1� Dcdroom� �_ Il uaCliroo,uu D� iahwaaher ❑Carbagc Disponal Wa�hing Machino ❑Da�emenl•/I�luu�ing ❑Ua::emenL•/iJu Ylwubiii� 7. IL Duainens/Induatsy /Othcr: veriiy type 1! l�coplc I} :;iulc� ..___._.�.. � Commodca !� Showcra � � Urinala 11 t9aecr Coolcr� IF FOODSERVIC�: �� SeaL-a �a�iinated i4ater U:;agc (Jallon:� per day) ` _._______ v j `� �"'~"' . e. zypc oE watcr aupply:�County/City � Wcll ' ❑ ConuuuniL-�� ' p cuf�S'� o�-- 9. Do you snticipatc addition� or C\i);1I151011J Ur 111C racility tliis sySlClll 1S![IlC1lt1C(l (U JL`1'YC':❑ ��c5 I�u If}'cs,��•liat tppc? • __ ***lAll'OR'l/IIY�**CL1LI`lTSAIUSTCOAI!'LETL•'Ti1L: R,GQUIItGU 1'lt01'Llt't'Y 1Nl�Oltl1�[rl'1'1C)l�' itlS�UliS'I't:ll� .•-I [3GL01V.' [:ichcr a PLA7'orSITG Pl,r�lY�ItUSTITCSUlI�Ill77'!'D by thc ciicnt n•iUi'!'FIIS AP1'1,1CA'1'ION. 1'ropct'O'�llliCiIS1UJlS: v �� ��`'� 1Y1t1'1'L•'llllZLCI'lUilS(fruiu Blucl;si•illc)lu l'RUI'1:(:'1'1': . , �' . _ .. :. ' l:iz Officc 1'!N: If .S� (�.�1 �1 l'�D�� �Q - ' �� � , S�U v����� .�.._._ . . . _ 5.'_l 3 , _.. Property Address: Road Naiiic'�_��ay�..Z.� '��- ���a,.ys ���v�c �� �, �—� • � �7 D� �� � City/Zip " . � `5 . , _�' .Q_ . If iii a Subdivisioii providc infornialion,as fullotivs: F�,,� �-� �� � �v�C �-v�,,)T' ���111C: ' ��J � �V�s� ��.'Y\�SS �� � Scction: Blocl:: Lot: Datc lionic coc•iicrs IIab�;cd:_1/ / l 9 � �/ �- Tliis is to ccrlify ihat ttic iiiforuiatiou providcd is corrcct(o tlic bcst of ury lcuotiti•lcdba ! undcrslaud (1►:it:ui}�peruiil(s) issucd licrcat(cr are subjcct to suspci�sion or rcvocation,if tlic sitc plaus nr iiitcudcd usc cli:uibc,ur if Uic iui'ur�u:�t;uu subniittcd ici tliis applica(ioti is L•ilsiiicd or cliaiibcd. I,also,unrlcrs[u�tcl drn�I�urr rc�pu�ra•iLlc jur�c!!c/ru�3�ca-iucrn•r�•r/fi•urri tlris uppliculiuir. I,licrcb)•,bivc conscut to tlic Autliori�cd Rcprescntativc of llic U:n�ic Cu�ui(y llcal(li 1)cp:u•tiu�n( tu cc�ta•upa�abo�•c dcscribcd pruperly loc:itcd iu llavic Couacy aud u�ti•iicd by tu couduct all tcsliug proccclures zs iicccss:uy to cictcruiic�c tlic sitc suit:�bilily. DA1'L; L �� �1� _ . .__ _ SIGI�IATURI, . � � . . �� _ .. . . _ __ _ . __ . , TIiIS AREA D'!AY 13�USLD TORDRA.WING YOUR SIT��'LAri(lucludc all�f lhc Cullotivii�b: Laisliiib auQ propusccl property lines aiid dimensious, structures, setbacics, �nd sepfic locatious). ' � Si(c12c��isi( Cli:u•�;c Datc(s): __ • C11Cll�N0�1lIC:l�lU11 v:ItC: ' LIIS: " / �' / S'c� �.f� o SiSc�givcn �/�✓ � Accouiit Na. .. ` ti , , . _ ' • • DAVIE COUNTY HEALTH DEPARTMENT � , , . , ' • • Environmentai Health Section � . Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003170 Tax PIN/EH#: 5707-91-6016 Billed To: John Bishop Subdivision Info: Reference Name: Location/Address: 573 Ridge Road-27028 Proposed Facility: Residence �Property Size: see map Date Evaluated: �� � Water Supply: On-Site Well Community Public v Evaluation By: Auger Boring 1/ Pit Cut � �''/a s� � FACTORS 1 2 3 4 5 6 7 Landsca e osition L. 1` ,� ,Z, Slo % HORIZON I DEPTH �' �i i� ��� ii Texture rou L 'C cS' Consistence Structure Mineralo HORIZON II DEPTH p �< <� °� �' �� Texture rou � G' ConSistence � , Structure 6 i9 � x / Mineralo X' � ' HORIZON III DEPTH �0 4 �/ � �. � �/ Texture rou f' � . -- Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , . . „ `� SITE CLASSIFICATION: �rsl�� . < LUATION BY: _ / � O/ 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-Slighdy 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 Mineraloev 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-gaUday/ft2 DCHD OS/99(Revised) � � �/ ■��■��■■iii��\li■����■��■■��■O■■■�1i�e�/!■■�■■��■�■�■^'�e■�������0���■ ■�������■�f1����■����\�����■����■i����������■����/l:J����■��0���0��■ ■�■��������■���■��0��■�����■�■�■��■�e���■�■����r!�J�11�■�8������■�■ ■�������������������/���/��■���■ ■�����/������rfi����������������■ ■����\��������■����■�����■��■�■��������■������f�(�11■��■■��■�������■ ■��������������■\■���■����■�������■■�■�����■���■f�f1���■�������■��\■ ■�����!■�■��/�����■��������■�0�����■��■��■���������■���■�������■�■ ■����������������������������������������������I������������������■ 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Environmentai Health Section P. O. Box 848/210 Hospital Street Courier 09-40-06 - Mocksvilie, NC 27028 w'�s .} •,"t �„".^�'n'.�„""�'.�°.t�5 TM—'�'�, �na%i��' �� a �y �.... + s.""�7�. z.� �� * � � � (336)751 8760 � f � � , �� ., � ��dx� ' `E� f 3 t � F � ,, t� � ' q t Y �.�.� ,�� . � df�y e . . ' Y t k i k d � - "- . � t b �` Y 4 �'z . � . ,�. 7 „ .F`�x. . � � � . . �'�'� :.w7x.�:.."� L�s�,..di t y,n.:^- _ .P.�,.w��..,..v.�s� ``,.�...�3'..0.::,...�.��t n..c.s:iaa..t.....,..:.b�. '�.:.»_,�.��:`�:.:.�...-:..�.•i. -:�.,..t ..�a.._,.�....e:s*".y.c..'Y�.�, Apri129, 2004 . John Bishop 243 Bonkin Lake Road Mocksville,NC 27028 Re: Site Evaluation/Ridge Road Tax Office PIN: #5707-91-6016 Dear Client(s): . As requested, a representative from this office visited the aforementioned site on, � Apri129, 2004. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site,the site was found to be • provisionally suitable for the installation of an oversized modified on-site sewage system. " Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, /��2!�,t���/��;. Robert B. Hall,Jr.,R.S. Environmental Health Specialist RBH/dlf Enclosure(s) ., ' ` . - . ' , . : � . . .,� � � ,�,��. � ���:� .����I�CC3U1�iTY��I�LT�Ix�����T1f�Eh�T�� '' {'���_&�� � �, � f _ f . t �, n i;3.. Environmental Health Section P. O. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 .�,'.,���.,�..�,...'����.�� ,,,,,�".� (336)75i 8760 ����'' '� � �;� , ��t������� s e a A ,�, a ���rs �� �.� ��'T� .:a � F� 'X$� `�:'t``��` . r F y i;. : r �,i� ; .�.e �b fr��"����r �,y;.t .8 ' 7 i P G - r � �. 'r r d � .. i '". � . � t'� S wu`" �9�C � '� �L� � � ,- b Yr"' ° '�� r C :�,"' � r- . � ' � ' �� � �� � ���,'� t'. v ?��'; , t a �; t t '-� �` �. �-���:..�� L�� �a . � ,t'. vt. �zr„ ..n.�.r..Lu..,1,� `� August 30,2004 � Joseph Byler 1270 Parks Road Woodleaf,NC 27054 ' Re: Site Evaluation/ Ridge Road . Tax Office PIN: #5707-91-6016 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, August 26,2004 Based upon the information provided on the Application for Site Evala�ation and after an evaluation was completed on the site,the site was found to be provisionally suitable for the installation of an oversized modified on-site sewage system. Before an Improvement Permit/Aacthorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, �������- Robert B.Hall,Jr.,R.S. Environmental Health Specialist RBH/dlf � Enclosure(s)