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113 Wyatt Drive Lot 54Davie County, NC Tax Parcel Report Tuesdav, December 20. 2016 WARNILI.VCT: THIS 1S NOTA SURVEY Parcel Information Parcel Number: F8030A0054 Township: Shady Grove NCPIN Number: 5870643273 Municipality: Account Number: 82528109 Census Tract: 37059-803 Listed Owner 1: PSC DEVELOPMENT COR INC Voting Precinct: EAST SHADY GROVE Mailing Address 1: P O BOX 5967 Planning Jurisdiction: Davie County City: HIGH POINT Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27262-0000 Voluntary Ag. District: No Legal Description: LOT 54 ESSEX FARM PHASE 1 B Fire Response District: ADVANCE Assessed Acreage: 0.76 Elementary School Zone: SHADY GROVE Deed Date: / Middle School Zone: WILLIAM ELLIS Deed Book / Page: Soil Types: GnB2,EnC Plat Book: 9 Flood Zone: Plat Page: 388 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: F-0 Davie County, �T l� C All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from anyandalldaimsorcausesofadlondueto or arising out of the use or Inability to use the GIS data provided by this website. IMPROVEMENT PERMIT �b Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336=753-6780 Fax: 336.753-1680 PERMIT VALID UNTIL 4/16/2020 ,NOTE TO INSPECTIONS DIVISION: Buildina Permits cannot be Issued with this Imarovement Permit. Applicant: PSC Development Cor, Address: PO Box 340 City: Mocksville State)Zip: NC 27028 Phone #: (336) 751-7300 ; cddress/Road #: Essex Farm Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC assitication: PS LPP perty Owner: PSC Development Cor, rP...,,..- .. .. Address: PO Box 340 City: Mocksville State/Zip: NC 27028 Phone #; (336) 751-7300 Subdivision: Essex Farm Phase: Lot: 54 Directions Hwy 64 East left on Comatzer Rd. Left into Essex Farm past Beauchamp Rd Saprolite System? OYes @ N o Design Flow: 4 8 0 Soil Application Rate: 0 a 5 u '*System Classification/Description: TYPE IV A. ANY SYSTEM WITH LPP DISTRIBUTION *Proposed System: 501% REDUCTION Minimum Trench Depth: a 8 Inches Maximum Trench Depth: a 8 Inches Septic Tank: 1 5 0 0 Gallons 1 -Piece: OYes No Pump Required: eyes ONo 0May Be Required Pump Tank: 1 5 0 0 Gallons 1 -Piece: OYes QNo Repair System Required:@Yes ONo ONo, but has Available Space Repair System .Site Classification: PS LPP Soil Application Rate: 0 a 5 *System Classification/Description TYPE IV A. ANY SYSTEM WITH LPP DISTRIBUTION *Proposed System: 50% REDUCTION Minimum Trench Depth: a 8 Inches Maximum Trench Depth: a- 8 Inches Pump Required: @Yes ONo O Maybe Required Page i of 3 CDP File Number 191865 -1 County ID Number: *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in noway guarantees the issuance of other permits. The Permit holder is responsible for Checking with appropriate governing bodies in meeting their requirements. The layout of the septic system has been designed by Soil & Environmental Consultant, PA. See page 3 for the design. All design criteria can be picked up at Davie Environmental Health. The house size and exact location must not exceed the design dimensions as specified in the design layout. Site Plan me Improvement Permit shalt be valid for 5 years from date of issue with a site pian (means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dlmenslons, the location of the facility and appurtenances, the site forthe 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 surveyor, drawn to a scale of one inch equals no morethan t;4 feet,'that includes:. the specific location ofthe 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 pian 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 satlsty the conditions, the rules, or this article. This perm it is subject to revocation If the site pian, plat, or Intended use changes (NCGS 130A•335(1)). The person awning 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 (A 938(b)} Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140 -Nations, Robert Date of Issue: 0 4 / 1 6 / a 0 1 5 ,F.—...` OValid without Expiration? Authorized State Agent: yt` _,.r-^,�, Q Create CA? OHand Drawing @Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 191865-1 • Davie County Health Department CDP File Number: 210 Hospital Street P.O. Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drawing Drawing Type: Improvement Permit Scale: , QBlock QN/A ----- – .--__ _.--- ____..-------- . . . ..... --_-_ —_.... ..K.t IK KIKKI IIMA'IKOKf K9t ILL K. Kl KIr KYY K KI A • KKIA Ki KK Al11KOK KL K KKMf I K{ KUKi10 SIMSIKiI11Kt Kf IV v FARM IKII M Mrar s K•Kt K+s M KIKt KIKKKAKiK MI Ilii Kf RMK Kt KK11 K KIKIKI M KmIIIKf r Kq nIw KIKI us tK' KKR � Kr KLL a KKII Kw Kir Imp w IIK. 1500 G TANKS French drain VALVE BOX it DESIGN SKETCH 55 45' / Yellow 4d _ Orange W PIT 1 se, Blue 75'® Or, ra!�w �j• 9e 43. 33. -Ya7ow / i/ / / / GRAPHIC SCALE 1 " = 50' 50 0 50 100 "BASE MAP PROVIDED BY CLIENT wr M Gaol mm0AK CUNN M KIOtf M eAnell R SEP SKEEN MAP T Soil & Environmental Consultants, PA KI lr� K K[ C YirL 1!M OraF� KIK KSI OWKFfIK I. MY K►MK ow"Um KKI Waft Ji >m w�aa r x a►ws lwaw w7wwwr r � uw r w wwc w r► awns w ws n � wsla roc ww7 s�wwan DESIGN SKETCH wt � wralwr w we wo. nw w r1i �7.w wlarww wrwwwa 4. 7• M av w71ew oow as awrr tart a►w1c sw.w1 rwr Ie1w 111w1 awrwlwew w1r wwn ww wwllar 11r wws s 101wwIw1 M Mild MwM Mw Si MI 1171011 wr wwnr uw \r wwo aw MM � w' Iwwlwi 1101 wlwa w7wa wt 1wa /1[ Illw{1fI me OAK"1 I � I S I / sync SYSTEM u►rouT SKETCH MAP I / / _ r 0• LOMW C..R C . R1s4..., a—" i .1�.. cmalm ,.... am 78"m I 1500 G TANKS 11i Ia1D¢ 1r11w Comm l� I / waawel Iti sw7 / 55' 45, Yd►ow _'w _ Orange 40' PIT 1A"t°a ss. Blue r5.0 Yana VALVE BOX Qb� Q w 4j. GRAPHIC SCALE 11f = 501 *BASE MAP PROVIDED BY CLIENT LOT54 L49a( IIQID DAZE CDUNTY 4. Si /1[ Illw{1fI me OAK"1 � S sync SYSTEM u►rouT SKETCH MAP _ �c Rm - Soil & Environmental Consultants, PA R _ r 0• LOMW C..R C . R1s4..., a—" i .1�.. cmalm ,.... am 78"m 11i Ia1D¢ 1r11w Comm l� waawel Iti sw7 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 191865 -1 County File Number: Date: LO 4/ 1 6/ 2 0 1 5 Click below to import an image from an external location: Drawing Type: Improvement Permit 1500 G TANKS VALVE BOX *BASE YAP PROVIDED BY CUENT DESIGN SKETCH GRAPHIC SCALE 1 50' s0 a so 1001 �. a'a rr rx wwr sE p .. wwwrrrs � f y 0p1ACSWUNUN�"'-o�uIws- �� SoA & EnvMonnental Consultnnts, PA { � � �S ryr rl�YlYr rIMPT[�.�rMY.Y r��.r-O�wM/.IY DIY Irr CMN•[ ONI ARAM/ HARM N NOM. K IMM 11"N AMMOMM=WNNMNNINRIN11110rWWONO. NOS IIIIIOC w I• N A ROIL NORMMN4 10 NN OR NONSPA M t IOOIMI O 1K ON NN �Illf M 1NW OIMN00 •f IM a ONIN00N � m ONNNN NN OM3t Mqf, ONN am�MONe7N1011NR W NINNIR ww NeNO t OOM1N N MNI/f � N6 Q •qw M /ONsnI Ms OK NNI IIMNNM RNR / Oma NYS NINe[ 1NY wr ONL n R wa DN OMwrww MiN fm" 45 FIELD LAYOUT I Yellow 50' Orange 50' Rte, PIT 1 © 49, Blue 75 R ev �, Pik gs. r�y�aw *BASE MAP PROVIDED BY CLIENT GRAPHIC SCALE 1"=50' utt 64 la= IOM DAME =Wff _ S as ISOfOr $M NNK1M I v SEP I C SYSTEMMAP - �soc naw - Soil & Environmental Consultants, PASKEMH $ ■� NIINI�. IOIDtI OIIMIIM OI Wmv p A[ O • fwrW IYrw dMN tO1R Nw OMIEIiRf M ti 0001 N!!OO IIOiO�I; l7 Essex Farm Lot 54 Project No. 4-1773 layout for a 4 bedroom home Dec -07 FLAG FLAGGED . LINE # COLOR BS HI FS ELEVATION LINE LENGTH TBM 2.2 100.0 INSTR.1 102.2 1 Yellow 3.30 98.9 41 2 Blue 3.90 98.3 53 3 Pink 4.10 98.1 66 4 Red 4.70 97.5 86 5 Orange 5.00 97.2 86 6 Yellow 5.20 97.0 73 7 Blue 5.60 96.6 75 8 Pink 6.00 96.2 58 9 Red 6.20 96.0 55 10 Orange 6.60 95.6 50 11 Yellow 7.00 95.2 50 Notes: ** TBM located on top of water meter **TBM is assumed to be 100' **All measures in feet **Nitrification lines are demonstrated on contour via colored pin flags **BS and FS indicate rod readings Notes: ** TBM located on top of water meter **TBM is assumed to be 100' **All measures in feet **Nitrification lines are demonstrated on contour via colored pin flags **BS and FS indicate rod readings Essex Farm Lot 54 Design Specs layout for a 4 bedroom home Dec -07 FLAG FLAGGED DESIGN LINE # COLOR BS HI FS ELEVATION LINE LENGTH LINE LENGTH TBM 2.2 100.0 INSTR.1 102.2 System 1 Yellow 3.30 98.9 41 41 2 Blue 3.90 98.3 53 53 3 Pink 4.10 98.1 66 66 4 Red 4.70 97.5 86 43 4A Red 4.70 97.5 43 5 Orange 5.00 97.2 86 43 5A Orange 5.00 97.2 43 332 Repair 6 Yellow 5.20 97.0 73 7 Blue 5.60 96.6 75 8 Pink 6.00 96.2 58 9 Red 6.20 96.0 45 10 Orange 6.60 95.6 40 11 Yellow 7.00 95.2 40 331 LINE LTAR SYSTEM LENGTH GPD/FT' TYPE DISTRIBUTION * System 332 0.25 Panel LPP Repair 331 0.25 Panel LPP Notes: ** TBM located on top of water meter **TBM is assumed to be 100' **All measures in feet **Nitrification lines are demonstrated on contour via colored pin flags **BS and FS indicate rod readings Essex Farm Lot 54 SYSTEM DESIGN SPECIFICATIONS Moles Line Line Line Line # Color #Panels Panel Length Hole Size Head Flow 1 Yelo 9 1 41 5/32" 2 3.69 2 Blue 12 1 53 5/32" 2 4.92 3 Pink 15 1 66 5/32" 2 6.15 4 Red 10 1 43 5/32" 2 4.10 4a Red 10 1 43 5/32" 2 4.10 5 Orange 10 1 43 5/32" 2 4.10 5a Orange 10 1 43 5/32" 2 4.10 76 332 31.16 Davie County Environmental Health P.O. Box`848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account M 990004425 IMPROVEMENT PE �IN/EH #: 5870-64-2265.54 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 54 Address: PO Box 340 Location/Address: Cornatzer Rd -27006 City: Mocksville Property Size: See Map Reference Name: Brad Coe Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a was 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: ❑New ❑Repair ❑Expansion Permit Valid for: 05 Years ❑No Expiration Residential Specifications: #,Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ❑County/City ❑Well []Community Well Site Modifications/Permit Conditions.: System Type LTAR Initial Repair Site Plan Environmental Health Specialist Date_ YAR./71. coum .M10> ff Aur OM IR rR ww f WO W M It A �BIPL PK Rli /Mg101R rL R IMMf Pic RIO WE W OOL MM.Nf M 101.i1MC O.rUrO. M. Am m.r..rt.1R /IIOL► O.[...rR 91...Y0 OL mm m M OD�O.H. r♦11r< Q 10'.OYOR Ir11 /.01a11Y IIIE ' AA Wm' aw"= MY �w W% K >D.IO( "S SEE AY r I.d N ...n.." N6... L *BASE MAP PROVIDED BY CLIENT FIELD LAYOUT 45 I Yellow 50' Orange 50' b, S PIT 1 A�vr Se, Blue 75'® Y�/ow O� Red P1 11k ss. 6/V e Si. ra/ow 47• GRAPHIC SCALE 1"=50' LOY d< e.`9. E7( f"D DAME COUM 1 SEPTIPOUT at / xww M 1RKM.. � _ ROAD _ Soil & Environmental Consultants, PA $ SKETCH MAP er Una* 0%8" C. Lwo1'L NrN 4rai. !!D . "— 0407W m . f.QW 7010E "A eorrc mm o.lowA �rrW1l�rMc moor 1Wt11an1s1rra �tarwns 111a Irr 11101DNr M A Kmo s! Ow woluNlnls ammmw NM IWa 01[ W tll Mr0lf /la We001r1W rIWMIR M Y! aMa' ww1�s aoo it fwnrn NR a1 -m[ sm Mrc ONMf. s anal mwNwwow e11a wlmr we flwonwln net �eMs s misaws N aacwrc �1 w � NfNm 1�IIr0e0 m r' >�w 1101 Nwaw6 eaR ax IM6 ro Nom\ M.1M11L 1500 G TANKS VALVE BOX DESIGN SKETCH GRAPHIC SCALE 1e7=50' 50 0 50 100 *BASE MAP PROVIDED BY CLIENT 4 wo mo mm w M= 1m�o cxMe counn 4 '� R � fens=�asls sePnc srsrEM LAYOUT CK rs_ CS= ROAD _ c Soil & EnvironMental Consultants, PA ; R SKETCH MAP amt c"W. 1001 twin (� ai Lana* h sic e a V-4 wtin erewlw manen.. da07O M6 w r.1 am 70 m ww000t r, soot 1.21out for a 4 bedroom home Notes: Essex Farm Lot 54 Project No. 4-1773 Dec -07 FLAGGED HI FS ELEVATION LINE LENGTH 100.0 102.2 3.30 FLAG. LINE # COLOR BS TBM 2.2 INSTR.1 98.1 1 Yellow 2 Blue 3 Pink 4 Red 5 Orange 6 Yellow ' 7 Blue 8 Pink 9 Red 10 Orange 11 Yellow Notes: Essex Farm Lot 54 Project No. 4-1773 Dec -07 FLAGGED HI FS ELEVATION LINE LENGTH 100.0 102.2 3.30 98.9 41 3.90 98.3 53 4.10 98.1 66 4.70 97.5 86 5.00 97.2 86 5.20 97.0 73 5.60 96.6 75 6.00 96.2 58 6.20 96.0 55 6.60 95.6 50 7.00 95.2 50 ** TBM located on top of water meter **TBM is assumed to be 100' **All measures in feet **Nitrification lines are demonstrated on contour via colored pin flags **BS and FS indicate rod readings Essex Farm Lot 54 Design Specs laymt for a 4 bedroom home Dec -07 FLAG FLAGGED DESIGN LIVE # COLOR BS HI FS ELEVATION LINE LENGTH LINE LENGTH 113M 2.2 100.0 INSTR.1 102.2 System 1 Yellow 3.30 98.9 41 41 2 Blue 3.90 98.3 53 53 3 Pink 4.10 98.1 66 66 4 Red 4.70 97.5 86 43 4A Red 4.70 97.5 43 5 Orange 5.00 97.2 86 43. SA Orange 5.00 97.2 4_3 332 Repair 6 Yellow 5.20 97.0 73 7 Blue 5.60 96.6 75 8 Pink 6.00 96.2 58 9 Red 6.20 96.0 45 10 Orange 6.60 95.6 40 11 Yellow 7.00 95.2 40 331 LINE LTAR SYSTEM LENGTH GPD/FT' TYPE DISTRIBUTION * System 332 0.25 Panel LPP Repair 331 0.25 Panel LPP Notes: ** TBM located on top of water meter **TBM is assumed to be 100' *All measures in feet **Nitrification lines are demonstrated on contour via colored pin flags **BS and FS indicate rod readings Line Flow 3.69 4.92 6.15 4.10 4.10 4.10 4.10 31.16 Essex Farm Lot 54 SYSTEM DESIGN SPECIFICATIONS #Holes Line Line Lhe # Color #Panels Panel Length Hole Size Head 1 Yelo 9 1 41 5/32" 2 2 Blue 12 1 53 5/32" 2 3 Pink 15 1 66 5/32" 2 4 Red 10 1 43 5/32" 2 la Red 10 1 43 5/32" 2 5 Orange 10 1 43 5/32" 2 Sa Orange 10 1 43 5/32" 2 76 332 Line Flow 3.69 4.92 6.15 4.10 4.10 4.10 4.10 31.16 DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENVIAON314ENTAL FIEALTH ONSITE WASTEWATER SECTION SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM Slwct Of — PROPERTY tD #: COUNTY: Davie OWNER: Michael Hauser Construction APPLICATION DATE_l l/13/07 ADDRESS: DATE EVALUATED: PROPOSED FACILITY: 4 bedroom Home PROPOSED DESIGN FLOW (.1949):480 Spd_ PROPERTY SIZE: LOCATION OF STIR: Let 54 PROPERTY RECORDED: WATER SUPPLY: Private Public Well Spring Other EVALUATION NIETHOD: Auger Boring 2'Pit Cut TYPE OF WASTEWATER: Sewage Industrial Process Mixed r o s r L It N .zv»o LANDSCAPE POSITION/ SLOM, To HORIZON DEPTFI (IN.) SOIL MORPHOLOGY (•1941) OTHER PROFILE FACTORS PROFILE CLASS & L'TAR .1941 .1'_14.1. STRUCTUREI CONSISTENCE/ TEXTURE MIIVERALOGY .1942 SOIL WETNESS/ COLOR .1943 SOIL DEPTH .145 SAPRO CLASS .1944 RESTR HORIZ l 2.5% 4-7- MFSBIVCL SS,SF1XKI5w ?49" 248^ NA PS PS -7-49 MFSBK/C S,SP.FWS"F 2 3 DF,swP nw, INITIATE SYSTEM REPAIR SYSTEM OTHER FACTORS (,1940.' SIZE CLASSIFICATION (.I948): PS EVALUATED BY. _Overby_ OTHER(S) PRESENT:__- Available Space (.1945) System Typc(s) Site LTAR COMMENTS: LEGEND use the following standard abbreviations Z 3AbIC' FOR SITE EVALUATION/IMPROVEMENT PERMIT & A AUG Davie County Environmental Health P.O. Box 848/210 Hospital Street �r1ZN Mocksville, NC 27028 JIR�t1�,Es�;�1 d y (336)751-8760/ Fax (336)751-8786 — Application For: YSite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System o ***IMPORTANT * * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. INFORMATION Name to be Billed PscV6GopKrNT em, /.i-- Contact Person 7c0WAy &f 7c t;Z Billing Address A -o -a_.,x .3f0 Home Phone City/State/ZIP r3G L 702 @ Business Phone 7S/ - 7300 Name on Permit/ATC if Different than Above Mailine Address PKUPEKIY IN 11VKMAIION *Date House/Facility Comers kla ed NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan lat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name ATA AFVjreoppWiJi cif Phone Number 7S/ - 73� Owner's Address 40 4XCity/State/Zip _ 7oL9 Property Ad& ss Cit Lot Size Tax PIN# [/ Subdivision Name(if applicable) . Ess Fk =*A" SectiotVLot# �7 ff the answer to any of the following (uestionstis "yes", supporting documentatiogg must be attlehed. Are there any existing wastewater systems on the site? Dyes ❑Np Does the site contain jurisdictional wetlands? Dyes ❑No Are there any easements or right-of-ways on the site? ❑les ❑No Is the site subject to approval by another public agency? Dyes 011� Will wastewater other than domestic sewage be generated? Dyes C�No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms _� # Bathrooms Garden Tub/Whirlpool Dyes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No 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: 66onventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: & County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? ❑ 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 if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating an ging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Prope r s or o er's legal represents re Date(s): 7 Client Notification Date: Date EHS: Sign given Dyes ❑No Revised 11/06 Account # Invoice to -�� 73 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PR ERTY INFORMATION Account-. #: 990OU4425 Tax PIN/EH #: 5870=61255.5 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 54 Reference Name: Brad Coe Location/Address: Cornatzer Rd -27006 Proposed Facility: Residence Property Size: 0.760 A. Date Evaluated:,T- ti — Water Supply: On -Site Well Community % Public Evaluation By: Auger Boring Pit ✓ Cut FACTORS @43 917-T 4 5 6 7 Landscape position L Slope % 1 HORIZON I DEPTH - ( 6 — C) -- Texture group C u ^C C Consistence I V t P 71 r Structure S R & V.W� •c 5_9 4 Mineralogy 5a Yn HORIZON II DEPTH' Texture group -Act Consistence Structure 51 C- Mineralo HORIZON III DEPTH 3 0 — Texture Eroup C Consistence p Structure Mineralogy HORIZON IV DEPTH Texture group Consistence, del Structure OLS` Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION j $u o LONG-TERM ACCEPTANCE RATE — 6• TO SITE CLASSIFICATION: �.D S �.� �c� 10 S F EVALUATION BY. Q f `1 61,t r O ►'t 6 LONG-TERM ACCEPTANCE RATE: tt JJ 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 MQist VFR - Very friable FR - Friable FI - Firm VFI Very firm EFT - 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 Mineral= 1:1, 2:1, Mixed NDICS 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) V1 LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/05 (Revicedl