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128 Wyatt Drive Lot 57Davie Countv. NC Tov parasol D--4 Tuesday, December 20, 2016 WAK1VM11-T: 1MN 1J P!V1 A JUKVhY Parcel Information Parcel Number: F8030A0057 Township: Shady Grove NCPIN Number: 5870635855 Municipality: Account Number: 8305794 Census Tract: 37059-803 Listed Owner 1: SIMMONS CHRISTOPHER Voting Precinct: EAST SHADY GROVE Mailing Address 1: 128 WYATT DRIVE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006 Voluntary Ag. District: Legal Description: LOT 57 ESSEX FARM PHASE 1 B Fire Response District: Assessed Acreage: 0.69 Elementary School Zone: Deed Date: 12/2015 Middle School Zone: Deed Book / Page: 010060744 Soil Types: Plat Book: 9 Flood Zone: Plat Page: 388 Watershed Overlay: Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 1r ADVANCE SHADY GROVE WILLIAM ELLIS GnB2,PcB2 DAVIE COUNTY 1:01 All data Is provided as is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the Davie County, 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, NorthCarolina, its agents, consultants, contractors or employees from any and all claims orcauses of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. -t;DP File Number 194298 - 1 1 Manufacturer: Shoaf STB: 760 Gallons: 1000 . Date: 0 8/ 0 1/ a 0 1 5 "Filter Brand: POLYLOK Dual PL -122 With Pipe Adapter ST Marker: ❑ Yes ® No nforced Tank: ❑ Yes ® NO 1 Piece Tank: ❑ Yes ® NO Manufacturer: Shoaf PT: 42 Gallons: 1250 / Pipe Size: inch diameter Pipe Length: 9 a feet *Schedule: 40 Pressure Rated ® Yes ❑ NO Approved fittings ® Yes ❑ NO Countv ID Number: 5870635855 Lat. _ 0 Date. 1 1/ 1 6/.2 0 1 5 Pump Type: Date: 0 9/ 0 3/: x 0 1 6 Installer: Riser Sealed ❑ Yes ❑ No - Riser Height: ❑ Yes ❑ NO (Min. 6 in.) Reinforced Tank- El Yes ❑. NO . 1 Piece Tank: ❑YeS *Chain: ❑ NO Date: / Pipe Size: inch diameter Pipe Length: 9 a feet *Schedule: 40 Pressure Rated ® Yes ❑ NO Approved fittings ® Yes ❑ NO Countv ID Number: 5870635855 Lat. _ 0 Date. 1 1/ 1 6/.2 0 1 5 Pump Type: Installer: Dosing Volume: - Gal Certification #: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ No Approval Status PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ No Page 2 of 4 OPERATION PERMIT ,.moo Davie County Health Department r 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: _ NC 27409 Phone #: (336) 978-7120 For Office Use Only *CDP File Number 194298 - 1 5870635855 County ID Number: Evaluated For: NEW �ownship: Property Owner: RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone M (336) 841-6699 Property Location & Site Information Address/Road #: Subdivision: Essex Farm Phase: Lot: 57 104 Wyatt drive Advance NC 27006 Directions Structure: SINGLE FAMILY HWy 64 east, left on Cornatzer Rd. on left # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP Issued by: 2140 - Nations, Robert *CA issued by: 2140 - Nations, Robert Design Flow: 4 8 0 Soil Application Rate: 0 a 7 5 Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: *System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Saprolite System? O Yes (9 No *Distribution Type: PUMP TO GRAVITY *Pre -Treatment: 1 7 4 5 Sq. ft. _5 436ft. g Inches O.C. Feet O.C. 3Q Inches Feet inches Minimum Trench Depth: a 4 Minimum Soil Cover: 1 a Maximum Trench Depth: 3 6 Maximum Soil Cover: a 4 Inches Inches Inches Inches Page 1 of 4 Pump Rewired? Oyes � No *System Type: 25% REDUCTION INNOVATIVE OR Installer: Frank Transou Certification M 2771 *EHS: 2399 - Eldridge, Tiffany Date: 1 1/ 1 6/.1 0 1 5 Approval Status ® Approved ❑ Disapproved CDP File Number 194208 - 1 NEMA 4X Box or Equivalent ❑ Yes Box 12 inches Above Grade ❑ Yes Box Adj. To Pump Tank ❑ Yes Conduit Sealed ❑ Yes Pump Manually Operable ❑ Yes "Activation Method: County ID Number: 5870635855 Electric Equipment ❑ No Installer: ❑ No Certification #: ❑ No ❑ No *EHS: ❑ No Date: n Approval, Status AlarmAuAla m Visible, e El Yes ❑ No ❑ Approved Disapproved ❑Yes ❑ No - 2399 - bdridge, Tiffany "Operation Permit completed by: Authorized Stafe Agent AAA& A Date of Issue: 1 1 1 6 a 0 1 5 Owner/Applicant Signature: - This system has been installed.in compliance with 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 roe is served b a TYPE m B. - , property � � y sewage septic system. - - Rule .1961 requires that a Type. TYPE ui B. septic system meet the following criteria: Minimum System Review By The Local Health Department: 5 YRS' 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 for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the 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. ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 3 of 4 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Operation Permit ' r CDP File Number: 194298 1 ' County File Number: 5870635855 Date: / / O Inch Scale:. . . . O Block O N/A Page 4 of 4 P1 P2 P3 OPERATION PERMIT Davie County Health Department 210 Hospital street CDP File Number: P.O. Box 848 5870635855 Mocksville NC 27028 County File Number: Date:. . Click below to import an image from an external location: Drawing Type: Operation Permit Page 4 of 4 P1 P2 P3 Drain Field: System Final Inspection Log: Remaining 4Q00 Septic Tank: Chwactera Remaining 4000 Pump Tank: - - Chwedera Remaining 4000 Supply Line: ' cireraaera Remaining 4000 Pump Requirements: Chwadw, Remaining 4000 Electrical Equipment: Characfma Remaining 4000 P1 P2 P3 • . , - � . ,ice, �: - �IGiC'fi7 Operation Permit Inspection Checklist Location and Separation DistancesPA- 1. Distance from septic tank/pump tank to foundationement feet 2. Distance from system to well if applicable L&W tic- feet 3. Any other setback (.1950) requirements Supply lineL4 D 1. Material supply line is constructed of diameter inches 2. Length of supply line (2' min.) 3. Amount of fall in supply line (1/8" per foot min) 4. Distance from ST/PT to the nitrification field/dist. device) feet Septic Tank/Pump Tank 1. Visually inspect top of tanks(s), interior & exterior walls, baffle wall and bottom 2. Any honeycombing or exposed rebar present? Circle.: YES or N(� 3. Visually inspect sanitary tee, lids, and air vent for proper installation and s alapt, 4. Tank Serial Numbers: STB !j�"l rV! D PT `"C of 5. ST Win 6" finished grade? Circle: YES or NO 6. Date of manufacture: ST PT cl 7. Liquid capacity of tanks ST l0 0 0 PT t c� 8. Effluent filter type 9. Pipe penetration seal present?Circle: Y S r NO 10. Riser(s) present? Circle:_' S or No ser Type 11. Pump Tank riser 6" above nished grade? Circle: YES or NO 12. Riser approved? Circle: ES or NO Nitrification Field 1. Septic Tank outlet elevation 2. Trench Depth Readings (inches) 3. Number of Trenches ot) Distance between trenches ll C f -n 4. Trench Width 5. Aggregate material type and size 3 4 5 6 57 (Circle) 6. Aggregate Depth (inches) 7. Nitrification lines installed on contour? Circle: Y or NO 8. Innovative system type Installer certified for installation? Circle: YES or NO 9. 2' earthen dam between ST (or d -box) and beginning of nitrification line? Circle: YES or NO 10. Stepdowns a. 2' undisturbed earthen dam(s) Circle: Y S or NO b. Proper rise over stepdowns? Circle: YE or NO c. Solid pipe used? Solid, Corrugated iter? jj..}}-- Irl J d. Elevation of each stepdown e. Are all stepdowns lower than the ST outlet elevations? Circle: YES or NO Distribution Devices 1. Type Is the device watertight? Is it level? t,S 2. Distance from Dist. device to trenches feet 3. Record elevations: Inlets Outlets C014SIRI CTION AUTHORIZATION 00-- Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 For Office Use Only *CDP Fite Number 194298-1 County ID Number 5870635855 Evaluated For: NEW Township: Phone: 336-753-6780 Fax: 336-753-1680 0 6/ 0 4/ a 0 a 0 Applicant: RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive CRY: Greensboro State2ip: NC Phone #: (336) 978-7120 Address/Road #: 104 Wyatt drive Advance Structure: # of Bedrooms: # of People: NC 27006 SINGLE FAMILY 4 'Water Supply: PUBLIC 27409 Property Owner. RS Parker Homes/Joy Springer Address: 502 Hickory Ridge Drive City: Greensboro State0p: NC 27409 � `, Phone #: (336) 841-6699 Site Information Subdivision: Essex Farm `Site Classification: Provisionally Suitable Saprolite System? OYes @No Design Flow: 4 8 0 Soil Application Rate: 0 - a 3 5 'System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP *Proposed System: 25% REDUCTION Nitrification Field 1 3 4 5 Sq. ft. Phase: Directions Hwy 64 east, left on Cornatzer Rd. on left at Lot: 57 Minimum Trench Depth: a 4 Inches Minimum Soil Covet 1 a Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches "Distribution Type: PUMP TO GRAVITY Septic Tank: 1 0 0 0 Gallons 1 -Piece: OYes @No Pump Required: @Yes ONo OMay Be Required Pump Tank: 1 0 0 0 Gallons No.. Drain Lines 5 1 -Piece: OYes @No Total Trench Length: 4 3 6 ft. GPM—vs— ft. TDH Trench Spacing: Inches O.C. 9 @Feet O.C, Dosing Volume: _ Gallons Trench Width:@Feet Inches — 3 Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -11 Septic Tank InstallerGrade Level Required: 01 Oil 0111 01V Dann 1 of Q CDP File Number 194298 - 1 County ID Number. 583635855 ❑ Open Pump System Sheet air System Kequirea: V Yes VNO VNO, DUI naS Avaliame Space /Repair System *Site Classification: Provisionally Suitable Design Flow: 4 8 0 Soil Application Rate: 0 2 7 5 *System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP *Proposed System: 25% REDUCTION Nilrification Field 1 7 4 6 Sq. ft. No. Drain Lines 5 Total Trench Length: 4 3 6 ft. Trench Spacing: 9 (� Inches OX — e Feet O.C. Trench Width: Inches — �► Feet Aggregate Depth: inches Minimum Trench Depth: 2 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches *Distribution Type: PUMP TO GRAVITY Pump Required: Oyes ONo OMay Be Required Pre Treatment: ONSF OTS -1 OTS -II "Site Modifications No grading or construction activity is allowed in areas designated for system and repairwithout approval of Health Department. a "Permit Conditions The issuance of this permit by the Health Department in no wayguarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Perml% not to exceed five years, and may be Issued at the sametime 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 invalld, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible forassuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance; monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps. Signature: Date:. 1 'Issued By: 2140 • Nations, Robert Date of Issue:. 0 6 1 0 4 l a 0 1 5 Authorized State Agent:/�--�''� Malfunction Log OYes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 r - CCNSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 194298 -1 County File Number: 5870635855 Date: 06/04/2015 Q Inch Scale: 013lock Q N/A K �u CAA11 -1-- -Uc�J <' l Ar K CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 194298 - 1 County File Number. U70635MS Date: .06/04 /2015 Click below to import an Image from an external location: Drawing Type: Construction Authorization APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ^� Davie County Environmental Health P.O. Bos 848/210 Hospital Street RECEIVED Mocksville, NC 27028 (336)753-6780/ Fax (336) 753-1680 �MAY 2 6 2015 � Iy1Fi J pplication For: Site Evaluation/Improvement Permit authorization To Construct(ATC) C Both Type of Application: kcw System CRepair to Existing System ❑Expansion/Modification of Existing System or Facility DC HEALTH ***I IPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed S P 00Y n -e-5 Contact Person JcSprt'naer Billing Address 570Home Phone ,3-,J0 ' ' % City/State/ZIP 10= WC SYMO Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip FKUrEK1 Y INPUKMAttUN 10ate House/Yactltty Comers NOTE: A survey plat or site plan mast accompany this application. Included: Site Plan CPlat(to scale) (Permit isslid fo 60 months with site plan, no expiration with complete plat.) Owner's Name H5 aa SPY 14 I r_ggS Phone Number 33 Owner's Address FiCoD 14101r -i-0. i Ct' 0Y- City/State/Zao(3borO 0 Property A ressv City. Lot Size Tax PIN# Subdivision Name ifapplicable) Sectiot Directions To Site: 5� 1 S n r-► d n ti C nr tb If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Does the site contain jurisdictional wetlands? C Yes o CYes Are there any easements or right-of-ways on the site? 11 Ye Is the site subject to approval by another public agency? CYes Will wastewater other than domestic sewage be generated? CYes o IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms# Bat rooms Garden Tub/Whirlpool es ❑No L4 — : CYes o m u BasementBasement Plung: ❑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: ,onventional ❑Accepted ❑Innovative CAltemative COther Water Supply Type: County/City Water C New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C 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 1904- ing anaagging or staking the house/facility location, proposed well location and the location of any other amenities. F P o e own 's or owner leg I representative signature Site Revisit Charge Date(s): - D Client Notification Date: Date EHS: Sign given CYes CNo Revised 11/06 Account # Invoice # �_ R—A SETBACKS: , FRONT: 45' SIDE: 15' SIDE: 25'(STREET) REAR: 30' ZIMMERMAN FAMILY LLC D.B. 520 PC. 668 WYATT DRIVE 50' R/W (PUBLIC) GRAPHIC SCALE 40 0 20 40 EO ( IN FEET ) 1 inch = 40 it RECEIV MAY 2 6 20 DC HEAL f PRELIMINARY PLOT PLAN FOR: RSP BUILDERS LOT 57 OF ESSEX FARMS, PHASE I—B P.B. 9 PC. 388 Rmial 611marAml, lar. 8518 Triad Drive Co ft NC 21235 Plane: 33H52-0791, Feic 33HU-0766 NCBELS C-0950 DATE: 05-21-2015 REF: PR0D\1831-01\dwg\ESSEXFARM.dwg 7 i NAP M#' N FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Q v Davie County Environmental Health P.O. Box 848/210 Hospital Street ASG 2 3 2001 Moeksville, NC 27028 (336)751-8760/Fax(336)751-8786 A t' '1 Site Eval ation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both ENVIRG y1;A i tion: ❑New stem ❑Repair to Existing System ❑Expansion/ModiScation of Existing System or Facility � i F CeJUI PORTANT* * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. TION Name to be Billed Asc /%c'V6GoprtrN7 5Z.%, Contact Person 7 —AwY ,&t7L OZ Billing Address A -o -Q„X 3-/o Home Phone City/State/ZIP _Lyvcrr�,.c� r►G L 7oZ 8 Business Phone 75'/ - 7300 Name on Permit/ATC if Different than Mailine Address PKUPEKI'Y 1NI UKMAIION 'Date House/Yacility homers ria ea 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 'D Se !L,%, /PiG Phone Number 75'1 - 73--,QOwner's Address 40 JoX City/State/Zip Property AddfTvss City Lot Size AW7 Tax PIN# 0_- - 'Z Subdivision Name(if applicable) Ess�=1c Fw.cn Sectiop/Lot# Jr7 jI If the answer to any of the following 4uestionstis "yes", supporting documentatiogg must be atiAched. Are there any existing wastewater systems on the site? ❑Yes I3N� Does the site contain jurisdictional wetlands? ❑Yes ❑No Are there any easements or right-of-ways on the site? PICS D o Is the site subject to approval by another public agency? ❑Yes 13WNp Will wastewater other than domestic sewage be generated? []YesCd1`lo IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms _!;14 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑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: e6mventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 2'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 ❑ No 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 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 Propert r s or o er's legal represents � re Date(s): 7 Client Notification Date: Date EHS: Sign given ❑Yes❑No Account# Revised 11/06 Invoice # -�� 73 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account #: 990004425 IMPROVEMENT PERMJ'PIN/EH M 5870-64-2265.' 7 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 5-7 Address: PO Box 340 Location/Address: Cornatzer Rd -27006 City: Mocksville Property Size: acre 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 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: Wew ❑Repair ❑Expansion Permit Valid for: B'S Years ❑No Expiration Residential Specifications: # Bedrooms 4 # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):q,90_ Type of Water Supply: PlC ounty/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions.: As stated in 15A NCAC 18A.1989(5) acceptedSystems may also be Site Plan System Type LTAR Initial cG a Repair o -73-72L 0 a` Environmental Health Specialist Date �Q — i7 Q7 e DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION X&Q=UIXINFORMATION Account : 990004425 Tax PIN/EH #: 58765, 7 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot #,57 Reference Name: Brad Coe Location/Address: Cornatzer Rd -27006 Proposed Facility, Residence Property Size: 0.689 Acre Date Evaluated: `- % — G� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS t $i� t $ tc I Y 7 4 5 6 7 Landscape position t_ Slope % HORIZON I DEPTH ©- Q Texture group C_ C Consistence Q t i / PA r' Structure $ 1L k Mineralogy -j gip HORIZON II 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 a lc S LONG-TERM ACCEPTANCE RATE (j. 7, O• 7 "' 0, a 2 SITE CLASSIFICATION:;`' EVALUATION BY: kl_, N1C 61iJ1N'c� LONG-TERM ACCEPTANCE RATE: • a S OTHER(S) PRESENT: REMARKS: �d 1/t Q 5 G R 4 d f c o a -tkfo L�'--4 � 1 f CSS u -'e U ctt 5 Landscape Position LEGEND 5 �� L -1--c O I -X R - Ridge S Shoulder L - Linear slope FS - Foot slope N - Nose slope �` p m d Co.,ti P avy CCS',e � EA- Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope k jo W -e H re 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 Dist 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 i Mineralog 1:1, 2:1, Mixed )rYotes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS (provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/0.5 (Revised) PN