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1157 Junction Rd, 115 Grant Trl Lot 4Davie Countv. NC Tax Panel R Pnnrt Tuesday, January 3, 2017 WAKNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: M401OA0004 Township: Mocksville NCPIN Number: 5726-81-9712 Municipality: Account Number: 82516538 Census Tract: 37059-801 Listed Owner 1: SPILLMAN ROGER P Voting Precinct: SOUTH CALAHALN Mailing Address 1: PO BOX 738 Planning Jurisdiction: Davie County City: COOLEEMEE Zoning Class: DAVIE COUNTY R -A R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27014-0000 Voluntary Ag. District: Legal Description: LOT 4 GRANT HEIGHTS Fire Response District: COOLEEMEE Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: 1.58 Elementary School Zone: COOLEEMEE 8/2011 Middle School Zone: SOUTH DAVIE 008660452 Soil Types: GnB2 10 Flood Zone: 371 Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Freatures Value: Total Market Value: No 17 �s�islLi' All data Is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the t Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS webstte shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to I __._.�o U N�� _. 1,or arising out of the use or Inability to use the GIS data provided by this website. TION NO: AUTHQ�' 1 4 U AV i., DIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittees / P.O. Box 848 Name: / ✓`l Mocksville, NC 27028 Subdivision Name: f✓ % 'f�. Phone #: 704-634-8760 Directions to property:Section: Lot: 't AUTHORIZATION FOR WASTEWATER Office ffice : %' SYSTEM CONSTRUCTION TPIN#- — '�P Road Name: `fWAS'I'G,1. Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pen -nits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED f Permittee's Name: P l'� } ._ Directions to property: DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITSPROPERTY IN)~ORMATION Subdivision Name Section: Z Lot: �-z IMPROVEMENT PERMIT Tax Office PIN:#. .,'�" -� +� -r Road Name: '`!<.,:7�b.+ Zip; **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a 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) - ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 4 4j�, ..� 4 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPED # BEDROOMS # BATHS --2 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE .14e, TYPE WATER SUPPLY Cy DESIGN WASTEWATER FLOW (GPD) �� NEW SITEy REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /Pnn GAL. PUMP TANK GAL. TRENCH WIDTH GIS ROCK DEPTH LINEAR FT�GU / REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT 46 U BY: loo exp'/ Z"), - AUTHORIZATION NO. L Y OPERATION PERMIT BY: / DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & O f? Davie County Health Department --V—u l� Environmental Health Section P. O. Box 848 JUN ' 3 I Mocksville, NC 27028 (704) 634-8760 ENVIROP IENTAL HEALTH ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS �p �� ALL THE REQUIRED INFORMATION IS PROVIDED. %� 1. Name to be Billed ' ` o I V r jv i I t m u1 Contact Person Q �� Mailing Address{�� Home Phone City/State/Zip ca o I VGo� ►, ! � tX �� m "f� Business Phone �U�1 d-6,6 2. Name on Permit/ATC if Different than Above Mailing Address _ 3. Application For: 4. System to Serve: 5. If Residence: ❑-"Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: City/State/Zip ❑ Site Evaluation Improvement Permit & ATC ❑ Both ❑ House C3/Mobile Home ❑ Business ❑ Industry ❑ Other # People # Bedrooms 3 # Bathrooms ❑ Garbage Disposal ❑Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 7. Type of water supply: Specify type # Showers # Seats / C� County/City # People # Sinks # Urinals Estimated Water Usage (gallons per day) ❑ Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes 8/ No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 1 WRITE DIRECTIONS (from G g /Mocksville) TO PROPERTY: Tax Office PIN: # �7%� 1 Property Address: Road Name � 1 City/Zip 1 If in Subdivision provide information, as follows: 1 hName:6r-k"4 1 1 Section: Lot #: 1 1 This is to certify that the information provided is correct to the best of my knowledge. I understand that 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, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County '�''1 and owned by l aQ 1/ - cU4'yuQ"N to conduct all testing procedures as necessary to determine the site suitability. DATE �% -9 SIGNATURE Q ��" � G�i2f2 o Revised DCHD (06-96) Z. 114V•---14 //_0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION 6�A.i Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit SECTION_ LOT - 75_% Af -92 DATE EVALUATED ZW— PROPERTY SIZE - �' �'jc ROAD NAME `I 461Za 'm Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure -it - Mineralogy _ HORIZON III DEPTH Texture group Consistence Structure ogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , < <— SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 0* REMARKS: LEGEND DCHD (O1-90) Landscape Position EVALUATION BY: & �Z OTHER(S) PRESENT: 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 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 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 ■ ■ ■ ■■■■■■■■■■■■■■/■■■/SSSS■■/SSSS■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■/■■■■■■/SSSS■■/■■■■■■■■■■■■■■■■■■■■■■■ SSSS■■M■■■■■■Me■■■■■■■■■■■■■/■■ ■■Ea■t■■N■■■t■■■■■■t■■■■■■ ■■■■■■■■■SSSS■■■■t■■■■■■■■■■/■■t■■a■■Et■■■teat■■■■■■t■E■■■■ ■■■■■MON■■■NM■N■NM■■■■/■M■■■■■■■■■■■■■■■■■■■■t■■■a■■t■■■■N■ ■■■■■■■■■■■■■■■■■■■■■■■■■a■■■■■■■■■■■■■■■■■■■■MMM■■■■■■■■■■ ■■■■■M■■■■M■■■■■■■■M■e■a■■■■SSSS■■■/■■M■■■e■■t■■■■■■■■■■■■■ ■■■■■/■■■■M■■■■■■■■■■■■■M■■■SSSS■■■e■■N■■EN■■■■■E■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■MM■■■■■■■■■■■■■ESN■■■■■E■■■M■N■■■■ ■■■■■M■■■■■■■■■■■■■■■■■■■■■■/SSSS■■■■■M■■■■■■■■■e■■■M■■■NN■ ■■■■■■■M■EE/■■■■■■■■■E■■■■■■■■■■■►��■■■■■■■■■■■■■■/SSSS■■/■■ SSSS■■■■a■■■■■■E■■NEN■■■■■■■■■■■■�fia■■■■■■■■■■M■■e■■■■■■Ma■ ■■■■■■■■■■ESN■■■■■SSSS■a■■■■■■■■■E:eE■■■■■■■■■■■■■See■■■■■■ ■■E■■■■■■■■■■NN■■M■■■■■■■■■■■■■■■■/■■/■■■■■■■■■■■/■■■■See■■ ■■■■■■■■■■■■E■■See■■■■■■■■E■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■See■■■■■■■■■■■■■■■■■See■■ ■■■■■■■■■■■■■■N■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■See■■■■■■ ■■■■■■■■/SSSSeaa■■■■■■■■Q■E■■■■■■■■■■■■■■■■■■■■■■■■■■■■■a■■ ■■■■■e�EMM■N■ ■NEEME MENN■N ■■■EEN EMEME■ MENNEN No ■■■■E■■ME■■■NON■■■■■aN■■�i■■■■■NNN■NNNNN■N�i■N■NN■N■N■N■■MME■ ■■■■MN■■■N■■■NON■■■■■■■■n■■�■_........■Me.■M■■■■■■■■EM■■■NE■ ■MSE■■■■■■■NM■■M■NON■N■■■■■■■■■ ■■MEEEE■MMEa■■■E■■■■■■■ME■ ■■■■■■■■■■■■■■ME■■■■■■■■■■E■■■■■■E■u■■■■■■■■■ESE■■■■E■■E■■■ ■■■M■■■■N■M■■M■■■■■■M■■MEN■E■■E■■■NON■■■■a■■■■■■■■■■■■■NN■■ ■N■E■E■M■■N■Nat■■■■■■■■■■■M■■NEN■■E■■NEE■N■■■N■■■■MEEM■MME■ ■■M■E■EMEEE■E■t■N■■N■N/■■■■Et■■■■■Eta■■■■■NE■■EN■■■■EMEEME■ ■NEEM■■■■■■E■■NON■■■■■■■■■■■■■■■■■■■■■■ENM■■■N■■■■EN■■■NN■■ ■■■■■■■t■■■■■■■E■■■■ESE■■■■■SSSS■■■M■■■■■E■■■E■EN■aEE■E■NE■ ■■■■■■■■■■■■EON■■EE■■■■■■■■■tN■�■■t■■■■■■t■■■N■■t■a■■■■a■■ ■■■■■■■t■■■/■■t■■■■■■t■■■■■■■■■ ■M■N■Ea■■NEN■■■■■■■■■■■■■■ ■■M■■■■■■■■■■■■■■■■■■t■■■■■■■■■N■E■t■■■■EOM■■Nae■NEe■■■■NE■ ■E■■eENNNM■NE■■N■■■EN■■NON■■■■■■■E■■■■■■EN■E■■■EE■■■■N■■■■■ ■■■M■■■■■■■e■■■■■■■■E■■■■NSM■■■■■■■NENE■M■NEM■■■■ME■■■■NON■ ■■■■eN■■■■■M■■■■■NON■■NON/■E■■N■/■Et■■■E■■■■■■■■EN■■■ESE■■■ ■■■■e■■■■■■e■■■■■■■■■■M■■■■■■■■�■■■N■E/NM■E■■■■E■■NON■■■M■ ■■■■■■■■■■M■■■■■■■■M■■■■■■■■■■■■■■Nt■■■■■■NESE■■■■■■■■■■■■■ SSSS■■■M■■■■■■■■■■/■NMN■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Eta■ ■■■■■■■■■■■■■■■■■■■■■■■■■N■■SSSS■■■■MM■■■M■■■■■■M■■M■e■M■■■ ■MMM■■■■■■■■■■■■M■M■■■■■■■E■■E■■e■E■■N■■EEM■■E■■aM■■■/■NON■ ���■��■��M■��M■■MMM■■■■■Me■■SSSS■SSSS■■/EM■N■E■■E■■■■■■■■M■ ■■ ■EE■ SEEN NONE ■E■■ SEEN SEEN NONE ■E■■ MEMO MEMO ■O■■ MEMO MEE■ MEMO NEWS ■ Davie County, NC Tax Parcel Report Wednesday, January 4, 2017 112 1133 `~ 13C '-_ 114~ 123 G) 1 1151 115 �} 167_. G 157 1157 107 O ti 214 1165 211 1168 ,.` 198 f Z 1175., 20 3 _ r� WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: M401OA0004 Township: Mocksville NCPIN Number: 5726-81-9712 Municipality: Account Number: 82516538 Census Tract: 37059-801 Listed Owner 1: SPILLMAN ROGER P Voting Precinct: SOUTH CALAHALN Mailing Address 1: PO BOX 738 Planning Jurisdiction: Davie County City: COOLEEMEE Zoning Class: DAVIE COUNTY R-A,R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27014-0000 Voluntary Ag. District: No Legal Description: LOT 4 GRANT HEIGHTS Fire Response District: COOLEEMEE Assessed Acreage: 1.58 Elementary School Zone: COOLEEMEE Deed Date: 8/2011 Middle School Zone: SOUTH DAVIE Deed Book / Page: 008660452 Soil Types: GnB2 Plat Book: 10 Flood Zone: Plat Page: 371 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 9 �m�ali` 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 - / r County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to n0 t7 tib NC or arising out of tha use or Inability to use the GIS data provided by this website. r' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation of a 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 6.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME b�L7�i°r 5,/;.'1//y!zg/ PROPERTY ADDRESS 1 �,+�7a� DATE LOCATION SUBDIVISION NAME r1 ✓ / �� / LOT NUMBER SEC./BLOCK NUMBER 47-11 RESIDENTAL SPECIFICATION: BUILDING TYPE W, # BEDROOMS .S # BATHS :? # OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY rfDESIGN WASTEWATER FLOW (GPD) NEW SITE !/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE �/�» GAL. PUMP TANK GAL. TRENCH WIDTH „3�� ROCK DEPTH ,' LINEAR FT. 11)6) OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PIANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INST ' 371,3 AUTHORIZATION NO. of 6 OPERATION PERMIT BY DATE " " v **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 TINE. DCHD 10/95 Davie County Health Department a ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits., This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** NAME �/ DATE J �� �� JA10HDRIZATI0D3Nlm9ER CY NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION Junil�' if/D.i � COMME MCONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM "*NITICE*ff THIS AUTHORIZATION =SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. -e ENVIRONMENTAL HEALTH trECIALIST DATE DCHD 10/95 1. Application/Permit Req Mailing Address APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PEF Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 . , By 15�L�OV L5 MAY 1 4 L S Home Phone �r1X�f r< y I Business Phonetil _� Zy 2. Name on Permit if Different than Above 3. Application for: a General Evaluation ►J.6eptic Tank Installation Permit 4. System to Serve: ❑ House b'dobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision �' r i t Section Lot # // t ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms `, ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions �nO dO,,-nfA Y�f�n_ �Y.��� �, j� ❑ 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: ublic ❑ Private ❑ Community' )n(' X W51 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? 'NOTE: Improvements Permits shall be valid MqWft from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: C, This is to certify that the information provided is correct to incurred from this application. I DAT ►�l�iZ�li��r y�S�J�Ltr�J1![�i���I3 Tax Office PIN: # ra (,ix 10 Map PROPERTY ADDRESS, a`s- follows: Road Name: , 1;� % i�1) i` r�/t City: SU13MIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. of my knowledge, and I responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. V2. 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 representati f ie C my h18 �gpa e,�t� enter upon above described property located in Davie County and owned by J 1. �� to conduct all testing procedures as necessary to de ermine said site's suitability for a ground absorption sews a tre t and disposal system ! R� DATE 51 SIGN RE DCHD (1193) �.. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY�``� Water Supply: On -Site Well Evaluation By: Auger Boring DATE EVALUATED c7 PROPERTY SIZE 1 2'C/ / LOCATION OF SITE Community Pit / FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH ZZIY 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 SITE CLASSIFICATION: JT EVALUATED BY: A & LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND DCHD(01-901 Public t/ Cut Landscape Position R -Ridge S7Shoulder L -Linear slope FS -Foot slope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope 'r vt.- 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- V -y 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 Mi neraloey 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 ■■..■■/■.■..■■■■■.■■■.■■.■...■■.■..■■■.■■. ■■..■■.■ ■M■O■MM■■■■■■ ■■■■/■...■■/...■■..../..■..■..■. 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