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225 Meadowlark Lane Lot 36CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 229280-1 Davie County Health Department County ID Number: 5822876736 t<' 210 Hospital Street Evaluated For. NEW .`�,. P.O. Box 848 Township: / Address/Road #: Meadowlark Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 5 # of People: 2 'Water Supply: PUBLIC Subdivision: Whip -O -Will ,`Site Classification: Provisionally Suitable Saprolite System? QYes QNo Design Flow: 6 0 0 Soil Application Rate: 0 a 5 *System Classification/Description: TYPE III B. SYSTEM WISINGLE EFFLUENT PUMP 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Phase: Lot: 36 Directions 1-40 east Exit 180 Left at the light go north Approx 8 miles. Past Farmington Drag Strip left on Cana right on Brangus Way left on Meadowlark spec a 4 0 _0 _ sq. ft. Minimum Trench Depth: a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: a 4 Inches Maximum Soil Cover: 1 a Inches 'Distribution Type: PUMP TO GRAVITY Septic Tank: 1 a 5 0 Gallons 1 -Piece: QYes QNo Pump Required: QYes ONo OMay Be Required Pump Tank: 1 a 5 0 Gallons 4 1 -Piece: QYes ONo 6 0 0 ft GPM—vs— ft. TDH 9 C)Feetes C.0 Dosing Volume: _ Gallons Q Inches 3 O Feet Grease Trap: Gallons inches PreTreatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01011 O 111 O IV Donn I ^f'1 Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 8/ a 6/ a 0 a 1 Applicant: Elizabeth Dawn Hill Property Owner: WOWAC, LLC Address: 140 Village Haven Circle Address: 571 Brangus Way City: Clemmons City: Mocksville State/Zip: NC 27012 State/Zip: NC 27028 Phone #: (336) 998-1338 Phone #: i / Address/Road #: Meadowlark Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 5 # of People: 2 'Water Supply: PUBLIC Subdivision: Whip -O -Will ,`Site Classification: Provisionally Suitable Saprolite System? QYes QNo Design Flow: 6 0 0 Soil Application Rate: 0 a 5 *System Classification/Description: TYPE III B. SYSTEM WISINGLE EFFLUENT PUMP 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Phase: Lot: 36 Directions 1-40 east Exit 180 Left at the light go north Approx 8 miles. Past Farmington Drag Strip left on Cana right on Brangus Way left on Meadowlark spec a 4 0 _0 _ sq. ft. Minimum Trench Depth: a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: a 4 Inches Maximum Soil Cover: 1 a Inches 'Distribution Type: PUMP TO GRAVITY Septic Tank: 1 a 5 0 Gallons 1 -Piece: QYes QNo Pump Required: QYes ONo OMay Be Required Pump Tank: 1 a 5 0 Gallons 4 1 -Piece: QYes ONo 6 0 0 ft GPM—vs— ft. TDH 9 C)Feetes C.0 Dosing Volume: _ Gallons Q Inches 3 O Feet Grease Trap: Gallons inches PreTreatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01011 O 111 O IV Donn I ^f'1 CDP File Number 229280-1 County ID Number: 5822876736 ❑ Open Pump System Sheet :WiCS VNV VIVV, LJUL 11 db1AV diIdUlC 0PdUU /Repair System Trench Spacing: 0Inches 0. 9 *Site Classification: Provisionally Suitable Feet O.C. Design Flow: Trench Width: Inches 3 6 0 0 _2 Feet Aggregate Depth: Soil Application Rate: 0 - a 5 inches Minimum Trench Depth: a 4 *System Classification/Description: .� .., Inches TYPE 111 B. SYSTEM WISINGLE EFFLUENT PUMP Minimum Soil Cover. 1 a Inches Maximum Trench Depth: a 4 *Proposed System: 25% REDUCTION Inches Maximum Soil Cover: 1 a Nitrification Field a 4 0 0 Inches Sq No. Drain Lines *Distribution Type: PUMP TO GRAVITY 4 Total Trench Length: 6 0 0 ft Pump Required: eyes ONo OMay Be Required Pre Treatment: ONSF OTS -I OTS -II *Site Modifications 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 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 permit, not to exceed five years, and maybe Issued at the same time 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 Invalid, and maybe suspended or revoked (.1937(g)). The person owning 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 (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature. Date: / / *Issued By: 2140 - Nations, Robert Date of Issue:. 0 8 / a 6 / a 0 1 6 Authorized State Age _ Malfunction Log OYes &Hand Drawing 0Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION ' Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 229280 -1 County File Number: 5822876736 Date: 0 8/ 2 6/.2 0 1 6 Q Inch Scale: . QBlock ON/A CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 s r CDP File Number: 229280 -1 County File Number: 5822876736 Date: 08/ 26 / a 0 1 6 Click below to import an image from an external location: Drawing Type: Construction Authorization r ' V Qoo o APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC �1 ti Davie County Environmental HealthrnQ �,Ci�' +• P.O. Bog 848210 Hospital Street �J J �\ Mocksville, NC 27028 C (336)753-6780/ Fax (336) 753-1680 Application For: C S' valuation/Improvement Permit ❑ Authorization To Construct(ATC) �oth Type of Application: VNew System ❑Repair to Existing System CExpansion/Modification of Existing System or Facility sstIMPORTAN7*sr THIS APPLICATION CANA'OTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION 1 N e to be Billed P► Contact Person filling Address Home Phone City/State/ZIP 133;i�j�Phone 4 Name on Permit/ATC if Dillerent than Above \\ Mailing Address Citv/State/Zin PROPERTY INFORMATION *Date House/Facility Cornets Flagged 1' NOTE: A survey plat or site plan must accompany this application. Included: VSite Plan ❑Plat(to scale) (Permit is validf 60 months with site plan, o expirpption wills o lecte pla Owner's Name taCY1l� t Phone Num er Owner's Address I 1 itx(State/Zip C Property Ad ss -NO \ Pg i y Lot Size OrUIL Tax PIN# ""� Subdivision Name(if a licable) -(} Section/Lot#, tR• L4311 Directions To Site: �y� Et�.S • , P(XI I Rmwk ► If the answer to any of the following questions is `yes", supporting documentati n must be attached. Are there any existing wastewater systems on the site? ❑Yes o Does the site contain jurisdictional wetlands? ❑Yes o Are there any easements or right-of-ways on the site? ❑Yes o Is the site subject to approval by another public agency? Dyes o Will wastewater other than domestic sewage be generated? ❑Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People o1 #Bedrooms #Bativooms 4.15 Garden Tub/Whirlpool ❑Yes Ufqo Basement: ❑Yews jo Basement Plumbine: Dyes 04o 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 o Type system requested: Anventionai ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: N County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or x��aannssions of%e faci 'ty this system is tended to serve? 67�Yes C No If yes, what type? -tVhyS 4. =�� Ptf�C��K�l►SQ� I`7PiPCnC_ V,, I�JCt1C(�1R` ��� ' "'� 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 arc 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 �loc d fl i ors j,& �t �/ h lily lot:ation, proposed well location and the location of any other amenities. i✓LS � 1 gn Site Revisit Charge Pro s or owner's legal representative signature 9 Date(s): Client Notification Date: Date EHS: Sign given Dyes ❑No Revised 11/06 Account # . 0 V Invoice # !'0�3(l0 51TE PLAN 1"=60' LOT 36 WHIP -O -WILL RESIDENCE FOR: STEVE KLINGENSMITH AND DAWN HILL Lot #36, Meadowlark Ln., Mocksville, NC 27028 t�"'►.... _ We=,m 7d -0 -m -r 1, m- r -f Lane N061D-5*-79-" t 1 'JepticArea i.. S Proposed Septic Area #2 Ar Ch • C Cry 2Sq,,&5• Proposed Driveway Pr000sed House 90' x 65' Future Parking Pad, Pool and Pool house/Garage -7Z. IMPROVEMENT PERMIT 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: 8/12/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: WOWAC,LLC Address: 310 Brangus Way City: Mocksville State2ip: NC 27028 Phone #: (336) 998-7298 Address/Road #: Meadowlark Lane Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: "Water Supply: PUBLIC Property Owner: WOWAC,LLC Address: 310 Brangus Way City: Mocksville State/Zip: NC 27028 Phone #: (336) 998-7298 Subdivision: Whip -O -Will Phase: 4 Lot: 36 Directions Hwy 601 N. right on Cana Road, Left on Brangus Way then Meadowlark system s ecirtcattons nitial S�ste�m. *Site classlticatlon: PS Shallow Placement Saprolite System? QYes ONo Design Flow: 4 8 0 Soil Application Rate: 0 a 5 'System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP 'Proposed System: 25% REDUCTION Minimum Trench Depth: a 4 Inches Maximum Trench Depth: a 4 Inches Septic Tank: 1 0 0 0 Gallons 1 -Piece: G) Yes ONo Pump Required: QYes ON o O May Be Required Pump Tank: 1 0 0 0 Gallons 1 -Piece: QYes ONo Repair System Required: QYes ONO ONO, but has Available Space Repair S sY tem .Site Classification: PS Shallow Placement Soil Application Rate: 0 a 5 'System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP 'Proposed System: 25% REDUCTION Minimum Trench Depth: a 4 Inches Maximum Trench Depth: a 4 Inches Pump Required: QYes ONo O Maybe Required Pagel of 3 CDP File Number 228326 -1 *Site Modifications County ID Number: 5822876736 ❑ 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 by the Health Department in no way guarantees the issuan0q of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be wild for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the G site for the proposed Wastewater system, and the location of water supplies and surface waters). Plat The improvement Permit shag be valid without expiration with plat (means a property surveyed prepared by a registered land O surveyor, drawn to a scale of one inch equals no morethan 60 feet, that includes: the specific location of the 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 plan 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 satisfy the conditions, the rules, or this article. This permit is subject to revocation if the site plan, plat, or Intended use changes (NCGS 130A335(t). The person owning 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 (.1938(b)} Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature: Date: / / 'Issued By: 2140 -Nations, Robert Date of Issue: 0 8/ 1 a/ a 0 1 6 Authorized state Agen OValid without Expiration? OCreate CA? OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Improvement Permit CDP File Number: 228326 -1 County File Number: 5822876736 Date: /./.. Q Inch Scale: . OBiock ON/a n—__ H —LN rV, `,. � 14 � � rm- f 00 U _� � � I _.._�, �'��;.• � Iso_ �._._.....__._ � _.__i I �I � � _ ., ..._._._.....± � � i 1 � _......._ {,.._,.._., A._ _.,.._1-„___`_,. _._.._......f......_._._ � I ► � � I ,.,,,y.�,......._„t..�.—«.n._�......._._,.._i._......_.._{.._...._....,k__�_i.., �_ _.._..... ,t,,.,.____.,{.,,._,....,.._.e _.._..,t,._. � IBJ .......-F........-».._-. 3+ t l� } VIII ' E ( I # --- I 3 i�l� III f I i •I- -------- � � I I ; I ' i I ' ; i j ^ i ------------- n—__ H —LN rV, IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 228326 -1 County File Number: 5822876736 Date: .0 8/ 1 2/ 2 0 1 6 % A—j Click below to Import an Image from an external location: Drawing Type: Improvement Permit NCDENR Division of Environmental Health On -Site Wastewater Section Soil/Site Evaluation For On -Site Wastewater System 'Date: 0 7/ 1 4/ 2 0 1 6 'File #: 3 2 8 3 2 6 PIN #: 5822876736 'Owner WOWAC LLC Proposed Facility SINGLE FAMILY Proposed Design Flow (.1949) Location of Site Meadowlark Lane Property Size 6 Water Supply PUBLIC Evaluation Method Pit 2 940 14 Horizon SOIL MORPHOLOGY Mea gr Profile#POS Lan scape Depth .1941 Other Profile 2-49 °!o (IN) Mineralogy Matrix Mottle Factors Slope Texture Structure Consistence Color Color i L 2 o10 0-4 SCL 1-Wea gr vfi ns np .1942 Wet. 4-50 SC 3-Stng gr fi s p .1943 Depth GPS Saprolite: (in) .1944. Rest. 4 L 3 % Saprolite:(in) 0-8 SCL 1-Wea gr vfi ns np Horizon JrAl .1942 Wet. GPS �rA' Copy rofile 8-50 SC 1-Wea abk vfi vs vp .1947 Class Ps .1943 Depth EHS .1944 Rest. Horizon .1947 Class U EHS Nations, Robe LIAR 0 . 2 5 Barbara Davi: 2 L 2 % Saprotite:(in) 0-2 SCL Mea gr vri ns np .1942 Wet. GPS rls Copy rofile 2-49 SC 3-Stng gr fi s p .1943 Depth 1944 Rest. Horizon .1947 Class Ps EHS Nations, Robe Profile 0 ;Z 5 LIAR ,_ 3 L 3 % Saprolite:Cn) 0-3 SCL 1-Wea gr vfi ns np .1942 Wet. GPS 12 Copy Profile 3-52 Sc 3-Strig gr fi s p .1943 Depth .1944 Rest. Horizon 1947 Class Ps EHS Nations, Robe Profile LTAR 0 2 4 5 _-_ 4 L 3 % Saprolite:(in) 0-8 SCL 1-Wea gr vfi ns np .1942 Wet. GPS �rA' Copy rofile 8-50 SC 1-Wea abk vfi vs vp .1943 Depth .1944 Rest. Horizon .1947 Class U EHS Nations, Robe Profile LIAR 5 L 3 % Saprolite:(in) 0-9 SCL 1-Wea gr vfi ns np .1942 W et. GPS Copy_Pjotile 9-54 SC 3-Stng gr fi s p .1943 Depth .1944 Rest. Horizon 1947 Class U EHS Nations, Robe LTAR Available Space (.1945) S OtherFactors(.1946) PS Site Classification (.1948)Ps Initial LTAR: o. 2 3 5 Repair LTAR: o. 3 5 Others Present: Comments: Shallow placement 24 inches pumped Evaluated By. Nations, Robert NCDENR Division of Environmental Health On -Site Wastewater Section Date: 0 8/ 1 2/ 2 0 1 6 Soil/Site Evaluation Fie #: 2 2 8 3 26 For On -Site Wastewater System PIN #: 5 8 2 2 8 7 6 7 3 6 Comments: < % Saprolde:(in) Horizon SOIL MORPHOLOGY Profile# dscape Lang Depth .1941 Other Profile Factors POS (IN) Mineralogy Matrix Mottle Slope % Texture Structure Consistence Color Calor % .1944 Rest. Horizon .1942 Wet. 1947 Class EHS .1943 Depth GPS Saprolne:(in) ,1944 Rest. oro Saprolde:(n) Horizon .1942 Wet. GPS CODy�rofil .1947 Class EHS itrir� Copy Proril 144 Rest. .1944, Rest. .1947 Class Profile Profile LTAR PAR _ • _ Comments: < % Saprolde:(in) .1942 Wet. GPS Copy�rofil .1943 Depth .1944 Rest. Horizon 1947 Class EHS Pro6te LIAR oro Saprolde:(n) .1942 Wet. GPS CODy�rofil .1943 Depth 144 Rest. .1944, Rest. .1947 Class EHS Profile LTAR Comments: < ' Attach Image The "Open Drawing Form" button, opens the the drawing form. The "Import" button, attaches the drawing, or other image Into the space below. n Open Drawing Form Profile: 1 Q X-- Y Z Profile: 2 X Y Z Profile: 3 X Y 2 Profile: 4 X Y Z Profile: b X Y Z Profile: X Y Z Profile: X-. Y Z Profile: X Y Z Profile: Q X Y _ Z Profile: X Y Z APPLIION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC �i Davie County Environmental Health ✓ �� i r P.O. Box 88/210 Hospital Street,.. 111 ' lP Mocksville NC 27028 (336)753=6780/ Fax (336)753-1680 Application For: � Site Evaluation/Improvement Permit C Authorization To Construct (ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System CExpansion/Modification of Existing System or Facility ***/AIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 111904 MGMUli14116)Nu/•rk(�)►1 Name W 0 W A.0 L LC Contact Person Zac t% 1A .W t1 6% Address , , 31u Ot ..s W4.v Home Phone 13(.911 -11 -Al City/State/ZIP N.C. ^Z3 Business Phone 331; 1403-139`i Email Email: ZtwA�klc a yo.t4m%.ws'k Name on Permit/ATC if Different than Above Mailing Address S City/State/Zip YKUFEKI Y 1NfUKMAI IUN • 'Date House/t•acility Uomers tlaggea_ NOTE:.A survey plat or site plan must accompany this application. Included: U Site Plan UPIat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name W C W tie , LLC- G (D Z • 0. �i. �J t. �{ Phone Number 31 Owner's Address 10 St.,, - -1 W! City/State/Zip IlocKs+•l1s Property A dress SeM•4-, City Lot Size 4?. 00— Tax PIM Subdivision Name(if applicable) L,1W. s - b- Wi k Sertion/Lot# Directions To Site: 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? _Yes YNo Does the site contain jurisdictional wetlands? Yes X No Are there any easements or right-of-ways on the site? _Yes YNo Is the site subject to approval by another public agency? Yes c&No Will wastewater other than domestic sewage be generated? Yes X No IF RESIDENCE FILL OUT THE BOX BELOW # People 5 # Bedrooms q_ # Bathrooms Basement: 9'4es ❑No Basement Plumbing: des ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Garden Tub/Whirlpool 14'Pes INo 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: Xonventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: 8"County/City Water ❑ New Well ❑Existing Well 7 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes LYNo 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 resp 'ble for the proper identification and labeling of property lines and comers and locating and flagging or stakinga house ity to t proposed well location and the location of any other amenities. Site Revisit Charge erty o' or owner's legartepresentative signature Date(s): I 0-t(. Client Notification Date: Date EHS: Sign given I Yes ❑No Revised 11/06 Account # �9L5?NC/ Invoice # NCD -EN -,R Division of Environmental Health On -Site Wastewater Section Soil/Site Evaluation For On -Site Wastewater System "Date: 07 / 1 4 / 2 0 1 6 "File #: 2 2 8 3 2 6 PIN #: 5822876736 'Owner WOWAC LLC Proposed Facility SINGLE FAMILY Proposed Design Flow (.1949) Location of Site Meadowlark Lane Property Size 6 Water Supply PUBLIC Evaluation Method Pit Profile# 1d940 Lan scape Slope % Horizon Depth (IN) SOIL MORPHOLOGY .1941 Texture Structure Consistence Color Color Other Profile Factors .1942 Wet. % Saprolite: (in) L C �% i J .1942 Wet. .1943 Depth .1942 Wet. GPS .1944 Rest. Horizon 6 .1943 Depth EHS .1944. Rest. Horizon 2 .1947 Class EHS .1947 Class EHS ILA UK a" 61 Profile LTAR G L�(g l: .1943 Depth GPS Cop rotilea %41 Saprolite:60 011 IIA .1942 wet. 1947 Class C �" 11 S & 1943 Depth GW-PLTAR .1944 Rest. Horizon .1947 Class ENS l C+ 3 Profile LTAR ._. GPS Copy..Profile % Saprolite:6n) 6 Cl S L .1942 Wet. L C �% i J .1942 Wet. .1943 Depth .1944 Rest. Horizon 6 .1947 Class Profile LTAR EHS .1944 Rest. Horizon °jo JS3prolite:on) .1947 Class EHS .1942 Wet. GPS rA Copy_profile G L�(g l: .1943 Depth .1944 Rest. Horizon 011 IIA (4 ,,, 1947 Class EHS GW-PLTAR GPS Copy ofile L-- °jo Saprol e:(in) 6 Cl L .1942 Wet. / �( .1943 Depth .1944 Rest. Horizon .1947 Class EHS g j Profile LTAR Available Space (.1945) Other Factors(.1946) Site Classification (.1948) Initial LTAR: Repair LTAR: Others Present: Comments: Evaluated By. ' NCDENR Division of Environmental Health On -Site Wastewater Section Comments: Date: 0 7/ 1 4 / 2 0 1 6 Soil/Site Evaluation Fie #: 2 2 8 3 26 For On -Site Wastewater System PIN #: 5 s a 2 8 7 6 7 3 6 (IN) Mineralogy Matrix Mottle Comments: % Saprolife:(In) Horizon SOIL MORPHOLOGY Profile# dscape Lang Depth .1941 Other Profile Factors POS 010 (IN) Mineralogy Matrix Mottle Slope Texture Structure Consistence Color Color a10 .1944 Rest. Horizon 1942 Wet. .1947 Class ENS .1943 Depth GPS Saprolite:00 .1944 Rest. Saprolde:00 Horizon Ols .1942 Wet. GPS Copy roti! .1947 Class EHS CoPLEratil .1944 Rest. Horizon .1947 Class Profits LJ Profile LTAR LTAR Comments: % Saprolife:(In) .1942 Wet. GPS ComLErofil �) .1943 Depth .1944 Rest. Horizon .1947 Class ENS Profile LTAR Saprolde:00 .1942 Wet. GPS Copy roti! .1943 Depth .1944 Rest. Horizon .1947 Class EHS Profile LTAR Comments: 010 Saproldc(in) .1942 Wet. GPS 12 copy Frofi .1943 Depth .1944 Rest. Horizon .1947 Class EH3 Profile LTAR Saprolde:(in) .1942 Wet. GPS CopyrP, atil LJ .1943 Depth .1844 Rest. onzon .1947 Class ENS LTAR L Comments: Attach Image The "Open Drawing Form" button, opens the the drawing form. The "Import" button, attaches the drawing, or other image into the space below. Open Drawing Form Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y— Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile:X Y Z Profile: X Y Z Profile: i X Y _ Z