256 Lakeview Road Section 2 Lot 18Davie County, NC ' - I Tax Parcel Report Tuesday, January 17, 2017
WARNING: THIS IS NOTA SURVEY
Parcel Information
Parcel Number:
1614OA0032
Township:
Shady Grove
NCPIN Number:
5758836302
Municipality:
Account Number:
72276000
Census Tract:
37059-804
Listed Owner 1:
SWICEGOOD JERRY
Voting Precinct:
WEST SHADY GROVE
Mailing Address 1:
1662 JERICHO CHURCH ROAD
Planning Jurisdiction:
Davie County
City: MOCKSVILLE
Zoning Class:
DAVIE COUNTY R-20
State:
NC
Zoning Overlay:
Zip Code:
27028-0000
Voluntary Ag. District:
No
Legal Description:
LOT 18 HICKORY HILL SECTION 2
Fire Response District:
CORNATZER - DULIN
Assessed Acreage:
1.63
Elementary School Zone:
CORNATZER
Deed Date:
10/2009
Middle School Zone:
WILLIAM ELLIS
Deed Book I Page:
008080799
Soil Types: GnB2,GnC2,GaD,WATER
Plat Book:
0005
Flood Zone:
Plat Page:
027
Watershed Overlay:
DAVIE COUNTY
Building Value: Outbuilding & Extra
Freatures Value:
Land Value: Total Market Value:
Total Assessed Value:
Davie County,
NC
All data Is provided as is wtthoutwarranty or guarantee of any Idnd either expressed or Implied Including but not limited to the
Implied warranties ofmerchantablitty or fitness for a particular use. All users of Davie Countys GIS webslte &hall hold harmless the
County of Davie, North Carolina, Us agents, consultants, contractors or employees from any and all claims or causes Of action due to
or arlsing out of the use or Inability to use the GIS data provided by this websIte.
DAVIE COUNTY HEALTH DEPARTMENT
Name: j 0 C 0 L kji r --e' C, G C� C,
Environmental Health Section
PROPERTY INFORMATION
P.O. Box 848
"I
Directions to property:
Mocksville. NC 27028
Subdivision Name:
(C,�� 1?j Q0 k"O.
Phone #: 336-751-8760
2,
A?
Section: Lot7
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Tax Office PIN:#
002'
8"' A
AUTHORIZATION NO:
Road Name:
Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pen -nits. This Form/Authorization Number should be presented to the bavie County Building Inspections
Office when applying for Building Permits.
0
(In compliance.with Article I I 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.
a lre—cl
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED edc,4,-
RESIDENTIAL SPECIFICATION: BUILDING TYPE #BEDROOMS-�� #BATHS -3 # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE — # PEOPLE/SHIFT — # SEATS — INDU�TRIAL WASTE: Yes or No
a C /-,C— 4;1
LOTSIZE TYPEWATERSUPPLY DESIGN WASTEWATER FLOW (GPD) -WSITE— REPAIRSrM
%MP TANK GAL. TRENCH WIDTH
SYSTEM SPECIFICATIONS: TANKSIZE� _-GAL. ROCK DEPTH Q LINEAR Fr.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:J fj') I
IMPROVEMENT PERMIT LAYOUT
TO 1)
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PE§V��? 1J.'ehAN" I M M VLe,
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AUTHORIZATION NOP2,&ZkOPERATION PERMIT BY: - a0/4"It�
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE FHAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WrrH ARTICLE I I 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 02/02 (Revised) 616-7-, I-kv-
DAVIE COUNTY HEALTH DEPARTMENT
<
Tiarne: Environmental Health Section PROPERTY INFORMAT�ON
P.O. Box 848
b , irection I s to p . roperty: Mocksville, NC 27028 Subdivision Name: kl)1?4 Hill
k '� Phone #: 336-751-8760 ' I
f '�C�_.i.l Section: 2— Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#'
SYSTEM CONSTRUCTION
Z. 7�
AUTHORIZATION NO: 0022,17 A koad Name: 1p:
**NOTE** this Authorization for Wastewater System Construction MUST BE I SSUED'by the Davie County Environmental Health Section prior
to issuance of any Building Pen -nits. This FornVAuthorization Number should be presented to the bavie County Building Inspections
Office when applying for Buildirig Permits.
(In.compliance with Article I I 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. a)
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED,
veon^
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
ILITY TYP #PEOPLE # PEOPLEISHIFT
COMMERCIAL SPECIFICATION: FAC iE' #SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE 3 TYPE WATER SUPF 649 DESIGN WASTEWATER FLOW (GPD) W SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE -� _'GA UMP TANK GAL. TRENCHWIDTH36 ROCKDEPTH LINEAR Fr.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITION§5 61 10 Z Lx!
IMPROVEMENT PERMIT LAYOUT
jut , 5
CM
Lu ct
TO
0
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE -CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PE5pyr-/ . I - lilt)"d_
_ _ I j) I I / j,.(j `J Or, Q- SYSTEM
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AUT�ORIZATION NO.C�2 2 7A OPERATION PERMIT BY DA_TE-.--11 9vo-od,
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDIC kTE)HAT THESYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION. 1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO-Wk�'BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
.. DCHD 02/02 (Revised) -#,5162, UV.
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FOR FINAL INSPECTION OF THIS SYSTEM PLEASE -CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
OPERATION PE5pyr-/ . I - lilt)"d_
_ _ I j) I I / j,.(j `J Or, Q- SYSTEM
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PAL'= BY\
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(I -k; I /M— I
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AUT�ORIZATION NO.C�2 2 7A OPERATION PERMIT BY DA_TE-.--11 9vo-od,
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDIC kTE)HAT THESYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION. 1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO-Wk�'BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
.. DCHD 02/02 (Revised) -#,5162, UV.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account M 990002793 Tax PIN/EH #: 5758-83-6302BF
Billed To: Ben Frye Subdivision Info: Hickory Hill 11 Lot# 18
Reference Name: Location/Address: Lakeview Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3483
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
NOTE This Authorization for Wastewater System Construction MUST BE ISSUED 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 I I 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: /V
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit
has been installed in compliance with Article I I 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.
kP
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tv
Septic System Installed By: LA4N
Environmental Health Specialist's Signature: t �j D
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 848/210 Hospital Street
Mocksville, NC 27028 P61
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002793 Tax PIN/EH #: 5758-83-6302BF
Billed To: Ben Frye Subdivision Info: Hickory Hill 11 Lot# 18
Reference Name: Location/Address: Lakeview Road -27028
Proposed Facility: Residence Property Size: see map
ATC Number: 3483
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type o& #People #Bedrooms #Baths
Dishwasher: ;!fl*' Garbage Disposal: 173 Washing MachineoE!r Basement w/Plumbing:,25" Basement/No Plumbing: 13
Commercial Specification: Facility Type #People _ #People/Shift #Seats Industrial Waste:
Lot Size Type Water Supply d Design Wastewater Flow (GPD) eVW Site: New;!r Repair 0
System Specifications: Tank Size,4C9J GAL. Pump Tank GAL. Trench Width,?4( 7!�Od
� Rock Depth Linear Ft.
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT OUT- A D EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISHED GRADE. ""NOTICE: Contact a repr ive of the Davie County Health Department for final inspection of this
system between 8:30 a.m. to 9:30 a.m. or 1: 0 p.m. the day of installation. Telephone # is (336)751-8760.
-rtpl-ylt ZA)vc
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
I -I TION 1`011 SITE EVALUATION/IMPIIOVENIENT PEIINIIT & ATC
Davie County Health Department
SO, EnYi1-0J7n7enWh1ea1t11 SeCt!017
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
KFOPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
�gp
RMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed Contact Person F/
V K - ------
Mailing Address P0 V. Home Phone qqO-37rd,
City/State/ZIP AAv-A,,cL Ak- Q 7GO& Business Phone Mq-cM I
2. Name on Permit/ATC if Different than Above
Mailing Address city/state/zip
3. Application For: B/Site Evaluation 11�imvrovement Permit/ATC Both
4. S�stem to Service: d House 13 Mobile Home El Business 0 Industry El Other
5. Type system requested:.12/Conventional 13 conventional modified innovative
6. If Residence: # P eople # Bedrooms it Bathrooms
EfDishwasher []Garbage Disposal EYWashing Machine B'B'asement/Plumbing [:]Basement/No PlLuiibing
7. If Business/Industry /Other: verify type ff People # Sinks
# Commodes # Showers # Urinals Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: E�County/City 11 Well [I Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes [ErN o
If yes, what type?
'IMPORTANP" CLIENTS MUST COMPLETE, THE REQUIRED PROPERTY INFORMA'I'ION REQUES'I'ED
BELOW. Eitlier a PLAT or SITE PLAN MUSTBESUBMITIED by the client witli THIS APPLICATION.
Property Dimensions: LeL PVAQ
Tax Office PIN: 115 -
Property Address: RoadName M I'Jfcv�cw
CitylZip-ADCL-11r, g 0700?7
If in a Subdivision provide information, as follows:
Name: IL
Section: Block: Lot:
WRITE DIRECTIONS (froin NlocksNille) to PROPERTY:
14, it -a L -Z) � 0 '� Ica,
Date home corners flagged: 6TM 1, C 47 093
This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernlit(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. 1, also, understand that I ain responsiblefor all charges hicurredfi-oln
this application. 1, hereby, give consent to the Authorized Representative of the Davie County IleaIth Department
to enter upon above described property located in Davie County and owned by _OCAI�,men V. E*( -
to conduct all testing procedures as necessary to determine the site suitability. I I
DATEAf4, SIGNATURE 726g,-, �/, In,
I f -
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Sign given.
Revised DCHD (05/03
Site Revisit Charge
Datc(s):
Client Notification Date:
EHS:
Account No.—,) -713
Invoice No. 3(,
SUIC . tGOOD WALL REALTORS 3367513931 12/11/00
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11123AW 141bot x FLAT or AM PLAN AIVMW4!�MITTlb bi the dkel *96 THIS APPLICATION.
'% - % 3XY 136 �0. Wmn DiRgm0m (fteam methmile) to PxopnTw-.
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ho"A homflor are embjM to mmpmWd w rcv=dkIN6 If the Mis. V4M or Istesded no sbamse, or It the 111formotwo
xnbml"ad to thb appacaffam Id Fshilled or 0fist4d to nbw, andeffliwW (kel J am r"Pulblefor alt cilepta lxcxtrgdfrvn
AftepHedflex 1, beriby. give commat toThe Authorized Roprawntisfift of the Davit County Health Department
to enter upas ebme docribed pftprfy kicsted Is Dsvb Cuumly and a a by
To Conduct all 101111 procedures as amotmary to determilas dw dto snftsbdlqj�
00
DATE
TM18 AREA MAY 81 USED FOR MAWING YOUR SM PLAN (jocled* all of the fAmingt Usting a14 propmed
property 11wo and dimessioK stractmrim matbacla, sadsapdalmadm�
gob" DCHD (071")
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APPLICANT INFORMATION
DAVIE COUNTY HEALTH DEPARTMIENT
Environmental Health Section
SoiVSite Evaluation
Account #:
990001513
Billed To:
Doug Randolph
Reference Name:
Kyle Swicegood
Proposed Facility:
Residence
PROPERTY INFORMAT10N
Tax PIN/EH #: 5758-83-6302
Subdivision Info: Hickory Hill two Lot # 18
Location/Address: Lakeview Road -27028
Property Size: see map Date Evaluated:
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
Public
Cut
FACTORS
2 3 4 5 6 7
Landscape position
/—
Slope %
Y
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON Il DEPTH
Texture group
C_
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
77
LONG-TERM ACCEPTANCE RATE
'/ i i 1 1 =
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
EVALUATION BY: /A�/ //
OTHER(S) PRESENT:
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 - 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
DCHD 05/99 (Revised)
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DAVIE Cob HEAUTHDEPARTMEW-
ENVIRONMENTAL HEALTH SECTION
P. 0. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #:.(336)751-8760
December 28, 2000
Doug Randolph
219 Lakeview
Mocksville, NC 27028
Re: Site Evaluation/ Lot 18 Hickory Hill
Tax Office PIN: #5758-83-6302
Dear Client(s):
As requested, a representative from this office visited the aforementioned site on
December 28, 2000. Based upon the information provided on the Applicationfor Site
Evaluation and after an evaluation was completed on the site, the site was found to be
provisionally suitable for the installation of an on-site sewage system.
Before an Improvement PermitlAuthorization 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,
X04,4 -'e, gvwA.
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/di
DAVIE COUNTY HEALTH DEPARTMENT
FACTORS
1 2 3 4 5 6 7
Environmental Health Section
Slope %
Soil/Site Evaluation
APPLICANT INFORMATION
PROPERTY U14FORMATION
Account #:
990002793
Tax PIN/EH #:
5758-83-6302
Billed To:
Ben Frye
Subdivision Info:
Hickory Hill 11 Lot # 18
Reference Name:
Consistence
Location/Address:
219 Lakeview Road -27028
Proposed Facility:
Residence
Property Size: see map Date Evaluated:
Water Supply:
On -Site Well
Community
Public L'�
Evaluation By:
Auger Boring
Pit
Cut
Mineralogy
HORIZON IV DEPTH
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
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
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:_ V5 EVALUATION BY: I LIZJZ&
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 Sl - 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
DCHD 05/99 (Revised)
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