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Home My WebLink AboutRBPR-09-2016-24692.TIF ,t4$A THIS IS NOTA PERMIT Case # RBPR-09-2016-24692 L y CATAWBA COUNTY HEALTH DEPARTMENT ay ,* v\ :r PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES •ti1T 4t3it \/842 sm Residential Building Plan Review - Building New AUTH_CONST- NEW WELL '' 4 - ❑m ' Contractor *GREY GATE PROPERTIES, LLC (BRUCE SUNDGREN), 1519 OAK PARK CT, IRON STATION N 28080 C:7042014822 SUNDGREN76@HOTMAIL.COM Owner GREY GATE PROPERTIES LLC, 1519 OAK PARK CT, IRON STATION NC 28080 B:704-240-4242 NAME TO APPEAR ON PERMIT GREY GATE PROPERTIES LLC SITE ADDRESS: 3814 E MAIDEN RD, MAIDEN NC 28650 PIN # 366604843698 NAME of SUBDIVISION: Lot# 3 Section/Block PROPERTY SIZE: Square Feet Acres 0.91 DIRECTIONS: 321 South, left on W Main St, Continue onto E Maiden Rd, Property across from Caleb Rd PRIMARY CONTACT: Contractor SEWER TYPE: Septic Tank GALLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: New, 60x60, one story single family dwelling, 3 bedrooms, no basement, attached garage w no bonus room. SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? No Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: 5 PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 60x60 single family dwelling #OF NEW BEDROOMS:: 3 BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?Yes Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO E9-chapplication 09/08/2016 15:00 Page I of 4 y,A • CATAWBA COUNTY Case# RBPR-09-2016-24692 :fit Public Health Department Subdivision ;kin y Environmental Health Division PIN# 366604843698 PO Box 389, 100-A Southwest Blvd,Newton.NC 28658 18.2 NAME ON PERMIT: GREY GATE PROPERTIES LLC ( ), 1519 OAK PARK CT, IRON STATION NC 28080 GREY GATE PROPERTIES LLC ( ) Site Address: 3814 E MAIDEN RD, MAIDEN NC 28650 Property Size: Square Feet Acres 0.91 Directions: 321 South, left on W Main St, Continue onto E Maiden Rd, Property across from Caleb Rd Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain speci -d onditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is no ransferabl:, Im.rovement P-r its and Well Permits are transferrable. Permits may be revoked if the information on this application,site plans or int- ded use cha ge for the pr.•0 -d facility. I have read this application and certify that the information provided herein is true, complete and c• ect. Authorized o ty and : a - officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws a . rue-. I understan• at I a ely responsible for the proper identification and labeling of all property lines and corners and making the site access.•le so at a comi.i e -va -tion can be performed. Date: -/e... Signature of Applicant or Agent An Environmental Health Specialist will contact you wi i " working el.ys of-pplic.tYdate. If you need further information or assista •- please call 821-46• 201 AREA1 ************************************************************************************************************ FE'ENAME DATE FEEAMOUNT :I Authorization to Construct Fee (New/Expansion) 09/08/2016 $150.00 Fee Well Permit & Inspection Fee 09/08/2016 $300.00 TOTAL FEES ,..:,. ... . , 7 $450 00 FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) E9-ehapplication 09/08/2016 15:00 Page 2 of 4 CATAWBA ATA THIS IS NOT A PERMIT couxrr v YsA CATAWBA COUNTY HEALTH DEPARTMENT • , Application for Environmental Services Page I Improvement Permit L Authorization to Const'uct Er/ Septic Repair❑ Septic Malfunction❑ Septic Expansion ❑ New Well Permit El Replacement Well ❑ Well Abandonment❑ Well Repair ❑ Existing System Inspection Pre-Approval Required) ❑ Application is for New Construction a Existing Facility ❑ Property Address 38tX r_ /1/t A IP 1C) —ea>. Subdivision 1�e r7 h- 0C- .28(p S<3 Lot# 0Z Acres • 91 Section/Block/Phase Driving Directions to Property UR 5792(..n1 6 010 ITh, i1/44 N I r- C, TI NuA_C oo r il A(-2 v: W 1917 r/ A�` Et lb& Iz IJ NAME TO APPEAR ON PERMIT? ❑ Owner [Applicant 0 Contractor Applicant Contact Information Name ( 1 'Q , ;7420 6-52,77,,c3 LLC Address /Cj/ 044 r -C-Aviv 5„9'/UN tic ggoy(3 Phone ,7 f -„7e/p - g�% Cell Phone J/7U/7 - o?o/- Owner Contact Information Name Address - Phone Cell Phone Contractor Contact Information Name 6iicy b,?%f- T/I.Gf'sere5 L G Address /5/9 0.94 Hee 15 -U 57;97-70A-) A3C „ZRo SIU Phone Cell Phone l 'gay- Cyd - y��z �� - 1/292.7 WHO WILL BE THE PRIMARY CONTACT? ❑ Owner © Applicant ❑ Contractor Description of Existing Structures on Site ,4/O.n.7y' #ofBedrooms *j' 3 Structure Dimensions 60X 1, ) #of Occupants ,j Basement 0 Yes [ No Basement Fixtures C Yes !'$Io The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property question. If the answer to any question is "yes",applicant must attach supporting documentation. Di Yes o Does the site contain any jurisdictional wetlands? ® Yes Digo Does the site contain any existing wastewater systems? ®Yes ®'ho Is any wastewater going to be generated on the site other than domestic sewage? )tYes to Is the site subject to approval by any other public agency? • D Yes folio Are there any easements or right of ways on this property? Describe Existing water supply in use ❑ Individual Well 0 Community Well Li Semi-Public Well 0 County/City/Township Water Line Is a public water supply available? ** ❑ Yes ivo If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) 0 Accepted 0 Alternative 0 Conventional 0 Innovative Er Othera572 Z Ctfl7io.'-D❑ Any („"Ail/ y j � . • ,(ATA 7B A THIS IS NOTA PERMIT CatrNT V V_Y-&? ,.. CATAWBA COUNTY HEALTH DEPARTMENT _.�'i+ -- Application for Environmental Services -Paget nam Cmotno Proposed Facility Type _/ . • ❑ Primary'Residence U✓ .New Residence ❑ Addition to Residence #of New Bedrooms *t 3 Project Description NJFts3 ConnbJrZtLr i iiv^) Structure Dimensions Cp0 x' (o0' #.of Occupants 5 BasementYes E❑ No Basement Fixtures a Yes e,140 CI Accessory Structure(s) Describe #of New Bedrooms *t if applicable Structure Dimensions #of Occupants Accessory Dwelling El Yes El No Plumbing ❑ Yes El No Describe Plumbing Needed , 0 Multi-Family Residence#Units #Bedrooms per Umt t Total#Bedrooms *t Structure Dimensions ❑ Food Service Specify Type . #Seats Floor Space-Entire Food Service Facility (Sq Ft) #Employees per Shift #of Shifts Dining Area(Sq..Ft.) U Business Specific Type of Business Retail Floor Space — - #of Employees per Shift #of Shifts • - ❑ Other Facility Type Specify - If Church#of Seats Kitchen 0 Yes El No If Daycare Specify Occupancy Application for Well Construction/Abandonment/Repair Proposed Well Type [-individual Well ❑ Semi-Public Well ❑ Community Well Abandonment Type Drilled ❑ Bored ❑ Dug ❑ Unknown • Well Repair Requested ❑Yes L , No Describe . Calculated Design Flow, Commercial t Additional information may be required to determine design flow from certain facilities. This value will be determined during consultation with on-site staff. • *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as.a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on house plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system size increase in the future. _ - t If structure is plumbed but no bedrooms,calculated design flow is required. **If No,a well permit must be issued with the Authorization to Construct. - • SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Improvement Permits issued as a result of this information are valid for 5 years or may be non-expiring under certain specified conditions.An Authorization to Construct issued by this department is valid for(5)five years from the date issued and is not .•,- transferable; transferable;Improvement Permits and Well Permits are transferrable. Permits maybe revoked iftheinformation'on this application, . site plans or intended use changes for the proposed facility. . . I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessaryinspections to determine compliance with applicable laws and rules. I .. understand that I ain solely responsible for the proper identification d4abeling o Al property lines and corners and making the site accessible so that a complete site evaluation canb- .erformed j ; , ' Signature of Owner or Agent ' Cb1.------b1.------ Date v`9 - /4 ' % Printed Name of Owner or Agent f7g2IL f e,.-;P(, es--J Catawba County Environmental Health z. ,/ o- �`" • m co • N co • Ery n co o 531//: :, ' w cp • • !wI 15 / aD</3 \filil 1 11 N InO ��O ...At 1�� 10'.. *.. .. • • Parcel: 366604843529, 3806 E MAIDEN RD lin=50ft MAIDEN, 28650 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2014 Catawba County NC 09/08/2016 Parcel Report Page 1 of 1 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 366604843529 Owner: GREY GATE PROPERTIES LLC Parcel Address: 3806 E MAIDEN RD Owner2: City: MAIDEN, 28650 Address: 1519 OAK PARK CT LRK(REID): 201305 Address2: Deed Book/Page: 3278/0989 City: IRON STATION Subdivision: State/Zip: NC 28080-9357 Lots/Block: 2/ Last Sale: School Information: Plat Book/Page: 65/50 School District: COUNTY Legal: LOT 2 PLAT 65-50 Elementary School: TUTTLE Middle School: MAIDEN Calculated Acreage: .740 Tax Map: High School: MAIDEN Township: CALDWELL School Map State Road #: 1855 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: BANDYS Zoningl: R-40 Building(s) Value: $0 Zoning2: Land Value: $11,900 Zoning3: Assessed Total Value: $11,900 Zoning Overlay: Year Built/Remodeled: / Small Area: BALLS CREEK Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permits for this parcel. Firm Panel #: 3710366600J Building Details 2010 Census Block: 4008 WaterShed: 2010 Census Tract: 011602 Voter Precinct: P9 Agricultural District: Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. ©2016, Catawba County Government, North Carolina. All rights reserved. 02/ \N .I LiSo 3 Zit\ ZOO sal It http://gis.catawbacountync.gov/nomap/parcel_report.php?key=366604843529&typ=P 9/8/2016 ENT r' r''1 ■ CaseU r tt� C:�TA15'BACDUNTY ❑,,� r❑ IMPS-01-2015-057331 ..3 f+l 7 Public health Department ��: a: -14. Subdivision tiY -.I I Environmental Health Division I '• •'� r } I'IN// 366604843529 PO Box 389. 100-A Southwest Bled,Newton. NC 28658 -104:1.ti. a LO'1'R 2 { t ❑' 13 "a '. NAME ON PERMIT: GREY GATE PROPERTIES LLC, 1519 OAK PARK CT, IRON STATION NC 28080 Site Address: 3806 E MAIDEN RD, MAIDEN NC 28650 Property Size: Square Feet 32.234.40 Acres .740 Directions: 321 South left on W Main St continue onto E Maiden Rd, property across from Caleb Rd Improvement Permit Facility: Primary Residence Permit Category; New Septic Bedrooms- 3 WATER SUPPLY: Private Well Basement? No Basement Plumbing? No INITIAL SYSTEM SPECIFICATIONS • Permit Valid: Expires In Five Years: XNo Expiration: Projected Daily Flow 360 g.p.d Proposed Wastewater System: 25% REDUCTION Type: IIIG - OTHER NON-CONN TRENCH SYSTEMS Permit Conditions: Keep all parts of septic system and repair system minimum: 50' from any we11,10'from property lines, 5' from home including decks and patios. Lines to be installed on contour. Do not grade drive or fill over system or repair area or permit will be revoked. Evidence of water infiltration into pits at time of inspection will require a curtain drain to be installed to divert subsurface water away from system. Curtain drain to be installed up slope minimum: 10' from drain field. REPAIR SYSTEM SPECIFICATIONS Repair System Required? Required Proposed Wastewater System: 25% REDUCTION Type: 1110 -OTHER NON-CONV TRENCH SYSTEMS Landscaping or other site alterations that potentially divert groundwater or surface water toward the septic system, or prevent proper drainage away from the septic system, including the direction of gutter flows or foundation drains, is not approved,and may result in failure to approve the initial system installation, or the suspension/revocation of existing permits. The issuance of this permit by the Health Department does not guarantee the issuance ol'other permits. ft is the responsibility of the applicant/property owner to insure that alt Catawba County Planning/Zonine and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a charge in ownership of the property. This permit was issued in corn plum ce with the provisions of the North Carolina 'Laws and Rules Mr Sewage Treulmern surd Disposal Systems' (ISA NCAC 184 .1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Jason Boyd 01/29/2015 AUTHORIZED STATE AGENT APPROVAL DATE Permit Expiration Date: 01/29/2020 No grading or construction activity is allowed in areas designated jar system and repair without approval of the Health Department. ehpermit 01/30/2015 09:22 Page i of) taiii\ PermitIIGI-IPR-I•15-20727 C.ATAW[3A COUNTY'—sa � Z Public Health Department Name Gray Gate Properties LLC .rr� Environmental Health Division Address 3806 E Maiden Rd Maiden NC ��ige Y PO Box 389, 100A Southwest Blvd. Newton NC 28658 PIN# 366604843529 is 42 ,,, (828)465-8270 Fax {828)465-8276 TOD(82S)465-8200 Lott Site Plan Improvement Permit t r 6 (c to r (, 0 �1r /` 0II5crv3 L•.c 1-a.! r// it r 5v5h o t .'tl= . l-C. r, .„n th )r0 :::_>, 1 ii) ' ti a ° is:11 11\5PO--o}, , ., f-±c1 to ,* c_ ,) r1-ai � 10rc1-'1 12_4_c+, u . ra..--.3 SY5t )O' 1" d {- 5t km,. 5vrPet_ I° --- 9.57. k".ICb.-r aw �Y Fro Li 2.17 I - 01r,,., 3 71 .'15 . “ It G6l- 0,,. we_ 11 titl • k l 1`1 V.re 111 sp�� •#- .,, ,Q Ic Ct.M"\t' 15 Y / r rp /I Sr�,.n s-S 52T�JG4_ 1; F. V i L C. vvC :ILL r. n, SSP I- ( C, V 1 5tpftL w. S /S ` G h I'. ✓741 i (( 1 99 ,9 7 ' 7 ec-l- Vic. , --)q---'r, g- 1 i Scale i _ 6 tS' Department of Environment,Health,and Natural Resources Sheet: Division of Environmental Health Property ID: On-site Wastewater Section Lot 4: SOIL/SITE EVALUATION File tit for ON-SITE WASTEWATER SYSTEM AppID: EHPR-1-15-20727 Owner: Grey Gate Properties LLC Applicant: Address: 3806 F Maiden Rd Date Evaluated: 1/28/2015 Proposed Facility: 3 BR Home Design How(.1949) 360 god Property Size: Location of Site: Lot 2 Property Recorded: Wafer Supply: pvl well [ ]Spring [ ]Other Evaluation Method: pits by Bobby Dellinger [ ]Cut Type of Wastewater: X Sewage ( I Industrial Process [ ]Mixed P , . R • . o • SOIL MORPHOLOGY b ' F - .1941 • ,.., PROFILE FACTORS I ,1940 - .1942 ' L Landscape .Horizon .1941 .1941 • Soil ) .1943''• .1956 .1944 Profile E Position! Depth Structure, Consistence Wetness! - Soil ' Sapro Restr Class s Slope% : (IN.) Texture Mineralogy Color Depth(IN.) Class Horiz &LTAR 1 LL 2-3% 0-5" topsoil PS 3 6-36" SCL SC SS SP SEXP FR 48" 2 LL 2-3% same as 1 approx 24•'wafer infil 48" PS.3 3 LL 3-5% same as 1 and 2 P5.3 4 5 6 7 Description Initial System Repair System Other Factors(.1945): Available Space(.1945) PS PS Soil Evaluation By: Jason Boyd System Type(s) 1110 1110 Others Present: Bobby Dellinger Site LTAR .3 .3 Site Classification(.1948)112 Site Evaluation By: Others Present: Sheet COMMENTS; FILE#: Landscape Position Group Texture .1955 LTAR Structure R-Ridge I S-Sand 1.2-0.8 SG-Single Grain SS-Shoulder Slope LS-Loamy Sand M-Massive LS-Linear Slope CR-Crumb FS-Foot Slope II SL-Sandy Loam 0.8-0.6 GR-Granular NS-Nose Slope L-Loam SBK-Subangular Blocky H5-1-lead Slope ARK-Angular Blocky CC-Concave Slope III SI-Silt 0.5-0.3 PL-Platy CV-Convex Slope SICL-SIIty Clay PR-Prismatic T-Terrace Loam FP-Flood Plain CL-Clay Loam SCL-Sandy Clay Loam IV SC-Sandy Clay 0.4-0.1 SIC-Silty Clay C-Clay Consistence Consistence Mineralogy Moist Wet SEXP-Slightly Expansive VFR-Very Friable NS-Non-Sticky EXP-Expansive FR-Friable SS-Slightly Sticky FI-Firm S-SStcky VFI-Very Firm VS-Very Sticky EFI-Extremely Firm NP-Non-Plastic SP-Slightly Plastic P-Plastic VP:Very Plastic Sketch of Soil Evaluation Locations A k � 4k 3 foo It L LID , i w t .CATAWBA COUNTY • 3 n `- ' Buhl 4-t dttl Deportment Case# N7,S2000-01851 N.�) Environmental Health Division Subdivision GEMINI HOMES.INC Cr. PO Box 380, 100-A Southwest Blvd,Newton.NC 28658 Sect/BL/Ph/Lot# 2 (82% 465-8270 FAX(828)465-8276 TDD 1828t 465-8200 PIN# 911366604845823-2 Applicant/Owner GEMINI HOMES Site Address: E MAIDEN RD LOT 2 MAIDEN NC c5.4eci Sc'. Property Size: SF .744 ACRES / Directions: HWY 321 S/TO MAIDEN TURN LF/GO TO E MAIDEN RD/LT ON LEFT ACROSS FROM CALEB RD Improvement Permit Permit Valid For: Five years ic No Expiration Facility(Residential): House HouseUX Mobile Home Multi-Family Bedrooms 4 New? A Addition? Projected Daily Flow Io g.p.d Water Supply Private Well? c<" Public? Semi-Public? Basement: N Basement Plumbinqg:,_, N HottTuh/Spa: N `Special Fixtures(explain): Proposed Wastewater System: 8529 £ t rT`^ Type: 3 G- Proposed Repair: as Lc 11..d3(r Permit Conditions: • Owner or Legal Representatiyq Signature:w a Date: Authorized State Agent: . : - Date: / - The issuance of this permit by the Health Department does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to insure that all Catawba County Planning/Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan,plat or the intended use changes,or if site conditions are altered. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina 'Laws and Rules for Sewage Treatment and Disposal Systems' (15A NCAC IRA.1900). Neither Catawba County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily for any given period of time. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments( Proposed Wastewater System: Type: Wastewater Flow g.p.d New Repair Expansion Soil LTAR: g.p.d./tt2 Type of Facility: Basement: N Basement Plumbing: N HotTub/Spa: N Special Fixtures(explain): Wastewater System Requirements Tank Size: Septic Tank gal Pump Tank gal Grease Trap gal Drainfleld: Total Area: sq ft Total Length: ft Maximum Trench Depth in Trench Width ft Minimum Soil Cover Minimum Trench Separation ft Distribution: Distribution Box SeridflDistribution_ Pressure Manifold LPP Other_ Additional Specifications: _ Authorized State Agent: Date: Permit Expiration Date: I have read and accept the specifications and all conditions of this permit as indicated. Owner or Legal Representative Signature: Date: Form B • - . CATAWBA COUNTY Y_,; [Lblic'4leelth Department Case N WLS2006-01851 I i: , Q\t Envirormtental Health Division Subdivision GEMINI HOMES.INC +'\77 sl.' i PO Box 389, 100-A Southwest Blvd.Newton.:NC 28658 Sect/BL/Ph/Lot# 2 ,.;.; . (8281465-8270 FAX 1828)465-8276 TDD18281465-8200 PINti 911366604845823-2 Applicant/Owner GEMINI HOMES Site Address: E MAIDEN RD LOT 2 MAIDEN NC Property S SF /44 ACRES Directions: HWY 321 S/TO MAIDEN TURN LF/GO TO E MAIDEN RD/ LT ON LEFT ACROSS FROM CALEB RD • ® Improvement Permit 0 Authorization To Construct (• O Well Permit tits • SITE PLA We fa') A7 al/ft ev` 5`I A 9. Kee!" wtr I • C flet sLtjA- r Ile � r 4t0� c,, tto ay 1 /-+rte �'�' rQ ;t c�� Fr.; � I d5`1 S,`Y tr, r I SySiv— avi r_ ( I- Gb ono lU---- r / - Scale 6"-/1T/ig4H a( System components represent approximate contours only. The contractor must flag the system prior to beginning the installation to ensure that proper grade is maintained. Do not install system under wet conditions. This permit is subject of revocation if the R site site or site conditions are altered. Ane 'lam (` fr'7 Autzed State Date Form C • DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES Sheet / of l DIVISION OF ENVIRONMENTAL HEALTH PROPERTY ID#:OLi-U/f(S7 ON-SITENVASTE WATER SECTION COUNTY: /hF SOIL/SITE EVALUATION M'4I n,f--or ON-SITE WASTEWATERSYSTEM OWNER 3.IoveC 0 ADDRESS: 3-(3 S t - Me-i inz..� APPLICATION Co£43 it1. -114.- DATE EVALUATED:/-S- PROPOSED FACILITY: ktM -C PROPOSED DESIGN FLOW(.1949): PROPERTY SIZE: . 7</t-1 LOCATION OF SITE• r HTh d-- d e 44. PROPERTY RECORDED: WATER SUPPLY: Private 0 Public 0 Well 0 Spring 0 Other EVALUATION METH : 0 Auger Boring it i I Cut TYPE OF WASTEWATER: Aiewage 0 Industrial Process 0 Mixed SOMUlPlLOLOGY" WI :::F. 0941) PiIONTLE.FACTIDT25 Ei L 1940 .. - - ... E LAND.— fIORI - :A942 ..... ... -: SGSY! 1441._,.,. :: 1941. i:SCilL 1,943 -1956 1944 P QF11.Y: ZON Ii N • ROS[TIONC. ..11EiPTH:: ST1tUt:TURt}J .CONSLSTENCFJ WETiVES5X SOIL SAI'R0 RESTR , ELAS ( 'I) TEXTURZ :.:::::MINERALOGY • E:COLOR.. . DEPTH. ..Ci;MSS: ::aLORIZ . :::: LASS :::&LTAR �� 0-!0 ('t2 Lc f • - will)) 55/ set: Gr 5`7/ IV 1 3 v_cS t.ix- • 0.: Hz_ „. I 9' q- u3 �3k 5(L, rl 5eW '- 2, LI -3 5 31 . ]I I 3 I I _ 1 I I 4 I DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): cC SITE CLASSIFICATION(.1948): -J Available Space(.1945) S -S System Type(s) t- <]17 <• e EVALUATED BY: GI1� OTHER(S)PRESENT: Site LTAR 3 S , j S COMMENTS: LEGEND use the following standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR5 CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 12-0.8 0.6-0.4 NEXP(Non-expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) SEXP(Slightly Expansive) M(Massive) D(Drainage Way) EXP(F•pansive) CR(Crumb) DS(Debris Skimp) II SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR((Subangular r(Granular) Blocky) FS(Flood pL(Loam) SDK ABK(Angular Blocky) HF(Head Slope)d H d Sbpe) III SCL(Sandy Clay Loam) 0.6-03 0.3-0.15 PL(Flory) L(Linear Slope) SiL(Silt Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SiCL(Silty Clay Loam) MOIST WET S(Shoulder Slope) Si(Silt) T(Terrace) VFR(Very Friable) NS(Mai-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2.0.05 FR(Friable) SS(SOelv)y Sticky) SIC(Silty Clay) Fl(Firm) S(Sticky) C(Clay) WI(Very Finn v.Very Sticky) VS(Very Sticky) 0(Organic) None EFI(Extremely Firm) NP(Noo.plWk) SP(Slightly Plank) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) /VOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FALL In inches front land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROLJTE S(suitable)or U(unsuitablcj SOIL WETNESS Inches from land surface to free water or inches from land surface to soil colon with chrome2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or ll(Unsuitable) Evaluation of saprolite shall beby pits. Long-tam Acceptance Rate(LTAR):gal/day/f12 Show profile locations and other site features(dimensions,reference or benchmark,and North). 74 7 y// / i I i ,. 'ITT\ Ii ... ... ... ... ... ...... ._.._ 1 { DENR(######) Review(#####)