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317 Rabbit Farm Trail Lot 24' ; �_ ? M 'i '���r 4 .,kY ,y 1 v . .. '._ •.-F' j - ii. .. ¢ .. •r f�� AUTHORIZ;4TION NO. r DAVIE COUNTY HEALTH DEPARTMENT o�j , 3© } Environmental Health Section PROPERTY INFORMATION Pehmttee's'--,,, P.O. Box 848 Name: '' a _r_a%d �'. Mocksville, NC 27028 Subdivision Name: �I?�� f'`a"�2'r.x Phone #: 704-634-8760 Directions to property: Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION r _ Road N 1 e: jq,3.8 1`i t -A �' M4p Oil **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 Permits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ENVIRONMENTAL HEALTH S ALIST DATE ISSUED ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. — ids P u / DAVIE COUNTY HEALTH DEPARTMENT i, r{ r IMPROVEMENT AND OPERATION PERMITS PROPRTY INFORMATION r 7—� Subdivision Name. i .,�.•' �,`,.,, Name.. / Dlrecf ons to property: Section: r Lot: _ IMPROVEMENT PERMIT. 11 17 f,. Tax Office PIN:#�� W Road Name.-/, t:; t + hit:,�'►�iD. i`: ,�,�, ���.j S **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 t • _ , 'tr' ; ^ PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. rz RESIDENTIAL SPECIFICATION: BUILDING TYPE /' # BEDROOMS ;:::' # BATHS �# OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT l # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE i1 f TYPE WATER SUPPLY /Y///DESIGN WASTEWATER FLOW (GPD) // NEW SITE L� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1Z_e?j_GAL. PUMP TANK GAL. TRENCH WIDTH k.-?/" ROCK DEPTH LINEAR FT. 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 SYSTEM INSTALLED BY: 4a r AUTHORIZATION NO. /67LPERATION PERMIT BY: DATE: C;) ` **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 & ATCe Davie County Health Department Environmental Health Section ' P.O. Box 848 SEP 2 3 197 Mocksville, NC 27028 )' (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TH E REQUIRED INFORMATION IS PROVIDED. / 1. Name to be Billed ' i �` , n' � Contact Person f� r 6 < F / d —, Mailing Address ©. ,(jv 2,100 Home Phone!% 9!Jr-- �1-7 % Z City/State/Zip as Ll SAW C L /V C -2-7--20( Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For:[ ] SSi e Evaluation [improvement Permit & ATC Both 4. System to Serve: [,r. House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. IfRe idence: # People # Bedrooms # Bathrooms [ �shwasher [vj Garbage Disposal [ zshing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated ater Usage (gallons per day) 7. Type of water supply: [ ] County/City [ /Well [ ]Community Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes/No 8 Y P P Y Y If yes, what type? CL IHYbL( A VLAL ULC PROPERTY INFORMATION REQUIRED: *** IMPORTANT **,*o`r OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: a 6"0 /\ gla Q WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 11x Tax Office PIN: #.��'7%y -AT�ins 3 /HCl ,S jj Z - 7 Property Address: Road e�'Rhh�i �i�/LM �e,f/ }- sA- %U:- City/Zip 0,01JAI+CE PSI L , %off o.+/ f1 h�, L 2�261 T�-•..,� If in Subdivision provide information, as follows: nn Name: Section: Lot #: 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 jthe Davie County Health Department to enter upon above described property located in Davie County and owned by -.o,&&5u ,all jesting procedures as n�sary to det!Fnine the site suitability. r0rwrma Revised DCHD (06-96) THIS AREA MAIJ 13E USEI) FOR I)RAWINC7 YOUR SITE PLAN: APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department - -- I RAI Environmental Health Section ��,_ '`i P. O. Box 848. + Mocksville, NC 27028 ' (704) 634-8760 __ AUG 2) 1997 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED U= ''i I �L�F1L{ILTil ALL THE REQUIRED INFORMATION IS PR?VJ 1. Name to be Billed llt415 4 (f t4 JJ 1101SO-1— Contact Person Mailing Address -/0. W [S a Home Phone �� City/State/Zip � C-- r /�l _y /7/l�t�- 2- 2d 0 (� Business Phone 2� /`/ 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑' Site valuation El Improvement Permit & ATC El Both 4. System to Serve: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Resi nce: # People —y"# Bedrooms -3 # Bathrooms ' Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing 5-Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS (from S� _ j �3 l Mocksville) TO PROPERTY: Tax Office PIN: # .5�7Q - 1 Property Address: Road Name City/Zip If in Subdivision provide information, as follows: Name: Q-1 l'� j�T- Ttt h /%� Section: 15 Lot #: 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 and owned by� to conduct all testing procedures as necessary to determine the site suitability. DATE o -Z6--?7 SIGNATURE Revised DCHD (06-96) �Aj GS Le'�— L�' Z k/ .,►C•ICD •• \ i t 1 � I ' • S �y oti nI N 0,c3'f61I 1 I , ►f Its " a I I P ••�' , � r I-Its 1 w ( I o It l9 i o 1 to- " I K .•rc I�f �. u 1 I 1 •� 1 � CD f All UP _ I Y• y N 'i J " I V ' V �i In► � N ' i Ab �to ,1 IIt N o N N ! R 0 ch ' i - ,1►-- —_ Ti'I ce- N O� f � I 1 " .•ti ILp . I .. F In � � t l• i` 1 i i •� PPP• � �� �� 9.41 Q z ° N 00 R Itoo �I c La wr+' ccs I t• I .ra•Ics I� d � N I dm apA• I ' ,t IC 1 1 U D ,p P '•1 N ' R ati g ' .vVILyVIC. SO I , I 1 1 ' y•V d c N PI gLp DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT� Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY is C)y �P SUBDIVISION�`�` \ TAS m- DATE EVALUATED PROPERTY SIZE ROAD NAME 1: _ A • `7 7 Water Supply: On -Site Well V Community Public Evaluation By: C''L-- Auger Boring V Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH q �1 Texture group Consistence FX Structure Mineralogy',1 ' HORIZON II DEPTH ya." " Texture group Consistence Structure Mineralogy + 1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 RESTRICTIVE HORIZON — SAPROLITE -- CLASSIFICATION S LONG-TERM ACCEPTANCE RATE ,LA % Li SITE CLASSIFICATION; LONG-TERM ACCEPTANCE RATE: REMARKS: 'S'? DCHD (01-90) EVALUATION BY: l� OTHER(S) PRESENT: \X3 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 ■E■■■E■ ■■ME■E■ ■■■■■■■ ■■■■OM■ ■EM■M■■ ■EE■M■■ ■■M■OM■ ■E■ME■■ SOMEONE ■■■■■E■ ■■■■EE■ ■■■ME■■■ ■EM■EME■ ■EMEMM■■ ■■E■■ME■ ■■■■EM■■ ■E■■■E■■ ■■■■■■■■ ■■MEM■E■ ■■M■■ME■ ■EMMEME■ ■■■■■ ■ ■E■EM�■ ■MM■■ME■ ■■■■MME■ ■EM■■E■■ ■■■MME■■ ■MEM■■M■ ■E■M■■E■ ■■M■■ME■ ■■M■■M■■ SEEN ■■E■ NONE ■E■■ ■OE■ ■■M■ NONE ■O■■ ■O■■ ■E■ME■■EE■■■■■ ■OMM■■EME■E■■■ ■EMM■■ME■■E■M■ ■E■O■■■M■■E■E■ ■■E■■MEM■MEME■ ■■MMEME■■M■■M■ ■■■MME■■EM■■■■ ■■■■■■EEE■■■■■ ■■■■■■■■■■■■■■ ■EEE■■■E■■■■■■ ■■■■■■■■■ESM■■ ■■■■■■■■■EEM■■ ■■■■E■■■■■■■■■ ■■■■E■■■■N■■■■ ■■■E■■■■■E■■■■ ■E■E■■■■■■■■E■ ■■O■■■■■■M■■■■ ■■MEMO■■■■■M■■ ■■■S■■■■■EE■E■ ■■■■■■■■■■■■■■ ■■ME■■■■■M■E■■ ■M■■■■■M■MEMEM ■E■E■■ME■MONEW ■MMM■■■F=n%wcR ■■MMM■■MM■M029 ■MMM■■RIM■MO■■■ ■■M■■■E■ME■EA■ ■■MMM■■7■►MMI■ ■E■M■MMEEAMME■ ■M■■■MM■■EGMM■ ■■M■MEMO■■■■■■ ■EM■MEMEMMEME■ ■■■MEM■■EM■M■■ ■E■EM■■■■M■■M■ ■E■MEME■■E■■E■ ■■■■EME■M■■E■■ ■■M■■M■■E■■M■■ ■■MME■■■E■■M■■ ■EMEME■EMEMEM■ ■EM■MEN■EEE■■ ■■■■E■ ■E■N■■ ■■EM■■E■EM■■■■ ■■MM■■M■E■■■■■ ■E■M■■ME■■O■M■ ■EMM■M■MME■■M■ ■E■MEMEMMEMEM■ ■■M■■■M■M■■E■■ ■M■E■■MME■ME■■ 0 M ■ ■■■MSE■■■■■■■M■ ■■■■■■■■■■■■■■■ ■■■■MM■■E■■E■■■ ■E■■■■■E■■E■■E■ ■M■■■EM■■M■■ME■ ■■■ME■EMEM■■EM■ ■EM■MMEMEM■MEM■ ■■M■ME■■■■■■■M■ ■EM■■■■M■■M■■E■ ■■ME■■M■■M■■M■■ ■■■E■ME■EME■EN■ ■MEMMEEN■EM■M■■ ■■MEM■■M■■M■■M■ ■EMEMEMEMEMEMM■ ■■■EMMU■ME■EMI ■■MEM■ ■O■ME■ ■M■■EM■■EMME■M■ ■■M■M■■MO■MOMM■ ■ESM■■M■■MM■■■■ ■M■■MME■■E■■E■■ ■EMEMMEMEMM■MM■ ■EMEM■E■ME■E■M■ ■■MEM■■M■■M■■E■ ■■■M■■M■■E■■M■■ ■E■■MM■MMEMM■■■ ■EMMEMO■MEEMEM■ ■E■■M■■M■■E■■M■ ■EMEMMEM■MM■MM■ ■■MEM■ME■EM■M■■ ■■M■M■■■M■■E■■■ ■ ■ ■ ■ ■ ■E■E■ ■E■E■ ■■■■■ a� Davie County Heafth Department and Home Heafth agency Environmenta(Heaf& Section P.O. Box 848 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 September 5, 1997 Curtis & Cindy Johnson 170 Wills Rd. Advance, NC 27006 Re: Site Evaluation/5 Acres Rabbit Farm II/Lot 24 Tax PIN: #5870-52-5731 Dear Client(s): As requested, a representative'.from this office visited the aforementioned site on September `, 1997. Based upon the information. - provided on the application for site evaluation and after the evaluation was completed, the site.was found to be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, I Charles E. Little, R.S. Environmental Health Specialist CL/wd Enclosure(s)