405 Rabbit Farn Trail Lot 19A6THORILATION NO: 19 5 . DAVIE CbUNTY HEALTH DEPARTMENT / V
environmental Health Section PROPERTY INFORMATION
Pecrfiittee's Pi .... P.O. Box 848
Name: l-" ", • �t-- Mocksville, NC 27028 Subdivision Name: CA
j �4 -1; one # 336-751-8760 Section: �— Lot:
f
Directions to property: � r '
AUTHORIZATION FOR
! '�'O,�,� i C n% X71 i` WASTEWATER
SYSTEM CONSTRUCTION
Tax Office PIN:#
Road Name: 1 T t f't' w Lz(ip: Ca
**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 I 1 of GJS: Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
i" ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
I ENVIROt�AGTAL•HEAETI-I SPECfjALIST�DATE ISSUED! ,
} i
195
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Pe
" Name.' � �= r ,a..:��s._:. j. t.� i. Subdivision Name: LA t'l r'A ,`.`.
Directions1tro e t :- ' (-k " Section: , .
Lot: 1
IMPROVEMENT
Li F'"
PERMIT Tax Office PIN:#
`• , ,,..�.-�y� � - � � �._ �, � C , h � tom,:
/(
Road Name: 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 I l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS PERNUT IS SUBJECT TO REVOCATION IF SITE
rj PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRO1�iMEIYTAL HEALTH SPECIALIST,. DATE IS UE INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE BEDROOMS #BATHS-- # GCCUPANTS GARBAGE DISPOS : Yes o No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT# SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZEIS - C— PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD)L90 NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK 000GAL. TRENCH WIDTH i l ROCK DEPTH (7 LINEAR FT.
OTHER ]J1> P� FZ 1 j OA
'AL -Ta L
REQV r I RDIF FATIONS/CONDITIONS:
f�
PR0 y' ERM YOUT
rCll
,
o,
**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 (336)751-8760.
OPERATION PERMIT t DY O be
SYSTEM INSTALLED BY:
11p
jzc> 05c)
Sp I
9P STL� t-�3
w,J
►s
AUTHORIZATION NO. A OPERATION PERMIT DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T E M DESCRIBED AOVE 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)
O
' APPIICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Q
Davie County Health Department
` • Environmental Health Section
P.O. Box 848/210 Hospital street JAN 2 8 1999
Mockaville, NC 27028
(336) 751-8760 ENVIRONMENTAL HEALTH
***ZWORTANr*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. flame to be Billed kB bH QJ 1J L1LC. Contact Persons -� E ►�� Hp:l.V�7� S
Hailing Address1 Trwn116 / 1_c1 some Phone-ioM1'/� y - I�Jp3�3
City/State/ZIP V1.5, �� l • Z2!')1 0,5 Business Phone Il9 '-t o
Z. Name on Permit/ASC if Different than Above
Nailing Address City/State/Zip
3. Application For: ite Evaluation 0 Improvement Permit/ATC Both
4. System to service: House 0 Mobile Home 0 Business 0 Industry 0 Other
a. 71DIshwasher
Residence: # People # Bedrooms # Bathrooms 3 iv
fI Garbage Disposal Kashin Machine 0 Basement/Plumbing U Basement/No Plumbing
g g 9
6. If Business/industry/other: Specify type # People # Sims
# Ccumodes # Showers # Urinals # Nater Coolers
IF FOODSERVICE: 1 Seats Estimated slater Usage (gallons per day)
7. Type of water supply: 0 County/City id %cell 0 Communi y
e. Do you anticipate additions or expansions of the facility this system is intended to serve! ❑ Yes 20
Y p p Y Y
If yes, what type'
***IMPORTANT*** CLIENTS AfUST COIIIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PIAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: a s o" X 900
Tax Office PIN:
Property Address: Read Name kAbb,A �nvvti Tr�,1
City/Zip Ad x Ar-jC e
If in a Subdivision provide information, as follows:
Name: 'Rrb6\\�
'V41%,Lr&
Section:
a
Block:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
40 E X-C) E301 40VAJ PJ
o Apt�vnx '7- R
Y-,45 �Qr,13 KJ
UR1 e��rn)A�7 �Y I rv� i IG tuY� I r
.0A /9. n'41 //
Date Property Flagged: a4 -99
This is to certify that the information provided is correct to the best of my knowledge. 1 understand that any permit($)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed 1, also, understand that I am rmponsiblefor all charges Incurred from
this application. 1, hereby, give consent to the Authorized Representative of the Davie Co my He th Department
to enter upon above described property located in Davie County and owned by io ►�
to conduct all testing procedures as necessary to determine the site suitability.
DATE j ' o18 99 SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07198)
Account No. 38
Invoice No. A
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From: Lawrence Langton To: Trent Adams (Business Fax) Date: 12/24/98 Time: 11:03:48 AM Page 2 of 2
Lot 19 Rabbit Farms. About 250' across at the street and 900' deep.
I submit this idea for consideration of how the house and driveway could be on
this lot.
House
b I
J V
3;Z5
Driveway
I I
AM
`t
i
The idea is that when looking 'up' the driveway from the street one only
will see trees. If it can not be done then it can't be done
. rt DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOTJ
Soil/Site Evaluation
APPLICANT'S NAME `�"� "s�• DATE EVALUATED Y! r Z 1LF 7
DDnDrAQE7T % T: A OTT TTV _ I40A)_ IU/ DD/IDlCDTV CT7II
SUBDIVISION ROAD NAME _0&q:!t
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit
Public
Cut
FACTORS
1
2
3
4 5 6 7
Landscape position
L
Slope %
L
HORIZON I DEPTH
19 - L.0
-
0_q
0 60
Texture
Texture rou
L
Consistence
r
S
Structure
z
Mineralogy
1: 1
HORIZON II DEPTH
Q - )
2-1
--
Texture group
G
G
Consistence
'
Structure
-56le-
Mineralogy
M ►
)
HORIZON III DEPTH
t 2 -- 1$
2
Texture group
G+
G
C
i s
Consistence
' 5
Structure
IS6LC
'
Mineralogy
M
1:
I
HORIZON IV DEPTH
C, I fi
Texture groupS
a
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S
S
LONG-TERM ACCEPTANCE RATE
O.
0.12,
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE: 0. 5
REMARKS:
DCHD (01-90)
LEGEND
Landscape Position
EVALUATION BY: C__P"
OTHER(S) PRESENT: (%n)y llg�'j (j.0
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
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