433 Rabbit Farm Trail Lot 18AUTHORI;TION NO: Q 6 3 6 DAVIE COUNTY HEALTH DEPARTMENT
` Environmental Health Section PROPERTY INFORMATION
PerinitE ' P.O. Box 848 -p
Name: Z O Mocksville, NC 27028 Subdivision Name: cWN—, fa'R-�
t Phone #: 704-634-8760
Directions to property: ("A � . �� �i� r\'.a Z. Section: 71 Lot: 1
_ AUTHORIZATION FOR
WASTEWATER i
CONSTRUCTION Tax Office PIN:#'J
Road Name:, .•T 1A�.ti�Zip: b(J
**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 11 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.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
-��0 , „ Subdivision Name:
I
Directions to property's- E + Section: _K[7 Lot: I '
y ,
IM�,
PROVEMENT
PERMIT Tax Office PIN:#:~ ' - ^1..
f
Road Name ' "t. '�� ., 1, Zip:
i
**NOTE** This Improvement Permit DOES NOT authorize the constriction 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
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE��toU ,2 # BEDROOMS_ # BATHS �� # OCCUPANTS GARBAGE DISPOSAL: Yes o No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
1 ,
LOT SIZE • -� TYPE WATER SUPPLY \ b DESIGN WASTEWATER FLOW (GPD) b� NEW SITE `` REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE 1 Obi GAL. PUMP TANK GAL. TRENCH WIDTH 31 ROCK DEPTH LINEAR Fr. �d
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
Cj
r
**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) 6348760.
a
OPERATION PERMIT
SYSTEM INSTALLED BY:
IY6 A,
u��� °4/
Pg
--- "Y ya
� r
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: b
**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)
t0 , APPLIC TION FO ITE EVALUATIONAMPROVEMENT PER f — -- —
. Davie County Health Department
Environmental Health Section
P.O. Box 848
�j OCT 2 5 1996
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
// ALL
THE REQUIRED INFORMATION IS PROVIDED.
be Billed L. CGS oq,Off/ Contact Person
g Address J%W Home Phone /O 8'
/State/Zip 11!% G 7li Business Phone rf!D Z!;
1. Name to
Mailin
City
2. Name on Permit/ATC if Different than Above
Mailing Address
City/State/Zip
3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC D<Both
4. System to Serve: �A House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other
5. If Residence: # People_ # Bedrooms --,6 # Bathrooms-,_: JK Dishwasher [ ] Garbage Disposal
N Washing Machine bQ Basement/Plumbing [ ] 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 XWell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes XNo
If yes, what type?
Ir
PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: X f%/.'N WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax Office PIN: #,a70 - c6-1 - e &964%e ea / 5,9"'A �
Propetty Address: Road Name Ahhd //L 64A6 Asx. Co P��
(��/ll/ICG
City/Zip �' , /UC a� �DO�_ ; L
If in Subdivision provide information, as follows:
Name: _J %l� / ilA14�F .2r—
Section: Lot #: Ar
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 a
byi 01i � L14. to conduct all testing procedures as necessary to determine the site suitability.
DATE SIGNATURE
Revised DCHD (06-96)
.. .t.ag bign d T140r►ORTJ
OIw om OI I WWAT.
Iywt• ar•.�• •••a
X1..1 wr.r aaw.M.
avawl t.•orr Hrwll.mrl.
I•
�t
L
•Tir
�IIIIa•Ta M ti ✓...••• A'+1� MMN ML a G'a'H 1.1. +•1��.w�•'••• ,y�,Vr�(j►aYM O.... _ ••
1.'.B.,
'�I+ .a.• .. L"la♦ ~ _.a►M.wi ►w.l 1•u.'. w.rwwa�'•r Liu waw+ iwo a•w ImIP IN bld.rs.�'
wI Er-, wlrr uiT1. 1MMlGda►f1-.-.._..M.N�+ _
a. a+11 �w •;T •MJ a.4W r••_• ^•N•wr.`.'r ."y^�^."•7 •'w�•_.... y.,..•�Mw .. a••..V r�.•r+u• MUMUII hWO V'O.1 ,rte ` ,,1, 7�`
• " l.• u (Iw rr •J r •Mwl ar _ _. __ M• .M•..�rlr•+w ►ww. rr�r1
•II rn•1• yy�• �'••
•II'•�+� •••Iw11� 1• MMM. a.a+t.� Nw. r. rr+•.w��+.r a� N.w•I.•►•�{\
A.�Y[{h 'y��• w rr .. �•
nI•r�••+•nIti •'I'.'.`ra•""'q•, u• if•? ., •1 ,
fT1TT- .w•wl a'•'••r•n•'•r• I�IH. at•r. w..-w...•.•C711% r�
-_ ..•.`•1 yr++.v_ SON r/l ~ � ! � •
(�
0
ou
I-�• 6••w--• � �' / - �cJYTIa�•1
1 oa;�-• io-..'ana. r..J- 1a•, ra � :� � r.nJ�t"
laa.y.l I -�•� /
Ia..Ni ar i.loN 1•Ja•O -."•
11 4
'41
��
_�
2ay1 M tM1•
f
I
-J:r..a•-
-c.•ai•-
-a.•.•.••-
-•asra•-
-s.as..a•--w•....•
.1
pa......t N +. ••a•• 1 J• 'Y a+.a .'
• - - -
- - - -
-
T
iir•Z'1 (/
--
'RA IT
FA
t �
/ y
13 14.C'`
t
-J
-7 •a •al- �I-7♦aacl -
�
-[A�i
f
��-,
J
-t 1•••
-f>t •+a•� ^7.o•K._ -1. •••,•- -[d Ac•-'
J
-
N-1
Lil 12,
,KN
' '..�•; fr ala�.�t
,. '.
'� a . \ •>� • •I
Em -,��,Y ! ♦• •
�� '"
11• �`,
•,
1 1 1..) .,.' . 111' U.1 1 �:: � �J �� 1 N•�I •• q
y . W 1 .••Iw•
JM 'r11 �Ir. •1 wNl•1•Iwl •lM / 1 h •^wnl'
•Ilr . 1 1.1•. •1J INI••1. 111 •�• w11N jN11•
•N . .•- •w•w
�•-1
nn •F' �4wy r •i%1�_i
••� � 1. •-�'♦
:w .. I"
- I
\.(�
t wn11. I�H1• .� �..,a
•1 w MI�•1
II
.� - — 1� 1. 2a P•c�es�-� � /
-- RHp,py1T I• ARM,
i H•. V-+ 61as+1-TbwNa_.IV
w la t.."c ,•i
61Z iti -7 CuN av'»i c•
t
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME �t
ADDRESS S��e
PROPOSED FACIILTYA
DATE EVALUATED
PROPERTY SIZE
LOCATION OF SITE 1) Q `p
Water Supply: On -Site Well it! Community Public
Evaluation By: G_ Auger Boring 1% Pit Cut
FACTORS
1
2
3
4
Landscape position
S
-5
Sloe %.
IS�ti
6
- C'IIE
HORIZON I DEPTH
Texture group
CL
L
L,
Consistence
-
_l_
-
Structure
Gam.
CSR.
C`tt
Q
Mineralogy
HORIZON II DEPTH
tA7 '
2
A:
Texture group
C
C
Consistence
F T
-
Structure
tK_
W101fl.
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
S S
S
RESTRICTIVE HORIZON
SAPROLITE
'-
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
.,�
SITE CLASSIFICATION: �l �' EVALUATED BY:
LONG-TERM ACCEPTANCE `RATE: y OTHER(S) PRESENT:
REMARKS: �-�� 'YVA �` - -- -°-- - -
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 <:lay 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
3C -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(01-901
Davie County Health Department
and Home Heafth Agency
Environmenta( ealtk Section
I P.O. Box 848 / 210 HosPirnL STREEr 1
COURIER #09-40.06 I
MOCKsvILLE, N.C. 27028
PHONE: (704) 634-8760
November 21, 1996
Judy L. Bahnson
5396 U.S. Hwy. 158
Advance, NC 27006
Re: Site Evaluation
Rabbit Farm II—Lot 18
Tax FAIN: #5870-51-5109
Dear Ns. Bahnson:
As requested, a representative from this office visited !the aforementioned
site on November 20, 1996. Based upon the information provided on the
application for a site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable for the installation of a modified,
oversized on—site sewage disposal system with a pump.
If you have any questions, please feel free to contact this office.
Sincerely,
6
Charlie Little, R.S.
Environmental Health Section
CL/wd
Enclosure