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443 Rabbit Farm Trail Lot 17DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004067 Tax PIN/EH #: 5870-50-5899 Billed To: Judy Bahnson Subdivision Info: Rabbit Farm II Lot # 17 Reference Name: Location/Address: 1433 Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: 8 acres ATC Number: 4611 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. �--e System Type. S.T. Manufacturer, s "� Tank Date 7 4 Tank Size Pump Tank Size � - .. � ,� �' t ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004067 Billed To: Judy Bahnson Reference Name: Proposed Facility: Residence ATC Number: 4611 Tax PIN/EH #: 5870-50-5899 Subdivision Info: Rabbit Farm II Lot # 17 Location/Address: 1433 Rabbit Farm Trail -27006 Property Size: 8 acres Site Type: QNew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use chance. Residential Specifications: # Bedrooms � # Bathrooms Z:> # People) Basement❑ Basement plumbinse", Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot SizeType of Water Supply: --❑County/City ell ❑Community Well System Specifications: Design Wastewater Flow (GPD)5*00 Tank Size f OC90 GAL. Pump Tank )MOGAL. I j► �' � Trench Widthr�u D Max. Trench Depth Rock Depth /2 Linear Ft. .51Vti Site Modifications/Condition,ther: 1ti.L<L-L &rV &516-29 A) A)4WI -'9014- A 0/L! A. _ t P 11 /n "''o n^ A .1 r ,9iw1 e -iv 'CV01' r¢ Contact the Davie County Environmental Health 8:30 — 9:30a.m. on the day of instal Environmental Health Section for final inspection of this system between l IPERMIT U�vleo asAPPLICATI FOR SITE EVALUATION/IMPROVEMEN& ATC Davie County Health Department �lvg'& Cd f Environmental Health Section P P.O. Box 848/210 Hospital Street Q ` 'ZQ06 Mocksville, NC 27028 Avg (336)751-8760/ Fax (336)751-8786 A lic rte E ion/Improvement Permit ❑ Authorization To Construct(ATC) [Both And ENR V`E�� *** TANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED NFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. A UpT T(' A ATT TAT-UnD Air A TTrIAT Name to be Billed Contact Person JAI - Billing Address Home Phone City/State/ZIP Business Phone Name on Permit/ATC if Different than Above Mailing Address -PROPERTY INFORMATION City/State/Zip NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address Subdivision Name Directions To Site: IF RESIDENCE FILL OUT THE BOX BELOW "'I# People # Bedrooms _-5 # Bathrooms J Garden Tub/Whirlpool>�Yes ❑No Basement: kXes ❑No Basement Plumbing: Wes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requestedonventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑. County/City Water New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? a This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections t terms a corn ianc wit applicable laws and rules on the above described property located in Davie County and owned by roper owner'sr owner's �galpresentative signature Date - Sign given ❑Yes ❑No Revised 2/06 Date(s): Client Notification Date: EHS: , A Account # lfll Invoice # Date House/Facility Corners Flagged 9.1-16 -04, If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes)4No Does the site contain jurisdictional wetlands? ❑YesVNo Are there any easements or right-of-ways on the site? ❑Yes dNo Is the site subject to approval by another public agency? ❑Yes XNo Will wastewater other than domestic sewage be generated? ❑Yes No IF RESIDENCE FILL OUT THE BOX BELOW "'I# People # Bedrooms _-5 # Bathrooms J Garden Tub/Whirlpool>�Yes ❑No Basement: kXes ❑No Basement Plumbing: Wes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requestedonventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑. County/City Water New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? a This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections t terms a corn ianc wit applicable laws and rules on the above described property located in Davie County and owned by roper owner'sr owner's �galpresentative signature Date - Sign given ❑Yes ❑No Revised 2/06 Date(s): Client Notification Date: EHS: , A Account # lfll Invoice # •I•e,.•�nllrr>H....•... ... .r..r.. ....�r N.av N�. G•a.«.a. �w.w...-w.. - _.--. -�.. ___.__.-____._-._---__ -_ crr+v+n.r•erwal.t erin w•.....�.... .w..�.�,...w.. w�... r..�-..aat+we,,. •� I�✓iaa:ar o AqO r I. :n.'+l�iiil T7 :t'�7 twil: rrlw �r.r ._. ►�Ir .. ti. M w o.n rr rrr � N +Sw'p arla.w ae1• 1 Fe.t. i . +...r n11r r , •11 ...n, �w0.1� M w��..«... �' •,COI rnrl l*t�. 1.•enit+i min 1 / A �., ' •=r rw _-I...r....� =... 1 w�.wr. ..^er .'-.- �.h ...... .+.. w•�.+•w�.y-.�.r+w r� Ndnitiw iiWduavl • .r.. !. • � Z -• r rr.. r. ••V. « r« I.e. -`yam /j� ��.''/1w.rr.►w«. w.•�,nrwrwl(/t .+.w.rw r�.r+� -. •�•• Hr. V. � ll. � ^.. .. r • rl�/L( r2�...4 (tJ/.'-`_ / r.r n... �� I w+w•.. ro.+ r.�•w ew... rtier.la..1. L-.Lta .t.a Mr••+rr+CM/2��/ TTiF.-iSllf�rn' ` � Jt r♦ � .rw rant u1.n PI•UIl / + '' �� r�o �1 r awr • wear . tCAL taoll M. SrV E� 1540 L Le: �•. eara_ p� c It 414 IIt.Y� el, G.bM w••L,RM � C L / r '., V t1r SLI. •b ` +`5t' �� r I li ' 11 to �� -S Yrae.- "Grime•--LI•r'•G _ -L.M ..e•- -6. Sa K•--f.1,a<1- -aw4•--ae..a' _-S.era•-�I -S.�r. ae -` -•.f.M.Le^- �I �n � __- �.. / 1 I t F eae.a.•. 1, ...r..e � ��•� 1 - - - - - - - - 17 F PNV.N r 1� f f 13 i' 14 15 IV 171 18 22 23 24- 1.5 4 f IIS 1. Z4 Ara -es! e ,1 IAO�IT F.A QM• R.At! II — � _• � r-_--. .1a • • ••� 1 Iwl ^•..11�••a 1 IIw e•1 e. n I.�•.�.. yy IM r. w1 1 I lw �•111•Ile�.f wa11.1•Iw .lw l�w•I n«•rw 9NraW ata! TbW Nrr1.P - _ - -- .. .. .i n ...�... ry-.Y� � • w• . � . + w.l. .11 I M wry« w �.. «« rIP�• r `•ll •O•• Yw .P•.•.11. .11� ~� • Df..fla GP�r+V• V.0 _ .� _ _ �__ _ . Ww....r � � �- E•�6 � MfTe.. O �r.Y 1 ai �v nMP e Y_ .......� ... r \ e..u.• a e a`v fie.. •. N �:er• • . a l.(T P { (.. PC M �.� c12Vcr� wev a.�... .... — - ��I'�� ....... �.-_... r•... ' ...� .. v.. —iaT: — c. . __ - ..--r.•;---T%--�- ... ..-�- t�..�. e., ..c..r+� ....•.f a,e•/ t�.la.... ..[ t,�ef y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004067 Tax PIN/EH #: 5870-50-5899 Billed To: Judy Bahnson Subdivision Info: Rabbit Farm II Lot # 17 Reference Name: Location/Address: 1433 Rabbit Far Wil -2 7006 Proposed Facility: ResidenceProperty Size: 8 acres Date Evaluated:� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut G1 1 i q SITE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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 uM, VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3y -d 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 05105 (Revised) position HORIZON I DEPTH Texture group HORIZONLandscape group ConsistenceTexture I Mineralogy Texture group ra, Consistence MUNI ,E2MRTexture �® Mineralogy sp—P-51I.Mm win_ V. 9 HORIZON IV DEPTH group Consistence Mineralogy SOIL WETNESS SAPROLITE CLASSIFICATION ---- SITE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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 uM, VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3y -d 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. 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acres, ? Date Evaluated: Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS '8 to 4 5 6 7 Landscape position L Slope % , HORIZON I DEPTH p Texture group 0111 SCL- Consistence mS f�f' _p {'r S Structure Mineralogy S �. HORIZON II DEPTH LF ZD 14 Texture group c4 Consistence F, Structure Mineralogy Mt n rN HORIZON III DEPTH { Texture group C_ -+ Consistence Structure Mineralogyk HORIZON IV DEPTH Texture groupc Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON '7-o SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND EVALUATION BY: OTHER(S) PRESENT: 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 u, VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm M11 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 Nis 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 05105 (Revised) APPLICANT INFORMATION Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation On -Site Well / Community Auger Boring Pit PROPERTY INFORMATION 17 Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position G cV L L L Slope % <6 ` Z ST, -%Zo HORIZON I DEPTH fQ^ 0- (2- 9,-7 0-S o Texture group CL_ CL_ SC -L- e -L- I S LL. Consistence C4- s fr .;SP r- Structure CT Mineralogy HORIZON II DEPTHiLl Texture group C' G- C Consistence VF; VS Structure k M Mineralogy, HORIZON III DEPTH S 2-2 - *Z4 - Texture group Gt C_ C�1 C -+g2 Consistence F` . y i ; S . Structure A3 Mineralogy PA I HORIZON IV DEPTH .h Texture group G Consistence P. V Structure Mineralogy L` SOIL WETNESS Z - 2 - - 7-4 RESTRICTIVE HORIZON -- 2Cp 5 2 SAPROLITE — -- — CLASSIFICATION 03 os uS V LONG-TERM ACCEPTANCE RATE 0 • c� 0"445 ►J1 v. L2S W 1 0 • zzs , i/fit"/�y� /� SITE CLASSIFICATION: VS CAP F PPVALUATION BY: LONG-TERM ACCE,,`PTANCE RATE: p r�� ` �,� � OTHER(S)1PRESENT: REMARKS: !� ` O 1' � VO -1 'AT + Rl-: XA '-mok)'1 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm met 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 LYQtes 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 05105 (Revised) t �. j, • \ '..� ,. / ♦Vi `�, _' 'TJeJZ' t� a 7{ w `'k in `cy LO 1 n IN 21 6.66A 2756 0 -- 389 5 0 oAC-) 172 N z \ N \ CW G\ w 871 <<i \ 691 W \ 405 5.o0A v 5404 1 \ ^cj> 7.?6A 2350 ti 5.35A 433 \, 5109 X71 �s Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004067 Tax PIN/EH #: 5870-50-5899 Billed To: Judy Bahnson Subdivision Info: Rabbit Farm II Lot # 17 Address: 1433 Rabbit Farm Trail Location/Address: 1433 Rabbit Farm Trail -27006 City: Advance Property Size: 8 acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: RrKew ❑Repair ❑Expansion Permit Valid for: ZYears ❑No Expiration Residential Specifications: # Bedrooms a # Bathrooms 3 # People 1 Basement❑ Basement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): `i Type of Water Supply: ❑County/City.. ell ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial 5=rvJ Go�.Z o•' Repair Z O. ZZ .::�/ Environmental Health