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444 Rabbit Farm Trail Lot 8Phone #: Address/Road #: 444 Rabbit Farm Trail Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC Phone #: Subdivision: Rabbit Farm Phase: Lot: 8 Directions Hwy 64 East left on Cornatzer Rd, Rabbit Farm on right past Beauchamp Rd. system specifications CONSTRUCTION Minimum Trench Depth: a 4 Inches For office use only • AUTHORIZATION Saprolite System? QYes QNo *CDP File Number 202406-1 Minimum Soil Cover. 1 a Inches Davie County Health Department County ID Number: Soil Application Rate: 0 a 7 210 Hospital Street Maximum Soil Cover: a 4 Inches Evaluated For: REPAIR P.O. Box 848 TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 4/ 0 6/ a 0 a 1 Applicant: John Drierzewski wner: John drierzewski Address: 444 Rabbit Farm Trail FAddress: 444 Rabbit Farm Trail City: Advance GPM—vs— ft. TDH Advance StatefZip: NC 27006 Trench Width:_ NC 27006 Phone #: Address/Road #: 444 Rabbit Farm Trail Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC Phone #: Subdivision: Rabbit Farm Phase: Lot: 8 Directions Hwy 64 East left on Cornatzer Rd, Rabbit Farm on right past Beauchamp Rd. system specifications Dorn 1 of Z Minimum Trench Depth: a 4 Inches Site Classification: Provisionally suitable Saprolite System? QYes QNo Minimum Soil Cover. 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a 7 5 Maximum Soil Cover: a 4 Inches 'System Classification/Description: 'Distribution Type: GRAVITY -SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: _ Gallons *Proposed System: 25% REDUCTION 1 -Piece: QYes QNo Pump Required: QYes QNo QMay Be Required Nitrification Field 1 3 0 9 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1 -Piece: QYes QNo Total Trench Length: 3 a 7 ft GPM—vs— ft. TDH Trench Spacing:9 _ Inches O.C. Feet O.C. Dosing Volume: _ Gallons Trench Width:_ 3 Q Inches Feet + Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: QNSF OTS -1 QTS -II 1 Septic Tank Installer Grade Level Required: 01011 Q III Q IV Dorn 1 of Z CDP File Number 202406-1 County ID Number: [] Open Pump System Sheet ulrea:ll i Cs I.JIVu Vwu, uUt lldb HVdllduic Qljol'u Total Trench Length: Pump Required: QYes ONo OMay Be Required Pre Treatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and maybe issued at the same time the Improvement Permit Issued (NCGS 130A-336(b)� If the installation has not been completed during the period of validity of the Construction Permit, the Information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature- Date: _ / "Issued By: 2140 -Nations. Robert -10-01 Date of Issue: 0 4/ 0 6/ 0 0 1 6 Authorized State Agen Malfunction Log QYes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 Trench Spacing:8Feet Inches O. *Site Classification: O.C. Trench Width: Inches 8Feet Design Flow: — Aggregate Depth: Soil Application Rate: inches Minimum Trench Depth: *System Classification/Description: Inches Minimum Soil Cover. Inches Maximum Trench Depth: *Proposed System: Inches Maximum Soil Cover: Nitrification Field Inches Sq. ft. No. Drain Lines *Distribution Type: Total Trench Length: Pump Required: QYes ONo OMay Be Required Pre Treatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and maybe issued at the same time the Improvement Permit Issued (NCGS 130A-336(b)� If the installation has not been completed during the period of validity of the Construction Permit, the Information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature- Date: _ / "Issued By: 2140 -Nations. Robert -10-01 Date of Issue: 0 4/ 0 6/ 0 0 1 6 Authorized State Agen Malfunction Log QYes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Type: Construction Authorization I 3 M n 1. CDP File Number: 202406 -1 County File Number: Date: 0 4/ 0 6/ 2 0 1 6 Q Inch Scale: pBlock ft. Q N /AJJ CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 202406 - 1 County File Number: Date: 04 / 06 /2016 Click below to Import an image from an external location: Drawing Type: Construction Authorization \� .. 'F S.'. `�a °e'.i+�c rr" .i.h {o��yf r�i'i.'Y'et''�.rni+. �,.rLL-- `� t` - r , is :. ... -.,., -;: `:— ,r' - ;-•.. .. AUTHORIZATION NO: 1,877 DAME 4QOUNTY HEALTH DEPARTMENT *; PROPERTY INFORMATION Environmental Health Section Permittee',-,_ t� P.O. Box 848 C Name: ,F �~%t { .) N�� �' �Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: !/,�'. P L 10 Section: Lot6 : AUTHORIZATION FOR 4^ r� 1 t 1�.1 .1 j (✓k1v WASTEWATER Tax Office PIN:#5) 20 -L ' f7 `( SYSTEM CONSTRUCTION ( Road Name: Zip: �- **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 compliant with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION )Sy-� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRON ENTAL HEALTH SPE�IA 1ST DA E 1 SUED DAME COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION 'Name °-.. J 1. l - % j Subdivision Name: - t:. �-1 t > 1 t ►`r. I►, Directions to property: �t- , �i' t Section: Lot: r - IMPROVEMENT ,t i, i•1 \ e ";e j+ 1t1 tr:j PERMIT Tax Office PIN:# ►.T- r �� ,.� 1 Road Name •� Zip. a **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 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVIRONMENTAL HEALTH SPECIALIST D SSUED INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE-LtO,%# BEDROOMS --- # BATHS -7— # OCCUPANTS q GARBAGE DISPOS Yes No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No &,P - S LOT SIZE' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE `� REPAIR SITE ffl� SYSTEM SPECIFICATIONS: TANK SIZE I QwGAL. PUMP TANK GAL. TRENCH� /WIIDgTH ROCK DEPTH [�_ LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IS, ur r L I D Lr -45 k� Ft ^^' IMPROVEMENT PERMIT LAYOUT `p0 xu- y- , 12r" o (.0 n}T�- 1Z 0 (— flcboS�- co najl' L,) --1 p -i A. V- S C - '[a T -- U c� , "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. 2 I AUTHORIZATION NO. Fwq- 1 vof OPERATION PERMIT BY: SYSTEM INSTALLED BY: S ITHE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THASYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I1 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) s `� M R g V R � l5Environmental APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMITEFO • " Davie County Health Department Health Section P. O. Box 848 - 9 19M Mocksville, NC 27028 RONMENTAL HEALTH (336)751-8760 DAVIE COUNTY****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ABB' CONSTRUCTION, LLC Contact Person VICKY/TFENT/M Mailing Address POST OFFICE BOX 24968 Home Phone 382-3076/659-3179 City/State/Zip IgINSTON-SALEM, NC 27114-4968 Business Phone 760-1840 n/a 2. Name on Permit/ATC if Different than Above n/a n/a Mailing Address City/State/Zip 3. Application For: Site Evaluation X❑ Improvement Permit & ATC >a�U Both 4. System to Serve: Q House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People _ 4 # Bedrooms 3 # Bathrooms 2.1 >U Dishwasher >R5 Garbage Disposal X6 Washing Machine ❑ Basement/Plumbing OYBasement/No Plumbing n/a n/a n/a 6. If Business/Other: Specify type # People # Sinks # Commodes n/a # Showers n/a # Urinals n/a # Water Coolers n/a If Foodservice: # Seats n/a— Estimated Water Usage (gallons per day) n/a 7. Type of water supply: ❑ County/City U Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? n/a ❑ Yes �O No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A Pip' EBF THE PROPERTY MUST BE (:v 7, q3,( 871,3yx -? 7,g5X g% 1.3 SUBMITTED WITH THIS APPLICATION. Property Dimensions: �3-5�G'QS 1 WRITE DIRECTIONS (from / J ` ocksville) TO PROPERTY: Tax Office PIN: # -5.,s,-r7 0 - -T � - (� • v����� 1 64 to CORNATZER TO Property Address: Road Name 8/ RABBIT FARM RI= INTO RABBIT FARM city/Zip ADVANCE, NC 27006 1 1 FIRST DIRT ROAD, RIC'TI'I' I If in Subdivision provide information, as follows: 1 APPROX z mile on ricrht 1 Name: THE RABBIT FARM 1 1 SectioS NEW 8 1 Lot #: 1 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 f the Davie County Health Department to enter upon above described property located in Davie County T and owned by h V-)Iio © tz to conduct all testing procedures as necessary to d termine the site suitability. DATE Revised DCHD (06-96) YOU MAY USE THE BACK OF THIS FORM FOR DRAWING PLAN. f _ f s �j1 10 4 Ij • ` r :w I 1 LP � a ill 11 =' io J � ='• B � J L � '� • J f 2L7.• f . 7a' -.< :.o - - .. s.+ - I f _ f s �j1 10 4 Ij • ` r I 1 4 2L7.• f . 7a' -.< :.o - - .. s.+ - - - t 2 u - - ~i FAQM-- I/ I I I I I I � s Zo . i Z� of X� •� r �'� - fljl a.< - /•LwL'-� t1 ,4.>.ct �.N H-77.t.Ct— 01r ••a' mit Ac. , .' - a.u.� �.. •.r( iY`� �i 1 \ I ----- — 24 AfV-F- � R A 0f31 rr ..• L,''• x * do �� oTI I � .N d�:rl aAl ..tr •�.1'I�Aj( y1_ � ..:1• .1,:1 -T i Y ` �C t' '4 � I t 1•r1 ru eLi -:Illi 1 ". .• •,•J 11.• .,•1.•rlal •.1 Int lf1•{ 1 1••1 1'•1 .1ii 51-i A'oY Gid ovE `YOw NbNa` ••• 'n IS •O ei jj1 •ul1 1.f �prr ly •I,wl1 . •I.l 1 .. •11. .Aotl 1111• pl tl..n of ..4A1 .1.141�••I tll .) 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W. 1r 1•r 1� M�•i� \ % w..•. , t_d 1.... ems-. ie.1 I, i � ./ r MIyW rr•.a WI Iw, F� . , . . 1 •r.wa.l� 1• •1r• r 1 l r ;� " . 4 w... ... _ • � ... r_ 1 iuu �� _ � I .•.I , ...... ��.,•.w.�.• I^iW ..1.;y.•i. i•.•... . . 1 .. , w v r . r..G Go Abby: -—Tn � o7v i i Qar,� 1 s' A3 DAYIE I'DUNTY HEALTH DEPARTMENT T Environmental Health Section a APPLICANT INFORMATION Solt/Site Evaluation PROPERTu INFORMATION Account #: 989900301 Tax PIN/EH #: 5870-40-6924.000EP Billed To: Abba Construction, LLC Subdivision Info: Rabbit Farm II Lot # 8 Reference Name: Location/Address: Rabbit Farm Trail -27006 r T:ZOPOSED FACILITY: �� DATE EVALUATED: vl r A Z5 PROPERTtY SIZE: 55SA612m Water :'.:ppiy: On -Site Well Community Public Eva:uation By: Auger Boring Pit Cut FACTORS 1 I 2 3 4 5 6 7 Landscape position L Sloe % ; HORIZON I DEPTH Texture grou C' Consistence Structure MineralogyI� 1; HORIZON It DEPTH Texture group Consistence K' Structure wiz ►L Mineralo 'l I: I HORIZON III DEPTH - Wo 'LO -H L4 Texture group 7 Consistence Structure G Mineralogy - HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION r5 95 - LONG -TERM ACCEPTANCE RATE O • , SITE CLASSIFICATION:U�_ LONG-TERM ACCEPTANCE RATE: O REMARKS: LEGEND Landscaue Position EVALUATION BY.`�-1LI'i� OTHER(S) PRESENT: C�4.r 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/f(2 DCHD tRevised 11/98) ■■E■■■■E■E■E■ ■U■■E■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■E■E■ ■E■■E■■ ■■■■E■■E■E■■■■■ ME MENEM iMEMNONEMENSE MEMMEM EMMEMMUMMINEME ■■■■■■■■■■■ ■■■■■■■!■■■■■■■■■■ ■■■■■■■■■■i■■■■■ 0 ■ ■E■ ■E■ ■E■ ■■■ ONE ■E■ ■ ■ NONE ■E■■ ■E■E■■■E■■E■■ ■■■E■E■E■■E■■ ■E■■■■E■E■E■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■E■■■■ ■■■■■■■■■■■■■ ■■■u■■■■■■n ■■■ ■■■■■■ ■■E■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■