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471 Rabbit Farm Trail Lot 16DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001422 Billed To: William Orr Reference Name: Mackie McDaniel Proposed Facility: residence ATC Number: 2593 471 &04 FA rt" -r'2 - Tax PIN/EH #: 5870-50-5673 Subdivision Info: Rabbit Farm Sect 2 Lot # 16 Location/Address: Rabbit Farm Trail -27028 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Tre ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur Date: 140 ()1?60M I -IMM / CATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. -gyp 2 I-) OL) L N)ES j�-(D % t'l ave -a Septic System Installed By: Environmental Health Specialist's Signatyr- Gtv DCHD 05/99 (Revised) l 3�v DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section •. P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001422 Tax PIN/EH #: 5870-50-5673 Billed To: William Orr Subdivision Info: Rabbit Farm Sect 2 Lot # 16 Reference Name: Mackie McDaniel Location/Address: Rabbit Farm Trail -27028 Proposed Facility: residence Property Size: see map ATC Number: 2593 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type 0DOS6 #People 2 #Bedrooms _ #Baths 2' Dishwasher: Garbage Disposal: 13" Washing Machine: 2 Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type 1� '#People #People/Shift Q#Seats Industrial Waste: ❑ Lot Size f),' ` 7N ype Water Supply �, � Design Wastewater Flow (GPD)7'Lyd ' Site: New 2( Repair ❑ System Specifications: Tank Size1000GAL. Pump Tank GAL. Trench Widtff� Rock Depth 1 z Linear Ft.1�1-1D f Other: ��5ybN)T10 &-,6 , VN ST^l l_ Required Site Modifications/Conditions: I amu , nm int}2, z.t I co IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW . FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 180 q �� ls' bow �s \ssaGb Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Vis- Inc "`fL-a^ C �► Date: Ob1p DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001422 Tax PIN/EH #: 5870-50-5673 Billed To: William Orr Subdivision Info: Rabbit Farm Sect 2 Lot # 16 Reference Name: Mackie McDaniel Location/Address: Rabbit Farm Trail -27028 Proposed Facility: residence Property Size: see map **N Is iIsbgmprovement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �c,�V�c' #People 2 #Bedrooms 44 #Baths 2• S Dishwasher: 12111, Garbage Disposal: P"— Washing Machine: 2 "" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �� I�t�{;,�t Type Water Supplyt=a-k- Design Wastewater Flow (GPD) -1V� ��1` Site: New M Repair 0 1 'fir& r/ ti � System Specifications: Tank Size /©Da GAL. Pump Tank GAL. Trench Width3& Rock Depth /Z Linear Ft.'E! Other: LJjlLL,-^dd Mat 6 OJSWW1O-) 25�)4!�S Required Site Modifications/Conditions: INLTA- LL eoj SOS le -V I M" , IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 2 stem between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** AQpwv-- ISO` vLt. Y x 1 E �l1 iof I� 1'61 -AL l Environmental Health Specialist's Signature: / DCHD 05/99 (Revised) 10 Date: V ' . APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT : Davie County Health Department SEP 2.6 20 Envltnonmen!al Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***nWORTANTk** THIS APPLICATION CANNOT BIC PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Naga to be 8111*d 1 ! ill�(p �� KI�'j` Contact Parson bM %YJA N i::L(--757(-qo,-i S) Mailing Address7 [((�1� 1 aes iHama Phone 70 3 - 4A4 1 -Z S32— City/state/LIP 00 'CY � V �-2O 2-� BuPh..asa Phe7 0 3 - 0 - 5-5M 1 2. Naas on.Permit/ATC if Different than Above Mailing Address City/Stat*/Lip 3. application For: 0 Site Evaluation 0 Improvement Permit/ATC K'Both 4. Syst*a to service: House ❑ Mobile Home ❑ Business 0 Industry 0 Other 5. If Residence: # People— # Bedrooms # Bathrooms Dishwasher @IGa;bage Disposal Hashing Machine ❑ Basement/Plumbing ❑ Sasament/No Pluabing 6. if Businoss/industry/Other: Specify type # Commodes # Shovers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) z. Type of Hater supply: ❑ County/City *Tell 0 Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: II exile L -y x 3 t� /3/95 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Oflice PIN: # 3 Property Address: Road City/zip If in a Subdivisio``n-provide infor=flon, as follows: Name: � ebb t r Section: c Block: Lot: � A FA V k�,A-�t Date Property Flagged: 5 — 19, 1-0 6 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 1 ant responsible for all charges Incurred from this application. I, hereby, give consent to the Authorized Representative of the Da County th 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 �Z~ J SIGNATURE 4, THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, nd septic locations). 14 $� n )L - fN Date(s): I Client Notification Date: Account No. w Revised DCHD (07/99) Invoice No. � -7 l���uo e U01 L � r+ • � `r' Q r V IL y � G� an � } n] - I I it V F3 r 0 5 s✓ / '� M tJ D V OJ{� ✓. r22`.4T-0 • c /' r€► ' � M Y w •/� V .1 D 0 C .A f. O• • Q O • w 4r •Y4 O• o 8o ao IL3 i i eo � 5 Lto , 4� I - a� c0 •0 •o - O f ✓ Jam...._.-. __- .� o f . r u y0 o s o i k P• C■ 4. 4 wM 4 L LL //yy O 0 • r V / 4. • V L L® •w � �O/�G d J ` N iii �•n r S Riot O O3460 ♦ P w C • y f d >� r✓O O• YO OCL. & KI Yx ✓ -.o✓✓ ✓0 � �Y � M• � � /r •r Lur• LM / C YO w�l PM 44��O.GabVC� n IV J N G e r • av 9 t� L0 04 600.4c 00 --foo, t0.✓ •M V4rM .80 MPV »� • �r 04.004" u I 40 xr:,:O:tk:MGCCP C . - � C] O e • + Z � � .--rte e a loco r1' \ a ao n rNf ' S APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Account #: 990001422 Tax PIN/EH #: 5870-50-5673 Billed To: William Orr Subdivision Info: Rabbit Farm Sect 2 Lot # 16 Reference Name: Mackie McDaniel Location/Address: Rabbit Farm Trail- 7 8 Proposed Facility: residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring cl_� Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % LQ 1 9 Z_c to W HORIZON I DEPTH D -At D Pb -17V - fo Texture group -Se, L 5C Cc, 6CL- Consistence S --r-55 S SS SP 5 55 S r 55Sr Structure 3k- 2 C"2 Mineralogy 1 • • I ' l HORIZON II DEPTH - 2 y co - ( - - 1 — Texture group C a Consistence Structure 541L Mineralogy Mi XL6A ► -A = ► I • IMI\LGID HORIZON III DEPTH 22 fi (0 -1 '-3c- 4 - 2- 2 - 2 - Texture group is.Ct Consistence Structure Mineralogy W\, HORIZON IV DEPTH 2.4 f Texture group 5.24 S. -IR Consistence Structure Mineralogy SOIL WETNESS 22 Ito RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION (/ LONG-TERM ACCEPTANCE RATE ©• 3 SITE CLASSIFICATION: P5. LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscane Position EVALUATION OTHER(S) PRESENT: 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 DCHD 05/99 (Revised) ■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ile■■■■■■■■■■■■■■■■ MEMO ■■NNEN M■I■MEG&M■■■■M■ ■■■■EMS■■MES MEM■E■MENEM ■■■■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■■■■■■■■■11■■■■■■■■■■■■■■■■■ i i ■ ■ ■■■■■■■■■■III■■■■■■■r■■■■■■■■■■■►�■■■■��■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■III■1�7,SY■►/■■■■■■■■■■■■■■■■■III■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■11■■■■■�i■■■■■■■■■■■■■■■■■■111■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■Irl■■■■■r■■■■■■■■■■■■■■■■■■iu■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■t■■■/!■■/I/■■!�1■i�■ilk/�■■■■■■■■■■■■■■■■■■■■■■■■■ �■������■!®�■�/7,%til/�%!l!■Oi;�'!�Il�■■■\■■■■■■■■■■■■■■■■■■■■■■■ DAVIE COUNTY HEALTH DEPARTMENT ' r Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME 0/-a- DATE EVALUATED ID/�eo PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit PROPERTY SIZE ROAD NAME Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position V L (� Slope % HORIZON I DEPTH d - 1 - Texture group Consistence PrS SP ff 5S . f SS Structure C U. Mineralogy HORIZON II DEPTH Texture groupG G Consistence S Structure ASk '50 Mineralogy I X - f X0- ; HORIZON III DEPTH 70-7 22 " 32 Texture group SA4 ; Consistence ; S Structure Mineralogy a3 HORIZON IV DEPTH yS Texture group r Consistence - 5 0 Structure Mineralogy1 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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 DCHD (01-90)