The URL can be used to link to this page

540 Rabbit Farm Trail Lot 12DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001466 Tax PIN/EH #: 5779-49-5755 Billed To: Steve & Pam Gray Subdivision Info: Rabbit Farm 2 Lot # 12 Reference Name: Location/Address: Comatzer Road -27028 Proposed Facility: Residence Property Size: 5 acres **NOTE*NiBtiibeimprov6ement/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 Wstzl #People _ #Bedrooms #Baths 3. S Dishwasher: Iff"" Garbage Disposal: ❑ Washing Machine: 19"*'- Basement w/Plumbing: 13"" Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industri13Jal Waste: Lot Size S. %Q�!1i� Type Water Supply �iEli.� Design Wastewater Flow (GPD) 2!&D Site: New u Repair ❑ System Specifications: Tank Size _QGGAL. Pump Tank GAL. Trench Width � \Rock Depth Linear Ft./—"— Other: 5 &)77©,� 00 -5 -TALL LIJmoiC--� "/ { M d. Required Site Modifications/Conditions: 1 ) S`jlit✓{ _ ( t/g ADDc%1 L4i6-L, kc 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 .m. to • 0 p.m. on the day of installation. Telephone # is (336)751-8760.**** J � � Environmental Health Specialist's DCHD 05/99 (Revised) L L1 Date: p a0),go I ,AAu^ Environmental Health Specialist's DCHD 05/99 (Revised) L L1 Date: p a0),go I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001466 Billed To: Steve & Pam Gray Reference Name: Proposed Facility: Residence ATC Number: 2617 Tax PIN/EH #: 5779-49-5755 Subdivision Info: Rabbit Farm Lot # I a Location/Address: Comatzer Road -27028 Property Size: 5 acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Uf **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of anybuilding 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE O IS V D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Si ture: Date: ` CERTIFICATE 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 Artic Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NOW be taken as a arantee that the system will function satisfactorily for any given period of time. A,t3 QO r0 0 - Septic Septic System Installed By: Environmental Health Specialist's Signature: ate: Z - ✓ DCHD 05/99 (Revised) J • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS U� Davie County Health Department • �� ,z� Environmental Health Section S �p ply P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address Home Phone d 2. Name on Permit if Different than Above DEC - 8 1996 =1W 3. Application/Permit for: (D -,General Evaluation ❑ Septic Tank Installation 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. It house, mobile home: Subdivision — i 7—,r_n'�--- Section Lot # L� Basement/Plumbing No. of People Xasement/No Plumbing No. of Bedrooms �T ashing Machine No. of Bathrooms 3. 1 2' +I 0041 t�a1� Cg Dishwasher Dwelling Dimensions =48 ID . /� ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals OCT 2 3^^ No. of Lavatories No. of Water Coolers No. of ShowersWater age Figures I U�Al i'�Y-�. i,rl 7. Type of water supply: ❑ Public �P• rolt Private ❑ Community 8. Property Dimensions -2 qU gZthq&Sewage Disposal Contractor 9. Do you anticipate additionstexpansion of the fa--'lity this sytem is intended to serve? ❑ Yes o If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued.Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: This is to certify that the information provided is correct to the best of my Incurred from this application. /xDATE U70ydA ,k and I understand 1 am responsible for all charges SIGNA CONSENT OR SITE EVALUATION TQ BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. f212. 1 DO NOT OWN the property. If youchecked Box #2, the rest of this form !JUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the vie C u ty Health Department to enter upon above described property located in Davie County and owned by _ to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. /-) —Z Sf— DATE SIGNATURE��l p0. rC ,er 18 ` s, DCHD (12.90) 1 w iq SIT - L i c�7� G� �vvt G l � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATEDS ADDRESS PROPERTY SIZE 5 ilc? PROPOSED FACIILTY rD a S `r° LOCATION OF SITE c Water Supply: On -Site Well V____ Community Public _ jib Evaluation By: Auger Boring _r Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % — HORIZON I DEPTH 6 d' z� Texture group CL S' Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence c Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 0, YdAd EVALUATED BY: AV LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 OTHER(S) PRESENT: END 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- Vf:-y 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 Davie County Nealtii De ariment and .dome NealtFr Ayency 210 HOSPITAL STREET I P.O. BOX 665 MOCKsvILLE. N.C. 27028 r/ PHONE: (704) 634 5985 9 / d January 5, 1996 Steve & Pam Gray c/o Hubbard Realty Attn: Cindy Johnson 5342 Hwy. 158, Suite 1 Advance, NC 27006 Re: Site Evaluation Rabbit Farm II—Lot 12 Cornatzer Road Dear Mr. & Mrs. Gray: As requested, a representative from this office visited the aforementioned site on December 28, 1995. 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. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure Oillf�...Y p�-- �4T E'i5it ?kis _t_ - �. oY,�xb� 199`x. or Stp - Fistiazibiy �'±u.-Zpyr - .,, 4 f . i irp 71 t_ '5 S9 4G G. oa Ac ` - - �. i9►G` -' -- 6r. �d �4� -.3� +AtG3 — �S_ 3'�SA�C� - t Q► E ^� P2tvA�E laG �ArL*aa14.� 0 00 -3 Z C.7. 43 2 L7 -a3.