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194 Rabbit Field Lane Lot 6DAVIE COUNTY HEALTH DEPARTMENT t Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Tax PIN/EH #: 5870-41-6476GJ qi i Billed To: Glenn Johnson Builders Subdivision Info: Rabbit Farm 3 Lot # 6 r Reference Name: Location/Address: Rabbit Field Road -27006 Proposed Facility: Residence Property Size: 7.26 acres 2:v **NOTE* Is 1m rovem0ent/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 #People #Bedrooms 133 #Baths Dishwasher: ER" Garbage Disposal:'El"'..,Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: na--- Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size A(oAA1 Type Water Supply LL"-LDesign Wastewater Flow (GPD) % t� _ Site: New Repair ❑ 'n it System Specifications: Tank SizelDde) GAL. Pump Tank�✓� GAL. Trench Width L� Rock Depth Linear Ft. o� Other: I o P d/ W. 454V 6170 Required Site Modifications/Conditions: 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 ofinstallation. Telephone # is (336)751-8760.**** Health Specialist's Signature: DCHD 05/99 (Revised) n sC, • DAVIE COUNTY HEALTH DEPARTMENT /f Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900573 Tax PIN/EH #: 5870-41-6476GJ Billed To: Glenn Johnson Builders Subdivision Info: Rabbit Farm 3 Lot # 6 Reference Name: Location/Address: Rabbit Field Road -27006 Pro osed Facility: Residence Property Size: 7.26 acres ATC Number: 3370 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION u **NOE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 501 " has been installed in compliance with Article I 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and 110 Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. sr ; 13 9 h lti `Z �o �3 '7o 100' Septic System Installed By: Environmental Health Specialist's Signature:_ W, Da ( �� r' DCHD 05/99 (Revised) J • v APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC VU Davie County Health Department Environmenta/Health Section P.O. Box 848/210 Hospital Street FE� Mocksville, NC 27028 (336) 751-8760 ** ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ( `) Je- 1/n-./y�'� SG•� Contact Person G�p.,,7 T lrnsa� Mailing Address ���b Uel <fy��SS /C c� Home Phone law City/State/ZIP /� �� Za Businnesns Phone 2. Name on Permit/ATC if Different than Above CJ2-- � t !'� % �~ Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation P-f�lovement Permit/ATC ❑ Both 4. System to Service: 5-Aouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms '� # Bathrooms —"�— shwasher Garbage Disposal ❑&Wshing Machine ❑ Basement/Plumbing asement/No Plumbing 6. If Business/Industry/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 ell ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # SSC' Property Address: Road Name R,6 City/Zip � tJ If in a Subdivision provide information, as follows: Name: !a, -tEire v2 Section: _ Block: Lot: WRITE DIRECITIIONS (fromMocksviilllee) to PROPERTY: n 7 140 (—A e-11 a?'�L "« - Date Property Flagged: -S �3 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 by to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE -I THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu I of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). ( �- � � Site Revisit Charge „ � 6 c.. Revised DCHD (07/99) Client Notification Date: EHS: Account No.f 's Invoice No. APPLICATION FOR SITE EVAIUATION/IMPROVEMENT PERMIT A ATC Davie County Health Department Environment/ Health SbWonD P.O. Box 848/210 Hospital Street Mocksville, NC 27028 APR - 11999 I 1336) 751-8760 ***ZHPpRTANT*** THIS APPLICATION CAMWr BE PROCESSED UNLESS ALL THN-REWIRZ INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instruction—a. 1. llama to be Billed Nailing Address City/state/LIP Contact Person 1-3 \J eAJ l5 '4�D Hams Phone Z. Hams on Permit/ATC if Different than Above ?()A Business Phone —/ft3 / - � / (60 Mailing Address City/state/Sip 3. Application For: b Site Evaluation 0 Improvement Permit/ATC 0 Both 4. system to service:House 0 Mobile Home 0 Business 0 Industry 0 Other S. It Residence: ; People 4 Bedrooms 3 f Bathrooms [:'Dishwasher 0 garbage Disposal B hashing Machine U Basement/Plumbing BSasement/Ho P1wnbinq 6. if Business/Industry/other: Specify type # People • Sinks f Commodes f Showers # Urinals # Nater Coolers IF FOODSERVICE: ## Seats Estimated Nater Usage tgalions per day) 7. Type of water supply: 0 County/City lir Well 0 Comlminity e. Do you anticipate additions or expansions of the facility ibis system Is intended to serve! 0 Yes V141 If yes, what type' ***IMP0RTAN7'*** CLIENTS AtUST CODIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the dient with THIS APPLICATION. Property Dimensions: - /-GCS At,& -5 WRITE DIRECTIONS (from MockrAlle) to PROPERTY: Tai Office PIN: # � 70 ~ �� ���� O—C-- TO Cpa 1 Z Property Address: Road Name E46611 1' 1 r-7 FDO) (4) od 42,6 /1- /5' eh — City/Zip X� c;i57 I'CZ / DO(a �/f-4 t t_ . Cz, / %- if in a Subdivision provide information, as follows:�il �C !7 Ln Name: Section: Block: Block: Lot: Date Property Flagged: a'SGh 1nc- 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 chmges Incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Heap Department to enter upon above described property located in Davie County and owned by 61=5 1 MT A.L-- to conduct all testing procedures as necessary to determine the site sultabilih. DATE �!'� SIGNATURE THIS AREA MAY BE USED FOR DRAWENG YOUR SITE PLAN (Include ill of the following: liiisting and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. .�• %- Invoice No. �- y6 I L-1540 �F = t 1 I k`w•1 G �� pp 4:v-v� f � � ri � 71 t ►e..w..a �(.'� ,� '�.�j �On:A i►�a jYn�na.� ~�'"' e Lox;". Al O .....�, •,... sl K!r 64 u� rK.RH S17 Q r I 5 4 - r LL A,,Ct ca a I � � — 547 �.c� — 1 � IL1•i43 .D 6 Er Szt oY'w 'ROAD- 1a .L-.7. rr•..w4.,) _ • _ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT Soil/Site Evaluation APPLICANT'S NAME � � DATE EVALUATED -/ PROPOSED FACILITY e PROPERTY SIZE -7 oP6 SUBDIVISION `L4=�"-�rl l ROAD NAME Water Supply: On -Site Well L�� Community Public Evaluation By: Auger Boring [_/ Pit Cut • • e©�©vova Landscape position HORIZON I DEPTH . • Consistence Fo—MR-4 9 R!Nri0WA 3 Mineralogy HORIZON . Texture group Consistence • ' • • i—Ar '��5 _;10Wf.AITr� — Texture group ConsistenceMineralogy HORIZON IV . Vic• ►�r���i_��i���� Texture Consistence Structure SOIL WETNESS • • a V40jem- SAPROLITE SITE CLASSIFICATION: pny,;Q/psi c5Ur LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY: 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 (01-90) ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■U■■■Ai!_�■■■�■�■■■■■■■furl■■■■■■ ■■■■■■■■■■I■■■■■■■■■■■■■■■■■■�■■■■■■■■�iI/■■IAV■■■■■■■■■■ ■■■■■■■■■%■■■■■■■■■■■■■■■■■■■■■■■■■■■■r•i�/I■■■Ili■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County Health Department Environmental Health PO Box848 Mocksville NC 27028 336-751-8760 Jeff Beauchamp 318 Cain Reavis Rd. Mocksville, NC 27028 April 13, 1999 Re: Site Evaluation Rabbit Farm Sec.3/Lot6 Tax# 5870-41-6476 Dear Mr. Beauchamp: As requested, a representative visited the site listed above on April 12th 1999. Based on the information provided on the application that you submitted and the information gathered during the site evaluation, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions or need assistance, please feel free to contact me at this office. Sincerely, Clint E. Dor n Environmental Health Specialist DAVIE COUNTY HEALTH DEPARTMENT •' Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAMEDATE EVALUATED // PROPOSED FACILLITYY PROPERTY SIZE 7. on(O 421 SUBDIVISION /CG�'! c ROAD NAME J 4C/�„'' Water Supply: On -Site Well Community Evaluation By: Auger Boring c./ Pit Public Cut SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD 101.901 EVALUATION BY: % ^✓—^�� OTHER(S) PRESENT: r 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 R 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 Texture group i OCNM WON= OEM,=�Arm HORIZON INWIm Texture •Mineralogy , r�rE-���r�r.���� Mineralogy W_i�I WAS_�_�'...aC'�.7�_�-- • • • . RA IVAConsistence Texture group A 1WjM1!!i Structure IMF ralm ��■� �■■ �� rRra r�Mineralogy Texture group Consistence-- VN . /. A --__--� Mineralogy SOIL WETNESS EMU • • �lr■�r��l�®��� SAPROLITE •N wwl SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD 101.901 EVALUATION BY: % ^✓—^�� OTHER(S) PRESENT: r 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 R 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