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288 Rabbit Farm Trail Lot 1Account #: 990002096 Billed To: Allen Surratt Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Rtbb.�r` Tax PIN/EH #: 5870-42-7954.as Subdivision Info: Location/Address: Rabbit Farm Trail -27006 Property Size: see map ATC Number: 3041 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 'tel ojslri #People 3 #Bedrooms 3 #Baths ; .!r Dishwasher: u Garbage Disposal: 0"' Washing Machine: [F Basement w/Plumbing: ET""Basement/No Plumbing: ❑ Commercial Specification: Facility Type �� ��,__� ��#People #People/Shift #Seats Industrial Waste: ❑ Lot Size 7-xu-sype Water Supply �Il Design Wastewater Flow (GPD) � Site: New G! Repair ❑ Ir Ir System Specifications: Tank Size1000 GAL. Pump Tank GAL. Trench Width —Z& Rock Depth Z Linear Ft.3-Sb Other: q b cL,� kt4Inis�Ql�.� [�� 1�• C.r l�/11t� Required Site Modifications/Conditions: leu- br� C�E%J7D(Z, �-1Y «, eiYf-I�JG� Per IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** Specialist's ta380, IC No�sL 27is gSw1T 5D1.-5 0 DCHD 0 (Revised) T -,0j (2E-vts6b Date: G tj .. DAVIE COUNTY HEALTH DEPARTMENT) Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002096 Tax PIN/EH #: 5$70-42-7954.as Billed To: Allen Surratt Subdivision Info: t_o + --4L ) Reference Name: Location/Address: Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3041 **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 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 DOC#People #Bedrooms #Baths 2-i97— Dishwasher: SDishwasher: Er Garbage Disposal: 0 Washing Machine: 12"' Basement w/Plumbing: Er"� Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats 1 _ Lot Size S� Type Water Supply tut Design Wastewater Flow (GPD) System Specifications: Tank Size OOOGAL. Pump Tank Other: Required Site Modifications/Conditions: Industrial Waste: ❑ Site: New IK Repair ❑ GAL. Trench Width 3& Rock Depth �Z sC I �6xw, . .las a ©c. t Linear Ft.� 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 between8:30 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.**** �� � Environmental Health Specialist's Signature: DCHD 05/99 (Revised) wELL— L-VC.a. r%D—j 0 N 7' u� �� ©C COU —� Date: ik, ,�Jat.L- DAVIE COUNTY HEALTH DEPARTMENT v Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002096 Tax PIN/EH #: 5870-42-7954.as Billed To: Allen Surratt Subdivision Info: Reference Name: Location/Address: Rabbit Farm Trail -27006 Proposed Facility: Residence Property Size: see ma ATC Number: 3041 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 Tr atment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW R N IS R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signat 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 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. 10 ' -3 GWI U(S'. a gat°LCSI 1S ��� � O&Pw�-t, 7 \ p IC pf � X3lo k12-46 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) --Z,Jv- t>n7c 9 -9 Date: ///`5/f a, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMI C Davie County Health Department {gyp Environmental Health Section V P.O. Box 848/210 Hospital Street Mocksville, NC 27028 JAM (336)751-8760 _ 7 M02 ***IMPORTANT*** THIS APPLICATION CANNOT BE:PROCESSED UNLE THEA INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for ins S. 1. Name to be Billed A i I Q SU r r A Td Contact Person Alto -,A Sy r r� Mailing Address �• 6oX D Home Phone 336 114 ^ 0919-1 City/State/ZIP . G w S I l e, tJ C- 21 OZ -3 f Business Phone 3 3 (n -` 1 4- 09 O-1 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Ptmprovement Permit/ATC ❑ Both 4. system to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 3 # Bedrooms 3 # Bathrooms 2. Jr 61 Dishwasher Garbage Disposal Ls Washing Machine YBasement/Plumbing II Basement/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 FrWell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? "cs ❑ No If yes, what type? 94 Ic P oss e b /y Le— A&V e cr-4 k4,5emert 4- 1 1 -( 0 -E U e - ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 7• J-5 Aches Tax Office PIN: # 5 S l O - q Z 19 5 q. A S Property Address: Road Name Rh a 6 4 f7&rw1 Tr. . City/zip A)v-weG' 2700(0 If in a Subdivision provide information, as follows: Name: h?,4WIL F.41101 NAI -Se WRITE DIRECTIONS (from Moct sville) to PROPERTY: lel o rH o/C /C d ;?� Or% ;Fd d 4,A f,4e-.m %r Section: Block: Lot: / Date Property Flagged: ��� o L 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. 1, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davi County Health Department to enter upon above described property located in Davie County and owned by Allo, 6vi,r,414 to conduct all testing procedures as necessan�o determine the site suitability. /l nn. DATE I�� f Z Gi SIGNATURE THIS AREA MAY BE USED FOR ING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setb cks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS: 1 SO Account No. - - e-, Revised DCHD (07/99) 1.2 Invoice No. �0 l3o SI e�� r 17,0 `f J (8.10A) 1666 . skiiq—, (36 Davle County )1ealth Department Environmental Nealth Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone. (336)751-8760 May 24, 2000 Mr. Marshall Horton 163 Country Circle Advance, NC 27006 Re: Site Evaluation -7.25 Acre Tract Rabbit Farm/Phase II, Lot #1 Tax PIN #: 5870-42-7954 Dear Mr. Horton: As requested, a representative from this office visited the above site on May 23, 2000. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Based on the evaluation, a three-bedroom residence would require approximately 350 linear feet of septic drain line. This is subject to change and actual dimensions of the septic drain field will be determined at the time an improvement permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. enc(s) If you have any questions, feel free to contact this office at (336)751-8760. Sincerel Jeff G. Beauchamp, R.S. Environmental Health Section APPLICATION FOR FArr EVAWATION/IMPROVEMENT PERMIT6c ATC Davld� County Health Department Envrirvnmental Has/th Sec fon Q.O. Box 646/210 Hospital Street Nockaville, NC 27026 (336)751-8760 IE DW D APR 2 5 ***DWCRTi"** THIS "ImICATION C91 WW II/! PROC omm U=99 ALL THTC RSQunum IN>rOlt MION 18 PROVIDIM. Rater to the INVORMATION BULL 2= !or instructions. 1. Name to be Billed _ !/�/.�2.s�ff� Z L %� i�,�T AJ cootsot "ego, ��1'J/i�—C- Uaiisng �adre.s /�3 ��u.- �, ne , - ase "Wae City/statemp �O ✓O �V L C /� C Business phone .3a Z - J ea 7 g Z. Yang on pewit/SSC is Ditlareat thea Above Wiling bddross City/state/sip s. Application tor: 0 Sita !valuation C-Zmprovement permit/ATC Doth a. system to services 13/11ouse 0 Mobile Home 0 Business 0 Industry 0 Other a. It Residence; I people '¢ # Bedrooms—? I Bathrooms G Diebwastaer e%arbage oispoaai 12-4ashin4 Uamtia. ol/aasesent/alusbiaq U "aament/se plumbing i. Zt susiness/iadustry/othore apeaity two i people i sinless I Ca so"@ E Shovers i Urinals i !later coolers IT t1+MSIMCR: f Seats Zatimated Nater 'Usage (gallons per day) i. Type of Mater supply: 0 County/City "all 0 Community a. Do you anticipate additions or expansions of the facility ibis system is intended to serve? 0 Yea KNo Hyes, what type? ***IMPORTANT*** CLIENT'S MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN MI,LSST'BESVBMLTTED by the client with THIS APPLICATION. Property Dimensions: 7. 0.5 45s Tax Office PIN% #. S 970 - Y Z- 77 S Property Address: Road Name CityiZip ,<J/'/.p Cl L' -C-- If in a Subdivision provide Information, as follows: Name: /—,'EgK,4 WRITE DIRECTIONS Unin Moclawille)to PROPERTY: 4�!le 7a�.( 4722 :Z:JZ 'l Z ,gra -f,g46,-r Section: Blocks Lots Date Property Flagged: This Is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permit($) Issued hereafter are subject to suspension or revocation, If the site plans or Intended we change, or U the information submitted in this application Is falsified or changed 1, also, understand $bat I ant responsible for all charges incurred front this application. I, hereby, give consent to the Authorized Representative of the IV County Health DepartMent to enter upon above described property located In Davie County and owned by /'t4r d4�� to conduct all testing procedures a necessary to determine the site Illty DATE Zsza SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the followings Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 1,,, /0 /06 r Ak- 1 Revised DCHD (07199) I Date(s)s I Client Notification Date: `EAS; Account No. Invoice No. �yl� OVAR"4M OF YMU flONTATIM amps fJrt wm-".Fwum wrq.tr.tq.l.•rtLe •r'q �qrr. •..•.aq•Mr.rww a.a t.r.fsaan... _ ..�.. 919 . ['a owrOMw NOIA111 1. t•t•Ij IA �rwr ___t SM.-__---.N._�•al 1•.rt a•Itrwnw,ewnw.q rrr.ra/w--wnf7iP,: toil a -i ni e:rfiliis:.i- rnP�� 18 rg 7 .. 1' woew sdk A r tituttwt iw p•ilt •.• ui I.wutrw« w.wrw�. (n.(.wr.y....r.(•wr.r�. r.. 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T' WNW.p poVIG Ceyrr�v •J.0 ow•.. •t .� �.ti H. .-la.•...-1 - P• L•OL N o.Y .r.Z. of Nr Sc....a-1-. tp0 • �•• � r � 11L 6.2 rti C.•i CUNav� :4 777 -r- Let �•• ILt-M. ♦a L,taM rmtrintt !b � u0 ®1rJtty t 1+1 o•b a •IA .*•. t �w •n) w 'd •r .,q•rb r � ••••r1.M •r rt W1 11 1•• •w•q Wya 1• tlr •f rM1,1•Ir •la q Itil At• •wra. w rrlwi:' r.ii. • At MO m A4,,.v j.:t- 3//4/IV ;— �,,w -- 1,51. 24 P♦cmesr — Ro0v�1 r r A[iM, R�AtE II g H..VV Gtee'+! T' WNW.p poVIG Ceyrr�v •J.0 ow•.. •t .� �.ti H. .-la.•...-1 - P• L•OL N o.Y .r.Z. of Nr Sc....a-1-. tp0 • �•• � r � 11L 6.2 rti C.•i CUNav� :4 Davie County Aealth Department Environmental ,Meal th Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 May 24, 2000 Mr. Marshall Horton 163 Country Circle Advance, NC 27006 Re: Site Evaluation -7.25 Acre Tract Rabbit Farm/Phase II, Lot #1 Tax PIN #: 5870-42-7954 Dear Mr. Horton: As requested, a representative from this office visited the above site on May 23, 2000. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Based on the evaluation, a three-bedroom residence would require approximately 350 linear feet of septic drain line. This is subject to change and actual dimensions of the septic drain field will be determined at the time an improvement permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at (336)751-8760. Sincerel L___ Jeff G. Beauchamp, R.S. Environmental Health Section enc(s) ,^ L , APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Account IM 990001136 Billed To: Marshall Horton Reference Name: Marshall Horton Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: -5870-42-7954 Subdivision Info: Rabbit Farm Lot # 1 Location/Address,,, Rabbit Farm Trail -27906 Property. Size: 7.25 Acres Date Evaluated: Z� Water Supply: ` On -Site Well Community Public Evaluation By: Auger Boring Pit Cut Slope % ei ..-,!'.'-'FACTORS 1 23 4 5 6 7 Landscape position 1� Slope % ei HORIZON.I DEPTH U 0-6- O - 4 Texture group C L_ Consistence Cr S55 5 S Structure ck C2 Mineralogy t : I t I HORIZON II DEPTH ta&2- L Texture groupL' Consistence i F: Structure Mineralogy, HORIZON III DEPTH Texture groupC-k Consistence • Structure - Mineralogy HORIZON IV DEPTH Texture group Consistence ` Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE ,3 SITE CLASSIFICATION: tS LONG-TERM ACCEPTANCE RATE: d.2-3; REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: kj�g,j,flA LL- I- -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/ft2 DCHD 05/99 (Revised) M■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■011 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■�1■■■■l�%�J■I■�/G'�IIII�VJIl1a1G"",■■I■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENiiiiiiiiiiiiliiiiiiMENNENMENNENMEESE ■■■■■■■■■■■N■■■■■■■■■■■■■■■■■■■■■■■■iiia■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■CII■►�■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■������I����������■■■fG■■IiC'G■■■®fir■■■■■■■■ ------------------------- ■ ■